More On the Apparent Health Care Deal In the House

by: Chris Bowers

Wed Oct 28, 2009 at 18:50


Tomorrow at 10 a.m., the House Democratic leadership unveil their health care bill. It is highly likely that it will include a public option with negotiated rates, rather than the more robust public option tied to Medicare (+5%) rates. There are many other details of the plan to discuss, but for now I will wait until the bill is actually unveiled to discuss them.

The remaining barriers to passage of the health care bill in the House are two-fold:

  1. Bart Stupak's Regressive Block. Representative Bart Stupak is still looking to round-up forty votes to prevent he bill from going to the floor unless abortions are not covered under all health care plans that receive subsidies in the new insurance exchanges.

    The leadership is convinced that if Stupak is able to offer an amendment to that affect on the House floor, that it will pass. If the amendment passes, it will kill the entire bill, because dozens of pro-choice Democratic votes would be lost. As such, the leadership will not allow any amendments to the health care bill on the floor. This means that once the bill hits the floor, that is the bill that will go to conference committee.

  2. The Tri-Caucus Progressive Block. For months, the Progressive Caucus, the Black Caucus and Hispanic Caucus (and, I think, the Asian-American Caucus) have been trying to round up House Democrats who would vote against a health care bill unless it included the Medicare +5% option. Now that the bill will not include the Medicare +5% public option, the tri-caucus is sounding noncommittal about the bill. They are also meeting with President Obama tomorrow:

    Some liberals were prepared to accept the negotiated rate structure. Others were still withholding support, even while pointing to Reid's inclusion of a government insurance plan in the Senate bill as a victory in itself.

    "We were laughed at in August. Who would have thought that the Senate bill would have a public option?" said Rep. Lynn Woolsey, D-Calif., a co-chair of the Congressional Progressive Caucus.

    Woolsey was noncommittal about whether progressives would accept the negotiated rates. "This is not walkaway time and it is not acceptance time," Woolsey said.

    Members of the progressive caucus, along with lawmakers from the black and Hispanic caucuses, were scheduled to meet with Obama at the White House on Thursday, she said.

    The Tri-Caucus does not appear to have won this time, but they do seem to have improved at playing the influence game. Threaten to vote against a must-pass bill, withhold your support even after a deal is apparently reached, and viola! You end up with a meeting at the White House. Not bad for a caucus that was the last to meet with President Obama at the start of his term.

Given both the Progressive and Regressive blocs, the passage of any bill will be by a narrow margin. No matter the disproportionate attention the Senate has received, there has always been just as much drama in the House.
Chris Bowers :: More On the Apparent Health Care Deal In the House

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Thanks, conservadems (4.00 / 2)
That means when I (a self-employed young man) buy into the public option in a few years, I will paying hundreds if not thousands of dollars a year more than I should have. But hey -- at least my doctor gets to buy a new Benz and the hospital board of directors don't have to cancel their ski trips to Aspen.

I'm still wondering why Obama hasn't become involved at all. Perhaps he's still doing the Booman thing where he will wait until it gets to conference before fixing everything and pressuring lawmakers.


how much of a threat is stupak's regressive block? (4.00 / 4)
are there really 40 democrats who would kill the bill over this?

Less likely now... I think... (0.00 / 0)
with the negotiated rates "compromise".  I think that the block was only maintainable with Medicare+5%, but don't quote me on that!

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 ]
depends (0.00 / 0)
if the other members in stupak's bloc oppose the bill for other reasons.


[ Parent ]
At most they will allow a manager's amendment (4.00 / 1)
which contains poison pills to prevent Republicans and other disgruntled parties from jumping on board.

[ Parent ]
So what will they demand from Obama when they meet? (4.00 / 1)
What's the opening bid?

No trigger. No opt-out or opt-in. Something more robust than Medicare +5. The Wyden Expansion on day 1 (of course when "day 1" occurs is another issue). A serious discussion about reversing that deals with Big Pharma with regard to negotiating drug pricing and efficacy/clinical trials. What did I miss?

Alternatively, propose to "start over" and propose non-profit private insurance that is regulated to the point that it is as close to a "public" option as possible. When he laughs, sit back and say, OK, let's talk about the potential cost savings in a single payer system. (fantasy is harmless).


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


How about the kucinich amendment.... (4.00 / 1)
...which has been stripped, apparently?

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 ]
Liberals better not vote against it because of abortion (0.00 / 0)
Like it or not, this is an anti-abortion country and to allow abortions under a healthcare bill is a horrible idea.  It would be a shame to see this die over one issue.  

