Stone Cupid Real

As politicians and interest groups try to shape the outcome of the health care overhaul, they've offered interpretations that are so wildly different that truth sometimes seems to be taking a vacation.

Some - like the contention that a House health care overhaul (HR 3200) would create "death panels" that decide end-of-life care - are false. Some are misleading, and others are true.

Many of the claims are being floated by advocacy groups, then amplified on the Internet and at town hall events hosted by members of Congress. Lawmakers have contributed to the rhetoric, as well.

The majority of the claims deal with the House bill that awaits floor action in September. The Senate is not as far along in the process with its legislative proposal. The Senate Health, Education, Labor and Pensions Committee has approved a draft bill, but the Finance Committee is still working on its version. The lack of a unified Senate approach has led proponents and opponents to focus much of their criticism on the House measure.

The following examination of health care claims and their sources is not comprehensive but provides an overview of the commonly recited talking points in the debate.

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Claim: The House bill would create a government committee to decide what treatments or benefits patients may receive in a retooled health care system.

Source: The office of House Minority Leader John A. Boehner, R-Ohio, made the claim in a news release. It also was found in a Web publication by the group Family Security Matters.

Misleading. A committee would make recommendations on what sorts of minimum benefits insurers should be required to provide, but these standards are a floor, not a ceiling. Insurers could offer more benefits if they chose, perhaps to gain a competitive advantage to draw customers, but they could not offer less.

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Claim: Under the House bill, health care will be rationed, especially care for seniors.

Source: A number of congressional Republicans and conservative groups have made this claim. It's been repeated online and in some television advertisements by groups such as Patients United Now, which is funded in part by another right-leaning interest group, Americans United for Prosperity.

False. The House bill says almost the opposite - that insurers can't charge patients more than $5,000 a year for an individual or $10,000 for a family toward the cost of their own health care. It does not set limits on how much the plans can spend on each patient, however. As for seniors, they would still be covered by Medicare, and the bill does not set any benefit limits for that program.

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Claim: Employers will have to automatically enroll their workers in the public plan, according to the House bill.

Source: This assertion originated from a handout that conservative groups circulated via e-mail and at rallies. It's derived from a Web publication by Family Security Matters and has been repeated online by groups such as Patients United Now.

False. The House bill would require companies to enroll workers in whatever group insurance plan they offer as part of the mandate that employers provide health insurance coverage. But workers could opt out of automatic enrollment in an employer's plan if they want. The House bill is silent about enrolling in a specific plan.

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Claim: Any individual who doesn't have acceptable health insurance as defined by the government will have to pay a 2.5 percent income tax.

Source: Several places, including a Boehner press release.

True. The bill requires all Americans to obtain insurance or pay a penalty. There would be exemptions for children and other dependents, people living overseas and members of religious faiths that believe in limiting medical treatment, among other groups.

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Claim: A government-run insurance plan would drive all private insurers out of business.

Source: A Conservatives for Patients Rights advertisement.

Misleading. A number of conservative groups have argued that a public plan would squeeze concessions out of health providers, undercut private plans and drive those insurers out of business. But a Congressional Budget Office (CBO) analysis of the House bill says that, of the people who would get coverage in the new health insurance exchange, 21 million would go to private plans, while 9 million would go to the public plan.

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Claim: The government would have "real-time access" to individual bank accounts and create a "national ID health card."

Source: Conservative groups opposed to the Democrats' health care overhaul have asserted this in chain e-mails and at rallies across the country. Many claims emanate from the Family Security Matters Web publication.

False. A section of the bill would require insurers to make it easier for patients to calculate the cost of their care by providing information about the prices of treatments in the doctor's office. The House bill also would allow - but not require - insurers to issue patients a "machine-readable health plan beneficiary identification card," similar to the insurance cards most people with coverage already carry. The card would not be issued by the government.

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Claim: The government would provide an "approved list of end-of-life resources," require health care providers to consult with the government on end-of-life care, require individuals to create living wills or advance directives regarding end-of-life care. Such mandates will lead to government-ordered "assisted suicide" or "euthanasia."

Source: Most famously, Alaska's Republican former Gov. Sarah Palin stated this on her Facebook page. The claim has been repeated by overhaul opponents.

