Health Insurance
(Part Two)

(1) Reducing Costs of Catastrophic Illnesses for Employers and Their Employees. Catastrophic health expenditures account for a high percentage of medical expenses for private insurers. The Obama plan would reimburse employer health plans for a portion of the catastrophic costs they incur above a threshold if they guarantee such savings are used to reduce the cost of workers’ premiums.

Support Disease Management Programs: Seventy five percent of total health care dollars are spent on patients with one or more chronic conditions, such as diabetes, heart disease and high blood pressure. Obama will require that providers that participate in the new public plan, Medicare or the Federal Employee Health Benefits Program (FEHBP) utilize proven disease management programs.  This will improve quality of care, give doctors better information and lower costs.

Coordinate and Integrate Care: Over 133 million Americans have at least one chronic disease and these chronic conditions cost a staggering $1.7 trillion yearly. Obama will improve coordination and integration of care of those with chronic conditions by making sure programs are fully implemented and encouraging team care.

Require Full Transparency about Quality and Costs: Obama will require hospitals and providers to  collect and publicly report measures of health care costs and quality, including data on preventable medical errors, nurse staffing ratios, hospital-acquired infections, and disparities in care. Health plans will also be required to disclose the percentage of premiums that go to patient care as opposed to administrative costs.

Promote Patient Safety. Obama will require providers to report preventable medical errors and support hospital and physician practice improvement to prevent future occurrences.

Align Incentives for Excellence: Both public and private insurers tend to pay providers based on the volume of services provided, rather than the quality or effectiveness of care. Providers who see patients enrolled in the new public plan, the National Health Insurance Exchange, Medicare and FEHBP will be rewarded based on how effectively they treat patients.

Comparative Effectiveness Research: Obama will establish an independent institute to guide reviews and research on comparative effectiveness, so that Americans and their doctors will have the accurate and objective information they need to make the best decisions for their health and well-being.

Tackle Disparities in Health Care: Obama will tackle the root causes of health disparities by addressing differences in access to health coverage and promoting prevention and public health, both of which play a major role in addressing disparities. He will also challenge the medical system to eliminate inequities in health care through quality measurement and reporting, implementation of effective interventions such as patient navigation programs, and making the health workforce more diverse.

Reform Medical Malpractice: Obama will strengthen antitrust laws to prevent insurers from overcharging physicians for their malpractice insurance and will promote new models for addressing errors that improve patient safety, strengthen the doctor-patient relationship and reduce the need for malpractice suits.

Most medical records are still stored on paper, which makes it hard to coordinate care, measure quality or reduce medical errors and which costs twice as much as electronic claims. Obama will invest $10 billion a year over the next five years to move the U.S. health care system to broad adoption of standards-based electronic health information systems, including electronic health records, and will phase in requirements for full implementation of health IT. Obama will ensure that patients’ privacy is protected.

Obama’s Record

on Ethics Reform

Federal Ethics Reform

Obama and Senator Feingold (D-WI) took on both parties and proposed ethics legislation that was described as the “gold standard” for reform. It was because of their leadership that ending subsidized corporate jet travel, mandating disclosure of lobbyists’ bundling of contributions, and enacting strong new restrictions of lobbyist-sponsored trips became part of the final ethics bill that was signed into law. The Washington Post wrote in an editorial, “The final package is the strongest ethics legislation to emerge from Congress yet.”

Americans have the right to know how their tax dollars are spent, but that information has been hidden from public view for too long. That’s why Barack Obama and Senator Tom Coburn (R-OK) passed a law to create a Google-like search engine to allow regular people to track federal grants, contracts, earmarks, and loans online. The Chicago Sun-Times wrote, “It would enable the public to see where federal money goes and how it is spent. It’s a brilliant idea.”

In 1998, Obama joined forces with former U.S. Sen. Paul Simon (D-IL) to pass the toughest campaign finance law in Illinois history. The legislation banned the personal use of campaign money by Illinois legislators and banned most gifts from lobbyists. Before the law was passed, one organization ranked Illinois worst among 50 states for its campaign finance regulations.

Unlike other candidates Obama’s campaign refuses to accept contributions from Washington lobbyists and political action committees.

Free From Influence

Close the Revolving Door on Former and Future Employers: No political appointees in an Obama administration will be permitted to work on regulations or contracts directly and substantially related to their prior employer for two years. And no political appointee will be able to lobby the executive branch after leaving government service during the remainder of the administration.

Free Career Officials from the Influence of Politics: Obama will issue an executive order asking all new hires at the agencies to sign a form affirming that no political appointee offered them the job solely on the basis of political affiliation or contribution.

Reform the Political Appointee Process: FEMA Director Michael Brown was not qualified to head the agency, and the result was a disaster for the people of the Gulf Coast. But in an Obama administration, every official will have to rise to the standard of proven excellence in the agency’s mission.

