I’m much more disgusted with both sides on the prop 72 debate than I was before this past week. I went to a “debate” on it at the Commonweatlh Club on Monday and then heard (and phoned into) an NPR show on it this morning. (The show wasn’t my finest hour, but then I matched the general level of debate and I’m on about 10 mins before the end of the show).

The opposition was the Allan Zaremberg from the American Chamber (at the debate) and a school board member Gabriella Holt (on the radio) representing public sector employers. The chamber of commerce’s major objection — and I am not making this up — was that the 20% of premium that Prop 72 would force the employee to pay (capped at 5% of income) would take away their choice to buy other things with that money! In other words the poor little poor minimum wage employee doesn’t want health insurance, otherwise he’d be buying it himself already! Obviously the Chamber hasn’t noticed how bitterly hotel and grocery workers in this state are fighting to maintain their health benefits, nor have they noticed how much employees in polls always favor health benefits over cash, nor have they noticed how shitty the individual insurance market is. This argument really reminded me of a southern lady I once sat next to on my first trip to the USA. I asked her about being in the south during the Civil Rights movement. The first thing she said to me was, “well I’ll tell ya one thing–the blacks didn’t want it!”.

My namesake from the public employer representative didn’t seem to realize that she was being a shill for the fast food companies and Walmart, which exposed its true colors by dumping $500,000 into the No on 72 campaign today. (I have a sneaking feeling that she’s a single payer advocate). She kept on claiming that the demands of 72 would increase labor costs for school districts, and therefore lead to lay-offs. I think she meant that there are some employees who do not get health benefits from school districts (my guess is that they are the lowest paid employees like the janitors), and that by covering them they’d run out of cash. However, even if that is right for a school district it certainly isn’t the case for other employers — especially the fast food chains and the Walmarts who cannot move their stores out of state, but would be forced to pay more in labor costs and TA-DA reduce their profits in consequence. That’s why they are opposing 72, and it doesn’t take a rocket scientist to figure out that they’d rather have the taxpayer take care of their employees than do it themselves. Worse, particularly in Walmart’s case, it’s forcing its competitors here (Albertsons, Safeway, etc) into the same behavior, which will force even more costs onto the taxpayer in the future in the absence of 72. This is a straight fight between allocation of revenue to labor versus corporate profit for immobile service businesses, whatever a certain Harvard PhD student might think.

The advocate of Prop 72 was the ex-head of the CMA and the AMA, Richard Corlin, and he wasn’t exactly a whole lot better. He delighted in consistently saying that he didn’t want government regulation, and that this was a tiny incremental solution that only worked for a few people (1 in 6 of the uninsured). He’s right but that’s not a good thing! As per usual you can expect organized medicine to protect its own arse first, and to only move very modestly in the direction of helping the people it serves.

So why am I for Prop 72?

1) It levels the playing field between big firms that can’t move (notably Walmart and the other grocery stores) preventing an ugly race to the bottom

2) The additional cost will start motivating large and medium sized business to finally get on the right side of this issue, pushing them to look for a universal solution that includes real cost containment and real universal coverage.

3) At the margin, as a value judgment, 1 million poor working people getting coverage is better than Walmart and McDonald’s shareholders getting slightly bigger dividends.

Meanwhile, polls have this Prop dominated by the undecideds.

Postscript: I have replied privately to the non-reply to my point by the Anna Sinaiko, the author of the Health Affairs article, and as she’s just a doctoral student I’ll give her a little while to respond to my attack on her dismal science. Of course if I don’t hear from her soon, there may just be one more little article on this topic before Tuesday. And it wont be pretty.

