Political activity slows down during the summer, especially in an off-year, but there’s still plenty for progressives to do. Event details are after the jump. Please post a comment or send me an e-mail if you know of other events I’ve left out.

If you live near southeast Iowa, please consider volunteering for Curt Hanson, Democratic candidate for the September 1 special election in Iowa House district 90. UPDATE: Senator Tom Harkin is headlining a fundraiser for Hanson on Saturday, Augsut 1. Details below.

The Iowa Department of Natural Resources is looking for volunteers during the Iowa State Fair (August 13-23):

The Iowa DNR River Programs will be at the Iowa State Fair this year and requests your help to staff our booth at the DNR building. We will have a River Programs staff person there the whole time, but our space is much larger this year. Because of the large number of visitors who pass through the building, any help we can get is greatly appreciated. We are asking for a 5 hour shift from each volunteer. You may sign up for more than one shift if you’d like. The morning shift will be from 9:00 to 2:00 and the afternoon shift will be from 2:00 to 7:00.  What you get: A River Programs Volunteer Cap and a ticket to the fair the day you volunteer, and the satisfaction of knowing you made a difference.

Please respond by email or phone with your desired shift(s) and availability Thursday, August 13th through Sunday August 23rd to John Wenck, IDNR River programs outreach coordinator, John.Wenck@dnr.iowa.gov, 515-281-8969 or 515-491-9881.

The offices of Congressmen Bruce Braley (IA-01), Dave Loebsack (IA-02) and Leonard Boswell (IA-03) announced big news on Friday afternoon:

Boswell, Loebsack, and Braley helped negotiate a compromise adding language to the healthcare reform bill changing Medicare to a quality-based payment system in two years.  Specifically, the compromise would (1) require Medicare to conduct a two-year study on a value-based system, and (2) at the end of the two year study period, Medicare would switch to a quality-based system unless Congress specifically cast a vote to disallow that change. […]

Medicare currently operates under a fee-for-service system, basing payments to doctors and hospitals on the amount of procedures completed and the number of patients seen.  This system creates a financial incentive to order more and more procedures.  Ironically, according to many studies, this increased number of procedures does not result in better outcomes for patients.

Boswell, Loebsack, and Braley have strongly advocated a switch to a Medicare payment system based on value and quality, which determines payments based on procedures’ effect on patient health.  In June, Rep. Braley introduced the Medicare Payment Improvement Act with Rep. Ron Kind (D-WI).  Reps. Boswell and Loebsack are co-sponsors of the legislation.  The bill would have required Medicare to switch to a quality-based payment system, outlining specific details on how to measure quality and value.

If Congress adopts a health care bill containing this provision, it will be very good news for Iowa health care providers, who are reimbursed by Medicare at much lower rates than in some other parts of the country. I’ve posted the whole press release from Braley’s, Loebsack’s and Boswell’s offices after the jump.

On a related note, Iowans who support a strong public health insurance option should contact Boswell’s office. There is some confusion surrounding his position on this issue. He expressed support for a public option in June. In early July he signed a good letter from a group of Blue Dogs and New Democrats advocating for a public option. However, when confronted on camera this week, Boswell said he wasn’t against a public option and wants to see the final version of the health care bill before making a decision.

A public option could provide coverage and competition in the majority of U.S. markets that are currently dominated by one or two private health insurance providers. It also could save hundreds of billions of dollars. Supporters of the public option can Stand With Dr. Dean here. Please also consider signing up with Health Care for America Now. Senators Richard Durbin, Patrick Leahy and Chuck Schumer set up this online petition supporting a public option as well.

In other health care reform news, Senator Tom Harkin is rightly frustrated that the Congressional Budget Office scoring of the Senate Health, Education, Labor and Pensions Committee bill didn’t include any cost savings from the prevention measures Harkin fought to have included. He’s concerned that the language on prevention might not survive Senate negotiations:

“We got a lot of savings out of it. But they just don’t score it that way. And I’ve got to fight like the dickens to make sure we keep it in there,” he added. “Otherwise, people will say, ‘We’ve got some costs here. But we don’t have any savings, and since we have costs, not savings, we’ll throw that overboard.’ “

Thanks for fighting the good fight, Senator Harkin. Private sector companies that have focused on prevention have reduced costs for treating some chronic conditions.

UPDATE: Boswell’s official website explains his position on health care. He seems focused on whether the public option will be “self-sustaining and deficit neutral,” as opposed to whether it will provide competition or coverage to his constituents who are badly served by the status quo.

Funny, I don’t ever remember Boswell insisting that other government spending (like agriculture subsidies) need to be self-sustaining or deficit neutral. If universal health care isn’t worth spending public money on, what is?

You can share anything that’s on your mind in this thread. I’ll update later with links on President Barack Obama’s press conference.

MyDD’s Jonathan Singer and Chris Cillizza of the Washington Post are liveblogging the press conference. Most of the questions are about health care reform.

Iowa Citizens for Community Improvement is holding its annual convention this Saturday, July 18, at the Hotel Fort Des Moines:

Iowa CCI’s statewide annual convention will feature workshops and plenary sessions on factory farming, campaign finance reform, immigration reform, and predatory lending. The convention will conclude with an exciting direct action targeting an undisclosed payday lender in a low-income community in  Des Moines.

More details on that and other events coming up soon are after the jump.

As always, please post a comment or send me an e-mail (desmoinesdem AT yahoo.com) if you know of another event I’ve left out.

To Bleeding Heartland readers who plan to do RAGBRAI next week: consider posting a diary about your experience or any candidates you encounter during the ride. I saw this at Bob Krause’s campaign site:

Eric Rysdam of  Fairfield, Iowa has agreed to ride across the state in  RAGBRAI, The Register’s Annual Great Bicycle Ride Across Iowa with a big Krause banner and shirt. Eric will be the core of an amorphous group participating and getting the word out about for us! Please wish Eric well with his training in anticipation of the July 19-25 event! Eric’s number is 319-293-6306 if you want to wish him well, or if you want to be on the ride with him.

Health Care for America Now, in conjunction with the Iowa Citizen Action Network, is running an online ad that links to a “job application” citizens can fill out to request a position with Senator Chuck Grassley’s office.

You may recall that Grassley told a constituent at a recent town-hall meeting to “go work for the federal government” if he wanted the same health insurance plan the senator enjoys:

Excerpt from an ICAN press release, which I have posted in full after the jump:

Senator Grassley, whose health care bills are picked up by taxpayers, pays $356.59 a month for health insurance.  The most he pays when visiting a doctor or hospital is $300. His “Let Them Eat Cake” attitude ignores the plight of working families, farmers, and small business owners in Iowa who don’t have adequate, affordable health care and are going broke trying to keep up with insurance premiums and medical costs.

“Polls show that the majority of Iowans, like the majority of people in America, want health care reform that achieves quality, affordable health care for all,” said Betty Ahrens, Executive Director, Iowa Citizen Action Network. “Senator Grassley keeps blocking progress in the Senate Finance Committee. He talks about bipartisanship but is showing no intention of compromise, and after his comments in Waukon, we know just how out of touch Senator Grassley is with the real struggles of his constituents in Iowa. Everyone here should see this video, and we will do what we can to make sure Senator Grassley knows his “Get a Job Like Mine” solution to the health care crisis is unacceptable.”

