Oh, the poor insurance industry! This just makes me feel so much sympathy for the companies that want to continue discriminating against people.

"Bennett-Wyden make it illegal for insurance companies to discriminate against people based on health status. It also makes it illegal for them to charge difference rates basd on customers' age, sex, or occupation"

What a shock! Healthcare for all really means healthcare for all????

Okay, gotta run, the Senate debate just started on KGW.

The Wyden-Bennett health care plan isn't all that great from a progressive point of view since it falls short of a single-payer system. It looks like Wyden and Bennett didn't arrange for enough of the health care loot to go to the insurance companies. Give 'em more and they'll come around to supporting this plan.

Bill, your preferred presidential candidate, Sen. Obama, is opposed not only to single-payer, but to any mandates. That puts him well to the right of Sen. Wyden, at present.

Two of my preferred presidential candidates - Russ Feingold and Dennis Kucinich - are no longer running. My third preference - Ralph Nader - may get my vote if the choice is between Hillary and McCain. I'll make my decision on that in November. Of the three that are in a position to become president, Obama is the least problematic. As for his or any other's health plan, I wouldn't pay too much attention to them. Any health plan that comes out of Congress will be decided by senators and representatives influenced by health care industry lobbyists. They should be doing the bidding of the people, but they don't give a damn about them and the people are willing to be treated as second-class citizens, which is a role they have been accustomed to performing for decades.

This isn't a Republican primary, Mr. Roberts. How would Obama make insurance affordable as you suggested? Don't you have to regulate insurance companies in order to change the way they make their money? I don't think you will find many Democrats receptive to a message that insurance companies can magically be made to provide more affordable coverage absent tough regulation.

I personally believe nothing will change as long as insurance companies make their money by seeking out the healthiest customers and delaying payments and denying coverage to the sickest.

The National Review won't be happy until we have some total Malthusian social Darwinist solution to healthcare.Those who don't have it, simply go off and die quietly. They seem to prefer a Dickensian 19th century America.- "Are there no prisons, are there no workhouses?"

We won't get any path to universal health care as long as the for-profit insurance companies, the drug companies, and all the other vested interests who are getting rich off the present system are excluded from the table. And the American people have to get a whole lot more angry than they are to kick them to the curb. Obama wants to do exactly that. Hillary wants to give them first seats at the table.

Along these lines I just saw an excellent program on OPB, comparing health care systems across the developed world. Makes what we have look absolutely medieval. The interviewer asks in each country, "Do you have people who go into bankruptcy because of health bills?" Each person asked the question looks incredulous. They can't believe such a thing would happen. And each of them says, "No, can't happen here. Health care is the right of every citizen." I should also say that some countries have something similar to what my wife are lucky to have with Kaiser. Very low co-pays, across the board coverage. Low waiting times, instant access. I have access through the internet with my personal physician and with my pharmacy. Works great! Not for profits, and/or single payer may be what "the doctor" ordered for us.

"We won't get any path to universal health care as long as the for-profit insurance companies, the drug companies, and all the other vested interests who are getting rich off the present system are excluded from the table."

Error- my apologies.. Should read **until.... vested interests are excluded from the table."

As John Edwards says, "They want the whole meal."

Does every issue have to be about demonizing those who disagree with you? - Jack Roberts

I had to go back and read what I wrote to see what you were talking about. I still have no idea. Has your skin always been that thin? I'm going to venture a guess that you are much happier out of public office.

I agree with you that, so far, this isn't about Republican versus Democrat, though McCain may turn it into that as the standard bearer for your party. Senator Wyden's proposal would not be getting the kind of attention it has been attracting - and now the bizarre attacks from the right -- if seven Republican Senators hadn't joined him on his bill providing universal coverage.

My point is that you were offering advice to Senator Obama on how to win the debate on health care which I, as a Democrat, think would fall pretty flat. I offer that up not as a demonization of you (pretty funny that a Republican thinks I'm demonizing him for pointing out that he's a Republican), but as an observation from a lifelong Democrat who has a decision to make in this primary.

Anyway, please continue to hang out at BlueOregon and comment away. I respect you for doing it, and really enjoy your participation, even if I agree with very little of it. Just don't be so touchy!

For those of you who want to learn some facts and interesting insights on the way other developed nations deal with health care, OPB ran an excellent hour from Frontline entitled "Sick Around the World" last night. You can watch the show on line by following links on the OPB site at http://www.opb.org/television/?mode=find#.

"The regulation in Bennett-Wyden do not merely impose limits on insurance companies. They attempt to change their business model. Insurance pools risks: You may behealthy, but you agree to pay a premium in case you get sick and need care. The business works as long as companies don't have to offer the same deal to people who are already sick ..."

How can you be said to be pooling risk in a system where none exists?

