Public Option Not A Dealbreaker for Blue Dogs

by: Chris Bowers

Thu Sep 24, 2009 at 17:47


According to an internal Blue Dog whip count, the public option doesn't even enter their top four concerns on the health care bill:

The Blue Dogs have been surveying their membership over the last several days; coalition co-chair Stephanie Herseth Sandlin (D-S.D.) has been collecting the responses. She listed the four top priorities that have emerged: Keeping the cost under $900 billion, not moving at a faster pace than the Senate, getting a 20-year cost estimate from the Congressional Budget Office and addressing regional disparities in Medicare reimbursement rates.

So, the Huffington Post asked, the public option is not a top priority?

"Right, the group is somewhat split," she said.

Given this, it would seem that if the other Blue Dog concerns are met, there should be negotiating room to include a public option tied to Medicare rates. That is, as long as the Blue Dogs are negotiating in good faith, which they might very well not be.

Meanwhile, the Progressive Caucus has completed its whip count of members willing to vote against a health care reform that does not include a robust public option. Progressive Caucus co-chair Raul Grijalva is claiming success, but not releasing numbers or names:

After conducting an internal and informal count of House liberals who are still willing to oppose health care reform without a robust public plan, Dem Rep. Raul Grivalja, the co-chair of the Congressional Progressive Caucus, says he's still confident that he has a big bloc of House liberals on board to vote against anything that falls short.

"We are comfortable with the sustained support for the public option and, for myself and others, the original letter we signed is still our position," Grijalva said in a statement emailed over to me, in a reference to 60 House liberals who signed a recent letter pledging to oppose any bill without a public option.

A Grijalva spokesperson confirms that he reached that conclusion after multiple conversations with House liberals in the last few days.

The lack of names and numbers leads one to believe that there is negotiating room for House Progressives, too. So, right now the best bet is that some kind of deal is out there that would get enough votes to pass the House, although exactly what that deal is remains unclear.

Over the in the Senate, which will have 60 functioning Democratic votes tomorrow if and when Paul Kirk is sworn in, the leadership is focused on stopping a Republican filibuster rather than on reconciliation. This is a viable strategy, given that not a single Senate Democrat has said s/he will vote against cloture on a health care bill with a public option. Some, like Ben Nelson and Mary Landrieu, haven't committed to opposing a Republican filibuster, but they haven't ruled it out, either. Others, like Joe Lieberman, have said they oppose a public option, but haven't said they would vote against any health care bill with a public option.

And so, the public option remains very much alive tonight. Far from secure, but very much alive.

Chris Bowers :: Public Option Not A Dealbreaker for Blue Dogs

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two questions (0.00 / 0)
Why $900 billion? What good is it to keep the cost under some arbitrary level?

How is Senator Byrd doing? Is he well enough to come to the Senate and vote?

Join the Iowa progressive community at Bleeding Heartland.


$900 billion (4.00 / 2)
That is just how these people think.  Pick a number and they want some round number less than that.  Asking for logic will get you nowhere.

[ Parent ]
answers (4.00 / 3)
1. less than a trillion dollars
2. so when somebody says "you voted for a trillion dollar national health plan!" they can say "no, no, no. Thanks to me it was only 900 billion."
3. Released from the hospital
4. I think the answer is "yes" but this could obviously change day to day.

[ Parent ]
Blue Dog Boswell (0.00 / 0)
still keeps saying he supports a public health insurance option. The Medicare reimbursement rate issue is huge for him, because those rates are very low in Iowa--I could see him voting against the bill if that issue isn't addressed in the final version.

Join the Iowa progressive community at Bleeding Heartland.

Herseth (0.00 / 0)
Herseth has been telling local press almost the same thing. She supports the public option in theory*, but if there is no reimbursement rate fix, she's going to vote no. A variation of this theme seems to be the norm for Blue Dogs of the region.

*However, Herseth's more wobbly though than Boswell, as she's from Northeastern South Dakota, which has a longstanding affinity for co-ops of any form.


[ Parent ]
How many dollars are we saving (4.00 / 3)
By paying doctors in LA more than doctors in Des Moines? And why? Right now a doctor practicing in Compton and living anywhere near his practice can afford a bigger house than a similarly situated doctor living and practicing in Santa Monica. That is just one of the tradeoffs lots of people face all the time. So what if some doctor in rural Iowa can afford a better material standard of life taking the same reimbursement for the same procedure as his city colleague? Because making the choice to practice in a small town means some social and professional tradeoffs to start with.

