We were fed a steady diet of fear, distraction and falsehoods to sell healthcare reform.

• We were told that unless something was done healthcare costs would bankrupt the country

The Congressional Budget Office (CBO) released a report admitting that the actual cost of the healthcare system would be far higher than was initially estimated  - a cost of more than 1 trillion dollars

• We were told that healthcare premiums would decrease for families

The CBO report estimates that the cost of healthcare premiums would go up by $2100 for the average family next year

• We were told that if we liked our health insurance and doctor we could keep them

Thousands of Medicare recipients from Massachusetts to Maine will lose supplemental insurance through Medicare advantage thereby increasing there healthcare costs exponentially.

• There will be no healthcare rationing

The choice of Donald Berwick speaks for itself. He is a champion of the British model of socialized one size fits all medicine. It is a broken system that is based on rationing of care that is collapsing under its own weight.

There have also been examples of nascent rationing here in the US. e.g, in Colorado the cancer drug Avastin is not covered by Medicare although it is covered in other states. In addition, the effectiveness of screening tools such as mammograms are being questioned. It is likely that these studies will eventually be used to argue that mammograms are not effective and therefore will not be covered by insurance.

The rising cost of private medical insurance premiums and deductibles in the current economic environment also lead to the rationing of healthcare. This is not surprising since the bill was written by and for the corporate medical cabal (i.e., the medical insurance and pharmaceutical industries, the Hospital Corporation of America and the American Medical Association) that make profit their number one priority instead of the health of our citizens.

By appealing to our lowest common denominator we have been divided and distracted by playing either the fear, race and/or class cards ad nauseam while nothing has been done to control the real reasons for the high costs of healthcare.  For example:

• Medicare still cannot import cheaper medications that would decrease the healthcare costs of senior citizens.
• Those with health savings accounts cannot use their account to buy cheaper over the counter alternatives or nutritional supplements. They can only buy prescription drugs.
• Healthcare reform now covers preventative tests, but there has been a movement towards limiting the indications for testing (eg, mammograms to detect breast cancer and PSA to diagnose prostate cancer).
• Nothing has been done to stop insurance companies from hoarding profits while systematically raising premiums.
• There has been no mention of tort reform.

Why have none of these changes been implemented? Perhaps it is because this is a system that is set up to fail. When people get so fed up with waiting for treatment, or no longer want to put up with being denied care because a decision is made that the costs outweigh the benefits, the government will be ready to step in with the solution of the single payer system. Unfortunately, when that happens medical care in the United States as we know it will be lost forever, and we will be saddled with a system that even the British find untenable.

There have been several iterations of the ICD. The most recent is ICD-10. Seven countries have adopted it to date. The first country to adopt it for clinical use was Australia in 1998 then Canada in 2000. The most recent country to adopt it was Thailand in 2007. The United States is scheduled to adopt it in 2013. Just in time for the major pieces for the healthcare reform pieces to take effect. The mad rush to pass healthcare reform makes a lot of sense when this time table is taken into consideration. It finally brings the US healthcare system into the global healthcare system overseen by the WHO.

How will our healthcare system change when 30 million new people will be covered and will need healthcare? The system in British Columbia, Canada provides an example of what we can expect. They have adopted a healthcare system that has clinical treatment guidelines set forth by a protocols advisory committee. Our healthcare reform system also sets up an advisory panel that will use evidence based medicine.

These advisory panels set up treatment flow sheets that will make it easy for healthcare providers such as physician assistants to provide care. Now I understand how Governor Rendell can make the statement that he did a couple of weeks ago that health care providers are “just as good as primary care physicians”. Although we have a shortage of physicians, the statement is clearly based in the premise that anyone can use algorithms to cookbook medical care. All you need to do is connect the dots.