So I’m in Vegas, which is in Nevada, and I’m getting a flavor of what a “swing state” means and where all the billion dollars (mostly raised from California & New York) has gone. Every single commercial is about the election. In California it wasn’t a quarter this bad when Arnie was running 2 per commercial break during the recall election. Not only does Kerry flip-flop on the war and Bush suck on the deficit, but lawyers and doctors are fighting on 3 separate malpractice propositions. And all this for the votes of 2 million people? About time something was done about the electoral college for the health of the populations of the swing states and the relative financial state of TV stations in Vegas and Los Angeles. Los Angeles is basically 9 times the size of Nevada, but tell that to the Founding Fathers.Meanwhile, congrats to health care wonks Ross at the PublicHealthPress and Jonathan Cohn on the Red Sox victory. Jonathan told me that it was the greatest day of his life, and given that mine was this day in 1997, I understand. Of course, these things come in threes, the Patriots, the Red Sox and maybe another late finisher from Boston?

Meanwhile, it does look like the docs might win one of those malpractice suit propositions in Nevada.

Note: due to a problem when Blogger had a malfunction this post dissapeared yesterday, so I’ve put it back in. I hope that Google (which owns Blogger) spends some more of their massive amounts of cash upgrading the whole thing soon!

A fascinating 2 pager from the kaiser Family Foundation looks at opinion polls in three swing states, Iowa, Ohio and Minesotta. There are some really amazing things in here:

A poll conducted October 8-11, 2004 by Market Shares Corp. for the Chicago Tribune among likely voters in key Midwest swing states found that health care ranked first as an issue of concern to voters in Iowa and Wisconsin, and ranked second behind job losses and unemployment in Ohio. Three weeks earlier, a series of polls conducted by Mason-Dixon Polling and Research for Knight Ridder and MSNBC found that health care ranked lower as a voting issue in these same states, behind terrorism and the economy (and in some cases behind other issues such as Iraq and jobs as well).

What was the difference? Well one difference was the 3 weeks between the two polls, but the main diffference was that one question asked “Which one of these are you most concerned about?” while the other asked “Which one of the following issues will be most important in determining your vote for President”. The latter found terrorism and Iraq most important. You’d think that should help Bush as he apparently does better in the polls in those two issues, and those are the ones people say will affect their vote (in an apparent rush of altruism — Bush is better for the country but I’ll be worse off!?”).

But by now pretty much everyone knows where they stand on those issues. The people who don’t are the “undecideds” or the “movable voters” who will of course be a big part of deciding who wins. ABC did a nationl poll of undecideds:

Turning to swing voters rather than swing states, another recent finding that sheds some light on the role that health care may play as a voting issue comes from a national poll conducted October 7-10 by ABC News. This poll defined “moveable voters” as those likely voters who either said they were undecided in their vote choice, or there was a chance they might change their mind (15% of all likely voters in the poll). When given a list and asked which would be the single most important issue in their vote for president, 24% of movable voters chose health care, compared with 9% of voters who had made up their minds, indicating that health care might play a larger role in vote choice among swing voters than in the population in general.

Now you have to do some methodological fudging, but assuming that the undecideds in the swing states are like the undecideds nationally, they will be voting about health care because they can’t get to an answer about the other stuff.

For the life of me, especilly given the unpopularity of the Medicare bill, I cannot understand why Kerry isn’t running wall-to-wall ads about health care in all the swing states.

So after the debate on Thursday, which didn’t feature health care, it looks like the Presidential election is back in a tie. Newsweek has Princeton Survey Research’s post-debate poll with Kerry leaving 47-45%, with a 4% margin of error. When Nader is taken out Kerry’s lead increases slightly. This is similar to the Harris poll that was released a couple of weeks back.

Now Bush may be feeling like the SF Giants on Saturday (who lost the NL West by giving up 7 runs in the bottom of the 9th) but in truth he was never as likely to win in a cruise as some pollsters have suggested. Worst offender here was Gallup which does the CNN/USA Today poll and has been consistently showing the Republicans doing better than most other pollsters. Gallup frankly (speaking as an ex-pollster myself) in the past few years has done its business some harm by not moving into Internet polling and now is engendering severe doubts about its political polling methodology (Having a former CEO who is an evangelical Christian when 8 out 10 evangelicals are on Bush’s side doesn’t exactly help their PR whether or not it has any influence over their methodology. By the way, Humphrey Taylor, chairman of the Harris Poll, has never taken US citizenship after 30 years of being here because he’s never wanted the possibility of his voting to impact his polling in any way). Speaking as someone who has commissioned polling from both Harris (and later worked there) and Princeton, and who also has looked at a lot of other polling organizations, I know that I’d tend to be more comfortable with them (and with Field in California) than most others. All Gallup really has left is the most famous name.

