The Trigger Fight As A Template For Obama's First Term

by: Chris Bowers

Wed Jun 03, 2009 at 14:39


Right now, the main fight over a public health care option appears to be whether it will be instituted immediately, or only sometime several years down the road once certain market conditions have been met (aka, a "trigger"). Yesterday, Mike discussed why the trigger for the public option was such a bad idea, and would signal the end of meaningful health care reform. I want tot ake this a step further, and argue that if the public option is watered down to a "trigger," then don't expect any major progressive legislation to come from this Democratic trifecta. On any issue. Ever.

Real health care reform--aka, a public option--is the lowest bar for progressives to clear with the current congress. It has the most lobbying behind it, bringing in not only health care reform groups, but also unions and mutli-issue groups like MoveOn. It only requires 50 votes in the senate, whereas Republicans will force 60-votes on virtually everything else. It is a very popular, not only in absolute terms (60%+), but also relatively popular compared to other major Democratic agenda items like climate change. And President Obama won't have a 60%+ approval rating forever, either.

The bottom line is this: if we can't get our most popular major agenda item, during the peak in Democratic popularity, when we need only 50 Senate votes, and on the issue where we have given our strongest lobbying and activist efforts, then we aren't going to pass meaningful progressive legislation on anything else.

We are at 35 votes in the Senate on a non-trigger public option. Unions and MoveOn are working on acquiring more. Instead of floating a "trigger" compromise, the White House needs to start getting on planes, and holding rallies in the states with Democratic Senators who are currently not on board with the public option. (Such a tactic, if effective, would also provide a template for future progressive victories in the Obama admintration.) We can do this--but we can't do it if the White House is willing to fold without even publicly pressuring the retrograde Democrats.

If we don't pass a non-trigger public option, it won't just mean the end of meaningful health care reform. It will mean the end of any meaningful progressive legislation for at least two more years, and possible eight. Given the low bar, high popularity, and peak efforts we have on this one, a defeat on health care means that Republicans and Senate conservodems will be able to water down, or kill, all other progressive legislation proposed to this Congress.

Chris Bowers :: The Trigger Fight As A Template For Obama's First Term

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The Trigger Fight As A Template For Obama's First Term | 78 comments
it would be better to defeat a trigger plan (4.00 / 12)
than to pass one. I hope the progressives in the House tell Baucus & Co that they won't settle for crumbs.
Now they want to tax the health care benefits (4.00 / 4)
people have to pay for it.   Sure, why not.  I'll wait for the bank CEOs to cough it up.  I will never vote for another Democrat again if they screw this up.  
[ Parent ]
If it gives me a public plan, then I can live with that Tax. (0.00 / 0)
Obama has said that he wants to avoid it, but if necessary will consider it.   His letter also seemed to advocate strong support for a public plan.
[ Parent ]
I can't. (0.00 / 0)
How about the people who earn money over the fica limit pay more taxes to pay for it?   How can the working people in this country with their stagnant wages and the sinking dollar afford to pay for all of the uninsured while the top 1% skate every which way but lose.   No way.  
[ Parent ]
it's prob a VA-killer too -- Obama already tried that, but vets pushed back -- "Veterans Groups Blast Obama Plan for Private Insurance to Pay for Service-Related Health Care" (0.00 / 0)
http://www.foxnews.com/politic...

... President Obama's plan to require private insurance carriers to reimburse the Department of Veterans Affairs for the treatment of troops injured in service has infuriated veterans groups who say the government is morally obligated to pay for service-related medical care.

...


[ Parent ]
oop -- this was supposed to be at bottom of post -- (0.00 / 0)
weird.
[ Parent ]
please, please don't link to those bastards (4.00 / 1)
[ Parent ]
This is it folks (4.00 / 8)
Chris is right - this is the very future of the nation right here.

If we cannot get this through, all other progressive initiatives that currently lack the support of public health care are non-starters.

Hey, Baucus, "Trigger" is a horse (4.00 / 16)
We will have single payer rallies scheduled at noon on Friday at all Montana Baucus offices.  This is probably Max's last term so he isn't scared of voters, but he doesn't like confrontation.  So I would suggest a lot of confrontation.  And he does want a legacy. No Mansfiled/Metcalf/Baucus Dinner.  No Baucus National forrest.  

Tommy Douglas is the most revered name in Canada.  He is the most loved.  He was the premier of Saskatchewan who brought health care to Canadians.

Confront him everywhere.  It's time for a whole lot of civil disobedience.  

Right on! (4.00 / 9)
I agree with you completely Chris.

Any reasonable trigger points have already been triggered a long time ago -- it is now time for a public option. Actually, it is really time for a comprehensive single-payer program, but if all we can get is a strong public option, then we might have to settle for that. But nothing less.

