Rep. Paul Ryan (R-WI) is the ranking Republican on the House Budget Committee and running for re-election. Ryan wants to eliminate the Medicare program and instead give vouchers to senior citizens that they can use to purchase private insurance policies. The value of the vouchers would not come close to the anticipated cost of the insurance.

I’d like to point out that insurance companies could refuse to accept senior citizens as policy holders until 2014. That’s when a provision in the new health care reform act kicks in that requires insurance companies to insure anyone who can pay the premiums, regardless of their pre-existing conditions. Rep. Ryan was opposed to the health care reform bill, of course, and he has said that repealing health care reform will be the first goal of a GOP Congress.

Think about this. The guy wants to eliminate Medicare and replace it with vouchers to buy private insurance. But if health care reform is repealed, there’s little chance private insurance companies will insure older people, vouchers or no vouchers.

Medicare is an important issue to people suffering from asbestos cancer. The cancer can take 20 to 50 years to develop after exposure to asbestos. It’s common for people who were exposed to asbestos at work to be diagnosed with mesothelioma after they retire.

Many candidates such as Ken Buck, Republican candidate for U.S. Senate from Colorado, make vague noises about health savings accounts somehow replacing Medicare. That’s, um, nuts. HSAs are special tax-free savings accounts in which you can save money to pay for medical expenses. These are combined with a high-deductible or “catastrophic” insurance policy as a safety net for major medical expenses. HSAs are a good deal for young and healthy people with high incomes who rarely need to see a doctor. For everyone else, they aren’t.

Sharron Angle, a Republican from Nevada running for the U.S. Senate, has similar ideas about Medicare. In a televised candidate debate last May, she said “We need to phase Medicare and Social Security out in favor of something privatized.” Later she elaborated on what she meant by that — in so many words, she thinks seniors should pay for their own health care out of retirement savings accounts. Lately she has been using the word “personalize” instead of “privatize,” but it means the same thing — you’re on your own.

The theory behind some of these cockamamie ideas is that the “free market” will find a way to make health care affordable if government just got out of the way. But before Medicare went into effect, 40 percent of people over age 65 had no medical insurance. Private policies were too expensive for many seniors, and insurance companies didn’t want to sell policies to seniors. There’s your “free market.” Medicare was a response to a problem the “free market” would not solve.

Dr. Berwick was chosen for the job through what’s called a “recess appointment,” meaning the appointment was made while the Senate was in recess. Normally, an appointment to such a position requires the approval of the Senate, but the Constitution allows a president to use recess appointments to put someone in a position temporarily. The Senate would have to approve Dr. Berwick if he is to remain in the position beyond 2011.

Apparently the White House used the recess appointment because the president wanted to avoid a replay of the acrimonious health care debates, especially right before a midterm election. But of course nothing in Washington ever happens without a hitch. Senate Minority Leader Mitch McConnell denounced the recess appointment and said the president was trying  to “arrogantly circumvent the American people.”

Note that President George W. Bush made at least 171 recess appointments while he was president, and Sen. McConnell didn’t have a problem with those.

When complaining about the use of a recess appointment didn’t stir up enough outrage against Dr. Berwick, Republicans tried a different approach. They sifted through all of his past speeches and writings for incriminating evidence of something. This wasn’t easy, since Dr. Berwick’s appointment was endorsed by the American Hospital Association, the American Medical Association, the American Association of Family Physicians and pretty much the entire professional medical establishment in the U.S.

The best, or worst, opponents could find was a 2008 speech Dr. Berwick gave in Britain for the observance of the 60th anniversary of Britains’ National Health Service. Not too surprisingly, in this speech Dr. Berwick said nice things about the NHS. This revelation incited a chorus of hysterical shrieking that Dr. Berwick would establish an NHS-style health care system in the U.S., even though there is no way he could do such a thing even if he wanted to. Only Congress can change the Medicare and Medicaid programs into something else.

