Sunday, January 28, 2007

How to Talk About Universal Health Care Insurance: Part 2

In How to Talk About Unviersal Health Care Insurance: Part 1, I talked about how the main crisis is not health care delivery, rather it is health care insurance.

This conversation was sparked by the response to another diary of mine published in December, How to Talk to Small Business People . Almost all the responses from small business people mentioned health care. They told me they are looking for a good way to get affordable health care insurance for themselves, their families and their employees. Of course these responses came from small business people who are progressive enough to comment and / or post on Daily Kos.

This diary is for people who want to advance the cause of Universal Health Care Insurance by persuading others. So let's get started...

Cross Posted from Florida Kossacks

If you have seen any of the other How to Talk to diaries, then you know the drill. If you are new to this, here is how we go about the task of talking to people already on our side. The purpose is to give them the tools to persuade people who should agree with us, but don't, that our ideas are the better ones.

The first thing to do is to define the values that relate to the task at hand. Here is my list of values applicable to this subject:

  • Community
  • That the promise of America is equal opportunity for all and special privilege for none
  • Mutual Responsibility
  • Inclusion
  • Work and Family

We then have to incorporate those values into an argument that fits into these tasks:

Define the Overarching Strategy

Define the Terminology

Mangle the Memes

We start with the strategy.

Define the Overarching Strategy

When you talk to the other side, you should start with your goal in mind. So first, you need to define your goal. Only then can you determine the best overarching strategy to achieve your goal without compromising your values.

As in most of these tasks, our goal is to persuade people who should agree with us but do not yet. We need to do this in a way that does not lose our audience at hello. The target community must receive our message in a way that resonates with them on a personal level. This can best by done by research and real world examples. First, some research.

Some of the best and most persuasive resarch done in this field has been has been done by physicians themselves. This research covers topics ranging from the huge administrative cost of our current system, taxes and who actually pays for these costs, and the sad fact that we already pay for national health care insurance, but don't get it.

If that isn't impressive enough, consider the research done by medical students . If the physicians already working in the health care delivery system and the medical students working to join them are in agreement, why would anyone else tell them that they are wrong?

Define the Terminology

Defining the terminology is akin to choosing the battlefield. If you let the other side define the terminology, you will be fighting your battle on the other guys’ battlefield. Any tactician will tell you that he who determines the battlefield has the much better chance of winning the battle.

We also must remember our audience. We are not preaching to the choir here. Out goal is to reach out and create a majority coalition in support of Universal Healthcare Insurance. Our target audience to get this coalition into the majority is twofold:

  • Small Business people who already know how hard it is to obtain affordable health care insurance in the current inefficient market.
  • Middle class taxpayers who mostly already have health insurance through their jobs.

The best way to reach this audience is to craft arguments where our values intersect with theirs. As we saw in Part 1, the census bureaus's research brought us these two telling tidbits:

  • 73% of the uninsured in the workforce worked sometime during the year.
  • 63% of the uninsured who worked during the year worked at companies with fewer than 100 employees.

This data give us the first things we can say about Universal Health Care Insurance - Most people who are uninsured are actively in the workforce. We are not talking about some giveaway program going mainly to those who are unwilling to work. We are talking about folks who work for a living just like you and I. Also, nearly 2/3rds of the uninsured in the workforce work for small businesses. This is just one more area where small businesses get the short end of the stick in this country.

So who are the uninsured? They are folks in our community who mostly work for small businesses. One would think that in a country that values entreprenuership, work and family, that we would take care of our workers and their families by making sure they all have equal opportunity to access quality, affordable health care no matter the size of the business they work for.

The other argument that should resonate particularly with small business people is the inefficiency of the current system. Health care insurance is ridiculously expensive, particularly so for folks who are not part of large byuying groups (big business, unions, professional associations, etc.). One of the reasons for the heavy cost is that the private insurance delivery system is incredibly inefficient in delivering the product. Small buisness people know better than most how crucial it is to control costs. The big business of health insurance delivery seems to believe thay can just pass these cost along to us.