Doing Business in Public

Hold 21st Century Fireside Chats: Obama will bring democracy and policy directly to the people by requiring his Cabinet officials to have periodic national broadband townhall meetings to discuss issues before their agencies.

Make White House Communications Public: Obama will amend executive orders to ensure that communications about regulatory policymaking between persons outside government and all White House staff are disclosed to the public.

Conduct Regulatory Agency Business in Public: Obama will require his appointees who lead the executive branch departments and rulemaking agencies to conduct the significant business of the agency in public, so that any citizen can watch these debates in person or on the Internet.

Release Presidential Records: Obama will nullify the Bush attempts to make the timely release of presidential records more difficult.

Transparency

Create a Public “Contracts and Influence” Database: As president, Obama will create a “contracts and influence” database that will disclose how much federal contractors spend on lobbying, and what contracts they are getting and how well they complete them.

Expose Special Interest Tax Breaks to Public Scrutiny: Barack Obama will ensure that any tax breaks for corporate recipients – or tax earmarks – are also publicly available on the Internet in an easily searchable format.

End Abuse of No-Bid Contracts: Barack Obama will end abuse of no-bid contracts by requiring that nearly all contract orders over $25,000 be competitively awarded.

Sunlight Before Signing: Too often bills are rushed through Congress and to the president before the public has the opportunity to review them. As president, Obama will not sign any non-emergency bill without giving the American public an opportunity to review and comment on the White House website for five days.

Shine Light on Earmarks and Pork Barrel Spending: Obama’s Transparency and Integrity in Earmarks Act will shed light on all earmarks by disclosing the name of the legislator who asked for each earmark, along with a written justification, 72 hours before they can be approved by the full Senate.

Lobbying

Centralize Ethics and Lobbying Information for Voters: Obama will create a centralized Internet database of lobbying reports, ethics records, and campaign finance filings in a searchable, sortable and downloadable format.

Require Independent Monitoring of Lobbying Laws and Ethics Rules: Obama will use the power of the presidency to fight for an independent watchdog agency to oversee the investigation of congressional ethics violations so that the public can be assured that ethics complaints will be investigated.

Support Campaign Finance Reform: Obama supports public financing of campaigns combined with free television and radio time as a way to reduce the influence of moneyed special interests. Obama introduced public financing legislation in the Illinois State Senate, and is the only 2008 candidate to have sponsored Senator Russ Feingold’s (D-WI) tough bill to reform the presidential public financing system.

One Historic Night, Two Americas

That Travesty of a Debate

Don’t accuse me of whining.  Like the rest of America, I just wanted to hear more about the issues.  No matter how devoted I am to Barack Obama, I still want to hear HOW he’s going to set the solutions in motion, HOW he’s going to pay for everything, HOW he’s going to mobilize Obama Nation into the army that will get us out of the worst mess since the Great Depression and World War II combined, with global warming added in.

Michael Barone wrote his usual crap.  My comment was Comment No. 285.

But if you don’t want to click and scroll, here’s what I said:

While Barack Obama did seem to be increasingly annoyed Wednesday night with the barrage of questions about crap like flag pins and past associations, he responded forthrightly and with dignity. The only “whining” that was done came from the aroused Obama Nation, of which I am a part.

You’ll be surprised to learn that I tuned in to the debate expecting Obama to be grilled on Jeremiah Wright and remarks about bitter voters who cling to guns and religion. I was looking forward to these questions, hoping for clarifications that would enable the undecided to understand my candidate a little better.

What’s most interesting is that in the distasteful aftermath to a debate that was a travesty mainly for the reason that it was frontloaded with 45 minutes of gotcha questions (some of which I’ve already admitted I was keenly interested in) rather than unfolding in a more balanced way that would include substantive questions on issues that mattered — in the distasteful aftermath, we all seem to have forgotten what Obama’s answers were in the first place.

Apologies for the long sentence just written. But really. Everybody’s just regurgitating their locked-in positions and nobody’s writing about what was actually said.

The moderators asked questions I wanted them to ask. I’ll give them a bit of credit for that. But they were clearly biased and so that cancels out whatever credit they might have earned. There’s a reason for the post-debate uproar.

There’s also a reason why Barack is winning two thirds of the states as well as holding substantial leads in delegates and popular votes. He’s the superior candidate, AND his campaign has been managed more intelligently than Hillary’s has.

You folks want to know who he is? Read his books, for heaven’s sake. He’s going to be your next President, so you should know where he’s coming from, what and how he thinks, and where he stands on the issues. It’s all there to read, in his books or on his website.

You folks want to know how he holds up to tough questions? Check out his March 18 speech on race. Check out how he did this past Wednesday night. Check out the class he exhibits every time he opens his mouth.

