The Best We Can Do ~ Digby on Health Care Reform

by digbyJim VanDehei was on Mitchell this morning talking about his new article which evidently reports that Obama is going to twist arms today to make sure health care reform passes before Christmas. Mitchell asked him if (as Chuck Todd absurdly posited) Lieberman actually pulled back from the brink and decided not to blow up the Democratic party or if he is sitting pretty because he actually got exactly what he wanted:

VanDeHei I don’t think there’s any question that he got what he wanted. He’s been able to kill, or help kill, the public option and now he’s single handedly killed this Medicare expansion for people over the age of 55.

And so now what the president is doing is calling in Democrats in the Senate and saying “listen this is the last chance we have to get health care reform and if I fail, like Clinton failed, we’re talking about generations before another Democratic president with this big of a majority can actually tackle health care reform”. His case is going to be that if we don’t do this in the next two weeks it’s never going to be done.

The big question is, will that message pacify liberals? Liberal Democrats on the hill are saying “listen we wanted a single payer system or at least we wanted the public option or at least we wanted the medicare buy-in. Now we’re getting squat on that end so what are we actually getting?”

Obama will say, you’re actually getting a lot. You’re getting coverage for everybody. You’re getting insurance reform. And he’s going to have to convince them that that is sufficient.

That doesn’t make sense and if Obama is able to persuade liberals with that incoherent line of reasoning then he really is good and they really are stupid.

If this is the only chance for reform in generations, wouldn’t it have made more sense to fight for a truly comprehensive bill that actually solved the problem? If you’ve only got one bite of the apple every couple of decades, it seems remarkably foolish not to really go for broke. To end up with a bill like this as your once in a generation liberal accomplishment is about as inspiring as a Bobby Jindal speech.

And Obama can say that you’re getting a lot, but also saying that it “covers everyone,” as if there’s a big new benefit is a big stretch. Nothing will have changed on that count except changing the law to force people to buy private insurance if they don’t get it from their employer. I guess you can call that progressive, but that doesn’t make it so. In fact, mandating that all people pay money to a private interest isn’t even conservative, free market or otherwise. It’s some kind of weird corporatism that’s very hard to square with the common good philosophy that Democrats supposedly espouse.

Nobody’s “getting covered” here. After all, people are already “free” to buy private insurance and one must assume they have reasons for not doing it already. Whether those reasons are good or bad won’t make a difference when they are suddenly forced to write big checks to Aetna or Blue Cross that they previously had decided they couldn’t or didn’t want to write. Indeed, it actually looks like the worst caricature of liberals: taking people’s money against their will, saying it’s for their own good. — and doing it without even the cover that FDR wisely insisted upon with social security, by having it withdrawn from paychecks. People don’t miss the money as much when they never see it.

And as for the idea that insurance reforms are a huge progressive victory that can only be accomplished once in a generation, well that’s a pretty sad comment on our country — and progressivism.

What this huge electoral mandate and congressional majority have gotten us, then, is basically a deal with the insurance industry to accept 30 million coerced customers in exchange for ending their practice of failing to cover their customers when they get sick — unless they go beyond a “reasonable cap,” of course. (And profits go up!) If that’s the best we can expect of progressivism for the next generation then I’m afraid we are in deep trouble.

*I realize that the subsidies and the medicaid expansion are meaningful. But they are also going to be subject to ongoing funding battles in an age of deficit hysteria. I don’t hold out much hope for any improvement on that count. Indeed, I fully expect they will be assailed as welfare and eliminated as soon as Republicans gain power. They have learned from their mistakes — don’t let any liberal “entitlement programs ” become entrenched. That’s why a big comprehensive program would have been better. It’s much harder to disassemble.

Update: I think it’s really cool being lectured to by Obama about not getting everything you want. I would imagine that Joe Liberman laughed and laughed and laughed at that one.

Harry Reid ~ Health Care Reform Bill ~ Presser

Conservative Democrats Signal They Won’t Block Public Option

R A W  S T O R Y
By John Byrne
Friday, October 23rd, 2009 — 8:07 am

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Conservative Democrats signal they wont block public optionSupport for including some version of a public option in the Senate’s version of a healthcare overhaul appears to be solider than initially believed.

In a series of comments that have received little attention, conservative Democratic senators — even those who’ve publicly said they oppose a public option — say they are unlikely to join a Republican filibuster to block it. Under Senate rules, Democrats would need to convince 60 members to support the ability to vote on healthcare legislation with the public option (cloture), and then just 51 to pass it.

Sen. Mary Landrieu (D-LA) told a reporter earlier this week that she wouldn’t join Republicans in voting against cloture.

