What he said...

by: Jay Stevens

Thu Oct 01, 2009 at 09:45:34 AM MST

You're looking at the narrative that will be written about this Democratic Congress, with Max Baucus as its figurehead, if the public option, and healthcare reform along with it, fails.

It may not be fair, it may show a lack of understanding of "how Washington works," it may even be pessimistic, but that's how it is. And I'm flabbergasted that this is surprising anyone, especially those that have the means to move the debate and change the narrative. And, oh yeah, pass meaningful healthcare reform.

There's still time, of course. Surprise me.

Baucus helps defeat both public option amendments

by: Jay Stevens

Tue Sep 29, 2009 at 15:11:49 PM MST

Baucus, Conrad, Carper, Lincoln, and Nelson voted against Sen. Rockefeller's public option amdendment.

Baucus, Lincoln, and Conrad voted against Sen. Schumer's public option amendment.

Baucus' statements about the Rockefeller amendment are below the fold.

One of Baucus' reasons for rejecting the public option was his belief that there aren't enough votes in the Senate to pass a healthcare bill with the public option. But Sen. Harkin and others maintain there are 51 votes for the public option -- obviously Baucus means that one or more Democrats would join a Republican filibuster.

Now we have to single out those Senators and put massive pressure on them.

In the meantime, we need to support the Progressive House Caucus and ensure they stick to their promise to vote against any bill without the public option. And we can fund the ad attacking Baucus over the public option.

Reform without the public option is not reform.

First public option amendment defeated...

by: Jay Stevens

Tue Sep 29, 2009 at 12:20:07 PM MST

"The Lie Machine"

by: Jay Stevens

Tue Sep 29, 2009 at 11:01:36 AM MST

According to internal documents obtained by Rolling Stone, Conservatives for Patients' Rights had been working closely for weeks as a "coalition partner" with three other right-wing groups in a plot to unleash irate mobs at town-hall meetings just like Doggett's. Far from representing a spontaneous upwelling of populist rage, the protests were tightly orchestrated from the top down by corporate-funded front groups as well as top lobbyists for the health care industry. Call it the return of the Karl Rove playbook: The effort to mobilize the angriest fringe of the Republican base was guided by a conservative dream team that included the same GOP henchmen who Swift-boated John Kerry in 2004, smeared John McCain in 2000, wrote the script for Republican obstructionism on global warming, and harpooned the health care reform effort led by Hillary Clinton in 1993.

Team Ginger

by: Jay Stevens

Sun Sep 20, 2009 at 16:07:44 PM MST

Dustin's injuries were severe; he spent a long time in the hospital under close supervision; and he has a lot of rehabilitation to go before he's completely healthy. Consider donating to his cause. By all accounts, Dustin's one of the nicest guys in Montana politics...

...I don't want to turn this political, but I can't help but note the irony here, that his boss recently said the healthcare crisis was limited to a pool of 8 million uninsured. Frost's need to raise money demonstrates otherwise...and, yes, I realize that Frost himself would probably disagree with me, that he's capable of raising the money on his own. Well, yes, he probably is. But then not every Montanan who runs into large medical bills is so lucky...

What needs fixin' in the Baucus bill

by: Jay Stevens

Fri Sep 18, 2009 at 10:57:11 AM MST

Here's what Krugman thinks needs fixing:

- The employer mandate, in which he ties "each employer's fees to the subsidies its own employees end up getting." (This is the free-rider provision Ezra Klein loathes.])

- Subsidies. Too low for middle-class families. Sure, the bill scores better with the CBO, but those families pick up the extra tab, and the CBO don't score that.

- No public option.

It's dang similar to Klein's five ways to improve the bill:

- Kill the free-rider provision.

- More subsidies.

- "Phase in Ron Wyden's "Free Choice Amendment," which would throw open the health insurance exchange to all. Baucus plan takes to long to open exchange.
- "Create competition in the market." Public option?

- "Create incentives for bipartisanship" by allowing his committee Democrats to add progressive amendments.

Frankly, the more I look at this thing, the more it's obvious we need both a public option and to open the health insurance exchange to everyone. If you want a better analysis of this bill, got to Jay Rockefeller, who says this is what's wrong with the bill:

- CHIP is put into the exchange.

- No public option.

- Already existing policies from big companies not affected by new regulations. You read that right! Almost half of the nation's consumers will have no protection from pre-existing condition clauses or lifetime caps!

- Affordability.

See, that's the thing. If you have crappy, employer-provided insurance, you have to keep it. As Baucus' bill is written now, you can't ditch it for something better in the exchange. That's unacceptable.

Anyway. Still reading this thing.