And I completely agree that it is time for Democrats to fight for us. If they are going to fold on this issue, then we might as well just hand the country over to the corporate Republicans. The Republicans have demonstrated that they can cater to big, special interests better than we can. Plus, as we've seen, they'll provide massive corruption, Ponzi schemes, Big Brother snooping, and torture at no additional cost.

expanding Medicare is all we need -- not a "public insurance option" -- or any insurance -- (4.00 / 2)
and that requires only budgeting it.

that they won't do this is the whole problem -- and no part of this "reform" is any kind of solution -- with a "trigger" or without.

they don't even really want to expand actual healthcare at all.

I'm mixed (4.00 / 6)
On the one hand, the virulent opposition of private insurance suggests to me that a strong public plan might indeed by a real crack in the insurance-based system, which could lead to its downfall.

On the other hand, I find the arguments against a public-private mix compelling. These, for example, from PNHP"

1 - It foregoes at least 84% of the administrative savings available through single payer. The public plan option would do nothing to streamline the administrative tasks (and costs) of hospitals, physicians offices, and nursing homes, which would still contend with multiple payers, and hence still need the complex cost tracking and billing apparatus that drives administrative costs. These unnecessary provider administrative costs account for the vast majority of bureaucratic waste. Hence, even 95% of Americans who are currently privately insured were to join the public plan (and it had overhead costs at current Medicare levels), the savings on insurance overhead would amount to only 16% of the roughly $400 billion annually achievable through single payer - not enough to make reform affordable.

2 - A quarter century of experience with public/private competition in the Medicare program demonstrates that the private plans will not allow a level playing field. Despite strict regulation, private insurers have successfully cherry picked healthier seniors, and have exploited regional health spending differences to their advantage. They have progressively undermined the public plan - which started as the single payer for seniors and has now become a funding mechanism for HMOs - and a place to dump the unprofitably ill. A public plan option does not lead toward single payer, but toward the segregation of patients; with profitable ones in private plans and unprofitable ones in the public plan.

http://www.pnhp.org/facts/sing...

If the second point proves to be accurate, this plan could actually undermine the single-payer cause.

Let me put this way: I wish the defining piece of progressive legislation were more definitely progressive.


[ Parent ]
these are serious issues, and there is absolutely no doubt that single (0.00 / 0)
payer would be far and away a better solution.  

i'd love to see people who actually knew about these issues talk about how the public plan might relate to the problem of cherry-picking.  it seems to me that, even if this were an issue, we would at least A) have many more people insured, and B) have a better set of conditions against which the private insurers had to compete for 'healthy' insurees.

also, a random thought: why is it that the left can't buy off people like baucus.  what if a coalition of people on the left promised to raise the same amount of money he has raised from the insurance companies in exchange for his support of single payer?  go down the line with the senators, and then organize massive mobilizations, and what would prevent us from having single payer?  

[ Parent ]
I really don't know (4.00 / 3)
What makes sense to me is a tiered system, modeled a bit after the French system (said to be the best in the world), where there is a national health insurance, which can be supplemented by private insurance and a willingness to pay more.  Perhaps, the best strategy is to start with a relatively small public option that just covers the basics and emergency treatment while leaving a decent chunk of health care as still the province of private insurance, but using that foothold to widen the scope of a public plan slice by slice, year after year in an incremental fashion.  Take the Dean strategy of getting everyone emotionally invested in the system first, then fixing the system.

I wouldn't be inclined towards the position of Canada's New Democratic Party, which broke with the Liberal Party and forced a vote of no confidence over a stated desire to ban private health care completely.


Things You Don't Talk About in Polite Company: Religion, Politics, the Occasional Intersection of Both

[ Parent ]
This is good too (4.00 / 1)
And all this needs to be a concern of the media and not which dress Michelle is wearing to what this week. No wonder the whole country is obsessed with trivia and women are focused on clothes and makeup unstead of competence and excellence in some career field. The expertise young girls devote to hair and makeup (animal grooming to ward off anxiety) could be displaced to so much better things.
[ Parent ]
Chronic conditions (0.00 / 0)
and end of life care account for most of the current costs. Are these "basics" ?. Presumably, ER visits would be reduced somewhat under the new plan because with health insurance no one would be using the ERs as primary providers as is currently the case.

As for "fixing" a system. Somethings are more difficult to undo once they are done. I suppose that if it were possible to remove the trigger at some future date, one might give the idea another look. I admit that I'm not the one to do so.


"It sounds wrong...
     ...but its right."

[ Parent ]
That's something I would leave to the experts (4.00 / 1)
I'm not a health care expert.  I'm just suggesting that you can draw a line somewhere and that people who know more than me have a better idea of where that line can be draw.  If you look at the Canadian system, there are some things that get treated faster than in the US and some things that get treated slower.  The standard example is that you can wait months for elective surgery such as hip replacements due to health care rationing.  

I actually support the concept of health care rationing, but I would be willing to accept the idea of supplemental private health insurance to cover such areas.  Does that mean that wealthier people will have better health care than poor people?  Absolutely.  Do I think that is a problem?  Not as long as everyone has a certain minimum level of health care.