Excerpt from the “job application”:

I work hard, and I pay my taxes, but I cannot keep up with health care costs that are rising four times faster than wages if I can even get health care at all, what with all the denials of needed care that my insurance company throws in my way. Meanwhile, Members of Congress get health care that’s affordable, and nobody is going to deny care to an elected official!

Senator Grassley has so graciously offered to provide me health care as good as he has if I work for the federal government, and so I am applying for a position in Senator Grassley’s office in the hope he will make good on that promise. If he cannot, the only hope I have to obtain quality, affordable health care for me and my family is if Senator Grassley drops his opposition and supports real health care reform – reform that gives me a choice of public or private insurance, make care affordable, and delivers good benefits.

Volunteers will deliver the “job applications” to Grassley’s office next week. Although he’s not going to change his mind about a public health insurance option, we can show how out of touch he is with Iowans.

Fortunately, a group of Senate Democrats are strongly committed to the public option, dimming prospects for a bipartisan compromise on health care that would please Grassley.

Such as the revolving door between Congress and corporate lobbyists:

The nation’s largest insurers, hospitals and medical groups have hired more than 350 former government staff members and retired members of Congress in hopes of influencing their old bosses and colleagues, according to an analysis of lobbying disclosures and other records. […]

Nearly half of the insiders previously worked for the key committees and lawmakers, including  Sens. Max Baucus (D-Mont.) and  Charles E. Grassley (R-Iowa), debating whether to adopt a public insurance option opposed by major industry groups. At least 10 others have been members of Congress, such as former House majority leaders Richard K. Armey (R-Tex.) and Richard A. Gephardt (D-Mo.), both of whom represent a New Jersey pharmaceutical firm.

The hirings are part of a record-breaking influence campaign by the health-care industry, which is spending more than $1.4 million a day on lobbying in the current fight, according to disclosure records. And even in a city where lobbying is a part of life, the scale of the effort has drawn attention. For example, the Pharmaceutical Research and Manufacturers of America (PhRMA) doubled its spending to nearly $7 million in the first quarter of 2009, followed by Pfizer, with more than $6 million.

So corporate groups are spending $1.4 million a day on lobbying to block a real public health insurance option, which most Americans want.

That’s on top of the millions of dollars the same corporate groups have donated directly to Congressional campaigns. Iowa’s Senator Chuck Grassley has taken hundreds of thousands of dollars from the industries with the most at stake in health care reform.

Members of Congress claim lobbyists and campaign money don’t shape their opinions, but Grassley should know better. He understands that big money from pharmaceutical companies can influence the conclusions of medical researchers–why not elected officials?

Nate Silver has found strong evidence that special-interest money affects Democratic senators’ support for the public option in health care reform.

By the way, I wasn’t too cheered by Senator Chuck Schumer’s promise over the weekend that the health care bill will contain a public option. The current draft in the Senate Committee on Health, Education, Labor and Pensions excludes lots of people from choosing the public option over their current health insurance. That will limit competition for the private insurers that have near-monopolies in many markets.

Back in 2003 all the Democratic presidential candidates talked a good game on health care. Now Dick “this is a moral issue” Gephardt is lobbying for a pharmaceutical company. I’ll stand with Howard Dean and hope that John Edwards was wrong about the system being rigged because corporations have too much power in Washington.

Final note: Moveon.org is organizing health care rallies this Thursday, July 9, at senators’ offices in their home states. Sign up here to attend a rally near you.

Political activity slows down a bit during the summer, but there are still plenty of things to do if you’re not spending hours a day training for RAGBRAI. Read all about it after the jump. As always, post a comment or send me an e-mail (desmoinesdem AT yahoo.com) if you know of something I’ve left out.

If you live in the first Congressional district, consider attending one of Bruce Braley’s town-hall meetings on health care reform in Dubuque,  Oelwein, Davenport and Waterloo (click “there’s more” for details). According to a statement from his office,

Braley will discuss the draft House health care reform bill, listen to constituents’ concerns, and take questions.  Braley is a member of the House Energy and Commerce Committee, the committee in charge of authoring healthcare reform legislation.

Braley’s town hall meetings on healthcare reform are free and open to the public.

Attendees are strongly encouraged to RSVP at: http://braley.house.gov/townhall.

Speaking of health care reform, Moveon.org is looking for people to help deliver petitions this Thursday, July 9, to the Iowa offices of Senators Tom Harkin and Chuck Grassley. Click here to sign up.

UPDATE: I added information about Governor Chet Culver’s upcoming appearances in eastern Iowa to highlight I-JOBS and Rebuild Iowa projects.

Senator Chuck Grassley has been holding town-hall meetings around the state this week, and the Iowa Democratic Party highlighted a fun clip from his June 30 meeting in Waukon. A constituent wanted to know why his health insurance policy was so much more expensive than Grassley’s, despite having less generous coverage.

The senator advised the questioner to “go work for John Deere” if he wanted a better insurance policy. (Not too practical, since Deere has laid off workers in Dubuque, Ottumwa and the Quad Cities this year.) As Grassley tried to move on to the next question, the man continued to press for details about Grassley’s own coverage, and the senator advised him to go talk to the people at the Farm Services Administration about health insurance.

But the questioner followed up again: “How come I can’t have the same thing you have?”

To which Grassley replied, “You can. Go work for the federal government.”

Since there aren’t too many federal government jobs in the Waukon area, I have a better idea: why doesn’t Grassley support a real public health insurance option for all Americans?

UPDATE: Here was Grassley in Iowa City today:

Hoping that health care reform plans implode under weight of Democratic in-fighting is a bet he’s not willing to make.

“I’m not a gambler.” Grassley said. “If you go a partisan way, the Democrats have the capability of screwing up our health care system forever. If it is screwed up forever, we could get big majorities two or four years down the road, but we ain’t going to turn it around. So I’m a little more cautious than a lot of my Republican colleagues.”

The best bet for getting a bill to President Obama this year is the bipartisan work being done by the Senate Finance Committee where he is the ranking Republican, Grassley said. Whatever reform plan that comes out of the House will be highly-partisan just by the nature of the House, he predicted. Sen. Ted Kennedy’s Health, Education, Labor and Pensions Committee has rejected Republican input.

I’m supposed to believe that Grassley is worried about the public option because it would “screw up” health care so badly that Republicans couldn’t fix it even with large majorities?

First of all, Republicans aren’t going to win back the Senate majority in two or four years. It will be a longer climb.

Second, Republicans are fighting the public option because they’re afraid it would work too well, causing private insurers to lose market share to the more affordable public plan. (See here.) They are desperate to avoid that outcome because it would likely realign American politics in the Democrats’ favor for a long time. That’s what Republican messaging guru Frank Luntz is warning them against.

I sincerely hope that the House Progressive Caucus votes down a Grassley-friendly bipartisan health care bill (individual mandate to buy for-profit private insurance that doesn’t compete with any public plan). If President Obama wants to claim victory on this issue, he’ll have to get behind a bill that would be better than the status quo. Democrats would be fools to listen to Grassley on either the substance or the politics of health care reform.