But what this all means is that the election is still as close as its been all along. So that means that turnout is the key and there are signs that the Democrats have done better in registering new voters. That of course doesn’t mean that they’ll get them to vote. However, anyone in health care assuming a straight Republican win should do some quick scenario planning about what happens if Kerry gets in. Particularly as the MMA gives the FDA (i.e. the Administration) the right to allow the importation of pharmaceuticals with no further Congressional action. When that was passed last year it looked fairly safe for the pharma business for some time. Right now they need to be thinking about plan B. (Of course I don’t think reimportation would be too dramatic and I have some ideas for Plan B that don’t lead immediately to Marxism).

Travelling and having too late a night tonight to post properly, but go look at this article about health care in America from the “liberal” UK pespective: Lifespan crisis hits supersize America

California voters haven’t seen much yet about the pay or play bill that Prop 72 represents. However, when read the text of the propsition over the phone by the LA Times‘ pollsters, 51% say they like it, while only 29% oppose it. Of course the advertising to beat it back will commence shortly, with an array of fast-food joints out to defeat the bill, which was passed by the legislature and signed by Gray Davis, as he was being kicked out the door last year. The Times’ story is quite interesting:

On the healthcare coverage referendum, 51% of likely voters said after hearing the ballot description that they would support it, while 29% said they were opposed and 20% undecided.Business groups, including the California Chamber of Commerce and the restaurant industry, placed the referendum on the ballot hoping to overturn a law passed last year that would require businesses with more than 50 workers to provide healthcare coverage or pay into a state fund created for the same purpose.Because the measure is a referendum, a “yes” vote would keep the law in place and a “no” vote would repeal it.

Ten percent of registered voters surveyed said they were without health insurance. Several respondents said in follow-up interviews that they believed healthcare should be more widely available, but differed on how an expansion should be accomplished.”I believe everybody should be offered health insurance,” said Patty English, 43, a stay-at-home mother of two children, who plans to vote for Proposition 72. “I’m not sure what’s a higher priority to me– education or healthcare — but I believe healthcare is our right.”But Fred Bauer, a llama rancher outside Petaluma, said he would vote to overturn the law because he believed the country should go to a universal healthcare system.”This is another Band-Aid approach that seems particularly unfair to small business,” Bauer said. More generally, Bauer expressed concern about the initiative process shared by other voters interviewed.”The process of how you get an initiative on the ballot has nothing to with the merits,” said Bauer, 65.”It has to do with who has money and what their little pet projects are, and I’m not sure it’s a good way to make law.”

So it’s apparent that the Times found the pro-pay or player while finding a single payer advocate to oppose it — not exactly the typical opponent to this bill you’d imagine. But then again the Time’s Democratic banners are nailed to its mast pretty clearly. Of course enough attack ads during the World Series and this could change fast.

The New England Journal of Medicine has a Bob Blendon special on politics and the election and it provides the proof in what I said a few weeks back. (And it’s fully available online without payment). Health care is issue #4, after Iraq, the economy and terrorism. But it is enough to cause a few people to change their mind in some swing states, especially if they’re elderly.

There is a wealth of polling data in this study and much collated from several polls. Two particular favorites of mine.

First, Harris has for ever asked the three part question about the health care system a) working pretty well, b) needing fundamental changes and c) needing to be rebuilt completely. Obviously most people are in the middle, but watching the last one go up gives a good idea of the mood for real action. In 1991-3 42% said the system needed complete rebuilding. By 2000 that number was down to 29%. Now it’s back up to 36%. That increase suggests to me that health care will be a very big deal in 2006-10 (depending on the economy of course.

Second, 48% of those polled hate the Medicare bill while only 27% have a favorable impression of it & 25% have no opinion. This is showing up in races in Pennsylvania where the elderly are hopping mad, and once vulnerable Democratic housemembers are riding high and some Republicans are in real trouble.