“I’m not right now inclined to support any filibuster,” Landrieu said.

“For the Republican Party to kind of step out of the game is very unfortunate,” she added, referring to the Senate Republicans’ intransigence on healthcare reform proposals. “I’m not going to be joining people that don’t want progress.”
Story continues below…

Indeed, Landrieu’s sentiment — that joining foes of healthcare reform would be an impediment to progress — may be the catnip that keeps Democrats on board.

Sen. Mark Pryor (R-AR), a moderate Democrat from the South, said Thursday he was open to some form of a government-run health insurance competitor.

“It depends on how it’s structured on whether I can support it,” Pryor remarked. “I just haven’t decided.”

But regardless of how he votes on the final package, he says he won’t join Republicans in filibustering the bill. Tellingly, he also signaled that he didn’t believe any other Democrats would either.

“I don’t think you’ll see me or any other Democrats do that,” Pryor told liberal blogger Mike Stark.

One conservative Democrat refused to tip his hand. Nebraska Sen. Ben Nelson (D-NE) occasionally joins Republicans on controversial issues.

“I believe in playing chess, but that’s about three moves ahead of me, and I’m not prepared to make those moves until I see some other moves in between,” Nelson told a reporter this week.

Jake Thompson, Nelson’s Communications Director, told Raw Story that he “would decline to comment” about how Nelson will react to a potential Republican filibuster.

Arlen Specter (D-PA) has said he’ll support a public option as well. Specter defected from the Republican Party to the Democrats earlier this year, against the backdrop of a tough primary challenge from his right. In an interview Thursday evening with MSNBC’s Ed Schultz (video below), he sounded confident that Democrats had the 60 votes to prevail.

“We have 60 votes without Sen. Snowe, so we can still invoke cloture and move to a vote on the public option,” Specter said. “With 50 votes plus the Vice President and my vote is going to be for the public option, robust public option, we can get it passed, even without Sen. Snowe. I hope we have her, but we may be able to do it without her.”

Sen. Olympia Snowe (R-ME) was the only Republican to join ranks with Democrats in approving a version of healthcare legislation that passed through the Senate Finance Committee. That version didn’t include a public option.

That said, Democrats need lose only one member to lose the battle for the public option. A 60-vote majority would also need to include independent Sen. Joe Lieberman (I-CT), who’s tangled with Democrats on various issues in the past.

Senate Majority Leader Harry Reid (D-NV) won’t say how many votes he has in his arsenal on a government run plan. In a statement Thursday evening, he said only that he was looking to pass a bill with as many votes as possible.

“We’ll continue to work together to seek broad consensus on the key issues before us and to craft the strongest possible bill that can garner 60 votes,” Reid said. “We will also continue to do our best to represent the views of all members of the Senate who have a genuine desire to see reform succeed. But our mission is clear: the American people want quality, affordable health insurance and failure is not an acceptable option. I am optimistic that we are close to laying a proposal before the full Senate that will do just that.”

In the House, some version of a public option is almost certain to pass. The version will likely be more liberal than that of the Senate’s, as Democrats hold a larger majority in the lower chamber.

President Obama’s position on the public option remains unclear. A Politico report Friday said that Obama prefers a “trigger option,” under which a public insurer would only be created if private insurers fail to meet key pricing standards. The White House, however, says Obama hasn’t taken a position either way.

The following video is from MSNBC’s The Ed Show, broadcast Oct. 22, 2009.

Republicans in Congress Argue on Behalf of the Poor Insurance Companies

Dday Explains the Baucus Health Care Plan : Winner = Insurance Companies

2009_6_sign1

The Reviews Are In!

by dday

Everybody’s talking about Max Baucus’ plan for health care!

Mostly, people don’t like it!

Republicans don’t like it because… it’s a health care bill. Democrats don’t like it because… it’s a bad health care bill designed to kowtow to Republicans who won’t even vote for it. Health care advocacy groups don’t like it because it “would give a government-subsidized monopoly to the private insurance industry to sell their most profitable plans – high-deductible insurance – without having to face competition from a public health insurer.” A good reason not to like it! And unions don’t like it because there’s no employer mandate and it would “tax health plans.”

A bill of particulars:

• The bill spends too little on coverage subsidies. While putting a price tag on something that is paid for inside the budget window is misleading, the fact is that Baucus artificially lowered that price tag to meet some conception of centrism, and the lowered subsidies have a direct impact on affordability.