Klein's take on the Baucus bill

by: Jay Stevens

Wed Sep 16, 2009 at 14:02:41 PM MST

CBO score? Swoons! "According to the CBO, the bill covers 94 percent of legal residents and actually reduces the deficit. More to the point, it keeps reducing the deficit as time goes on." (A robust public option would only make the score better.)

Health insurance exchange? Surprisingly progressive. "In other words, by 2022, the Health Insurance Exchanges will be open to all businesses of all sizes." (All the more reason to include the public option into the bill!)

Coverage? Comprehensive, but... "This is much better than what many people get now. But given the insufficiency of the total funding, the question is how much cost-sharing is allowed in these plans."

State regulation? Possibly transformative. States could form "compacts" with other states with a similar regulatory environment to allow insurers to sell policies across state lines. National plans meeting certain regulatory standards could be created. "Presumably, that plan would also have more bargaining power and substantial efficiencies of scale, as it will be national, rather than confined to a single state. This could prove seriously transformative in the private insurance market." (I am not optimistic as to believe states' attempts to regulate insurers won't be undercut by federal officials; nor is bargaining power a sure way to lower costs when there's still the inefficiencies and profits of private insurers propping prices up.)

Individual mandate? The fine is logical. "This is, on some level, paying for services that will be rendered. It's not a penalty as much as it is a charge, as the uninsured actually do use care, and the rest of us actually do pay for it." (Doesn't justify the morality or cost of forcing individuals to purchase private plans, though.)

Insurance cost variation? High. The variation cushions the impact to profits of the implementation of the community standard - forbidding insurers to discriminate against customers based on pre-existing conditions. It's a ratio of how expensive a policy for a certain risk category can be compared to the lowest offered price. Insurers can charge more for age, tobacco use, family situation, or geography. "At the end of the day, the maximum variation, which is to say the plan for the most expensive risk as compared to the least expensive risk, is 7.5:1, which is quite high."

Affordability? Bleh. Subsidies for folks making up to 300 percent of poverty level are "pretty good." And if you get sick? "...pretty much that people making more than 200 percent of the poverty line will be less ruined than they'd be under current law, but still facing tens of thousands of dollars in out-of-pocket expenses a year."

Co-ops? Neutered.  "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."

Free-rider provision? Hates it. "This isn't just the worst policy in the bill. It's one of the worst policy ideas I've ever seen. It creates a huge incentive to build a workforce that entirely excludes low-income workers." Was it intended to compel big corporations - like Wal-Mart - to offer its employees health insurance?

Baucus introduces his bill

by: Jay Stevens

Wed Sep 16, 2009 at 07:52:42 AM MST

Senate Finance Committee Chairman Max Baucus unveiled an $856 billion health-care reform plan Wednesday that would require nearly all Americans to carry health insurance while barring insurance companies from discriminating against people based on their health status or denying coverage because of preexisting conditions.

The plan does not call for a government-run insurance option, as advocated by President Obama and most Democrats, but would set up a system of nonprofit consumer-owned cooperatives to compete with private insurers -- a provision intended to appeal to Republicans who have railed against the "public option" in recent weeks.

The bill is what's called the "Chairman's Mark," a document that conveys the intent of legislation in accessible language. (Read it for yourself!) Once it's voted on in committee & etc, the actual legislation will be written...

Baucus' chickens ready for bed

by: Jay Stevens

Wed Sep 16, 2009 at 06:30:39 AM MST

Frankly, she's not the only one. Chuck Grassley says he can't support Baucus' bill because he's worried about illegal immigrants and abortion. (And just when did Grassley take the crazy turn?) Mike Enzi doesn't think states should pick up any of the tab for Medicaid expansion, and doesn't like fees imposed on insurance companies to help defray the cost of reform. (Of course, Enzi's admitted his job is to block reform.)  Ron Wyden thinks the subsidies are too low. John Kerry: "It's not going to be the bill we're going to vote on."

More importantly for the bill's future in the Senate Finance Committee, Jay Rockefeller despises the bill and claims "four to six Democrats" in the committee feel the same way. If true, Baucus will need to find four to six committee Republican votes to pass his legislation out of committee.

Nate Silver crunches the numbers and finds that Senator Baucus is the only person who supports his bill. Silver:

But let's be clear -- some of this is Baucus's chickens coming home to roost. When you make a unilateral decision to negotiate with only five other people from a 23-person committee and 100-person Senate, and two of those five people have clear electoral disincentives against supporting any plan that you might come up with, the negotiations are liable to end in failure far more often than not. The flurry of on-the-record statements against Baucus's reform plans -- not "leaks", not trial balloons -- points toward a defective process.

And that may suit Democrats just fine.

Without any Republican support, any health care bill that passes Congress now has a real chance of including effective and progressive reform. It'll be tricky dancing around a Senate filibuster, but it likely be easier than getting something out of the Senate Finance Committee with Republican support.

