The Public Option: It's Up To The Congress

It's endgame on health care reform. Credit to President Obama for taking on the issue early in his tenure. While my own view is he has not played his cards correctly in the HCR debate, we must all acknowledge that he took the important step of putting it in play. Of course now, he is a bystander, and will sign whatever bill the Congress produces. In short, it is up to the Congress. Speaker Nancy Pelosi said:

I guess I'm just so busy with what I'm doing that I'm not worrying about what somebody else is doing, and I have confidence in the President of the United States. He wants the strongest best possible bill that will work for the American people. And we have to convince him that what will pass in the Congress is something similar to what we have in the House.

In my view Speaker Pelosi has done a great job on health care reform and I support the bill she has produced from the House. Senate Leader Reid is wokring hard and has signalled that an opt out public option will be in the Senate bill. It looks like that bill can not defeat a filibuster at this time. So in the end, Reid and Pelosi will have to either threaten to or actually, pass HCR with a public option through reconciliation. I want to be clear where I stand at least - health care reform without a public option is NOT worth passing. I do not believe in "reform" absent a public option. Paul Krugman writes:

But the [House] bill does include a “medium-strength” public option, in which the public plan would negotiate payment rates — defying the predictions of pundits who have repeatedly declared any kind of public-option plan dead. It also includes more generous subsidies than expected, making it easier for lower-income families to afford coverage. And according to Congressional Budget Office estimates, almost everyone — 96 percent of legal residents too young to receive Medicare — would get health insurance. So should progressives get behind this plan? Yes. And they probably will.

I agree. But if it does not contain the "medium strength" public option, then I say No, progressives should not back this bill. This is not a "sliver." This is not a "nonessential" element of health care reform. It is the key to health care reform. Without it, you have no reform.

Now you can pass a health care bill with the extra funding for Medicaid, for the faux "regulatory" changes, heck even the exchanges hooey, but you will not be passing reform.

And without reform, mandates are a nonstarter.

It is up to the Congress now. And in part, it is up to Progressives in the House. They have played their hand well. Now it is endgame. They need to make clear what they will and will not do. To the Speaker. To the Senate Leader. And to the President.

Speaking for me only

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    Why do they have to convince Obama (5.00 / 2) (#2)
    by Cream City on Fri Oct 30, 2009 at 08:43:00 AM EST
    of this, as Pelosi puts it?: "We have to convince him that what will pass in the Congress is something similar to what we have in the House."

    There's something weird about that wording, something between the lines. . . .

    Re-reading the Best Speech Evah on HCR for clues (5.00 / 1) (#11)
    by Ellie on Fri Oct 30, 2009 at 10:44:04 AM EST
    ... over here, but the fine-tooth comb won't come out till I figure out the size of the gap between Medium-Strength and Robust.

    (Or is it like olives? There are no Petite or Medium ones anymore and I can't remember the last time I saw anything smaller than the med-looking Jumbo.)


    OBAMA MORE THAN WEIRD (none / 0) (#58)
    by norris morris on Fri Oct 30, 2009 at 07:50:07 PM EST
    The HCR bill is openly being sabotaged by Obama in that he does not want a strong public option and prefers triggers.

    No matter whatever his reasons are they are smarmy,ill advised, and ultimately...a sellout to Insurance Monopoly.

    The current watered down bill is entirely inadequate and does not allow a level playing field at all, in fact it delivers  high premiums
    for new victims forced into bad insurance.

    This sellout is brazen in the few it covers, and the high price with no recourse to the insured this Insurance will cost. Medicare will take the big hit on this to be sure. There will still remain millions uninsured or underinsured. This bill seems to cost those that join it, even  more than the current premiums.

    Obama's claim to bi-partisanship with the likes of Snowe and maybe one more vote,to be a real bi-partisan effort?  This is a political miscalculation that will cost the ununified Dems who received no leadership on this from  Obama.

     Obama has played this out close to the vest for political gain and in the end he has rolled us over.


    what ever happens BTD (5.00 / 6) (#5)
    by Capt Howdy on Fri Oct 30, 2009 at 10:01:35 AM EST
    thank you for your tireless work on this.

    no one in blogistan has worked harder.

    Do they see how ties into economy, new jobs, biz? (5.00 / 1) (#6)
    by Ellie on Fri Oct 30, 2009 at 10:08:33 AM EST
    The kind of disinformation that's being put out there, like this example, is the last thing anyone needs right now.

    Krugman calls it out ...

    Or consider the remarkable exchange that took place this week between Peter Orszag, the White House budget director, and Fred Hiatt, The Washington Post's opinion editor. Mr. Hiatt had criticized Congress for not taking what he considers the necessary steps to control health-care costs -- namely, taxing high-cost insurance plans and establishing an independent Medicare commission. Writing on the budget office blog -- yes, there is one, and it's essential reading -- Mr. Orszag pointed out, not too gently, that the Senate Finance Committee's bill actually includes both of the allegedly missing measures.

    I won't try to psychoanalyze the "naysayers," as Mr. Orszag describes them. I'd just urge them to take a good hard look in the mirror. If they really want to align themselves with the hard-line conservatives, if they just want to kill health reform, so be it. But they shouldn't hide behind claims that they really, truly would support health care reform if only it were better designed.

    For this is the moment of truth. The political environment is as favorable for reform as it's likely to get. The legislation on the table isn't perfect, but it's as good as anyone could reasonably have expected. History is about to be made -- and everyone has to decide which side they're on.

    I haven't read any of the versions straight through yet because so much is in flux. As someone whose plans down the road (eg, potential relocation for work/ new opportunities next year) I'll be carrying enough risk, I don't want to jeopardize that by adding the financial risk of health care to the other, already considerable risks.

