Progressive Health Care Backlash Update

by: Chris Bowers

Thu Jul 30, 2009 at 16:07


Here is the current status of the House Progressive backlash against the health care "deal" negotiated by Henry Waxman and four Blue Dogs on the Energy and Commerce Committee:

  1. 53 House Progressives will vote against deal: In their press conference today, the Congressional Progressive Caucus stated that 53 Progressives will vote against any bill containing the measures in the Waxman-Blue Dog deal. With 218 required for a majority, and 178 Republicans, that is more than enough to block health care reform from passing the House until these Progressives are statisfied.

  2. Medicare rates are the line in the sand: There were several Progressive objections to the Waxman-Blue Dog deal, but the line in the sand appears to be a public option with Medicare rates. From the letter signed by 53 House Progressives:

    Any bill that does not provide, at a minimum, for a public option with reimbursement rates based on Medicare rates - not negotiated rates - is unacceptable.

  3. Waxman-Blue Dog deal will pass out of committee. The progressive backlash will not stop the Waxman-Blue Dog deal from passing out of committee. The markup in the committee has continued today, and none of the 53 progressives mentioned above sit on the Energy and Commerce committee.

  4. Progressive plan is to change the bill both before, and in, the Rules Committee. Before there can be a full House vote on health care legislation, the three different health care bills that have / will come from three different committees need to be merged by the Rules Committee. One of the other committee chairs to produce a health care bill, Charles Rangel, has made it clear that strengthening the public option in the rules Committee is his plan.

  5. Rules Committee is relatively progressive. You can see the members of the Rules Committee here. Democrats hold an 8-5 advantage on the committee. There are five members of the Congressional Progressive Caucus, plus Doris Matsui. There are also two Blue Dogs, Mike Arcuri and Dennis Cardozza. However, while they are Blue Dogs, neither Arcuri nor Cardozza signed any of the various letters expressing "concern" over health care reform. As such, this is indeed fertile ground for making sure the Waxman-Blue Dog deal doesn't make it to the floor.
Of course, all of this remains contingent upon the ongoing strength of the Progressive Block relative to the Blue Dogs. We have to make it easier for the leadership to break the Blue Dogs than to break the Progressive Block. Keep up the calls--this fight remains very winnable.
Chris Bowers :: Progressive Health Care Backlash Update

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That seems like a pretty stupid place (4.00 / 1)
to draw a line in the sand. A lot of doctors won't even see Medicare patients right now; if the public plan is tied to Medicare rates, those patients will suffer the same fate.

On top of that (0.00 / 0)
the Medicare rate based is only for a couple of years before it goes to market rates.


[ Parent ]
+10% (0.00 / 0)
I believe the plan uses Medicare rates +10%, so it should be more accepted.

[ Parent ]
Agreed (0.00 / 0)
This is the worst possible line to draw. The real issue is will people be able to buy into it? Right now it could possibly be expanded so everyone can buy in sometime in the future but that won't be true for years. Progressives should demand at the very least that all small biz can buy into it from the very start. That would be a much better idea.  

John McCain: Beacuse lobbyists should have more power

[ Parent ]
Why not just lower Medicare eligibility year by year? (0.00 / 0)
Lower eligibility by two years every year until everybody's in.

Now all we're doing, with a small business buy in, is adding extra levels of complexity to something that's horribly complex as it is.

I am in earnest -- I will not equivocate -- I will not excuse -- I will not retreat a single inch -- AND I WILL BE HEARD.  


[ Parent ]
Disagree (4.00 / 5)
If Medicare rates apply to all people, instead of just people over 65, that is too much business to push away if you are a businessman/woman.

In fact, a public option only practice could reduce overhead by not having to hire the people needed to beg for payment for a procedure from a patient's insurance company, and be quite profitable.