Gang of Six still mauling healthcare reform

by: Jay Stevens

Tue Sep 15, 2009 at 10:31:06 AM MST

Baucus acknowledged that the mark-up could prove a busy one but predicted that Democrats would support the package he plans to unveil Wednesday without major changes.

"I don't see any deal-breaker amendments," Baucus said. "Put it this way: It's unlikely that any amendments, which basically change the framework, will be accepted."

Apparently Senate Democrats, like anyone else who's seen reports of Baucus' legislation, are very concerned that they'll be pushing Americans through an individual mandate to buy private insurance policies that will be priced extremely high.

Other bad things Baucus' legislation does:

The health reform "framework" put forward by the Senate Finance Committee's chairman, Max Baucus, Democrat of Montana, proposed a new standard that would permit older people to be charged significantly higher premiums than would be the case under any of the other health care reform bills.

Under Senator Baucus's plan, insurers would be permitted to charge older people five times more for their health insurance premiums than younger people. That proposal, first circulated in a Finance Committee policy options paper last spring, is a significant departure from the approaches put forth by three House committees and the Senate Health, Education, Labor and Pensions Committee. Those bills would only allow insurers to charge older people twice as much as younger ones.

While most employer-provided insurance plans protect policyholders from insurer "age rating," but individual plans don't - the very kinds of plans that those affected by the individual mandate likely will be required to buy.

dday:

We've already seen an outline of it, so we know that it would still cripple people financially who have the temerity to get sick, it would criminalize people who do not buy inadequate private coverage from the insurance industry, it would incentivize employers to offer crappy coverage and discriminate in hiring against people who have no coverage from a family member, and it would not include a public insurance option to compete with private plans.

Even Ezra Klein is concerned about the affordability of medical costs for American families experiencing illness under the Baucus plan. No wonder former Cigna executive Wendell Potter calls the legislation "an absolute gift to the  industry."

Which dday says explains why pharmaceutical corporations are happy to pitch in with $150 million of "pro-reform" advertising. (See Matt Taibbi's comments on matter.)

From where I'm sitting, this kind of reform isn't worth passing. Or am I missing something?

Maybe they should call it the "Coalition to Protect Specialists' Timeshares"

by: Jay Stevens

Mon Sep 14, 2009 at 10:28:46 AM MST

...reforms should allow insurance companies to operate across state lines, abolish most mandates to cover certain health items, and revise tax laws to make it easier for individuals to buy health coverage, he said.

Those changes would allow more people to shop around and find a policy they want and can afford, rather than requiring them to buy something that is likely to be too expensive, Beck said. People also could use tax-exempt health savings accounts, which would pay for smaller medical expenses, he added.

Er, what's the point of buying insurance doesn't cover any of the illnesses or injuries you have? And I've addressed the idea of allowing people to buy health insurance across state lines. If you love the rates and practices of credit card companies, you'll love the health insurance industry under Beck's plan. And we all know there's nothing more consumer-friendly than the credit card industry...right?

And does anyone else find it odd that Beck, as an advocate of "patient's rights" said his group "wants to reform medical malpractice to make it more difficult to sue medical providers"?

I recently wrote a post at the b'birds demonstrating that tort reform, or capping punitive damages in medical malpractice suits, does not at all affect health care costs, and often has no effect on the cost of malpractice insurance. At best, it lowers costs for folks like Dr. Beck, who then pockets his savings. At worst it lowers costs for private insurers, who then pocket their savings.

But in that post, I almost completely neglected the effect that malpractice reform has on patients - i.e., regular slobs like you and me. Pursuing a medical malpractice case is extremely expensive; trial lawyers usually pick up the tab for court costs, hoping to recoup their expenses from punitive damages - the damages often capped in states' tort reform schemes. Thus, in areas where damages are capped, lawyers are reluctant to take cases, and more doctors get away with malpractice.

Texas is the classic example. There, with a $250K cap on "noneconomic damages," patients must prove "loss of earning power" to earn economic damages that cause awards to be more than expenditures. You know what that means: the poor and elderly have no legal recourse against bad medical care.

And, as Matt Osborne reminds us, malpractice cases serve a valuable need for patients:

Mind you, doctors are required by law to carry malpractice insurance; because they are wealthy, and the insurance companies are profit-driven, a far more likely explanation for the high premium increases over the last decade is that doctors are just getting screwed. Given the way health insurance premiums have skyrocketed in the same time frame, it's a logical explanation.

Nor are malpractice suits as common as we're led to believe: very few malpractice victims actually sue their doctors. Frivolous suits are far more rare than advertised, as judges throw most of them out of court. It's incorrect to say that juries are the problem, either, since malpractice suits are much more likely to go against the plaintiff.

Nevertheless, when the jury does find for the plaintiff, the awards tend to be much higher. That fact tells you the real culprits in malpractice cases are bad doctors.

