Left in the West - healthcare reform

The deeply flawed Senate health care bill: is it worth saving?

Jay Stevens — Thu, 17 Dec 2009 16:42:36 GMT

I haven't been writing much about the healthcare bill in Congress right now - I've been writing about this issue for months now, and all that happens is that it gets uglier and messier. A grind. Frankly, I have no idea how staffers and lobbyists deal with the schedule, the endless bickering, the soul-sucking compromises.

In the Senate, of course, the public option was dropped in favor of Medicare expansion. Which, well, I would take as a start towards "Medicare for all." But then Joe Lieberman stepped in, and they dropped the Medicare buy-in. And now, thankfully, Bernie Sanders says he won't vote for the bill without the public option or Medicare expansion. Howard Dean's also speaking out against the legislation:

If I were a senator, I would not vote for the current health-care bill. Any measure that expands private insurers' monopoly over health care and transfers millions of taxpayer dollars to private corporations is not real health-care reform. Real reform would insert competition into insurance markets, force insurers to cut unnecessary administrative expenses and spend health-care dollars caring for people. Real reform would significantly lower costs, improve the delivery of health care and give all Americans a meaningful choice of coverage. The current Senate bill accomplishes none of these.

Even the SEIU is balking at the bill.

FDL's Jon Walker has a nice post on the reasons why a lot of us feel the Senate bill unacceptable, and why killing it is a good strategy. Read it. It's pretty much how I feel about this thing. I see the bill as fatally flawed, offering the wrong incentives, mandating that individuals purchase deeply flawed and expensive health insurance that may not cover their healthcare anyway.

There are progressives who do still support the bill. John Podesta:

The Senate health care bill is not without its problems. But if enacted, it would represent the most significant public reform of our health care system that Congress has passed in the 40 plus years I have worked in politics. The bill will give health care coverage to a record 31 million Americans who are currently uninsured, lay a foundation that will begin to lower costs for millions of families, and provide all Americans with the access to adequate and dependable coverage when they need it most.

Nate Silver:

So, we've talked a lot about what the bill is not. It's not structural reform. What is it, then? At the end of the day, it's a big bleeping social welfare program -- the largest social welfare program to be implemented since the Great Society. And that's really what it's been all along: fundamental reform like single-payer or Wyden-Bennett was never really on the table. The bill comes very close, indeed, to establishing what might be thought of as a right to access to health care: once it's been determined that people with pre-existing conditions cannot be denied health care coverage, and that working class people ought to receive assistance so that they can afford health care coverage, it will be very hard to remove those benefits. It's the sort of opportunity that comes around rarely -- and one that liberals will greatly regret if they turn down.

(By the way, as I understand the bill, most of us will not enjoy the protections against pre-existing conditions, lifetime caps, etc. Most employer-based insurance won't be subject to those new regulations in the near future, although I believe they will eventually be rolled into those provisions.)

That's an argument that's hard to ignore. A greatly flawed bill will actually help millions. Still, I don't think that argument is enough to have progressives go belly-up at the kind of egregious deal-making that's currently going on in the Senate. Hopefully Senator Sanders will stand firm and find a few friends, and force this bill to improve.

On taxing benefits

Jay Stevens — Mon, 23 Nov 2009 16:27:57 GMT

Matt threw down the gauntlet yesterday with his support of the Senate bill's excise tax on high-end insurance plans:

My friend Jay Stevens wrote a while ago that his problem with the excise tax was that it penalized spending on healthcare and that we should be happy to encourage people to spend more on healthcare. If healthcare actually improved health, I'd be inclined to agree that it is worth subsidizing. But the correlations are relatively weak (and the odds that hospitalization can hurt or kill you are unfortunately high). Under these circumstances, reducing healthcare spending and allowing ourselves to spend more money on other things (perhaps sporting equipment or healthy local food, both of which can be expensive but would do more in general to improve health than more heart surgeons) would be a good thing.

I wrote a lengthy post on this subject before, but some of its essential points are worth repeating.

Insurance companies have for years sought to discourage policy holders from seeing their doctors by using low-end policies with high deductibles and higher out-of-pocket costs associated with preliminary doctor vists. The premise -- and Matt gets at this, too -- is that consumers, if allowed, would opt for expensive and unnecessary medical procedures, driving up the cost for their treatment. Insurance companies, by throwing road blocks between consumers and their doctors, goes the theory, cuts down on wasteful healthcare spending.

This is one of Ezra Klein's favorite lines of reasoning: because people don't understand how much their insurance actually costs -- employers a large portion of the costs -- they are less likely to consume rationally. And while that's true for, say, selecting prescription medicine, it's actually an illogical argument because people aren't rational consumers of healthcare to begin with.

Simply put, we don't like to visit the doctor. Giving people an economic incentive to avoid seeing their doctor only gives them permission to do so. Minor illnesses turn serious, and expensive. Malcolm Gladwell eviscerated this argument years ago in his piece, "The Moral Hazard Myth," which is well worth a read.

The problem, of course, isn't consumers. We're not choosing unnecessary procedures. We do what our doctor tells us. Our doctors, on the other hand, have a distinct economic incentive to give us procedures instead of care -- and Atul Gawande already covered this in his New Yorker piece, "The Cost Conundrum." Doctors get paid by what treatments they give to patients. Therefore, they give lots of treatments.

The answer is twofold: easy access for consumers to their doctors, and a payment system that pays doctors for seeing patients, not treating them. Good, affordable insurance and salaried doctors, say.

So, yeah, I'm not crazy about an excise tax on benefits. We've been down the road of discouraging patients from seeing their doctors, and it's only helped drive healthcare costs higher.

Opposition expected to stiffen against ban on subsidized Viagra

Jay Stevens — Fri, 13 Nov 2009 18:51:03 GMT

Digby:

I have a moral objection to paying for any kind of erectile dysfunction medicine in the new health reform bill and I think men who want to use it should just pay for it out of pocket. After all, I won't ever need such a pill. And anyway, it's no biggie. Just because most of them can get it under their insurance today doesn't mean they shouldn't have it stripped from their coverage in the future because of my moral objections. (I don't think there's even been a Supreme Court ruling making wood a constitutional right. I might be wrong about that)....

Given the makeup of the SCOTUS, I wouldn't make any bets...

I realize that many people disagree with my moral objections to men getting erections which God clearly doesn't want them to get, but my principles on this are more important to me than theirs are to them. So too bad. If you want a boner, pay for it yourself.

Sure, digby's jokingly responding to the justification behind Stupak amendment, and the House vote disallowing insurance purchased in the health insurance exchange from covering abortion...but, hell! She's got a point! Why does insurance cover Viagra? It's not like it actually affects any urgent medical condition...? And it certainly isn't as critical to men as abortions are to women...