This is great until you apply it to the real world. Take for example the treatment of middle ear infections or sore throats. I have treated many children who finally get referred to an ENT after months of recurrent ear infections after they have speech delay and/or are not doing well in school because of hearing loss from the chronic infection. I have also treated adults with hearing loss that resulted from childhood ear infections that were never definitively treated as children with ventilation tubes. What is lost in these guidelines is the fact that in some patients surgical intervention is cheaper in the long run because it can solve the underlying problem instead of managing the symptom.

The one size fits all approach takes away the importance of individualized medical care. Although these guidelines are based on research they will inevitably lag behind research, and that will have a negative impact on patient care. For example, the Canadian Advisory Panel guideline for the treatment of sore throats is not true. “With the exception of rare infections by certain pharyngeal bacterial pathogens (e.g., Corynebacterium diphtheriae, Neisseria gonorrhoeae and Arcanobacterium haemolyticum), antimicrobial therapy is of no proven benefit in the treatment of acute pharyngitis due to bacteria other than group A streptococcus”.  I just drained an abscess on a patient who was not placed on antibiotics because the strep test was negative. He actually had a staphylococcal infection. This blanket application if applied to other diseases such as screening mammograms and other ailments can lead to people falling through clinical cracks and getting sicker requiring more expensive and invasive care.  The practice of good medicine will always be unpredictable and will require the ability to practice the art of medicine.

A preview of the future:

1. the payment set up with covered medical services in British Columbia
2. Physicians in the US are already being paid using this system of bundling charges.  The Canadian fee schedule is similar to rates paid by Medicaid. If healthcare reform leads to the implementation of the ICD-10 fee schedule with the adoption of these lower rates, it will likely lead physicians in private practice to drop out of the system in order to stay in business. Quite simply, adding this to the ever rising overhead and malpractice premiums will simply be overwhelming.

It’s a veil few have the stomach to look beneath.  Regardless, Massa’s comments were seized upon as proof of what has been said all along about the administrations tactics to do anything necessary to pass ObamaCare.

Is Massa telling the truth?  I don’t know.  It seems plausible.  It certainly seems to fit the matrix of what the administration has done in the past to twist arms and pressure members of Congress to pass its bill.

But I do know Massa took heat last summer when his meeting with a group of liberal bloggers was recorded and put on YouTube.

Massa: So what happens at my town hall meetings, frankly, is important, because I’m in one of the most right-wing, Republican districts in the country.  And I’m not asking you guys to go back to wherever and send people to me, this is a generic statement about ‘what can I do?’ Well, that’s one thing we can do.

Blogger: So if we got your meetings to 60/40 and there was single payer in a bill, you’d vote for it?

Massa: Oh absolutely, I’d vote for single payer.

Blogger: If it was 60/40 sentiment in the room…

Massa: Listen, I tell every audience I’m in favor of single payer…

Blogger: So it there was still 80/20 in the room…

Massa: If there was a single payer bill?

Blogger: If there was a single payer bill…

Massa: I will vote for the single payer bill.

Now, I’m no prosecutor, but this exchange certainly does not seem to jive with what Massa has said in recent days.  Just Monday, he said:

The entire nation has said let’s re-write the health care bill, let’s find what we can agree upon. No, no, no, no. We’re going to ram this down the throats of the American people and anyone who stands in the way of doing that is going to be smeared, and they are going to be kicked out of Congress.

But in that same exchange with the bloggers, Massa also said:

I will vote adamantly against the interest of my district if I actually think what I am doing is going to help them. … I will vote against their opinion if I actually believe it will help them.

So, acting as an amateur prosecutor, I ask Rep. Massa, were you telling the truth then or are you telling the truth now?  I’d like to believe you – I want to believe you – and your accusations against the Obama administration but something just doesn’t smell right.

Many of you know me.  You have cheered for me.  I miss those days.  I just want to say to each of you, simply and directly, that I am deeply sorry for my irresponsible and selfish behavior.

