Today, the Senate Finance Committee voted down the amendment for a public option to be included in that committee’s health reform bill.

Specifically, this was the Rockefeller amendment that would include the public option which is a part of the other 4 committees’ approved bills.

Voting against the bill were Conrad (D-ND), Baucus (D-MT), Carper (D-DE), Lincoln (D-AR) and Nelson (D-FL), and all 10 of the Committee Republicans.

More importantly now is the Schumer/Cantwell amendment for the public option. It’s being debated as I type at 3:15 EST. Still looks to go down, however. It’s a slightly different model – around whether rates float based upon negotiations (Schumer/Cantwell) or whether they are pegged to Medicare (Rockefeller).

Senator Patty Murray and Washington State Insurance Commissioner Mike Kreidler released statements in response to the White House’s release of their report on “The Burden of Health Insurance Premium Increases on American Families.”

The report highlights the fact that in Washington State insurance rates have gone up by 129% in ten years, while wages have increased only 46%.

Read both of their statements beyond the break.

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I gave a talk this weekend at the Mukilteo Library on my book, “Dear Governor: About that healthcare crisis,” (shameless plug), which was one of a number I’ve been honored to have over the last 6 months. I closed with three insinuations into our language and the broader conversation about healthcare that I thought worth posting here. After all, the framework for our conversation impacts the outcomes of our debate.

1) “Do you have healthcare?” This is one of the greatest success stories in the history of PR. When one asks “Do you have healthcare?”, what one is really asking is “Do you have health insurance?” We’re not asking “Will the emergency room take you if you’ve been in an accident?” Of course they will. We’re not asking “Do you have a trusted family doctor that you see?” We’re asking “Do you have health insurance?” And, more specifically, what we’re really asking is “Do you have health insurance from your employer?” More on this last point in the days to come. However, the fundamental issue is that insurance companies, starting in the early ’70s, have done a magnificent job of re-defining “healthcare” as health insurance. Good PR has changed the lexicon of medical care so markedly that we must be aware of the dynamic to fully understand what we’re actually saying when we talk.

2) “Our healthcare system…” The “healthcare” debate in America is actually not about “our healthcare system.” As most observers will tell you, “our healthcare system” is actually an “illness care system.” The US system provides “medical care” for symptoms of illness or disease. In the best cases, the system treats the cause of the symptoms, too, though that happens far less often than it should.
If we had a “health care system,” we’d be focusing on building health and wellness, rather than treating illness and disease. In fact, the incentives in our system tend to promote procedures and treatments rather than prevention and wellness. That is old news (though here are some articles here, here and here). But the language matters, and this is a subtle insinuation that makes the best reform more difficult so long as it is taken for granted.

3) “Doctor knows best.” Starting really in the mid-20th century, physicians as whole started taking on an “all knowing aura.” That “doctor knows best” became a mantra for health and medical care. Consumers of this medical service, otherwise known as patients, became a submissive, passive player in the transaction known an medical service. The American Medical Association did, again, a wonderful PR job to convince Americans that somehow all that they knew in the way of healthcare was somehow not as credible as the word from a physician’s mouth. How many times have you heard someone say “Well, my doctor says that…”? On the one hand, this deference makes makes us, as patients, completely free to abdicate our responsibility for our own health. If we want to manage our health, we go to the doctor, right? On the other hand, it puts doctors in a hugely influential position to impact our care. If you have a great physician, you’re in luck. If you don’t, well – in the American system – you’re probably out of luck. Lord knows you couldn’t know as much about your health as a good doctor, right?

Try as we might to fully engage the healthcare debate, if we’re not clear about what we’re saying – or at least what we think we’re saying – then we will be hard pressed to truly get our hands around this challenge.

Here is a take on the politics of the day by Saturday Night Live (SNL) in a way only SNL can provide. First a behind the scenes look on the Joe Wilson outburst and then an interview with James Carville on “Weekend Edition.” This comes from the Huffington Post, and is a good laugh, if not directly related to health care.

Just making my way through the Sunday NY Times this evening, and came across this article. It offers a “Tutorial from Lyndon B. Johnson” on how to get health care passed. It excerpts a book from David Blumenthal and James Monroe called “The Heart of Power: Health and Politics in the Oval Office.”

Here is a quote from recently released tapes, quoted in the book, where LBJ is talking to Hubert Humphrey:

“Don’t ever argue with me [about health]. I’ll go a hundred million or a billion on health or education. I don’t argue about that any more than I argue about Lady Bird [Mrs. Johnson] buying flour. You got to have to have flour and coffee in your house. Education and health. I’ll spend the goddamn money. I may cut back some tanks. But not on health.”

I guess this is worth pondering since, after all, LBJ was the last president to fundamentally transform American health care.

LBJ