on cost (0.00 / 0)

Speaker Pelosi's goal is to pass a bill through the House with a public option that is cheaper than the Senate Finance Committee's bill which lacks a public option. The idea is that it would put public option opponents, who have repeatedly harped on the cost of the bill, in a position where they would have to support a more expensive bill in order to oppose the public option.

as far as i can tell, we don't know the actual cost (and i don't think speaker pelosi does either) of any of the bills because none of them have been scored properly: which would be for total national health expenditures including household, employer, state and local gov and fed gov costs.

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by: selise @ Tue Oct 20, 2009 at 16:29:16 PM CDT

Trade delay for PO support (0.00 / 0)

"One of their key demands--which they consider more important than the public option--is that the House not move any faster on health care reform than the Senate."

OK, so give them that in exchange for public support for a strong public option. Specifically, don't slow up the process, but offer to delay the final vote till the day of the Senate Final vote, provided the latter is within, say, three weeks. You can extend again later if it seems wise. Not an ideal situation, but worth it for blue dog PO support.

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by: bento @ Tue Oct 20, 2009 at 16:30:26 PM CDT

The 60 are not immortal (4.00 / 1)

The Senate might want to get about their business with a bit more urgency. There's no guarantee they'll always have 60 members in the caucus. They're not immortal, Byrd's not getting any younger and, God forbid, accidents do happen.

Or course, the Conservadems (and Reid?) would much prefer having only 59 so they can promote President Snowe to Queen and take the pressure off of themselves...

Health care reform = Employer payroll savings = More hiring and more jobs!

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by: Steve in Sacto @ Tue Oct 20, 2009 at 16:36:39 PM CDT

cpc's robust public option (4.00 / 1)

The goal of the Congressional Progressive Caucus is to pass a health care bill with a "robust" public option, which means a public option tied to Medicare rates +5%.

on june 5th, the cpc published their criteria for a robust public option. it included the following requirements:

The Congressional Progressive Caucus calls for a robust public option that must:

* Enact concurrently with other significant expansions of coverage and must not be conditioned on private industry actions.

* Consist of one entity, operated by the federal government, which sets policies and bears the risk for paying medical claims to keep administrative costs low and provide a higher standard of care.

* Be available to all individuals and employers across the nation without limitation

* Allow patients to have access to their choice of doctors and other providers that meet defined participation standards, similar to the traditional Medicare model, promote the medical home model, and eliminate lifetime caps on benefits.

* Have the ability to structure the provider rates to promote quality care, primary care, prevention, chronic care management, and good public health.

* Utilize the existing infrastructure of successful public programs like Medicare in order to maintain transparency and consumer protections for administering processes including payment systems, claims and appeals.

* Establish or negotiate rates with pharmaceutical companies, durable medical equipment providers, and other providers to achieve the lowest prices for consumers.

* Receive a level of subsidy and support that is no less than that received by private plans.

* Ensure premiums must be priced at the lowest levels possible, not tied to the rates of private insurance plans.

In conclusion, the public plan, like all other qualified plans, must redress historical disparities in underrepresented communities. It must provide a standard package of comprehensive benefits including dental, vision, mental health and prescription drug coverage with no pre-existing condition exclusions. It must limit cost-sharing so that there are no barriers to care, and incorporate up-to-date best practice models to improve quality and lower costs. All plans, including the public plan, must include coverage for evidence-based preventive health services at minimal or no co-pay. All plans, including the public plan, should be at least as transparent as traditional Medicare.

to call the single requirement of "medicare rates +5" the cpc's definition of robust is confusing at best and probably misleading (i do not doubt it is untentional).

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by: selise @ Tue Oct 20, 2009 at 16:40:31 PM CDT

Bait and switch alert! (0.00 / 0)

Strange - no big lefty blogger names seem to be picking up on this pretty jawdropping bait and switch from the Progs - Say it ain't so, Raul!