I was unfaithful.  I consorted with Republicans.  I engaged in bipartisanship.  What I did is not acceptable, and I am the only person to blame.

As you know, I am trying to get a health care reform bill through Congress.  In so doing, I made a reach-around across the aisle.  I avoided talk of a single-payer system.  I watered down and then removed the public option.  I took out the death panels, benefits to undocumented immigrants, and federal funding for abortion that our critics so callously and falsely observed were in the bill.

I know I have bitterly disappointed all of you.  I have made you question who I am and how I could have done the things I did.  I am embarrassed that I have put you in this position.

To everyone involved in the White House, my staff, cronies, minions, toadies, lackeys, lickspittles, parasites, finaglers, blackmailers, and, most importantly, the young people, I want you to know that I’m sorry.

To my outside allies, the netroots, Daily Kos, MoveOn.org, myDD, firedoglake, trousersnakeswamp, and the Soros Alliance for Liberalism And Democracy — shout-out to my SALAD tossers! — your support means more than ever.

I know people want to find out how I could be so selfish and so foolish. People want to know how I could have done these things to my wife Michelle, who had just become proud of this country.

I knew my actions were wrong, but I convinced myself that the normal rules didn’t apply.  I ran straight through the boundaries that a liberal president should live by.  I felt that I had worked hard for several months of my entire life and deserved to enjoy all the temptations that the Beltway could provide, including the forbidden fruit of David Gergen’s love.  I felt I was entitled.  I was not.

First, let me address one issue.  Some people have speculated that Susan Collins somehow hurt or attacked me.  It angers me that people would fabricate a story like that.  Yes, we had lunch several times.  Once, Susan became angry with me when I made her pick up the check because I mistakenly thought she was nodding her head.  And yes, we engaged in a threesome with Olympia Snowe at a public golf course.  I shot an 87.  That is no excuse for rumor-mongering.

Still, I have much to atone for.  I stopped living by the core values that were inculcated in me at a young age by the public schools of Jakarta.  It was there that I was taught such Christian beliefs as love thy neighbor, do unto others, and there is no God but God.

Those values led me to consider the opinions and beliefs of my Republican friends.  This was wrong.  As a liberal president with large congressional majorities, I should not have given in to the temptations of bipartisanship.  I am deeply ashamed that our health care bill was so badly compromised it attracted one Republican vote.  Some Vietnamese dude.  Let me be clear, I shall never cave in again.

It’s hard to admit that I need help, but I do.  For 30 days since the election of Scott Brown, I have been receiving inpatient therapy from Barney Frank, Barbara Lee, and Bernie Sanders.  I also built a house for homeless AIDS patients.  It has been rewarding and enlightening work.  But I know I have a long way to go.

As we move forward on legislation that shares our progressive values, such as closing Guantanamo Bay and eliminating the scourge of carbon dioxide from this Earth, I will adhere to the one clear path, the path of partisanship.  You have opened my eyes.  I will no longer engage in backdoor shenanigans.  I will not bend over for Ben Nelson.

I once heard, and I believe it’s true, that it’s not what you achieve in life that matters.  For that reason, I have tried to achieve as little as possible.  Instead, it’s what you overcome that’s important.

Together, we shall overcome the false prophets who say this is one America, red, white, and blue.  It is blue, period.  And as long as I’m in the White House, the blues will continue.  Thank you.

While Lieberman has been hammered by the left for many of the supporting reasons he has given for opposing the public option, the centerpiece of his argument has always been that the public option was a policy instrument designed by liberals to move the country towards a single payer system. Here is Lieberman speaking on Face the Nation back on Nov. 1 when this controversy initially erupted:

The public option I think was raised in the last year by people who really want to have a government-controlled health insurance system. That’s their right. I think they’re wrong.

And here is Lieberman speaking to CNS News on Nov. 10:

People, I think, who really want a single-payer system and government control of health insurance are using the public option as a nose under the tent, a camel’s nose under the tent…they’ve got a right to that point of view – I think they’re wrong and I think it would be terrible for the country and for health care, so I’ve got to stop it.

