HEALTH INSURANCE COMMITTEE

 Chairperson:  Sandra Alfrey, Eric Southwick

Health Care Issues

BENEFIT DESIGN SERVICES

Story reprinted from the Tribune of the United Kingdom.

Next Wednesday: National Call-In Blitz for Health Care Reform Deluge the U.S. House with phone calls on Wednesday, Jan. 13. Demand health care reform that works for working families.    Dear Sisters and Brothers, Get ready: We’re taking the fight for health care reform to the finish line Wednesday, Jan. 13, with a national call-in day. Pledge now to call your congressional representative and urge your friends to call the House, too. Our message to representatives: Vote for health care reform that: DOES NOT tax our health care benefits. Requires employers to pay their fair share. Controls health care costs—and the best way to do that is by creating a public health care insurance plan option. Pledge now to make your call. The fight for health care reform has been long and hard—and we’re just weeks away from a final bill merging the versions passed by the House and Senate. Both bills greatly increase the number of people who will have health care coverage and end some of the most egregious insurance company abuses. But the bill passed by the House is far better for working families—and now is our time to tell representatives to stick to their guns and vote for health care reform that will really work for working families. The Senate bill is badly flawed. It would tax middle-class health care benefits, allow employers to escape responsibility for paying a fair share and does not include a public health insurance option to reduce costs and hold insurers accountable. We’re down to our final opportunities to make sure that health care reform passed this year works for us. Pledge now that you will call your representative next Wednesday and urge your friends to call, too. In solidarity, Marc Laitin AFL-CIO Online Mobilization Coordinator

So the House Passed Reform, What’s Next?

A lot of you have been asking, ‘What should we do now that the U.S. House has passed its version of health insurance reform?’

The short answer is: keep it up. The mission is not complete. We're still facing a tough Senate vote, and we need to keep up the push to ensure we get health insurance reform that helps, doesn't hurt, working families and retirees.

It’s important for us to keep focused on our principles and our ultimate goals, not just one specific piece of legislation or step in the process. Here are some ideas for action to help us do that:

q      Regarding those in the House who voted against the Affordable Health Care for America Act: It’s up to us to find out why and try to help address any concerns on specific issues for future votes. Take a moment to find out how your member of Congress voted, and if appropriate, take some time to thank them, or schedule some time to discuss concerns.

q      Review the Affordable Health Care for America Act as it passed the House.

q      Visit our online USW Health Care Tool Kit for the latest information, and please pass it on.

GET READY FOR NOV. 5

THIS IS IT!

We have a once-in-a-lifetime opportunity to achieve something that American working families have fought for for decades:  genuine health care reform.  This is our chance to stop greedy insurance companies and win affordable, attainable health insurance for everyone.  We have to do this for ourselves, for our children and for our grandchildren.

Victory is in our sites and we simply cannot let up and let this win slip through our hands.

Well-heeled insurance industry and short-sided business lobbying groups are spending millions every day to convince Congress to maintain the status quo and kill any kind of health insurance reform.  That is why we are asking all affiliated unions, once again, to mobilize in support of health insurance reform that includes a robust public option.

When our members of Congress hear from you - they listen and on November 5, we want them to hear loud and clear.

Your calls can make the difference.  Let them know that union members are standing firm in what we expect our of this legislation:  a strong public option to create needed competition and cost savings, coverage that is affordable and accessilbe for everyone and NO taxation of our existing health benefits.

TAKE ACTION!!!  Here is how you can help on Nov. 5:

 Commit to handing out stickers and flyers at your union worksites on Thursday, Nov. 5  (Contact our office for stickers).

Use the handouts to generate as many calls to Senators and House members as possible.

Take photos at the events and e-mail them to chedge@unions-america.com for inclusion in a national scrapbook on the web.

Report all results, including job sites and number of phone calls generated, to Cindy Hedge at chedge@unions-america.com or call her at 208-321-4814.

This is history in the making.  Quality, affordable health care for everyone.  Imagine having contract negotiations focus on wage and other improvements rather than health care giveaways.