But wherever you draw the line, create a public option for that part of health needs.  Tell the insurance companies that they can cater to needs in the other share without government competition.  Then, you start stripping away parts of their space, slice by slice, based on what the public wants.

Things You Don't Talk About in Polite Company: Religion, Politics, the Occasional Intersection of Both

[ Parent ]
OK (0.00 / 0)
I know something about the need to reorient the emphases of our current healthcare system away from emergency and intervention and toward prevention and risk awareness. Many friends are physicians and I work in the research division of a hospital. This is a topic within the community because many health care workers want to provide this kind of care, but have problems because the system (read hospital and insurance suppliers, even big pharma)actively pushes them away from it.

I can see how the hospitals and insurance can work it out,maybe, but big pharma will always be the hold-out. You see, their product lines are favored by the interventionist methodology and they lose out under the prevention regimen. Witness Medicare Part D and the Bush Administration for examples of their power. I've always considered the insurance companies as viable negotiating partners because they will follow the money. Readjust the profit motives in more positive directions and they should go along. Physicians are, on the whole and in my experience, mostly interested in taking care of their patients. If the average salary of the MD is reduced in the new mechanism, those that would leave the field won't be very much missed, I suspect. Big Pharma's incentives are trickier to rejigger. I'd settle for negotiating much lower costs for routine, high-volume drugs and helping them to set up an independent Institute to oversee clinical trials of new drugs and support on-going Comparison Trials (easily and ideally tied in to the proposed eHealth Histories) to determine best practices. The former is the bait that Pharma would like to nibble, and the latter a demon they'd hope to banish. Therein, may lie the nub a a negotiation.  

"It sounds wrong...
     ...but its right."

[ Parent ]
The "high administrative costs" is a red herring (4.00 / 9)
It's not about clerks, administrators, computers, etc., being that expensive. They're not, at least if managed well (which most successful corporations seem to be quite good at). It's about two completely other things. One, the high salaries and bonuses paid to their top execs, which can be in the tens and sometimes hundreds of millions. And two, the huge amount of money spent on marketing, underwriting and claims denial, all intended to attract only the most profitable (i.e. healthy and affluent) of members, and deny coverage to everyone else. Both of these have nothing to do with peoples' health or a well-run health care system, and everything to do with profits. They're a big reason for why the private system is so expensive, and doesn't serve tens of millions of people who are un or underinsured.

Done right, a true public option would have none of these, since it would be run by the government, or by a strictly regulated public utility-like non-profit corporation that would be mandated to offer decent and affordable plans to EVERYONE, and subsidize whose who could not afford them. Right off the bat it would be far cheaper to run than anything the private sector could offer, and over time would siphon off millions of their members to the point where it effectively became a single-payer system. THAT is why they fear and oppose it.

"Those who stand for nothing fall for anything...Mankind are forever destined to be the dupes of bold & cunning imposture" -- Alexander Hamilton

[ Parent ]
single payer is ideal - a public option is realistic (0.00 / 0)
     I had not heard of points (1) and (2). But, unfortunately, they may both be correct. And item #2 has a lot of insidious implications.
    One of Obama's traits is that he wants to be the anti-Bush when it comes to compromise. Bush was quite happy to say (paraphrased for satire) "According to Katherine Harris, I got at least 50.1% of the vote... I will now rule with absolute power and not give a damn about those who did not vote for me." Obama does not want to come off as a partisan extremist. And every dittohead like Joe the Plumber will already say that if one penny of tax money is spent to save the life of a poor child, it is "socialism".
    So, regardless of the cost savings, even Obama does not want force a better, more-efficient single-payer system upon the fools like Joe the Plumber who want to overpay for bad service from the insurance companies. Add to that the fact that the insurance companies are fanatically opposed to single payer, and you will see why it will be politically difficult to pass HR 676, even though it is the most moral and most economically efficient plan.
    But even if a public/private arrangement is the best we can hope for in the short run, and even if it MIGHT pave the way for eventual single-payer... it sounds like the insurance industry would just rig the system, and push the poor and sick into the public program, while enrolling as many healthy and wealthy people as possible into their for-pay health plans.
    What this means is that we have a long fight ahead of us. But if Chris Bowers is correct, this is a fight that we MUST win, if we want to get ANYTHING progressive done this year. After we get a public option out there, we can expect to fight the insurance co.'s for several years... trench warfare, one inch of progress at a time. (Our next move, after getting the public option now, will be to put more Progressives in the House and Senate in 2010, and then push for more progress towards an eventual single-payer system, like HR 676.)