If making some medical providers in the mid and mountain west happier is all it takes to deliver us three or four senators and a dozen or more Blue Dogs then do it.

Although there are some pay adjustments for living in more expensive cities for some federal workers, generally they are not enough to offset the savings in transferring from headquarters to a field job. We don't bitch because some GS-9 in Boise can afford a house on acreage while his DC counterpart is stuck in some small townhouse, why then squeeze rural practitioners just because their cost of living is lower?


[ Parent ]
The Blue Dogs are actually right on this one (4.00 / 2)
There is a serious shortage of physicians willing to practice in rural areas, for a variety of reasons. Paying physicians more to practice in rural areas makes sense and might actually attract some of them to areas where they are really needed.  

[ Parent ]
Yup, that's a point, but it's a bit more complicated in reality. (4.00 / 1)
This may sound harsh, I know, but face it, it's still the people's own choice to live in rural areas. And it's obvious that this comes with some inherent restrictions. Why should the overwhelming majority subsidize services for those people who live in sparsely populated areas where it's more expensive to have essential services at a close distance? Creating incentives for country doctors, fine, but let's not go that far as to generously subidize hospitals there which will never reach a sufficient number of patients to warrant their operation! This is one of the well known money wasting factors in healthcare. It's a problem here in Germany, and it sure has to be even more problematic in the US because of the lower population density.

[ Parent ]
I want a rural living option to remain (0.00 / 0)
Even though I choose to live in a city, why should a lack of healthcare, or any other infrastructure for that matter, not allow the same for those who choose to live in a rural setting? Surely a nation with the amount of wealth and resources we have in the States can manage to strike a balance between rural and urban living. no?

Don't forget, Gray, the "choice" you cite is a bit theoretical for folks that can't afford to pull up stakes and move to the city.  

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


[ Parent ]
Sure, Spitty. But hospitals are very expensive infrastructure... (0.00 / 0)
..and there has to be a limit somehwere. Nobody in the middle of nowhere can expect to have a hospital within 25 miles or so. I know this is a difficult issue, because of course sometimes 25 miles more to drive can be the difference between life and death. However, most of the time it's just that the visitors have to invest 30 minutes more to get there. And hospitals have to have a certain size for all the costly equippement to be adequately used.

So, those aren't really easy decisions to be made, but at least some people should make those decisions, too, if they want to enjoy the comforting feeling that the next ER is just 10 minutes away. Let's not forget, people have to move because of their jobs,too, and often take a financial hit. Why should it be different for country folks?


[ Parent ]
Exactly my point (0.00 / 0)
Why should it be different for country folks?

My job keeps me near urban centers and research universities. Its a choice I made when I decided to pursue my career path. If some of my fellow citizens choose to pursue lives that are not as restricted to urban centers, more power to them.

Cost is not a front-burner concern for me, especially for public infrastructure projects. Why not do a little "nation building" here at home? Its an investment. How many rural clinics and hospitals could we have built with the $ thrown into Iraq and Afghanistan? Priorities.

I'm not saying that every person in the US should expect to live 20 minutes from a level 1 trauma center. But why shouldn't they expect to be able to see a family doctor, or visit a medical clinic within 25-30 minutes of their home? That clinic, of course, would be connected to the trauma centers and such.

As for visitors, some hospitals maintain nearby, free, temporary housing for out of town visitors. Many of these are run by private concerns, i.e. Ronald McDonald House, but not all.


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


[ Parent ]
I see your point, and if people are willing to bear the additional costs... (0.00 / 0)
..this is simply a democratic decision. However, in these times of dangerously rising healthcare costs, I don't really see a majority in the US being willing to subsidize the lifestyle of some folks with their hard earned bucks. But it may be that I underestimate the solidarity of the people, who knows...

[ Parent ]
I admit I can be a bit idealistic (4.00 / 1)
Mine is a nation rife with contradiction.

When you write:

I don't really see a majority in the US being willing to subsidize the lifestyle of some folks with their hard earned bucks.

I can't help but think that many US taxpayers seem rather content to subsidize the lifestyles of Wall Street execs, health insurance CEOs, lobbyists, and owners of professional sports teams.


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


[ Parent ]
Amen, brother! (0.00 / 0)
Not that Germany is any better, all in all. It's just that the contradictions are different!

[ Parent ]
Pressure (4.00 / 1)
I'd like the court to recognize this qualifies as putting pressure on conservative Democrats.

