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From Bill Moyers Journal:

BILL MOYERS: You know from the news that early next week the Senate Finance Committee is expected to vote on its version of health care reform. And therein lies another story of money and politics.

Polls show the overwhelming majority of Americans favor a non-profit alternative -- like Medicare -- that would give the private health insurance industry some competition. But if so many Americans and the President himself want that public option, how come we're not getting one?

Because, the medicine has been poisoned from day one, in part because of that same revolving door that Congresswoman Kaptur and Simon Johnson were just talking about. Movers and shakers rotate between government and the lucrative private sector at a speed so dizzying they forget who they're working for.

SEN. MAX BAUCUS: Our plan does not include a public option.

BILL MOYERS: Take a close look at that woman sitting behind Montana Senator Max Baucus. He's the Democrat who's the Chairman of the Finance Committee. Liz Fowler is her name. And now get this. She used to work for WellPoint, the largest health insurer in the country. She was Vice President of Public Policy. And now she's working for the very committee with the most power to give her old company and the entire industry exactly what they want: higher profits, and no competition from alternative non-profit coverage that could lower costs and premiums.

I'm not making this up. Here's another little eye-opener. The woman who was Baucus' top health advisor before he hired Liz Fowler? Her name is Michelle Easton. Why did she leave the Committee? To go to work -- where else? -- at a firm representing the same company Liz Fowler worked for WellPoint. As a lobbyist.

It's the old Washington shell game. Lobbyist out, lobbyist in. And it's why they always win.

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John Conyers and some allies on the House Judiciary Committee have come up with a fabulous way to get the insurance industry in line - by threatening to remove their anti-trust exemption.

Many people don't know that the insurance industry, under the McCarran-Ferguson Act of 1945, has a broad anti-trust exemption that facilitates regional monopolies. The Act allows states to regulate the insurance business instead of the federal government, but also allows that, as long as the state regulates the industry, federal anti-trust laws would not apply.

As a result of this exemption, states have seen markets for health insurance where one or two companies predominate. In the state of Maine, Wellpoint controls 71% of the market. In North Dakota, Blue Cross controls 90%. Using the Herfindahl/Hirschman Index, a metric for market concentration, a 2007 study by the AMA found almost every health insurance market in the United States is highly concentrated.

This edition of the study analyzed 313 MSAs. This compares with 292 metropolitan areas in the 2005 study, 84 in the 2003 study, 70 in the 2002 study, and 40 in the 2001 study.

In terms of market concentration (HHI), the study found the following:

In the combined HMO/PPO product market, 96 percent (299) of the MSAs are highly concentrated (HHI>1,800), applying the 1997 Merger Guidelines.
In the HMO product market, 99 percent (309) of the MSAs are highly concentrated (HHI>1,800), applying the 1997 Merger Guidelines.
In the PPO product market, 100 percent (313) of the MSAs are highly concentrated (HHI>1,800), applying the 1997 Merger Guidelines.

Here's the AMA study. Paul Rosenberg has a lot more on this.

The point is that the concentration of the health insurance market among regional monopolies leads to higher costs for consumers, almost by definition. What the legislation by Conyers (D-MI), Hank Johnson (D-GA) and Diana DeGette (D-CO) would do is end that anti-trust exemption for health insurers, allowing for enforcement in all of these highly concentrated markets. The Senate has companion legislation:

“This legislation would specifically prohibit price fixing, bid rigging, and market allocation in the health insurance industry,” said Conyers. “These pernicious practices are detrimental to competition and result in higher prices for consumers. Conduct that is unlawful throughout the country should not be allowed for insurance companies under antitrust exemption. The House Judiciary Committee held extensive hearings on the effects of the insurance industry’s antitrust exemption throughout the 1980s and early 1990s. It became clear then that policyholders and the economy in general would benefit from eliminating this exemption.

“The legislation we introduced today is intended to root out unlawful activity in an industry grown complacent by decades of protection from antitrust oversight. In doing so, we aim to make health insurance more affordable to more Americans. I want to thank my friend Senator Leahy for his leadership on the bill and for working with the House on this joint introduction.”

Many of the actions taken by the insurance industry over the years simply violate federal law. Repealing their anti-trust exemption would force the industry to end their criminal ways or face punishment. As a companion to insurance regulations designed to lower prices for consumers, but perhaps without the kind of enforcement necessary to maintain it, I couldn't think of anything better. And if nothing else, this legislation is a powerful whip to keep the industry in line as they try to extract more perks from the health care bill. Combine this with the multiple investigations into industry practices from Dennis Kucinich, Henry Waxman and others, and you have real pressure on the industry for the first time in a while.

Good for John Conyers.

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All day I've been hearing how stupid Max Baucus was to release his plan this week which is basically the same bill he leaked back in June. Chuck Todd was wondering why he took so long to produce nothing new. Suddenly the lead Baucus Dogs' bill isn't the be all and end all.

Todd and Andrea Mitchell were saying that Baucus still has a role, but he screwed up by taking so long. He lost his leverage. We'll see, but it was fascinating watching the media turn on the the king of the gang of six.