I don’t agree with everything Obama says. I happen to think that Jeremiah Wright is a patriotic American who loves his country and should have been defended much more vigorously by the candidate. (But I’ll admit: Barack is smarter than I am, and his decision to distance himself from Wright’s extremist remarks seems to be working well enough; it’s hard to convince some types of people that you can love your country at the same time as you’re wailing about the mistakes that it has made.) I happen to think that Jimmy Carter was right to speak to Hamas. Obama has distanced himself from Carter’s actions. Pity. It’s inconsistent with his announced declaration that he will speak to the leaders of Iran, North Korea and Cuba without preconditions. On that I DO agree with Obama. We will never be able to move toward a more peaceful world if we refuse to engage in dialogue with leaders from the other side.

Barack is the preferred candidate over John McCain for other reasons as well. Our failing economy is the result of Republican mismanagement, and the problems have been exacerbated by our preposterous presence in Iraq. In fact, on every issue that matters, Barack is on the side I agree with.

And the country is with me. Thank goodness.

Can’t Think of a Headline for This

Tomorrow night’s debate will be must-see television.

Dick Polman is a political columnist for the Philadelphia Inquirer.

 Polman’s column appears below.  See it online here.

Monday, April 14, 2008

Obama and the perils of Cling-gate

Can Bill and Hillary achieve Restoration by exploiting Cling-gate?

Perhaps the small-town burghers and downscale workers of Pennsylvania will answer that question when they vote in the primary eight days hence. But, until then, all we can do is speculate – and marvel at the notion that the outcome of this Democratic death march might actually hinge on a single ill-considered verb.

No doubt you know the verb already, but I’ll highlight it anyway. Here was Barack Obama, recorded a week ago at a private fundraiser: “You go into these small towns in Pennsylvania and, like a lot of small towns in the Midwest, the jobs have been gone now for 25 years and nothing’s replaced them…And they fell through the Clinton Administration, and the Bush Administration, and each successive administration has said that somehow these communities are gonna regenerate and they have not. And it’s not surprising then they get bitter, they cling to guns or religion or antipathy to people who aren’t like them or anti-immigrant sentiment or anti-trade sentiment as a way to explain their frustrations.”

As Obama told an audience of steelworkers last night, “I am not a perfect man and the words I chose, I chose badly.” He certainly did. Politically, that latter sentence is a potential train wreck. The Democrats have been trying for several decades to reconnect with the white culturally-conservative working stiffs who exited the party during the Reagan era, and it’s questionable whether the reconnection process can be enhanced by implying (however inadvertently) that these voters react to hard times by “clinging” to their God and their guns.

Church-goers don’t “cling” to religion out of bitterness; they tend to see religion as an affirmative pursuit, in both good times and bad. And small-town Pennsylvanians don’t “cling” to guns out of bitterness; they happen to enjoy hunting, in a state where hunting has long been a tradition (at least outside of the Obama-friendly Philadelphia region). Obviously, Obama did not intend to paint these folks as dummies who worship and shoot only because they have nothing better to do – why would he want to insult people whose votes he has been seeking? – but that’s how the sentence reads. And it would appear that his uphill climb in Pennsylvania has become a bit steeper, given the fact that those people are also the swing voters in this primary.

Nevertheless, it’s fair to ask – in the interests of proportionality – whether a race such as this, with so much at stake at home and abroad, should hinge on some errant phrasing. The Hillary Clinton counterattack this weekend was truly something to behold; the barrage of Saturday afternoon messages in my email box (11 in six hours) prompted me to suspect that perhaps Obama had promised on Day One to convert to Islam and make it the national religion.

If you want to enjoy a belly laugh, here are three reliable suggestions: (1) rent an old Woody Allen movie, especially Bananas, (2) rent Borat, or (3) listen to Hillary Clinton, of all people, attack Barack Obama as “elitist.”

This is the same woman who, during the past seven years, as evidenced by her tax returns with Bill, has become a millionaire 109 times over; whose husband has long supported the Colombian free-trade deal (which is deemed hurtful to American workers), and long defended his signing of NAFTA (also hurtful); whose husband earned $800,000 in speech fees from Colombian interests; who, during her Senate career, voted in favor of confiscating guns during a national emergency (one of only 16 senators to do so; Obama voted against confiscation); and who, during the Democratic debates, has refused to shed any light on why the Clintons are safeguarding the identities of the global heavy hitters who are bankrolling the Clinton Presidential Library…and whether any quid pro quos are involved. Not to mention any deals that may have been struck with the felons whom Bill pardoned in his final days as president (the Clintons are blocking release of those records as well).

