Bipartisanship And The HCR Endgame

By Big Tent Democrat, Section Other Politics
Posted on Fri Sep 11, 2009 at 10:44:24 AM EST
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Ezra writes an interesting post:

It's like the old joke that you don't have to outrun the bear, you just have to outrun the other guy. Obama doesn't have to be bipartisan. He just has to look more bipartisan than the Republicans. . . . The White House can't stop the Republicans from using procedural tactics to obstruct legislation, but they can keep them from improving their electoral position while they do it. . . .

(Emphasis supplied.) But in fact the President can stop the Republicans from obstructing health care reform - he can follow Senator Charles Schumer's lead and use reconciliation for health care reform. If in fact that is President Obama's endgame, then good for him. Time will tell. In the meantime, the Progressive Block has to hold strong - no robust public option, no "health care reform" bill. (A bill increasing Medicaid funding and funding for health care for the working poor is always welcome, but let's not call that health care reform.)

Speaking for me only

< Yglesias' Sociopathic Indifference To Health Care Reform | Legacy of September 11th >

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Bipartisanship And The HCR Endgame | 31 comments (31 topical)

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It's probably been answered, but (5.00 / 1) (#3)
by NYShooter on Fri Sep 11, 2009 at 11:13:17 AM EST

Why can't we just declare health care a critical industry and regulate it? We do it with electricity; we forbid strikes by teachers; what's so different about health care? (Besides the obvious power of their lobby, of course)

Wouldn't that be the simplest and cheapest way?

That's obviously the (5.00 / 1) (#8)
by SGITR on Fri Sep 11, 2009 at 11:45:37 AM EST

right thing to do and the right way to go about it. But...

First you need a congress and a President who have the citizens of this country's best interests in mind instead of the interests of their corporate donors. If we can't even get them behind an undefined public option you can forget regulating them at a federal level.

However there is a glimmer of hope. I'll remind everyone of Howard Dean's successful 50 state strategy. I'll be the first to say it:

That is the new battle ground now for HCR.

Remember the insurance companies are regulated on a state level, not a federal level. So over time is we can get enough states to better regulate the insurance companies to reflect the needs that have been discussed all through the summer then we can gain momentum one state at a time. Massachusetts tried but it was way too short of what is needed. Maybe purposely so. But they were quite the talk in the beginning. What we need is another Massachusetts to step forward and do it right and get the momentum rolling and start the talk of how successful regulation is working and eventually each state will be under pressure to do the same.


And I can celebrate all that (5.00 / 2) (#16)
by Spamlet on Fri Sep 11, 2009 at 01:27:02 PM EST

at my big fat gay wedding, too!


Not if Baucus provision is in final legislation (none / 0) (#12)
by MO Blue on Fri Sep 11, 2009 at 12:18:54 PM EST

Interstate Sale of Insurance. Starting in 2015, states may form "health care choice compacts" to allow for the purchase of non-group health insurance across state lines. Such compacts may exist between two or more states. Once compacts have been formed, insurers would be allowed to sell policies in any state participating in the compact.Insurers selling policies through a compact would only be subject to the laws and regulations of the state where the policy is written or issued. dday

Provision would have the same effect as what happened in the credit card industry.


Even with Baucus (none / 0) (#13)
by SGITR on Fri Sep 11, 2009 at 01:06:22 PM EST

the regulation reform I am talking about would still take place at a state level.

So let's say a state re-regulated to reflect our wants and needs. And then say an insurance company in an non re-regulated state wanted to sell insurance in the re-regulated state. That would be a good thing wouldn't it? That would mean the insurance company would have to come up to standards.

On the flip side it could mean insurance companies chartered in a re-regulated state may cease selling in that state and opt to go across state borders. Of course they would end open that market to companies who want the business which may not be too smart. It would also mean that the policies that they do have there would have to be brought up to complying with the new regulations.

But that said, even with Baucus, is it a bad idea to push states to re-regulate? I don't think so. In a regulated state the policies that exist there have to comply with the progressive regulations. It is good for the people of that state.