Read differently, that excerpt is defending the privilege of insurance companies to mint money.

...And the horse they rode in on.

Does the bill also promise to curtail the increasingly common tactic of dragging large claims into litigation at the first hint of ambiguity? (I've watched this happen first-hand.)

well, i have to say that this article is great news for wyden's plan! as the far-right approach has demonstrably failed to meet people's needs, and the public is coming to realise that, it's to the benefit of the wyden plan to get demonized by them.

okay, i may be a little hyperbolic here, but in general, i do believe that this does more good than harm.

The National Review, Wyden, Obama, and Clinton are all to the right of a healthcare system that would work for all Americans.

NR is correct that Wyden's plan would make the insurance companies somewhat like regulated public utilities. That does not work well with providers of electricity, and I doubt it would work well with providers of healthcare. I propose a Peoples Healthcare District [PHD] that would encompass the 50 states, Guam, Puerto Rico, and the US Virgin Islands.

All the candidates have good intentions. My question is this: Can they create a plan that will survive congress, in workable form, will function well in the American context, and be genuinely affordable for the nation as we simultaneously confront our economic challenges? So far, the so-called plans look more like sketches. I've yet to see the details that will be necessary before any candidate's plan can be carefully examined.

tom, why do you say that regulated public utilities do not make good providers of electricity?

has the deregulation of the utility industry been a good thing do you think?

trishka,

No, deregulation is an attempt to further privatize profit while socializing costs. The problem with regulated public [actually private] utilities is that they capture the bureaucracies charged with regulating them. This is done through the political process where the investment of $thousands in lobbying and campaign contributions can reap $millions in added profit, all at the expense of the consumers and the integrity of the political process.

Public utilities are best owned by the public. This is not just rhetoric. The record clearly shows that public entities supply utilities at lower cost to consumers and also are more responsive to the greater public good.

That goes for healthcare as well. Nations with public systems have better healthcare for less money. Medicare provides more for less than does private healthcare in this country.

Private ownership works well in sectors where real competition is appropriate and possible, like computers, bicycles, and deodorants.

“I don't think you will find many Democrats receptive to a message that insurance companies can magically be made to provide more affordable coverage absent tough regulation.”

Missy, Missy, Missy: Health insurance companies may be part of the health care problem, but your “regulate insurance companies” approach to health care reform ignores the 85-90% of the health care dollar that is driving health care costs. The Oregon Insurance Department has compiled and published information on the major health insurers in Oregon. If you check the regulator’s own data, you’ll see that for Oregon’s eight domestic insurers, profits and insurer administrative costs are not the issue: • Ten year net income “profitability” average? 2%
• Five year average general administrative expenses? 8% • Five year net underwriting gain/loss? 2% • Five year net investment gain? 1% • Five year average medical loss ratio? 88%

So where does the other 85-90% of the premium dollar go?? It goes to pay medical claims. And why is the medical claim trend increasing at a rate greater than medical CPI? It’s something called utilization. The cost of care is not just a factor of how much the cost of one unit of care increased this year over last year. Rather, it is the increase in the cost of each unit of care plus the increase in the number of units of care delivered. And the increase in utilization is driven primarily by new drugs, new procedures and new medical devices that didn’t exist last year.

If you really want to get to a more equitable, cost effective and sustainable health care system, regulating the hell out of insurance companies won’t get you there. You’re approach to health care reform is the equivalent of saying lets solve the problem of high gasoline prices by regulating gas stations and gas wholesalers.

“I personally believe nothing will change as long as insurance companies make their money by seeking out the healthiest customers and delaying payments and denying coverage to the sickest.”

This statement also shows your lack of understanding of the insurance market in Oregon. All group insurance in the 2-50 market segment is guaranteed issue and guaranteed renewable—that means insurers can not refuse to offer insurance to any group of 2-50 employees (regardless of age or health status), and once placed, can’t cancel except for non-payment of premium. In the individual insurance market, insurers are allowed to medically underwrite applicants, and refuse to insure those who have certain medical conditions. This process is regulated with a standard application that must be used by all insurers. Every individual who is declined in this process is then entitled to guaranteed issuance of coverage in the Oregon high risk pool-- “OMIP.” This pool is governed by the state through the Oregon Insurance Department, and premiums are limited to 125% of market average. The medical loss ratio for this pool is typically 170% or more, and the losses are then assessed to the very insurance companies who declined to cover these persons due to identified medical underwriting concerns. Delaying claims payment is also not an issue—Oregon has a statute requiring prompt payment of claims, and each insurer is required to pay interest on all claims not promptly paid, and report to the Insurance Department the timeliness of payment of claims. These reports are public information. Check out these sources: Here is the link to the Oregon Insurance Department analysis on Health Insurance in Oregon:
http://www.cbs.state.or.us/external/ins/health_report/3253_health_report.pdf

Here is a link to the Oregon Insurance Department requirements on insurance prompt pay reporting:
http://www.cbs.state.or.us/external/ins/bulletins/bulletin2007-01.pdf

Finally, check out the work of OHSU health economist Dr. John McConnell, regarding what drives health care costs, and the impact of new technology.