    Just for my situation, staying put means the dormant state of 2-5 student training paid work/academic cred positions and 12-15 new jobs in the first year with more added depending upon stability. (The latter aren't McJobs, either, but family breadwinner-level.)

    as much as we have bashed them (5.00 / 1) (#7)
    by Capt Howdy on Fri Oct 30, 2009 at 10:09:03 AM EST
    there must have been times when Harry and Nancy felt like Piscine Molitor Patel.

    The story follows a young Indian boy who ends up stranded on a boat for 227 days with a hyena, zebra, orangutan, and a Bengal tiger.

    I can't support (5.00 / 7) (#8)
    by Makarov on Fri Oct 30, 2009 at 10:09:36 AM EST
    a light/medium/whatever public option that isn't; in other words, a publicly administrated insurance plan that isn't available to every American.

    I's like to think Pelosi is at least somewhat on the side of Progressives and Liberals in this, but we'll know next week when Weiner either gets or doesn't get an up or down vote to swap the 1900 pages (interesting how it doubled in size since July) of the current bill with HR 676. That amendment certainly wouldn't pass, but at least it would show us where some representatives stand on single payer.

    Pelosi said yesterday they didn't want to let amendments onto the floor that haven't been scored by the CBO. Fair enough. That isn't a good reason to strip out the Kucinich Amendment that only stated states would retain the ability to adopt single payer on their own. In regards to HR 676, the CBO has had ample time (since July, when Pelosi and Waxman promised they would allow a vote on the House floor) to score that.

    Finally, I think AHIP's recent study is right about one thing. Passing a mandate for middle class Americans to purchase private insurance will increase premium rates and overall health care costs across the board faster than if we did nothing at all. For that reason, if the final bill does this (and there's no indication it will be any different), I'll never vote for someone who votes for such a measure. Instead, I'll focus my energies on changing the Democratic Party away from its increasing trend of supporting corporate interests over those of Americans with modest or limited means. If it means "Democrats" in name only lose House and Senate seats, it will be good for the party in the long run.

    Have you read the bill? (5.00 / 1) (#9)
    by Samuel on Fri Oct 30, 2009 at 10:31:06 AM EST
    I don't understand how you can say you support a 1,900 page document as it's described by Nancy Pelosi, a proven liar.  I also don't understand what gets you from a medium to a large public option.  

    Also - if companies in food/tech/any-other industries are allowed to compete across state lines why can't health insurers?  How can one trust a politician saying that the public option will increase competition when the same politicians look to severely limit competition by creating/retaining state to state barriers?

    While I don't disagree (5.00 / 3) (#12)
    by Makarov on Fri Oct 30, 2009 at 11:19:16 AM EST
    with your general assessment about the bill, you're completely wrong about competition "across state lines". That's a conservative meme.

    In reality, letting companies based in one state insure people without being subject to the regulations in their state will just start a race to the bottom.

    It happened in the 80's, when credit card issuers (after a big Supreme Court decision) all moved to states without usury laws (DE and SD) so they could charge whatever interest rate they wanted. The result, all (or nearly all) states have pretty much removed usury regulations from their books, so individuals are "free" to get "payday loans" at 99% APR.

    States have also been the only ones prosecuting companies (you may have seen them advertise on cable TV) for what are more clearly complete scams; selling cheap insurance that never pays out.

    If you trust the Texas Insurance Commissioner to protect your rights when you live in CA, or any other state, then you should support selling insurance "across state lines".


    Interstate Health Insurance Compacts (none / 0) (#14)
    by Coldblue on Fri Oct 30, 2009 at 11:36:47 AM EST
    is in the House bill, beginning Jan, 2015.

    Sec. 309.


    How does it start a race to the bottom? (none / 0) (#15)
    by Samuel on Fri Oct 30, 2009 at 11:56:31 AM EST
    If I live in state A and can now buy a better policy previously available in state B I'm better off.  If I'm in state B I will retain my previous policy.  

    The worse policy from State A has now been driven out by competition.  What did I miss?


    How about this? (5.00 / 2) (#16)
    by Erehwon on Fri Oct 30, 2009 at 12:34:09 PM EST
    Assume the better policy in State B is shut down by the insurance company offering it (why? because they can do it and because it's not making them much money). So what policy are you left with? The crappy one from state A.

    What else?


    Not sure I follow that logic. (none / 0) (#21)
    by Samuel on Fri Oct 30, 2009 at 01:07:01 PM EST
    You're saying that the provider issuing the policy in State B would choose to scrap the policy that's garnering a high market share in order to issue a product identical to State A's provider's policy with the hopes of increasing the margin while losing volume?

    I guess my questions would be:

      -Wouldn't the provider from state B be concerned that a third company would issue a policy identical to their initial policy to grab up market share?  
      -Wouldn't the policy from state A be immediately met with solvency issues as customers flocked to state B's policy?  Wouldn't the state B provider notice this and determine that their current model is successful as they're actively taking business from their competition?
      -Wouldn't the policy from State A immediately trim their margin and offer a B-type policy in hopes of increasing volume as the alternative is to face total elimination by competition arising in State B?

    If orange sales were restricted state to state and it cost $10 for an orange in NJ and $2 for one in FL and then one day the restrictions were lifted why would the Florida orange provider attempt to charge $10?  Local competition had driven his prices down to $2 and he will have to compete with this group all over the country.  It is unlikely a savvy business man would adopt the pricing scheme of the NJ company as it's assured demise (just as orange production would shift to more conducive/efficient locales.)  


    The example above you (5.00 / 3) (#22)
    by Makarov on Fri Oct 30, 2009 at 01:21:45 PM EST
    is exactly correct. To put it another way:

    If interstate sale of insurance is permitted, all insurance companies will simply relocate to the state with the least regulation. The few remaining BC/BS companies that are still non-profit probably wouldn't, along with regional non-profit HMOs, but everyone else (including the for-profit BC/BS) would simply issue their policies from, say, Texas.