Then, they found an interview of Dr. Berwick from 2009 in which Berwick said, “We make these decisions [about how to use medical resources] all of the time. The decision is not whether or not we will ration care. The decision is whether we ration care with our eyes open. And right now, we are doing it blindly.” In other words, we already are rationing health care and doing a stupid job of it.

Many right-wing news outlets picked up this quote but chopped off the beginning and end, so that it became “The decision is not whether or not we will ration care. The decision is whether we ration care with our eyes open.” The quote was published under headlines screaming things like “ObamaCare Will be Rationed!”

Anti-reformers refuse to admit that health care already is rationed. It is rationed by insurance companies, which decide what they will and will not pay for, and it is rationed according to whether the patient has money or insurance at all. One of the reasons we have so needed health care reform is to stop rationing health care and just let people get the care they need. But this continues to be an uphill battle.

Most graduate medical education in the United States is funded, at least in part, by Medicare. Back in 1996, Medicare decided it would pay for no more than 100,000 medical residencies a year, and that number hasn’t changed since. This in turn has limited the number of medical school graduates who can complete residencies and become certified doctors.

Why did Medicare decide to limit  funding of residencies? Believe it or not, a few years back there were predictions the nation was educating too many doctors. Medical journals of the 1980s and 1990s warned that there would be a glut of doctors in America. Some doctors worried the competition would erode their income. The American Medical Association and other professional organizations actually lobbied for the cap on the number of funded residencies.

Now the shortage is so acute that the only reason many of us don’t have to wait many weeks for a doctor’s appointment is that so many Americans have been without medical insurance. But the new health care reform bill is expected to enable many millions of Americans to obtain insurance who don’t have it now.

Further, that other famous glut called the Baby Boom generation is getting older and will need more medical services in the years ahead.

And even further, of those doctors who do finish their residencies and become licensed to practice medicine, fewer and fewer are becoming family practice physicians. There are several reasons for the shortage of primary care doctors, but most of them boil down to the fact that primary care doctors work longer hours and get paid less for it than doctors in other areas of medicine.

What about cuts to the Medicare program you might have heard about? Medicare is a critical concern to people suffering from asbestos cancer, because the cancer can take decades after exposure to asbestos to develop. Many patients receiving mesothelioma treatment are on Medicare and are no doubt worried that their doctors will stop accepting Medicare.

First, understand that the recent cuts in Medicare payments to physicians were not part of the health care reform bill, although I’m sure many people believe otherwise. Here’s the real story:

Many years ago, Congress established a payment formula for Medicare that was supposed to keep costs under control.  Reimbursements to physicians were supposed to be trimmed a little every year. But beginning in 2003, Congress voted to defer those cuts every year — until this year.

And now all those deferred cuts are going to be imposed all at once. and Medicare fees are being cut by more than 21 percent. In June Democrats in Congress tried to pass “doc fix” legislation that would have prevented these cuts, but Republicans blocked it. And yes, if you are on Medicare, you should be concerned.

Nate Silver, the statistician famous for his accurate predictions of elections, also keeps track of polling companies and analyzes their results for accuracy. He nearly always put Rasmussen at the top of the error list. Rasmussen’s poll results overwhelmingly tend to err in favor of conservative candidates and causes, Nate has found.

It is unlikely that Rasmussen is deliberately mis-reporting its findings. It is more likely the company crafts its surveys in a way to achieve the desired outcome.  In polling, this is called a “house effect” — a company that works on behalf of a particular cause, party, or candidate will find ways of polling to get the best (for them) possible results. The way a question is worded, or other questions in the poll, can considerably alter results.

The health care reform law has a number of provisions that will be enormously helpful to people suffering from rare and deadly diseases such as mesothelioma cancer, once they are in effect. Beside making it easier for everyone to get affordable health insurance, for example, the reform law also provides for research into the effectiveness of medical treatments. As it is now, most physicians have to rely on what pharmaceutical and medical technology companies say about their products.