Eileen Dover,

Single payer does not regulate health insurance companies, it eliminates them. Rather than regulating gas stations, a better analogy is making a private electric utility into a municipal or PUD. Going public provides documented savings to power consumers, and I expect it would to healthcare consumers. This is the experience in nations, like Canada, who provide healthcare to all citizens, unlike the sorry US system.

Healthcare administrative cost estimates on the national level that I have seen are closer to 20%. Perhaps the lower number you cite does not account for the cost to providers of complying with insurance requirements. Providers I have talked with find the costs onerous.

A New England Journal of Medicine article comparing the US system to Canada's single payer system found "that bureaucracy accounted for at least 31 percent of total U.S. health spending in 1999 compared to 16.7 percent in Canada. They also found that administration has grown far faster in the United States than in Canada. Between 1969 and 1999, administrative and clerical personnel in the United States grew from 18.2 percent to 27.3 percent of the health work force. In Canada, those personnel grew from 16 percent in 1971 to 19.1 percent in 1996."

The problem most people have gaining insurance is when they change jobs or seek new insurance on their own. Pre-existing conditions are a huge problem for millions of people. The problem exists not only in obtaining insurance, but also in obtaining treatment covered by insurance.

Bill R: "We won't get any path to universal health care as long as the for-profit insurance companies, the drug companies, and all the other vested interests who are getting rich off the present system are excluded from the table. And the American people have to get a whole lot more angry than they are to kick them to the curb. Obama wants to do exactly that. Hillary wants to give them first seats at the table."

What? I was right with you until that nonsequitor of "Obama wants to do exactly that." Obama, Clinton and McCain are all in bed with health-non-care industry interests.

Financial-services, insurance and real-estate companies have donated to Obama over McCain by almost two-to-one -- and favored Clinton by even more. Health-care and pharmaceutical firms have given three times as much to each of the two Democrats as to McCain (WSJ, Brody Mullins, April 2). And this is reflected in their corporatist positions on health care.

Missy said: "I don't think you will find many Democrats receptive to a message that insurance companies can magically be made to provide more affordable coverage absent tough regulation."

This kind of argument is what makes right-of-center Democrats vulnerable to arguments like Eileen Dover's. Regulation is only necessary as long as insurance corporations are players. Insurance corporations are totally unnecessary, so regulating them only increases the socialized costs borne by most of us.

Q: Who wants a single payer, Canadian style, private delivery, public health insurance system?

A: Only a majority of the people, so it's politically unfeasible, since the health-non-care industry and its political lackies won't allow it.

And only one presidential candidate will fight for what the people want. Guess who. (Hint: It's not Obama, Clinton or McCain.)

I am a supporter of socialized medicine having benefited from such a system for much of my life prior to immigrating to the US in 2001. I believe, however that it will be sometime before we see a national resolution of America's healthcare crisis owing to the entrenched opposition of the insurance and pharmaceutical industries and the prevailing prejudice in some quarters that universal health provision is somehow too costly or undesirable. Meanwhile could we not concentrate on local initiatives in order to accustom people to planned provision and catalyse the whole process at a national level?

I am of course referring to measure PDX 14 " A Real Healthcare Plan for Portland's Kids". The website has recently been revamped and can be foundHERE. They are currently appealing for donations and volunteers on their action page. I would strongly urge people to consider this. Local initiatives of this kind may prove to be the way forward.

Ceri: I agree that "socialized medicine" will not fly here. However, the single payer, Canadian style, private delivery, public health insurance system favored by Nader and Kucinich is not "socialized medicine", regardless of the attempt to portray it as such by right-wingers of both major parties.

What we have now is a fragmented, largely publically financed system that primarily benefits corporate interests and their political lackies. By adding more fragments to the pot, whether they be military veteran fragments, elderly fragments, or child fragments, we move further from a fair and cost-effective system that we both seem to favor.

In the U.S., there is an elite consensus around drowning the baby (socially desired and desirable programs) in the bath water by increasing social costs and risks until programs must be abandoned altogether. As Physicians for A National Health Program (Single Payer Fact Sheet) argues effectively, the "middle ground" of competition between corporate health care and public programs is a disaster for those of us who are required to bear those costs and risks.

Sign up for Dr. Don McCanne's (Physicians for a National Health Program) "Quote of the Day": Single Payer Universal.