UpstateDem/Kent, you're so transparant lol (4.00 / 2)


[ Parent ]
"To allow abortions under a healthcare bill?" (4.00 / 12)
Last I checked this was America, not Saudi Arabia. Women are citizens here, and abortion is legal.

Montani semper liberi

[ Parent ]
I agree with you on principal, but (0.00 / 0)
the issue, I think, is funding abortion under a government-run public option.

Though it's a talking point for the crazy right-wing world that abortion could derail health care reform, IMHO, it's unlikely it will get that far.

I don't know how they're going to resolve that funding issue - there's probably some way around it.

As far as I'm concerned, abortion is just not a salient issue for me anymore. Though I am pro-choice, I'm old!


[ Parent ]
oops, not principal, but principle !!! (0.00 / 0)


[ Parent ]
it's not about funding abortions under the public option (4.00 / 1)
there is already a provision preventing this.  rather, it's about whether tax payer money can be used as subsidies for buying private health insurance plans that offer abortions.  Stupak wants to to prevent this too.  what's next?  prevent public money from being spent on police and fire services if they are used for abortion clinics?  should we prevent public money from servicing roads if they are close to abortion clinics?  stupak's provision is just ridiculous.

[ Parent ]
So you don't care (4.00 / 1)
what happens to anyone else? Nice.

Montani semper liberi

[ Parent ]
Because do you see the strategy? (4.00 / 2)
If insurance companies that cover abortions are ineligible for subsidies none of them will cover abortions.

That's the goal of the forced childbirth movement -- it's not enough that women and girls on the public option won't be covered, they want to make sure no one is.

And they won't be satisfied with that, either. If they win this battle their next target is contraception.

Montani semper liberi


[ Parent ]
But you're obsessing for no reason (0.00 / 0)
http://www.openleft.com/diary/...

On Bart Stupak. In what was almost certainly a reference to Bart Stupak's efforts to disallow any health insurance plans in the new exchanges from covering abortions, she [Pelosi] said that "no poison pill" amendments that would kill the entire bill would be allowed. If offered, Stupak's amendment would probably pass, and then the entire bill would go down because it would lsoe dozens of pro-choice Democratic votes.


[ Parent ]
No (4.00 / 6)
Polling has shown over and over that solid majorities oppose overturning Roe or outright banning abortion.

Calling America an "anti-abortion country" is just empirically wrong.


[ Parent ]
No, it's a country with a lot of anti-abortion loons (4.00 / 1)
But they aren't a majority, and just about all of those for whom it's a deal-breaker don't vote Democratic often. Even in regions like the Upper Peninsula - they may profer an anti-choice candidate, but they still voted for Obama.

There is a very simple answer to people who say that a healthcare bill is immoral because it includes funding for abortions. It goes like this: "Fuck off back up the nearest dark alley." It's not even worth debating, because anybody who'll blow the bill up over this is negotiating in bad faith.

Forgotten Countries - a foreign policy-focused blog


[ Parent ]
Abortion is a legal medical practice (4.00 / 2)
in the US and I see no reason why our tax dollars should not go towards paying for legal medical procedures.


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


[ Parent ]
WTF? (4.00 / 3)
Sen. Evan Bayh's wife is on the Wellpoint board.  Sen. Max Baucus' chief of staff is a former Wellpoint executive.  Sen. Joe Lieberman's wife worked for a firm that represented the drug industry.

This is democracy?  I can't believe there isn't more widespread exposure and outrage over stuff like this.


Your comment (4.00 / 1)
Illustrates the point of a corrupt Congress.

[ Parent ]
Baucus's former Chief of Staff (4.00 / 1)
works for Obama.

[ Parent ]
Yes he does (4.00 / 2)
and I know Jim pretty well from his days when he was cheif of staff for Carolyn McCarthy here in New York.

If Baucus still had Jim, perhaps we would be in better shape. A shame a progressive like Jim no longer works for him. I'm sure you know about him Jim spearheaded the strategy to kill Social Security privatization. Yes?  


[ Parent ]
Engineer a bare majority passage (4.00 / 2)
If it's to be negotiated rates in the House, the public option cause and the House negotiating position will be strengthened by casting enough progressive dissenting "no" votes so that the bill only barely passes, thereby showing that any further compromise at conference will jeopardize final passage.

