Another Health Care Hurdle

Amazingly, that 60-vote bloc of Democrats and Independents hung together through a series of cloture votes and the Senate was finally able to pass their version of a health care bill. The final bill only needed 50 votes, but, in a rare Christmas eve sunrise session, the Senate voted for the bill 60-39. Every Reactionary voted no -- they'd probably kick anyone who voted aye out of the party.  The final vote took about 15 minutes, the entire session lasted about 30, then lawmakers headed out of town.

The senator that didn't show up for the vote was Jim Bunning (R-Ky). The Louisville Courier-Journal says this "caps a year of unusual incidents involving the senator." Bunning has missed 21 votes this month, one more than the ailing 92-year-old Robert Byrd.

If you slept through your high school civics class, we now have two versions of a health care bill; one from the House and one from the Senate, and there are significant differences that will have to be reconciled.  The House bill is better, but the final bill will look more like the Senate bill to make it through the 60-vote gauntlet again.  The House is back in session on January 12; the Senate on January 19.  President Obama would like to have a bill to sign before the State of the Union address, but final passage might slip on into February.

Paul Krugman weighs in...

If progressives want more, they’ll have to make changing those Senate rules a priority. They’ll also have to work long term on electing a more progressive Congress. But, meanwhile, the bill the Senate has just passed, with a few tweaks — I’d especially like to move the start date up from 2014, if that’s at all possible — is more or less what the Democratic leadership can get.

And for all its flaws and limitations, it’s a great achievement. It will provide real, concrete help to tens of millions of Americans and greater security to everyone. And it establishes the principle — even if it falls somewhat short in practice — that all Americans are entitled to essential health care.

Many people deserve credit for this moment. What really made it possible was the remarkable emergence of universal health care as a core principle during the Democratic primaries of 2007-2008 — an emergence that, in turn, owed a lot to progressive activism. (For what it’s worth, the reform that’s being passed is closer to Hillary Clinton’s plan than to President Obama’s). This made health reform a must-win for the next president. And it’s actually happening.

So progressives shouldn’t stop complaining, but they should congratulate themselves on what is, in the end, a big win for them — and for America.

Related articles

• Democrat healthcare support holds up | Michael Tomasky (guardian.co.uk)
• White House Does Not Expect Conference Bill Before State Of The Union Speech (medicalnewstoday.com)
• Sen. Kennedy Remembered in Health Debate (time.com)
• Congress Raises Debt Ceiling to $12.4 Trillion (abcnews.go.com)

The Cost of Dying

60 Minutes had an excellent segment Sunday on "The Cost of Dying" -- how Medicare (and by extension, we the taxpayers) spent $50 billion, more than the budget for the Department of Homeland Security or the Department of Education, on end-of-life treatment, doctor and hospital bills during the last two months of a patient's life.

They're talking about people with terminal illnesses whose lives are prolonged in ICUs at a cost of about $10,000 a day.  That might sound crass, but, in many cases, it's treatment that doesn't do much good, that only delays an inevitable death.

"Families cannot imagine there could be anything worse than their loved one dying. But in fact, there are things worse. Most generally, it's having someone you love die badly," (Dr. Ira) Byock (of the Dartmouth-Hitchcock Medical Center in Lebanon, N.H.) said.

Asked what he means by "die badly," Byock told Kroft, "Dying suffering. Dying connected to machines. I mean, denial of death at some point becomes a delusion, and we start acting in ways that make no sense whatsoever. And I think that's collectively what we're doing."

A vast majority of Americans say they want to die at home, but 75 percent die in a hospital or a nursing home.

We've heard all the diatribes from the tea-baggers -- rationing, death panels, and pulling the plug on grandma -- and thus this topic has become off-limits, but...

Multiple studies have concluded that most patients and their families are not even familiar with end-of-life options and things like living wills, home hospice and pain management.

"The real problem is that many of the patients that are being treated aggressively, if you ask them, they would prefer less aggressive care. They would prefer to be cared for at home. They'd prefer to go to hospice. If they were given a choice. But we don't adequately give them a choice," (Dr. Elliott) Fisher (of the Dartmouth Institute for Health Policy) said.

"At some point, most doctors know that a patient's not likely to get better," Kroft remarked.

"Absolutely," Fisher agreed. "Sometimes there's a good conversation. Often there's not. You know, patients are left alone to sort of figure it out themselves."

Read the story or watch the video.  There are also two short web extra videos, "At Home, At Peace" and "Comfort and Costs."

Oops!

If you're hoping for meaningful health care reform, you've got to like this story.  Blue Cross Blue Shield of North Carolina recently sent out a mailer to voters in the state urging them to send an enclosed pre-printed, postage-paid card to Senator Kay Hagen asking her to oppose any government-run health care program that would compete with private insurers.  The punch line?  They sent out this mailer at the same time that they sent out a notice to customers that their premiums would be increased by an average of 11% next year.

The Raleigh News and Observer picks up the story...

Indignant Blue Cross customers have rebelled against the insurer's message, complaining that their premium dollars have funded such a campaign.

They've hit the Internet in a flurry of e-mails to friends and neighbors throughout the state. They've called Hagan's office to voice support for a public option. They've marked through the Blue Cross message on their postcards to instead vouch support, then dropped them in the mail -- in at least one case taped to a brick -- to be paid on Blue Cross' dime. Or dimes...

Lew Borman, a Blue Cross spokesman, said he wasn't sure how many people got the flier urging them to contact Hagan, but he said the mailing relied on voter registration records, not a customer list.

Since the company controls more than half of the state's health insurance market, there was unavoidable overlap.

Borman declined to reveal how much money the insurer paid for the mailing. Blue Cross is a nonprofit, so its finances are not as open as public companies.

He acknowledged the timing was unfortunate, coming as the firm typically sends its annual notices about rate increases. But he said the two mailings were coincidental, hinged to current events in Washington.

"We said from the beginning we were going to be involved and would tell North Carolinians what kind of impact the health-care proposals would have, and that's what we've been doing," Borman said.

Jenny Warburg, a freelance photojournalist in Durham, said she wishes she could switch insurance carriers over the issue, but no other company will cover her.

So she's stuck, and that makes her even madder.

"You're over a barrel," she said. "You have no choice."

And that, she said, is exactly what Blue Cross is eager to protect.

Cross-posted at The Blue Voice