And now it appears that Liz Fowler has her hand in the Senate Finance bill.

Max Baucus' plan had the name of Liz Fowler, a former WellPoint VP who now works for the Finance Committee, in the metadata. When you have WellPoint personnel instrumental in writing the laws, you get little provisions like this:

Interstate Sale of Insurance. Starting in 2015, states may form “health care choice compacts” to allow for the purchase of non-group health insurance across state lines. Such compacts may exist between two or more states. Once compacts have been formed, insurers would be allowed to sell policies in any state participating in the compact. Insurers selling policies through a compact would only be subject to the laws and regulations of the state where the policy is written or issued.

This is something that conservatives have been begging to do for years. Even the most outgunned conservative on a talking head debate can vomit up "let people take their insurance across state lines to increase competition!" It sounds reasonable. But there's a very good reason why it would quickly turn into a nightmare, and you can see it in the examples of Delaware and South Dakota.

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Consumer Watchdog jumped on this today, claiming that this race to the bottom could be expanded...read on

Now Baucus is saying he'll go it alone without Republican support. So why was there a delay if that's the case? Grassley has been acting like an ass the whole time.

Max Baucus is getting serious. Just a few hours before President Obama is scheduled to address a joint session of Congress, the Finance Committee chairman announced that the committee would be moving forward with a health care reform bill - with or without the GOP.

The announcement followed a morning meeting with the so-called Gang of Six. A source with knowledge of the situation said that Baucus told the two other Democrats and three Republicans that he will be putting out a "Chairman's Mark" by the middle of next week whether he has Republican support or not. (A Chairman's Mark is a bill written by the chairman of the committee.)

Amanda Marcotte understands what's happening. I only wish the media would do their job.

It’s obvious that people who show up screaming about how they want the government out of their Medicare and who go into a faint because they heard that the health care bill has no provision to ban abortion aren’t people that you can respond to in any way. They can’t compromise or understand the concept. They’re too busy struggling against reality itself.

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It’s the people who are putting corporate profits ahead of human lives who need to explain themselves. They’re the ones who should be asked why corporate profits count more than lives. They’re the ones who should be asked why working class citizens should be forced to decide between paying for an insurance bill or paying their rent in order to make sure that no insurance company executive goes without a fresh supply of yachts and fancy cars. They should be forced to explain why insurance company executive yachts count more than your ability to avoid homelessness, or your ability to have a perfectly treatable illness actually treated.

Angela Braly, the CEO of Wellpoint, called for health care reform at a meeting in Indianapolis.

One of them most powerful women in the nation is calling for health care reform. Wellpoint CEO Angela Braly says she supports guaranteed coverage for everyone - as long as everyone gets and stays covered [...]

"The high and rising cost of health care in America is just not sustainable," Braly said. She said the current system, including Medicare, which is administered by the federal government, was inefficient and promotes quantity over quality. She also said it posed "a real threat to the social and fiscal obligations of the government and to the health and prosperity of the American people."

"We believe insurance companies have a role to play. We can and are making a difference," Braly said. She said Wellpoint's strategy was moving beyond processing claims and managing risk, noting employee incentives when customers get healthy.

Braly says the what worries her most about the plan currently under consideration is the "public option."

This is, essentially, the insurance company-approved argument for health care reform. They see it as forcing everyone to buy their coverage, making refusal to buy their insurance a crime, and offering no competition to their monopoly over it. I'm sure they don't want to see that anti-trust exemption of theirs lifted either, the one that has led to 94% of the individual insurance market becoming "highly concentrated" in the hands of one or two companies.

Braly kept talking about how the current system is inefficient and leads to skyrocketing costs, as if she has no agency over that whatsoever. There are issues with how the fee-for-service system promotes quantity of medical care and not quality, but that's due to the profit incentive, which is exactly the same in the insurance market. Braly's argument seems to be that it's doctors and hospitals at fault for chasing profit in health care, but insurance industry CEOs like her are good samaritans and innocent bystanders who just so happen to do the same thing. If a profit-driven health care system is wrong, then it's pretty much wrong across the board. And she actually advocated for an outcome where insurers would be "free to offer a range of choices," while worrying about a public option... which would just be another choice, one that could deliver quality coverage at a lower cost.

Braly tried to argue that health insurance profits aren't all that big:

According to Braly, the difference between the Medicaid or Medicare payouts and actual costs are shifted to the private plans, costing you $1,500 a year. Add that to the $1,000 a year shifted to the private plans to cover the uninsured and it costs you a total $2,500 a year.

"Sounds a lot like the Fannie Mae for health care and I think we all know how that experiment is going," Braly said [...]

"If you completely eliminated insurance company industry profits which is clearly the aim of some, you would pay for two days of health care in America and in the process you would eliminate the market mechanism to control costs and improve quality of health care being delivered," Braly argued.