The Republicans are also trying to paint Obama as “elitist,” but that’s the standard GOP template (twice used successfully by George W. Bush – a graduate of Phillips Academy Andover, Yale University, and Harvard Business School, son of a former president and grandson of a former U.S. senator). It’s particularly amusing to hear that “elitist” label being thrown around by John McCain, given the fact that McCain is married to a multimillionaire heiress; that McCain wants to extend the Bush tax cuts that help the rich at the expense of the working class; and that he has spent weeks tweaking his mortgage assistance proposal, which originally offered homeowners the same quality of aid that Herbert Hoover extended to Great Depression victims nearly 80 years ago. (Another thigh-slapper: William Kristol – descendent of a Manhattan intellectual family, and son of a New York University professor – used his New York Times column today to argue that Cling-gate is proof of Obama’s attitudinal ties to…Karl Marx.)

But I digress. Hillary was more fun to watch this weekend, as she went into blue-collar overdrive – waxing nostalgic about how as a youngster she was taught to shoot a gun; walking into a bar and downing a drink in one gulp; telling a faith forum last night how she always feels “the enveloping support and love of God”….by tomorrow, I half expect to see her marching in the Lehigh Valley, clad in a bowling shirt, with a 12-gauge in one hand and the New Testament in the other, with John Mellencamp’s “Small Town” blasting on a loudspeaker.

But that’s politics. If she can successfully brand as “elitist” a guy who was raised by a single mother far from the comfortable suburban trappings that she enjoyed as a child…well, to the victor goes the spoils. If Cling-gate buoys her Pennsylvania vote tally, and helps her surpass the 10-point margin she won in Ohio, Obama will have to deal with the consequences – including talk, encouraged by the Clinton camp, that he’s just another rareified Adlai Stevenson egghead.

Hillary will take it to him during the debate on Wednesday night, probably in the first 10 minutes (unless they reprise the traditional opening spat over who has the better health insurance plan). His challenge is similar to what happened during the Wright controversy. He has to turn this flap to his advantage, reframe the issue in a broader context, make the case for an economic populism that connects with Pennsylvania’s working-class voters – and force Hillary to explain why those same voters, long ignored and taken for granted, received so little help from the Bill Clinton administration.

Obama screwed up badly during that fundraiser in San Francisco. But it’s the successful politician who bounces back from adversity, aided by outsize powers of persuasion. He tried out a few lines last night, and no doubt there will be more. We’ll soon see whether Obama has the gift that saved Bill Clinton from Bimbo-gate in 1992.

The following article was written by Jane Smiley for the Huffington Post.

***************************

“Here We Go Again”

by Jane Smiley

You know, I just spent seven and a half years disagreeing with the administration that has given us an unprecedented military and economic mess. I saw it coming, it came, and in some ways it was worse, and promises to get worse, than I foresaw. In the course of these seven years, I have had my patriotism questioned and demeaned fairly often. I was even put in a book, as one of a hundred people who were hurting America. When I got into this book, my relatives worried that I would get shot by some rightwing nut, even though several of them were and are rightwing nuts themselves (and they carry guns). All this time, though, I considered myself a patriot and a loyal American because I was able to see the destruction that was being wreaked upon the nation, and in particular, upon the middle and working classes, by the Republican liars and war criminals and job outsourcers and health care destroyers and army wreckers and infrastructure ignorers and media whores and agriculture blackmailers (see this month’s Vanity
Fair).

So now, Barack Obama tells the truth about conditions as we know them–that the countryside and the small towns are dying in many places in our country, and that the corporatocracy doesn’t care enough to do a thing about it. He points out that immigrant-baiting, gay-baiting, gun-baiting, and religious pandering have helped to destroy those towns and that countryside, that those being destroyed have been cynically enlisted by their very own destroyers to provide the votes that help accomplish the destruction. And this is what Senator Hillary Clinton says about it: “Senator Obama’s remarks were elitist and out of touch. They are not reflective of the values and beliefs of Americans.”

From Senator Clinton’s remarks, I infer that to actually see what has gone on in the US in the last 20 years is unAmerican. It doesn’t matter who you are, where you were born, what you pay in taxes, what else you might have contributed to the culture, how you vote, who you support. If you don’t support fundamentalist religion, job outsourcing, and free access to guns, then you are not even American.

I cannot believe how angry this makes me. I cannot believe that after the last seven and a half years, I can even get this angry. Yes, I know she is pandering to her audience. Yes, I know she will do anything to get elected. Yes, I know that she and Bill Clinton are corrupt to the core, and that I should have never expected anything better of her. But, please, any of you angry white women who still support this craven shill, don’t mention it to me. Do me the following favor — apologize to your children for not stopping the war that HIllary voted for, the war that is going to impoverish them. Then apologize to them for the effects of global warming that are going to make their lives hell. Then apologize to them for the school shooting they may someday see, the one where the kid gets the guns out of his father’s gun case, or buys at a gunshow. Apologize to them for the meaningless wars they are going to fight and pay for. Then tell them that “American values” killed their hopes and maybe killed them. And ask them if they think it’s going to be worth it.