Don't think that is how it will work (none / 0) (#14)
by MO Blue on Fri Sep 11, 2009 at 01:22:09 PM EST

The insurance companies would domicile in a state(s) where the regulations are extremely weak or nonexistent. As part of a federal HCR co-op program, those companies could be part of the exchange and would only be required to abide by the weak regulations of their state of origin.

BTW, Reid just signed up for the co-op program as the public option of choice and Pelosi is said to be open to idea. link


Nope... (none / 0) (#17)
by MileHi Hawkeye on Fri Sep 11, 2009 at 02:24:52 PM EST

...A company could domesticate in a state with no regulation, but if they are issuing a policy to a Colorado resident, for example, the contract would be subject to Colorado insurance laws and regulations. Colorado would be considered "the state where the policy is written or issued".

Credit cards are issued out of states (5.00 / 1) (#23)
by MO Blue on Fri Sep 11, 2009 at 02:50:55 PM EST

that have very weak regulations and sold to people in other states.


We're not talking... (none / 0) (#24)
by MileHi Hawkeye on Fri Sep 11, 2009 at 02:52:35 PM EST

...about credit cards.


Same principle will apply (none / 0) (#25)
by MO Blue on Fri Sep 11, 2009 at 02:58:03 PM EST

when you are able to sell a regulated product to people in one state using the laws and regulations of another.

We are not going to agree on this. Maybe we will both be around 10 -15 years from now and we can discuss what actually happened.


It's not the same. (none / 0) (#26)
by MileHi Hawkeye on Fri Sep 11, 2009 at 03:10:12 PM EST

The authority that I have today to go to a Company domiciled in any other state and examine/regulate their business issued to Colorado residents would still apply.

That applies to health, life, auto--any kind of insurance.

States are not going to give up their consumer protection oversite when it comes to insurance of any kind unless pre-empted by the Feds.


Hmmm (none / 0) (#27)
by MO Blue on Fri Sep 11, 2009 at 03:29:15 PM EST

Preempt by the feds? I was under the impression that HCR legislation and its provisions would be federal legislation.


: We'll have to see if the Feds... (5.00 / 1) (#31)
by MileHi Hawkeye on Fri Sep 11, 2009 at 07:41:52 PM EST

...do in fact enact any HCR legislation and if so, what form it ultimately takes.
Large group coverage is already regulated by the Feds through ERISA. However, that regulation is overlapped by the States in some areas. Claims handling is one of those areas, as well as certain contractual requirements.
No doubt industry, like their cronies in the financial sector, would like nothing more than leaving all regulation to the Feds. Fortunately (IMO), the regulatory reforms drafted so far are very broad in nature (no pre-ex and the like) and appear to leave the finer points to the States.
To that end, while we're waiting on what happens inside the Beltway, there is nothing that says we can't advocate for enactment of sweeping consumer protections on a State level.

That is not what the provision say (none / 0) (#20)
by MO Blue on Fri Sep 11, 2009 at 02:45:36 PM EST

Interstate Sale of Insurance. Starting in 2015, states may form "health care choice compacts" to allow for the purchase of non-group health insurance across state lines. Such compacts may exist between two or more states. Once compacts have been formed, insurers would be allowed to sell policies in any state participating in the compact.Insurers selling policies through a compact would
only be subject to the laws and regulations of the state where the policy is written or issued
.

If Colorado enters into a "health care choice compacts" with two or more states in order to have co-ops, (ex: Colorado, Utah, Montana) a insurance company in Montana could issue a policy in Colorado through the co-op and the insurance company would only be required to meet the laws and regulations of Montana.


: Read what you just wrote... (none / 0) (#22)
by MileHi Hawkeye on Fri Sep 11, 2009 at 02:49:38 PM EST

a insurance company in Montana could issue a policy in Colorado.
But hey, what do I know, it's only my job.