Bob Krause, who is running for U.S. Senate next year against five-term incumbent Chuck Grassley, was in the news last week with some sensible comments about health care reform. He encouraged Grassley to demand higher reimbursement rates for Iowa health care providers in exchange for dropping his opposition to a public option in the Senate bill:

Iowa ranks 49th in Medicare reimbursement, Krause said. That makes it hard for the state to attract and retain health professionals, according to various state officials, including Grassley, who has long advocated for reforms in the reimbursement system.

“This has hurt the quality of medical care in Iowa as some doctors refuse Medicare patients because of the low reimbursement rate,” Krause said. “On the flip side, continuing with only private providers for health insurance coverage hurts Iowans because it locks in a monopoly.” More than 80 percent of the Iowa health insurance market in Iowa is controlled by just two companies.

A public option would provide competition for the private insurers, Krause said.

Krause is obviously right on both counts, but don’t expect Grassley to listen. He is the leading Republican voice against the public option and has an ally in Senate Finance Committee Chairman Max Baucus, a Democrat whose health care reform plan may be worse than the insurance industry’s.

Iowa Democrats have given Grassley a pass for too many years. I appreciate Krause’s commitment to running a real race against him. I encourage you to donate to his campaign and get to know him better by checking out his website. Blog for Iowa’s three-part interview with Krause is a good read as well. Here are the links:

part 1 (a bit of personal history, Iowa Democratic Veterans’ Caucus, plus views on gay rights and progressivism)

part 2 (about Krause’s campaign strategy and views on the environment and Judge Sonia Sotomayor)

part 3 (about health care reform, media reform and RAGBRAI)

This thread is for any comments about the 2010 Senate race in Iowa. How could Krause use his campaign funds most effectively? Which issues should he emphasize in making a case against Grassley?

Health and Human Services Secretary Kathleen Sebelius issued reports on Friday detailing the problems with the “health care status quo” across the country. You can find the reports at HealthReform.gov. The report for Iowa is here, and I’ve also posted it after the jump. Among other things, it shows the percent increase in family health insurance premiums since 2000 and the percentage of uninsured Iowans.

A couple of points jumped out at me:

• Choice of health insurance is limited in Iowa. Wellmark BC and BS alone constitutes 71 percent of the health insurance market share in Iowa, with the top two insurance providers accounting for 80 percent.11

Iowa is not unusual in this regard. Most insurance markets in the United States are dominated by one or two companies. My family’s Wellmark premiums went up 10 percent this year alone. Speaking of which, the annual salary of Wellmark’s CEO has “nearly doubled” in the past five years to about $2.5 million.

• Choice is even more limited for people with pre-existing conditions. In Iowa, premiums can vary, within limits, based on demographic factors and health status, and coverage can exclude pre-existing conditions or even be denied completely.

I know a family in Des Moines who were unable to purchase health insurance at any price because the mother has a thyroid condition. They are now covered through the father’s employer, but if he loses his job they will have no health insurance options.

Two more reasons why we cannot settle for health care reform without a public option, or with a fake public option. I was glad to see several House Democratic caucuses affirm that they will fight any health care bill lacking “a real and robust public option that lives up to our criteria”.

Click “there’s more” to read the whole report, with supporting footnotes.

I was not able to watch President Obama’s health care forum on ABC Wednesday evening. ABC News posted a summary here. I liked that Obama defended the public option and said Republican senators who criticized it are wrong.

If you watched the program, what did you think of the questions and the president’s answers?

Consider this an open thread for any comment about health care reform, or any other political issue that’s on your mind.

At some point I’ll write about whether health care activists were right to draw a line in the sand early over a public option, or whether ragbrai08 is right that it was a mistake not to organize more strongly for single-payer (HR 676). What do other Bleeding Heartland readers think?

Following up on yesterday’s post, I see that a brand-new New York Times/CBS nationwide poll shows widespread support for a real public health insurance option. The wording of the question was clear: “Would you favor or oppose the government’s offering everyone a government administered health insurance plan like Medicare that would compete with private insurance plans?”

Results: 72 percent of respondents favored the public option, including 87 percent of Democrats, 73 percent of independents, and 50 percent of Republicans.

Senator Chuck Grassley works overtime to snuff out a public option, urging President Obama to support a bipartisan bill in the Senate. But in the real world, a strong public option has bipartisan support. Even half of Republicans favor making a “government administered health insurance plan like Medicare” available to all Americans.

A public option would increase competition and give Americans more choices while driving down costs. A recent report found that one or two companies dominate the health insurance market in most parts of the country.

Obama will speak to ABC News about health care on Wednesday. I’ll be listening carefully to see whether he endorses a strong public option, which the House Democrats’ draft bill contains, or whether he remains open to a fake public option such as regional cooperatives or a “trigger”.

UPDATE: To be clear, the CBS/NYT poll is not an outlier. An NBC/Wall Street Journal poll released last week found, “Three in four people said a public [health insurance] plan is extremely or quite important.” A poll “bankrolled partly by previous opponents of health care reform” showed that “a majority (53%) strongly back the availability of a public plan, while another 30% ‘somewhat’ support it.”

Health Care for America Now launched television commercials in 10 key states today. Here is the Iowa version (click here to view the others):

It’s a good ad. As Jason Rosenbaum writes,

This is the vision of a public health insurance option. Contrary to Republican talking points, nothing in the proposed plans for a public health insurance option would take away your choices and your relationship with your doctor. Nothing.

If you donate at least $10 to keep this ad on the air, Health Care for America Now will send you  a “high-quality, union-made t-shirt” (view the shirt here).

I’m also looking forward to seeing the commercials Blue America has in the works, which you can support by donating here.

Even if you can’t afford to make a donation, you can express your support for the public option by signing the petition at StandWithDrDean.com and sending an e-mail to your senators.

It wouldn’t hurt to contact your House representatives to let them know we need a public option. If the final bill out of the Senate ends up looking like the latest draft circulating in the Senate Finance Committee, we’re going to need House Democrats to vote this sham reform down.

UPDATE: According to slinkerwink at Daily Kos, the House Democrats’ draft health care bill does contain a public option. Thanks to members of the Progressive Caucus, including Iowa’s Dave Loebsack, for making this happen.

The White House and key Democratic senators, including Iowa’s Tom Harkin, appear to be walking into a trap for the sake of bipartisan agreement on health care in the Senate.

There is growing support for a fake “public option,” as opposed to a government health insurance plan that would compete directly with private insurance companies.

If Congress passes this kind of deal and President Barack Obama signs it, we will get a enormously expensive non-solution to an enormous problem, and Democrats will pay the political price.

After the jump I’ll explain why political hacks as well as policy wonks should refuse the latest efforts to derail the public option.  

Iowa State Senator Jack Hatch was in Washington yesterday to chair the first meeting of a working group on health care. According to a White House press release,

State Legislators for Health Reform includes leaders from across the country who will educate their communities on the need for health reform this year.  The legislators will host public events, author opinion pieces in local publications, and use their established networks to organize constituents in support of health reform.

The Iowa Senate Democrats issued a statement from Hatch, who said the state legislators told Health and Human Services Secretary Kathleen Sebelius that “state-level health care reforms can only go so far.” He added that Sebelius

“stressed the need to expand choices in the health insurance market is essential.  Increased competition will lower costs and improve patient care.

“That’s why we all agreed that Americans must have a public health insurance option and now is the time to speak up.”

