Monday, October 26, 2009

If Democrats own healthcare, we can own the Governor's Mansion in 2012

It's not often that Harry Reid and Alan Levine team up on anything, but they did today in laying out the path to Democratic success in Louisiana in the 2011 statewide elections.

That path will be healthcare. Specifically, it will be Governor Bobby Jindal's ideological rigidity on taxes in the face of what will be draconian (criminal?) cuts in healthcare in the state budget over the next two years. With healthcare and higher education still the only funding streams not constitutionally protected and the state facing a billion dollar revenue shortfall, Jindal will force the Legislature to make heavy cuts in both programs.

Last week, the Baton Rouge Advocate carried a story saying the higher education cuts will amount to 60 percent over the next two years. No mention of healthcare, but that's where the bulk of the cuts will be and for two reasons. First, that's where the money is (Medicaid is a $6 billion program). Secondly, no one in the Legislature is lobbying to protect the interests of the poor, the handicapped and those with special needs — the victims of these coming cuts. Oh, the hospitals, nursing homes and doctors will object, but you won't see anything resembling the "Intervention at the Mansion" earlier this year where all of the non-imprisoned former governors got together to tell the Boy Governor that he just could not cut $200 million-plus from higher education.

No notables stood up for Medicaid clients then. And none will do it in the coming session.

They are, in the current world of Louisiana politics, "expendable."

That's what happens when Democrats forget who they are and who they represent and buy into the conceit that they can get elected if they run as 'Republican-lite' candidates. Ultimately, they are not Democrats and their votes show it.

Today, Jindal's DHH Secretary Alan Levine dropped the first of what will be many shoes. According to The Advocate, he announced another round of Medicaid budget cuts made necessary because of rising enrollments in the program and the inability of the department to implement cuts fast enough. Poverty is up in Louisiana. Unemployment is up. The number of companies offering health insurance coverage is falling through the floor.

So, Levine, working within Jindal's "No Taxes for Any Reason" straight jacket, is ordering more cuts. This is, of course, a result of issues in the current fiscal year. This isn't even related to the even bigger cuts that will be needed next year.

Senator Harry Reid handed Louisiana Democrats a gift today by including the Public Option in the bill that the U.S. Senate will debate and vote on in a couple of weeks. Word is that the bill will include an "opt out" clause for states to leave the public option.

Is there any doubt as to which way the Jindal administration and Louisiana Republicans will lurch on this? Levine has been taking part in Louisiana Republican Party workshops talking against healthcare reform. Jindal's path to the national Republican stage requires he follow the party's rejectionist strategy, so he will clearly push to have the state opt out of the public option.

But, here's where it gets interesting.

Depending on the year, anywhere between 17 and 25 working age Louisiana adults are uninsured. In July, the Baton Rouge Business Report quoted a spokesman for BlueCross/BlueShield of Louisiana who said that only 30 percent of Louisiana small businesses offer health insurance to their employees and that the number is falling due to skyrocketing rates.

While no one will speak up for Medicaid patients, surely someone will speak up for the rights of the working uninsured and fight the Jindal administration's expected push to, in fact, opt out of the public option — the path to provide affordable coverage to those working age residents without coverage.

The 2011 statewide elections will be the battle ground where this fight takes place. Jindal, if he follows his current course, will have cut higher education by three-quarters of a billion dollars. He will have cut a billion in healthcare spending, eliminating services, shutting institutions, impacting the families of the disabled, the sick and the infirm.

This election will take place on a re-districted state Legislative map. Every district will be redrawn, and it will be pretty radically different due to post-2005/2008 storm induced population shifts.

Democrats should be easy to distinguish from Republicans. The Republicans will be the ones saying they are sorry for the pain, injury and even deaths their cuts inflicted, but that they had no choice. Democrats will be the candidates motivated by outrage at the callous, depraved disregard for the health and well-being of their fellow citizens.

Jindal will be vulnerable in 2011. He will have revealed that everything said about him in 2003 was true — that his knowledge of numbers is matched only by his inability to see the people behind the numbers in state budgets and programs. The healthcare ads that Kathleen Blanco ran against him in 2003 — those credited with sealing her victory then — will ring prophetic.

This man is devoid of compassion and is blinded by his ambition. Our state is paying — and will pay — a fearful price for his limitations.

But, elections are about changing course.