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by: skeptic06 @ Tue Oct 20, 2009 at 17:33:39 PM CDT

[ Parent ]

Who the hell was baited? (0.00 / 0)

The bait and switch line is both absurd and offensive. Who the hell was baited? And then who actually performed the switch?

The ego-centric response to think that this was all somehow a ruse to get a few activists excited, and then to intentionally pull the rug out from under them, is ridiculous.

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by: Chris Bowers @ Tue Oct 20, 2009 at 17:42:41 PM CDT

[ Parent ]

not a bait and switch (0.00 / 0)

i agree it was not a bait and switch. the cpc did however bail on their own criteria.

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by: selise @ Tue Oct 20, 2009 at 17:50:36 PM CDT

[ Parent ]

I'd agree with that (0.00 / 0)

I agree with that assessment.  

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by: Chris Bowers @ Tue Oct 20, 2009 at 18:16:23 PM CDT

[ Parent ]

Do we know for sure that the "robust" PO under discussion (0.00 / 0)

is missing all the other criteria?  I know it won't be open to everyone (unfortunately) but what about the others?  It should already at least meet the first two criteria.

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by: liberalmaverick @ Tue Oct 20, 2009 at 21:33:45 PM CDT

[ Parent ]

the cpc bailed on their own criteria (0.00 / 0)

it was the cpc that bailed on their own criteria. that was certainly not the fault of any bloggers. my only objection was to the use of the word "robust" in chris's post. it's a simple matter to adjust, which i'm sure chris will want to do. please give him a break unless such a strong criticism is actually merited.  

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by: selise @ Tue Oct 20, 2009 at 17:48:32 PM CDT

[ Parent ]

Which of those points are most in danger? (0.00 / 0)

I'd say

* Be available to all individuals and employers across the nation without limitation

and

* Utilize the existing infrastructure of successful public programs like Medicare in order to maintain transparency and consumer protections for administering processes including payment systems, claims and appeals.

Others?

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by: pualo @ Tue Oct 20, 2009 at 18:35:48 PM CDT

[ Parent ]

Can't we freakin just use Medicare as the PO through a Medicare buy-in (0.00 / 0)

as that would easily meet ALL the criteria?

Hell, even Mike Ross supports that idea! (Okay not really, but it'd be fun to throw that in his face.)

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by: liberalmaverick @ Tue Oct 20, 2009 at 21:35:18 PM CDT

[ Parent ]

imo a bad idea (0.00 / 0)

see comments on this thread from a few days ago for why:

http://www.openleft.com/diary/...

especially the bit starting with my comment, "how to destroy the single payer system we have"

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by: selise @ Tue Oct 20, 2009 at 21:54:33 PM CDT

[ Parent ]

Yes I know (0.00 / 0)

if you look at that thread you'll see that I was there too, arguing against your claim that private insurers will so easily cherry-pick Medicare into oblivion.

But even if that happened, I think Medicare is robust enough to withstand that.  Certainly more so than a brand new, weaker PO.

We can't just create a weak PO and let it die thinking that will lead to single-payer.  While it'd be nice if it did, chances are (and I think you know this) it would instead strike a huge blow into the liberal, pro-government argument.

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by: liberalmaverick @ Wed Oct 21, 2009 at 02:48:15 AM CDT

[ Parent ]

my bad (0.00 / 0)

my apologies for not remembering your presence on that threat.

We can't just create a weak PO and let it die thinking that will lead to single-payer.  While it'd be nice if it did, chances are (and I think you know this) it would instead strike a huge blow into the liberal, pro-government argument.

completely agree. imo a weak po is worse than no po for just the reasons you cite.

...arguing against your claim that private insurers will so easily cherry-pick Medicare into oblivion.

as i said before, the issue is not cherry-picking the over 65 population, it's the under 65 population that would be cherry picked.  medicare works because it's single payer.

the model of healthcare financing currently being discussed (po in a weakly regulated multi payer market) has never been shown to work. it has failed whenever it's been tried. that is why i don't want to risk a critical program like medicare that works (even if greatly weakened by previous attempts at privatization) for an experiment likely to fail.

please don't put medicare at further risk. trying to rescue today's stupid policy choices does not justify it.