False. Claims that the legislation would establish "death panels" have made this one of the most controversial and talked-about provisions in the House measure. But they are fiction. The bill would authorize Medicare reimbursement for doctors who consult with their patients on end-of-life care, including the creation of advance directives, powers of attorney and orders for life-sustaining treatment - documents that allow individuals to control the care they receive when they are incapacitated.

Nothing in the bill would mandate such consultations, nor would patients be required to create advance directives or other documents related to end-of-life care in order for doctors to be paid.

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Claim: The bill tells doctors what and how much they can own.

Source: A handout being circulated via e-mail and at rallies by conservative groups opposing Democrats' health care effort, with many of the claims taken from the Web publication by Family Security Matters.

Misleading. Congressional Democrats and some Republicans have long sought to limit the creation and growth of "physician-owned" hospitals. Studies have shown that physicians tend to refer patients to hospitals in which they hold a financial stake and prescribe more procedures than necessary when they have a financial stake in the hospital. Over the last decade, Congress has periodically enacted moratoriums on physician-owned hospitals.

The House bill spells out a limited set of circumstances in which physicians would be allowed to invest in hospitals and how much of an ownership stake they can take. Existing hospitals owned by physicians would be "grandfathered" in, but their stakes would not be allowed to expand.

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Claim: Preventive screenings for disease, aggressive treatments to keep illnesses from becoming acute and making changes in communities to promote healthier lifestyles would reduce the cost of health care.

Source: Many overhaul proponents inside and outside of government have made this claim. Democrats have cited it as a rationale for using preventive care as a source of cost-savings: A Partnership for Prevention policy paper, the Senate Health, Education, Labor and Pensions Committee's a Health Care for America Now fact sheet, and a Prescription For Change fact sheet.

Misleading. Although liberal lawmakers and advocacy groups frequently say preventive care will lower health care costs, experts disagree when it comes to preventive care provided by doctors. The cost of screening and treating a large population is often greater than caring for the smaller groups of people struck with diseases. A CBO analysis of the House bill found that provisions that would remove co-payments for preventive services for Medicare and Medicaid patients would cost $9.9 billion. The CBO has not released an analysis of the Senate's draft bill, but past CBO reports have calculated preventive care as a cost, not a savings.

However, advocates argue that preventive care goes beyond medical treatments. Significant savings could be gained from investing in sidewalks to promote exercise, and making other changes such as healthier food in schools and labeling menus to promote good heath, proponents say.

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Claim: Legislation restructuring the health care system will not add to the federal budget deficit.

Source: Top Democrats, including President Obama and Senate Majority Leader Harry Reid of Nevada have made such claims.

False. A CBO analysis of the House bill found that it would produce a deficit of $239 billion over 10 years. House Democratic aides contend that this figure is inaccurate because it includes a $245 billion provision to adjust Medicare payments to physicians. They argue that the fix to physician payment rates is undertaken every year, and Congress is likely to pass it again with or without a health care overhaul.

In the Senate, the CBO scored portions of a measure being drafted by the Finance Committee at a lower cost than the House bill. The Senate Health, Education, Labor and Pension Committee's draft bill was scored at $611.4 billion, meaning it would not impact the deficit. Senate Finance Committee members also have talked about keeping the Medicare physicians' payment adjustment off the books, as well - meaning that the Senate bill could boost the deficit.

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Claim: Individuals who like their current health insurance plans can keep them.

Source: President Obama and many other Democrats have cited this in calling for a health care overhaul.

Misleading. Neither the House nor Senate legislation would require individuals with insurance to change their coverage. Both bills would continue the practice of workers enrolling in plans offered by their employers. But, if enacted, the overhaul would trigger significant changes in the health insurance industry, which could prompt employers to change the menu of plans they offer employees. An insurance plan offered by employers before the overhaul may not be the same one offered after the overhaul.

An overhaul also is expected to reduce reimbursement rates for a private-sector Medicare alternative called Medicare Advantage, leading some insurance companies to decrease plan offerings. Seniors covered by those plans would likely end up back in regular Medicare.

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Claim: A health care overhaul will lower premiums for people buying insurance.

Source: Democratic leaders have made the claim, and it was a centerpiece of Obama's justification for a health care overhaul. More recently, the president has talked about slowing the growth of health care costs.