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

I get a few minutes to comment, and the first thing I see is, "well, we tried." (4.00 / 2)
The Tri-Caucus does not appear to have won this time, but they do seem to have improved at playing the influence game. Threaten to vote against a must-pass bill, withhold your support even after a deal is apparently reached, and viola! You end up with a meeting at the White House. Not bad for a caucus that was the last to meet with President Obama at the start of his term.

Are you shitting me?  This thing ain't over, and you're already giving up?  Who lacks a spine, now?  "Oh look.  There goes Chris again.  He talks a good game, but he never follows through.  Just ignore him."  Reminds me of Lieberman.

Someone tell me why we're not pressuring/encouraging the Prog Block to hold strong?  We got this far with their help, and they held strong with ours.  Was "a robust, medicare-like PO with no triggers or kill the bill" just talk?  If you're not willing to hold to that, why the fuck should I or anyone else ever believe you the next time you talk big?

C'mon, people!  Don't give up now!  We're this close to the gates.  Can't you taste it?  Can't you smell it?  How bad do you want to win?  Not just any bill, but a good bill.  We can still do that.  But we have to hang together.

Never give up!  Never surrender!

Health insurance is not health care.
If you don't fight, you can't win.
Never give up. Never Surrender.
Watch out for flying kabuki.


I have to agree (4.00 / 2)
I'm amazed at how quietly everyone seems to be taking this.  I would've thought Open Left would be up in arms over what happened.

It's as if we've resigned to always be screwed over, like that's a fact of life.  Maybe it is because we let it.


[ Parent ]
Here, here! (4.00 / 2)
But what to do? KILL THE BILL OR NOT?

I think we have to just keep paying attention....there are some important details that will hopefully come to the fore, for me anyway, as the House and Senate commence debate on actual bills.

I'm thinking of the mandate to purchase health insurance - at what rates? at what available subsidies? What will the coverage be like that satisfies the mandate?


[ Parent ]
"Kill the bill or not?" That is the question. (4.00 / 1)
If the bill that comes out of conference is negotiated rates with an opt-out, it better be a damn strong negotiated rates and a damn hard to opt out opt-out.  Better yet, no opt-out.  If it's Level Playing Field of any sort, kill it.  That's about as weak and un-robust a PO as there is, not to mention it doesn't even hint at being medicare-like.  If it's medicare +5, I'd be willing to accept an opt-out under certain conditions, which I outlined in another comment.

But to do any of this, we have to keep the prog bloc strong.  Otherwise we're screwed.

Health insurance is not health care.
If you don't fight, you can't win.
Never give up. Never Surrender.
Watch out for flying kabuki.


[ Parent ]
Yeah (0.00 / 0)
I couldn't tell if that passage was supposed to be serious or a joke or ridicule or what.

As glad as I've been that the grassroots and netroots were able to force the PO issue into the center of the fray, and cram it down the throats of Obama, the establishment Dems, and the MSM, I've still never seen any reason to change from the position that a reactionary bill should be Blocked.

It seems like in the end the enemies of reform managed to achieve their bait-and-switch after all, even if it was harder than they expected.

Sure enough, it looks like the Progressive Block was just a temporary stiffening of the spine that they just couldn't bring themselves to sustain.

Like that sneer above said, in the end just being acknowledged and "validated" was evidently enough, and now everyone will cave in just like the scoffers always said.

One thing's clear - no real public option is going to come out of this.


http://attempter.wordpress.com


[ Parent ]
Caught Between A Rock And A Hard Place (4.00 / 2)
No doubt, the Progressives have made significant progress towards fair representation in Congress, and have done so by being a force for positive change rather than being the Blue Attack Dogs of big business.  This has earned them a seat at the big table.

But now it's crunch time for the Progressives. I realize I'm just one little voice in the wilderness, but I'll offer my two cents:

Stick together - that's how you got to the WH, if you get picked apart now, it's all over for you, if you remain united, you will attract more like minded legislators.

Look to the future, not the past - remind all back in DC that we, the people, are more than aware of the dire economic condition of our country, and that a second collapse of even larger magnitude than that in 2008 is extremely likely.  We are going to have MORE lost jobs, MORE unemployment, MORE lost homes, and MORE economic turmoil.  It's time to decide who you represent - the American people, or big business.

Make the President do the right thing - Obama knows quite well that what's best for the American people and America's future is not in any of the current proposed bills.  He is dealing with the political reality of the entrenched DC powers, and trying to get the best bill possible.  Remind him how quickly the political reality shifted last fall, and how quickly it will shift again with continued economic turmoil.  What's perceived as a victory now could very be seen as a complete sellout to big business by 2012.