What most of us don't know is that the government is already paying the lions' share of health insurance costs in this country.

the amount of public health spending in the U.S. is greater than the combined public and private spending of nations which provide universal comprehensive health insurance. A single-payer system could provide such coverage to all Americans with no need for additional health dollars.

So we could provide equal opportunity for an all inclusive health care insurance sytem without spending additional tax dollars. Is that not a win-win for middle class taxpayers and small business people?

So why do we not already have such a sytem?

Mangle the Memes

The first thing to understand is that there is a powerful lobby in this country that is determined to maintain the status quo. One of the main ways this lobby goes about maintaining the status quo is by demonizing the alternatives. So let's talk about what we are not suggesting.

We are not talking about socialized medicine. Remember, this discussion is about health care insurance. The main problem is not with our health care delivery system. So do not let anyone get away with telling you that it is.

We are not talking about some inefficient government bureacracy deciding who gets what health care procedure and when. In fact, an efficient health care insurance system will put even more of the choice for health care decisions back into the hands of the doctors and their patients. Doctors and patients will take back the decision making from some faceless private insurance bureaucrat.

How do we do that? With a single payer universal health insurance plan, we would wring the waste out of our health care insurance delivery system. Turns out this is a case where private industry is less efficient than government.

administration consumes 31.0 percent of U.S. health spending. Average overhead among private U.S.
insurers was 11.7
percent, compared with 1.3 percent for Canada’s single-payer
system and 3.6 percent for Medicare.

Who would have thought that the US government provides health insurance administration at one third the cost of private insurance?

We have a mutual responsibility to include working families in the health care insurance system. Healthy communities are productive communities. W can provide equal opportuity for access to affordable health care insurance at no additional costs to taxpayers. Ultimately we will have the luxury of seeing health care insurance costs falling for everyone.

So, get away from the keyboard and get out into your communities. Deliver thse messages to your elected officials and other opinion leaders in your community. A concerted netroots / grass roots campaign for single payer universakl health care insurance could get this issue past the tipping point.

What are you waiting for, someone else to do it? Start today.

Sunday, January 21, 2007

How to Talk About Universal Health Care Insurance: Part 1

A few weeks ago I posted a diary titled How to Talk to Small Business People . So many of the comments were about health care issues that it become apparent that this was a topic in desperate need of further conversation. So instead of "How to Talk To..", today it is "How to Talk About..."

Usually you will see this subject discussed using the short hand of "Universal Health Care" as if that were the issue. That is not the issue. As we will see below the fold, we already have Universal Health Care. What we do not have is Universal Health Care insurance.

So follow along and we'll see what can be done about this situation.

Cross Posted from Florida Kossacks

We need to make one thing perfectly clear right from the start. That is that we do not have a health care crisis in this country. We do have a health care insurance crisis. No one in need of care who presents themselves for treatment is denied treatment. Ok, almost no one. But the general rule is that if you present yourself for health care, you will receive it. From

Karen Davenport, executive director of health care policy for the Center
for American Progress:
"The ones that are probably of greatest concern would be the people who are
uninsured who delay care and who end up using not just emergency room services,
but more complex, more complicated, more intensive services when they do get
care," she said.

Since they are uninsured, these patients run up bills that they are unable to pay. More from VOANews:

Children's National Medical Center in Washington provides specialty and emergency care to children. Kathleen Chavanu, the hospital's executive director of Quality Improvement and Clinical Support Services, says some people are unable to pay for the care they receive there.

"I think that we provide a high amount of uncompensated care here at Children's National Medical Center, anywhere from $28 and $30 million a year that we report that is provided as uncompensated care," noted Chavanu. "And that's really approximately eight to ten percent of our population."

According to the American Hospital Association, hospitals doled out $27 billion in uncompensated care in 2004.

Like any other business, hospitals pass along the cost of bad debts to their other customers in the form of higher prices. Unlike other businesses, hospitals are not able to control their credit risk. They treat whoever shows up. We all wind up paying for this in the form of higher hospital bills which ultimately turn into higher health care insurance premiums. So what can be done to alleviate this situation?

MALCOLM GLADWELL lays out some of the facts about our current health care system in this article in the New Yorker:

Americans spend $5,267 per capita on health care every year, almost two and
half times the industrialized world’s median of $2,193; the extra spending comes
to hundreds of billions of dollars a year.