John McCain won't insure children


[ Parent ]
Plus its ten percent higher (4.00 / 1)


--

The government has a defect: it's potentially democratic. Corporations have no defect: they're pure tyrannies. -Chomsky


[ Parent ]
plus "negotiated" rates are a loophole (0.00 / 0)
Medicare is, for now anyway, a lot more visible. coupling the public option rates to Medicare means you start out with a lot less uncertainty. and a lot less wriggle room for a compliant HHS to cave in on rates in the future.

not everything worth doing is profitable. not everything profitable is worth doing.

[ Parent ]
I don't know if she'll stiill be there (0.00 / 0)
but if anybody should be in charge of negotiating rates, it should be Kathleen Sebelius based on her performance as Kansas Insurance Commissioner.  

[ Parent ]
But Medicare rates won't apply to all people (0.00 / 0)
Most people will still be on private insurance, even under the House bill. If the public plan pays Medicare rates (or slightly above), those patients are probably not going to be able to see a doctor. At the very least, they're going to have a lot of trouble.

[ Parent ]
Volume and flexibility (4.00 / 4)
I do some work for surgeons.  What keeps them in Medicare is the volume.  Dropping it altogether would put an immediate cut in the income of the younger doctors and the income is needed to pay mortgages and pay off med school debts.  What keeps the established doctors in, is not the money but the volume.  A steady volume of surgeries earns them Operating Room time.  Medicare patients can also be conveniently slotted in to fill cancellations due to medical clearance issues (infections, underlying medical consitions like heart problems) that prevent planned surgeries of more profitable patients.

The other plus of Medicare is that although they pay poorly they pay quickly.  Many doctors prefer Medicare to the poorest insurance plans that pay only a little more.

That said, Medicare pays less than half what many insurances pay and as little as 10% of what some policies pay.  That's right 10%.  And Medicare over the last several years has increased its hassle factor considerably by calling on patients to report doctors for fraud and by saggressively auditing over small amounts.  They never challenge the surgeries, a big ticket item, but frequently hassle the doctors over the level billed for office visits, amounting to a savings of under $20 for a $3,000 case.


[ Parent ]
Something constructive the Progressive Caucus could do (4.00 / 3)
Kip Sullivan:

Proposed resolution for the Congressional Progressive Caucus
WHEREAS the Congressional Progressive Caucus has evaluated the "public option" in HR 3200;

WHEREAS the CPC has determined that the "public option" in HR 3200 is not "robust";

WHEREAS HR 3200, therefore, is just another Massachusetts-style bailout for the health insurance industry;

WHEREAS a Massachusetts-style debacle on a national scale will set back the movement for universal coverage under a single-payer system;

WHEREAS the CPC has repeatedly put Democratic leaders on notice that they intend to vote against legislation with a weak "public option"; therefore be it

RESOLVED that the Congressional Progressive Caucus members will instead support an amendment to HR 3200 that replaces HR 3200's language with that in HR 676, The United States National Health Care Act.


Heck, they could even change the RESOLVED to reboot the whole process, if they want to play 11-dimensional chess.

I am in earnest -- I will not equivocate -- I will not excuse -- I will not retreat a single inch -- AND I WILL BE HEARD.  

i missed you, Chris. very realistic analysis. (4.00 / 3)
and some good news in there too. let's keep the pressure on.  

Blue dog token resistance was bad enough... now this shit. Whatever, i guess someone has to work the refs (0.00 / 0)


clarification (0.00 / 0)
Progressive plan is to change the bill both before, and in, the Rules Committee. Before there can be a full House vote on health care legislation, the three different health care bills that have / will come from three different committees need to be merged by the Rules Committee. One of the other committee chairs to produce a health care bill, Charles Rangel, has made it clear that this is his plan
does this mean, am I reading it right the three different health care bills that have come or will come from three different committees need

I assume so but want to check.


--

The government has a defect: it's potentially democratic. Corporations have no defect: they're pure tyrannies. -Chomsky


Yes (0.00 / 0)
The Rules Committee (really Pelosi, but via the Rules Committee) will merge the bills into one big bill. The CPC wants to make sure the Blue Dog compromise isn't in that bill...I never thought it would be anyway

The Rules Committee is chaired by Louise Slaughter of Rochester, New York, who is a member of the CPC.