Harry Reid has just set up Louisiana Democrats to take our state back, to walk it back from the brink.

It will be a hard fight — beating incumbents always is. The Louisiana Committee for a Republican Majority (David Vitter's homage to Tom DeLay) did not quite succeed in taking over either house of the Legislature, but they succeeded just enough to give Jindal the ability to defeat tax increases that could stave off some of these cuts. They will also work to ensure that the re-districting process is skewed to favor Republicans.

They, too, are setting him up for defeat — and the members of the House and Senate they sent there to do their ideologically driven work.

The world has shifted. They have not changed. The opportunity to oust them is ripening.

Saturday, October 24, 2009

More from the forum

Robichaux: Employees will pay 10 percent more across the country next year. We cannot sustain the rates of growth we are experiencing now. Healthcare is one of the things forcing our economic problems. We will pay one way or another.

Landrieu: In 1993 68 percent of small businesses offered some kind of insurance. Today it is down to 39 percent and falling because rates are going through the roof. One employee gets ill, all rates go up. That is not fair. We are trying to create exchanges to help eliminate that so that we can create access to low cost care just like big companies. This is very important in Louisiana because of the number of small businesses.

Audience: Joyce Landry: What is the reason that members of Congress take part in an elite healthcare program paid for by taxpayers?

Senator Landrieu: I am a co-sponsor of the bill that would provide the same kind of coverage that all federal employees are in. This is the Wyden Bill. Every federal worker has 15-30 choices. It is private insurance with a 70-30 pay split (employer/employee). Should we expand Medicaid to 130 percent of poverty? Should we subsidize system like members of Congress have? I like the choice model. Others like the expansion of Medicaid.

Question: How can average citizen determine who is paying for all those ads?

Senator Landrieu: All the names sound alike and that's intentional. All have to have their donors listed and there should be some registration to let them know. AARP is pretty good. American Nurses Association. AMA. Look to nonpartisan groups.

Question: Will providers be taxed for services?

Prudhomme: Look at what is going on in hospitals, you are paying for the care that people who could not pay for their care. You are being taxed now.

Landrieu: One of the way we support healthcare is in the tax code. We now give tax deductions for that. We are subsidizing these high end plans. Anything over a certain limit might be beyond the level of the subsidy. The best plans are not necessarily the most expensive plan. We have to pay for this bill up front. May cost it up front, but over time it pays for itself. That is what we are trying to accomplish. Will cost up front but save long-term.

Rolfes: question: Worked in oilfield in the early 70s. Had full insurance for lifetime after retirement. Will company drop me?

Senator Landrieu: these bills will not address that in any way. Might lose some of the subsidy. Contracts should stand. When companies go bankrupt, those plans go with them. Not honored. But these laws will not affect those plans.

Rolfes: What is in store for those on Medicaid in this transition?

Landrieu: Trying to keep Medicare the way it is. Keep Medicaid the way it is, but expand it to 130 percent of poverty level  with the Federal government picking up 95 percent of the costs. Want to see subsidies for businesses under 25 employees to make insurance affordable.

Pennsylvania Life Insurance company reps: If do not enroll, what will happen to the penalty? Amnesty?

Landrieu: Not sure if there is a grace period in the Senate bill. Not going into effect immediately.

Complicated system. Not trying to change everything. But, working to improve the broken parts. Reform the private insurance markets by giving consumers better choices.

Closing statements:

Robichaux: Medical costs have been a problem for decades. Academic society late sixties wrote a paper on the price of prescription medicines. Celebrex and other drugs just as effective and cheaper. Marketing is the issue.

Prudhomme: We can get something done, I believe we can get healthcare that is affordable. I get excellent healthcare as a veteran. Affordable and accessible.

Senator: Thanks to the station and the Lafayette Democrats. If I could try to convince you of the importance of doing something, that would be it. The current system is unsustainable. Your premiums because you pay for those without insurance. No preventive care. No ability to catch things early. Some of it is good, but we are trying to fix the broken part, primarily the private insurance market. President is being criticized but he is trying to do the right thing. We can compromise on some of these things and do the right thing.

That's a wrap!

Second question: from the audience

Jeremiah Supple: Thank you Senator for coming. Thank you for addressing the people outside. Government option: Run through reconciliation. Government spending has gone from 50 percent to 44 percent of GDP. It will go over 50 percent of GDP with public option. Reconciliation. Will you support reconciliation?