The United States spends more than a thousand dollars per capita per
year—or close to four hundred billion dollars—on health-care-related paperwork
and administration...

Other countries pay around 30% of what we spend on health care related adminstrative overhead. Between the uncompensated service hospitals provide and the excess cost of administration, there is about $300 billion needless spending in our current health care system. That comes to more than $1,000 per year for every man, woman and child in this country.

So we have plenty of room for improvemnt in the administration of our health care delivery system. There is one other myth to bust about health care in this country. We already have a working model for a single payer health care system up and running in the United States. It is called Medicare.

So who are the uninsured? The Census Bureau provides us with this information:

  • In 2004, 45.8 million people were without health insurance coverage, up from 45.0 million people in 2003.
  • The percentage and number of children (people under 18 years old) without health insurance in 2004 was 11.2 percent and 8.3 million.
  • With a 2004 uninsured rate at 18.9 percent, children in poverty were more likely to be uninsured than all children.
  • The uninsured rate and number of uninsured in 2004 was:
  • 11.3 percent and 22.0 million for non-Hispanic Whites, and
  • 19.7 percent and 7.2 million for Blacks.
  • The number of uninsured increased in 2004 for Hispanics from 13.2 million in 2003 to 13.7 million; their uninsured rate was 32.7 percent.

These figures show us that an undue burden is placed on people of color, who also tend to be at the lower levels of the socio-economic ladder. Blacks and Hispanics make up 46% of the uninsured population. They account for only 19% of the total population.

How about some characteristics of the uninsured? Again, from the Census Bureau :
  • 73% of the uninsured in the workforce worked sometime during the year.
  • 63% of the uninsured who worked during the year worked at companies with fewer than 100 employees.
  • 62% of the uninsured in the workforce had a high school diploma or less.

It turns out that the uninsured are not only the unemployed. In fact, nearly 3 out of 4 uninsured in the workforce had been employed during the year. Of this group, nearly 2 out of 3 worked for small businesses (less than 100 employees.) And nearly 2 out of 3 uninsured in the workforce had only a high school diploma or less.

Some of the issues and makeupp of the health insurance problem have been laid out. this is the first step. In Part 2, we will talk about some proposed solutions and how to talk about them.

In the meantime, talk amongst yourselves. But be gentle.

Friday, January 12, 2007

Democracy: A Very Messy Business

A tyrant is deposed and executed. The long suffering majority, oppressed by the tyrant and his band of cohorts begins a blood letting in retribution. "Dead Ender" supporters of the deposed regime attempt to fight back. The American Secretary of State expresses his strong support for the new government in their struggle against these "Dead Enders". The President of the United States exceeds his constitutional authority because he believes it is in the best interests of the country.

Any of this sound familiar? Is this Iraq we are talking about.....?

Cross Posted from Florida Kossacks

All of these dire predictions coming from the Bush Administration about what will happen if we pull out of Iraq got me to thinking about this. I am a Viet Nam veteran, so I well remember the Domino Theory, which did not come to pass.

So, who were we talking about above the fold? Why, only the country most of us love and many Americans love to hate. So how did France get from a monarchy to the republic that it is today? According to Wiki:

The French Revolution (1789-1799) was a vital period in the history of France and Europe as a whole.... While France would oscillate among republic, empire, and monarchy for 75 years after the First Republic fell to a coup d'√©tat, the Revolution is widely seen as a major turning point in the history of Western democracy — from the age of absolutism and aristocracy, to the age of the citizenry as the dominant political force.

This was not achieved witout a considerable amount of blood letting. But who was this American Secretary of State who supported the Revolutionaries in France? Why none other that the principal author of the Declaration of Independence:

Sensing rising criticism of the excesses of the French Revolution in the letters of William Short (1759-1848), his handpicked chargé des affaires in Paris, Secretary of State Jefferson sharply chastised Short and praised the revolution despite its rising irrationality and violence: "and was ever such a prize won with so little innocent blood? my own affections have been deeply wounded by some of the martyrs to this cause, but rather than it should have failed, I would have seen half the earth desolated. were there but an Adam and Eve left in every country, left free, it would be better than as it now is."