We are so close to making this happen.  BE A PART OF CHANGING AMERICA FOR THE BETTER.

Download attachments:

·         Health Care Reform (Powerpoint)

·         Health Insurance Reform PowerPoint Script (PDF)

•  Health Insurance Reform Where We Stand (PDF)

·         Health Care Reform District Coordinators (Excel)  

Congress "Getting Completely Crushed" With Over 100,000 Calls For Obama's Healthcare Reform

It's not even noon on the West Coast and already Capitol Hill staffers say they're getting nonstop calls from constituents in support of President Barack Obama's health insurance reform. At about 2:15 EST, Organizing for America (OFA) surpassed it's goal of 100,000 phone calls to Congress, each one imploring representatives to vote for reform.

The nationwide "Time to Deliver on Health Reform" event is the most massive outpouring of support from Obama supporters since Election Day 2008.

Senate Democratic aides told HuffPost that their phones have been ringing off the hook. "We're getting completely crushed with calls, jamming our phone lines from the moment we opened," said one aide.

Another said they'd gotten "pretty much non-stop health care calls from OFA." A third also said their office was getting bombed and that four out of every five calls specifically mentioned the public option.

Only one aide contacted said that the calls had not been heavy. "We've had about 130 [health care] calls to the DC office today," said a staffer, explaining that on busy advocacy days the number can climb much higher.

Several aides said the callers seemed less informed about the issue than typical advocates, indicating that Obama is reaching a wide variety of voters who do not typically engage in the political process. Almost all of them called on the senators to support the President's health care plan. Several aides noted with irony that the president doesn't have a specific plan that he has endorsed - to the great frustration, in fact, of many Democrats.

After the election, Obama for America (OFA) became Organizing for America (OFA), an issue-oriented advocacy arm of the DNC whose primary purpose is to help make campaign promises a reality by cultivating public support for Obama's agenda.

Calls officially started at 9:00 AM Eastern, and supporters reached 40,000 calls about noon. From there, the numbers climbed quickly, hitting 85,000 around 1:30 PM and 95,000 around 2:00 PM -- fifteen minutes after that, 100,000.

To generate these numbers, OFA organized over 1,000 phonebank events across all 50 states. Yesterday, OFA said its phonebanks would make hundreds of thousands of calls to voters in order to generate 100,000 calls from constituents to Congress.

This morning's email to OFA members said, "If we hit 100,000 calls made or committed to, we'll send an unmistakable signal that this time, families must come before insurance companies. We'll be tracking progress toward our goal publicly -- make sure to report your call back to us so we can count it." (See the current count.)

President Obama will speak to OFAers across the country today at 8:00 PM Eastern to kickoff the evening phone banks. Sources within OFA say they are going to raise their goal to 150,000 calls to Congress but no official word yet.

The Truth About Healthcare. . .Did You Know?    

August 24, 2009

Out-of-network fees can devastate families

Emergency care outside approved hospitals can lead to astronomical bills

On the evening of March 1, 2008, Gary Diego was relaxing with his wife, Ellen, when she abruptly lost her hearing, began repeating herself, and seemed to be losing her grip.

Alarmed, Diego rushed her to his insurance company’s in-network hospital, near his home in Truckee, Calif. Unable to handle what was determined to be bleeding in the brain, the hospital quickly transferred her to Renown Regional Medical Center in Reno, Nev., where she spent 17 days in intensive care. While recovering, she caught pneumonia and died.

A few weeks later, a still-grieving Diego learned from his insurer, Health Net, that he owed the Reno hospital $75,462.77. The reason? The hospital was not in his approved network.

Diego’s story is an extreme example of what can happen in medical emergencies. Consumers who are careful to choose in-network doctors and hospitals for their routine medical care often cannot choose where or how they are treated in an emergency. In a practice known as balance billing, insurers pay a portion of the out-of-network charges, and the balance owed to hospitals and doctors is dumped on patients.

Until recently, the problems associated with out-of-network emergency care had received little attention. But now they’re being attacked on multiple fronts, with insurers, hospitals and doctors pointing fingers at each other, and patients stranded in the middle.