A public option that makes health insurance more accessible and affordable for adults is also likely to improve the health of children. Kevin Concannon of the Iowa Department of Human Services explained why in his contribution to the Reforming States Group’s May 2009 Healthy States/Healthy Nation report:

Ultimately, to achieve better health care access and better health status for children, the United States needs to cover parents as an essential, linked strategy for children. If parents have health insurance, they will better utilize the health care systems available to their children.

If you believe that real health care reform requires a public option for health insurance, you have two new and easy ways to do something about it. Neither will take more than a minute or two of your time.

Details are after the jump.

Congressman Leonard Boswell still supports a health care reform bill containing a public option that would go into effect immediately, Boswell’s spokesman Mark Daley confirmed today via e-mail.

Background and details are after the jump.

Senator Chuck Grassley didn’t take kindly to President Barack Obama’s weekly radio address about the need to accomplish health care reform this year. Early this morning, Grassley wrote on his Twitter feed,

Pres Obama you got nerve while u sightseeing in Paris to tell us”time to deliver” on health care. We still on skedul/even workinWKEND.

A little later, the senator Tweeted,

Pres Obama while u sightseeing in Paris u said ‘time to delivr on healthcare’ When you are a “hammer” u think evrything is NAIL I’m no NAIL

First of all, Obama recorded the weekly address before leaving for France. Second, it’s bizarre for Grassley to mock Obama’s “sightseeing in Paris,” as if that were the main purpose of his foreign visit. You can be sure that if Obama had not gone to France to commemorate the D-Day invasion, Republicans would be howling in protest.

Perhaps Grassley is venting because this week the president strongly affirmed his support for a public option in health care reform. Grassley has been working to forge a bipartisan consensus with no public option and published an op-ed in the Iowa City Press-Citizen on Friday warning against that approach. (Chase Martyn’s take on Grassley’s piece is worth reading.)

Or maybe Grassley’s just a little touchy lately. He wrote a letter to the editor of the Des Moines Register correcting a mistake from the Register’s vox-pop feature, “My 2-cents’ worth”:

In the Register’s Your 2 Cents’ Worth feature May 4, “Disgusted 50010 Woman” said I pay $40 a month for health insurance. In fact, I pay $356 a month for Blue Cross insurance coverage, a plan that is available to federal employees. This differs from health plans for state government employees in Iowa, where no portion of the premium is paid by the employee. There’s no basis for the assertion in her comments.

Fair enough, senator. But you have to admit, you’ve got a pretty good deal going. A couple half your age who purchase their own Blue Cross insurance plan could easily pay two or three times as much in premiums for comprehensive coverage. Even a bare-bones policy covering primarily catastrophic care could cost individuals more than $356 a month, and they’d have to pay out of pocket for most routine medical expenses and prescription drugs.

Natasha Chart recently looked into her health insurance options as a single 34-year-old woman. If she can afford it, she’ll pay $200 to $300 a month for less coverage than what members of Congress receive. I encourage Senator Grassley to read her post.

UPDATE: Greg Sargent received clarification from Grassley’s office about what the senator meant to convey in the hammer/NAIL tweet:

Senator Grassley has been urging the President to let the legislative process work so that health care reform legislation restructuring 17 percent of America’s economy will reflect broad consensus and garner bipartisan support from as many as 80 senators.

Still pushing the pipe dream of a large bipartisan majority for health care reform.

I got so busy this month that the event calendars fell by the wayside. After the jump I’ve posted details about lots of things going on this week and next.

As always, please post a comment or send an e-mail (desmoinesdem AT yahoo.com) if you know of something I’ve left out.

House Republican leader John Boehner was on CNN Sunday morning:

“We’ve got the greatest health care delivery system in the world,” he added. “Why do we want to jeopardize that with a big government run health care system?”

Because our health care delivery system directs about 31 percent of total health spending to administrative costs.

Because our health care delivery system makes Americans more likely to go without certain medical procedures despite astronomical per capita spending on health care.

Because our health care delivery system leads to overuse of emergency rooms by insured as well as uninsured Americans.

Because our health care delivery system leaves uninsured trauma patients 50 percent more likely to die than trauma patients covered by insurance.

Because our health care delivery system causes uninsured people to be denied organ transplants on the grounds that they will lack the capacity to pay for anti-rejection medications.

Because our health care delivery system prompts insured as well as uninsured Americans to delay medical treatment for chronic illnesses.

Because our health care delivery system makes uninsured people much more likely than insured people to be diagnosed with “advanced cancers […] that could have been detected early through proper screening.”

Because our health care delivery system puts paperwork from insurance companies rather than a doctor’s recommendation in charge of the timetable for cancer surgery.

Because our health care delivery system can force cancer patients to forgo radiation or chemotherapy if they lose their insurance.

Because our health care delivery system can leave insured as well as uninsured people with crushing debts after completing cancer treatment or care for a medical emergency.

Feel free to add your own answers in the comments.

UPDATE: MyDD user Trey Rentz adds that medical bills are the leading cause of bankruptcy in the U.S.

I’m shocked, shocked to read that

Hospitals and insurance companies said Thursday that President Obama had substantially overstated their promise earlier this week to reduce the growth of health spending.

Mr. Obama invited health industry leaders to the White House on Monday to trumpet their cost-control commitments. But three days later, confusion swirled in Washington as the companies’ trade associations raced to tamp down angst among members around the country.

Jason Rosenbaum has more on the story at Health Care for America Now.

Looks like the White House was a bit too eager to herald a breakthrough with various interest groups that want to block serious health care reform.

I think David Sirota was on to something when he wrote on Monday,

Isn’t President Obama legitimizing voices that will use that added credibility later on to try to derail serious health care reform? Today’s press conference has the President of the United States effectively saying that the health insurance industry should have a major seat at the health-reform table – and that it should be trusted. But any serious health care reform will need to take on the health insurance industry in a way that will make that industry unhappy. When that eventually happens, won’t the previous efforts to legitimize the health insurance industry’s voice add credibility to its opposition to reform? […]

Obama’s political calculus throughout his life has been to avoid making enemies. He seems to believe that he can make lots of different interests happy – and on many issues, that’s certainly possible. But on some issues, like health care, it’s a binary fight: Either you appease the health industry and preserve the status quo they are making big bucks off of, or you take on the health industry and make real change. Touting the industry’s “voluntary” commitment to not rip off consumers seems more in the appeasing camp than in the “real change” camp.

Obama won’t be able to get the health care reform we need without making enemies among those who profit from the current system. When push comes to shove, he may need a dose of FDR’s “I Welcome Their Hatred” tonic.

Senator Chuck Grassley laid out his case against a “government-run” health care plan on the Senate floor yesterday. He used some of the same arguments he’s been making in conference calls with reporters and in his guest editorial at Politico.

I don’t know whether Grassley and the insurance lobby will be able to scare Senate Finance Committee Chairman Max Baucus away from supporting a public health insurance option.

However, after reading the highlights from recent opinion research that Richard Kirsch summarized at the Health Care for America Now blog, I am confident that the American public will not buy rehashed Republican talking points from 1993. For more on this point, follow me after the jump.

Iowa Independent posted a piece by Congressional correspondent Mike Lillis today: “Grassley leaves door open for government health care plan.” Lillis was on Grassley’s conference call with reporters today and heard the senator say this about a public health insurance option:

I think right now there’s a lot of people, including me – I’d prefer it not to be in [the bill]. Then there’s a lot of people that say, well, it’s got to be in or [there’ll be] no bill. And then there’s a dozen ways to look at possible compromises. And I think before I would write [it] off completely, I would want to look at what those possible compromises are.