Obama is caught between a rock and a hard place.  Unlike FDR, he was not elected President after three long years of economic collapse under Hoover. He was elected during the collapse and doesn't have nearly as clear a situation or course of action.  Any future problems will be laid (right or wrong) at his doorstep, and blamed on his actions.  The WH needs to get ahead of this situation which is not easy to do, but playing the political game for the next three years with yesterday's rules will be a disaster.


Exactly…the progressive block has no choice… (4.00 / 2)
...but to kill the bill. It's not even worthy of discussion. If the progressive caucus is worried about the messy, blame-the-liberals headline, well, I'd remind each and every one of them that with time comes cleanup. Barack Obama might not be president today if he hadn't distanced himself from the Iraq War at a time when doing so seemed crazy rather than prescient. The corporate media have worked against us every step of the way, so does anyone really think they're not going to take apart a shoddy, more expensive healthcare bill once the smoke clears? We've gotta wise up if we're really gonna accomplish anything for the American people.  

"This ain't for the underground. This here is for the sun." -Saul Williams

[ Parent ]
Are you really comparing this to the Iraq War vote? (4.00 / 1)
Basically you've given an argument for "We should just forget about ever doing this period"

If the corporate media is against us every step of the way, then we can never accomplish anything for the American people.  


[ Parent ]
The American people would like healthcare reform… (4.00 / 3)
...not something that says "healthcare reform". And the other point is that time usually brings exposition, so if a bad bill passes nothing will have been solved. The problems will actually be just beginning.  

"This ain't for the underground. This here is for the sun." -Saul Williams

[ Parent ]
All because the public option (0.00 / 0)
went from Medicare +5 to negotiated rates, which is actually better in certain parts of the country.

I'm sorry, but I think some of you are just looking to win political battles and stick it to people you don't like, because if you were't, you'd see a bill with negotiated rates, even with opt out, isn't worse than the status quo.


[ Parent ]
that's not the last sellout (4.00 / 1)
the kucinich amendment seems like it is also leaving the station. and there'll be other sellouts too.

[ Parent ]
And? (4.00 / 1)
With anti-trust still in, and the rest, you still think it's a good idea to kill the bill?

I'm reasonably sure Kucinich is going to run for President as an Independent in 2012, you'll have your ability to vent your frustration and screw the rest of us then.  


[ Parent ]
let's see what else will be be removed (0.00 / 0)


[ Parent ]
If you believe this: (0.00 / 0)
If the corporate media is against us every step of the way, then we can never accomplish anything for the American people.

And, it seems you do believe that the M$M is an almost insurmountable force, why do you even bother paying any attention to the political fights and debates?

You've already admitted that you are impotent, why keep running your mouth?

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


[ Parent ]
So we should accomplish nothing? (4.00 / 1)
And just give up on reform?  Doing that is simply telling Republicans that they won.  

[ Parent ]
Hipocrates (4.00 / 5)
The first rule of medicine is "First, do no harm."  If the bill does do harm, kill it.  Some of the proposals seem to do a lot of harm to benefit insurance companies.  No thanks.

[ Parent ]
Why even try? (0.00 / 0)
If reform is simply going to make things worse, then why even try for it?

[ Parent ]
Reform is a category (4.00 / 2)
Not one particular bill.

Forgotten Countries - a foreign policy-focused blog

[ Parent ]
Some times 1/8 of the loaf is simply not enough (4.00 / 2)
If no bill passes, will the issue of our broken healthcare system disappear?

I think we agree that the status quo is not acceptable and polls show that we are not alone in that assessment.

Why would all that desire for reform evaporate just because the particular bill that is voted on this time in Congress does not pass?

On the other hand, what do you think the chances will be of convincing the Congress to revisit the issue to tweak the results a a poor bill after passing it this session? The answer will be: "Been there. Done that. Time to move on".

If you don't like the final bill, vote it down and start over.


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


[ Parent ]
So is there any hope for the Medicare +5 PO (0.00 / 0)
Or do we just give up now?

Incidentally, I feel a little guilty since Nancy Pelosi is my Representative and I never got around to writing her a letter or anything.  I don't know if it would've made a difference, but I feel like I didn't do my part.


Well Anthony Weiner is my congressmen (4.00 / 1)
but I know him pretty well personally and to be honest, in private conversation, he never felt optimistic about a Medicare +5 PO.


