The Senate Parliamentarian has ruled that President Barack Obama must sign Congress’ original health care reform bill before the Senate can act on a companion reconciliation package, senior GOP sources said Thursday.

HORROR!  Oh no!  What a shocker!

Go to memeorandum now.  Check the news.  See how many stories are talking about how this dims prospects for the passage of health care reform.

Now go back to a post I wrote on March 1:

I’m starting to despair that no one in the media has any idea what they are talking about. I get why Republicans are trying to portray the passage of health care reform as some betrayal of principles or the tyranny of the majority, but it’s not.

Using reconciliation is not “ramming it through”.

Look – the bill has already passed through the Senate.  It got 60 votes.  It’s done.  Was that ramming it through?

Now, let’s say the House of Representatives passes the Senate bill, by a majority.  Is that ramming it through?

And then, the President signs the bill – passed by both houses of Congress.  Is that ramming it through?

No, it’s not.  It’s how laws (that overcome filibusters) are supposed to pass.  And then we would have health care reform.  No reconciliation.  No “ramming it through”.

Today is March 12.  This is news to them?  Really?

You pass the bill.  The President signs it.  Then you do reconciliation.  This isn’t rocket science, people.

In addition, some of you have asked if I’m on Twitter.  The answer is yes.  I post links to articles I think are interesting there, as well as some less formal thoughts in general.  If you want to follow me, I’m at DSYGAaron.

My new fear is that it would just be talking points.  And, you know, this is my blog.  I post people’s emails when they make solid arguments against what I’m saying, or pose good questions, but I’m not looking for anecdotes or talking points as rebuttal.

But I’m willing to reconsider.  Do you feel like I need to have a comments section?  Email me and tell me why.  Maybe I’ll give it a go.

Stop worrying about it.

There are a number of reasons to do so. The first is – as any good therapist would tell you – your worrying is not going to effect the outcome.  Second, no one who tells you they know how it is going to end is telling you the truth.  Not even this guy.  Nearly everyone who is making a bold prediction is biased or has something to gain by being right.

But the real reason is this.  For Democratic Congresspeople, there will probably be no time in the near future where they can get more press and influence than by appearing to waver on health care reform.  Do you think Rep. Stupak doesn’t know that?  He’s in the paper every day right now.  Do you think other staffers in other representatives’ offices aren’t telling their bosses right now that if they waver, they will get the same publicity?

Want to get a personal phone call from President Obama right now?  Waver.  Want to get a promise for something in your district in the next budget?  Waver.  Want to make sure your pet piece of legislation gets a committee hearing?  Waver.  Want to be on TV?  Waver.

There’s almost no downside.

Look, it’s really out of our hands.  Yes, you can call your representative and tell them what you want.  In fact, that’s always a good idea.  But at some point you have to trust that Speaker Pelosi and President Obama and even Rahm Emmanuel know what they’re doing (or not if you oppose reform).  Either they will get it done or they won’t.  But nothing you will hear on TV or in the paper in the next few days about vote counts will likely predict the outcome.

But I also scoffed at opponents of the piblic option who said it would “limit competition”.  As if competition existed right now.  Quoth the AMA (not a very progressive organization):

The AMA’s most recent look at the health insurance market — “Competition in health insurance: A comprehensive study of U.S. markets,” released Feb. 23 and based on 2009 data — finds that 99% of 313 metropolitan areas tracked would be considered to have “highly concentrated” insurance markets under guidelines used by the U.S. Dept. of Justice and the Federal Trade Commission. In its 2009 version of the study, the AMA found that 94% of metropolitan areas were ranked “highly concentrated.”

Only Miami, Fort Lauderdale, Fla., and Colorado Springs, Colo., are not considered to have highly concentrated markets. But even these metropolitan areas are not deemed to have competitive markets but instead are rated as “moderately concentrated.” The Justice Dept. and the FTC would consider a highly or moderately concentrated rating as a point against a merger or acquisition of plans within the same market.

One insurer held 70% or more of the health plan market share in 24 of 43 states measured, up from 18 in 42 states in the previous year’s study. In 92% of the 313 markets in the report, one insurer held at least a 30% share.

In past releases of its survey, the AMA has noted that insurer market dominance has allowed health plans to force physicians into take-it-or-leave-it contracts. But this year the AMA — echoing other experts — noted that market dominance has allowed plans to give patients take-it-or-leave-it pricing.

Are you getting that?  Competition has gone down since last year.  Almost 100% of markets are highly concentrated, as calculated by the number of available options and their individual market share.  That means there are limited choices available, leaving people at the mercy of rate increases and coverage decreases.  Adding a public option would increase that number significantly, and therefore increase competition.

And that’s the best argument I’ve heard yet for a public option.  I still don’t think we’re going to get one right now, and I don’t think it’s worth sinking the bill over.  But if the insurance industry wanted to make sure that Democrats considered adding one in later, they sure are on the right path.

