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Do Pass as Amended

by: Matt Singer

Thu Sep 17, 2009 at 07:23:47 AM MST

As countless others have noted, our senior Senator bent over backwards, watered down his legislation, all in search of a bipartisan bill...and was left with 0 Republican backers. So that's point number one, it is increasingly clear that even Olympia Snowe is going south on even the most agreeable of health care reform offerings. The path to a bipartisan bill is not through negotiations (there is possibly a different path through popular legislation).

That said, there is some praiseworthy material in Max's bill. For example, the public option that people are seeking would "live" in the health insurance exchanges, which are themselves absolutely crucial to meaningful health insurance reform (exchanges will make it possible for individuals and small groups to pool their purchasing power more like large groups and also provide clearer choices for consumers purchasing insurance), are open to a lot more people and employers. In the House bill, for example, you get kicked out of the exchanges if your business grows to larger than 20 employees. In the Baucus bill, you'd have to be given access until you have 50 employees, possibly until you have 100, and eventually anyone would be able to buy-in. In other words, the Baucus bill gives a platform where, with a public option, the option would actually be an option for everyone, individuals, small employers, big employers, etc. That's big.

I'm also a fan of this idea, which I basically think of as insurance reciprocity. Rather than either putting up firm walls that don't let insurance plans cross state lines or tearing down all the walls between states and creating a credit-card-deregulation like nightmare in the insurance system (as Rep. Rehberg and others have advocated), the Baucus plan would allow Montana to permit, say, Californian insurers to sell policies in Montana if we deem California insurance to be regulated enough to satisfy us (note, it might be regulated differently than Montana plans, but still be deemed sufficient by our regulators). Again, this allows for bigger pools and more competition, especially for places like Montana. So that strikes me as good and smart.

The Medicaid and CHIP provisions are also apparently very well-written.

With most other stuff, except for the public plan and a significant change to the employer responsibility section, progressive complaints here are on the margins: subsidies should be more significant, penalties on the individual mandate should be lower, the community rating constraints should be tighter, and the out-of-pocket limits should be lower.

That's all fixable. It isn't fixable without increasing the costs of the bill a bit, but the bill is so fiscally responsible that we can increase its cost and still have it be reducing the deficit (!). So that means we have some room to work.

The bigger problems are that the bill needs a meaningful employer mandate and meaningful competition. Meaningful competition here is a code word for a public option, because no one has yet structured a meaningful alternative to the public option to actually achieve its goals. As is clear, the public option is also a political necessity to building the movement necessary to pass a bill, if the strategy is an outside (pressure) one as opposed to an inside (negotiations) strategy.

There's also some room for feedback on the financing measures, I'm sure, but I haven't really read the relevant material there yet.

Final thought: the biggest problem both with the delivery reforms that Max's bill includes AND with the public option (except for a Medicare-like public option that has its own problems) is that CBO doesn't have a way to score them as providing savings and so presumes that they won't save money. But both Max's Medicare reforms and a real public option will probably result in real cost savings and a public option AND improved access to primary and preventive care will be popular with people. There's some things that can't be scored that easily.

Anyways, check Ezra's five ways to improve this bill. But my friends who are saying this bill needs to die are wrong. It has some excellent stuff in it. It needs amendments, but don't throw the baby out with this bathwater.

Matt Singer :: Do Pass as Amended
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Do Pass as Amended | 16 comments
it was never intended to be good legislation & succeeded (4.00 / 1)
For example, the public option that people are seeking would "live" in the health insurance exchanges [...] In other words, the Baucus bill gives a platform where, with a public option, the option would actually be an option for everyone, individuals, small employers, big employers, etc. That's big.

That is kinda like a used car salesman saying:

This is a great car. The engine would "live" right there, under that hood. This car has great engine mounts, where, if you were to install an engine, it could be a race car engine. Lots of horsepower

TWITTER: @BobBrigham

....if the public option... (0.00 / 0)
...is added to this bill during the legislative process, it would be more progressive than what the House wrote...

[ Parent ]
That's a rather large "if" (0.00 / 0)
don't you think?

[ Parent ]
it's more possible now... (0.00 / 0)
...than it was a week ago.