[ Parent ]
From tomorrow's NYTimes (4.00 / 2)
October 29, 2009
Pelosi Backs Off Having Set Rates for Public Option
By ROBERT PEAR

WASHINGTON - Under pressure from moderate-to-conservative members of the House Democratic caucus, Speaker Nancy Pelosi has decided to propose a government-run insurance plan that would negotiate rates with doctors and hospitals, rather than using prices set by the government, aides said Wednesday.

Ms. Pelosi said the public plan, which she prefers to call a "consumer option," would compete with private insurers. But the speaker was apparently unable to muster the votes needed for the "robust" liberal version of a public plan, which she has repeatedly said would save more money for consumers and the government.


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So, which of the Blue Dogs backed out on Medicare + 5% ? (4.00 / 3)
the provision that would have saved $85 billion more than negotiated rates would?

Any blue dog that doesn't want Medicare + 5% (w/ a bump in needy rural areas, by circumstance) can hardly make a credible claim to having fiscal responsibility as their watchword.

I heard a better term for these guys. They're not blue dogs, they're "Blue Cross Dems".


Michael Moore says don't vote for it... (4.00 / 3)
...because the only thing that would make it acceptable is for Weiner's amend-by-substitution move to succeed.

The D leadership (and WH-supported) move to "no amendments" is perfectly in line with the for-profiteers' fondest wishes -- exactly like Hillarycare in '93 (also authored by the  Jackson Hole Group acolytes), this "reform" will criminbalize single-payer attempts by the states.

A real industry "bonanza" is coming closer. Can you hear the champagne corks popping?


Here's my question at this stage of the game (4.00 / 1)
What is the net effect of all this focus on the public option? There's a lot of stuff in this bill. Is it worse than it would otherwise be because all our attention is on the PO? Or is drawing the battle line through the PO protecting the other stuff from succumbing to compromise? I have no idea what the answer is to that question.

The net effect (4.00 / 2)
Is to bail out the insurance companies, set up a complex and unworkable health exchange system, demand that people pay now for junk insurance they'll be forced to buy later (with the IRS acting as the collection agent), with perhaps 10 million enrollees in the public option by 2019 (CBO estimates), which isn't enough market power to change anything. In addition, there's no win on the "principle of universality," since the program isn't available to all; if you have insurance from your employer, even if you don't like it, you can't go on the health exchange. Finally, if I understand the rule on no amendments correctly, they've outlawed single payer experiments in the states, so the Sasketchewan route to single payer isn't available.

In other words, you're getting the semantics of having the words "public option" in the bill, and not a whole lot else. In exchange for that, private insurance and health care for profit is baked into the system for a long time to come.


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 ]
NO amendments allowed? (4.00 / 1)
Not even the Weiner amendment?  This is ridiculous.  So what if they try to pass that stupid abortion amendment.  We'll whip hard and defeat it.

Btw, shouldn't Republicans be against that abortion thing since it's government "meddling" in the business of insurers?  I don't get why government isn't allowed to require insurance companies to cover mammograms but somehow is allowed to require insurance companies NOT to cover abortions.


cause we've been doing a bang up job whipping so far (4.00 / 1)
The problem with the Stupak amendment is that there are going to be people on OUR side who will vote for it...Marcy Kaptur for example.

Weiner amendment would never pass, Stupak's will, it will almost certainly lead to a weakening of the bill.


[ Parent ]
Not to sound like I support the Stupak amendment (0.00 / 0)
but if we passed a "good" amendment (e.g. Medicare +5, Kucinich amendment, Wyden amendment) and the Stupak amendment, would the end product be worthy of support?

Which combination do you think would be worth it?


[ Parent ]
Yeah try telling pro-choice Congressmembers (4.00 / 2)
to vote to ban any subsidies for abortion because, hey, we got everything else we wanted.


[ Parent ]
Because women are icky. (4.00 / 2)
Conservatives want the government to require women and girls to have children against their wills, you can't say they don't believe in "meddling."

It would be more accurate to say they don't believe in the government meddling in the affairs of straight white Christian men.

Montani semper liberi


[ Parent ]
pelosi should have gone bold (0.00 / 0)
pelosi should have been bold here and put what 80pct fo her caucus wanted a robus po. she put in a po favored by 20pct of her caucus. whatever happened to bold? cpc meets tommorrow after bill announced then off to wh. cpc still holds cards

Does the bill outlaw single payer in the states? (0.00 / 0)
Or will the Kucinich amendment still be possible?

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

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