But just as the members of the Republican party look to impose penalties on the rest of us that they don't feel apply to themselves, don't hold your breath that a bunch of old white guys will be preventing private insurers from paying Viagra claims...

Rehberg flirts with the lunatic fringe

Jay Stevens — Tue, 10 Nov 2009 16:23:52 GMT

Look who voted against the healthcare reform bill in the House, and why!

Rep. Denny Rehberg, who joined all but one of his fellow Republicans in voting "no" Saturday on the major health-reform bill that passed the U.S. House, said the measure is an ill-advised "trillion-dollar government takeover of health care."

I wish!

Wait, there's more!

"I'm standing with Montanans in favor of sensible reforms that don't simply replace insurance bureaucracies with more expensive government bureaucracies," he said.
Rehberg said he supports a Republican alternative proposal rolled out last week that would allow Americans to buy health insurance across state lines, encourage small-business health insurance pools, increase the use of individual health savings accounts and reform medical liability to reduce the cost of medical-malpractice lawsuits.

Okay...two outright falsehoods in those statements. The House bill is definitely anything but a government takeover of healthcare; and insurance bureaucracies are not more expensive than government bureaucracies. In fact, the opposite is, of course, true.

We're in Beck-ian territory here.

As for the Republican proposal, well, I've written about this stuff before, but buying insurance across state lines will only make insurance less reliable, cover fewer conditions, and cause you more out-of-pocket medical costs; small business insurance pools and individual health accounts don't solve the problem of the uninsured; and tort reform doesn't work, doesn't lower healthcare costs, and gives medical professionals a disincentive to give good care.

In these few words, Rehberg illustrates the difficulties facing progressives and reformers who, like me, are not entirely pleased with a healthcare reform bill that preserves the broken-down insurance status quo and essentially bribes the industry to cover the uninsured. On one hand, we need to pressure Democrats into adopting real and effective policies. On the other hand, Republicans -- and Rehberg now, too, apparently -- are entering crazy land. We can't entrust governance to these people. Things were bad enough under the recent Republican hegemony -- widespread corruption, a broken economy, stagnant wages, wars, the politicization of government, illegal domestic spying, torture -- how much worse would things be under lunatic rule?

Health care reform passes House, with gut punch

Jay Stevens — Mon, 09 Nov 2009 13:29:32 GMT

Well...the healthcare reform bill passed the House, but not without a gut punch to women.

First, Democrats struck a deal over healthcare to win the support of Catholic bishops by allowing an amendment to reach the House floor that would disallow any insurance passed in the health insurance exchange to cover elective abortion procedures.

Jane Hamsher: "Democrats in Congress have just proudly signed a deal...which allows a bunch of old men who have spent the better part of the last century avoiding their own sexual issues to dictate access to abortion services..." Hamsher rips Planned Parenthood and NARAL for rolling over on this and other women's issues wrapped up in health care reform.

Even Ezra Klein thinks it's a bad deal:

The idea that people are going to go out and purchase separate "abortion plans" is both cruel and laughable. If this amendment passes, it will mean that virtually all women with insurance through the exchange who find themselves in the unwanted and unexpected position of needing to terminate a pregnancy will not have coverage for the procedure. Abortion coverage will not be outlawed in this country. It will simply be tiered, reserved for those rich enough to afford insurance themselves or lucky enough to receive from their employers.

A great day for women, that started off with the Democratic women's caucus being repeatedly shouted down by Republican Congressmen on the House floor.

It's hard to jump and down and cheer for a bill with so many bad compromises in it - how did we get here? In part, I blame the group of "moderate" or "centrist" Democrats who drag their feet on Democratic policies while taking in industry donations. But those Democrats exist and wield power because the Republicans are quickly ceding their role as rational political players. They vote against every piece of legislation in Congress, and refuse to even enter negotiations in crafting legislation. The effect is particularly dire in the Senate, where Republicans so far have filibustered, or threaten to filibuster, nearly every Democratic bill or judicial nomination. As a result, the worst Senators - Lieberman, Baucus, Nelson, Lincoln - are having the most influence on policy.

And it might get worse. Krugman:

In fact, the party of Limbaugh and Beck could well make major gains in the midterm elections. The Obama administration's job-creation efforts have fallen short, so that unemployment is likely to stay disastrously high through next year and beyond. The banker-friendly bailout of Wall Street has angered voters, and might even let Republicans claim the mantle of economic populism. Conservatives may not have better ideas, but voters might support them out of sheer frustration.
And if Tea Party Republicans do win big next year, what has already happened in California could happen at the national level. In California, the G.O.P. has essentially shrunk down to a rump party with no interest in actually governing - but that rump remains big enough to prevent anyone else from dealing with the state's fiscal crisis. If this happens to America as a whole, as it all too easily could, the country could become effectively ungovernable in the midst of an ongoing economic disaster.
The point is that the takeover of the Republican Party by the irrational right is no laughing matter. Something unprecedented is happening here - and it's very bad for America.

Congress to kill SCHIP?

Jay Stevens — Fri, 06 Nov 2009 17:03:10 GMT

John Morrison, on Facebook:

[John] notes that the health care reform bill emerging now in the U.S House terminates the Children's Health Insurance Program in four years.

It's true:

The $894 billion, 1,990-page health reform bill unveiled by House Democrats last Thursday would repeal CHIP at the end of 2013, shifting millions of kids instead into private plans contained on a proposed health insurance marketplace, dubbed the exchange.
Party leaders have been mostly tight-lipped about their motivations. But a series of factors seem to have driven their decision, according to sources on and off Capitol Hill, including hopes to get family members under the same plan, to centralize control of the state-run CHIP program, and to shift more folks into private coverage to win the support of both the insurance lobby and moderate Democrats.

What th--? How do you justify something like this?

Suzy Khimm:

It could strengthen one of the most fundamental parts of the Democratic reform package -- a robust insurance exchange with a pool of participants that's large enough to drive down costs precisely because insurance companies have an incentive to jump in and compete for customers. Moreover, folding CHIP into the exchange would add a younger, healthier pool of participants to the exchange, offsetting its potential of becoming a dumping ground for the sick and elderly. Finally, CHIP has always suffered from under enrollment -- about 6 million children aren't insured in the program who should be -- and by bringing whole families in under the same plan, more children will be covered.

Call me unimpressed with this line of reasoning. Essentially Khimm is arguing that we should offer up the children of the least wealthy Americans to the private insurance industry in hope that they'll lower prices for the rest of us.