    They wouldn't have to give up anything. They have a pool of both customers and health care providers. They'd just quickly or gradually terminate the policies that don't earn as much profit and offer only the ones that do, based on lower regulations. Even the profitable ones would gradually phase over to the state with least regulation, though. It isn't hard to figure this out.

    Have a complaint if live you in state A? Call the insurance commissioner or legislature in state B. Good luck with that.


    Sorry but my questions were not answered. (none / 0) (#24)
    by Samuel on Fri Oct 30, 2009 at 01:30:40 PM EST
    What would keep a new company from providing a superior plan in order to grab market share?

    This occurs in all of the business world.  For example if I have a $100 million line of credit and notice that the only insurance options available in the US are terrible but return the investors say 6% and I do a study that shows I can grab virtually all of the market share by offering a superior plan that nets 5% it would seem wise to provide customers with what they want in return for what is still a positive return on my money.  

    I'm not sure what you're referencing when it comes to state regulations - most vs least.  Cars are another consumer good.  They have varying levels of quality, the proof of which is heavily dependent on trust through examination of a companies track record.  Honda avoids making cars that break down not because they're worried the government will hit them with fines, but because they'll ruin their reputation and lose customers to their competitors.  


    So you oppose the insurance industry's efforts (none / 0) (#28)
    by Socraticsilence on Fri Oct 30, 2009 at 02:19:42 PM EST
    to remain exempt from anti-trust regulations?

    I'm proposing that (none / 0) (#33)
    by Samuel on Fri Oct 30, 2009 at 03:08:39 PM EST
    'barriers to entry' be removed.  I understand your concern, it is counter intuitive.  Could you be more explicit with your post?

    The biggest barrier to entry (none / 0) (#50)
    by Makarov on Fri Oct 30, 2009 at 05:05:58 PM EST
    in the health insurance market is two things which amount to a chicken and the egg scenario:

    1. provider network
    2. customers (individuals/employers who buy your insurance)

    If you want to sign up providers, they want to know how many people you insure and where they live before agreeing to reimbursement discounts.

    If you want to sign up customers, they want to know what the premium is going to be and what providers are covered in your network.

    For this reason, just creating a national public option from scratch is going to be difficult. If the House version passes, they'll at least start with the Medicare provider base (>99% of providers). Unfortunately under the current bill, they can choose to opt-out without affecting Medicare reimbursement status.

    For more details, read the following which includes stories of large, established insurers being driven out of markets. That should give you some perspective why new companies aren't going to flock to offer policies where they currently don't:

    http://pnhp.org/blog/2009/09/05/the-chicken-and-egg-problem-can-the-public-option-succeed-where-prud ential-failed/


    Honda? (none / 0) (#72)
    by norris morris on Sat Oct 31, 2009 at 07:20:12 PM EST
    We haven't been able to manufacture decent cars and have lost out to the competition. But these losers get bailed out with our dollars.

    We gave up making cars entirely with our own labor in auto companies frozen in time. No innovation or product integrity.  But they've been bailed out.

    The mathematical formula for health insurance on a level laying field hasn't been presented to us.

    Triggers are an insult and are meaningless in real time. Opt out could work with a stronger design within a reform bill.

    Social Security bill took 64 pages. At 1900 pages you know there's tons of B.S.

    Probably this is 1900 pages akin to a General Motors relic of a business model.


    For these arguments to have any validity (none / 0) (#29)
    by Steve M on Fri Oct 30, 2009 at 02:29:13 PM EST
    you will first need a magical transparency pony.

    How so? (none / 0) (#32)
    by Samuel on Fri Oct 30, 2009 at 03:06:54 PM EST
    Consumers of the auto nor computer industries do not rely on magic nor ponies to see continually dropping prices and improving quality.  

    Candy bars and cars are different then insurance (5.00 / 1) (#38)
    by samtaylor2 on Fri Oct 30, 2009 at 03:31:02 PM EST
    Only a tiny percentage ofthe population understands all the language in an insurance policy- so by its nature it can't be as cut and dry as a tastier candy bar or a car that drives faster.  

    I don't know how my transmission works (none / 0) (#39)
    by Samuel on Fri Oct 30, 2009 at 03:36:13 PM EST
    or the architecture of the processor in the computer I am using.  I don't have the resources to evaluate these products in terms of effectiveness, longevity and by extension value without external assistance.  

    Could you be more distinct as to why the complex nature of insurance is different from the complex nature of other goods when it comes to evaluating said good?


    Are you serious? (5.00 / 1) (#59)
    by samtaylor2 on Fri Oct 30, 2009 at 07:57:59 PM EST
    Your literal view of the world must make it hard to get through life.

    Reading an Insurance Policy (none / 0) (#73)
    by norris morris on Sat Oct 31, 2009 at 07:29:51 PM EST
    I dare you to understand all of the items in any Insurance Policy be it Life,Disability,Health,Major Medical, Drug,Auto,Fine Art, and last but not least:
    Your credit card computations and language are impossible to understand even by experts.

    Credit cards are kept impossibly difficult to understand since there is no regulation that demands they do so.

    Our wonderful legislators and leaders are supposed to boil it down for us. Some are too lazy and/or stupid to understand this bill.

    Now, this is BEFORE amendments and changes if it's voted on by Cloture.