On Aug. 12, an insurance industry trade group released a report saying some out-of-network doctors and charge much more than the negotiated fee they would collect in a network.

The group, America’s Health Insurance Plans, noted that out-of-network fees are not regulated and asked Congress to investigate the issue. None of the leading reform bills addresses the issue now.

Doctors, on the other hand, complain that insurers pay them too little. Many have been critical of a January California Supreme Court decision that banned balance billing, meaning that physicians cannot charge patients on top of what the physicians have received from an insurance company.

In a victory that same month, the American Medical Association and others reached a $350 million settlement with UnitedHealth Group, the nation’s second largest insurer, over what the AMA charged were unfairly low out-of-network payments. That dovetailed with another agreement New York Attorney General Andrew Cuomo reached with UnitedHealth to help fund a new independent means of determining appropriate payment rates for out-of-network care.

Sen. Jay Rockefeller, D-W.Va., held hearings on the practice in March and April, during which he said inadequate payments by insurers constitute “outright fraud.”

“All physicians want to do is get paid fairly,” said Dr. Ray Johnson, an emergency room physician in Mission Viejo, Calif., and a board member of the American College of Emergency Physicians. “We don’t want to balance-bill patients. The key is to come up with a fair payment number” that would be covered by insurance.

Insurance companies say the same thing — but the two sides have trouble deciding what a fair payment should be.

It’s impossible to determine in Diego’s wife’s case whether the hospital overcharged her — that is, balance-billed her — or whether the insurance company initially refused to cover a legitimate bill. That’s because the hospital is not in Diego’s network, and so the insurer and hospital have no agreement spelling out charges.

Even when emergency care is delivered in an in-network hospital, patients often receive bills from laboratories and doctors who worked on their case but are not in their networks — sometimes from radiologists or pathologists they have never met.

June 25, 2009

What Must be Included in Health Care Reform Legislation?

QUESTION:  “The U.S. House and Senate are completing drafts of health care reform legislation. President Barack Obama has said he wants Congress to pass the legislation so he can sign it this fall. What do you believe must be included in that legislation to resolve the health insurance crisis in the U.S.?”

GO TO THE USW BLOG AND READ WHAT OUR LEADERS HAVE TO SAY...CLICK THIS LINE

APRIL 14, 2008

Crisis = Opportunity for Single-Payer

Fiscal crises may force Obama to save costs via a single-payer plan.

http://www.dollarsandsense.org/archives/2009/0309bybee.html

By Roger Bybee as seen in the April/May issue of "Dollars and Sense" magizine.

President Obama seems ready to proceed full-throttle toward a health care reform plan, but one that will keep private insurers at the center of the system. The plan, termed “guaranteed affordable choice,” would allow workers to “keep the insurance they like,” find a rival private insurer, or opt into a Medicare-style public plan.

To date, Obama has sensibly insisted that quick action on health care is imperative. “It’s not something that we can put off because of the [financial] emergency,” Obama declared in December. “This is part of the emergency.” Questioned about the wisdom of launching a $100 billion health care program at a time of mounting government deficits, “I ask a different question,” Obama countered. “How can we afford not to?”

He’s right: economic meltdown is making health care reform more urgent by the day. Hospitals are hurting; while “the number of paying patients and profitable elective procedures is down . . . ,” the LA Times reported recently, “the number of uninsured patients whom hospitals treat is rising.” At the same time, escalating health care costs are squeezing private employers and governments alike. “The new Congressional Budget Office report shows that rising health care costs are the largest driver of the nation’s long-term budget problems,” budget watchdog Robert Greenstein of the Center on Budget and Policy Priorities told Congress last fall.

But Obama’s hybrid, public-private plan is likely to hit a fiscal wall as federal spending balloons, and along with it the deficit. In the end, both popular sentiment and fiscal barriers may force him to follow a different course.

The administration’s plan subsidizes lower-income Americans to enable them to buy private health insurance. Contrary to Obama’s statements during the campaign, his plan will “need to require” all individuals to have health insurance, concludes the respected Commonwealth Fund. Such a mandate would be crucial to securing industry concessions necessary to move toward universal coverage, particularly a ban on excluding people with pre-existing conditions from coverage.