The WSJ has an interesting report on the impact of Medicare in those races in Pennsylvania and concludes that it’s really hurting the Republicans. Six weeks is a long time in politics. Whether CBS-Kerry own goals can continue to distract from the carnage in Iraq and what some seniors feel will be the coming catastrophe in Medicare is an open question.

As I’ve saying for a while, this Presidential race remains too close to call, and today my favorite polling organization confirms that. A Harris Poll taken late last weekend showed Bush and Kerry tied. Why believe Harris? Well aside from being bright enough to employ me for a little while in the late 1990s, they have a very good record in very close elections. For example they were the only ones to get the UK 1992 election right (a very narrow Tory win) and the most accurate in the 2000 Presidential election in which they called the popular vote a tie (and it was).

Which all lead me to the conclusion that Bush needs to stop talking about health care. On the other hand some commies might suggest that the other parts of his record that he is running on aren’t too strong either. But the point is that (gullible or not) the public thinks that he’s a better bet than Kerry on that furr-in terra stuff. Of course them furr-iners massively prefer Kerry — lucky for Bush they don’t get to vote.

So the mudslinging has begun with the No on 72 crowd calling it a government takeover of the health care system in California. Prop 72 is an up or down popular vote on the SB2 “Pay or Play” passed last year just before Gray Davis was booted out by Arnie. Calling Pay or Play a government takeover as have recent ads is pretty disingenuous, as the law only gives the government control over those who choose to “pay” into the pool in order to stop employers gaming the system. But why waste precious ad time saying that, especially as it smacks of the truth.

Of course if you really want to find out what this is about you need to follow the money. The California Health Care Foundation’s HealthVote 2004 site shows who’s spending what. Unions are supporting the campaign with about $1m so far, and that’s mostly an ideological buy to support SB2’s sponsor State Senator John Burton. On the other side is $6 million from the people who’d have to –shock-horror — pay for their employees’ health care! Who are this disinterested crowd? The list of contributors by size

There was a lot of fuss about Medicare and health care in the last few days, particularly brought up by Bush. I think this is a serious blunder on his part. Given Swift Boat and Kerry’s non-position (or actually he should just use Bill Maher as spokesman because he explains it well) on Iraq, why is Bush trying to change the subject?

Here’s why I think Bush is being politically dumb here. If you look at these polls, things are still very close, and the Bush convention bounce seems to be over. Now if you play with the electoral college (try here) basically if Kerry wins Florida and Pennsylvania, then Ohio, Missouri, etc, don’t matter. What is special about Florida and Pennsylvania? They are the two oldest populations in America. Why did Clinton win Florida in 1996? Because he scared seniors into believing that the Republicans would kill Medicare as seniors knew it. Now, premiums are going up, and HHS’ own data is showing that the cost of the drug benefits to seniors will consume most of their social security checks, and seniors hate the Medicare bill, especially the ban on drug importation.

So let’s play it out. Seniors vote at roughly one and a half times the rate of those under 65s. Four in ten seniors say that they’ll vote based on health care. While 12.1% of the US population is over 65, the number is 18.1% for Florida, and 15.8% for Pennsylvania’s. So essentially the more voters focus on health care, the more likely it is that they’ll vote for Kerry, and each one of those votes in magnified by 1.5 X 1.5 for seniors in those two states. (or to be really pedantic only 1.5 x 1.25 for Pennsylvania).

So why is Bush bringing this up? I don’t know. If I were him I’d go back to terra, terra, terra. Otherwise Kerry can keep bringing up this kind of stuff.

UPDATE: A correspondent tells me why Bush is bringing this up. Karl Rove apparently believes that you should attack the other guy’s strength, and so that’s why Bush is attacking Kerry on health care. With that strategy, I don’t think Rove would last long as a coach in the NFL, and he hasn’t won a national campaign yet (after all tying is like kissing your sister), but Arianna Huffington thinks that Kerry should take Rove’s advice and come after Bush on terrorism and Iraq.