Luke 12:48 "to whom much is given, of him shall much be required". Would Jesus want progressive taxation, or regressive taxation?
[ Parent ]
Medicare for all yes (4.00 / 2)
The VA hospitals are all in place. At least until they decide to dismantle them as the bulk of vets are old and dying off.
[ Parent ]
True enough (4.00 / 1)
The hospitals and clinics will be hurting for patients in the near future, but it would require a significant change in the mission. I can see alot of opposition from the vets and the employees (I work in the VA). It would be a tough argument to make. Its tough to ask this population of citizens to sacrifice any more for their fellow Americans. The truth of the matter is that the VA often fails to meet the needs of the vets and care is very uneven across the system. Aside from appropriating more funds, this idea has many significant political hurdles.


"It sounds wrong...
     ...but its right."
[ Parent ]
Be careful what you ask for (4.00 / 5)
I can easily see them adopting this path, but in name only. I.e. turning Medicare Advantage, which is basically minimally regulated government-subsidized private insurance, into "Medicare for all", and then renaming it so people don't realize that it's lipstick on a pig. Even if this leads to more people being covered, it won't lower costs or improve health care. It'll just be yet another corporate giveaway sold as "progress". And they'll have the world's best salesman pushing it for them. Yes he can!

"Those who stand for nothing fall for anything...Mankind are forever destined to be the dupes of bold & cunning imposture" -- Alexander Hamilton
[ Parent ]
Maybe... (4.00 / 1)
But, then a lot of hospitals will close...

Medicare simply doesn't pay doctors enough....

When thy dole out 32 cents for a b-12 shot, not a lot of facilities will survive.

Medicare for all sounds great on the surface, but there needs to be other fundamental changes for it to work, otherwise, the unintended consequences could be disastrous...

It's not just as simple as extending medicare to more people...  a total revamp of funding and reimbursement would also be necessary...

REID: Voting against us was never part of our arrangement!
SPECTER: I am altering the deal! Pray I don't alter it any further!
REID: This deal keeps getting worse all the time!

[ Parent ]
France (4.00 / 2)
Although as others have pointed out, France uses a tiered system where the single-payer portion is fairly minimal but people still can buy private insurance for additional coverage.  Given that France is considered to have the best health care according to studies, that might not be a bad place to end up.
[ Parent ]
That is essentially Medicare in the states, too.... (4.00 / 1)
Medicare parts A & B & D have lots of gaps in coverage... Part B has no out of pocket limit, and part D has the donut hole.  Many people enroll in Medicare Advantage Part C which fills most of the holes for almost no fee... or people get medigap plans on top of regular medicare.  Many retiree medical plans are standard major medical, but only pay second after medicare.

Medicare for all would not eliminate the insurance companies... it would allow them to market and sell profitable niche products to nearly everyone...  It really is a program that would work for insurers, but they'd lose  a lot of control.

In business, money is second to power and control, and that's what this health reform fight is really about.

REID: Voting against us was never part of our arrangement!
SPECTER: I am altering the deal! Pray I don't alter it any further!
REID: This deal keeps getting worse all the time!

[ Parent ]
Wealth redistribution (4.00 / 1)
Very highly paid docs will have to take a hit, so that others can still have a job. In fact, this has already been happening in some practices. Physicians of various specialties form joint practice (like law firms) and all payments go through the firm from which all pull a salary (some bonuses, too). Main effect is to make it financially feasible for some to work as an up-dated version of the town doctor. Develop long-term relationships with the patients, make house-calls, and provide the impetus for preventative care, that kind of thing. The supplement comes from the surgeons and other in-demand specialists.

"It sounds wrong...
     ...but its right."
[ Parent ]
Redistribution? (0.00 / 0)
This isn't about taking money people already have and giving it to someone else. It's whether a set of government rules that allow some people to make great sums of money will be changed in a way that achieves our purposes better (ensuring health care for all) that will allow some people to make great sums of money that are somewhat smaller than they were previously.  

Politics is the art of the possible, but that means you have to think about changing what is possible, not that you have to accept it in perpetuity.
[ Parent ]
If the new system is going to support all the docs (4.00 / 1)
in the current system, there will have to be some redistribution within the doctor community, or maybe some will leave their practice. A finer grain of problem than you detail, its part of the issue. One I'm a bit more in tune with because I work with MDs and in a very clinically oriented institution.

Under the current system, preventative care is not incentivized and, hopefully, whatever system results from this round of reform will change that situation. Lack of incentive means low compensation. Even so, few physicians live below the poverty line.

"It sounds wrong...
     ...but its right."

[ Parent ]
Medicare is NOT the answer (0.00 / 0)
Expanding Medicare might be a way to get a foot in the door, so to speak, for UHC, but Medicare is a relatively poor program that can best be described as better than nothing.

Medicaid is a bit better, but its payment system to providers is crap.  Try finding a doctor or dentist that will take more than a few Medicaid patients at a time, its a money loser (a cardiac specialist told me he made roughly $7-$8 an hour per Medicaid patient, in a state with a minimum wage of $8.55/hr).

