Volume 43 Number 43

It’s the insurance companies, stupid

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EDITORIAL It’s hard to imagine a better time for real, lasting health care reform. A popular president with a reform mandate has made it a top priority. The Democrats control both houses of Congress, with enough votes in the Senate to block a filibuster. Medical costs are soaring, driving individuals and businesses into bankruptcy. Even some big corporate executives, who recognize that the United States can’t compete in the global economy when companies have to spend so much on employee health insurance, are starting to come around.

So why is the bill working its way through Congress so incredibly weak?

One reason: the private insurance industry is still calling the shots.

In fact, from the very beginning, private insurers were involved in the policy discussions. Nancy Ann DeParle, President Obama’s senior health policy advisor and the White House point person on reform, brought the industry into the room on day one. Sen. Max Baucus of Montana, who heads the Finance Committee that is now considering the bill, received more contributions from the insurance industry than any other Democrat in the Senate.

And as long as the needs of an industry that makes profits by denying medical coverage to sick people matter more than the needs of the American people, there’s not going to be a decent reform bill.

The best experts all agree that the only way to hold down costs, insure everyone, and make the nation competitive again is to eliminate private insurance and create a government-run, single-payer system. That’s what almost every other industrialized country has — and it works. Canada spends far less than the U.S. does on health care — and the health outcomes for Canadians are far better by every measurable standard.

Yet single-payer health insurance was never on the table. The best Obama and Congress have to offer is a complex measure that increases some regulations on the industry and offers (for now) the prospect of a public option — that is, the ability of any citizen to buy a Medicare-style public insurance plan. The public plan is obviously an attractive option — private companies spend as much as 40 percent of every health care dollar on administrative overhead and profit. The figure for Medicare is about 2 percent. But even that option may not survive the final wording of the bill.

And in exchange for accepting a few new rules and (maybe) having to compete against the government, the insurers get a huge bounty: the plan would mandate that every American buys health insurance. Even if many people choose the public option (if it’s even available), the insurance industry will get millions of new customers.

And there’s no guarantee that those who are currently uninsured will be able to afford the plans they need. Many will probably buy a minimal policy and wind up vastly underinsured — which means they’ll go broke and fall onto the medical and social safety net if they get seriously ill. As Steven T. Jones and Rebecca Bowe report in this issue, the vast majority of the medical bankruptcies today involve people who have insurance.

The House Progressive Caucus is only willing to support the bill if it includes a strong, viable public option. We’d go even further: if Congress can’t offer a single-payer plan, it should at least allow the states to do that. Rep. Dennis Kucinich (D–Ohio) has an amendment that would authorize single-payer in any state that wants to try it, and that must be part of the final bill. Rep. Nancy Pelosi, who supports the current House package, should make clear that the Kucinich amendment must be part of the final package.

State Sen. Mark Leno has a single-payer bill in Sacramento that has passed twice but been vetoed by Gov. Schwarzenegger. Both Democratic candidates for governor, Mayor Gavin Newsom and Attorney General Jerry Brown, need to pledge to sign that bill if they get elected.

There’s too much at stake here to accept an industry-backed plan masquerading as reform. If this crashes and burns, it will be years before reform comes back. Let’s get it right this time. *

Editor’s Notes

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Tredmond@sfbg.com

All the great sci-fi and comic book movies have some sort of larger social metaphor. Robocop, one of my all-time favorites, was really about the privatization of public resources. Our hero gets mangled in a firefight because Detroit turned its police department over to Omni Consumer Products Corp., which cut staffing to boost the bottom line and there’s no backup available.

So when I was editing this week’s cover package on the battle over health insurance, I couldn’t help thinking about The Incredibles. See, Mr. Incredible is this great superhero, but liability lawsuits force him to retire and he winds up as a claims clerk in an insurance company, where he sits around all day stamping "denied" on health insurance claims. Then he gets in trouble for quietly telling customers how they can appeal.

I’ve always imagined that real health insurance offices look exactly like that. People sit around all day and get paid to make sure that other people don’t get health care. And if they deny enough claims, they get a nice bonus. If they approve too many claims or help the poor customers appeal, they get fired.

The thing is, the bonus part is true. Many insurance companies pay their staff based on how much they have done to keep costs down — that is, to make sure expensive medical treatments are denied. I’ve been through this. The medical insurance won’t pay for the anesthesia my son needs for complicated oral surgery because the procedure happens in a dental office. The dental insurance won’t pay because the drugs are administered by an anesthesiologist, who is a doctor, not a dentist. Someone is smiling in both the medical and dental insurance offices; they just saved $1,000. Bonus on the way.