[ Parent ]
Yes i was confused just by Chris' use of "/" in the article quoityed (0.00 / 0)
But I am sure now that my use of
the three different health care bills that have come or will come from three different committees need
come or to replace the /

so it its have come or will come from three Ctte's

In fact its obvious so lets not talk about it any more.

[lying] I never force people to read past my typos[/lying]

--

The government has a defect: it's potentially democratic. Corporations have no defect: they're pure tyrannies. -Chomsky


[ Parent ]
Best damn news I have seen so far. (4.00 / 1)
53 House Progressives will vote against deal: In their press conference today,

Best damn news I have seen so far.

When coupled with the Front page headline on Huff Post
PELOSI BLASTS INSURANCE "VILLAINS"
"They've Been Immoral All Along. They Are Doing Everything
In Their Power To Stop A Public Option"

I think congress may have the spine to make a good bill. Ian Welsh, among other good Posts, made a post about ensuring the Public Option was robust enough. Are there other yardsticks like that?


--

The government has a defect: it's potentially democratic. Corporations have no defect: they're pure tyrannies. -Chomsky


Here's the actual post: "The current House Plan is not viable as written" (0.00 / 0)
Welsh writes:

The current House Plan is not viable as written and other options are worse.  There is no practical difference between no public option, and a non-viable public option and at that point the argument of "don't let the perfect (single payer) be the enemy of the good (a public option which will save some lives)" becomes non operational.

I will be happy to support a viable public option.  So far we don't have one.  I urge public option advocates, and even single payer advocates, to push for one.


It's not a question, as HouseOfProgress seems to think, of "ensuring the Public Option* is robust enough," it's about making sure it's viable at all. And now it isn't.

NOTE * It's no more clear what it means in policy terms with caps, as without. And it's no more clear what the outcome will be from Pelosi's rhetoric, whether its all caps, bold, and red, or not.  

I am in earnest -- I will not equivocate -- I will not excuse -- I will not retreat a single inch -- AND I WILL BE HEARD.  


[ Parent ]
Er... (0.00 / 0)
He was just recreating the text the way it appears on HuffPo.

[ Parent ]
Then my comment applies with greater force (0.00 / 0)
Meaningless formatting is one thing; regurgitating meaningless formatting is another.

Also, we have this thing called a "Quote" button? Bottom left? If material isn't formatted like a quote, readers are going to assume it's not a quote, but a paraphrase, as I did. Eh?

I am in earnest -- I will not equivocate -- I will not excuse -- I will not retreat a single inch -- AND I WILL BE HEARD.  


[ Parent ]
Your arrogance is again the most noticable thing about your posts. (0.00 / 0)
If it was accompanied by anything useful, like Dr. House's eventual amazing observation skills and diagnoses, which always ended saving the patient, it would it require grudging acceptance.

Spewing blame without recourse, attacking personally to no end, offering no workable or even unworkable solutions is closer to Ann Coulter, or more like Dr. House's final episode, when his misanthropy is diagnosed, and he seeks help.

I wonder if you will, read the line presented above the headline, which reads: When coupled with the Front page headline on Huff Post, because it was presenting the Front page headline, which was, on Huff Post.

As to whether it means anything that the people we have asked for spine, and the only allies who are also voters in this struggle, are showing publicly some vision of spine, YMMV.

Apparently your main purpose is to create controversy without recourse.

--

The government has a defect: it's potentially democratic. Corporations have no defect: they're pure tyrannies. -Chomsky


[ Parent ]
Pelosi's kabuki (4.00 / 1)
I would just point out that in the last election cycle, she took more then $300,000 in money from the Medical-Industrial Complex, or about 10% of her total war chest.

If she wants to point fingers at  bulwarks against progress, perhaps she should look in the mirror. She's Speaker of The Freakin' House. She was elected and collects a government paycheck which is dwarfed by her takings from the M-I Complex alone.

The lobbyists weren't elected by anyone, she was. The lobbyists don't have any constitutional obligations, she does.