If so, the plan would eventually deliver tens of millions of new enrollees —the number of uninsured is about 47 million—to the insurance companies. Some 31% of their premiums, in many cases government-subsidized, will go into overhead and insurance company profits—an estimated $400 billion annual burden weighing down the health care system.

But this plan is on a collision course with the fiscal realities. On top of the budget wreckage left by the Bush years, the federal government’s fiscal demands are exploding. Health care reform faces daunting competition from a $787 billion stimulus package; the president’s $72 billion decision to delay repealing the Bush tax cuts for high earners; a Wall Street, bank, and insurance company bailout at $700 billion to date and likely to grow; and the ongoing Iraq and Afghanistan wars, together costing $170 billion in “extra” defense spending in FY2009.

Still, a leading advocate of the Obama plan, political scientist Jacob Hacker, argues that it can be billed as an important economic stimulus and thus escape the fierce budgetary competition. In December, Hacker cheerfully declared in The New Republic that the Obama plan offers nothing less than a “magic bullet” that will yield “short-term spending and long-term saving”—a perfect combination as the economy moves deeper into recession.

However, it is likely that Hacker seriously overstates the long-term savings while underestimating the clash of government priorities that lies just ahead. First, Obama-style individual mandate plans have run aground in at least six states that have tried them. With no mechanism to control the premiums charged by private insurers, the ever-higher cost of subsidizing low-income residents’ premiums soon exhausts available funds. Nor will sufficient savings be derived from Obama’s plan for electronic recordkeeping and more treatment of chronic illness, recent studies by the Congressional Budget Office and others suggest.

To many, a single-payer plan is the obvious way to ensure universal health coverage while containing costs. In addition to the dramatic reduction in administrative costs, single-payer plans offer other opportunities for controlling costs. For instance, they allow government—the “single payer” —to negotiate for lower costs with providers like doctors, hospitals, and pharmaceutical companies.

Unfortunately, Obama’s statements and key appointments suggest he has already disqualified single-payer as a serious option.

Tom Daschle, tapped for Health and Human Services secretary and “point man” on the health care reform effort until tax problems forced him to withdraw his name in February, appeared unwilling to let the private insurance industry go. His basic policy direction emerged in an interview last May. In a remark that seems staggering in hindsight, Daschle said, “And I would ask the question, if you think our banking system today is reasonably regulated, why not try the same model for our health-care system?”

Obama’s initial pick for surgeon general was TV health expert Dr. Sanjay Gupta. Gupta was trounced by Michael Moore in a televised debate over Moore ’s documentary “Sicko,” and was then forced to retract some of the factually inaccurate criticisms of single-payer he had offered.

Another key player is Senate Finance Chair Max Baucus, author of a plan similar to Obama’s. Baucus recently dismissed the single-payer option on this basis: “We are Americans; we’re different from Canada , we’re different from the United Kingdom .” Baucus was probably not referring to the United States ’ poorer health outcomes at vastly higher costs when he spoke of the American “difference.”

Promoted by this kind of team, Obama’s health-care plan could prove to be the most vulnerable component of his domestic program. The Republicans feel confident about their ability to brand Obama’s plan as overly complex and a threat to consumer choice in medical care, as they did so successfully with the Clinton plan in the 1990s.

The Obama plan’s “pay or play” component, giving employers a choice between insuring their employees or paying a tax to help finance the government plan, will no doubt open it up to conservative criticism as a coercive, big-government program. This line may also strike a chord among moderate-income citizens who earn too much to qualify for a subsidy and consequently lose enthusiasm for reform once they start to pay mandatory health premiums.

The single-payer approach, on the other hand, would disarm many of the most explosive Republican arguments. It is far less costly to both employers and individuals—nearly 50% lower per person in Canada than the United States , for instance—and there is no billing of patients or other complexity. Every citizen enjoys the right to health care and a free choice of doctors and hospitals. Start-up costs would be minimal, especially if Medicare were simply expanded to cover the entire public.