In fact, studies have found more than 100,000 Americans die every year from bad medicine. The Journal of the American Medical Association lists it as the third-leading cause of death in the United States (warning: registration required). Yet a very small number of physicians is responsible for an outsized number of these cases. This really is a "bad apples" problem, one that could be greatly improved by use of best-practices and better physician access to information.

Removing the threat of malpractice - which is what tort reform would essentially do - might have disastrous consequences for patients' health.

Now, I'm not sure why Dr. Beck shows no inclination to effectively lower litigation costs and improve patient safety by singling out the bad doctors - maybe he's got a Key West timeshare with some - but to claim that he has patients' interests at heart is, to say the least, inaccurate.

"Regression toward a phony mean"

by: Jay Stevens

Sat Sep 12, 2009 at 16:17:20 PM MST

Here he quotes former WaPo reporter, Paul Taylor:

Sometimes I worry that my squeamishness about making sharp judgments, pro or con, makes me unfit for the slam-bang world of daily journalism. Other times I conclude that it makes me ideally suited for newspapering- certainly for the rigors and conventions of modern 'objective' journalism. For I can dispose of my dilemmas by writing stories straight down the middle. I can search for the halfway point between the best and the worst that might be said about someone (or some policy or idea) and write my story in that fair-minded place. By aiming for the golden mean, I probably land near the best approximation of truth more often than if I were guided by any other set of compasses- partisan, ideological, pyschological, whatever... Yes, I am seeking truth. But I'm also seeking refuge. I'm taking a pass on the toughest calls I face.

I'm reminded of this concept by the coverage of Tea Bagging and the protests and disruptions so frequently covered this summer, culminating today in a protest in Washington DC.

Big news, right? Huge demonstration? Michelle Malkin says, OMG, 2 million!!! except high estimates put the crowd about about  60,000, and David Shuster says Freedomworks - who organized it - put the number at 30,000, and a "park official says this is being 'generous.'" Devilstower: "More people showed up for the Apple Butter Festival in Kimmswick, MO -- a town with a population of 93."

Compare the coverage these people get with other, past demonstrations. Like the Million Man March (1995 and 800,000 participants), March for Women's Lives (2004 and 1.1 million participants), the antiwar protests on the eve of Iraq (2003 with a million protesters in New York, San Franciso, and Los Angeles). Clearly it's only news if conservatives protest.

Really, have so few, acting so poorly, and with less understanding of the issues, ever swayed the media so much? Not since the Brooks Brothers riot.

Somehow, the millions without health care in this country, and very conservative reform proposed in this Congress, have been "balanced" all summer with the outrageous and false claims of the Tea Baggers, a small, if fanatic, group worked up into a froth by cable news pundits...

Matt Singer writes letters

by: Jay Stevens

Sat Sep 12, 2009 at 11:11:21 AM MST

Congressman Rehberg:

I read with interest your comments in yesterday's Lee Newspapers regarding the President's proposal for health care reform. Over the past three years, Forward Montana's members and volunteers have engaged thousands of Montanans in one-on-one conversations regarding health care. While we've heard opinions from across the political spectrum, much of the feedback we have received matches up with the concerns you raised: will we focus on preventative care, what can be done about malpractice costs, and can we increase the size of insurance pools to lower rates?

In part because of these needs, we are extremely optimistic about the President's proposed reforms. As I'm sure you heard, his speech touched on each of these points.

Regarding preventative medicine, President Obama said last night:

[I]nsurance companies will be required to cover, with no extra charge, routine checkups and preventive care, like mammograms and colonoscopies, because there's no reason we shouldn't be catching diseases like breast cancer and colon cancer before they get worse. That makes sense, it saves money, and it saves lives.

In the greater details provided regarding the plan on the White House website, more details are given:

Eliminates extra charges for preventive care like mammograms, flu shots and diabetes tests to improve health and save money. The President's plan ensures that all Americans have access to free preventive services under their health insurance plans. Too many Americans forgo needed preventive care, in part because of the cost of check-ups and screenings that can identify health problems early when they can be most effectively treated. For example, 24 percent of women age 40 and over have not received a mammogram in the past two years, and 38 percent of adults age 50 and over have never had a colon cancer screening.

Regarding medical malpractice costs, the President wants to act immediately. His plan states:

Orders immediate medical malpractice reform projects that could help doctors focus on putting their patients first, not on practicing defensive medicine. The President's plan instructs the Secretary of Health and Human Services to move forward on awarding medical malpractice demonstration grants to states funded by the Agency for Healthcare Research and Quality as soon as possible.