And the next question is, why would a polling company try to distort public opinion? Well, for one thing, it results in headlines that say 60 percent of Americans want health care reform to be repealed. The natural reaction of most people reading that headline is, wow, there must be something really wrong with health care reform.

In other words, the purpose of such polling is not to measure public opinion, but to manipulate public opinion. Sociologists and political scientists call this the “bandwagon effect.” This is a tendency for people to believe things because many other people believe those things. The bandwagon effect has been around for a long time, but publicists and politicians have gotten very good at using mass media to amplify the effect. Publishing poll numbers favorable to your cause is one way to create a bandwagon effect.

If you go further into Rasmussen’s press release you see this paragraph –

“Supporters of the health care plan have often looked north to Canada’s nationalized system as a model for what they have in mind, but just 32% of voters nationwide say Canada has a better health care system than the United States.”

This is piling propaganda on top of propaganda. The health care reform bill that became law last spring in no way resembles the health care system of Canada, so why drag Canada into this survey? Because Americans have been subjected to many years of scare stories about how awful health care is in Canada, and so many Americans are certain Canadians have a terrible health care system. Canadians disagree, but propaganda isn’t famous for being truthful.

And one of the propaganda techniques used by opponents of health care reform is to associate U.S. health care reform with the Canadian single payer health care system. Hence, a completely irrelevant mention of the Canadian health care system is added to the release.

So whenever you hear a news story about a poll that says “Americans think” this or that, take it with a grain of salt. Just because 80 percent of adults can be persuaded to say the sky is green doesn’t mean the sky is green. All it means is that somebody wants you to think the sky is green.

That’s what happened in Massachusetts after that state passed its own health care reform bill in 2006. By 2008, at least 340,000 citizens of Massachusetts were covered by health insurance who had not been covered before. The problem was that there were not enough primary care physicians to take care of 340,000 additional people. One health clinic in Holyoke soon had 1,600 people on a waiting list, and the wait for a first appointment was four months. Those who couldn’t wait went to emergency rooms for care.

So, one reason the Massachusetts health care reform law resulted in crowded emergency rooms is that there were not enough primary care physicians to take care of the people who needed to see doctors. And the fact is, there’s a shortage of primary care physicians just about everywhere in the U.S., especially in more sparsely populated areas. The only thing that’s prevented long waiting lists to see your family doctor is the fact that so many Americans have no insurance and can’t afford to see a doctor.

Why aren’t there enough primary care physicians to go around? The biggest reason is that fewer and fewer medical students are choosing that field of medicine. “Family doctors” work longer hours for less money than many other specialties. These days young doctors leave medical school with $120,000 or more in student loan debt, which makes the higher salaries offered to surgeons and other specialists very appealing. It is especially tempting to go into specialties like sports medicine that mostly serve the wealthy and well-insured.

Primary care physicians also have higher administrative overhead than other doctors. They deal with more insurance company paperwork, such as referrals, than other specialties. They are also the ones to sign notes to employers and school principals about absences, requests for handicapped parking stickers, etc.

For the past several years, the standard “solution” offered by conservatives to alleviate the doctor shortage is “tort reform.” The theory is that the reason there aren’t enough doctors is that physicians are being driven out of medicine by high malpractice insurance costs. But the truth is that many of the specialties attracting younger doctors have much higher malpractice insurance costs than primary care.

Another theory offered by anti-reformers is that if government just got out of the way, the “free market” and the law of supply and demand would eventually even everything out. But in a way, the law of supply and demand has made the problem worse. As more and more Americans lost insurance, the system no longer responded to their health care needs. When “demand” comes only from people with the best insurance and highest income, the system supplies plenty of plastic surgeons and sports medicine specialists but not enough family doctors.

This is a complex issue, and the real solution probably will include education subsidies and other incentives for young doctors to stick to family medicine. And this issue touches on several other issues of particular interest to people suffering from asbestos cancer and other deadly but rare diseases. First, “tort reform” unfairly punishes the people who are most damaged by the negligence or carelessness of others. Second, rare and devastating diseases that are unprofitable to treat would be ignored by a “free market” system.