I do not interpret this comment as a sign that Grassley is open to a government health plan. It sounds to me like he is working with Senate Finance Committee Chairman Max Baucus on a compromise that might be called a “public plan” but would not force private insurers to compete against a government plan like Medicare for All.

As Bleeding Heartland user ragbrai08 has noted, lots of things that could be characterized as a “public option” fall short of what we need.

Perhaps Americans would be allowed to buy into the health insurance program for federal employees, which is provided by various private insurance companies.

Lillis noted that during today’s conference call, Grassley suggested the federal government is not competent to “run a government-run health insurance plan in competition with the private sector […].” I read this to mean that Grassley is still working overtime to keep a public health insurance option out of the Senate’s health care legislation.

Here’s hoping Senate Democrats who understand the need for a public option are able to prevail with Baucus.

The White House is making a huge deal out of a commitment to introduce cost-saving measures from “the presidents of Pharma, Advamed (device manufacturers), the American Medical Association (doctors), the American Hospital Association, America’s Health Insurance Plans, and SEIU’s Health Care project.”

The White House arranged an urgent Sunday-afternoon conference call with reporters to break the news, and President Obama went on tv on Monday to talk about it. (Click here for the transcript of Obama’s televised remarks.)

Unlike the 1970s, when stakeholders’ promises to hold down costs derailed legislative action on health care, Obama made clear today that the current agreement on savings is “complementary to and is going to be completely compatible with a strong, aggressive effort to move health care reform through here in Washington [….]”

It’s too early to know how significant today’s announcement will be, so I’m laying out the cases for optimism and pessimism after the jump.

Congress is getting to work on the details of health care reform, and a major battleground will be whether to include a strong public health insurance option for all Americans.

Republicans like Senator Chuck Grassley are revving up their scare tactics about “government-run” health care. Coalitions of Democrats who back a public option are also taking shape in the House and the Senate.

The new Populist Caucus led by Congressman Bruce Braley (IA-01) has yet to weigh in on the specifics of health care reform. That needs to change soon if Braley is serious about turning this caucus into a voice for the middle class in the House.

More thoughts on this subject are after the jump.

As the ranking Republican on the Senate Finance Committee, Senator Chuck Grassley will influence the shape of health care reform. For that reason, he and Senate Finance Committee Chairman Max Baucus of Montana were invited to lunch at the White House on Wednesday with President Barack Obama and Vice President Joe Biden.

Grassley’s message to the president and vice president, as well as to every journalist who’ll listen, is that health care reform should be done through a bipartisan bill that can receive 70 or 80 votes in the Senate. (See also Grassley’s recent guest editorial at Politico.)

Many Democrats want to include a health care bill in the budget reconciliation process, which would prevent a Republican filibuster. Grassley warns that it would be a mistake to reform such a large part of the U.S. economy without broad support from members of Congress in both parties.

After the jump I’ll explain why Grassley is wrong, wrong, wrong about health care reform.

Congress will begin making important decisions on health care policy very soon. The Senate Finance Committee began drafting a health care bill a few days ago.

I was glad to see two Iowans among the representatives and senators who urged colleagues this week to include a strong public option in any health care reform plan.

After the jump I have more on where Congressman Dave Loebsack and Senator Tom Harkin stand on health care, as well as the benefits of creating a public health insurance option.

UPDATE: Thanks to Populista for reminding me that all Iowa Democrats in Congress (Bruce Braley, Dave Loebsack, Leonard Boswell and Tom Harkin) have signed on to support Health Care for America Now’s core principles for health care reform.

I receive notices for many upcoming events I’m unable to attend, even though they would provide good material for a post at Bleeding Heartland.

Health Care for America Now has scheduled forums across the country this spring, including three in Iowa during the next month. The forums in Ottumwa and Sioux City will focus on rural health care reform and are co-hosted by the Center for Rural Affairs, Iowa Farmers Union, Iowa Citizen Action Network, Working Families Win, and Health Care for America Now Iowa.

The organizers are willing to accredit someone to cover each Iowa event for Bleeding Heartland. Please send me an e-mail (desmoinesdem AT yahoo.com) or post a comment in this thread if you are interested in attending one of these forums, taking notes and posting a diary about it later.

Wednesday, April 15 from 5:00 PM – 6:00 PM

Host: Charlie Wishman

Location: Ottumwa Public Library, 102 W 4th St in Ottumwa. Click here for more event information.

Wednesday, April 22 from 6:00 PM – 7:00 PM

Host: Charlie Wishman

Location: Western Iowa Tech, 4647 Stone Ave in Sioux City. Click here for more event information.

The Des Moines event is a longer symposium on what needs to be done to get health care reform passed in 2009. Co-sponsors include Health Care for America Now, the 1st Unitarian Church, RESULTS, AFSCME Council 61, and Every Child Matters.

Saturday, May 2 from 12:00 PM – 4:00 PM

Host: Charlie Wishman

Location: 1st Unitarian Church, 1800 Bell Ave in Des Moines. Click here for more information.

I’ll post a more detailed calendar of events this week later today or this evening.

This thread is for any comments about health care reform or good organizing work going on around Iowa.

A few days ago Chris Bowers reported welcome news from the progressive wing of the Democratic delegation in the U.S. House of Representatives. He posted a letter to House Speaker Nancy Pelosi from the co-chairs of the Progressive Caucus:

Dear Madam Speaker and Majority Leader,

Regarding the upcoming health care reform debate, we believe it is important for you to know that virtually the entire 77-Member Congressional Progressive Caucus (CPC) prefers a single-payer approach to healthcare reform.  Therefore, it will come as no surprise as you work to craft comprehensive health care reform legislation, that we urge the inclusion of a public plan option, at a minimum, in the final legislation.  We have polled CPC Members and a strong majority will not support legislation that does not include a public plan option that is supported on a level playing field with private health insurance plans.

We look forward to working with you to ensure inclusion of a public plan option and the successful passage of healthcare legislation that will provide a choice of  quality healthcare for all Americans

Sincerely,

Lynn Woolsey, Co-Chair, Congressional Progressive Caucus

Raul Grijalva, Co-Chair, Congressional Progressive Caucus

Many arguments lie ahead regarding what kind of public option would be acceptable as a compromise. Like most members of the Progressive Caucus, I would prefer an option for Americans to buy into an existing government-run program such as Medicare. Presumably corporate Democrats will be pushing for no public option or at best for allowing Americans to buy into the federal employees’ health insurance plan, which is provided by various private insurers.

I am glad to see progressive leaders warn that they will not support a Massachusetts-style health care reform, with a mandate for individuals to purchase private health insurance. There must be a public option.

Congressman Dave Loebsack is the only Iowan in the House Progressive Caucus and the only Iowan among the co-sponsors of HR 676, the single-payer health care bill. I am seeking comment from his office about whether he would reject any health care reform bill that does not include a public option.

Although Congressman Bruce Braley is not a co-sponsor of HR 676, I would think that fighting for a strong public option on health insurance would be a natural position for his Populist Caucus to take. I will seek comment from his office on this matter and write a follow-up post later this week.