Finally, you raised the important issue of increasing the size of insurance pools to lower costs. As an employer that currently purchases insurance on the small group market and as an individual previously insured through the individual market, I assure you that this concern hits close to home for me. The President's plan creates a new health insurance exchange specifically designed to tackle this problem. As he explained last night:

We'll do this by creating a new insurance exchange -- a marketplace where individuals and small businesses will be able to shop for health insurance at competitive prices. Insurance companies will have an incentive to participate in this exchange because it lets them compete for millions of new customers. As one big group, these customers will have greater leverage to bargain with the insurance companies for better prices and quality coverage.

I hope you find this information helpful as you consider whether to support this legislation that is, as the President explained last night, going to be fully paid for, rather than debt financed like past years' tax cuts and program expansions. This responsible plan will help today's Americans without taking out a second mortgage on the future.

Please contact me if I can be of any further assistance.

Sincerely,

Matt Singer
CEO, Forward Montana

Nice speech!

by: Jay Stevens

Thu Sep 10, 2009 at 09:17:05 AM MST

The president's support for the public option was a little...ambiguous...to say the least, but it was support. Remember, it's the Progressive House Caucus that decides whether the public option gets into the bill, not the president, not Max Baucus. I think this speech aids them, and I'm more optimistic today about the public option than I was yesterday.

Thoughts...yes, we all know about Joe Wilson's outburst (which would have gotten him suspended from Britain's parliament), but the general boorish behavior of the Republicans would have been laughable if some of these *sshats weren't actively trying to derail reform that will protect Americans from insurers' predatory practices that drive many Americans into bankruptcy and often even death. What got me was when Obama decried the lie of the death panels, and the Republicans sat on their hands glumly, while the rest of the room stood and cheered wildly.

What? This is what they cherish? This is what they make a very public stand for? Lies and calumny?

This, in contrast, is what I stand for:

You see, our predecessors understood that government could not, and should not, solve every problem. They understood that there are instances when the gains in security from government action are not worth the added constraints on our freedom. But they also understood that the danger of too much government is matched by the perils of too little; that without the leavening hand of wise policy, markets can crash, monopolies can stifle competition, and the vulnerable can be exploited. And they knew that when any government measure, no matter how carefully crafted or beneficial, is subject to scorn; when any efforts to help people in need are attacked as un-American; when facts and reason are thrown overboard and only timidity passes for wisdom, and we can no longer even engage in a civil conversation with each other over the things that truly matter - that at that point we don't merely lose our capacity to solve big challenges. We lose something essential about ourselves.

I also was amused by the sight of a very dour Max Baucus during Obama's points on the public option. He, like his Republican peers, also refused to rise and cheer when Obama reiterated the importance of the public option.

(Quick note. FactCheck.org debunks Wilson's accusation; the language of HB 3200 reads, "Nothing in this subtitle shall allow Federal payments for affordability credits on behalf of individuals who are not lawfully present in the United States." Odious, yes. But true. So why the fuss? From what I can tell - and it ain't easy wading through the morass -- conservatives are angry that illegal immigrants aren't prohibited by the bill from buying any kind of health insurance, without government assistance. Which doesn't go far enough by half, I'm guessing. Why do we let those pesky Mexicans even buy food?)

But the best part of the speech was that it worked. Those that saw it, liked what he had to say. Which just goes to show that if you're a public figure, and you're forceful enough about the reform, and clear enough in explaining it - working hard to strip away the lies - people will support it.

Cowboy up, Max!

by: Jay Stevens

Wed Sep 09, 2009 at 16:22:42 PM MST

Point...

President Barack Obama, in a high-stakes speech Wednesday to Congress and the nation, will press for a government-run insurance option in a proposed overhaul of the U.S. health-care system that has divided lawmakers and voters for months.

Counter-point...

Hours before President Obama was set to deliver a make-or-break speech on health care reform, a top Senate negotiator conceded the government-run insurance program so dear to the president's supporters cannot pass the Senate.

Sen. Max Baucus, D-Mont....made clear that the so-called "public option" would not be part of any deal with his name on it.

"The public option cannot pass the Senate," Baucus said. "I could be wrong, but it's my belief that the public option cannot pass."

Remember this?

"It's funny," Baucus says, "I don't know if it would be more accurate to say I've prepared my entire career for health care reform, or if my entire career has prepared me for it. And to be quite frank, it could be my whole life that has prepared me for this moment."

Somehow, I don't think that means what he thinks it does.

Krugman defends the public option

by: Jay Stevens

Wed Sep 09, 2009 at 06:50:07 AM MST

So it's good to see Krugman step up for the public option.

Krugman claims the public option would achieve three things: keep costs down, provide the only real competition in many markets, and offer a buffer for consumers from an individual mandate.