So where is the liberal rebuttal to this argument? There is none because this assertion is irrefutably true. We know this thanks to a handful of prominent liberal supporters of healthcare reform who have been caught on tape over the past year admitting that this was indeed the ultimate agenda of the public option.

Washington Post blogger Ezra Klein, who accused Lieberman of being willing to “cause the deaths of hundreds of thousands of people” in order to settle a political score, admitted on tape at a conference last year that the public option was a “sneaky strategy” to move towards a single payer system. And that it would be “sweet” to put private insurers out of business. When his comments were made public earlier this year he lied. Repeatedly.

New York Times columnist Paul Krugman, who also accused Lieberman of “gutting” the health bill out of spite, has been caught on tape more than once stating that the public option would “kill” private insurers and “sneak up on” a single payer system.

Yale Professor Jacob Hacker, also known as the “father of the public option”, accused Lieberman this week of misrepresenting his (Hacker’s) position on the Medicare buy-in as a basis for opposing it. Yet Hacker has had his own YouTube moment, admitting at a conference last year that the public option “is not a trojan horse” for single-payer, “it’s just RIGHT THERE”. Adding, “we’ll get there, over time, eventually”.

And lastly, there is the video which started it all. Congresswoman Jan Schakowsky, speaking at a health reform rally this past April, unequivocally stated that the public option would “put private insurers out of business and lead to single payer“. Furthermore, she argued that the dispute between public option and single payer supporters was “not a principled fight”. But rather – “this is a fight about strategy for getting there and I believe we will”.

Liberals try can shift the blame to Lieberman all they want, but the simple fact of the matter is he has taken a principled position in opposition to a blatant attempt to deceive the American public about the ultimate goal of reform.

THIS DECEPTION IS THE BASIS FOR HIS OPPOSITION.

Lieberman took liberals at their word when they admitted that their ultimate aim was a government take-over of the heath care system. And he is hardly alone in believing this to be a bad idea. So he opposed the provision. It’s as simple as that.

Ultimately if there is anyone who should be held responsible for the public option debacle, it’s President Obama. He bought off on including it as part of his healthcare platform during the campaign. And in spite of his repeated claims this year that the public option is not a trojan horse for a single payer system, it defies belief that someone as politically astute and detail-oriented as Obama was not fully aware that this was indeed the intention of those who originally conceived of and promoted the idea.

Furthermore, throughout the debate this year the President and others in his Administration have repeatedly made confusing and contradictory statements about their level of support for the public option. On various occasions it was necessary in order to “keep insurers honest” and provide “choice and competition” in the market. But then it wasn’t “the entirety of reform”, and was obviously expendable in the end.

But the current proposal Reid is loudly trumpeting is horribly flawed as well.

It has all of the old flaws (minus the public option) in that the government, through the Secretary of Health, will decide who gets what treatment at what cost and will force rationing through an artificial scarcity on all people, particularly the elderly. And it still has such high premiums for young uninsured people that it will compete with student loans for the honor of being their number one headache.

But the compromise itself is flawed:

1. By breeching the historic dividing line between private and public plans now at 65, it opens the door for an expansion of Medicare to become just the single payer we are trying to stop.
2. How can you expand Medicare, potentially to tens of millions more people while cutting it by $500 billion?
3. The cuts in doctor and hospital reimbursement rates written into this bill will force hundreds of thousands of medical providers to refuse to treat Medicare patients. By applying these low reimbursements to patients 55-64, now, you are driving doctors out of the profession and discouraging others from entering it. A permanent scarcity of doctors will be the inevitable result.
4. The expansion of Medicaid to 150% of the poverty level imposes huge new financial burdens on states. It will cost Texas $3 billion, Pennsylvania $2 billion, California $2 billion, and Florida $1.3 billion. It will cost Arkansas and Louisiana $500 million each. This is net of federal aid and only counts the 10% share of expanded Medicaid costs the states must pay.