Of all the systems that we already have and I have had experience with, the VA system (in a properly run hospital, which is hit or miss) is the best format I can think of.  All services provide based on need, regardless of cost.  Private insurance is billed for service with no deductible or unpaid portion passed on to the patient.  If no private insurance, patient is billed based on income level.  Federal VA system subsidizes the rest.

I think expanding the VA system to include non-vets (which could require it to be transfered to another Department), opening Medicare to everyone and loosening the requirements for qualifying to Medicaid is a good start to covering more people.  

Starting from scratch, though, is probably the best thing to do for a good system.

[ Parent ]
Has it really been definitely decided (0.00 / 0)
that this legislation will be dealt with under the reconciliation process, so that only 51 votes will be needed to pass the Senate?

I had thought for a while that maybe it was so; then one of the major selling points for Specter's turning into a Democrat was that he could break a filibuster on health care.

Has anything since been said that makes the use of reconciliation more definite?

my understanding, though i don't have readily available links, (0.00 / 0)
was that they were going to go forward without making a determination about reconciliation, but would go with reconciliation if they couldn't get 60 votes for a decent plan.  basically, they are providing the fence sitters with a chance to get on board before the train leaves the station (and there would probably be a certain amount of compromise involved in the non-reconciliation bill).  what confuses me is how this all relates to Baucus.  He is clearly not one of the 50 more progressive senators on healthcare, but he also clearly has a major role in the drafting of this legislation.  is the White House actually considering cutting him out of the process?  if so, good.  if not, the whole reconciliation threat seems pretty hollow.  
[ Parent ]
They set a date, I think (0.00 / 0)
if a plan hasn't been passed by Oct 15, then they'd go to reconciliation.  
[ Parent ]
hmmm, seems too far off.... they should move it up to august. (0.00 / 0)
thanks for the info :-)
[ Parent ]
Baucus chairs finance (4.00 / 1)
Due to Kennedy's health, he can't lead the process as the chair of the HELP committee, so we get Baucus instead.

It sucks, but it's hard to circumvent him.

Forgotten Countries - a foreign policy-focused blog

[ Parent ]
It's still under the category (4.00 / 1)
Of a threat to throw everything into chaos that they haven't pulled the trigger on yet.  Reconciliation could kill a public option or it could be the only way to pass it.  No one knows.  It's the sort of uncertainty that the threat of Chrysler and GM bankruptcies were supposed to present to creditors.  The deadline for a bill is October 15.

Things You Don't Talk About in Polite Company: Religion, Politics, the Occasional Intersection of Both
[ Parent ]
Get some Democratic Senators to commit to filibustering (4.00 / 3)
Any health care that doesn't include a non-trigger public option even if it means joining with Republicans who oppose all health care reform to do so.  You need a recalcitrant minority of only fifteen or so Democrats to prevent a slim majority of the rest of the Senate Democrats plus a handful of Republicans from passing a watered-down bill.  Progressive politicians should use the rules of the Senate to their advantage to say that the status quo is preferable to a plan that includes a trigger public option, even if it technically isn't, in order to prove a point.

Can someone come up with a list of 15 Senate Democrats who might be willing to kill any improvements in health care and prevent even a vote on a watered-down plan if there isn't a genuine public option?  Are the lobbying groups willing to ask for this effort?

Things You Don't Talk About in Polite Company: Religion, Politics, the Occasional Intersection of Both

i think this would be harder to make happen than the threat to filibuster a bill without (0.00 / 0)
any public option at all.  but there is no harm in trying.  
[ Parent ]
My problem (4.00 / 5)
Is that this idea never seems to even cross people's minds.  I sometimes think that progressives are weak because they don't seem interested in scorched earth tactics.

Things You Don't Talk About in Polite Company: Religion, Politics, the Occasional Intersection of Both
[ Parent ]
Might as well get Obama to threaten veto, too (4.00 / 1)
I say not intending to imply an either/or choice needs to be made.

But as long as we're at it.....

"It sounds wrong...
     ...but its right."

[ Parent ]
I don't think they're willing... (0.00 / 0)
to expend the political capital of being an 'obstructionist' no matter how good the cause is...especially if it puts them in the camp with the Republicans. I just don't think they would do that. I think they'll go along with pretty much any 'reform' that's presented, and if it doesn't have single payer they kill two birds with one stone: 1) we passed reform and 2) their campaign's contributions from the insurance industry are secure because they didn't piss them off. It's a win-win for them.  
[ Parent ]
"Level Playing Field" == Poison Pill (4.00 / 5)
According to some informed observers, the real poison pill is not the trigger but rather Schumer's "level playing field" proposal which requires that

"¶The public plan must be self-sustaining. It should pay claims with money raised from premiums and co-payments. It should not receive tax revenue or appropriations from the government."

According to the Physicians for a National Health Plan

"With the concession of the progressives, the strategy for a Medicare-like public option has already failed. Moving forward with what amounts to another private PPO with a government seal of approval means that the private insurance industry will maintain control of health care financing for the majority of Americans."  