As the many provisions of the health care reform bill go into effect, we will hit some rough patches. People who oppose reform will use every one of those rough patches as arguments for scrapping reform and going back to the old system. Just remember that the old system seemed to “work” only because so many people were cut off from it by lack of insurance.

Just five weeks ago, the Senator was actively participating in Senate subcommittee hearings on the Upper Big Branch mine disaster that killed 29 coal miners earlier this year. Massey Energy CEO Don Blankenship  told the senators he was committed to workplace safety, but his company’s dismal safety record told a different story.

Senator Byrd admonished Blankenship. “I cannot fathom how an American business could practice such disgraceful health and safety policies while at the same time boasting about its commitment to the safety of workers,” Byrd said.

AFL-CIO President Richard Trumka said of Robert Byrd, “He tirelessly fought for health and safety laws that protected workers, opposed job- killing trade deals and when it came to standing up to the coal companies, a miner never had a stronger ally.”

The fight for workplace safety was going on long before Robert Byrd was first elected to the Senate — which was in 1958, by the way. The first coal mining safety commissions were organized after the Civil War. The federal government began to regulate consumer and worker safety after 1900. The Bureau of Mines was begun in 1910, for example.

Robert Byrd was raised in the coal-mining region of southern West Virginia, and he never lost touch with his roots. Yesterday Mine Workers (UMWA) President Cecil Roberts remembered Senator Byrd’s support for the 1969 Coal Mine Safety and Health Act that created the Mine Safety and Health Administration (MSHA), and how Senator Byrd convinced President Nixon not to veto the bill.

“In the 40 years prior to its passage, 32,000 miners lost their lives on the job,” Roberts said. “In the 40 years since, that number stands at slightly more than 3,200. One could argue that thanks to Sen. Byrd’s efforts, 29,000 lives were saved.”

The struggle for safer workplaces continued. In the years after the passage of the Coal Mine Safety and Health Act, the asbestos manufacturing industry continued to expose workers to asbestos for years after medical studies had linked asbestos to mesothelioma. Today, in the
coal industry, mine owners hire lobbyists to fight safety regulations rather than invest in making mines safer.

Last month Senator Byrd called for legislative changes that would require publicly traded companies to disclose health and safety violations to investors. “Investors ought to know if a company is jeopardizing its workforce in order to maximize its profits,” said Byrd.  “In addition, failure to disclose these adverse safety or health conditions could have a significant financial impact on investors, especially if there is a halt in operations because a company failed in its obligation to protect its workers.”

After the Upper Big Branch mine disaster, the Senator said, “The old chestnut that coal is West Virginia’s greatest natural resource’ deserves revision. I believe that our people are West Virginia’s most valuable resource. We must demand to be treated as such.” So simple, so true, yet so few politicians seem to realize this.

The policemen, firemen, construction workers, ironworkers, and others who worked at the site were the heroes of the hour. Yet little effort was made to protect these heroes from the toxic fumes they were breathing. Now many are disabled and unable to work, and some have died. Health experts think many more will develop cancers such as mesothelioma and other devastating illnesses in the years to come.

Now it appears this same terrible negligence is being repeated on the Gulf Coast. Oil cleanup workers are not getting proper safety equipment, and some of them are getting sick.

BP, the corporation whose oil rig meltdown caused the leak, hired crews of fishermen and others to clean oil from the Gulf. Many of these workers had lost their regular livelihood because of the oil spill, and they need the money. But soon they began to complain of headaches, dizziness, nausea, and breathing problems.

Safety experts say these complaints are the least of the workers’ problems. Workers who helped clean up the Exxon-Valdez spill of 20 years ago came down with severe chronic respiratory and neurological problems and several kinds of cancers. And many of these workers were never compensated for their injuries. In fact, 20 years later Exxon is still fighting some claims against it in appeals courts.

