"The AMA is not as powerful as it was in the mid 20th Century,"  when it was arguably the organization most responsible for blocking efforts at national health insurance," writes Jonathan Cohn in The New Republic  "Nor does the medical community speak with the same unified, conservative voice it once did. Different types of physicians hold different views and speak through different organizations. Primary care physicians in partiuclar--organized through groups like American Academy of Family Phyisicians and the American Pediatrics Association--are generally more liberal and may well speak out in favor of the public plan, if they haven't already."

If health care legislation is approved, it will be an interesting indicator of which group(s) are the new 800 lb. gorillas in DC...

“As Mayor of San Francisco, the first city to offer universal access for the uninsured, I know that America’s cities can provide compassionate and innovative health care to their residents,” said Mayor Newsom. San Francisco is attempting to offer universal health care through its controversial Healthy San Francisco program, which has won plaudits from some health reform advocates while antagonizing many small businesses in San Francisco.

Read more.

"It is clear to me that there is real movement in the Senate on the issue of taxation of health benefits. I can see key Senators on both sides of the aisle agreeing to it as a means to help pay for reform. Likely, it would take the form of taxing everyone’s benefits above a certain threshold or taxing all health benefits for higher income people.

Read the whole post here.

Hope Street Group's Monique Nadeau submitted the following letter to the editor of the New York Times in response to an April 9 op-ed:

To the Editor:

    Forget universal health care coverage? Then you can forget the American Dream, too.

    Ramesh Ponnuru, in his April 9 op-ed ("The Misguided Quest for Universal Coverage"), is wrong to oppose the goal of universal access to health care coverage.

    While Mr. Ponnuru takes on the "practical, moral and political" cases for universal coverage, he ignores the most compelling case of all – the economic case. Hope Street Group, the non-partisan policy organization that I lead, has developed an Economic Opportunity Index (EOI) to show that the economic future of our people and our country depends on all of our citizens having access to health care coverage. The EOI demonstrates that health accounts for almost 25% of the total variation in economic opportunity.

    The author seems to imply that the only debate is about providing universal health care, unnecessarily raising costs. The fact is that controlling costs and improving quality are just as important, and are an integral part of all serious health reform discussions taking place in DC.

    To deny universal coverage -- and to ignore this opportunity to drastically remake the system -- is to deny millions of Americans the opportunity to lead healthy, productive lives and diminishes our country’s chance to regain its global competitiveness and widespread prosperity.

    Monique Nadeau
    Executive Director
    Hope Street Group

Access to quality health care and higher education is a fundamental human right to which all Americans should be entitled regardless of socioeconomic background, race, or gender.  Health and education are the most important drivers of economic opportunity in the United States according to Hope Street Group's Economic Opportunity Index, and yet our current system is set up in a way that essentially only allows those who are already benefiting from economic opportunity to profit from decent health care and education.

In their article, Viewpoint: Parallel crises in health care, higher education, Patrick Callan and Andrew Yarrow argue that this crisis is enormously dangerous to "a prosperous, optimistic American future" - but I would take their argument one step further and add that this crisis is detrimental to the survival of America as we know it, and the signs are beginning to show already.  The United States was a major force behind the creation of the global knowledge economy, and yet, compared to many industrialized countries, it is churning out one of the most ill-prepared workforces entering this economy.  If this continues, our nation will see an increasingly larger portion of future generations working harder and achieving less.  If we reach a point where hard work is no longer rewarded, we will in essence create a system that mimics an old arch-enemy that haunted our very existence during the Cold War.  Ironically, we continue to fight wars to protect our democracy from foreign influences, while our internal politics slowly chips away at the very foundations on which our democracy is based.

Our forefathers built a democracy on the intentional use of the word suffrage, signifying the right rather than the privilege to vote, and to maintain this great democracy our policymakers need to continue to build on our rights by including quality health and education.

This weekend I received a letter from Blue Shield, my insurer, telling me that two weeks ago they terminated their contract with my health care provider and hospital. Yes, that's correct--they told me two weeks after the fact, leaving me and countless others scrambling to figure out where to go for health care, and whether their care during the previous two weeks had been covered. Being strongly attached to my doctor (who is also my son's doctor), I got on the internet to see if I couldn't just switch health insurance companies. I soon discovered that as woman of documented child-bearing abilities, I (or, more accurately, my employer) would need to shell out a lot of cash to get insured.

Before panicking, I phoned a state agency called the "Department of Managed Care" (and if this sounds like it's straight out of Kafka to you, you're not the only one) to get their take on the situation. And that's when they told me that insurers and providers often have these "spats," terminate contracts, and then renegotiate, a process that can take months. In other words, they are playing chicken--although in this case, the victims are neither the hospitals nor the insurance company, but patients.

When I sat down to lunch at Luna Park in San Francisco the other day, I noticed a postcard telling customers that the restaurant would be adding a $1.00 service charge per guest to each check to help pay for the health care of its employees. Say what? Recently, the city of San Francisco mandated that all employers within the city provide paid sick leave and health care to employees who work more than ten hours per week. Healthy San Francisco was unveiled with much fanfare by Mayor Gavin Newsom, who had made it a campaign promise to provide universal health coverage to the city's large number of uninsured.

However, the program has exposed some interesting tensions and fault lines within this unabashedly liberal city. For while the goal of providing universal health care is something most San Franciscans would be happy to get behind, when the rubber hit the road, business owners of all stripes fought against it, concerned about being put out of business by the mandate.

So it was interesting to see one business's response to the requirement. Luna Park proudly passes off some of the costs to the customer in a straightforward way, stating, "Rather than raising menu prices, we have chosen to offset these costs by adding a $1.00 service charge per guest to each check. We wish to be able to maintain our menu pricing methods and represent our prices properly to our out of city guests." I liked that the restaurant was not only being honest with its customers but that it was also drawing attention to the issue (click on the thumbnail image to see how it looked on the check). It also made me wonder how other small business owners in the city are coping with the requirement.

It remains to be seen how the program will impact the health of its citizens--the mayor's hope is that by encouraging people to seek preventive care, the city can offset larger medical costs in the long run. In the meantime, it's a fascinating case study of how one major metropolitan city is responding to the health care crisis.