Misleading. While the jump in the cost of premiums may slow, it's unlikely that their cost will decline. The House bill with its public option aims to lower government payments to providers. Reduced payments mean the government could charge those enrolled in the public option lower premiums than private insurers charge. Such a move could put pressure on private insurers to lower their premiums.

However, in a concession to fiscally conservative House Democrats known as Blue Dogs, the legislation would require public option administrators to negotiate rates with providers, instead of pegging payments at a fixed level above Medicare rates. If public option administrators are unsuccessful in negotiating lower payments to providers, there will be significantly less pressure on private insurance companies to lower premiums.

Hasty headlines to the contrary, it is very likely that a strong public option will be part of a final health insurance reform bill when it finally passes Congress this fall. There are three reasons:

1). A Public Option is the most elegant and politically viable solution to a major practical problem. Three basic models have been adopted by Western industrial nations to provide universal health care to their populations.

The government can directly employ doctors and hospitals to provide service. That is the system they have in Britain where they spend 40% less per person on health care than in the U.S. and get pretty good reviews from their citizens. It's the same system that we use to provide health care to veterans through the Veterans Administration.

The government can provide heath insurance for everyone as it does in Canada - or as we do in the U.S. with Medicare. Medical practices and hospitals are in private hands, but the health insurance fund is managed by the government. Again, that system seems to work quite well and also does a good job at controlling costs.

The third approach is to require individuals and businesses to purchase insurance and leave it to private insurance companies to provide that coverage. The problem with this approach is that requires some mechanism to control costs. That is particularly true in the United States where insurance companies are one of only two industries (Major League Baseball being the other) that are excepted from the anti-trust laws that are aimed at insuring competitive markets. In fact, most major health insurance markets are dominated by two or three companies so there is no real competition - particularly with respect to price.

Once everyone is required to buy insurance, the companies can have a field day raising prices and profits using the government to guarantee they are paid - either through subsidies or the imposition of fines. You can see why, from an insurance company perspective, this would be a great deal.

But from the point of view of the taxpayers - and the insurance ratepayers - it would be a disaster. It would be like giving the insurance companies a license to take your money - with no regulation - all enforced by government edict.

This, of course, is basically what happened with the prescription drug benefit - Medicare Part D. But there is a big political difference. A huge percentage of the money used to pay the insurance and drug companies in Medicare Part D comes from the taxpayers (or deficits). Most of the money that will go to pay for health insurance in a new system will come from ratepayers - individuals and companies who will feel the sting of rate increases directly.

What politician in his right mind would pass a law that requires individuals and businesses to buy products from companies who can then charge whatever the traffic will bear - especially in an industry where premiums have increased three times faster than wages, and profits keep heading skyward even in the worst recession in 60 years? Once government requires you to purchase a product, it has to provide some means to guarantee that the price is fair.

There are only two real practical solutions to this problem. On the one hand, you could set up a public health insurance option that does not have the same incentives to increase profit or CEO salaries and would compete against the private insurance companies and keep them honest. That is what President Obama has proposed. Or you could regulate health insurance rates.

Now rate regulation is not a crazy idea. It's been done for years in segments of the insurance market at the state level. But if you think the private health insurance industry is fighting tooth and nail to stop a Public option - wait to see what they would do to stop rate regulation.

A public option has none of the bureaucratic complexity of rate regulation and uses competitive forces to keep rates down. It is simple and elegant.

That's why the President and his top advisors support a public option.

2). The politics of Congress and the White House. There are a couple of political givens:

• Both the White House and Democratic Leadership understand that they must pass health insurance reform. Defeat is simply not an option. Both the Carter and Clinton administrations foundered because they proposed major policy initiatives and failed to achieve them. The effect was to depress overall support for the President and Democratic Party. In 1994 it cost the Democratic Party the control of Congress when large numbers of Democratic Members (mostly moderates) lost their seats in the mid-term elections. These defeats crippled their ability go back to the political well for subsequent big initiatives.

So far this White House is batting 13 for 13 in major initiatives - but health care is by far the biggest of them all. The White House and Democratic Leadership will do whatever is necessary to win. Health care is their signature issue.

• Finance Committee Ranking Member Charles Grassley has made it increasingly clear that he will not support any "bi-partisan" measure that is not endorsed by a majority of Republicans. That means that the likelihood of a "bi-partisan" deal are about zero.