You seem to be (none / 0) (#18)
by SGITR on Fri Sep 11, 2009 at 02:32:25 PM EST

presenting two different arguments which contradict each other. Yes I know in the last one you introduced exchanges which has a different set of rules than you mentioned in your first post. So I guess that makes clear that we don't know exactly what we will end up with, other than no public option.

Whatever the case I don't see a viable argument on why progressive re-regulation at a state level would not only not be a bad idea, it would be a good idea, particularly for the people of that state and subsequent states once the idea of progressive re-regulation gained momentum. Certainly you can see the advantages of it. Unless of course you are against re-regulation at a state level.


I am not against progressive regulation (5.00 / 1) (#21)
by MO Blue on Fri Sep 11, 2009 at 02:48:29 PM EST

I don't think that is what will happen. I think that what happened in the credit card industry will be the end result of this legislation.


: Massachusetts (none / 0) (#28)
by SGITR on Fri Sep 11, 2009 at 05:09:37 PM EST

re-regulated, although progressively weakly imo. But they still attempted universal coverage. So although you don't think it will happen it has already started. It can happen in other places but not without a fight and a can do spirit.
As for your credit card example that already is happening in the insurance industry with limitations. Sure credit card companies are headquartered in one state but issue cards in another. Insurance companies already do that too. The difference is that health insurance is under state laws and must comply with the laws in each state. That's not going to change which is why a movement at the state level for tougher regulation makes sense. You seem to be choosing what you see as the handwriting on the wall which surprises me. But I'm not. And I'm not quiting either. Each state is a target starting with the states with the most liberal state legislatures. Then the wave moves on from there.

Sorry... (none / 0) (#19)
by MileHi Hawkeye on Fri Sep 11, 2009 at 02:43:43 PM EST

...but you are not the first one to say that. I've said it way before now.

And the "momentum" and "pressure" for increased state regulation (notice I did not use the term "re-regulation" as that incorrectly implies there has been a deregulation) comes at the NAIC level. That is where model laws are drafted and then it is up to the state's to codify them.


OK fine (none / 0) (#29)
by SGITR on Fri Sep 11, 2009 at 05:22:22 PM EST

I said the industry needed tougher regulation more than 10 years ago but the important thing isn't who said it first.

And no when I say re-regulation I am not implying it has bee previously deregulated and anyone reading my post would not think that is what I meant because it has not been deregulated. So everyone including myself knows that. I'm baffled that you even brought that up.

As for the NAIC, that is a good place to start pressuring for re-regulation (meaning new progressive regulation), but doing so doesn't negate putting pressure on each individual state's legislatures or insurance regulation departments. They are free to do as they choose without following NAIC.


: It must have some import (none / 0) (#30)
by MileHi Hawkeye on Fri Sep 11, 2009 at 07:23:31 PM EST

...since you saw fit to mention it in the first place and then decided to further clarify with the "more than 10 years ago" statement.
But I will grant you that it isn't important who said it first, but rather it gets done.
Now on the pedantic...
Definition of re:

re-prefix meaning "back to the original place, again," also with a sense of "undoing," c.1200, from O.Fr. and directly from L. re- "again, back." Often merely intensive.

My reading of the above does not reveal any meaning that connotes "new". However, I certainly won't be so brash as to suggest what "everyone" knows or thinks in that regard.
In the end, I think we can both agree that there is absolutely, positively nothing wrong with consumers putting pressure on their elected officials for increased health care consumer protection. Especially with regard to individual consumers of health care as they're the ones that get stuck holding the bag because the laws and regulations applicable to them and lobbyists for them are few and far between.