The federal purchasing program that solicits bids from insurance companies and offers the policies to members of Congress actually functions quite well. It does tend to widen coverage and hold down costs and, at least in its current form, does not pretend to be an insurance company, just a kind of broker.

If the program is unchanged in the new law, its work could be valuable in helping consumers choose adequate and affordable insurance. But who knows whether Reid will try to ramp it up to be a government run and owned insurer?

The strategic message from all of this is that we have them on the run! We have forced Obama to retreat from a very dangerous excursion into socialism. Our pressure is working and we must keep it up.

[This article was co-authored with Eileen McGann]

I also singled out Julie Rovner from NPR as an example of a media health policy expert who has failed to fully (and fairly) report on the public option. Including the fact that many of its original (and current) proponents believe it could ultimately lead to a single payer system. Instead, Rovner has been a consistent voice of support for the Administration’s assertion that this is only a “myth”. I asked Rovner to comment on this prior to publishing part I. Here is the relevant excerpt from her response (emphasis mine):

I think what’s been missed in much of the debate is that the public option construct envisioned by the Democratic candidates during the primaries is fundamentally DIFFERENT from the one that’s on the table now…

Edwards’ plan would have opened his “exchanges” to basically any business that wanted to join, hence giving the public plan very wide availability. That’s what led him to say that over time, if it proved popular enough, the public plan could have morphed into a single-payer system.

But that is NOT the case with the current plans now under consideration. They all have very strict “firewalls” that limit availability to the new marketplaces that will include a public option (or not) to those in the individual market and small businesses (the size varies by each bill). That’s why the CBO estimates that only a few million people would end up in the public plan. And that’s been my (and most other reporters’) justification for reporting that these plans wouldn’t represent a government takeover of the health care system. In their current form, they couldn’t, at least not without a change in the law to open them up to the larger population.

What Rovner says is basically true: the public option outlined by Edwards was different in design than what is being considered in Congress now. But so was the public option outlined by the President during the campaign. In the run-up to the election, Obama repeatedly said of his health plan not only that “if you like the plan you have you can keep it”, but also that “if you don’t like the plan you have” he was going to provide a set of options, including a public plan. In other words, Obama also envisioned an insurance exchange open to everyone.

The so-called “firewall” that Rovner refers to was only crafted in the Spring after early estimates showed that in excess of 100 million people would transition into the public plan within the first 10 years. In other words, it was a little too obvious that the public option would quickly lead to a single payer system. So this relatively simple design change was made.

But guess what? There are many Democrats in Congress – and even some Republicans – who are pushing to expand the initial eligibility for the exchanges. Even if they are unsuccessful, under the House bill expanding the exchanges is under the discretion of the Secretary of Health. This means that no further change to the law would even be necessary, contrary to what was asserted by Rovner in her statement above. The “firewall” was put up overnight and it can be torn down just as quickly. And there will be a lot of public and congressional pressure to do so.

So Rovner’s statement is completely reasonable – but only as an excuse for her selective coverage on this issue. But the job of the media is not to provide selective coverage, especially when from all appearances it’s being done in support of a partisan agenda.

The fact that the public option became the center of the health care debate all but obligated the media to provide a fuller history of it’s inception, and to cover the full range of possible policy ramifications. Especially in light of the fact that so many people – both opponents AND proponents of reform – have claimed that the public option could ultimately lead to a single payer system.

And I’m not just referring to John Edwards, but a whole host of proponents of reform, as outlined in an earlier article on this topic at BigGoverment.com. Notably Rep. Jan Schakowsky (D-IL), Rep. Barney Frank (D-MA), Sen. Russ Feingold (D-WI), Paul Krugman from the NY Times, and Ezra Klein from the Washington Post. The corroborating statements from any one of these individuals were newsworthy enough to warrant coverage by Rovner and others in the media. Is there any doubt that if a Republican President had been implicated in misleading the public over major legislation that this would have been major, tier one news? (It probably would have been treated like Watergate.)