This leaves two other approaches to victory. First is a strategy that works to get all Democrats and a couple of Republicans to vote for cloture, but not necessarily for a final bill. Second is the budget process known as reconciliation under which the bill could pass with just 50 votes (plus the Vice-President). Either of these options will make possible passage of a public option in the Senate.

• There are at least 100 Democrats in the House who would have to be dragged kicking and screaming to vote for health insurance reform that does not include a public option. In fact, it is hard to see how a bill could pass the House without a public option.

3). Inclusion of a public option is necessary to assure a mobilizable base to counterbalance a highly-motivated right wing and make passage of any health insurance reform possible. The public option has become an iconic symbol for Progressives. Without it, many would lose the passion that sends them to town meetings, phone banks and demonstrations. Without a public option to fuel this passion, the forces for reform would likely be overwhelmed by the shock troops of the right wing.

When you put all of these factors together, it is very likely that later this year President Obama will sign a health insurance reform bill into law that will indeed include a strong public option - not simply because the President clearly supports it, but also because of the practical policy and political considerations that make it critically necessary to success.

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Robert Creamer is a long time political organizer and strategist, and author of the recent book: "Stand Up Straight: How Progressives Can Win," available onAmazon.com.

They came in their thousands, queuing through the night to secure one of the coveted wristbands offering entry into a strange parallel universe where medical care is a free and basic right and not an expensive luxury. Some of these Americans had walked miles simply to have their blood pressure checked, some had slept in their cars in the hope of getting an eye-test or a mammogram, others had brought their children for immunisations that could end up saving their life.

In the week that Britain's National Health Service was held aloft by Republicans as an "evil and Orwellian" example of everything that is wrong with free healthcare, these extraordinary scenes in Inglewood, California yesterday provided a sobering reminder of exactly why President Barack Obama is trying to reform the US system.

The LA Forum, the arena that once hosted sell-out Madonna concerts, has been transformed – for eight days only – into a vast field hospital. In America, the offer of free healthcare is so rare, that news of the magical medical kingdom spread rapidly and long lines of prospective patients snaked around the venue for the chance of getting everyday treatments that many British people take for granted.

In the first two days, more than 1,500 men, women and children received free treatments worth $503,000 (£304,000). Thirty dentists pulled 471 teeth; 320 people were given standard issue spectacles; 80 had mammograms; dozens more had acupuncture, or saw kidney specialists. By the time the makeshift medical centre leaves town on Tuesday, staff expect to have dispensed $2m worth of treatments to 10,000 patients.

The gritty district of Inglewood lies just a few miles from the palm-lined streets of Beverly Hills and the bright lights of Hollywood, but is a world away. And the residents who had flocked for the free medical care, courtesy of mobile charity Remote Area Medical, bore testament to the human cost of the healthcare mess that President Obama is attempting to fix.

Christine Smith arrived at 3am in the hope of seeing a dentist for the first time since she turned 18. That was almost eight years ago. Her need is obvious and pressing: 17 of her teeth are rotten; some have large visible holes in them. She is living in constant pain and has been unable to eat solid food for several years.

"I had a gastric bypass in 2002, but it went wrong, and stomach acid began rotting my teeth. I've had several jobs since, but none with medical insurance, so I've not been able to see a dentist to get it fixed," she told The Independent. "I've not been able to chew food for as long as I can remember. I've been living on soup, and noodles, and blending meals in a food mixer. I'm in constant pain. Normally, it would cost $5,000 to fix it. So if I have to wait a week to get treated for free, I'll do it. This will change my life."

Along the hall, Liz Cruise was one of scores of people waiting for a free eye exam. She works for a major supermarket chain but can't afford the $200 a month that would be deducted from her salary for insurance. "It's a simple choice: pay my rent, or pay my healthcare. What am I supposed to do?" she asked. "I'm one of the working poor: people who do work but can't afford healthcare and are ineligible for any free healthcare or assistance. I can't remember the last time I saw a doctor."

Although the Americans spend more on medicine than any nation on earth, there are an estimated 50 million with no health insurance at all. Many of those who have jobs can't afford coverage, and even those with standard policies often find it doesn't cover commonplace procedures. California's unemployed – who rely on Medicaid – had their dental care axed last month.