I haven’t had a chance to watch today’s White House regional forum on health care yet (the Des Moines Register made the video available here).

According to the Des Moines Register, Senator Tom Harkin promised that health care reform will not fail this time:

“This is not something that we’re going to kick the ball down the field,” he said. “This is going to happen this year.”

The Register noted that some people at the forum favored single-payer health care reform, while others would like to see only small incremental changes. Protesters supporting a single-payer system gathered outside the forum too. I agree that single-payer makes the most sense for all kinds of reasons, but President Barack Obama will not seek that change, and Congress will not pass it. I’m willing to settle for a compromise that includes a strong public-insurance option.

Obama’s representative at today’s forum expressed optimism about finding an acceptable compromise:

Nancy-Ann DeParle, the leader of Obama’s health-reform effort, said past health-reform debates saw too many people who were wedded to specific plans. They wouldn’t compromise if they couldn’t get everything they wanted, she said. “Their fall-back position was always the status quo.”

This time, she said, people seem more willing to listen to other people’s ideas and find compromises.

Prospects for passing universal health care reform will depend on large part on whether the bill is subject to a filibuster in the U.S. Senate (meaning it would need 60 votes to pass). Obama reportedly wants to include health care reform in the budget process, so that it could pass with only 51 votes.

Chris Peterson, president of the Iowa Farmers Union, talked about health insurance for rural Americans at today’s forum:

“Rural Iowans struggle with finding affordable insurance. Even solidly middle class farmers are feeling the pinch. Nearly one in eight Iowa farmers battle outstanding health debt,” Peterson said. “I am one of them.”

Peterson, who is 53, was kicked off his private insurance plan about two years ago for what the company said was a preexisting condition. Peterson and his wife, who has no private insurance either, have accumulated $14,000 in medical debts in the past two years. “The health care system in this country is dysfunctional and burdensome,” Peterson said of the private insurance industry. “…Personally, what I’ve been through, it seems at times it’s a ponzi scheme — they’re taking your money — or (it’s) just the robber barons pulling money out of your pockets.”

On this note, I highly recommend reading this article by Steph Larsen: “For healthy food and soil, we need affordable health care for farmers.”

Getting back to today’s events, @personaltxr was at the forum and tweeted that Senator Chuck Grassley was expected but didn’t turn up. Does anybody know why? Grassley has an important role to play as the ranking Republican on the Senate Finance Committee. UPDATE: The Des Moines Register reported that Grassley stayed in Washington because of ongoing Senate business.

If you saw the health care forum, either live or on video, let us know what you thought. Everyone else can use this thread for any comments related to our health care system and prospects for reform.

I haven’t written anything yet about Senator Chuck Grassley’s comments on the AIG bonuses. The whole episode was such an empty populist gesture. First he said the AIG no-goodniks should act like the Japanese and either offer a humble apology or kill themselves. Then he walked back his comments and said they should offer a sincere apology. That’s all? I’d like to see more strings attached to the Wall Street bailout program, which Grassley voted for.

The Twitterer for the Daily Iowan Opinion page had the best response to Grassley I’ve seen so far. After the senator explained that “I do want an attitude in corporate American that’s similar to what they have in corporate Japan,” DIOpinions commented, “Making failed American executives more like their Japanese counterparts would require massive pay cuts.” Don’t hold your breath until Grassley gets behind that.

Anyway, we’ll find out how much Grassley cares about getting taxpayers’ money back from AIG when the Senate votes on the bill the House of Representatives passed yesterday.

Follow me after the jump to read about Grassley’s recent comments on medical marijuana and health care reform.

Also, I can confirm that at least one Democrat is stepping forward to challenge Iowa’s senior senator in 2010. Details are below.

Earlier this month President Barack Obama hosted a health care summit at the White House and announced plans for regional health care summits in Iowa, California, Michigan, North Carolina and Vermont. The governor of each state will host the regional events.

Governor Chet Culver announced yesterday that the Iowa forum will take place at the Polk County Convention Center on Monday, March 23, at 10 am. To enter the random drawing that will assign tickets to members of the public,

go to www.healthreform.gov and click on the “submit your question or idea” icon. Then click on the “Des Moines, Iowa” icon.

People can also call to request tickets from 9 a.m. Monday through noon Wednesday. The number is (800) 645-8864.

Nancy-Ann DeParle, director of the White House Office of Health Reform, will attend this forum and will be an influential voice in shaping Obama’s health care policies. Here’s a good background piece about her.

Some have expressed concerns about DeParle’s ties to companies with a stake in health care reform:

Since leaving the Clinton administration, Ms. DeParle has been managing director of a private equity firm, CCMP Capital, and a board member of companies like Boston Scientific, Cerner and Medco Health Solutions. White House officials said Ms. DeParle was severing ties with those companies and would recuse herself from participating in any matter that was “directly or substantially” related to former clients or employers.

“It is our view, and the view of counsel here, that the incidence of that will be very low,” an administration official said of the need for Ms. DeParle to recuse herself from decisions. The official, who was not authorized to speak publicly, said Ms. DeParle would be working mostly with federal agencies and lawmakers, and not directly with companies.

Allies of Ms. DeParle described her work in the private sector as a plus, because her familiarity with the industry would enable her to lean on companies to make tradeoffs essential in expanding access to the uninsured.

“She can call their bluff far more credibly and say, ‘Come on, guys, I’ve seen the books, I know you can do this with lower margins and higher market share, and you’ll do quite well,’ ” said Chris Jennings, who was President Bill Clinton’s top health policy adviser. “To me that’s very, very helpful.”

In general, people who come from industry to a government job don’t use that position to “lean on” companies where they have connections. But I am reserving judgment until I see what DeParle does in the coming months.  

President Barack Obama held a summit on health care yesterday with about 150 politicians and experts in the field. This morning the White House followed up by announcing plans to hold regional forums on health care in five states, including Iowa. From the press release:

The Regional White House Forums on Health Care Reform will be hosted by the states’ Governors and will include participants ranging from doctors to patients to providers to policy experts.  They will be open conversations with everyday Americans, local, state and federal elected officials – both Democrat and Republican — and senior Obama administration officials.  The events will begin with a video recorded by the President, a summary of the findings from the Health Care Community Discussions that took place in December, and an overview of the discussion that took place at the White House Forum on Health Reform.

The meetings in California, Iowa, Michigan, North Carolina and Vermont will take place in March and early April.  Further logistical information about the forums is forthcoming.

Presumably Iowa was chosen because both of our senators will play an important role in drafting health care legislation. Chuck Grassley is the ranking Republican on the Senate Finance Committee, and Tom Harkin will be in charge of drafting the parts of the bill concerning disease prevention and public health.

Ezra Klein posted about an exchange between Obama and Grassley at the White House yesterday:

“Max Baucus and I have a pretty good record of working out bipartisan things,” said Grassley. “I think only two bills in eight years that haven’t been bipartisan.” (One of them, however, was the S-CHIP bill, and another was Medicare payment reform, so their record on health care is more contentious). Grassley then moved onto a more relevant sore spot: The public insurance option. “The only thing,” he pleaded, “that I would throw out for your consideration — and please don’t respond to this now, because I’m asking you just to think about it — there’s a lot of us that feel that the public option that the government is an unfair competitor and that we’re going to get an awful lot of crowd out, and we have to keep what we have now strong, and make it stronger.”