How many times do we have to watch the lives of workers taken for granted? We see over and over again that many employers would rather risk workers’ lives than spend the money to make jobs safer. We see this in the coal industry, where mine owners hire lobbyists to fight safety regulations instead of spending the money to make mines safer. We saw it in the asbestos manufacturing industry, which continued to expose workers to asbestos for years after medical studies linked asbestos to mesothelioma.

In the case of the Ground Zero workers, the culprit was not a corporation but the New York Department of Design and Construction, which Mayor Rudolph Giuliani placed in charge of the cleanup operation. Apparently this Department made no effort to provide workers with the safety equipment they needed.

The settlement would provide $800,000 to $1,000,000 to people with severe diseases caused by the toxins at Ground Zero, and up to $1,500,000 to the families of those who already have died. All plaintiffs will get a cancer insurance policy. The settlement requires that 95 percent of the plaintiffs accept it by September to go into effect.

Recently, however, the White House revealed that employers could lose the “grandfathering” protection if they changed to a worse insurance plan. For example, if the plan dropped essential benefits or substantially increased deductibles, the plan would no longer be sheltered by the grandfathering clause and would be subject to the same regulations as new plans. These regulations include eliminating the co-pays for preventive care and giving the insured person a right to appeal if coverage is denied.

Demagogues on the Right seized this announcement as proof that President Obama lied when he said most Americans could keep their health care plans. This claim made no sense to me, so I went to the website of the Department of Health and Human Services to find out what, exactly, was causing the hysteria. I found this in a press release dated June 14:

While the Affordable Care Act requires all health plans to provide important new benefits to consumers, under the law, plans that existed on March 23, 2010 are exempt from some new requirements.  The “grandfather rule” issued today makes it clear that these plans can continue to innovate and contain costs by allowing insurers and employers to make routine changes without losing grandfather status.  Plans will lose their “grandfather” status if they choose to significantly cut benefits or increase out-of-pocket spending for consumers – and consumers in plans that make such changes will gain new consumer protections.

It seems to me that the threat of losing the grandfathering protection would be a big incentive to employers to not change your health care plan to a worse one, thereby making it more likely you would keep your existing plan. But of course that makes sense, so no one on the Right sees it that way. Instead, they’ve been pumping up the hysteria as loudly as they can about the terrible government regulations that will rip away your health insurance.

The point of this hysteria is to frighten people into giving up reforms they need but which corporations fear will cut into profits. As I’ve been saying in the past several posts, there are a number of issues, from consumer protection to legal reform to workplace safety, of especially interest to people stricken with the deadly lung disease mesothelioma, caused by exposure to asbestos. On each of these issues, voters have been frightened into thinking something terrible will happen if progressive reforms go into effect. But if you look closely, you see there’s nothing to be frightened of.

This time, you’ve got Senator Pat Roberts telling his constituents in Kansas that  “Under regulations proposed by the Department of Health and Human Services to implement the new law, more than 51 percent of American workers could lose the plans they currently have.”

Exactly where the Senator gets this “51 percent” figure is a mystery, but  Health and Human Services says “Most of the 133 million Americans with employer-sponsored health insurance through large employers will maintain the coverage they have today.” The most likely exceptions are the 42 million people insured through small business, because small insurance plans tend to make big changes more often than bigger insurance plans.

But say, worst case, your employer loses the grandfathering protection. How would your insurance change? HHS says you would gain additional benefits, including patient protections such as guaranteed access to OB-GYNS and pediatricians.

So, while I suppose you could call that “losing” your existing plan, the existing plan would be replaced by a better plan.

And that’s a shame, because there is evidence that health care reform already is working as promised. For example,  many insurers are beefing up customer service to compete for new customers.

Two major parts of the health care reform law will go into effect in 2014: One, insurers will no longer be able to refuse coverage to people with pre-existing conditions. And two, the individual mandate that will require most Americans to be insured will kick in. These two provisions are expected to bring millions of people into the health insurance marketplace who are not insured now.