"We have in the making yet one more example of where the Republicans will extract enough concessions from the Democrats to ruin the legislation, and then when it comes time to vote, the Republicans will vote against it anyway."

It is the typically devious plan from Senator no-capital-gains-on-hedge-fund-CEOs which we should be lobbying against, it seems to me.

it isn't the republicans extracting concessions here. its the conservative (0.00 / 0)
democrats.  and unless reconciliation is utilized, they will be needed to vote for the bill.  

but agreed about the problems with 'level playing field.'  

[ Parent ]
Theater (4.00 / 6)
Agreed, but I think there is a bit more to the Kabuki.  Namely, the Republicans as Dr. McClellans blog predicts, will vote against the plan, even after it has been watered down to insignificance-at their demand- to satisfy the insurance companies.

But the Dems will vote for the final plan allowing themselves to simultaneously posture as progressives all the while amounting to being no less faithful servants to the insurance industry.

 

[ Parent ]
oh, don't get me wrong, i fully expect the GOP to vote against the plan.... (4.00 / 1)
but i'm not at all convinced that they will be let in on the process enough to water it down. all the watering down is being done by democratic members of the finance committee.  
[ Parent ]
You are right (4.00 / 3)
Where in the heck is Obama?
Obama (4.00 / 4)
The public option wasn't even considered a "serious" possibility a couple months ago.  According to Ezra:

The White House, which seemed relatively unsinterested in the issue a few months ago, has begun pushing hard for it.

And that, in my reporting, is what seems to be underneath the change. A few months ago, most observers thought the public plan was a bargaining chip. It had a lot of public supporters but few real friends. In recent weeks, that's begun to change. The White House seems genuinely intent on including a public plan -- or at least some form of public competition -- in the final bill.


[ Parent ]
What does a public option look like? (4.00 / 1)
Does anyone have a link discussing what a public option would actually look like?  I ask, because I find I bring assumptions into this that differ from the assumptions others bring in.  From a previous discussion:

Me: Single payer basically by definition means everyone is in.  You can't just offer it to "those who want it".  When you mix and match what you get is a public option, which you claim to be against.  I'm confused.

NABNYC:I don't know what you are thinking when you say "public option."  My understanding is this:  Obama wants to have a special insurance package available to the public that they can buy which will be similar to the insurance package bought by people in the government.  That's it.  It's still private insurance.


it's run by a private hmo and is purposely hamstrung -- it's Schumer's "compromise" (0.00 / 0)
plus the whole pool thing ("connector") is like they have in Congress, and in Mass -- and will be run by a private company too.
[ Parent ]
Link? (0.00 / 0)
What do you base this on?

Obviously a "public option" that is run by a for-profit private company doesn't seem to be a very good idea.

[ Parent ]
Baucus put Schumer in charge of the "public" option -- many links are all over the place -- (0.00 / 0)
they're not hard to find.
[ Parent ]
here's one of many -- "Schumer Offers Middle Ground on Health Care" -- it's not public nor is it govt-funded -- (0.00 / 0)
http://www.nytimes.com/2009/05...

... One way they propose to do that is by requiring the public plan to resemble private insurance as much as possible.

"The public plan," Mr. Schumer said Monday, "must be subject to the same regulations and requirements as all other plans" in the insurance market.

Democrats in Congress hope to shift the debate from the question of whether to create a public health insurance plan to the question of how it would work.

In so doing, they look for the support of influential moderates. But in the last few days, three moderate senators - Ben Nelson, Democrat of Nebraska; Olympia J. Snowe, Republican of Maine; and Arlen Specter of Pennsylvania, who switched parties to become a Democrat - have expressed reservations about a public plan.

Insurers also remain skeptical. Karen M. Ignagni, president of America's Health Insurance Plans, a trade group, said, "We are very, very grateful that members of Congress have been thoughtfully looking at our concerns." But she said she still saw no need for a public plan "if you have much more aggressive regulation of insurance," which the industry has agreed to support.

Linda Douglass, a White House spokeswoman, said that Mr. Obama was for a public plan but that he realized it could be defined in different ways.

Mr. Schumer said his goal was "a level playing field for competition" between public and private insurers. But Ms. Ignagni said, "It's almost impossible to accomplish that objective."

The chairman of the Senate Finance Committee, Max Baucus, Democrat of Montana, asked Mr. Schumer to seek a solution. In his response, Mr. Schumer set forth these principles:

¶The public plan must be self-sustaining. It should pay claims with money raised from premiums and co-payments. It should not receive tax revenue or appropriations from the government.

¶The public plan should pay doctors and hospitals more than what Medicare pays. Medicare rates, set by law and regulation, are often lower than what private insurers pay.

¶The government should not compel doctors and hospitals to participate in a public plan just because they participate in Medicare.