I don't know what any of this means. The market mechanism in health care has not controlled costs in America whatsoever, yet throughout the industrialized world we see public programs that control costs and provide better health outcomes. Private industry has begged off completely from limiting health care costs through any means other than denying coverage to their customers and rationing. Health care spending in Medicare and Medicaid is lower than spending through the insurance market. And insurers have used the employer market effectively to confuse employers and employees alike about the true cost of their service. Braly throws out "Fannie Mae" for health care, but the current system is clearly "Goldman Sachs" for health care - where the relentless drive for profit at the expense of people creates a spending bubble that nobody ever bothers to burst until it's too late.

In the end, Braly calls Wellpoint a "supporter" of health care reform. That's funny, I would think that a company committed to health care reform wouldn't illegally force their employees to lobby against it.

Consumer Watchdog in Santa Monica has asked California Atty. Gen. Jerry Brown to investigate its claim that UnitedHealth Group and WellPoint Inc. pushed workers to write their elected officials, attend town hall meetings and enlist family and friends to ensure an overhaul that matches their interests [...]

WellPoint, whose Anthem Blue Cross unit is the largest for-profit insurer in California and employs 8,000, took a more overtly negative tack.

"Regrettably, the congressional legislation, as currently passed by four of the five key committees in Congress, does not meet our definition of responsible and sustainable reform," Anthem said in a company e-mail last week. The proposals would hurt the company by "causing tens of millions of Americans to lose their private coverage and end up in a government-run plan."

The appeals amount to illegal coercion under California law, Consumer Watchdog research director Judy Dugan said. "While coercive communications with employees may be legal, if abhorrent, in most states, California's labor code appears to directly prohibit them," said Dugan, citing sections forbidding employers from "tending to control or direct" or "coercing or influencing" employees' political activities or affiliations.

Insurance companies like WellPoint support health care reform, all right - completely on their terms, and guaranteed to provide them a financial windfall. Anything else would be unacceptable, and they will take any tactic - no matter legal or illegal - to stop it.

(Disclosure: I'm working with Brave New Films on their Sick For Profit campaign, exposing insurance industry practices. Check us out on Facebook.)

The New York Times published a very nice press release from the desk of Humana, one of the nation's largest health insurance companies. The reporter interviewed a bunch of employees at Humana, all of whom were horrified to see themselves depicted as "villains" in the health care debate. I agree with Yves Smith, this is an absurd angle for a story, an extreme example of selection bias. The people who work at Humana probably have a sense that their employer, um, pays their salary, and thusly, what's good for the employer is probably good for them. Similarly, most people hold a favorable opinion of themselves just as a matter of getting through the day. Not to mention the fact that their understanding of the functioning of Humana is limited to their job description. It is not possible to gain much of a perspective on the health care debate or industry practices by asking a midlevel manager "Do you think you're the worst person alive?"

Since when is it legitimate, much the less newsworthy, to get a company's perception on its embattled status, at least without introducing either some contrary opinion or better yet, facts, to counter the views of people who will inevitably see what they are doing as right? I hate to draw an extreme comparison to make the point, but staff in Nazi concentration camps also thought they were good people. It is well documented that for all save the depressed, people's assessments of their own behavior is biased in their favor.

There is some revelatory stuff in the article, however. David Sirota flags one employee saying that Humana believes in keeping down costs by "controlling utilization":

Now, I know we're supposed to think that private for-profit health care companies don't ration care, while government-run programs like Medicare do - but as the insurance industry admits right here for all to see, that's just not the case. The obvious truth is that the health insurance industry works hard to "control utilization" - that is, it works hard to make sure that when you need a costly medical service, you are "controlled" (read: prevented) from getting it.

Sure, we're all against excessive testing - and there are good ways to deal with those inefficiencies. But that's not what the insurance industry is talking about. It is talking about its practice of rationing care - and now that reality is right there in black and white for all to see.

The truth of the matter is that many of the charges that insurance companies like WellPoint level at the public option and regulatory changes sought in the health reform bill mirror accepted industry practices. WellPoint, which emailed its own customers yesterday attacking the Democratic plan, claimed that health reform will “increase the premiums of those with private coverage.” Yet WellPoint routinely hikes their own premium prices by close to double digits annually, leading to ever-increasing profits. The email stated that millions of Americans would lose their private coverage and be forced onto a government-run option if the Democratic bill passed (nothing could be further from the truth); yet WellPoint routinely uses the practice of rescission to drop their own customers from coverage if they ever try to use it, and they've admitted they would continue doing so unless forced to stop by law.

The email is an example of the astroturf practices from the industry, including, no doubt, pitching to the New York Times a story putting the human face on insurers. Many of these astroturf efforts spring from the same sources as the corporate lobby groups activating the tea party protests at town hall meetings throughout the country this August. They're trying to change the subject, away from facts, like how they're spending less of their premium revenue on medical care over the years, from 90% in the early 1990s to around 80% today. Or how they use rescission and pre-existing condition to make profits off cherry-picking the healthy and denying everyone else care. House and Senate leaders have requested more and more information about insurance company practices; Dennis Kucinich has joined that effort. But the insurance industry, while nominally siding with reform, wants to keep the focus on efforts against it, in service to de-fanging it.