The question was no surprise: In recent Finance hearings, Grassley has clearly signaled his anxiety on this issue. What was a surprise was that Obama rejected Grassley’s plea to think it over and instead replied on the spot with a strong articulation of the case for a public plan. “The thinking on the public option has been that it gives consumers more choices, and it helps give — keep the private sector honest, because there’s some competition out there. That’s been the thinking.”

“I recognize, though, the fear that if a public option is run through Washington, and there are incentives to try to tamp down costs and — or at least what shows up on the books, and you’ve got the ability in Washington, apparently, to print money — that private insurance plans might end up feeling overwhelmed. So I recognize that there’s that concern. I think it’s a serious one and a real one. And we’ll make sure that it gets addressed.”

I love it when conservatives like Grassley drop the free-market-warrior act. David Sirota asks the right question: if what we have works so well, why are “Republicans insisting that Americans would overwhelmingly opt to be covered by a government-run health care program, if given the choice?”

Also, why are there 48 million Americans without health insurance, with 14,000 Americans losing their health insurance every day lately? Why do the uninsured have less access to basic care and even organ transplants?

And why do so many people who do have health insurance face financial ruin following a medical crisis?

There must be a public health insurance option for people too young to qualify for Medicare and not poor enough to qualify for Medicaid. Someone close to my family just got laid off this week and was diagnosed with diabetes within the last few months. What are his chances of finding good private health insurance coverage under the current system?

This thread is for any thoughts about the substance or the politics of health care reform. I’ll post more details about the upcoming White House regional forum when they become available.

President Barack Obama formally announced on Monday that he is nominating Kathleen Sebelius to serve as Health and Human Services Secretary in his cabinet. She should be confirmed with little trouble, as various Republicans have already praised her nomination.

After the jump I’ve posted my initial thoughts on the pluses and minuses of this appointment.

President Barack Obama will present his first budget request to Congress today.

Early leaks indicate that he will propose some tax increases on the wealthiest Americans as well as some spending cuts to help pay for health care reform.

Ezra Klein, an excellent blogger on health care, is excited about what’s in the budget regarding health care reform. Although there is no detailed plan, Obama is submitting eight principles that should define health care reform efforts. Klein believes the principle of “universality” is likely to lead Congress to propose an individual mandate to hold health insurance.

I support mandated coverate only if there is a public plan that any American, regardless of age and income, can purchase as an alternative to private health insurance. The public plan would work like Medicare, in that individuals would be able to choose their own providers. Unfortunately, the Massachusetts model of mandatory private insurance without a meaningful public option has left a lot of problems unsolved.

It is not clear how much Obama will do to roll back George W. Bush’s tax cuts for the wealthiest Americans. I am with House Speaker Nancy Pelosi and others who would prefer to start rolling back tax cuts for the top 1 percent immediately. Last month the president seemed to be leaning toward letting those tax cuts expire over the next two years rather than fighting to repeal them this year.

According to Bloomberg,

President Barack Obama’s first budget request would provide as much as $750 billion in new aid to the financial industry […]

No wonder Obama went out of his way to make the case for helping banks during his address to Congress on Tuesday night. I firmly oppose shelling out another $750 billion toward this end, especially since the bailout money we’ve already spent hasn’t accomplished the stated goals of the program.

According to AFP, today’s budget proposal will include a plan

to raise money through a mandatory cap on greenhouse emissions.

Obama’s budget director Peter Orszag earlier estimated that a cap-and-trade scheme could generate 112 billion dollars by 2012, and up to 300 billion dollars a year by 2020.

Cap-and-trade may be more politically palatable, but a carbon tax may be a better approach for reducing greenhouse-gas emissions.

In cabinet-related news, have calculated that expanding the food-stamp program

Interior Secretary Ken Salazar wasn’t the top choice of environmentalists, but I was pleased to read this post:

Interior Secretary Ken Salazar canceled oil shale development leases on Federal lands in Colorado, Utah and Wyoming and announced that the Interior Department would first study the water, power and land-use issues surrounding the development oil shale.

Meanwhile, Homeland Security Secretary wants to review US Immigration and Customs Enforcement raids and told Congress that employers should be the focus of raids seeking to enforce immigration laws at workplaces. Obviously, swooping in and arresting a bunch of undocumented workers does nothing to address the root of the problem if employers are not forced to change their hiring practice.

Yesterday Obama named former Washington Governor Gary Locke as his latest choice to run the Commerce Department. Locke seems like a business-friendly Democrat, which is a big improvement over conservative Republican Judd Gregg, who thankfully withdrew his nomination for this post.

Republicans have been freaking out because of alleged plans by the Obama administration to “take control of the census.” Of course the GOP wants to continue the practices that have caused millions of white Americans to be double-counted in past censuses while millions more Americans in urban centers (largely non-whites) were not counted at all. Click here for more on the political battle over the census.

This thread is for any thoughts or comments about Obama’s cabinet or budget.

One year ago today I was battling an ear infection that turned bad enough to put me in the hospital for a week.

What I went through then was among the worst experiences of my life. Yet looking back on the experience, I realize how lucky I was.

The rest of the story is after the jump.

Daily Kos user JoesUnionReview brought Nigel Haskett’s story to my attention. Haskett was working at a McDonald’s in Arkansas and saw a woman being assaulted in the restaurant. He threw her attacker out and stood at the door to keep the man from coming back in. The assailant got a gun from his car and shot Haskett multiple times. Three abdominal surgeries later, Haskett has $300,000 in medical bills, but “the insurance agency representing McDonald’s says he doesn’t qualify for Worker’s Compensation in this incident.”

JoesUnionReview goes over the legal issues surrounding the worker’s compensation claim and why McDonald’s should be liable.

To me, this is even more unfair than Pizza Hut firing the Des Moines delivery driver who shot a would-be armed robber. That case prompted some people to boycott Pizza Hut. Will anyone boycott McDonald’s for its treatment of Haskett? I would, but I don’t think McDonald’s would notice, since I haven’t eaten there for years.

By the way, if we had universal health care in this country, someone who got shot while doing a minimum-wage job with no benefits would not get stuck with a $300,000 bill.  

Yesterday Marc Ambinder mentioned Senator Tom Harkin as a possible nominee for Health and Human Services secretary in Barack Obama’s cabinet. As much as I agree with Harkin’s views on health care, I would hate to lose his voice in the Senate.

Huffington Post contacted Harkin, who praised the idea of nominating former Vermont Governor and Democratic National Committee Chairman Howard Dean for the job:

“I think that would be a very good move,” Harkin told the Huffington Post. “He brings all the background and experience. He’s very strong on prevention and wellness, which I’m very strong on. I think he’d make an outstanding secretary of HHS.”

Asked if he had spoken to White House on the matter, Harkin demurred: “I’m not going to get into that,” he said after a pause.

You may recall that Harkin endorsed Dean for president shortly before the 2004 Iowa caucuses. I like Dean and his views on health care, but I fear that he is not necessarily the best person to bring Democrats in Congress along with a comprehensive health care reform package.

I had to laugh at this paragraph in the Huffington Post piece:

Whether this endorsement helps or hurts is a topic of debate. The conventional wisdom seems to be that Dean’s frosty relationship with White House chief of staff Rahm Emanuel will be the main impediment to his ending up at HHS. Others are concerned that a major netroots movement to appoint Dean will actually turn the White House off the notion. They don’t want it to seem like they are “bending to the demands of the left,” as one Democrat put it — not because they aren’t concerned with progressive priorities, but because the choice will be criticized as an effort in political pacification.