Additionally, it's probable that most of these families whose children we'll be thrusting into the private market will need taxpayer subsidies to afford the more expensive private plans for their children, which seems to me to be a much less efficient use of tax dollars, given private insurers' much less efficient coverage. And what about the health of the children under CHIP? CHIP insurance plans actually pay claims to ensure that children get the medical care they need. There's no such guarantee under private plans.

Lieberman vs. good ideas

Jay Stevens — Wed, 28 Oct 2009 20:26:56 GMT

The big piece of news being bandied about today is that our favorite "Democrat" - Joe Lieberman - vows he'll block any healthcare reform bill that includes the public option, as he positions himself, according to the Politico report, to be a "fiscal hawk" on the issue. Even though the CBO has time and time again scored any reform bill that includes a public option lower than bills without it. In fact, the bigger and more inclusive the public option, the lower the cost of reform.

Either Lieberman is a complete idiot, bluffing, petty and revenge-minded, or he's using his position on the bill to kick off a bidding war for his services from both parties.

And Harry Reid appears nonplussed about Lieberman's threat.

(Frankly, I would like to see the Senate Democratic leadership pull out the stick for a change. You know, strip Joe of his committee chair and deny him of his appropriations requests, and watch how his lobbyist friends abandon ship. No better way to hurt a Senator like Lieberman than to go after his goody bag.)

And as Lieberman disses the public option, its popularity among voters continues to climb.

No wonder a majority of Americans in a recent WSJ/NBC poll think the US is on the wrong track. And while conservatives are off braying, seeing in the results a rejection of liberal politics, if you look closer at the numbers, it's pretty obvious the reverse is true:

-- Obama's approval rating remains at 51% in the poll, exactly where's it's been for the last few months.
-- 43% approve of the president's handling of health care. For Republicans, it's 23%.
- 42% have a favorable opinion of the Democratic Party. For the Republican Party, it's 25%. (Update: The GOP's rating is even worse now than it was during Bush's two terms.)
- On the generic ballot test, respondents favored a Democratic candidate over a GOP candidate, 46% to 38%. A month ago, the margin was only three points in Dems' favor.
- 63% believe the economic problems the White House is dealing with were inherited from the Bush era. That's down from 72% in June, but it's still quite high.

Combine those results with, say, Sarah Palin's popularity, and it's obvious the numbers show that the Republican brand is toxic. That's the real story here. No one scores worse on healthcare than Congressional Republicans. The economy is still seen as a Republican creation. And the likely drop-off in numbers about the direction of the country and the handling of healthcare is likely coming from disillusioned liberals and independents, who see Congress playing politics-as-usual footsies with corporate America.

And politicians know it, too. Those Senators facing tough re-election campaigns are often the public option's biggest boosters. First, it was Alren Specter, who favors a robust and accessible public option. And, more recently, there's Harry Reid, who looks like he's going to include it in the Senate healthcare bill over fears for his approval numbers back home.

The key, now, is to hammer this home, again and again to our elected representatives. Yes, it's work. Yes, it's slow and painful. But, yes, we can move this thing, bit by bit...

We've got the public option...now what?

Jay Stevens — Tue, 27 Oct 2009 15:40:45 GMT

Best Ezra Klein analysis I've seen in a long time. And it's framed around this quote from Rep. Anthony Weiner:

What are we trying to protect when we're trying to protect against the destabilization of a system we all agree isn't working and that we think people are trying to leave?

And Klein lists the various contradictory precepts driving healthcare reform, explaining the limping pox-scarred legislation Congress came up with to link all the contradictions. Klein:

You can go on in this vein, of course. It's a bit of a problem. Underlying it is the political insight that people want the system changed but are afraid of rapid changes to their personal situation, and so reformers are trying to build out their reforms such that people can transition to new and better options gradually. The problem with that, of course, is that the reforms won't necessarily have the size or scale to show their power, and many people will be legally prevented from changing over even if they would like to. It's a bit like rolling out a new television, but refusing to sell it to people who own televisions larger than 25 inches. You've lost a big pool of early adopters, which means you might also lose the people who would otherwise follow them.

We've the framework for reform. The next battle: getting access to reform.

The public option fight is just beginning

Jay Stevens — Mon, 26 Oct 2009 22:40:51 GMT

So we got a public option in the Senate bill. The bill and its version of the public option is far from perfect - that it's opt-out at the state level is the least of its problems. For one, it'd be available - along with the community standard provisions - to only a handful of consumers. And that's critical, for in order for the public option to be successful it needs to be national, and it needs to be big. Still, if this is the most conservative, weakest version of the public option that could make it to the final Congressional bill - the worst-case scenario, if you will - that's not a bad thing.

Still, that it got in the bill is a huge victory for the progressive activists who fought for it. Huge. Despite being outspent by industry lobbyists, despite not garnering the frenzied media coverage that the Teabaggers did (memo to self: blog while armed), despite the attempts at marginalization by both Congressional and White House Democrats and the open hostility of some single-payer advocates, a lot of good people stirred up a big fuss, and a public option will be in the final bill.

We were wanted for door-knocking and phone-calling and t-shirt-buying and our votes, but we weren't wanted when it came time to craft policy. Well, despite the public option's relative insignificance (compared to say, real health care reform in the form of a single-payer system), we've forced a place a the table. And we're not going away. We'll be there for climate change legislation, immigration reform, bank regulation, Net Neutrality, consumer protection legislation, gay rights, tax reform, and on and on and on.

Get used to us.

Thoughts below the fold.
First, this isn't pretty reform. Krugman:

Like the bill that will probably emerge from Congress, the Massachusetts reform mainly relies on a combination of regulation and subsidies to chivy a mostly private system into providing near-universal coverage. It is, to be frank, a bit of a Rube Goldberg device - a complicated way of achieving something that could have been done much more simply with a Medicare-type program.

Krugman's optimistic. He points out that Massachusetts' system has nearly achieved its goal - universal coverage - and that it's popular. He admits that system, and this bill, have little in them to control costs, but as in Massachusetts, the reform will be a framework that spurs more reform. Krugman: "The new health care system will be criticized; people will demand changes and improvements; but only a small minority will want reform reversed."

I agree, although I'm a little more pessimistic at the bill's outcome. Massachusetts voters didn't have the same expectations national voters do. America's voters are expecting health care reform - they'll be getting a weird insurance welfare bill with a convoluted payment system and no real change for most policyholders, other than higher premiums. And nothing will happen until...when? 2013? And you think this is a recipe for success?

Second, the next big thing we have to fight for is an open health insurance exchange. Without it, reform is going to be meaningless for most of us. We all should have the right to ditch our health insurance policy if we don't want it, and shop for a policy on the health insurance exchange - a policy that's subject to the community standard regulations. I don't want a policy owned by insurers who will search my medical records for a reason to deny my claim. Likewise, I want the option to buy the public option - at any time.