Back in 2003, Barack Obama told the Illinois AFL-CIO: “I happen to be a proponent of a single-payer universal health care program. I see no reason why the United States of America , the wealthiest country in the history of the world, spending 14% of its Gross National Product on health care, cannot provide basic health insurance to everybody . . . a single-payer health care plan, a universal health care plan. And that’s what I’d like to see. But as all of you know, we may not get there immediately. Because first we have to take back the White House, we have to take back the Senate, and we have to take back the House.”

Now that Obama himself occupies the White House and health care costs consume nearly 17% of GNP, the new president may rediscover that single-payer is the truly pragmatic course on health care reform. Hemmed in on all sides by the enormous costs facing the federal government, Obama may find—despite his misgivings—that pursuing a single-payer reform plan is the sole means of creating a low-cost and appealing alternative to the health-care status quo.

SOURCES: Jacob S. Hacker, “A Healthy Economy,” The New Republic, Dec. 31, 2008; S. Woolhandler, T. Campbell, and D. Himmelstein, “Costs of Health Care Administration in the United States and Canada,” New England Journal of Medicine, Aug. 21, 2003; Physicians for a National Health Program, “Barack Obama on single payer in 2003,” posted June 4, 2008; Maggie Mahar, “On Healthcare Reform Stimulating the Economy: the Massachusetts Example,” Health Beat blog (Century Foundation, Dec. 12, 2008); Sara Collins et al., “An Analysis of Leading Congressional Health Care Bills, 2007-2008: Part I, Insurance Coverage,” Commonwealth Fund, Jan. 9, 2009; Kevin Freking, “Health secretary pick seeks health care overhaul,” Associated Press, Jan. 10, 2009.   #30#

You can encourage President Obama to support HR 676, single payer health care, here: 

Email:  www.whitehouse.gov/contact/

Write:  The White House
            1600 Pennsylvania Avenue NW
            Washington , DC 20500

Call:  202-456-1111
Fax:  202-456-2461

Distributed by:
All Unions Committee For Single Payer Health Care--HR 676
c/o Nurses Professional Organization (NPO)
1169 Eastern Parkway, Suite 2218
Louisville, KY 40217
(502) 636 1551
Email: nursenpo@aol.com
http://unionsforsinglepayerHR676.org
04/14/09

                  THE PROGRESS REPORT

 April 3, 2009

HEALTH CARE

The Case For A Public Health Care Plan

Though President Obama and 73 percent of voters strongly support a new public health insurance plan that can compete with private insurers equally and transparently within an insurance exchange, some lawmakers have indicated that a public plan may not be part of the final reform legislation. Yesterday, the Congressional Progressive Caucus threatened "to vote against any health plan that doesn't include a public plan option." "We have polled CPC members very carefully in recent weeks and a strong majority will only support comprehensive healthcare reform legislation that includes a public plan option on a level playing field with private health insurance plans," explained CPC co-chairmen Reps. Lynn Woolsey (D-CA) and Raul Grijalva (D-AZ)." Senate Finance Committee Chairman Max Baucus (D-MT) has recently said that the public plan is just a bargaining chip to "encourage the private health insurance industry to move in the direction it knows it should move toward -- namely, health insurance reform, which means eliminating pre-existing conditions, guaranteed issue, modified community rating." "I think we can accomplish" health care reform "without" a public plan, Baucus said in an interview with The Progress Report. The insurance industry asserts that a new public plan would underpay medical providers, increase costs for Americans with insurance, and force millions to leave the employer market and move into a public plan. There is also limited bipartisan support for the plan. Sen. Ron Wyden (D-OR) has warned that there is "no GOP support for a plan that included a government option" and in March, Sen. Mitch McConnell (R-KY) sent a letter to Obama, effectively taking this option off the table.