Heaven forbid Obama should appoint someone from the Democratic wing of the Democratic Party! People might think he cares about left-leaning Democrats. Never mind that thousands of former Deaniacs became dedicated volunteers for Obama’s presidential campaign. Without people like them he never would have won the nomination.

Marc Ambinder reported yesterday that Congressman Raul Grijalva has urged Obama to appoint Dean. Grijalva is a leading figure in the House Progressive Caucus and was favored by more than 130 environmental organizations for Secretary of the Interior (a job Obama gave to conservative Democrat Ken Salazar).

According to Ambinder, Governor Phil Bredesen of Tennessee is “a top candidate.” Daily Kos diarist DrSteveB discussed some of the names being floated yesterday and explains why Bredesen would be “beyond awful.” After reading that diary, I’m ready to remove the Obama-Biden magnet from my car if Obama nominates Bredesen.

By the way, DrSteveB likes Dean but doesn’t think he’s a good fit for Secretary of Health and Human Services.

Update: On February 3 Daschle withdrew his nomination for secretary of Health and Human Services. It looks like he won’t be the “health care czar” in the White House either.

When Barack Obama announced plans to nominate Tom Daschle to run the Department of Health and Human Services, I agreed with Ezra Klein that the choice signaled Obama’s commitment to get comprehensive health care reform through Congress. I knew that Daschle’s wife was a longtime lobbyist, and that Daschle was not nearly as liberal as the right-wingers made him out to be. But we all know that the Senate will be the biggest obstacle to any good health care plan. Daschle knows that body’s procedures and the majority of its members extremely well.

The choice isn’t looking so good today.

Not paying taxes on the use of someone else’s limousine looks bad, but as we saw last week with Treasury Secretary Timothy Geithner, failure to fully meet one’s tax obligations no longer seems to be a barrier to serving in the cabinet. (By the way, Daschle knew about this problem last summer but didn’t tell Obama’s vetting team.)

Many people might honestly not realize that if they use someone else’s car, they need to report the value of that service as taxable income. But what is Daschle’s excuse for overstating his tax-deductible charitable gifts and not reporting more than $83,000 in consulting income? If Bill Richardson was asked to step aside because of an investigation that hasn’t even proven wrongdoing, then Daschle should not get a pass for not paying his taxes.

As is so often the case in politics, though, what’s legal can be even more disturbing. From Politico:

Daschle made nearly $5.3 million in the last two years, records released Friday show, including $220,000 he received for giving speeches, many of them to outfits that stand to gain or lose millions of dollars from the work he would do once confirmed as secretary of Health and Human Services.

For instance, the Health Industry Distributors Association plunked down $14,000 to land the former Senate Democratic leader in March 2008. The association, which represents medical products distributors, boasts on its website that Daschle met with it after he was nominated to discuss “the impact an Obama administration will have on the industry.”

This week, the group began openly lobbying him, sending him a letter urging him to rescind a rule requiring competitive bidding of Medicare contracts.

Another organization, America’s Health Insurance Plans, paid $20,000 for a Daschle speaking appearance in February 2007. It represents health insurance companies, which under Obama’s plan would be barred from denying coverage on the basis of health or age.

There was a $12,000 talk to GE Healthcare in August, a $20,000 lecture in January to Premier, Inc., a health care consulting firm, and a pair of $18,000 speeches this year to different hospital systems, among other paid appearances before health care groups.

The speaking fees were detailed in a financial disclosure statement released Friday, which showed that Daschle pulled down a total of more than $500,000 from the speaking circuit in the last two years, and $5.3 million in overall income.

These speaking engagements are legal, but it is an unacceptable conflict of interest for Daschle to have taken that much money from groups with a major financial stake in health care reform.

At Daily Kos nyceve examines one of those paid speeches and tells you why you should care: As UnitedHealth subsidiary Ingenix defrauded Americans, Daschle was its 2008 keynote speaker.

A lot of liberal bloggers are now calling for Obama to withdraw Daschle’s nomination and appoint Howard Dean to run HHS instead. As much as I like Dean, I do not think he’s the person to shepherd health care reform through Congress. But I agree that Obama needs to find a replacement for Daschle–the sooner, the better.

If Obama stands by Daschle, I suspect the Senate insiders’ club would confirm him, but let’s hope it doesn’t come to that.

Speaking of stalled confirmations, Senator Mike Enzi of Wyoming appears to be the Republican who is holding up Hilda Solis’s nomination for Secretary of Labor. This is purely ideological, based on Solis’ support for the Employee Free Choice Act. Solis has not been accused of any wrongdoing.

Will Obama stand behind his choice for this cabinet position? The president expressed support for organized labor on Friday while signing executive orders to boost labor unions.  

Last year at this time I was scrambling to make as many phone calls and knock on as many doors as I could before the Iowa caucuses on January 3.

This week I had a little more time to reflect on the year that just ended.

After the jump I’ve linked to Bleeding Heartland highlights in 2008. Most of the links relate to Iowa politics, but some also covered issues or strategy of national importance.

I only linked to a few posts about the presidential race. I’ll do a review of Bleeding Heartland’s 2008 presidential election coverage later this month.

You can use the search engine on the left side of the screen to look for past Bleeding Heartland diaries about any person or issue.

Strong words from President-elect Barack Obama at yesterday’s press conference introducing Tom Daschle as Secretary of Health and Human Services:

Some may ask how, at this moment of economic challenge, we can afford to invest in reforming our health care system. Well, I ask a different question — I ask how we can afford not to….If we want to overcome our economic challenges, we must also finally address our health care challenge.

Obama also promised to address health care “this year,” implying that he will spend political capital to get a plan through Congress in 2009.

Daschle linked health care reform to economic recovery:

Addressing our health care challenges will not only mean healthier and longer lives for millions it will also make American companies more competitive, address the cause of half of all of our personal bankruptcies and foreclosures and help pull our economy out of its current tailspin.

Obama also named Jeanne Lambrew as Daschle’s deputy. Ezra Klein is very pleased with that pick:

Lambrew is an incredibly talented and knowledgeable health wonk, and her involvement should cheer liberals. Unlike during the campaign, when Obama’s health care team seemed heavy on relatively cautious academics, Lambrew has long White House and executive branch experience, and comes to health care as a crusade as much as a topic of study. As Jon Cohn says, the importance of her presence “goes beyond the fact that she happens to know a heck of a lot about health care. She, too, has a strong commitment to what you might call the ‘social justice’ side of the debate.”

For more from Lambrew, check out her congressional testimony from late October, where she argued that “the short-run economic crisis has health policy causes and effects-and arguably the most serious long-run economic challenge is our broken health care system.” That was almost exactly the message Obama delivered today. And it’s the message that will be heard in the White House, and translated into a political strategy by Tom Daschle.

In this article for The American Prospect, Klein compares Obama’s team of “health care heavyweights” to Bill Clinton’s disastrous strategy for pushing health care reform in 1993 and 1994.

The major battle will be making sure there is some public insurance plan Americans can opt into, so that private insurers will need to cover health care in order to compete for customers.