Third, the Senate is a mess. Its use of the filibuster has impeded that body's constitutional duty. And it's not just healthcare. Thanks to Republicans filibustering nearly every bill and judicial appointment, the Obama administration is essentially handcuffed to enact the change it promised - if, of course, it's actually interested in reform. But we are, and the Senate has become an unreasonable obstacle. All the power of the Senate is vested in a few corporate-controlled "moderate" Democrats and Republicans - Mark T's bogeyman Democrat come to life. Senate Democrats need a new leader, one that's more progressive and more aggressive, who'll work to strip vacillating Democrats of their committee chairs and break Republicans of their knee-jerk filibustering.

Harry Reid: supporting an opt-out public option is not enough.

Fourth, the biggest reasons politicians pull sh*t like this bill is because of fear. Fear they won't be re-elected. But the support for Democrats is bottoming out. Why? Because Democrats and Independents want real progressive change. It's hard to get fired up about this healthcare bill. It's the ugliest kind of compromise: assembled by committee, dedicated to preserving the status quo with taxpayer subsidies, and pleasing to no one. If the GOP wins back a few dozen House seats in 2010, it won't be because of conservative "values" - the Republican party is almost universally loathed - it'll be because Democratic supporters, who worked so tirelessly to completely turn DC around in two elections and two short years, will have little to show for their work and will stay home.

If you want to preserve power, do something bold.

Next up: climate change!

Of course, the carbon tax has already been pushed off the table...and the Senate promises to strip all of the meaningful provisions from the already-stripped-down cap-and-trade bill...

Sound familiar?

Remember, the public option IS the compromise

Jay Stevens — Sat, 24 Oct 2009 01:13:57 GMT

Ezra Klein today reported that Harry Reid was very close to including a national public option into the healthcare reform bill that would be voted on in the Senate. Until...

...Max Baucus held a meeting.
Here, stories begin to diverge. Depending on who you talk to, Baucus either held a routine, informational meeting telling the Senate moderates and members of the Senate Finance Committee what's going on, as he's been doing fairly regularly, or he held a meeting in which he tried to rally Senate moderates to change Reid's mind. Or maybe there's no difference between the two. The first to really speak out after the meeting was Sen. Ben Nelson, and, as one staffer pointed out, Nelson didn't need Baucus to remind him that he was opposed to a national public option. Soon enough, Olympia Snowe was also making firm statements against the public option, and threatening a filibuster.

Sort of astounding for a Senator who claims to support the public option. In fact, right now, we have to assume that Max Baucus is actively working against the public option.

This week, George Ochenski wrote a pretty d*mning op-ed in the Missoula Independent, accusing state Democrats of lining up to praise Baucus' efforts on healthcare and his bill because of money. Campaign money. Oodles and oodles of cash. And you know what? He's got a point.

But money isn't everything. Votes matter, too. And I guarantee they can't have both Baucus' money and widespread support among voters, especially those of the Democratic base. Because this bill, without a robust, widely-available public option, is going to affect a majority of Montanans' not one single bit, except to raise their premiums. Many, if not most, voters will wake up the day the bill goes into effect, and still find rejected claims due to preexisting conditions in their mailbox along with a stiff little premium hike to cover those the insurers will be forced to cover. (You know how they'll frame it, too. Those "shiftless""irresponsible" ones, the "parasites" who don't take care of their health.) And a lucky few union families will find a nice fat tax hike in their pay stub, too.

The bill without a robust public option is a kind of welfare program for the poor. Which is fine. But it's been framed as healthcare "reform." And when people hear "reform," and want "reform," and you give them something else that's definitely not "reform," you know what their reaction will be.

It will destroy the Democratic party.

So. Montana Democrats. You either stick with Baucus and drive off a political cliff, or you ditch him and find another way to raise money. H*ll, if you come out strong and hard against Baucus and for the public option, raising money probably won't be an issue.

And, frankly, Baucus isn't the only one who appears to be against us. Also from Klein's piece:

On Thursday night, Reid went over to the White House for a talk with the president. The conversation centered on Reid's desire to put Schumer's national opt-out plan into the base bill. White House officials were not necessarily pleased, and they made that known. Everyone agrees that they didn't embrace Reid's new strategy. Everyone agrees that the White House wants Snowe on the bill, feels the trigger offers a safer endgame, and isn't convinced by Reid's math. But whether officials expressed a clear preference for the trigger, or were just worried about the potential for 60 votes, is less clear. One staffer briefed on the conversation says "the White House basically told us, 'We hope you guys know what you're doing.'"

Frankly, I hope the White House knows what it's doing. Because from here, it looks like they're pushing for the clusterf*ck.

Once again, with feeling: the public option is popular!

Jay Stevens — Fri, 23 Oct 2009 01:20:51 GMT

The warning bell for timid Democrats from Public Policy Polling's Tom Jensen:

Our polling continues to find that the problem for Democrats right now isn't so much that people are switching sides to the Republicans, but that D voters have become sort of complacent/disengaged. There is no greater threat to the party next year than for its voters to feel like getting in power in 2006 and 2008 hasn't accomplished anything, and that their votes didn't really make a difference in policy making. That's when they stay home. So the impact on turnout next year that not doing something meaningful on health care could have is to my mind the greater risk for Democrats right now.

Let's see. The public option. It saves money for reform, even helps reduce the deficit over time. It promises reliable, affordable insurance that will help keep costs down. It's wildly popular. (With sixty-one percent in a CNN poll.)

And if you don't pass it, your base will turn on you.

Okay. Tell me again why you don't support it?

The public option is Popular, redux!

Jay Stevens — Wed, 21 Oct 2009 14:24:43 GMT

Some more thoughts on the Washington Post/ABC poll results that was released this week...

Okay. We all know the public option is wildly popular.

Fifty-seven percent of those polled favor it, only 40 percent oppose. Support for the public option shoots up to seventy-six percent if states run the public option, and it's available only to those who have no option for private insurance. In that case, even 56 percent of Republicans favor it. Additionally, 51 percent prefer the public option, even if Republicans don't support. A meager 37 percent prefers a bipartisan bill without the public option. Independents prefer a public option to bipartisanship on a 52/32 percent clip.

But what's surprising is when you compare those numbers to approval of healthcare reform overall, in which only 45 percent support it, while 48 percent oppose it. That's right, the public option is +11 over the reform package as a whole! More intriguing, 56 percent of those polled favor an insurance mandate. And if subsidies are provided for "lower-income" consumers, support jumps to 71 percent! (In fact, that jump so violates DC Conventional Wisdom on healthcare reform, that Kevin Drum called out for some help in showing the numbers were the result of how the poll questions were asked.)