    Computer and auto industries (none / 0) (#41)
    by Politalkix on Fri Oct 30, 2009 at 03:50:56 PM EST
    see continually dropping prices and improving quality, an argument can therefore really be made that these industries should be held up as role models for the health insurance industry.
    However the argument also has its caveats. To see dropping prices in computer and auto industries, we rely on the following (1)significant influx of engineers and scientists from other countries to the United States (2) no constraints on the number of engineers and scientists that can graduate from American Universities and (3) increasing amounts of offshore manufacturing. Will people in our country be ready to bring medical doctors from other countries on H-1B visas, remove AMA restrictions that limit the number of doctors graduating from US Universities, remove all restrictions on import and prescription of generic drugs and offshoring of health industry clerical jobs?



    Great points. (none / 0) (#42)
    by Samuel on Fri Oct 30, 2009 at 03:58:47 PM EST
    I would certainly argue for those reforms.  But that debate need not be referenced to make the simple observation that State by State entry barriers for insurance providers reduce competition just like any geographical restrictions on the sale of any good or service.  

    Competition?? (none / 0) (#60)
    by norris morris on Fri Oct 30, 2009 at 08:45:22 PM EST
    Auto and computer companies face huge pools of consumers along with open competition. Therefore the consumer has SOME choice. Insurance prices nevertheless are mostly fixed too high, State to State.

    Healthcare claims victims by ofering no choice regarding lower prices.  Unless they have to, which is what a strong public option can provide. Lowering costs and levelling the consumer's buying field can only occur if Insurance has real competition. Historically they just continue to pig out, raise premiums, and deny claims whenever possible.


    Hey Samuel.... (5.00 / 1) (#43)
    by christinep on Fri Oct 30, 2009 at 04:12:17 PM EST
    Whats with the namecalling of Nancy Pelosi? A proven liar is she? Hmmm...where did you come from? Are you getting tired of your homebase.  BTW, the supposed "issue" about not-being-able-to-sell across state lines is really a two-edge sword, as I would hope that you know. Because once across-state-lines comes into play, the antitrust implications cannot be ignored. Or, did you not realize that? Seriously, I did not know that it was in bounds to use terms like "proven liar" without proof nor did I understand it to be within bounds to bash the Speaker in such manner on this site.

    Speaker Blasphemy! (none / 0) (#47)
    by Samuel on Fri Oct 30, 2009 at 04:26:53 PM EST
    Haha.  Sorry if it came across as rude.  Here's one example.  Now I'd argue that she's lied about a lot more regarding economics but I think this may be enough to satisfy you.  

    As far as anti-trust...I'm not sure how removing barriers to entry encourages monopolies.  Can you explain in more detail?  The current system favors state by state oligopolies.


    Wow (none / 0) (#52)
    by Steve M on Fri Oct 30, 2009 at 05:22:06 PM EST
    You have really, really casual standards for declaring someone a "proven liar."  Maybe dial it back a bit when you have no actual proof.

    Yeah we tried that with credit (none / 0) (#26)
    by Socraticsilence on Fri Oct 30, 2009 at 02:15:55 PM EST
    and what happened- they all ran to the states with the least regulation and became predators.

    Credit is a cartel (none / 0) (#31)
    by Samuel on Fri Oct 30, 2009 at 03:05:29 PM EST
    because of the dollar monopoly.  Banks within the cartel are allowed to lend money into existence.  Since we have a legislated currency which is allowed to be created by banks, there is no possibility of competition from an alternative currency that isn't being debased through credit creation.  

    The fix was in from the beginning (5.00 / 6) (#13)
    by shoephone on Fri Oct 30, 2009 at 11:23:34 AM EST
    brought to you courtesy of your spinless POS Democratic party.

    Single payer? "Screw you," they said.
    Robust public option? "Screw you," they said.

    And now we're fighting for... what? A "medium-strength public option"? WTF???

    This Congress and this president are a steaming pile of failure. Mandates + "Screw You" is what we end up with.

    Excuse me if I don't join in the celebration. The bill they sign will do nothing for me but make buying insurance even harder.

    So much for health care reform.

    I love a good shoephone (5.00 / 1) (#19)
    by Pacific John on Fri Oct 30, 2009 at 12:57:42 PM EST
    ...or in a pinch a snarky shoephone.

    One thing is clear, what has happened in DC has no relationship with what a large majority of Americans want. What happens in the party is with near-complete disregard for actual Democrats... but we knew this when it refused to let MI and FL count cleanly, not to mention the pro-caucus state fetish that seems to place more weight on cows than people.


    No Leadership On HCR (none / 0) (#61)
    by norris morris on Fri Oct 30, 2009 at 08:53:42 PM EST
    Right you are. A lack of leadership from WH with political gamesmanship the prime purpose of Blue Dogs and Obama does not get us a good HCR bill.

    Obama looks for bi-partisanship?  He's kidding.
    He is not this naive. It's an excuse for taking political cover. Inexperienced as he is, he has purposely not led on stating his HCR preferences BECAUSE he's aready been elected.

    Now along with the spineless wonders that have not backed Pelosi and Reid on a robust PO, what we can expect is  what Obama's rollover preference really is.  Triggers. Another word for a snow job on HCR.


    My last nerve is hanging by a thread. (5.00 / 11) (#17)
    by Anne on Fri Oct 30, 2009 at 12:35:49 PM EST
    Part of the problem is that I think the people who are responsible for the legislation really do not completely understand the issues, and have relied far too heavily on industry insiders to educate them.  That reliance is what those insiders paid for either through campaign and PAC contributions, or by virtue of legislators' family members being employed by or sitting on the boards of some of these companies which stand to gain by the eventual legislation.

    There was never any real effort made to hear from all sides; shutting out the single payer advocates, of which there are many in the medical field, distorted the conversation.  I still find it mind boggling that for all the ranting about needing to bend the cost curve and not raising the deficit, there was no interest in considering single payer; these people would rather the government spend billions more than it needs to as long as nothing interferes with their personal financial interest.