A few points... (5.00 / 1) (#15)
by masslib on Fri Sep 11, 2009 at 01:25:32 PM EST

Obama endorsed the Baucus position in his speech, note insurance stocks are on the rise.
Obama will not be the last President to reform health care, even David Brooks recognizes this, because Obama choose to expand not fix. For his part, Brooks thinks there are only two legitimate fixes, consumer driven like Wyden-Bennett, which he supports, or single payer(which he admits is not bad...duh)
The Democrats choose a federal role in insurance markets over a larger federal role via program, ie Medicare expansion. They are kicking the can down the road, thinking they will be able to enforce stricter regulations at some later point. I don't think they can, but the reforms should modestly improve private insurance markets in states with loose regulations. A Medicare expansion isn't "radical". Bill Clinton argued for a voluntary one the last term of his Presidency for 55-64 years, ask yourself where we would be today in the reform efforts if that had past.
The CBO analysis shows why a larger federal role in health care by program will come back to the 800 pound gorilla not the PO.

Ok, how my point relates to your post. The "bipartisan" stuff and the meager PO is largely theater. The dye has been cast. The Democrats are initiating a federal role in the private insurance markets. So, I understand what the CPC is trying to do, but the tide is certainly greatly against them, and has been for sometime.

Mugged by Political Reality (none / 0) (#1)
by SOS on Fri Sep 11, 2009 at 10:45:56 AM EST

might be the case.

One more reason that the public option is critical (none / 0) (#2)
by Faust on Fri Sep 11, 2009 at 10:59:15 AM EST

In the current framework as I understand it. I didn't really get the "insurance exchange" idea presented in Obama's speech. It sounded like garbage to me. And based on what I've read it was an idea originally floated by the Heritage foundation. In it's current form in Massachusets it doesn't seem to be doing any helpful work, but if you add a public option it creates a leverage point for the whole exchange framework. That's why the Heritage foundation vehemently opposes even Obama's pathetic 5% public option: because it functions as the camel's nose in the insurance exchange system. No public option: the much vaunted exchange system becomes pure garbage.

So if the progressive block doesn't hold the line on the public option this bill will basically be something that comes straight from the Heritage foundation as far as the exchange element is concerned.

With no public option the exchange (none / 0) (#4)
by MO Blue on Fri Sep 11, 2009 at 11:16:01 AM EST

will only allow you to pick between private insurance companies whose premiums will be all be in the same dollar range. IOW do you want to choose Company A for $1,000, Company B for $1,001 or Company C for $1002?


Yep (none / 0) (#7)
by Ga6thDem on Fri Sep 11, 2009 at 11:33:08 AM EST

which is pretty much the way it is now.


Unless... (none / 0) (#10)
by SGITR on Fri Sep 11, 2009 at 11:54:53 AM EST

http://www.talkleft.com/comments/2009/9/11/114424/539/9#9


: IIRC most of the things that (5.00 / 1) (#11)
by MO Blue on Fri Sep 11, 2009 at 12:09:53 PM EST

are in your comment are part of the current bills voted out of committee (who knows what Dems have given away lately).
It is my understanding that all new policies and those in the exchange must accept pre-existing conditions and cannot be canceled due to illness. I also think (not positive) that people who receive subsidies go through the exchange.
What is not there is any real cost containment on premiums.

And frankly (none / 0) (#6)
by Ga6thDem on Fri Sep 11, 2009 at 11:32:39 AM EST

I just don't see the point of exchanges at all. A place where you can shop for insurance? Do they not know that any indepedent insurance agent can do that for you?


: If they made exchanges (none / 0) (#9)
by SGITR on Fri Sep 11, 2009 at 11:53:11 AM EST

the only place people could buy insurance and still be subsidized; and only let insurance policies that reflected what was being talked about with the public option participate then they could be a good thing considering that there will be no public option.
If the insurance companies want those tens of millions of additional customers who will be subsidized then force them to come up with new policies that accept pre-existing conditions and cannot be canceled, and have more affordable premiums, etc etc.

If one's position is that you want (none / 0) (#5)
by my opinion on Fri Sep 11, 2009 at 11:23:19 AM EST

the "robust public option," you will never obtain it by making that your stated position. You have to ask for a lot more than you actually want.

In addition, if one's position is to back the robust version of a poorly defined position you are destined for failure.

The above would be true even if we were operating in a truly open and fair negotiation, which we aren't.