This is just kabuki bullshit, deflecting responsibility away from herself and towards people she and many other bend over backwards to please... and not out of any real obligation aside from all that lovely cash and prizes.

"More than any other time in history, mankind faces a crossroads. One path leads to despair and utter hopelessness. The other, to total extinction. Let us pray we have the wisdom to choose correctly." -Woody Allen, My Speech to the Graduates


[ Parent ]
The Speaker of the House of Representatives (0.00 / 0)
is not going to do those kind of favors for a measly $300k.  

[ Parent ]
Rules Committee (0.00 / 0)
I know Rules is considered an arm of the Speaker (and chaired by my hometown girl, Slaughter, who is awesome) but I don't know if that's bad or good. I lean towards good because of how many times the Speaker has come down saying a bill would not pass without a robust public option, and how much she supports it. On the other hand, it depends on whether she thinks a public option without Medicare negotiation rates is robust, and whether she think the deal Waxman and the Blue Dogs cut is actually not all that bad. I have to think in many situations, Rules does what the leadership tells it to do.

At the end of the day, though, if she thinks the Blue Dog deal isn't all that bad, it seems most likely that she weighs 53 against a fraction of the Blue Dogs who oppose the W&M/E&L bill, and however you get to 218 is the way she goes.


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How about enrollees? (0.00 / 0)
Is there any kind of estimate at all?

I am in earnest -- I will not equivocate -- I will not excuse -- I will not retreat a single inch -- AND I WILL BE HEARD.  

[ Parent ]
This is a good question similar to one of Ian Welsh's yardstick of robustness (0.00 / 0)
Is CHIP being rolled into this? Are other plans rolling into the PO, to fund it and make it viable.  

--

The government has a defect: it's potentially democratic. Corporations have no defect: they're pure tyrannies. -Chomsky


[ Parent ]
I think you mean SCHIP (0.00 / 0)
However, your post again points out the lack of a plan to actually sell. If we don't know basic stuff like how many people will it cover, what do we know?  

I am in earnest -- I will not equivocate -- I will not excuse -- I will not retreat a single inch -- AND I WILL BE HEARD.  

[ Parent ]
The plan that has the greatest support, unaltered, is 98% I understood. (0.00 / 0)
It seems we should be pressing for more.

--

The government has a defect: it's potentially democratic. Corporations have no defect: they're pure tyrannies. -Chomsky


[ Parent ]
I hope that's how it shakes out, because... (0.00 / 0)
... I think there are enough (oxymoron alert) well-intentioned Blue Dogs who are OK with a robust public option to get past the 218.

Question.  Does a vote need 218 to pass or just a majority of those voting to pass (e.g. 216-215 with 4 not voting or not present)? If it's the latter, is there any sense in asking the Blue Dogs to sit out the final vote if they don't feel they can vote for a public option.

John McCain won't insure children


[ Parent ]
There's no definition of what "robust" means (0.00 / 0)
If we've got HouseOfProgress pointing to a post by Ian Welsh as the definition of what "public option" should look like, as opposed to the Democratic leadership and/or Obama, then we're in trouble.

Even basic numbers like how many enrollees there are going to be are in dispute!  

I am in earnest -- I will not equivocate -- I will not excuse -- I will not retreat a single inch -- AND I WILL BE HEARD.  


[ Parent ]
Pelosi is a member fo the progressive caucus. (0.00 / 0)
If she didn't sign the Bill, it doesn't mean she isn't with them. It is probably more that a Speaker, though while she can vote, is advised against that while acting as Speaker, but IANAL and IANAMOC.

--

The government has a defect: it's potentially democratic. Corporations have no defect: they're pure tyrannies. -Chomsky


[ Parent ]
She's not anymore (0.00 / 0)
Pelosi left all the caucuses when she became House Minority Leader...she is, however, a former member of the CPC.  

[ Parent ]
Yes as I assumed, thanks for the clarity. (0.00 / 0)


--

The government has a defect: it's potentially democratic. Corporations have no defect: they're pure tyrannies. -Chomsky


[ Parent ]
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