    I'd give more credit to Obama, but what did he do?  He gave a couple of speeches, had a few town halls, quickly moved from talking about health CARE reform to talking about health INSURANCE reform.  He waffled, he wavered, he did the one-hand-other-hand two-step, he sucked up big-time to Republicans and asked Olympia Snowe to go steady.  He was a speed bump, not a leader.

    But the Congress disappoints, too, for not politely telling Obama to move out of the way while they went about doing what needed to be done.  But then we're back to where we started, which was with a group that mostly wanted to protect the industry, and their campaign coffers, and could not have led a parade if they were the only person in it.

    "Medium strength" reform doesn't cut it, not when it won't get stronger from here.  It's like negotiating a salary where instead of asking for  $150K when you want $100K, you start by asking for $50K - the other side is not going to up that number, they're going to lower it.  At best, they will say, "okay, you're hired at $50K," and it will be a cold day in hell before you ever see $100K.

    I fully expect the end result to be the complete clusterf**k it's been heading toward for the last nine months.  I wish I felt differently, but I think the debacle that is the Congress' idea of health care reform is going to make Katrina and The Wars look like good government at work.

    If Those Responsible (none / 0) (#54)
    by CDN Ctzn on Fri Oct 30, 2009 at 07:01:13 PM EST
    for the legislation don't understand it's because they don't want to understand. In reality, I think they do understand, but don't give a damn because they refuse to bite the hands that feed them ie; the healthcare industry.
    Let's face it, with very few exceptions, the legislators do not represent your interests. This whole charade has made abundantly clear what we've suspected for a long time; our corporate candidates only pay us lip service when it's time to be elected. Why should they care? They know that we're sheep who will complain now, but come election time, we'll mindlessly buy into the rhetoric, step into the booth and pull the lever, and empower them to screw us all over again.

    HC Debacle (none / 0) (#62)
    by norris morris on Fri Oct 30, 2009 at 08:58:39 PM EST
    Anne, you've said it all. A very good post.

    Your reasoning is well thought out, and your disgust is as robust as mine with Congress, the WH, and the mess we've seen developing for 9 months.


    There's a lot we don't know about this bill (5.00 / 2) (#18)
    by Pacific John on Fri Oct 30, 2009 at 12:47:37 PM EST
    ...and forgive me if I don't trust the party leadership on it. The earliest CBO scoring of a public option that does not have Medicare-like muscle showed no cost savings, and next to no enrollment, between 0 and 10 million members. The Senate version leaves out 17 million people, and the House version starts with something that has the same whiff of nothing that the original House proposal did. So where do we go from here? Does it possibly get better when the two chambers produce a compromise?

    Since real information on the House bills is sparse, we can only go with what we know: PhRMA is happy and their original deal with BHO is intact. According to AHIP, they are getting everything they want except the death of whatever it is we're calling a "public option." Sans a real public option, going in, there is nothing elegant about this, like an incremental expansion of Medicare to allow older or younger workers to buy in at actual cost. I'm and engineer and an entrepreneur. If you can't explain something clearly, it's bs, every time.

    Although I don't think the situation is nearly as rosy as BTD does, I join the comment upthread that he deserve huge kudos for studying and reporting the story so the rest of us didn't have to sift the propaganda at the boi blogs. It's been a herculean, largely thankless job.

    Has anyone here sussed out what will (none / 0) (#20)
    by oculus on Fri Oct 30, 2009 at 01:04:14 PM EST
    happen to Medicare?  Do I want to know?  

    I would definitely like to know (none / 0) (#23)
    by MO Blue on Fri Oct 30, 2009 at 01:30:00 PM EST
    Seems like the bits and pieces I've read all indicate cuts to growth rate and payments. Don't know how they plan to accomplish that without reducing care.

    HOUSE BILL - REDUCES COSTS OVER LONG TERM: Encourages payment reforms that can help lower costs. Requires the Department of Health and Human Services to establish specific benchmarks for expansion of the Accountable Care Organization, Payment Bundling, and Medical Home pilot programs. The bill will also slow the rate of growth of the Medicare program from 6.6% annually to 5.3%. link

    Extends the Medicare Trust Fund:  Following the advice of non-partisan experts at the Medicare Payment Advisory Commission, the proposal makes numerous changes in provider payments that extend the life of the Trust Fund for five years and put the program on stronger financial footing for the future. link

    Those elements look like wishful thinking (none / 0) (#25)
    by Pacific John on Fri Oct 30, 2009 at 02:00:43 PM EST
    You can't actually cut Medicare arbitrarily without mechanisms for lower cost, and it looks to me like lower cost is off the table to make AHIP and hospitals happy. Paying for this whole thing primarily by siphoning from Medicare won't work; Medicare and the rest of the healthcare delivery system are tied together. You can, and should, lower costs for both simultaneously, but you can't maintain or grow costs on one side and make cuts on the other - it will only come back to bite you, as we have seen with cost shifting shell games going back to at least Joe Califano's era in the Carter administration.

    Califano tried to take on our current problems when they were fresh shortly after Medicare and Medicaid began. That the current crop of D politicians think they can reform a system that has been this way for at least 30 years with a new cost shifting scheme points either to their lack of competence, honesty, or both.


    Ding, ding, ding! (5.00 / 4) (#30)
    by Pacific John on Fri Oct 30, 2009 at 02:30:10 PM EST

    Shifting cash too private insurance from Medicare isn't a bug, it's a feature! We taxpayers will cover Medicare shortfalls no matter where the money goes.

    Medicare makes up a huge fraction of the healthcare system (half?) that is unavailable to private insurers who lust for it and are fixated on ways of siphoning cash from it. Under Newt Gingrich, who famously tried to privatize Medicare so it would "wither on the vine," insurers made a crass lunge that didn't quite work out.