Purpose

Uninsured children face health-related disparities in screening, treatment, and outcomes. To ensure payer status would not influence the decision to provide emergency care, the Emergency Medical Treatment and Active Labor Act (EMTALA) was passed in 1986, which states patients cannot be refused treatment or transferred from one hospital to another when medically unstable. Given findings indicating the widespread nature of disparities based on insurance, we hypothesized that a disparity in patient outcome (death) after trauma among the uninsured may exist, despite the EMTALA.

Methods

Data on patients age 17 years or younger (n = 174,921) were collected from the National Trauma Data Bank (2002-2006), containing data from more than 900 trauma centers in the United States. We controlled for race, injury severity score, sex, and injury type to detect differences in mortality among the uninsured and insured. Logistic regression with adjustment for clustering on hospital was used.

Results

Crude analysis revealed higher mortality for uninsured children and adolescents compared with the commercially or publicly insured (odds ratio [OR] 2.97; 95% confidence interval [CI], 2.64-3.34; P < .001). Controlling for sex, race, age, injury severity, and injury type, and clustering within hospital facility, uninsured children had the highest mortality compared with the commercially insured (OR, 3.32; 95% CI, 2.95-3.74; P < .001], whereas children and adolescents with Medicaid also had higher mortality (OR, 1.19; 95% CI, 1.07-1.33; P = .001).

Conclusions

These results demonstrate that uninsured and publicly insured American children and adolescents have higher mortality after sustaining trauma while accounting for a priori confounders. Possible mechanisms for this disparity include treatment delay, receipt of fewer diagnostic tests, and decreased health literacy, among others.

Here’s the gist – people wanted to see if being uninsured was associated with worse outcomes at the emergency room after trauma.  Because, you know, we have a universal system where everyone can get free care at the emergency room.  Or not.

The researchers looked at tons of data, almost 175,000 children injured between 2002 and 2006.  They controlled for race, injury severity score, sex, and injury type.  And even after doing that, children who were uninsured had more than three times the odds of dying from comparable injuries than children covered with private insurance.

So there you have it.  Being uninsured is associated with an increased risk of children dying, from injuries, in an emergency room.  Maybe someone should tell the people who claim there’s no evidence that uninsurance leads to a higher chance off death.

It’s unlikely you can get the whole article, because it’s probably behind a paywall, but it’s entitled, “Lack of insurance negatively affects trauma mortality in US children.”

Well, it looks like the health care reform process that’s been alive, and then comatose, is now flickering back to life.As we record this mid-week, President Obama is laying out what he hopes will be the end-game to get the House to approve the bill that has already passed the Senate …with the understanding that then, the Senate will go back and amend its version so that both sides can pass it.

And as one step, the President has said that he SUPPORTS four adjustments to the measure that Republicans have proposed.

Here to walk us through what those changes would be is our regular analyst on this topic, Dr. Aaron Carroll.

Dr. Aaron Carroll directs the Center for Health Policy and Professionalism Research at the IU School of Medicine. He’s a regular contributor to this program.

Listen to the interview.

“As I weigh it, I think — for me — a ‘no’ vote is something that I continue to lean toward,” Rep. Raúl Grijalva, D-Ariz., the co-chairman of the Congressional Progressive Caucus, told Salon in a brief interview off the House floor Wednesday. “Especially the last additions — that was kind of a slap in the face for all of us who fought for the public option.”

Those provisions he’s referring to are the “Republican ideas” that President Obama has incorporated in order to placate those who oppose the bill.

Look, I’d have no issue with Re. Grijalva if he said that he thought that those provisions made the bill worse, or if he had policy objections to them.  But to oppose the bill because you think you haven’t been wooed as much as others?

You know who else has been slapped in the face throughout this process?  Me – and every other supporter of single payer health insurance.  We were told to give it up, for nothing in return.  We were told it wasn’t politically feasible, that it couldn’t be done.  We were told to get on the “public option” bandwagon instead.  Some did and some did not.  But I find it the height of hypocrisy for those same people who told single payers to suck it up are now acting as if doing the same is the greatest possible insult.

Real people are at stake here, politicians.  I have no problem with you representing your constituents and their interests.  Please don’t make this about you, and especially not about your “feelings”.

When I’m guessing, or talking on a topic where I don’t feel confident, I will say so.  I will also use less declarative language.  This is especially true when discussing politics.

But if you turn on the TV today, you’re likely to see – sometimes in the same segment – people declaring as absolute truth that health care reform is going to pass or fail.  Obviously both can’t be true.  Even Megan McArdle notes this:

The opinions on both sides seem so confident, and so incompatible, that one group of people is clearly borderline delusional.  I don’t see how they can be right–even if passing health care makes the party better off (I’m doubtful), it does not improve the fortunes of members in conservative districts who do not get much mileage out of their affiliation with the Democratic Party (and will get even less mileage if they are seen as enabling unpopular legislation).

But of course, borderline delusional people don’t think they’re delusional, or else they wouldn’t be delusional.  So there you are: either it’s a done deal, or it’s dead.  There’s no longer much middle ground in between.