Usually, we try our best here to explain things. But there are some things we just can't explain. All we can do is link to the Wonk Room blog for reports of two similar events:

• A few days ago, Sarah Palin spoke in the Canadian city of Calgary. "We used to hustle over the border for health care we received in Canada," she said. "And I think now, isn't that ironic?" Wonk Room reported. Previously, as Wonk Room reminded us, Palin had said she and her husband, Todd, had "gone though periods of our life here with paying out-of-pocket for health coverage until Todd and I both landed a couple of good union jobs."
• Rush Limbaugh said he would leave the United States if health care reform passes. Wonk Room, which reported Limbaugh's comments, noted that "Limbaugh's announcement could very well inspire liberals to pass reform." Furthermore, as Work Room points out, "Costa Rica's hybrid government-private health care system provides comprehensive universal coverage to all residents - and even sells affordable policies to soon-to-be visitors like Limbaugh. The government owns several major hospitals and operates small clinics in almost every community. Workers are required to contribute 15% of their salaries to health insurance" and the government pays for care for the unemployed.

– 03/11/10

Thousands of activists – many from CWA and other unions – marched yesterday in Washington to demand health care reform and to confront insurance company executives.

The insurance bigwigs were meeting at a plush Ritz-Carlton hotel. Outside, the protestors chanted slogans such as, "Blocking health care is a crime" and "Health care can’t wait," according to the AFL-CIO's blog.

"The insurance companies won’t stop unless we stop them—and we do that by passing health care reform legislation," AFL-CIO President Rich Trumka told the rally. "So today we’re here to put the insurance companies on notice: We will not allow you and your lobbyists to bully Congress into not acting. Not on health care or any of the issues important to America’s working families."

Gerald McEntee, president of the American Federation of State, County, and Municipal Employees, said the rally was "to expose the high crimes and misdemeanors perpetuated by the insurance industry time after time and year after year," the Wall Street Journal reported.

The rally was sponsored by Health Care for America Now!, a coalition of which CWA is a member.

The insurance companies don't have to march in the streets. They speak through their lobbyists. Industry – insurers and their allies, such as the Chamber of Commerce – spent more than a billion dollars last year to influence or block health legislation. They hired an army of 4,525 lobbyists, or eight for each member of Congress, according to a recent analysis by the Center for Public Integrity.

– 03/10/10

Health insurance is primarily regulated by states, which set the rules for what policies must cover, how they are priced and who can buy them. So, you can only buy New York policies in New York and Wyoming policies in Wyoming.

Republicans are proposing to allow policies to be sold across state lines – a New Yorker could buy a Wyoming policy. Since insurance is cheaper in some states than others, this could save consumers money, they argue.

There are two problems with this:

First, it would weaken consumer protections. One reason insurance is more expensive in some states is that those states have adopted more rules to protect consumers. Policies have to cover certain services, and consumers can appeal if they disagree when an insurer refuses to cover an operation or treatment. By allowing sales across state lines, insurance companies could simply set up shop in states with the least regulation, avoiding state rules to protect consumers. This has already happened with credit card companies, as Washington Post blogger Ezra Klein recently pointed out:

This is exactly what happened in the credit card industry, which is regulated in accordance with conservative wishes. In 1980, Bill Janklow, the governor of South Dakota, made a deal with Citibank: If Citibank would move its credit card business to South Dakota, the governor would literally let Citibank write South Dakota's credit card regulations.

Citibank wrote an absurdly pro-credit card law, the legislature passed it, and soon all the credit card companies were heading to South Dakota. And that's exactly what would happen with health-care insurance. The industry would put its money into buying the legislature of a small, conservative, economically depressed state. The deal would be simple: Let us write the regulations and we'll bring thousands of jobs and lots of tax dollars to you. Someone will take it.

Second, it wouldn't save much money. Much of the variation in costs between states isn't a result of regulation – it's a result of the treatment options available; for example, Massachusetts has lots of sophisticated hospitals and specialists. If care costs more in Massachusetts, insurers aren't going to sell Massachusetts residents coverage at Mississippi prices.

I happen to live in a state – Maryland – with lots of regulations on health insurance. It requires the insurance companies cover mammograms; some states don't. Among other services it requires, which some neighboring states don't, are: in vitro fertilization; treatment for mental illness, morbid obesity and smoking cessation. If your insurance company says it won't pay for a treatment, you can appeal to the Insurance Commissioner, who gets neutral medical specialists to review whether you need the recommended care.

If insurance were sold across state lines, all of these protections would go away. I wouldn't have the choice of a Maryland policy or a cheaper policy from a state with light regulations – all policies would be offered from states with light regulations.

But these protections don't add a lot to the cost of buying health insurance. An actuarial study for the Maryland Health Care Commission estimates that policies in Maryland cost about 1 percent more than insurance in neighboring states with fewer rights for patients. What drives costs are not consumer protections but differences in prices and treatment options.

– 03/08/10

President Barack Obama called today for Congress to take a final vote on health reform in the next few weeks.

"I believe it's time to give the American people more control over their health care and their health insurance," he said. "I don't believe we can afford to leave life-and-death decisions about health care to the discretion of insurance company executives alone."

Obama, who is supporting a compromise between the already-passed House and Senate reform bills, said there has been lengthy debate with all options have been on the table. A government-run single-payer system, he said, is "neither practical nor realistic." On the other hand, he rejected "those, and this includes most Republicans in Congress, who believe the answer is to loosen regulations on the insurance industry - whether it's state consumer protections or minimum standards for the kind of insurance they can sell…I'm concerned that this would only give the insurance industry even freer rein to raise premiums and deny care."

Obama said his plan would do three things:

• "End the worst practices of the insurance companies," including refusing or cancelling coverage, imposing unlimited out-of-pocket costs on patients, and "arbitrarily and massively" raising premiums.
• "Give uninsured individuals and small business owners the same kind of choice of private health insurance that members of Congress get for themselves - because if it's good enough for members of Congress, it's good enough for the people who pay their salaries." It would do this by creating a large insurance group and by offering tax credits to help families and small businesses afford policies.
• "Bring down the cost of health care for millions - families, businesses, and the federal government. We have now incorporated most of the serious ideas from across the political spectrum about how to contain the rising cost of health care.... But we do this while protecting Medicare benefits, and extending the financial stability of the program by nearly a decade."

The complexity of health reform "lends itself to demagoguery and political gamesmanship, and misrepresentation and misunderstanding," he said. "But that's not an excuse for those of us who were sent here to lead. That's not an excuse for us to walk away." The politics are not what's important, he continued.

This is about what reform would mean for the mother with breast cancer whose insurance company will finally have to pay for her chemotherapy. This is about what reform would mean for the small business owner who will no longer have to choose between hiring more workers or offering coverage to the employees she has. This is about what reform would mean for middle-class families who will be able to afford health insurance for the very first time in their lives and get a regular checkup once in a while, and have some security about their children if they get sick.

This is about what reform would mean for all those men and women I've met over the last few years who've been brave enough to share their stories. When we started our push for reform last year, I talked to a young mother in Wisconsin named Laura Klitzka. She has two young children. She thought she had beaten her breast cancer but then later discovered it had spread to her bones. She and her husband were working and had insurance, but their medical bills still landed them in debt. And now she spends time worrying about that debt when all she wants to do is spend time with her children and focus on getting well.

This should not happen in the United States of America. And it doesn't have to.

– 03/03/10