    What's happening now is right there in plain view, a few hundred billion dollars are being taken from Medicare by Congress and given to private insurers. Everyone knows that the "cut" to Medicare in isolation is ephemeral - across the board costs will keep rising - but a financial mechanism will be in place to launder cash that would go to the elderly and give it to insurance corporations.

    Like I said, if you can't explain something so it's easy to understand, you either don't understand it yourself, of are hiding something. The reason why only people like Greenwald, Wiener and Kuscinich are the few speaking in plain language is, the rest of the party can't admit that this is primarily intended to enrich private companies.


    Medicare cuts (5.00 / 1) (#67)
    by gyrfalcon on Fri Oct 30, 2009 at 11:07:53 PM EST
    concern me a lot, since I'm a few years away and can't afford private insurance.

    But one of the things that keeps being brought up is that "a lot" of the trimming is supposedly going to involve Medicare Advantage-- which is the one place in the Medicare system the private insurance companies get to run the show.  MA is basically an "alternative" Medicare that has seniors sign up with private insurance companies, with their premiums to those companies heavily subsidized by the government.  (It's pretty ridiculous, actually.)

    So anxious and uncertain as I am about this, I don't think it makes sense to say that money cut from Medicare will go straight to the private insurance companies, since it's the subsidies to the private insurance companies for Medicare Advantage that are supposedly going to be gutted.

    It certainly does, however, put the lie to Obama's constant declaration that if you ilke your current insurance, you will get to keep it.  From what I've heard/read, MA will is expected to basically collapse and disappear altogether.


    Sparse Information on HCR (none / 0) (#64)
    by norris morris on Fri Oct 30, 2009 at 09:19:27 PM EST
    Thanks Pacific John.

    Sparse information because it keeps stirring the pot of confusion and deception.

    Obama started with compromise and rolled over at once for Big Pharma in his devil's deal approving of $80 billion in 10 years.  All the more degrading, as Billy Tauzin currently $2million a yr Pharma lobbyist struck the deal. Since leaving congress this one time Dem, [now Rep] flipper was originally one of Tom Delay's group that snookered MedicareRX Plan D into it's horrendous doughnut hole and deceptive "savings'.

    Obama promised transparency,change,and boldness in creating a new model of leadership.

    First thing Obama did was to surrender to Tauzin and Big Pharma insuring them safety for 10 years, and to call for compromise and "bi-partisanship" as the covering meme for a watered version of HCR.

    Deception,compromise,opaqueness,and 1900 pages of unexplained details that no one has had the guts to tell the truth on.

    I guess this is what Bi-Partisanship looks like. Ech!


    I don't (none / 0) (#1)
    by Ga6thDem on Fri Oct 30, 2009 at 08:39:04 AM EST
    know. It seems to me that the bill congress actually has put out is substancially weaker than what they said. I see this bill actually being turned into a trigger bill and that being the one that passes.

    Speaking for me too (none / 0) (#3)
    by ruffian on Fri Oct 30, 2009 at 08:47:46 AM EST
    A bill with no public option at all is no reform. Even the 'medium strength' (half robust?) option in the House bill is barely acceptable. I'd rather see the whole thing dropped than waste the one chance in a generation we get. I hope the Progressives hold firm.

    Good luck with that (none / 0) (#66)
    by lambert on Fri Oct 30, 2009 at 10:07:10 PM EST
    Check this out:

    "The current language is far weaker than what I would have preferred, and I think that is also true of the Progressive Caucus," Rep. Emanuel Cleaver, D-Mo., a member of the Congressional Black Caucus, said Friday. "But because I did not come up here to participate in gridlock and acrimony, I have told leadership that I am willing to compromise."

    Profiles in courage...


    Whip count? (none / 0) (#4)
    by mike in dc on Fri Oct 30, 2009 at 09:03:32 AM EST
    Can we get a complete or near-complete list of every "moderate" Dem in the Senate who's either a "no" vote or is iffy on the opt-out public option?
    I know there's Lieberman, Bayh, Lincoln, Nelson, Carper, Landrieu, Conrad(possibly), and who else?

    If there's 11 Dem Senators who will vote no on cloture and no on reconciliation, then there's no meaningful health care reform, period.  Are there 11?  If there are, how do we flush them out into the open?

    Would it be hardball to run ads against these guys in their home states, pointing out how much money they've taken from the insurance industry, and what percentage of voters in their state support a public option?  Or would that just be completely appropriate public pressure?

    The count (none / 0) (#46)
    by christinep on Fri Oct 30, 2009 at 04:21:51 PM EST
    The Senators that you named have not said that they would vote "no" on cloture. They have indicated concern with the bill. So far as I know, Lieberman is the only one dancing directly with the cloture matter. So...unless I missed some other count, the matter of cloture is very much in play.  In my mind, it may come down to that man Lieberman, and whether he is only playing today at possibly not running in 2012...playing for maximum effect...or whether it is the usual bluff. But, even Lieberman left very open the matter of getting the bill to the floor for debate.  Thats important.  First steps first.

    Hardball? (none / 0) (#65)
    by norris morris on Fri Oct 30, 2009 at 09:35:43 PM EST
    It would be good hardball to uncover the truth about those who stand against their own party and the interests of real HCR. Exposure and taking to the streets are always nexessary to bring about change. Since Obama will never do this as we've seen, it's up to us to challenge our politicians and WH.

    There must be a challenge from the voters to get this leadership and  the pack of weaklings who parade as Democrats. These obstructionists belong in the GOP and should be routed out of office.


    CONgress (none / 0) (#10)
    by SOS on Fri Oct 30, 2009 at 10:38:32 AM EST
    Anyway be aware of booby traps, tap doors and trick ending$.