Sound familiar? I bet you’ve been through it too.

This is why the only way health insurance is going to get better is if the profit is taken out of it. And why it’s absolutely nuts that the insurance industry is still considered part of the solution.

The city budget didn’t come out well. The cops, the mayor’s press office, the mayor’s 311 call center, the places where there is still a lot of bloat, saw no real cuts. Public health and human services, which have already been cut to the bone, got hacked even more. And there is no concrete plan to even try to raise new revenue this fall.

There are some lessons here, and let me start with an obvious one. The final deal went down with two people — Sups. John Avalos and David Chiu, both new to the board — in the room with the mayor’s staff. Same thing in Sacramento — five people cut the deal. There’s got to be a better way. *

How to help Iran without meddling

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OPINION Two of us, Penn and Erlich, traveled to Iran in 2005 and interviewed numerous ordinary Iranians. People were very friendly toward us as Americans but very hostile to U.S. policy against their country. We visited Friday prayers where 10,000 people chanted, "Death to America." Afterward those same people invited us home for lunch.

That contradiction continues today as Iran goes through its most significant upheaval since the 1979 revolution. Iranians are rising up against an authoritarian system, but they don’t want U.S. intervention.

Many Iranians believe that they have experienced a coup d’état, in which the military and intelligence services have hijacked the presidential election. Through vote-buying and manipulation of the count, President Mahmoud Ahmadinejad guaranteed himself another four years in office.

In June more than a million Iranians marched in the streets of major cities across the country. The spontaneous demonstrations included well-to-do supporters of opposition candidates, but also large numbers of workers, farmers, small-business people, and the devoutly religious. They were fed up with 30 years of a system that used Islam as an excuse for breaking union labor strikes, stripping women of their rights, and repressing a nation.

The Iranian government responded to these peaceful protests with savagery, killing dozens of people. Some human rights groups put the number at more than 100. The government admits arresting 2,500 people nationwide and continues to hold at least 500. Most are being held without charges or have simply disappeared.

The repression hasn’t killed the movement. On July 17, more than 10,000 people came to Friday prayers in support of the opposition. Instead of chanting "Death to America," they chanted "Death to the Dictator," a reference to supreme leader Ali Khamenei. Police attacked them with clubs and tear gas.

Meanwhile in Washington, some politicians tried to use the crisis for their own ends. Sen. John McCain criticized President Obama for not taking a stronger position against the Iranian government. It’s ironic to hear McCain and other conservatives proclaim their support for the people of Iran when a few months ago they wanted to bomb them.

That doesn’t exactly build credibility among Iranians.

President Obama faces tough choices on Iran. If he speaks out loudly against Ahmadinejad, he is accused of meddling in Iran’s internal affairs. If he says too little, then right-wingers in the U.S. accuse him of being soft on Ahmadinejad.

In reality, the U.S. has very little ability to impact what has become a massive, spontaneous movement for change. And it shouldn’t. The CIA overthrew the democratically elected government of Prime Minister Mohammed Mossadegh in 1953, bringing the dictatorial shah back to power. George W. Bush’s administration attempted to overthrow the Iranian government by funding and arming ethnic minority groups opposed to Tehran.

The U.S. government has no moral or political authority to tell Iranians what they should do. Iranians are perfectly capable of deciding for themselves.

That’s why citizen diplomacy is so important. Iranian demonstrators welcome the support of ordinary Americans. Joan Baez recorded a Farsi-language version of "We Shall Overcome" that has shot around the world on YouTube. She sang it July 12 at San Francisco’s Stern Grove.

Iranian activists are holding a hunger strike in front of the United Nations in New York from July 22 to 24, demanding that Secretary-General Ban Ki-moon send a special commission to Iran.

With hundreds of thousands of Iranian-Americans in California, it would be unconscionable to ignore the nonnegotiable right of peaceful dissent by millions of people in Iran. Join us in the San Francisco Civic Center plaza on July 25, from noon to 4 p.m. Stand in solidarity with Iranians and against U.S. intervention in Iran (www.norcal4iran.org). *

Sean Penn is an actor, director, and writer who visited Iran in 2005. Ross Mirkarimi is a San Francisco supervisor, the first elected Iranian-American to hold that office. Reese Erlich is a freelance journalist and author of The Iran Agenda: The Real Story of U.S. Policy and the Middle East Crisis.