Add that data to the low confidence Americans have in the Republican party - only 19 percent said they had "confidence" in the GOP to make "right decisions" for the country - and Obama's approval rating (57 percent), what I take away from this data isn't that Americans are uneasy about healthcare reform from conservative, Teabagger-like concerns, but because the legislation isn't progressive enough.

That, of course, runs counter to how moderate Democrats have reacted to polling data and Teabagger protests. What it's beginning to look like is that the traditional media - and jumpy Dems by proxy - was punked this summer: it wildly inflated Teabagger protests and charted them against declining support for healthcare reform, thinking the two related. Instead, it's looking like Democratic and independent voter defection that's driving support down.

In short, any moderate backing off the public option for fear of a public backlash is making an egregious mistake.

Health care reform links...

Jay Stevens — Tue, 20 Oct 2009 16:20:08 GMT

The New York Times: "In the debate over health care reform, no issue has produced more fury and sound bites than the question of whether to include a government-run insurance plan. It is not indispensable, and its role would be limited. Even so, we strongly support inclusion of a public option - the bigger and stronger the better. That is the best way to give consumers more choices, inject more competition into insurance markets, hold down the cost of insurance policies, and save money for the federal budget."

Open Congress put up S.1796 - the Senate Finance Committee's health care legislation - on its site.

Max Baucus thinks a "watered down" version of the public option could get 60 votes in the Senate:

"This issue is alive and we are looking at it to see what makes the most sense," the senator declared on a conference call with reporters. "The major overall goal here though is to get health care reform that passes the Senate, gets 60 votes, and I just don't know if there is 60 votes for the most pure kinds of the public option. There may be 60 votes for the less pure kinds."
The less pure kinds, Baucus explained, were co-ops, a public plan triggered by economic conditions and an insurance structure that allowed states to opt in or out of a public option. He seemed to find the last option the most intriguing.

A. Co-ops and a trigger are not a public option, even "watered down."

B. Why does anyone care what Max Baucus thinks anymore? Frankly, he shouldn't be involved in the creation of the final bill the Senate votes on. His role now is to vote for cloture on whatever bill the leadership crafts.

Be sure to check out "This American Life" and its two-part series on healthcare reform: "Someone Else's Money," on the health insurance industry; and "More is Less," on the reasons behind the rising cost of health care in the US.

Here's the SNL sketch where the "Rock Obama" makes Max Baucus bark like a dog, and then throws him out the window:

I have to admit, I enjoyed watching the Rock rip off Mitch McConnell's arm...heh heh.

The public option is popular!

Jay Stevens — Mon, 19 Oct 2009 22:26:12 GMT

I mean, we all knew this, didn't we?

...a new Washington Post-ABC News poll shows that support for a government-run health plan to compete with private insurers has rebounded from its summertime lows and now wins clear majority support from the public....
On the issue that has been a flash point in the national debate, 57 percent of all Americans now favor a public insurance option, while 40 percent are opposed. Support has risen since mid-August, when a bare majority, 52 percent, said they favored it. (In a June Post-ABC poll, support had been at 62 percent.)

Additionally, 56 percent favor an insurance mandate. A full 71 percent favored the mandate -- including a majority of Republicans -- if government subsidies were available for "lower-income families."

Unbelievable that any conversation in Congress wouldn't include a public option.

One of the more interesting numbers from the poll shows that Democratic support for Obama dropped 15 points since mid-September. Essentially, it appears that if numbers are dropping about healthcare reform as it stands in Congress, the wavering is coming from the left, not independents or conservatives.

In short, if Democrats really want to lose a lot of House seats in 2010, they should ditch the public option.

Baucus: swimming with sharks...or jumping them?

Jay Stevens — Fri, 16 Oct 2009 17:25:58 GMT

Uh...is this stuff legal?

At a meeting last April with corporate lobbyists, aides to President Barack Obama and Sen. Max Baucus (D-Mont.) helped set in motion a multimillion-dollar advertising campaign, primarily financed by industry groups, that has played a key role in bolstering public support for health care reform.
The role Baucus's chief of staff, Jon Selib, and deputy White House chief of staff Jim Messina played in launching the groups was part of a successful effort by Democrats to enlist traditional enemies of health care reform to their side. No quid pro quo was involved, they insist, as do the lobbyists themselves.
...The Democratic officials made no overt demands. Rather, they brought together the players and laid the groundwork for the creation of the coalition, and that was followed by more direct solicitations from an outside Democratic consultant, Nick Baldick, retained by Healthy Economy Now, asking attendees at the meeting to join the coalition and contribute to its ad campaigns.
One ethics expert, however, said the meeting still raises issues. No matter how careful Messina and Selib were to avoid conversation about Healthy Economy Now, their mere presence at what proved to be the coalition's creation raises questions, said Bill Allison, a senior fellow at the Sunlight Foundation, a nonpartisan, nonprofit group that advocates for greater transparency and ethics in government.
"There's no problem with sitting down at the table and talking," said Allison. "But if they are signaling that they would really like these groups to support health care reform and trying to tell the groups how they'll benefit from the plan, they're laying a 'quid' on the table, and - even if they don't discuss dollar amounts or advertising strategies - they're suggesting what the 'quo' is, which is the groups' support for the plan."

Basically, in exchange for a $150 million ad campaign, Baucus and the White House promised to make reform friendly to the industries that pitched in.
This is probably a good time to give some props to the Sunlight Foundation, which has done great work on exposing the amount of money our elected representatives are raking in from lobbyists. JC posted on the Sunlight Foundation's work on how lobbyists "bundle" donations to candidates - essentially, hundreds of individual lobbyists bundle campaign contributions, amassing tens or even hundreds of thousands of dollars from given "clusters." According to the Sunlight Foundation, working with OpenSecrets.org, Max Baucus "has received more than $453,000 from the health care industry - or 20% of his cash on hand."

In a recent interview with John Adams, Baucus said, "money means nothing to me. I pay no attention to campaign contributions. Nothing. Makes no difference." And he sounded like he meant it, and it may even be true. But what's also true is that Max Baucus has very strong ties to the industries he's trying to reform. Maybe it's not about the money, it's about who has access to him, and who he listens to. Again, the Sunlight Foundation traced the relationship that Baucus had to the health and insurance industries through his former staffers; there's no doubt that those who he trusts the most - those that were in the political trenches with him over the years - are working for the corporate interests that we're trying to beat back in healthcare reform.

And, as JC reported over a month ago, the author of Baucus' legislation was senior aide, Liz Fowler, who was previously vice president for public policy and external affairs at Wellpoint, Inc, the largest member of Blue Cross/Blue Shield and an outspoken opponent of the public option. ("Cost shifting," by the way, is a bogus argument.)

