health care

It was hard not to chuckle when I learned that blooper-prone Vice President Joe Biden, thinking he was out of earshot of the cameras when President Obama signed the heath-care legislation today, told the prez: "This is a big f--king deal!"

But crying is more in order if you listen to what Obama said at the bill-signing in remarks about what's next. Why? Because it ain't climate legislation. Here's what our surpreme commander had to say about how he's going to use the health-care win to push Congress on other fronts (italics are mine):

  "We all know our journey is far from over.  There’s still the work to do to rebuild this economy.  There’s still work to do to spur on hiring.  There’s work to do to improve our schools and make sure every child has a decent education.  There’s still work to do to reduce our dependence on foreign oil.  There’s more work to do to provide greater economic security to a middle class that has been struggling for a decade."

Notice the emphasis not on what would surely be a hard fight to pass climate legislation, but rather on something (almost) everyone can agree on: Escaping this precipice where countries that hate America control something so vital to our well-being.

No, Obama doesn't risk offending anyone with that sentiment.

Here's how the situation was sized up in a note to clients and other contacts by Capitol Hill veteran Frank Maisano of the lobbying firm Bracewell & Giuliani (yes, that Giuliani!), whose clients include a number in the energy business:

A rowdy team of six Oregon doctors set off on a cross-country road trip, reaching their first destination today, as they campaign for support of a single-payer health care plan, writes Bill Graves of the Oregonian. Their slogan? "I'm mad as hell, and I'm not going to take it anymore."

The procession of physicians is cruising east in a used motor-home to Washington, D.C., stopping in 27 cities along the way and blogging daily about their journey. They hope to gather support for a single-payer model, and possibly bring the idea back to the congressional drawing board. The doctors believe a single-payer health care plan has been shot down because of politicians' close ties with drug and insurance companies, who often contribute to their campaigns.

Dr. Paul Gorman, one of the touring doctors, believes that insurance companies are responsible for low life expectancies and high infant mortality rates despite quality hospital equipment and well-trained doctors, wrote William McCall, Associated Press writer. Said Gorman:

We're getting Third World results and third-rate health care because of an insurance system that prevents those nurses, prevents those doctors, and prevents those hospitals from giving the care they can.

Despite entering somewhat late in the healthcare debate, the group has received heavy publicity in recent weeks.

I will be covering the Obamacare speech tonight, in partnership with public radio's Capitol News Connection. CNC provides localized Washington, D.C. coverage to public radio stations and is, like InvestigateWest, a founding member of the national Investigative News Network. Anne-Marie Taylor of InvestigateWest will be there as a working photojournalist, to bring you literally an insider view of what's happening.

Since we focus on the environment, health and social justice, it's a natural for us to cover the speech. And given the tight realities of modern newsrooms, it's important that InvestigateWest also helps our partners cover these important issues.

So email, comment or tweet me your questions about the speech, so I can get you some answers. You can also go to AskYourLawmaker.org, CNC's site for crowdsourcing questions.

So Obamacare, what do you want to know?

The following is by InvestigateWest advisory board member Mark Trahant:

Sen. Edward M. Kennedy jumped into American Indian issues with zeal after his brother, Bobby, was assassinated. Sen. Robert F. Kennedy had used the Indian Education Subcommittee as his platform during his extensive travels across Indian Country with the anti-poverty tour.

A young Ted Kennedy wrote in Look Magazine that RFK “saw, as I have seen, the resilience of the Indian way of life, a way of life that has for many generations resisted destruction despite government blunders that almost seem designed to stamp it out.”

In October 1969 Kennedy attended the National Congress of American Indians meeting in Albuquerque and called for the establishment of Select Committee on Human Needs of the American Indians in the U.S. Senate. The young senator blasted away at the Nixon administration. “We need no more presidential task forces. We need no more buck passing; we know where the blame lies,” the Albuquerque Journal quoted him telling the delegates. “We need no more empty promises; we know they are empty.”

A few months later Kennedy joined Bobby’s widow, Ethel, at an NCAI banquet. He promised to champion the native cause and to turn to American Indians because self-determination is the best solution.

But in the Senate there were competing ideas about how to make self-determination the policy of the land. One specific challenge was the Indian Health Care Improvement Act.

“The more serious threat (to the bill) came from Senator Edward Kennedy, a Massachusetts Democrat, or more accurately, from Senator Kennedy’s staff. As chair of the Health Subcommittee, Kennedy asked to share jurisdiction over the Indian health legislation,” wrote Dr. Abe Bergman and his co-authors in “A Political History of the Indian Health Service.”

Had the bill gone to Kennedy’s subcommittee there likely would have been little or no Republican support.

The L.A. Times is among those reporting that the Obama administration may be shying away from government-run health insurance plans and opting for a new model: insurance co-ops. The Washington Post also took on the story today in an interesting piece that looks at two U.S. organizations as potential blueprints for Congress, including one in the Northwest.

Group Health Cooperative, a Seattle-based member-owned nonprofit, has been providing coverage to more than half a million residents in Washington and Idaho since 1947. It has been touted as a potential model because of its success as a fused insurer and provider, networking with local clinicians as well as employing their own doctors and medical facilities. Here's how Group Health spokeswoman Katie McCarthy touts the group:

Group Health is able to focus on prevention and care because doctors are paid with a salary and aren't focused on getting fees for services.

Co-ops have some obstacles to conquer, including lacking some of the cost-saving reinmbursement rates of government-run plans, and facing heavy opposition from private insurers. But their lure remains the same: nonprofit health-care co-ops would provide freedom from shareholder pressures and an avenue for marketplace competition.

Rep. Earl Pomeroy, D-N.D., a former state insurance commissioner is a backer of the concept:

A cooperative could provide an alternative source of insurance and some interesting competition for premium dollars. A co-op could operate at lower costs, in part because it would not need to pay its executives so generously.

Spokane Public Radio's Amanda Loder has an interesting story about a clinic on an Indian reservation that stays afloat by treating non-natives. The Benewah Medical Center on the Coeur D'Alene tribe's reservation in Plummer, Idaho, started as a condemned building where a doctor showed up once a week. Now, with income from non-native patients and revenues from the tribe's casino, it's been built into a multi-building complex.

The recession is driving more people than ever to seek state assistance with health care in Colorado, reports Tim Hoover in the Denver Post. The state saw a 14 percent spike in Medicaid enrollment in the budget year that ended in June, a "record-setting rate that capped a year with the largest-ever number of people in the health insurance program." In June alone, there were 80,000 more Coloradans on Medicaid than the previous month. Nearly 10 percent of the state's residents are now enrolled in Medicaid, which covers low-income pregnant women, children, the elderly and disabled.

State officials say they are seeing a pattern of unemployed people laid off from good jobs who have never sought state assistance before being driven to seek assistance from Medicaid and other programs in order to get health insurance for themselves or their children.

A group of doctors in Bend, Ore., known at the Physician Alliance is promising better health care through more cooperative relationships with each other and with local hospitals, Markian Hawryluk reports in the Bend Bulletin. Against a backdrop of historic divisiveness in the health-care community, the Alliance announced the new effort in concert with Cascade Healthcare Community, the parent company of St. Charles hospitals. The parties "have committed to working together to create an integrated health care delivery system that would enhance care, reduce costs and improve the health of the community," Hawylruk reports. The parties pledge "trust, mutual respect, accountability and loyalty to the group as a whole."