People in Massaschusetts are by and large satisfied with the Connector. It’s toughest on the fairly small number of families earning just over 300% of FPL (of which there aren’t that many), and on the larger number of young individuals who make just over 300% of FPL (which is $32,320 for an individual, so there are a decent number of those folks). Working class families earning up to 200% of FPL have fairly low premiums. $90 per month is going to pinch, but for uninsured households, they’ll get some real value out of that: Commonwealth Care plans include dental insurance, wellness checkups have low co-payments; chronic disease care is especially well covered, and so forth. Likewise, three hundred pre-tax dollars a month for a family with a gross income of $60,000 per year is Real Money, but it’s not going to break the bank. It’s less than what they should be saving for college, for instance.

But as you can see from the graph, the Baucus bill doesn’t fare as well. It’s not even close to faring as well. The eight million individuals without insurance who earn between 200% and 300% of FPL will pay more than twice what similar households in Massachusetts currently pay. And working class families will feel a real pinch; $250 per month ($3,000 per year) for a family of four with an income of $38,000 is going to hurt.

• The community rating provision, mandating that insurers offer the same price to everyone regardless of medical history, comes with a tremendous loophole that will allow them to change five times as much for a policy based on age, which is just another way to discriminate against the sick.

• The employer “free rider” problem, called “one of the worst policy ideas I’ve ever seen” by Ezra Klein, would penalize employers for hiring anyone who qualifies for subsidies, encouraging them to find people who get coverage through a spouse or illegal immigrants. It also gives large employers like Wal-Mart a competitive advantage for paying crappy wages. And you can’t opt out

• The excise tax for violating the individual mandate could cost up to $3,800 but wouldn’t kick in if the individual could not find coverage that costs more than 10% of his income. In which case, you’ve built a robust architecture for a useless plan, because if millions opt out the coverage gets less universal and insurers want to stop come-as-you-are guaranteed issue.

• The co-ops are even weaker than imaginable:

of the garbage insurance that giant employer – let’s call them Ball Bart – might offer you.

The co-ops can only compete in the small group and individual markets. That is to say, if the co-ops prove effective, and The Washington Post would like to offer co-op coverage as an option to its workers, it can’t. The co-ops are not allowed to contract with large employers, which is to say, they can’t compete with private insurers in the largest market, and they can’t get the purchasing power that would come from a serious foothold among corporate customers.

Not only is their size restricted, so too is what they can do with their size. The co-ops can band together to increase their purchasing power, but they can’t set national payment rates for their members, a la Medicare. As I understand it, they have to bargain with each provider and drug manufacturer and hospital and so forth separately, meaning they’re denied one of the main advantages of size. The insurance industry is, in other words, being protected from not just public competition, but co-op competition.

Jay Rockefeller today sent a letter proving, based on tons of research, that co-ops were a complete sham that have failed in the marketplace on a number of occasions, saying that “I believe it is irresponsible to invest over $6 billion in a concept that has not proven to provide quality, affordable health care, when we know that a public health insurance option will rein in costs and save taxpayers billions of dollars.”

Marcy Wheeler has a lot more. There’s one promising sign that the exchanges look expandable and available to all businesses, a neat way to gradually wean the system off of exclusive employer-based insurance, but that’s about the only silver lining. Kent Conrad’s gambit of increasing the budget window to make the Senate Finance bill look better did work, as the deficit reduction aspects look improved for the bill over the House bill. But crucially, that’s a function of the funding, not the outlay in subsidies. Those will be too stingy to make the bill work for people, only for the bean-counters. In fact, the bill will start taking more and more from the middle class, much like the alternative minimum tax, and political reality will force scalebacks, so the budget picture doesn’t look as rosy as advertised.

But it also suggests some real dangers in the bill’s second decade. The unpopular elements of the bill become a lot bigger and more onerous. The excise tax on high-cost insurance plans begins affecting insurance plans that aren’t particularly high-cost. The Medicare and Medicaid savings begin to tighten. That said, there are a lot of potential savings that the CBO isn’t taking into account here, so that might ease the pain. Plus, at some point, we are going to have to start cutting costs in the system, and you can’t escape some eventual hurt in that. But you can be sure the GOP is going to run these numbers aggressively and spin them viciously.

The good news is that this is in no way “the bill” that will get signed by the President. It has to go through a significant amount of changes, and key Democrats are already balking at it. In fact, lil’ ol’ Roland Burris said he wouldn’t vote for anything without a public option, and with the numbers so tight, every Senator is in a bargaining position. Baucuscare is an abomination. But it doesn’t have to be the endpoint, only the beginning.

I should say that one group really, really likes the Baucus bill – insurance companies.

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dday 9/16/2009 08:00:00 PM // // Comments (55) | // Trackback (0)

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