Landrieu: Inclined not to vote for reconciliation. Believe 60 votes to vote for cloture. Still working to try to get Republicans to join. Level of the deficit is a concern for all. President Bush came in with a surplus from President Clinton. The Bush years, Congress drove surplus into a deep deficit. If we don't do something to control healthcare costs for government and individuals (16 percent of GDP — twice as much as any other country), so we need to change the system.

Generally, not supportive of the public option. I want to reform the private insurance markets. Give people more choice, lower premiums. That's what I'm generally supporting.

Rolfes: what's in the plans? How best learn what is in it? Is the bill posted?

Senator: all the bills are posted for anyone to read. Yes, there are long and difficult, but it is a complicated issue. Qualifications in various plans. Big companies, small companies. Not defending the complexity, but it is a complex process. Like to hear what the doctors have to say.

Robichaux: Having served in the state Legislature, I know how complicated the bills can be. No one can learn all the aspects of the bill, and it changes as it moves through committees. Things change minute to minute. Don't known how to keep up with it. Five different bills, each different.

Landrieu: I have read the bills in the Senate, the bills are out there on the Internet. There are summaries from various organizations.

Prudhomme: American Nursing Associations has taken look at the bills side-by-side. Cost effective care is the key. The association is looking at all elements. They are accurately calling it insurance reform. Does a great job of putting decisions.

Adam Mouton, Question 2: Prescription drug issue. Could save millions of dollars by changing the way they price their drugs. $130 for celebrex; cost to produce $.60. High profits. The reason Canadian drugs are cheaper than ours is that the government has gotten involved to control prices. Is there anything in these bills to lower the cost of drugs? Since we have the best, why are we trying to fix it all instead of what's broken?

Senator Landrieu: the general idea is to use generics and to negotiate with the drug companies. Also the issue of how long patents last. You are right. We can support reasonable profits for drug companies, but we want them to operate on a level playing field.

Parts of our system are the best, but just because we are spending more does not mean we are getting the best outcomes. Louisiana has high death rates from chronic disease. Way to judge is the outcome. Other countries doing better.

I am for our public/private system. But it is costing too much and it is not delivering the outcomes. That is part of the reform role.

Question: Loss of jobs means loss of health coverage. How will cover them if they can't afford COBRA?

Robichaux: Louisiana has 27 percent uninsured. We have 44,000 people who die because they lack adequate healthcare and adequate access to care. This is a major problem in this country. Bankruptcies are unbelievable. 60 percent linked to healthcare expenses. 1.5 million families lose their homes to foreclosure due to healthcare costs. I don't know exactly how they will impact. We are the only highly industrialized country in the world that does not have some kind of subsidized healthcare program. We need to move past this. We are a better country than this.

Senator Landrieu: Almost every version of this bill, reform of insurance markets is included. Cannot be denied due to pre-existing condition and can't be dropped when adverse diagnosis. Also working to bring equity to rates charged to men and women. 60 percent of the uninsured are working. Small businesses can't afford the coverage. But we want to make sure that those who are working have decent choices in the market.

Prudhomme: Stop pre-existing condition exclusion. People call me about this all the time. People with COBRA can't continue that for long because of costs. What we are asking for in any bill that goes forward, we need to stop this business of exhorbitant amount of copays and deductibles. Preventive care needs to be included so that they can have quality care. This is what we are fighting for. We need to stop what is going on now.

First Question: Healthcare Reform Forum

Rolfes: Format questions submitted by viewers. Audience questions as well. Closing statements 2-3 minutes.

First question:
As a senior citizen, concerned about rising costs of Medicare. How will this affect Medicare.

Senator Landrieu: No one plan yet. Several versions. Different versions in each bill. Generally, we are trying to get the waste and fraud out of Medicare and to strengthen it. Prescription drug program has the doughnut, so we are trying to eliminate the doughnut. Idea is to take action to control costs because it is not sustainable as it is now. Must be careful to preserve it. 13 percent of Louisiana is on Medicare. Government run, and it's done pretty well.

Dr. Prudhomme: There are concerns. Overutilization of ERs would help control cost.

Robichaux: Medicare Part D needs improving. Doughnut is tough on seniors, good for drug companies. Wrote paper on the bill before it became law. Pharmaceutical companies derive most benefits. Government not allowed to negotiate. Lose benefits if you don't join. Businesses have a provision in the bill that would let corporations make money if transfer costs of retiree benefits to retirees. Good to know working to correct that.