So I don’t accept Rovner’s rationalization of this, for her or anyone else in the media. And let’s not forget that NPR is publicly-funded, which only increases Rovner’s obligation to provide fair and non-partisan coverage.

Unfortunately, it’s the American people that stand to pay the price for the media’s failure to provide comprehensive coverage of the public option. Is there any doubt that if the broader media had highlighted the ulterior motives behind the public option that it would have been killed off in Congress long ago? As it is, it’s only barely survived to this point. And yet even now, the Democratic leadership is doing everything they can to cram it into the final bill.

While I am wholeheartedly opposed to the public option, and believe it will ultimately create a crushing burden of debt, this is not even the biggest travesty of the whole affair. The media has failed America not because health reform legislation is on the verge of passing, but because the wrong reform is on the verge of passing. By employing a disingenuous strategy to force through the public option, the Administration and Democratic leadership have missed a real opportunity to implement much-needed insurance reforms on a truly bi-partisan basis. Reforms which would have had a much better chance of actually lowering the growth rate in healthcare spending, as opposed to the Democrats’ legislation which is primarily focused on expanding coverage.

One such example is the long-term decoupling of health insurance from employment. An idea which had significant bi-partisan support under Sen. Ron Wyden’s (D-OR) proposed bill, and which could have dramatically altered the market dynamics causing healthcare costs to skyrocket. This was also a key component of Senator McCain’s plan during the election, so there is no question there would have been significant Republican support for this idea.

But this idea was never even seriously considered, primarily because of the President’s simplistic campaign promise that “if you like what you have you can keep it”. Which we now know was really just a cover for the hidden agenda of the public option. Fair and balanced reporting on this would have quickly cut through this spin, and America would have been better off for it.

And what happened to the idea of promoting greater portability of insurance? Those “firewalls” that Rovner referred to will result in utter chaos when it comes to changing employers. Sure, the uninsured, unemployed and those working for very small businesses will enjoy the convenience of having continuous insurance through the exchanges. But anyone else who changes jobs regularly, especially the 50+ million temporary workers in America, will be required to bounce from within and out of the exchanges frequently based on their employment status. And remember that these firewalls were only necessary to limit the initial growth projections in the public option. (And also to limit the government subsidies paid to participants in the exchanges.)

A system of health insurance exchanges (or one national exchange) open to everyone, without a public option, would have had bipartisan support, and would have solved once and for all the portability issue. Combined with some or all of Senator Wyden’s ideas, it also could have dramatically lowered healthcare costs in the long run. But by continuing to promote the public option, the Administration drove a wedge right through the possibility of bi-partisan reform. While some of the media has stood on the sidelines and watched, many of its most prominent personalities have marched in lockstep behind the Administration’s flawed agenda.

Without a doubt the media has failed in their basic responsibility to inform the American public on this issue (with some notable exceptions). And considering the amount of media time and access the Administration has been granted, there is just no excuse for this. Of course the blame extends far beyond just NPR and Julie Rovner. Rovner is an extremely thorough and well-intentioned reporter, and there is no one else in the media more knowledgeable on health policy issues. But perhaps it’s time for Rovner and others in the “non-partisan” media to reflect more closely on their reporting, and to ask themselves whether they have let their desire for this Administration to succeed influence their coverage on this and other issues. Most of them would still passionately defend their record, no doubt. And this is their right.

But whether they recognize it or not, most of America has long since judged their coverage to be biased and unfair. This judgement will only become more pronounced in the years ahead as the hidden consequences and unexplained trade-offs of healthcare reform become increasingly evident. Unfortunately by then it may be too late for them to rescue their credibility. Perhaps it already is.