Klein - one of the targets of Krugman's column - objects to the idea that the public option would help tamp down costs. He sees the public option's customer base as being too small to negotiate prices down - but then one assumes, also, that the public option wouldn't implement a pay-for-service model, but a patient-centric payment model, which would lead to lower costs and better care. And Krugman also notes the public option wouldn't be burdened by the private insurers' administrative costs. The public option wouldn't have to worry about profit, either. The public option would be cheaper - and private insurers would have to react in order not to lose customers as soon as their customers have access to the health insurance exchange.

Josh Marshall addressed Krugman's point about the political necessity of the public option on Monday:

Am I the only one who thinks that if the Dems pass a bill with mandates and subsidies for poor and moderate income people to purchase it but no public option or competition with the insurers, that it will be pretty much a catastrophe for the Democrats in political terms?

You 'solve' the problem of the uninsured by passing a law forcing them to buy health insurance which, by definition, most a) cannot afford or b) are gambling they won't need because they're young and healthy. Either you end up with low subsidies which still leave it onerous to buy, thus creating a lot of disgruntled people, or you get generous subsidies, which cost a lot of money.

It's sort of like reform with all the cool political downsides but none of the reform.

Under an individual mandate - what Baucus is currently threatening us with - the effect is increased exponentially, as some employers will no doubt dump their workers from their expensive benefits packages and let them fend for themselves. (RJ Eskow makes it clear that a mandate without reduced costs is madness, and explains how misguided progressives put us in this awkward position.)

Bob Cesca:

Backlash understates the impact. But there's also a core values and morality component here that feeds the backlash. The politics are bad, yes. And the backlash will be significant. But the Democratic Party and the White House will be asking us to do something that is morally impossible for many of us. A compulsory corporate giveaway is unthinkable.

Righties are calling the public option "a Trojan Horse" for a single-payer system. In a sense, they're right, although their fears are absurdly overblown.

For one, the public option would allow the American people to decide for themselves what kind of healthcare payment system they want. If the public option is efficient, provides good service, and costs a fraction of a private policy, consumers will use it. If the fears of the right are realized - the public option, as a government program, is bloated, inefficient, expensive, and inhumane - consumers will not use it. If the public option is what they say it is, it will die.

It's not a top-down mandate. No one's being forced to buy a government-provided policy. No one's being forced to abandon their private insurance. The public option won't transform the way we deliver health care - this isn't a plan to implement socialized medicine.

The public option is just that - an option to buy insurance that is provided by a public institution. It's that simple. The public option will allow Americans to drive healthcare reform at their own pace and in the way that they like.

But without the public option, reform is merely a (temporary?) brake on the degradation of service from private insurance, and an expensive bribe to private insurers to cover some of the costs of our sick.

Your daily healthcare post

by: Jay Stevens

Tue Sep 08, 2009 at 09:54:28 AM MST

First, not many folks think too highly of Baucus' rumored proposal floating around the Senate Finance Committee.

Ezra Klein's taken some (deserved) heat for tweeting support for Baucus' proposal, but he's the same guy that wrote this post, "What Happened to Last Year's Max Baucus?" speculating the reason behind the yawning gulf that separates Max Baucus' white paper from the recent proposals he's doling out in committee, still relevant today:

...Baucus pulled a bit of a bait-and-switch. That paper proved less his plan than his effort to articulate the Democratic consensus in such a way that Democrats were comfortable with him leading the debate. In particular, Kennedy had to be happy with that paper, because Kennedy was the threat to Baucus's leadership.

But Kennedy's illness took him out of the game. Baucus no longer needed to worry about Kennedy stealing the leadership of health-care reform away from him, which meant he stopped looking over his left shoulder. The effect was a bit like shutting down a primary challenge against Baucus: His surprising leftward lurch stopped entirely, and he drifted back to the more centrist approaches that had defined his career. It's hard to say how the process would have differed if Baucus had spent his days worrying about keeping Kennedy onboard, but it seems possible that the practical impact would have been to keep Baucus closer to the paper he'd written to attract Kennedy's support.

Makes you wonder how this debate would have gone if Kennedy hadn't gotten sick, and Clinton hadn't accepted a post as Secretary of State.

And then it's important to remember that there are two bodies in Congress, and that the House will have as much say about how reform takes place as the Senate. The LA Times has a nice little primer on the difference between the House reform bill's and what's being discussed in the Senate - which only underscores how superior the House bills are.

Also, according to The Hill, 23 House Democrats have said they won't vote for any of the reform bills that have been discussed. Pelosi can afford to lose only 38 members of her caucus total; the defection of the 23 gives the progressive bloc all the more power, as only 15 have to keep their promise to vote against any bill without the public option to kill toothless reform.