Of course, the question that stands before us is how much of an influence did all of this have on how healthcare reform played out? Was the legislation bought? Was it the result of a kind of institutional myopia, too much attention to the fortunes of the insurance industry, and a bill that he probably thought would work to "everyone's" benefit? Or was he Obama's agent to keep conservative Senate Democrats on board? A kind of stealth reformer?

To put it slightly differently, if you imagine that Max Baucus was given responsibility for keeping conservative Senate Democrats committed to health-care reform (and that's how his role was often described at the beginning, with Kennedy and then Dodd playing the same role for liberals), it appears he has succeeded. Indeed, if Baucus's schedule partly led to the long month of August, you also have to give him credit for not losing a single Democrat in its aftermath, and for having the savvy to use the release of his bill and CBO score to change the media's narrative and refocus the conversation on the advancing legislative process.

And all the old arguments repeat themselves. Baucus nixed single-payer healthcare because he's a company man. Baucus nixed single-payer healthcare because there's little support for it in the Senate. Baucus did his best to kill the public option. Baucus had the public option in his white paper, but cut it out of his bill - and voted against public option amendments - to get it passed, even if he does, personally support the public option.

But there's that money, that $450,000, that says Baucus and the industries that need reform, at the very least see eye-to-eye on an awful lot of things. Maybe Baucus was tasked to herd the conservative Democratic Senators because the White House knew he'd proffer them palatable fodder, legislation devoid of the spice of audacity, transformation, or effectiveness. We'll never know, of course. I don't think even Baucus himself knows what he knows. Was he the sly, smoke-filled-room dealer who made reform possible? Or the bought-and-paid-for politician keeping an eye out for old friends? Probably the answer is "yes."

Where angels fear to tread

Yellowstone Kelly — Tue, 13 Oct 2009 13:58:55 GMT

The websites of Montana's two major parties are intriguing. (OK, so it's cold outside and the internet beckoned.) Neither is particularly current. Each has a sterile consistency.

On the Montana Republican Party website (aka: Republicans), the last post was on June 25, but the big news is the party's convention on June 11, 12 and 13 (2009). Don't miss it. The training sessions look good, especially the one called "Winning Pro-Life Strategies," including a thorough examination of the Personhood Initiative, hosted by Sen. Dan McGee and Rep. Wendy Warburton.

Scroll down on the home page and you find an array of selected articles, each receiving a five-star rating. Kinda wonder who at the party decides how many stars.

Evidently, nothing much about R's is newsworthy. D's, on the other hand, rule the site: Schweitzer; Lindeen; Laslovich; Villa.

Note this headline on June 19: "Republicans plan rival U.S. healthcare plan." So, what have the R's been doing since June, that is, besides tea-bagging? Working on that rival plan. Its exact status is remains unclear. Sort of a stealth plan.

Speaking of healthcare plans, another headline, this one about Max, dated June 16 caught my eye: "Insurance, health interests fill Baucus' coffers." That's news? And, by inference, the R's believe "insurance" and "health interests" are bad? Green with envy.

The "Events" calendar is vacant. No kidding. Preparing that rival plan is totally consuming the party.
Under "Contact" it lists its offices (with maps) conveniently located in 5 locations (Kalispell, Bozeman, Missoula, Great Falls; Billings) outside of Helena to better serve you. There you can connect with R's, presumably to help plan events that no one else will know about.

When you click on "MT GOP Info," you learn the Republican Party is "led by Chairman Erik Iverson." Sorta suspected as much because of how quickly he surfaced when the Good Ship Lollipop ran aground at Bigfork. However, the article posted on June 16 says Will Deschamps is the chairman. A titular head, perhaps. Hmmm. BTW: Is it just me or is Deschamps' tie over the top?

The GOP has no slogan, but is does have exciting footage under "MultiMedia." Speaking of over the top: How about that ducktail Rehberg is sporting?

So far, so good.

The D's refer to themselves as Montana Democrats, not the Montana Democratic Party, and certainly not Montana "Democrat" Party. There was that whole adjective/ noun thing that Bush II and Rove conjured up labeling Democrats as belonging to the "Democrat" Party. Democrats were offended and said so. Consequently, the R's plan to roll out "Democrat Party" ad campaign. Meanwhile, 140,000 Montanans have no health insurance.

The D's do have a slogan: Party of the People. Careful now. You might want to copyright that. After all, no one else has ever used that slogan before.

The D's also have a snappy logo.

The D site is much more current (by three months). The latest posting entitled "Schweitzer says the state leads in energy production" caught my eye. The article includes this sentence:

The governor also pointed out to the environmental council that Montana produces large amounts of water for the entire country.

And, all along I thought nature and precipitation played a part in our water supply. Montana is a source of water, yeah. But, "produces" it, nah, we'd better change that. Evidently, Schweitzer wants to use his magical rhetorical prowess to convince the rest of the world that we here in Montana actually "produce water." Is the governor claiming credit for a thriving "water producing" cottage industry that creates jobs? Do you think the employer provides health care benefits?

Speaking of jobs, the website includes an announcement for a Party Fundraiser. Now, you know these guys provide health insurance, right?

Its "Calendar" of events is both homey and busy. That's because the D's, unlike the R's, have a healthcare plan: The Max Tax. That done, D's have time to spare and are free to meet and frolic.

The Party of the People is a shy bunch. Not a lot of pictures.

Here is a shot of the party chair, Jim Elliott. He seems like a happy chap. Again, that tie!

Click "Contribute" and you can send money instantly. Note: Under "Donate" at the Republican website, the R's pledge (1) that your credit card information is secure and (2) not to "give or sell information to any third party organizations." The D's provide no such assurances. Quicker than you can say identity theft.

You'll find a disappointing "Media" link, too.

So, why is this important? Both are fluff. Just like the white stuff that powdered most of Montana late last week. Devoid of substance. Empty rhetoric.

What about those without health insurance and access to health care?

The economy?

Climate change?

Energy policy?

At last count, two unwinnable wars?

Like the lead said, neither site is particularly current.

And, for that matter, neither is either party.

Private insurers to raise prices!

Jay Stevens — Mon, 12 Oct 2009 18:32:42 GMT

All hell broke loose on the 'Tubes when an insurance industry trade group - AHIP - announced plans to release a study showing Congress' healthcare reform would result in rate hikes: an extra $4,000 per family in 2019!