LOWERS COST: Despite the opposition, a new public health inurance plan could restore competition into the consolidated health insurance market, lower health care premiums, lead the way in innovation, and improve health quality. As CAPAF Senior Fellow Peter Harbage and Director of Health Policy Karen Davenport argue in a new report about the public plan, "in the face of tremendous consolidation in the health insurance market, employers and individuals have a shrinking set of health insurance options. Private insurers have used this market power to boost their profits." Harbage and Davenport add, "By including a public health insurance plan as another insurance option and creating a health insurance exchange that delivers transparency and accountability to the market, we can assure both viable competitors and real competition." As former Gov. Howard Dean (D-VT) argues, health reform "rises and falls on whether the public is allowed to choose" a public option. In a recent interview with The Progress Report, Dean explained that "the free market does not work in health care, except in very perverse ways. So, you have to find a system that works better in addition to the free market...it's a structural problem in delivering health insurance." According to the Urban Institute, "the presence of a well-run public plan would constrain private spending, as the plans would have to compete on price." Forcing private insurers to compete fairly with a public model that has lower administrative costs and operates with greater efficiency could "reduce projected health care costs by about $2 trillion over 11 years, and lower premiums by about 20 percent on average."

IMPROVES QUALITY: Traditionally, public health insurance plans like Medicare have "been the source of important payment innovations" that private plans have generally adopted." Today's Medicare program, for instance, "promotes quality care alongside cost containment. ... Medicare's refusal to pay medical care providers for 'never events' where a patient suffers a knowable and catastrophic mistake such as having the wrong limb removed is something other major insurers are now adopting." Similarly, Medicare development of its provider-payments systems and its investments in measuring and reporting quality care indicators are "two things that private insurers are now following the Medicare lead in doing." Moreover, "the way in which Medicare pays hospitals -- on a per stay basis rather than by reimbursing on a system that charges for each service or treatment delivered -- helped to change the way that care is delivered in the United States ." The Veterans Health Administration has also "implemented a sophisticated electronic medical record systems and a quality measurement approach that focuses on preventive care and chronic disease management." A new public plan has the potential to do even more "to drive improvements in the health care system" and set the standard for developing new payment models and investing in preventive care and care coordination.

DESIGNING FAIR PUBLIC-PRIVATE COMPETITION: While the public option has become the subject of heated debate, few have spent much time sketching out the details for how to foster fair private-public competition. Robert E. Moffit of the Heritage Foundations has argued that it would be impossible to design a framework that pits for-profit private insurers against a government program that need not turn a profit. The government will institute lower rates, taxpayers will assume liability, and private insurers, Moffit warns, will simply go out of business. But eliminating medical underwriting will lower the administrative costs for private insurers and force companies to compete on quality, not risk. As health care economist Uwe Reinhardt explains, "if the new public plan had to negotiate its own prices, then it would not have a competitive advantage any more 'unfair' than is the ability iof large insurers -- such as Aetna and Wellpoint -- to negotiate lower prices with hospitals and physicians than these providers charge smaller insurers. For some reason, no one has ever called this form of price discrimination 'unfair.'" In fact, more than 30 states already have public health insurance options. In their role as self-insured employers, states are responsible for containing costs, promoting quality, and assuring that employees get the benefits and the care they need. In these states, employees may choose between private plans and the public plan, while in some states this pool is open to private employers as well -- a clear example of a public health insurance plan offering additional choices. Len Nichols of the New America Foundation has designed a framework that would ensure that the same body that's running the government plan isn't setting the rules of the competition, charging unreasonably low rates, or assuming too much risk. Such models already exist. Under Nichols' conception of a competing public option, the new program would "be accountable to an entity other than the one identified to govern the marketplace." The managers would be evaluated by patient satisfaction, not profits, and the people running the plan would have no incentive to stint on patient care in favor of the bottom line. In other words, public and private payers compete on a completely level playing field and follow all of the rules of the marketplace. The public plan would be actuarially sound, would not leverage Medicare to force providers to participate or use Medicare payment rates, and would have to adhere to the same rules regarding reserve funds. Costs would be lowered through competition and system-wide reform. By changing the way Medicare and the public option reimburse for services and increasing the efficiency of both programs, the government can encourage private insurers -- who are now competing directly with the new public plan -- to also adopt more efficient payment practices.