And let's not forget to poke conservatives on this issue. There's been no leadership from the right. There's been no acknowledgment that there even is a problem with health care in this country. The Republican strategy all along has been to kill this bill and continue the status quo, and by any means necessary, even if that means obfuscating, Red baiting, and stirring up racist resentment to do so. Hugh Hewitt's post is on reform is unusually bald in this regard. He admits the goal is the status quo, and he ends his post by pimping for the RNC and the NRSC: a nice reminder that the ultimate goal of TeaBagging and Hitler signs and shouting down your neighbors is to put Republicans back in Congress and back at the lobbyists' teats.

The latest rumored healthcare reform proposal from the Gang of Six

by: Jay Stevens

Mon Sep 07, 2009 at 11:43:09 AM MST

As you might imagine, there's no public option.

From the WaPo:

The Baucus plan, circulating among the Finance Committee's "Gang of Six" this weekend, sets forth provisions that have already gained the group's unofficial support and adds nothing new to the mix that the group has not already deliberated, senior Senate aides said. But Democrats are wary that two of the three GOP negotiators -- Sens. Charles Grassley (Iowa) and Mike Enzi (Wyo.) could still walk away, under pressure from their Republican colleagues to allow Democrats to fight for a bill on their own.

Two of the Baucus measures reflect the group's long-standing goal to find common ground on highly contentious issues. Instead of a government insurance option, the Baucus proposal would create a network of non-profit cooperatives -- an alternative that Grassley, the lead Republican negotiator, has backed. And it would levy a fee on insurers for providing high-cost plans, a provision aimed at curbing health-care cost inflation that Democrats and Republicans have endorsed, but that would violate an Obama campaign pledge not to target more generous plan covering many union households.

Taxing health care benefits? And no public option? To paraphrase Mike Trumka, are you out of your everlovin' mind? (And can you imagine the chutzpah of releasing a proposal to tax health care benefits on Labor Day?)

I'm thrilled Senator Baucus is negotiating like crazy with Senate Republicans. But this bill won't pass the House. And with the price tag at $900 billion, one wonders why the so-called fiscal conservatives aren't backing a robust public option, which would make the price of reform cheaper.

Again, and I'm sad to say this bears repeating, but instituting a mandate without a public option is simply a payout to the insurance industry to sell policies to people that need health care coverage.

The one concession to liberals in Baucus' proposal is a fee levied on insurance companies to help pick up some of the tab for insuring the uninsured:

The separate new fee on insurance companies would help raise money to pay for the plan. The fee would raise $6 billion a year starting in 2010, and it would be allocated among insurance companies according to their market shares.

Which makes my head spin, frankly. So...we're making everyone buy insurance who doesn't have it...and we're giving subsidies to those who can't afford insurance...which goes to the private insurers...who'll then give some of it back, no doubt after raising prices...spin spin spin...

And that's not even the kicker, according to David Dayen. It's that Baucus' proposal allows insurers to provide even worse coverage than ever, mandating that insurers need pay less than 70 percent of medical costs accrued by policyholders:

The only way to keep insurance premiums down for the poor, and therefore keep the subsidies down, is to make the coverage less generous. And the insurers would only pay for covered expenses. Anything not covered by the plan would go directly to the consumer. Someone making $20,000 a year would still be on the hook for up to $6,000 in medical bills under this plan, and that doesn't include their premiums or non-covered expenses. Insurers, then, get off the hook for a huge chunk of medical costs while having to pay a nominal tax, and the goal is actually to have them not pay it at all, but simply to discourage companies from buying good insurance policies for their workers. And you would still see plenty of medical bankruptcies. Virtually everyone's health coverage gets worse under this Baucus scenario. I don't remember "Less Quality Now!" being part of any sloganeering on the reform side.

Right now, about the only good in this bill is the proposal to expand Medicaid to 133 percent of the poverty level. Frankly, enacting a community standard would do little good under this model; sure, those with preexisting conditions could get coverage, but would still hover on the verge of bankruptcy, as their out-of-pocket expenses would be prohibitively high, and that's doubly so for anyone suffering from an ailment that requires extensive and expensive treatment. That is, the same folks who this reform was targeting.

And to "twist" insurers' arms to even cover what little they will, this proposal would degrade everybody's insurance coverage.

You'll probably hear wide cry that this proposal is unacceptable to progressives because it lacks the public option. (Which is true.) But this proposal is so bad on almost every level, that no reasonable lawmaker should even consider voting for it, no matter their stance on the public option...

Baucus healthcare plan to be unveiled today?

by: Jay Stevens

Sat Sep 05, 2009 at 06:50:06 AM MST

The chairman of the Senate Finance Committee told colleagues on Friday that he would soon present them with a detailed proposal for overhauling the nation's health care system in an effort to force either an agreement or an acknowledgment that further bipartisan negotiations would be futile.

The chairman, Senator Max Baucus, Democrat of Montana, signaled his intentions in a telephone conference call with five other committee members who have been struggling for months to forge a bipartisan bill and break a partisan stalemate in Congress, an official familiar with the call said.