We should be directing our attention and support to those fighting for the public option, and pressuring those on the cusp to get with it.

Jane Hamsher's been working tirelessly for the public option. Jim Dean's Democracy for America's been pushing hard. Sign up with those organizations. Donate some change to those progressive House members who made the pledge.

Frankly, throwing your hands up in the air should not be option...

[ Parent ]
If wishes were fishes, we'd have a fish fry! Am I right? (0.00 / 0)

[ Parent ]
To Klein's 5 ways to improve this bill (0.00 / 0)
I must add "50 Ways to Leave Your Lover:"

"The problem is all inside your head", she said to me
The answer is easy if you take it logically
I'd like to help you in your struggle to be free
There must be fifty ways to leave your lover

She said it's really not my habit to intrude
Furthermore, I hope my meaning won't be lost or misconstrued
But I'll repeat myself, at the risk of being crude
There must be fifty ways to leave your lover
Fifty ways to leave your lover

You just slip out the back, Jack
Make a new plan, Stan
You don't need to be coy, Roy
Just get yourself free
Hop on the bus, Gus
You don't need to discuss much
Just drop off the key, Lee
And get yourself free

Actually, what I really want to know here (4.00 / 1)
is why do some people think that amending the Baucus/Wellpoint bill is a good strategy? It just needs to get out of committee. Then the Baucus stranglehold/veto on the process is over.

If there are some good points in the bill, why don't we start by implanting them into the House bill(s)? Beefing up the House's efforts seems like a much better strategy to me. But I guess that there may be too many weak knees here to want to go to conference with a strong dem House caucus with a strong bill, and no progressives willing to go the Baucus route.

I always knew that this legislative struggle was going to come down to backfilling Baucus' efforts, once he had watered them down to a worthless mish-mash. And the mash is sourer than I could even had imagined.

Why don't people start to think about moving the HELP bill with parts of the Baucus and Wyden bills thrown in? The real work in the senate is going to be combining the three bills, no matter where Baucus' bill ends up.

Assuming Max's current position as the new starting point is a recipe for continued failure. Giving Max the continued power to be the vehicle to move reform is hopeless.

Folk might find this funny (0.00 / 0)
In an ironic kind of way, of course.

That's friggin' great, Wulfgar (0.00 / 0)

[ Parent ]
Jesus... (0.00 / 0)
So Matt, you have fallen for the political gobbly gook speak...exchanges=co-ops...and that you know equals failure.

This "proposal" from Baucus is crap...it really doesn't change much at all...in fact it is FAR from being "change we can believe in"...

Fortunately....4 of the other 5 "proposals" out there DO HAVE a strong public option and make real changes to the current system...

And fortunately Baucus's little bill is pretty much dead..and will be buried by the time the House and Senate conferees do their work...

"Countless others have noted"??? (0.00 / 0)
That's sloppy.  Who are the "countless others" that have noted our Senator bending backwards? I'll help you out: I can count you and Jay.  But the countless others are the  thousands of investors in health insurance companies;
But now let me regal you with perhaps not countless but quite a few people who would agree that Max is indeed bending over...
Joshua Frank (Montanan) http://www.counterpunch
James Kwak of baseline scenario; http://baselinescenario.com/20...
One reason the Baucus bill is "cheaper" than the House bill is that it has lower subsidies. For illustration, let's assume that the whole $140 billion difference is due to lower subsidies. Relative to the House bill, then, the Baucus bill costs the government $140 billion less; but it costs middle-income people exactly $140 billion more, since they have to buy health insurance. The difference is that in the House bill, the money comes from taxes on the very rich; in the Baucus bill, it comes out of the pockets of the middle-class people who are getting smaller subsidies. Put another way, the Baucus bill is the House bill, plus a $140 billion tax on people making around $40-80,000 per year. That' s not only stupid policy; it's stupid politics

Obama was booed today at the U of Maryland when he mentions the Max Tax: http://thehill.com/homenews/ad...

Howard Dean blasts Baucus bill: http://www.usnews.com/blogs/wa...

Whistleblower Wendell Potter: http://www.huffingtonpost.com/...