Senate Democratic leaders are launching a renewed effort to get all 60 members of their caucus -- even those who might eventually vote against health care legislation -- to at least commit to blocking a Republican filibuster.

After that, the bill itself could win passage with only a simple majority.

Proponents of the strategy say it is being actively discussed both on Capitol Hill and within the White House -- "every day," said one Democrat who is actively involved with both branches when it comes to passing health care legislation. "That's the whole conversation. At the end of the day we don't need them to vote for the bill. We need to get them to get to cloture to end the debate."



the WH and every liberal senator should be going on every (4.00 / 2)
talk show and demand over and over an up-or-down vote.  why they don't is beyond me.

[ Parent ]
re: demand (0.00 / 0)
why they don't is beyond me.

because doing so won't determine if someone filibusters or not?


[ Parent ]
magic ponies for everyone! (0.00 / 0)


3 out of 4 demands are do-able (4.00 / 6)
The 20 year score is kind of a gimmick but I suspect the House Bill as structured should score pretty well. People who are touting Baucus's budget neutral bill don't seem to realize that House leadership has numbers showing that HR3200 is also budget neutral. CBO scored it with a $239 billion 10 year deficit but the House has a separate piece of legislation that would change pay-go rules in a way that would score as $245 billion in 'savings' for a net surplus of $6 billion. I know it sounds funny to say that simply changing the rules means anything substantive was done. But CBO scoring is kind of screwy to start with, it starts with a baseline that little discernible connection to probable policy outcomes.

And I don't have a problem changing reimbursement rates that give doctors a financial advantage if they agree to deliver services in more rural areas. People in all walks of life understand that dollars go farther in those areas, salaries that would have you sharing an apartment in NYC would buy you a nice big house lots of places. That is one of the urban/rural tradeoffs. I can't imagine why we would financially penalize some GP for relocating her practice from LA back home to whereever.

Now keeping the cost under $900 billion is kind of stupid. On the other hand the HELP bill scored below that when just looking at coverage costs and Obama is already signalling that $900 billion is his number. What it does is take coverage down from 97% of legal non-elderly Americans to 94%. Pretty crappy news for the 10 million extra people that will remain uninsured and for those people earning right under and over the subsidy cap. But the subsidy schedule can be fixed, not having the PO not so much.

But trying to keep the House on a slower track than the Senate is insanity. Pass a House Bill with a PO and get it scored. All indications is that the score will come as a pleasant surprise and serve to put pressure on the Senate.

Make these three concessions and get the bill with PO done.


It's critical that the house pass a bill (4.00 / 3)
that doesn't just have a PO, but a PO tied to medicare rates. This leaves room for the inevitable concession once the leadership begins exerting pressure. We already heard from Kent Conrad today that his issue is a PO tied to medicare rates, so, to them, that would be a huge concession. Now, of course, we all want a PO with medicare reimbursement rates, but i would be satisfied with one that has the HHS negotiate, as long as the donut hole is completely removed and the PhRMA deal is nixed. Ideally, Wyden's free choice ammendment would also be part of the package but the Senators who represent the insurance industry won't ever let that happen.  

One other issue... (4.00 / 3)
...to be careful about is separation of networks. For maximum negotiating strength we must require that providers take both Medicare and the PO, or neither. Groups looking to weaken the PO will want to allow Medicare providers to opt out of the PO. We need to hold firm opposing any opt out for providers.

Self-refuting Christine O'Donnell is proof monkeys are still evolving into humans

[ Parent ]
Absolutely critical (4.00 / 3)
There needs to be a federal mandate ala Medicare, otherwise people on the PO will have to travel 50 miles to get treatment. There are those who want to weaken the PO to the point where its not a popular program, which re-inforces the meme that government is inefficientt.  

[ Parent ]
Not exactly projecting strength (4.00 / 1)
Stephanie Herseth Sandlin: "Right, the (Blue Dog) group is somewhat split," on the public option.

If that's what she's saying publicly...

CW is the Blue Dogs are looking for cover from the Senate moderates, but perhaps this may resolve the other way, where a deal endorsed by the Blue Dogs in the House (again, assuming good faith) gives Nelson, Landrieu, Lincoln and maybe even Snowe cover in the Senate.

Self-refuting Christine O'Donnell is proof monkeys are still evolving into humans


I doubt the Senate (0.00 / 0)
obstructionists will take their queues from the Blue Dogs. The house had 3 blue dog supported bills with variations of a PO and it brought us to where we are today, with a Senate that's still trying to single-handedly kill the PO.  

[ Parent ]
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