Klein:

In the hallowed tradition of the tobacco and energy industries, the health insurance industry has commissioned a report (pdf) projecting doom and despair for those who seek to reform its business practices. The report was farmed out to the consultancy PricewaterhouseCoopers, which has something of a history with this sort of thing: In the early-'90s, the tobacco industry commissioned PWC to estimate the economic devastation that would result from a tax on tobacco. The report was later analyzed by the Arthur Andersen Economic Consulting group, which concluded that "the cumulative effect of PW's methods ... is to produce patently unreliable results." It's perhaps no surprise that the patently unreliable results were all in the tobacco industry's favor. He who pays the piper names the tune, and all that.

Color me completely unsurprised. Even if this is all a sham intended to derail reform, who doesn't believe the insurance companies won't raise rates? Of course they'll raise rates!

I'm with Digby:

Frankly, I wouldn't expect any less of them. They will raise premiums sky high even if reforms don't pass. They always have before. Indeed, the only thing that kept them in check at all over the past 20 years was a roaring stock market, which allowed them to make huge profits while only gouging their customers at about 15% inflation. Lately, they've had no choice but to jack that up and gouge the sick customers even more. They are, after all, profit driven corporations.

Digby suspects this has something to do with an amendment capping industry tax exemptions for executive salaries at $500K instead of $1M. (Er...we allow companies to deduct executive salaries???) Digby jokes, "Nobody puts CEOs in the corner," and says this:

There has never been a better argument for the public plan than the one the insurance company just handed the Democrats in congress. They have produced a shoddy, self-serving report as a blatant threat to raise premiums higher than they already plan to raise them. If there has ever been a more obvious case of bad faith than this, I haven't seen it. The only thing that will keep these corporate criminals in line is either price controls or stiff competition and if they can't keep their companies solvent without giving their executives outrageous pay packages, charging ridiculous prices while denying care to sick people, then maybe their financial model just doesn't work.

Again, there are good elements of reform apart from the public option. Universal coverage, say, a community standard that prohibits insurance companies from discriminating against the sick. But none of this works, IMHO, without a widely available public option as a safety outlet for American consumers against rising policy costs and increased unreliability of coverage...

Tester favors public option

Jay Stevens — Sat, 10 Oct 2009 13:26:29 GMT

Saw it on the b'birds, who saw it on Kos, who read it on a Chris Bowers' post, who heard "word" that Jon Tester supports Chuck Schumer's version of the public option.

Which pushes the Senate whip count in favor of the public option to 51.

Links...

Jay Stevens — Fri, 09 Oct 2009 17:22:56 GMT

In case you missed it, a lot of interesting things happened this week, a lot of them deserving their own posts. But, sadly, there's only so much time in the day...

Just when you thought the issues around the Flathead Lake Boat Crash couldn't get any more asinine, they do.

James Conner has the details of that night's incident - apparently Barkus thought he was heading in the opposite direction than he actually was, and was pulling a u-turn at 45 mph in the dark in treacherous waters when he struck the lake bank. Dan Testa, too, has a good roundup of that night's events - two scotches and an unknown amount of red and white wine for Barkus. Just the thing for a chilly night out on the lake.

Now Barkus' lawyer is challenging the .16 BAC results - which, I know, is his right to do and probably a smart legal maneuver. But Barkus is also planning on finishing out his Senate term, as if nothing's happened here, as if he hadn't just boozed up and almost killed himself and four others on Flathead Lake.

The crash was a good sign he's got a problem, eh? I mean, for most of us, this would be a kind of, I dunno, a wake-up call, wouldn't it?

That's the way I'd see it if it were me. I'd be apologizing my *ss off to the friends and family of those I injured through my loathsome behavior, I'd cooperate with the authorities and plea bargain my way into a just punishment, resign my public office because of the deficiency of my character, and I'd check myself into a rehab clinic, ASAP. I mean, wouldn't most people feel some remorse, and want to repent and work to rehabilitate themselves?

Instead, Barkus is still out there, still a drunk, and, probably as soon as he's walking again, back behind the wheel. And he'll be passing laws over you. So much for personal responsibility.

* * *

As always, there's plenty of news from Hardin.

The Billings Gazette got its hands on the "memorandum of understanding" between Hardin and the APF - which it had to get by court order, apparently because it's pretty embarrassing to Hardin officials - that revealed the city did have an agreement with Hilton's company to have the APF supply Hardin with a police force for $250K. The contract toned the language down, but the memo certainly explains the Hardin Police Force decals on APF SUVs.

Naturally, with all the furor over these SUVs, Hardin is looking to start its own police force.

But the American Police Force takeover of the Hardin jail only looks dead. While Hardin put the deal with APF on hold after revelations of Michael Hilton's checkered past, a mysterious APF investor stepped forward (anonymously, of course) and noted the firm would still pursue the Hardin jail contract, only without "Captain" Michael Hilton on board.

Whee!
Apparently Max Baucus put his support for the public option up for sale on eBay - free shipping! - but the sale has since been removed. Did someone select the "buy now" option?

* * *

One of the first things that newly elected Senator Al Franken did was introduce an amendment to the defense appropriations bill that would cause the U.S. government to withhold defense contracts to any company that requires their employees to sign a waiver prohibiting them to bring a suit against that company for workplace sexual assault, battery and discrimination.

Sadly, this isn't some random amendment - it's in reaction to waivers signed by female Halliburton/KBR employees...who were subsequently raped in Iraq by co-workers, and denied access to justice because of the fine print in their contracts.

In the Senate the amendment passed 68 - 30 - thirty Senators voted against this bill, all Republicans, all men. The four women Senators of the GOP backed this bill.

I have to second Kos' astonishment:

Will the GOP soon introduce a new Constitution Amendment that reads, "Congress shall make no law respecting the ability of corporations to gang rape their employees"? Is support for corporate gang rape already in the GOP platform, or does it need to be added at their next meeting? Is there a huge corporate gang rape lobby that is funneling millions into GOP pockets, or did they vote this way out of personal conviction?

* * *

As the US Chamber of Commerce bleeds members because of its "extremist" climate change rhetoric, it decided to shift gears and try a new way to approach the issue. And you won't believe the results!

The Administrator has thus ignored analyses that show that a warming of even 3 [degrees] C in the next 100 years would, on balance, be beneficial to humans because the reduction of wintertime mortality/morbidity would be several times larger than the increase in summertime heat stress- related mortality/morbidity.

OMG! Every day will be like the Fourth of July!

* * *

I heart Alan Grayson, who's propelled himself into the spotlight with hard-hitting rhetoric about Republican obstructionalism on healthcare reform. This is how every Democrat should be talking about their nay-saying peers:

American understands that there is one party in this country that is favor of health care reform and one party that is against it, and they know why.
They understand that if Barack Obama were somehow able to cure hunger in the world the Republicans would blame him for overpopulation
They understand that if Barack Obama could somehow bring about world peace they would blame him for destroying the defense industry.
In fact, they understand that if Barack Obama has a BLT sandwhich tommorrow for lunch, they will try to ban bacon.
But that's not what America wants, America wants solutions to it's problems and that begins with health care, and that's what I'm speaking for tonight.