¶To prevent the government from serving as both "player and umpire," the officials who manage a public plan should be different from those who regulate the insurance market.

In addition, Mr. Schumer said, the public plan should be required to establish a reserve fund, just as private insurers must maintain reserves for the payment of anticipated claims. And he said the public plan should be required to provide the same minimum benefits as private insurers. ...


[ Parent ]
it's not public at all -- not run or funded by govt -- and pays more than Medicare (like private supp'l hmos for that) (0.00 / 0)
there's nothing about it that's really public at all.
[ Parent ]
Not to be facetious (4.00 / 1)
but GM used to be run as private company, too. Why not use the "too big to fail" thing as a stealth means to a single-payer system? Build it in the private sector, then nationalize it.


"It sounds wrong...
     ...but its right."
[ Parent ]
Only problem here.. (0.00 / 0)
...is that nationalization of any sort is really only popular at OpenLeft.  This is about the only place where there's been any support our nationalization of GM.

REID: Voting against us was never part of our arrangement!
SPECTER: I am altering the deal! Pray I don't alter it any further!
REID: This deal keeps getting worse all the time!
[ Parent ]
Where is a single payer option popular? (0.00 / 0)
probably to "multidimensional chess" - like to become an actual plan. You'd need a crisis to force nationalization. But then, manufacturing "crises" seems to be a forte among some circles in DC and elsewhere.


"It sounds wrong...
     ...but its right."
[ Parent ]
I'm surprised you say that (0.00 / 0)
I think support for nationalization of GM is a bit more widespread than that, don't you? And I've seen a lot of support for a temporary nationalization of the banking system.

[ Parent ]
Every other progressive blog is PISSED... (0.00 / 0)
...it seems, that we put more money into GM...

If it was any other company, maybe, but the hated GM, no...

Conservatives, of course, oppose it and will probably boycott GM products...

So, that leaves the mushy middle who are probably split.

This is the one and only progressive blog that is really supporting the government propping up the automakers.

REID: Voting against us was never part of our arrangement!
SPECTER: I am altering the deal! Pray I don't alter it any further!
REID: This deal keeps getting worse all the time!

[ Parent ]
That has been discussed by house members... (0.00 / 0)
...but, doesn't seem to be talked about at all in the Senate versions... which I find weird... the insurance companies would be all for that, and it could be marketed as a "oublic option" even when it isn't...

REID: Voting against us was never part of our arrangement!
SPECTER: I am altering the deal! Pray I don't alter it any further!
REID: This deal keeps getting worse all the time!
[ Parent ]
Obama weighs in (4.00 / 4)
This letter from Obama, released today, is relevant to this discussion:

Letter from Obama to Kennedy and Baucus

ec=-8.50 soc=-8.41   (3,967 Watts)

Thanks for that link. (4.00 / 3)
The take-away sentence in Obama's letter for me was:

I strongly believe that Americans should have the choice of a public health insurance option operating alongside private plans.

Leaves a lot of wriggle room, but has he said that so strongly recently?  A statement like that has to help...

Decarbonize, Deglobalize, Demilitarize

[ Parent ]
I agree (4.00 / 1)
The letter is clear on that point. It is also very significant that he sent it to Baucus. Kennedy is not the problem here. I think Obama knows that Baucus is one of the players most likely to torpedo his health care agenda.

ec=-8.50 soc=-8.41   (3,967 Watts)
[ Parent ]
This is the real deal, folks (4.00 / 4)
As far as I've heard, this is the first proposal that people really think is a serious threat to health reform. Anything you can do to put pressure on Congress is really helpful.
One quibble (4.00 / 2)
I completely agree that the public option is ESSENTIAl and that it has to happen for both humanitarian and political reasons.  However, I would say that it is not clear to me from Stein's article that Obama is floating the trigger idea.  Its not even clear from that vaguely worded article that Obama is considering it.  Generally I agree with you in your criticisms of the administration's centrism, but I'm not sure there is evidence of this on the trigger issue YET.  
the whole thing is a Medicare-killer -- "To help pay for coverage of the uninsured, Mr. Obama called for additional cutbacks in the growth of Medicare/Medicaid, beyond the savings he proposed in Feb" (4.00 / 1)
... To help pay for coverage of the uninsured, Mr. Obama called for additional cutbacks in the growth of Medicare and Medicaid, beyond the savings he proposed in February as "a down payment on health care reform."

In his earlier request, Mr. Obama proposed savings of $316 billion in the two programs over 10 years. On Wednesday he said he wanted to work with Congress to reduce projected spending on Medicare and Medicaid by an additional $200 billion to $300 billion over the next 10 years.

Such proposals are sure to face stiff resistance from health care providers, who were already alarmed at the president's initial proposals to cut payments to hospitals, drug companies, H.M.O.'s and home care agencies, among others.

Mr. Obama said he was "committed to working with the Congress to fully offset the cost of health care reform," by curbing the growth of Medicare and Medicaid and "by enacting appropriate proposals to generate additional revenues."