The Wall Street Journal Market Watch reports that many major insurers already are working to improve phone-based customer service and are even opening new retail stores. Forms are being simplified, and employees are being trained to communicate to customers more clearly. The insurers believe that building brand recognition and customer trust now will make them more competitive after 2014.

Another change is arriving in the mail for some Medicare recipients — rebate checks for the prescription drug “doughnut hole.” The “doughnut hole” is the gap between the coverage for yearly out-of-pocket expenses provided by Medicare Part D and expenses covered by Medicare’s “catastrophic coverage.” The Part D benefits help pay for annual prescription drug costs up to $2,700, and catastrophic coverage pays for nearly all yearly prescription drug bills over $6,154, but the costs in between must be paid entirely by the Medicare recipient.

The health care reform law will close the doughnut hole incrementally, and this year’s rebate check is for only $250. The hole will be completely closed by 2020, if the health care reform law is not repealed.

Health care reform is just one of a complex of issues that touch on the special concerns of people with mesothelioma, a deadly lung cancer caused by exposure to asbestos. As I wrote in an earlier post, so often we find the same cluster of organizations and politicians lined up against the reforms real people need to get on with their lives.

But because so many of the bill’s provisions won’t go into effect for another two to four years, politicians have been able to frighten the public with scare stories about how awful it’s going to be. The pro-repeal crowd fears people will like health care reform once it’s all implemented, so the race is on to kill the bill while the public can skill be bamboozled.

For example, yesterday Senator Pat Roberts of Kansas published an op-ed in the Kansas City Star warning that “Under regulations proposed by the Department of Health and Human Services to implement the new law, more than 51 percent of American workers could lose the plans they currently have.” Wow, that sounds as if all those people will lose health insurance!

But what the regulations really will do is force employers with substandard plans to improve them. For example, eventually plans will have to eliminate copays for preventive care.  This is what Senator Roberts means by “losing the plans they currently have.”

However, what Senator Roberts didn’t mention is that the health care reform law has a “grandfather clause” so that existing plans will not be affected by the regulations as long as the plans remain as they were before the law was passed. I guess that slipped the Senator’s mind.

And what we’re hearing is the old, old story — BP executives gambled with safety to save money. And we all lost.

Before the explosion, subcontractors working on the rig and BP’s own engineers warned the company that the Deepwater Horizon rig was at risk. But the advice given to BP was not taken, because corporate executives thought the “safe” way to do things was too expensive.

Reps. Henry Waxman, D-Calif., and Bart Stupak, D-Mich, are chairs of House committees investigating the Deepwater Horizon disaster. They have sent a letter to BP CEO Tony Hayward that points to at five risks BP executives chose to take in the days before the explosion.

“The common feature of these five decisions is that they posed a trade-off between cost and well safety,” the letter said. “Time after time, it appears that BP made decisions that increased the risk of a blowout to save the company time or expense.”

Many of these details require some engineering background to understand. But in one instance, BP choose a less expensive design for the pipes that line the wells than the one recommended by engineers. The lining method that was chosen aved BP $7 to $10 million dollars, but it provided less protection if cement were damaged or if gas pressure rose in the well.

We see this same pattern over and over again, in industry after industry. We see coal mine owners deciding it’s less expensive to hire lawyers to fight oversight than to take steps to protect miners, for example. Pharmaceutical companies fought to keep products with phenylpropanolamine (PBS) on the market for years after PBS was known to cause strokes, because the products made millions of dollars.

And, of course, many asbestos manufacturers continued to put workers, consumers and the environment at risk for many years after medical studies proved a link between asbestos exposure and mesothelioma, a deadly lung cancer.

As oil continues to spread in the Gulf of Mexico, a chorus of politicians (many with long ties to the oil industry) are calling for offshore oil drilling to continue. There is no question that the offshore drilling has been a major source of income to some Gulf states.

But the lesson we keep having to learn, over and over, is that where making money is a factor, human consideration often goes out the window. The captains of industry simply cannot be trusted to make responsible, altruistic decisions about the lives of workers, consumers, or the environment.