    Good Luck

    The danger of the ... (none / 0) (#27)
    by Robot Porter on Fri Oct 30, 2009 at 02:19:33 PM EST
    "medium strength" public option is it could die before it becomes real.  Even if rates were tied to medicare setting this thing up is a nightmare.  But without that it becomes a nightmare wrapped in another nightmare.

    It's probably best to support it anyway.  But there's a real chance that such a public option starts small and shrinks to nothing.  Or never gets off the ground at all.

    Correct me if I'm wrong (none / 0) (#68)
    by gyrfalcon on Fri Oct 30, 2009 at 11:12:59 PM EST
    but "negotiated rates" seems to me to be most likely to be stronger than Medicare-plus-5, at least as far as making the public option widely available through providers is concerned.  I believe it makes the public option actually stronger and broader for potential customers.  But what it will do is make public option premiums higher and it will do less to rein in overall health care costs.

    I think.  Far as I can figure this out.  Etc.  Eager to be corrected if I've got this wrong, though.


    I understand why you might ... (none / 0) (#74)
    by Robot Porter on Sun Nov 01, 2009 at 05:11:16 AM EST
    think that.  But remember you need a group who has empowered you to negotiate for them, and a providers willing to accept that group.

    Without rates tied to medicare you have difficultly gathering the group.  And without a group you can't negotiate with providers.

    Or to put it simply:  Who signs up for a plan with no idea of what the rates are going to be?  Probably only the people who have no other choice.  The sickest of the sick.  And what kind of negotiating power will that group have?  Not huge.

    Hence, what type of plans will such negotiations create?  Bad ones.

    All of this can't be solved by tying rates to medicare.  For that you need a pre-populated public option.  But it will help.


    No one can logically support (none / 0) (#34)
    by Slado on Fri Oct 30, 2009 at 03:12:17 PM EST
    anything this congress is putting forth.

    I'm partisan but if I put myself on the otherside of this I don't understand what they think they're getting.

    When did a bad bill mean less then a political victory.

    Sure there could be a water downed public option in some form but it will come at huge expense and that expense is more then likely under represented because like all things congress does it's based on seriously rosy scenarios and no plan for the unintended consequences.

    The bill is horrible and it would take weeks to read it.  

    This is going to hurt.

    It's going to be bad (none / 0) (#36)
    by Slado on Fri Oct 30, 2009 at 03:24:07 PM EST

    Massachusetts has the highest rates of insurance in the country?  Who would have known?

    Can't wait.

    Now for the disguises. The president promised that there will be no new taxes on anyone making less than $250,000 but let Congress craft health-care legislation loaded with new taxes. They're just not called taxes. Instead we have reams of new regulations, "fees," and revenue-raising "items" that will increase the cost of insurance even as the low- and middle-income uninsured are required to buy government-mandated insurance plans. New insurance rules (like community rating, guaranteed issue, and the elimination of lifetime limits on spending) along with $130 billion in new fees (in the Senate Finance bill) on insurance companies, drug makers, and diagnostic manufacturers will all drive up the costs of insurance premiums for even basic plans. The non-partisan Joint Committee on Taxation has estimated that nearly 90 percent of these costs will fall on individuals and families making less than $200,000 a year

    Want proof? Look at Massachusetts, which has many of the insurance "reforms" that the Democrats have embraced, including a mandate (enacted in 2006) requiring all individuals to buy health insurance or pay a penalty. Today, the Bay State has the highest insurance premiums in the country, and expects double-digit premium increases again next year. If you don't qualify for a state subsidy to buy insurance, you're out of luck. As one uninsured, middle-class resident told the Wall Street Journal recently, "I can't use up all of my savings just to buy mandatory insurance. It's like penalizing the homeless for refusing to buy a mansion.

    There is no (5.00 / 1) (#44)
    by CST on Fri Oct 30, 2009 at 04:15:04 PM EST
    public option in MASS.  FYI.

    huh? (none / 0) (#35)
    by Capt Howdy on Fri Oct 30, 2009 at 03:18:06 PM EST
    is that rain or someone piddeling on my head?

    Wait A Minute--The Public Option's Premiums Would Be Higher On Average?

    Two different concepts (5.00 / 1) (#40)
    by Steve M on Fri Oct 30, 2009 at 03:40:51 PM EST
    The argument is that public option premiums in, say, 2020 would be higher than the average private insurance premium in 2020, because the public option will attract a less healthy class of individuals overall.

    But that says nothing about whether the public option will succeed in driving premiums lower (or reducing the rate of growth, which is the same thing) between now and 2020.  It's a different issue.


    I think this is ... (none / 0) (#45)
    by Robot Porter on Fri Oct 30, 2009 at 04:15:19 PM EST
    the critical point:

    Park says the best hope for reform is to create strong regulations and a strong public option, and the worst hope for reform is to create weak regulations and no public option--and that the House performs much better on this score than the Senate does. But was Pelosi right? That there's no philosophical (or, at least, theoretical) difference between a public option that sets rates, and a public option that negotiates them? This CBO report suggests otherwise.

    Of course, the greatest problem with both concepts is the lack of pre-population.  This increases administrative costs and has a huge impact on setting up, maintaining and expanding a public option.

    Pre-population is one of the keys to the success of medicare.

    I don't understand why this issue hasn't become a bigger part of the debate.


    Maybe because nobody knows (none / 0) (#70)
    by gyrfalcon on Fri Oct 30, 2009 at 11:16:26 PM EST
    what "pre-population" means?  At any rate, I sure don't.  Could you spell this out?

    What's up with the 2? (none / 0) (#71)
    by ChiTownDenny on Sat Oct 31, 2009 at 12:21:05 PM EST
    Thought better of you than that.  Have a good day.