That's all for now.  My lunch break is over.

I also should note (0.00 / 0)
that a strategy of "fixing" the Baucus bill by backfilling its provisions that were inserted to garner GOP support is guaranteed to put an end to any nonsense about getting republican votes, or bipartisanship. The only bipartisanship that exists now is opposition to the bill.

So, we're left with a bill that only dems can pass. Which can either be a blessing or a curse, depending on party unity. So people should start strategizing on how to get a bill through Congress utilizing only democrats.

The illusion of bipartisanship has come to an end. Dems need to figure where to position their efforts so as to pass a unity bill. And that should become the starting point for moving forward.

The dem party will raise or fall together on what they do with health care reform, moving forward from this point.

And meet the Mad as Hell Docs in Washington on Sept 30. (0.00 / 0)
And surround the capitol in a huge ring.

[ Parent ]
Re: Do Pass as Amended (0.00 / 0)
It's tough to make a good case for a guilty client. So, I think we should cut Matt some slack here. He gave it his best shot.

Unfortunately, Max Baucus' defenders have perishingly little to work with. His chairman's mark (it's not a bill; more mischief could occur in the bill) clearly was written to please, or at least buy off the opposition, of the insurance companies. Baucus would make purchasing health insurance mandatory, and levy heavy fines on the scofflaws who decided to insure themselves (in the age of Charles Dickens, Baucus would have substituted debtors prisons for the fines). And he would provide some subsidies for those who cannot afford the up-front cost of health insurance.

But instead of letting Americans buy into Medicare or something similar, something run on a nonprofit basis and backed by the full faith and credit of the U.S., he condemns them to the chaos of an insurance exchange where they can choose among competing plans. The exchanges are simply another way of selling private health insurance -- and private health insurance is the problem of which we need to rid ourselves.

Baucus' mark does promise to outlaw denials for pre-existing conditions. That would be good were it ever enforced. How many bureaucrats will have to be hired to keep an eye on the insurers to make sure they abide by the letter and spirit of the law?

The fundamental problem with Baucus' chairman's mark, and with most the legislation now in Congress, is that it preserves the two features of our system to pay for health care that are the most damaging and irrational: employer based health insurance, and private health insurance.

Employer bases systems, especially those that provide benefits to retirees, put and unsustainable burden on older companies such as General Motors, placing them at a competitive disadvantage worldwide. The best thing government could do for the American automobile industry is to directly pay for the health care costs of the industry's workers. For more on this, I recommend Neil Buchanan's fine post on Findlaw's Writ http://writ.lp.findlaw.com/buc...

Private health insurance can be modified, but it can never become an economically positive force. Most medical activities produce something of value to the patient: the care of physicians, healing pharmaceuticals, hospital rooms, wheelchairs and other medical equipment. What does health insurance produce that is of tangible value? Nothing. It simply increases the cost of health care by diverting to Wall Street money that could have been spent to heal the sick. Private health insurance is a legalized extortion racket. And Max Baucus wants to continue it, to provide even more subsidies.

Matt is right: if the mark becomes the bill, it should be passed only as amended. But the only amendment that will do the country some real and lasting good would substitute a zero-dollar, government owned and administered, single-payer system that's financed with the progressive income tax and coupled with an end to fee for service medical business models.

It that possible? Yes. Is it likely? Well, it's about as likely as rolling snake eyes 500 times in a row using fair dice.

This is a great tragedy in the making. A senior senator in a safe seat, a man whose personal experience with a brain injury should have taught him how radically the system needs to be fixed, spends a year stiffarming all but five of the members of his committee in a delusional quest for Republican votes. At the end, not one Republican stood by his side, even after he had modified his proposal to the point where it cannot secure sufficient Democratic votes for passage.

It's also a great outrage, for while the Gang of Six were running their stall, making a mockery of democracy, both the Congressional leadership and the President let him get away with it.

If Matt wants to mount a successful defense of this proposal, he has only one honest option: persuading his client to plead insanity.

Do Pass as Amended | 16 comments

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Purely Hypothetical, of course, but - The best candidate for the Republicans for US Senate is:
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Dennis Rehberg
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