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by: selise @ Wed Oct 21, 2009 at 03:35:01 AM CDT

[ Parent ]

No worries (0.00 / 0)

As for cherry-picking, I don't think it'll be as easy or bad as you do, given the new insurance regulations, but to debate over how bad the cherry-picking will be is academic until we actually see what happens under Obamacare.  In any case, a Medicare-based PO would at least withstand cherry-picking a lot better than an independent PO would.  Whether it would hold up is a different question - going purely off of blind faith I say it would.

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by: liberalmaverick @ Wed Oct 21, 2009 at 22:26:31 PM CDT

[ Parent ]

with Medicare premiums going up (0.00 / 0)

this would be a disaster right now.

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by: DTOzone @ Tue Oct 20, 2009 at 22:20:24 PM CDT

[ Parent ]

Which premiums are NOT going up right now? (4.00 / 2)

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by: liberalmaverick @ Wed Oct 21, 2009 at 02:43:32 AM CDT

[ Parent ]

Choose vs. Merge (0.00 / 0)

You say "choose" a bill in the house, and "merge" the bills in the senate. Is there actually a distinction between the two bodies in this way?

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by: pualo @ Tue Oct 20, 2009 at 18:37:28 PM CDT

Both are mergers and choices (0.00 / 0)

Both are mergers. Also, both mergers can simply be one of the bills that passed committee, leaving out all differences with the other bills.

So, both are mergers, and choices.

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by: Chris Bowers @ Tue Oct 20, 2009 at 19:08:29 PM CDT

[ Parent ]

re: bill (4.00 / 1)

This is largely due not to the cost of the robust public option, but to Speaker Pelosi's desire to pass a bill with around 230-240 votes, rather than a wafer thin 218.

1. when did that happen?

2. what kind of stupidity is this?
who cares if the bill passes with 240, 230 or 220 votes?

also, if I remember correctly (I think I read it here), the one time (budget?) the house margin was smaller than the senate margin, the house did better on the conference negotiations. does anyone else remember that?

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by: The Big Hurt @ Tue Oct 20, 2009 at 20:01:28 PM CDT

The House will be in a stronger position (0.00 / 0)

in conference if they get more votes. Pelosi is right to not want this to pass the House by the skin of it's teeth, the Senate will point to it as reason that it's radical.

If the bill gets 90%-95% Democratic Support in the House, it's much easier to go to the Senate and say "Hey, look, moderates and liberals support this, it has broad support in our caucus"

If it narrowly passes, it becomes a fringe bill and the Senate centrists balk.  

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by: DTOzone @ Tue Oct 20, 2009 at 21:08:00 PM CDT

[ Parent ]

How much watering down needs to happen for 230 votes? (0.00 / 0)

If it's just the $20 billion for rural hospitals fine.  But they better not jettison anything.  The bill is weak enough already as it is.

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by: liberalmaverick @ Tue Oct 20, 2009 at 21:31:58 PM CDT

[ Parent ]

Probably the same amount it needs to be watered down (0.00 / 0)

to pass the Senate, so either way it doesn't matter.  

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by: DTOzone @ Tue Oct 20, 2009 at 22:22:38 PM CDT

[ Parent ]

I thought the whole point of this is to get the strongest bill possible out of the House (4.00 / 1)

so we have negotiating room in conference.

I'm not sure if whatever good is added with 10 or 20 extra votes outweighs the bad that will be done to get those votes.

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by: liberalmaverick @ Wed Oct 21, 2009 at 02:58:15 AM CDT

[ Parent ]

Will children be covered too? (0.00 / 0)

Once a determination has been made about whether or not to include a pubic option, the merged Senate bill will be sent to the CBO for scoring. This process always takes a few days. No bill will be sent to the floor before the scoring is released.

Do you have to have reached puberty to be covered by this option?  :)

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by: rickd24 @ Tue Oct 20, 2009 at 23:30:41 PM CDT