Landrieu: I have a slightly different view. Some like Medicare Advantage a lot. Trying to figure out how to keep best parts of it. Maybe letting government negotiate prices is the way to control the cots.

Clifton Chenier Panel being seated

Senator Landrieu in the center. Dr. Nellie August-Prudhomme to her left. Dr. Mike Robichaux to her right.

Mike tests being conducted. Technical tests.

Blue Rolfes: Welcome to forum hosted by Lafayette Parish Democratic Executive Committee.

Hot topic.

Take two due to technical difficulties.

Here we go again.

People want to know what is in the plan and what will it mean. How will it affect us.

Louisiana Senior Senator Mary Landrieu. First Louisiana woman elected to full term in the U.S. Senate. Appropriations committee member. Senate Energy committee. Won the energy bill with big bucks from off shore (you know, the one Jindal took credit for).

Dr. Michael Robichaux of Raceland. LSU Tiger all-SEC in the 1960s. National Guard. Private practice. Former member of the Louisiana state Senate. Working on price and safety of prescription drugs.

Dr. Nellie August-Prudhomme is a doctor of Nursing Sciences and a Master of Public Health from Tulane. RN. Psychiatric nurse, too. Clinical faculty at LSU-Eunice.

Opening statements next.

Live at the Clifton Chenier Center

Blue Rolfes of KLFY is setting out the rules for the event. Turn off cell phones.

Protocol: this is an important issue. Exchange of information in mature, calm and adult manner. No outbursts. No disruptions.

Please don't allow emotions to cloud sensibilities.

Seating of the panel begins now.

Lafayette Democrats' Healthcare Forum is Today

The televised forum on Healthcare Reform featuring Senator Mary Landrieu, Dr. Mike Robichaux, and Dr. Nellie August-Prudhomme will be held in Lafayette today at the Clifton Chenier Center Auditorium.

This is the forum that the Lafayette Parish Democratic Executive Committee won after KLFY and two other stations ran an all-Republican, anti-healthcare reform forum in September.

The program will be recorded today and rebroadcast on Monday in Lafayette.

I am in the auditorium and will (hopefully) be blogging live from here once the event gets under way.

Monday, October 5, 2009

FTC calls for transparency in blogging

The Federal Trade Commission (FTC) is calling for bloggers to be upfront about those who provide them financial support.

ComputerWorld reports it like this:
The U.S. Federal Trade Commission (FTC) today released new guidelines requiring all bloggers to disclose any payments or freebies they get from companies in exchange for writing reviews of their products.

The new rules come as part of an update to the FTC's guidelines on keeping advertisements and testimonial ads in line with the FTC Act, which was set up to prevent unfair competition methods, as well as deceptive acts that would affect commerce. The FTC noted that this is the first update to guidance for advertisers since 1980.
I think this should apply for bloggers discussing public policy issues.

Here are two specific examples.

Cheron Brylski operates a public relations company in New Orleans. She also runs a blog that she calls "Krewe of Truth" which is a truly great name. I know Cheron and like her and we agree on a lot of issues. But, on at least one issue, I think she's crossed the line.

That issue is healthcare reform. Cheron's firm represents the pharmaceutical industry. And her Krewe of Truth blogs did not make that clear for a while, until some readers called her out on it.

All of her readers would have benefited from knowing that some of her opinions were work products. Are there others beyond healthcare reform? I don't know, but I do know about that one.

A second blogger with paid clients who benefit from his writing is Geoff Dailey, whose Apprising blog is widely circulated on various technology lists nationally. Geoff has been paid by Lafayette Utilities System (LUS) for at least several months this year. He is paid to promote the LUS fiber story. It's a great story. I worked to get that system approved by voters. I subscribe to the system now.

I heard about Geoff's contract a few months ago. Like Cheron's readers,  I think all of Geoff Dailey's readers are entitled to know when his opinions are the paid product of work for his clients.

There is nothing wrong with bloggers writing favorably about products and issues they believe in. That is what it's about.

But, paid opinions are another matter. They cross a line. And readers have a right to know when what they are reading is the unbiased belief of the blogger, or is part of a paid effort they have undertaken as part of their work for clients. The FTC says this rule should apply to product reviews.

I think it should apply to public policy blogging as well.

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