Washington insiders are pushing the idea of taxing health benefits provided by employers.  It is an outrageous idea that had been proposed by Presidential Candidate John McCain and rejected by the nation.

 

Such a tax would undermine employer based health benefits without guaranteeing the care that would come with a single payer plan. 

 

Only through single payer can we save the $400 billion annually from the profits and administrative waste of the private insurance companies.

 

You can express your opposition to taxing employer health benefits and your support for HR 676, national single payer health care, here:  http://www.whitehouse.gov/contact/   and here:  http://www.healthreform.gov/communityreports/comments.html

 

 

Administration Is Open to Taxing Health Benefits

section on the Make Our Future Work site at www.makeourfuturework.org.

For an updated version of the Resource Guide for Laid Off Steelworkers visit the Make Our Future Work

site at www.makeourfuturework.org.

USW Rapid Response ? (412) 562-2291 ? http://www.uswrr.org

U.S. President Barack Obama speaks during the opening session of the White House's forum on health care reform in the East Room of the White House on March 5, 2009 in Washington, DC.

Chip Somodevilla / Getty

There is a battle looming in Congress, a contest that will pit many of the most powerful companies in America against each other, potentially reallocate trillions of dollars in spending, and literally impact the future health and well-being of each and every American. No one knows how the conflict will end, just yet, or who the winners and losers will be. But if Thursday's Health Care Reform summit at the White House is any indication, there is no doubt who will be standing at the middle of the scrum: The nation's self-anointed Mediator-in-Chief, President Barack Obama.

"I just want to make sure that I don't get in the way of all of you moving aggressively and rapidly," he told a crowd of corporate and trade group Leaders and members of Congress in an afternoon East Room ceremony. "To the extent that this work is being done effectively in these various committees, then I assure you that we are going to do everything that we can to work with all of you." (Read "Obama Moves Health Care to the Front Burner.")

They were soothing words, but all was not as touchy-feely as it seemed. Even as he offered himself up as a head referee more than a star player, Obama left no doubt about who was in charge. Congress and the trade groups, he said, could haggle over the terms. But they could not obstruct the project, and they would walk away at their own peril. "The status quo is the one option that's not on the table, and those who seek to block any reform at all, any reform at any costs, will not prevail this time around," he told the group.

The sheer enormity of the task has been clear for months. But it was on sometimes painful display at the two breakout sessions to discuss healthcare that Obama has already organized at the White House. The first session, which occurred in late February in the Indian Treaty Room, had a somewhat comical cast to it. Dozens of powerful people sat around a square table in one of the most gaudy and expensive marble rooms ever built by the U.S. government. The task: Figure out how to save money on health spending. The solution, according to almost every person present: Spend more money. (Read "Senate Democrats Optimistic on Health Reform.")

The nurses association wanted more investment in the nursing workforce. The head of the hospitals association wanted more money for hospitals. The head of the American Medical Association wanted higher Medicare reimbursement rates for doctors. Rep. James Clyburn, D-S.C., wanted more money for community healthcare centers. Sen. Arlen Specter, R-Penn., wanted a better focus on investigations of white collar fraud in the healthcare sector. Rep. Barbara Lee, D-Calif., wanted greater investment in HIV-AIDS prevention. Rep. Mike Castle, R-Del., spoke of greater National Institutes of Health Funding. It went on. (See the most common hospital mishaps.)

If there was hope, it was to be found in the fact that all these people were, in fact, sitting at the same table. All of them, from health insurance companies and medical providers to politicians from both left and right, said they were committed to reducing healthcare costs, and growing coverage, the two guiding principles that Obama has insisted on.

Sen. Sheldon Whitehouse, D-R.I., spoke to this commitment on Thursday, during the second round of breakout sessions organized by the White House, this time in the more tastefully appointed State Dining Room. "I just want to express the intensity of my confidence that there is a path through this for us," he said, before referencing the famous television advertising that the insurance industry funded to knock down the last major attempt at health-care reform. "We are past the 'Harry and Louise' moment. We are at the Thelma and Louise moment. We are in the car. We are headed for a cliff."