Julie Shay was one of the many, waiting to slide into a dentist's chair where teeth were being drilled in full view of passers-by. For years, she has been crossing over the Mexican border to get her teeth done on the cheap in Tijuana. But recently, the US started requiring citizens returning home from Mexico to produce a passport (previously all you needed was a driver's license), and so that route is now closed. Today she has two abscesses and is in so much pain she can barely sleep. "I don't have a passport, and I can't afford one. So my husband and I slept in the car to make sure we got seen by a dentist. It sounds pathetic, but I really am that desperate."

"You'd think, with the money in this country, that we'd be able to look after people's health properly," she said. "But the truth is that the rich, and the insurance firms, just don't realise what we are going through, or simply don't care. Look around this room and tell me that America's healthcare don't need fixing."

President Obama's healthcare plans had been a central plank of his first-term programme, but his reform package has taken a battering at the hands of Republican opponents in recent weeks. As the Democrats have failed to coalesce around a single, straightforward proposal, their rivals have seized on public hesitancy over "socialised medicine" and now the chance of far-reaching reform is in doubt.

Most damaging of all has been the tide of vociferous right-wing opponents whipping up scepticism at town hall meetings that were supposed to soothe doubts. In Pennsylvania this week, Senator Arlen Specter was greeted by a crowd of 1,000 at a venue designed to accommodate only 250, and of the 30 selected speakers at the event, almost all were hostile.

The packed bleachers in the LA Forum tell a different story. The mobile clinic has been organised by the remarkable Remote Area Medical. The charity usually focuses on the rural poor, although they worked in New Orleans after Hurricane Katrina. Now they are moving into more urban venues, this week's event in Los Angeles is believed to be the largest free healthcare operation in the country.

Doctors, dentists and therapists volunteer their time, and resources to the organisation. To many US medical professionals, it offers a rare opportunity to plug into the public service ethos on which their trade was supposedly founded. "People come here who haven't seen a doctor for years. And we're able to say 'Hey, you have this, you have this, you have this'," said Dr Vincent Anthony, a kidney specialist volunteering five days of his team's time. "It's hard work, but incredibly rewarding. Healthcare needs reform, obviously. There are so many people falling through the cracks, who don't get care. That's why so many are here."

Ironically, given this week's transatlantic spat over the NHS, Remote Area Medical was founded by an Englishman: Stan Brock. The 72-year-old former public schoolboy, Taekwondo black belt, and one-time presenter of Wild Kingdom, one of America's most popular animal TV shows, left the celebrity gravy train in 1985 to, as he puts it, "make people better".

Today, Brock has no money, no income, and no bank account. He spends 365 days a year at the charity events, sleeping on a small rolled-up mat on the floor and living on a diet made up entirely of porridge and fresh fruit. In some quarters, he has been described, without too much exaggeration, as a living saint.

Though anxious not to interfere in the potent healthcare debate, Mr Brock said yesterday that he, and many other professionals, believes the NHS should provide a benchmark for the future of US healthcare.

"Back in 1944, the UK government knew there was a serious problem with lack of healthcare for 49.7 million British citizens, of which I was one, so they said 'Hey Mr Nye Bevan, you're the Minister for Health... go fix it'. And so came the NHS. Well, fast forward now 66 years, and we've got about the same number of people, about 49 million people, here in the US, who don't have access to healthcare."

"I've been very conservative in my outlook for the whole of my life. I've been described as being about 90,000 miles to the right of Attila the Hun. But I think one reaches the reality that something doesn't work... In this country something has to be done. And as a proud member of the US community but a loyal British subject to the core, I would say that if Britain could fix it in 1944, surely we could fix it here in America.

Healthcare compared

Health spending as a share of GDP

US 16%

UK 8.4%

Public spending on healthcare (% of total spending on healthcare)

US 45%

UK 82%

Health spending per head

US $7,290

UK $2,992

Practising physicians (per 1,000 people)

US 2.4

UK 2.5

Nurses (per 1,000 people)

US 10.6

UK 10.0

Acute care hospital beds (per 1,000 people)

US 2.7

UK 2.6

Life expectancy:

US 78

UK 80

Infant mortality (per 1,000 live births)

US 6.7

UK 4.8

Source: WHO/OECD Health Data 2009

Thanks always to  t r u t h o u t