    Just wait (none / 0) (#37)
    by Slado on Fri Oct 30, 2009 at 03:27:19 PM EST
    1900 pages and that in it's initial form.  It will be added to by possibly up to 200% by the time it's actualy voted on.

    If the press only doex 10% of their job you will see instance after instance of these kinds of nuggets that will piss off progressives, moderates and even libertarians like me.

    This legistlation will be awful but don't worry.  It's a first step so we have to jam it through.   we wouldn't want Obama to have a political failure.   Better we screw up healthcare so he can feel good about himself.


    To Slado (none / 0) (#48)
    by christinep on Fri Oct 30, 2009 at 04:27:36 PM EST
    You indicated that you are libertarian. So...as I understand libertarianism, it would eschew government involvement of any sort in matters such as health care. Do I have that correct about the classical definition of libertarianism? I don't want to be too snotty, but your comment did not indicate what you want with regard to health care, only that you did not want President Obama to get healthcare reform through Congress. Did I miss something? Or is the gist of your comment something like "mischief making?"

    Will you give it a rest? (2.00 / 1) (#51)
    by ChiTownDenny on Fri Oct 30, 2009 at 05:11:49 PM EST
    This isn't KOS.  People on this site actually express their thoughts, which may run counter to the herd mentality displayed at the Orange Satan.  
    After reading your comments, it's easily discernible that you support Obama.  Fabulous.  Now, bring something to the table, other than Kool-Aid.  Thanksmuch.

    Actually, you don't know... (5.00 / 2) (#55)
    by christinep on Fri Oct 30, 2009 at 07:03:30 PM EST
    Lots of things are easily discernable. But, you don't know.  So, cut it yourself. I addressed Slado the way I did because the comment about libertarianism may well speak for itself.  E.g., If one says that he/she has a particular political philosophy that indicates--by classical definition--that minimun government is favored, the question then becomes whether any form of government intervention in the area would have satisfied that individual. I believe that Slado's own statement raises that question, and thus the question of intellectual integrity about taking sideswipes about the content of any government fix. So...if you want to argue about the issues, fine.  Clearly, we have had a minor history of talking past each other Chitown.  For what its worth, my political support early on was squarely with Hillary Clinton...in terms of hours spent organizing, maximum donation, etc.  I have come to respect the President very much in the aftermath, and support him very much. Yet, I do not drink anyone's kool aid. Do not assume as much. AND, I generally do not read Kos, because the level of commentary often is plain emotionalism...fine for yelling and handwringing, but not much else. I would expect that you--as a visitor here--could comment without misplaced perjoratives.

    weak mandate is bad (none / 0) (#49)
    by diogenes on Fri Oct 30, 2009 at 04:29:43 PM EST
    So sick people can sign up for the public option while healthy people pay $700 to be allowed to go without insurance.  The public option is going to be a money drain.

    I'm getting the impression (5.00 / 2) (#53)
    by nycstray on Fri Oct 30, 2009 at 06:14:57 PM EST
    that the uninsured are misunderstood by many. Most of us (healthy people included) would like affordable insurance over paying a fine and still not having access to affordable insurance. It's really not that difficult . . . . If there is an affordable PO, it won't just be the sick buying in. There's a large pool of relatively healthy folks between say 30-60 out there. Yearly check ups and the like . . . And if allowed, there are also the folks that would like to drop their overpriced insurance in favor of a more affordable PO . . .

    I think there is a bigger risk of people just paying the mandate fine without the PO. I might actually fall into that category  ;)


    The manipulation... (none / 0) (#56)
    by NealB on Fri Oct 30, 2009 at 07:12:12 PM EST
    ...of progressives by Obama especially, and Reid, is disgusting.

    Disgusting. Puke on the floor disgusting. Reid has always been a crappy leader, a shame to the Democratic Party. That Obama has become a puddle of puke so quickly after his arrival in national politics is even more disgusting. And, Limbaugh-like, Obama, stinking on the floor like the smelly mess that he is, has the gall the call on others to grab a mop.

    When Obama cleans himself up off the floor and removes his own disease-causing excrescence, then he may speak again. Until then, every word he speaks is more bilious vomit adding to the mess.

    As if the sh!tted bed left behind by Bush wasn't enough, we have a pair of puking Democrats out to drown us with their lies.

    Hmmm NealB... (none / 0) (#57)
    by christinep on Fri Oct 30, 2009 at 07:49:57 PM EST
    Fascinating.  You seem to be upset. Lots of excremental language in your comment.  So...is there something specific that you want (and why)? C'mon. I get angry myself. It can be liberating to purge oneself. But...do you just want to purge, or do you want to talk about the specifics of a Democratic vis-s-vis Republican plan?

    I want to liken their lies to puke (none / 0) (#63)
    by NealB on Fri Oct 30, 2009 at 09:16:34 PM EST
    Obama's lies = vomit. Reid's lies = puke. No need to read any deeper into my comment.

    Obama and Reid are puking liars. It's a simple observation. They are drowning us with their lies. And it stinks. And it's sickening. It's as bad as the sh!t Bush left us with.

    Simple observations. Obama: puke. Reid: puke. That's all I had to say.

    In case you're still wondering whether I had anything more worthwhile to say, let me clarify. I did not. Obama is a sickening leader. He makes me sick. He has you asking stupid questions because you can't breathe through his vomit. Reid, likewise.


    Is it OK if I throw up in my mouth a little? (none / 0) (#69)
    by lambert on Fri Oct 30, 2009 at 11:14:16 PM EST
    Having Obama call us "little single payer advocates" made me throw up in my mouth a little.

    Well, no, not really. Just a metaphor for a really foul taste.

    Then again, as you point out, there was a kind of relief. It was nice to hear, right from Obama, where we stood and what we were going to get from the Dems.