Whitehouse's optimism was confirmed a few minutes later by Scott Seroto, the president of the Blue Cross Blue Shield Association and a representative of the industry that had funded the "Harry and Louise" ads in 1994. "Consider that the past," he said of the ads. "We are embracing the need for reform... It just needs to be appropriate and sustainable."

This message was long ago delivered to the White House. One senior Administration official explained the situtation, last week, during an interview in the Ward Room, a navy themed dining hall near the White House mess. "If you reflect back on what health-care reform looked like and how it played out 15 years ago, some of the stakeholders who were fighting very hard against it are people who I think will start to come around to the table for the conversation now," the official said.

At the center of this strategy, as its linchpin, is the President, who has positioned himself not as the author of the new health plan, but as its mediator, facilitator and, if needed, as the taskmaster who intends to keep everyone on track. In his recently proposed budget, and on the campaign trail, Obama proposed the vague outline of a policy solution, including nearly $630 billion in new spending on health care in the short term, which would be coupled with long term cuts in the growth of medical costs. But he told leaders Thursday afternoon that he is not wedded even to his own ideas.

"If there is a way of getting this done where we're driving down costs and people are getting health insurance at an affordable rate and have choice of doctor, have flexibility in terms of their plans, and we could do that entirely through the market, I'd be happy to do it that way," the president said. "If there was a way of doing it that involved more government regulation and involvement, I'm happy to do it that way, as well. I just want to figure out what works."

If that was the carrot for lawmakers, his command that they fix the problem was the stick. At one point, he joked about Whitehouse's allusion during the breakout session to Thelma and Louise, a movie that ends with the protagonists dying in a blaze of glory. "If you actually saw the movie, they did drive over the cliff," he said, to laughter. "So just want to be clear, that's not our intention here."

Study Looks At The Vanishing Health Care for Retirees 
According to a survey by the consulting firm Hewitt Associates and the Kaiser Family Foundation, people who retire in 2004 face insurance premiums about 25 percent higher than those who retired last year.

The report goes on to say that in 1991, 80 percent of companies that employed 1,000 or more workers offered health coverage to retirees, but by 2003 that number had fallen to 57 percent.

Many workers on the verge of retirement are having to look at altering their plans and stay on the job longer as more and more companies are dropping health benefits for future retirees. And of the plans covered by employers, many are asking retirees to pay more of their health costs through higher insurance premiums and larger co-pays for doctor visits and prescription medicines.

While most of those affected are new hires, the prospect of losing health coverage in retirement is troubling particularly to people who are considering changing jobs or who want to retire between the ages of 55 and 64.

Although Medicare kicks in at age 65 for older and disabled Americans, its benefits are usually not as generous as those offered by employers, mainly because the workplace plans cover prescription drugs.

To add to the worries of potential retirees, the Bush Administration has been working on a plan to privatize Social Security, which will place an even greater burden on those workers who were considering enjoying their "golden years."

President Bush Admits Problems With Drug Discount Cards 
Even President George W. Bush now is admitting that there are deficiencies with the drug discount cards that became available two weeks ago.

"We've got some problems," Bush told a crowd in Liberty, Mo., a suburb of Kansas City. He said the obtaining and using the cards are so complicated that few older Americans are signing up for them. Most of the 3.3 million Medicare patients who have the cards were signed up automatically by private health plans to which they belong.

At the American Association of Retired People (AARP), only 5,900 persons have signed up. "People are having a tough time" understanding the program, AARP spokesman Steve Hahn said. "They are a bit confused, and they are getting overwhelmed with information."

Massachusetts Sen. John Kerry said the discount drug card could result in older Americans paying more for prescriptions than they already can obtain though other kinds of pharmaceutical discounts. He said a better strategy to try to lower drug prices would be for the government to negotiate discounts directly with pharmaceutical companies and make it legal for people to import U.S.-manufactured drugs from Canada and other countries where they are sold at lower prices.

The new Medicare law specifically prohibits both actions.