The president did not comment on proposals to tax some employer-provided health benefits, an idea favored by Senator Baucus but strongly opposed by labor unions and many employers.

-- http://www.nytimes.com/2009/06...
I don't mind some cuts in Medicare spending (4.00 / 1)
if it can be done by eliminating Medicare Part D. Part D is the right wing's tool to eventually force the gutting of Medicare. I have not heard anything from any Dem politician about getting rid of this huge giveaway to the pharma co's. And we expect them to push for single-payer? Ridiculous.  
[ Parent ]
There has been talk about... (0.00 / 0)
...the government negotiating directly for drug costs as part of a greater reform bill.  

REID: Voting against us was never part of our arrangement!
SPECTER: I am altering the deal! Pray I don't alter it any further!
REID: This deal keeps getting worse all the time!
[ Parent ]
Great article - send it to Obama (4.00 / 3)
I just pasted a juicy excerpt at:

http://www.whitehouse.gov/cont...

Also, I've been emailing and calling Arlen Specter, telling him I donated the max to Obama and Lamont and will do the same with Sestak if he doesn't oppose the trigger.

Specter: (202) 224-4254

you can leave a message after hours

Here's a list of all the senators

http://www.senate.gov/general/...

Let's get on this thing!!

and what's sad is that a "public option" was already a compromise from single payer (4.00 / 7)
this is what happens when you pre-emptively compromise. they're going to pull you to the right anyway. why start half-way to surrender?
"why start half-way to surrender?" (0.00 / 0)
It is closer to the trough.

"It sounds wrong...
     ...but its right."
[ Parent ]
Or (4.00 / 2)
Why get off in Chicago, if you're going to New York?

National Nurses United (AFL-CIO) is America's RN union, representing 150,000+ nurses from all 50 states.
[ Parent ]
this is true, but had already occured in the fall of 2007. (0.00 / 0)

[ Parent ]
Generational changes (0.00 / 0)
If there is a real public option, and

If health care for minors (what is now SCHIP) is covered, by default through the public option, and

If local clinics, like community health care centers (which are now funded at least partially by local governments) develop a workable relationship with the "public option" plan (keeping in mind that these same clinics generally have dysfunctional relationships with private insurers), then

Within a decade or so, a generation of young people and their parents will come to expect de-facto single payer.

My projection is that we end up with a two-tiered system:

(1) The public option eventually becomes a bit like single payer, but adults of working age have to buy in if they have income, or face some financial consequences when they need emergency medical services, and

(2) A "private" health care system that is focused on the rich and old. Where end-of-life care and life extension measures that are not affordable under a public plan are delivered. I think it might be pretty gross, kind of like paying for more years of life, in addition to cosmetic surgery, etc. Young people will have little interest in this type of plan.

I sounds kind of sci-fi, but I really expect the political struggle of the future will be between the young and old, and fancy health care technology will determine who has the privilege of getting very old. Personally, I'm not looking forward to a bunch of 90 year old senators and judges.

ec=-8.50 soc=-8.41   (3,967 Watts)

[ Parent ]
The question in the poll - yes 64% (0.00 / 0)
Federal leaders are considering expanding Medicare to all Americans, so that 
people have another option besides private health insurance or an HMO.  
Do you favor or oppose the creation of this type of public health plan option? 

64% favor. 28% oppose. That was in Feb. this year. Call your senator, ask how hard is? To agree with the 64% who want your to open Medicare to all Americans?

http://www.consumerwatchdog.or...

[ Parent ]
Strategery (4.00 / 1)
I think we need to rank the chances of getting the remaining 65 Senators on our side and start politely advocating to the top on the list.  We need to also identify the biggest Dem traitors and let them know we will primary them tooth and nail until they lose or are retired if they add a trigger.  Further, they will NEVER see a dime from us again.        
The hope is... (4.00 / 2)
If Obama wants to spend Political Capital on something... THIS is it!  Based on some of the things yesterday, I think he is going to fight for this.    Knock on wood.    

Right know we are at 36.  We need 14 more (as Biden should break a tie in favor of the Public option), but of course, the more the better.  I'd love to get 60 although that may be a pipedream.

I think Obama has to know if a Public Option gets past, it will almost assure a second term and a strong legacy.  it will also give him further capital to use.    

Here's to hoping.   I've seen some articles on the administration gearing up the email lists gor the SCOTUS pick and for Healthcare... knock on wood... this is true.

I was going to say... (0.00 / 0)
Joementum is undecided.  HE OWES Obama for letting him stay in the caucus.  I hope they call that in.
[ Parent ]
On the Same Page (0.00 / 1)
Democrats and Republicans are the same.

They don't appeal to voters...they appeal to Organized contributors as Pritzker who headed the fund raising for Obama has stated.

It's all a show.

The Trigger Fight As A Template For Obama's First Term | 78 comments
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