* * *

And, oh yeah, Obama won the Nobel Prize for his "extraordinary efforts to strengthen international diplomacy and cooperation between people."

Wow. That doesn't happen every day.

The reactions were...well, you can probably guess. Most righties were as furious over the award as they were ecstatic Chicago lost its Olympic bid, and some liberal doves were perplexed that Obama - still pursuing war in the Middle East - should have won a "peace" award.

(Some great tweets about the conservo-sphere reaction via @markos:

@markos: "So I thought losing the Olympic bid was a big "fuck you" to Obama..."

@OldSchoolGamer: "The most angry reactions to Obama's Nobel Peace Prize - Hamas, the Taliban, and the American right."

@JC_Christian: "I hope @KarlRove doesn't ruin Obama's #nobel acceptance speech by grabbing mic and saying 'W deserved to win.'"

@mattyglesias: "They should institute a Nobel Prize for driving conservatives crazy."

@jaihind77: "@markos hitler did not win nobel roize so that means its end of nazism rhetoric for conservatives ?")

I like this from Joe Weisenthal:

He deserved it. People in the US might be jaded, but it's hard to estimate how badly America's reputation had been damaged internationally after 8 years of George W. Bush, and though Obama hasn't really done anything different, just the perception is big. And then of course there was the historic nature of his Presidency in the most important country in the world, which really shouldn't be discounted as an accomplishment - it's a lot more impressive than anything anyone's ever done in the Mideast, a region which has had its share of undeserved Peace Prizes.
But the real reason it's a brilliant choice is that when it comes to making world Peace, putting the cart before the horse is exactly the right way to go. Now Obama can sit down at the negotiating table with Ahmedinijad or Benjamin Netanyahu, and slap hisNobel Prize on the table and say: "now deal."
In other words, this Nobel Prize was an investment in future world peace - a bet that by lending some support to the leader of the free world, that leader would be able to achieve something.

Support the public option, Jon

Jay Stevens — Thu, 08 Oct 2009 16:01:42 GMT

You voted for him. You walked the streets, knocking on strangers' doors for him. You manned the phone lines for him. Not only because there was a Senator representing the state who was bloated with corruption, but because Jon Tester was one of us, someone who didn't live and breathe politics, a farmer who was as far removed from DC as you could be. Someone who promised to be a progressive populist, looking out for our concerns.

So. Where did he go? We haven't heard a peep from Jon on healthcare. Well, except for the news that jhwygirl related, as reported in Roll Call, that he - and Schweitzer - are concerned about the share of the Medicare expansion that states are expected to bear, and will lobby Baucus to have that provision struck from his bill. (And while Republican Senators have adopted that concern as their new means to oppose any and all reform efforts, it's actually a legitimate concern, especially for small states like Montana.)

But what we want to hear about is Jon's stance on the public option. Where does Jon Tester stand on the public option? Based on the usual fare we get from Tester's office, who can say?

A spokesman for Sen. Jon Tester said the public option makes sense to Tester, but Montana's junior senator "wants to make sure whatever the Senate does is right for Montana."
"Jon isn't ruling out supporting a public option, as long as it's done right so that it works for Montana families and small businesses," said Tester spokesman Patrick Devlin. "He knows that our health care system is badly broken and the status quo is the worst option on the table for working families."

We are left knowing less than before.

As Yellowstone Kelly pointed out today, Democrats have really scr*wed themselves with their lukewarm (at best) approach to reform and public policy. Hiding from healthcare reform is only going to hurt Jon Tester in 2012. On the other hand, with Democrats and independents overwhelmingly supporting a public option, seizing the issue and advocating for it can only benefit Montana's junior Senator.

Oh, and supporting the public option is the right thing to do.

And I'm glad to see that Health Care for America Now is asking Jon to sign a letter addressed to Senate Majority Leader Harry Reid that he ensure a public option is contained in the healthcare reform bill that passes the Senate.

Senator Sherrod Brown of Ohio signed it. This is why:

As we finalize health reform legislation, we shouldn't forget that a majority of Americans, doctors, and Members of Congress support a public option. Four out of five congressional committees passed health reform legislation that includes a strong public option. We owe it to hardworking families, small businesses, and taxpayers to pass a public option that lowers costs and ensures much-need competition in the insurance industry.

Support the public option, Jon.

Letter after the jump:
Dear Majority Leader Reid:

We have spent the better part of this year fighting for health reform that would provide insurance access and continuity to every American in a fiscally responsible manner. We are concerned that - absent a competitive and continuous public insurance option - health reform legislation will not produce nationwide access and ongoing cost containment. For that reason, we are asking for your leadership on ensuring that the merged health reform bill contains a public insurance option.

As it stands, the health insurance market is dominated by a handful of for-profit health insurers that are exempt from the anti-trust laws that ensure robust competition in other markets across the United States. Without a not-for-profit public insurance alternative that competes with these insurers based on premium rates and quality, insurers will have free rein to increase insurance premiums and drive up the cost of federal subsidies tied to those premiums. This is simply not fiscally sustainable.

We recognize that the two Committees with jurisdiction over health reform - the Senate Finance Committee and the Senate Health, Education, Labor, and Pensions (HELP) Committee - have taken two very different approaches with respect to this issue. However, a strong public option has resounding support among Senate Democrats - every Democrat on HELP, three quarters of those on Finance, and what we believe is a majority of the caucus.

While promoting more co-ops is a worthy goal, it is not realistic to expect local co-ops to spring up in every corner of this country. There are many areas of the country where the population is simply too small to sustain a local co-op plan. We are also concerned that the administrative costs associated with financing the start-up of multiple co-op plans would far outstrip the seed money required to establish a public insurance program.

Opponents of health reform argue that a public option presents unfair competition to the private insurance companies. However, the HELP Committee's version of the public option is modeled after private insurance - rates are negotiated, and providers are not required to participate in the plan. The major differences between the public and for-profit plans are that the public plan would report to taxpayers, not to shareholders, and the public plan would be available continuously in all parts of the county. The number one goal of health reform must be to look out for the best interests of the American people - patients and taxpayers alike - not the profit margins of insurance companies.

Health reform is about improving access to health care, containing costs, and giving Americans a real choice in the insurance plan best suited to their needs. We urge you to fight for a sustainable health care system that ensures Americans the option of a public plan in the merged Senate bill.