And the American President who exceeded his constitutional authority? Why none other than that self same Thomas Jefferson who executed the Louisiana Purchase even as he was doubtful of his own authority to do so.

I guess my point in all this is that all these dire predictions of the Bush Administration about what will happen if we were to leave Iraq are just not either or propositions. There are many things we could do to prevent these bad consequences that do not involve keeping our troops in Iraq to referee a Civil War. On Meet The Press today, Senator Hagel touched on a plan that has been diaried here.

So our King George wanted to establish a democracy in Iraq. He has. Maybe he should have been careful about what he wished for.

Monday, January 1, 2007

Values Based Foreign Policy

As the 110th Congress is getting ready to come into session, I have been thinking quite a bit about a Values Based Foreign Policy. The Democrats in Congress have been shut out of any meaningful role in US foreign policy for six long years. Now, with the advent of Democrats in control of Congress seems to me a good a time as any to write about how we define our foreign policy parameters.

I will confess first that I have been thinking about this in terms of Values Based Decision Making, but otherwise within the vacumn of my own little noggin. A little research quickly showed me that, once again, I have not come up with anything particularly original. But I still believe a discussion of this topic is particularly timely. So, here we go...

Cross Posted from Florida Kossacks

I had intended to start this diary off with a discussion of the famous "Long Telegram" by George Kennan which was published in Foreign Affairs in July 1947 as The Sources of Soviet conduct by X where the policy of "containment" of the Soviet Union was first and most famously espoused. I was, in fact, all set to blame Kennan for all the sins against "values based foreign policy" committed in the name of "containment". Imagine my surprise then upon re-reading this article and discovering this:

It is rather a question of the degree to which the United States can create among the peoples of the world generally the impression of a country which knows what it wants, which is coping successfully with the problems of its internal life and with the responsibilities of a world power, and which has a spiritual vitality capable of holding its own among the major ideological currents of the time. (Emphasis mine)

And this, the conclusion of the article:

Thus the decision will really fall in large measure on this country itself. The issue of Soviet-American relations is in essence a test of the overall worth of the United States as a nation among nations. To avoid destruction the United States need only measure up to its own best traditions and prove itself worthy of preservation as a great nation.

Surely, there was never a fairer test of national quality than this. In the light of these circumstances, the thoughtful observer of Russian-American relations will find no cause for complaint in the Kremlin's challenge to American society. He will rather experience a certain gratitude to a Providence which, by providing the American people with this implacable challenge, has made their entire security as a nation dependent on their pulling themselves together and accepting the responsibilities of moral and political leadership that history plainly intended them to bear.

In essence, Kennan was saying that we only had to live up to our values to ultimately prevail. Forty years later, in 1987, Kennan had this to say about "containment":

There are many other sources of instability and trouble. There are local danger spots scattered about in the Third World. There is the dreadful situation in southern Africa. There is the grim phenomenon of a rise in several parts of the world of a fanatical and wildly destructive religious fundamentalism, and there is the terrorism to which that sort of fundamentalism so often resorts. There is the worldwide environmental crisis, the rapid depletion of the world's nonrenewable energy resources, the steady pollution of its atmosphere and its waters -- the general deterioration of its environment as a support system for civilized living.

And finally, there is much in our own life, here in this country, that needs early containment. It could, in fact, be said that the first thing we Americans need to learn to contain is, in some ways, ourselves: our own environmental destructiveness, our tendency to live beyond our means and to borrow ourselves into disaster, our apparent inability to reduce a devastating budgetary deficit, our comparable inability to control the immigration into our midst of great masses of people of wholly different cultural and political traditions.

At this juncture, I was going to launch into my own discussion of the pitfalls of the so called "pragmatic approach" to foreign policy versus the "values based" model. I still intend to do so in future diaries. I would be entirely remiss if, at this time, I did not offer my apologies to the late George Kennan, a man who 60 years ago typed these words on his typewriter:

gratitude to a Providence which, by providing the American people with this implacable challenge, has made their entire security as a nation dependent on their pulling themselves together and accepting the responsibilities of moral and political leadership