The official said Mr. Baucus had told the group that he would circulate a detailed proposal as early as Saturday. In doing so, he would be taking a big step toward forcing a final decision by the group as to whether it sees any realistic prospect of a deal.

It'll be interesting to see what's in the proposal, and whether Republicans will go for it. In an interesting twist, progressive pressure for a public option and the threat of taking the bill to reconciliation may actually spur Senate Republicans to participate in negotiations.

Still, keep in mind that any bill lacking the public option won't pass the House...

Whatever. I'm headed out the door on a family, long-weekend excursion -- if the proposal is released today, I hope some soul will see fit to post a diary with a link to the text, etc & co.

...and it's interesting he's planning on releasing it today, the Griz home opener. Makes you think it's going to really, really suck.

Opposition to public option may hurt Blue Dog Dems' electoral chances

by: Jay Stevens

Fri Sep 04, 2009 at 11:27:26 AM MST

The central thrust of the post is Silver's speculating that maybe Blue Dogs are opposing the public option because liberals are strongly for it - and shows that there is a partisan split on support for its inclusion in reform. Quinnipiac has 88 percent of liberals supporting the public option, as opposed to 51 percent of conservatives. CBS/NYT has it pegged at 87/50.

Silver:

I wonder, in other words, whether the insistence of some liberals on the public option hasn't tended to move the Overton Window in the wrong way, making it seem like more of a partisan issue than it really is, or at least ought to be. That it's come to be seen as the sine qua non of an acceptable liberal health care package may be reason enough for Blue Dogs -- especially some of the more slow-witted ones -- to oppose it.

Silver, like Klein, believes that dropping polling numbers for reform mean that Blue Dogs have little interest in the threat of a bill's failure (although it's not the Blue Dogs who need fear a threat).

But...is that true?

First of all, the support for the public option is remarkably high among Republicans, and is extremely high among independents and Democrats. If you think putting down the public option is smart politics, then you're making two assumptions:

One. Those who oppose the public option feel very strongly, and will base their support for the Blue Dog on the defeat of the public option.

Two. Those that favor the public option don't feel very strongly, and won't base their support for the Blue Dog on the passage of the public option.

Ultimately, these assumptions are incredibly flawed. For one, the most virulent opponents of the public option and health care reform, I'm guessing, are movement conservatives who wouldn't vote for a Democrat under any circumstances. For another, most of the public is egregiously misinformed about what is actually in the health reform bill. Once a bill with a public option is passed, without affecting Medicare, people's private plans, and failing to nationalize the health care industry, opposition will fade away.

On the other hand, I'd argue, support for the public option will be a deciding factor in many liberal votes.

To wit, here's Idahoian MountainGoat on her newly elected Democratic representative, Walt Minnick:

The people of the 1st District had enough of the rigid ideology that told them they weren't worth the price and sent you to represent them instead. They didn't expect to get a more finely honed rigid ideologist. They didn't expect, nor did they deserve to get their lives turned into political footballs-least of all by you.

Yet that is exactly what you've done. You joined the chorus of townhall crazies and fear mongering ideologues who turned Tom and Karen and every other Idahoan who can't afford medical care into political footballs.

Instead of coming home and working to convince Idahoans that they had nothing to fear and much to gain from health care reform (something many of us were prepared to help you do), you and your advisors (with their legendarily acute grasp of messaging) sent out misinformation-laden press-releases playing up the fears of Idahoans using triggers like "socialized medicine," "big government" and "raising taxes."

Fellow Idohian, Sara Anderson:

Naively, I thought that getting an Idahoan into the Democratic majority could give the progressive agenda some kick to it. But those damn dirty blue dogs rolled right over when they saw blood in the water and donations to their re-election funds. I'm disappointed by Obama in a lot of ways, but I may in fact regret my vote for Walk Minnick.

Will there be enough resentment to run a real primary at Minnick? Or even have a third-party single-payer candidate foul the general election waters? Certainly voting against the public option will dampen voter enthusiasm on the left, which means a lack of campaign volunteers and low voter turnout.

It seems a tremendous risk to oppose something that even half of self-identified Republicans favor...

Update: Research 2000 data shows that voting against a public option would have a net negative effect among voters in all regions except for the South.

And that's based on the poll's conservative wording. Emphasize the choice, or option, of the public option, I suspect support goes up, as well as the net negative effect of opposing the public option.

Two observations: First, despite the media's emphasis on the anti-reform movement and the "dropping" poll numbers for reform, etc & co, public support for the public option still remains high. Second, based on the disparity between results based on how the question surrounding the public option is asked, it would seem an easy feat to create a concerted campaign in favor of the public option, should Democratic representatives were interested in doing so...