Some more details on the compromise--Franken amendment in bill!

by: Chris Bowers

Wed Dec 09, 2009 at 02:24


Quoting at length from TPM:

If this trade-off carries the day, the opt out public option is gone.

In its place will be many of the alternatives we've been hearing about, including a Medicare expansion and a triggered, federally-based public option, the aide said.

As has been widely reported, one of the trade-offs will be to extend a version of the Federal Employees Health Benefits Plan to consumers in the exchanges. Insurance companies will have the option of creating nationally-based non-profit insurance plans that would offered on the exchanges in every state. However, according to the aide, if insurance companies don't step up to the plate to offer such plans, that will trigger a national public option.

Beyond that, the group agreed--contingent upon CBO analysis--to a Medicare buy in.

That buy-in option would initially be made available to uninsured people aged 55-64 in 2011, three years before the exchanges open. For the period between 2011 and 2014, when the exchanges do open, the Medicare option will not be subsidized--people will have to pay in without federal premium assistance--and so will likely be quite expensive, the aide noted. However, after the exchanges launch, the Medicare option would be offered in the exchanges, where people could pay into it with their subsidies.

By 2019, 26 million people will are projected to get their insurance from the exchange in the Senate health care bill, according to the CBO (PDF, p. 20).  If one-third of the people eligible are projected to purchase a public option tied to Medicare rates (as the CBO says), than even if the Medicare expansion was open to everyone in the exchange, it would only cover 8.7 million people.  However, it will only be open to 55-64 year olds in the exchange, and as such could cover less than 2 million people.

It is worth noting, however, that the current Senate health bill would cover 15 million more people with Medicaid than current law.  With even 1.5 million coming in from the Medicare expansion, that is a total of 16.5 million more people receiving public health insurance.

That compares to 11 million under Medicaid (PDF, p. 17) in the House bill that came out of committees in July, plus another 10 million from a Medicare +5% public option.  That is a total of 21 million more people receiving public health insurance.  It is a decline of 4.5 million, or about 20%, from where the campaign stood in July.

The expansion of Medicaid was included in the bill as an attempt to mollify progressives who wanted a new public option program.  The Medicare buy-in was done to do exactly the same.  This means that even if there is no new public option, the campaign for the public option still will have resulted in millions more Americans receiving public health insurance.

It is not the scope of victory we aimed for, but it is hard to call a significant expansion of public health insurance a total defeat for a campaign that was designed to expand public health insurance.  While it was not expanded in the way we envisioned, it was expanded nonetheless.  Directly as a result of the public option campaign, at least five million more Americans will receive good, public health insurance.  And this is part of an overall bill where at least 16-17 million people--most of them low income and currently uninsured--will receive public health insurance.

Plus, the Franken amendment will be in the bill:

Additionally, there was consensus support for a requirement long backed by Sen. Jay Rockefeller, D-W.Va., and other liberals for insurance companies to spend at least 90 percent of their premium income providing benefits, a step that supporters argue effectively limits their spending on advertising, salaries, promotional efforts and profits.

Score! That is actually up from 85% in the House bill.  This is a major improvement.

In summary, here are the important concessions that have been won since July in return for dumping the Medicare +5% option (that public option would have been available to everyone in the exchanges, and would have covered 10 million, but didn't even have the votes to pass the House):

  • 4 million more people covered by Medicaid
  • 1-2 million covered by a Medicare buy-in
  • An increase in the percentage of money received by health insurance premiums that must be spent on health care from 85% to 90%
And there is a trigger too, but so friggin' what.  That was never meaningful.

Now, even a Medicare +5% public option, available to everyone in the exchange, was a major concession from Medicare for all.  Still, there is no way we would have gotten even the three meaningful concessions listed above without the broader campaign for the public option.

Chris Bowers :: Some more details on the compromise--Franken amendment in bill!

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So that's it then? (4.00 / 2)
Really? I'm sort of serious. Really?  

No, still more (4.00 / 3)
Its not a done deal yet. However, it likely won't get any worse than this. Or, it could be this plus Stupak language, so I guess it could get worse.

I think the fights now are to:

--Keep Stupak out of the bill

--Open the exchanges to as many people as possible (which would open the Medicare buy-in to more people)

--Expand Medicaid eligibility to 150% of poverty level (as per the House bill)

--Keep the subsidy levels closer to the House bill than the Senate bill

And, two more longshot efforts:

--Keep some sort of triggerless, new public option progrma
--Get the Franken amendment

Its pretty late, and I am sure I am forgetting other fights, but more lies ahead.


[ Parent ]
Check that (4.00 / 1)
It appears we already got the Franken amendment. Cool.

[ Parent ]
What about the antitrust excemption? (0.00 / 0)
NR, downthread, raises a good question: Is it on the table at all? Imho, this is a very important issue, since without the po, there is nothing in the bill to ensure more competition, afaics.

Oh, and btw, Chris, once again, can't you delete my damn sigline? I can't do it myself, my profile is somewhat broken, and I can't stand seeing that phony inauguration speech brouhaha anymore. Pretty pls, with a cherry on top!


[ Parent ]
Supposedly it's been offered as an amendment... (0.00 / 0)
No idea how that will play out, but it will be voted on...

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 ]
If Nelson opposes it, as Chris says, it prolly has no chance. (0.00 / 0)
Very unlikely that a rethuglican would vote for this, right?

[ Parent ]
Noslon lost the abortion vote... (4.00 / 1)
...and he's still in.  If he bails, he loses influence and power.  He's tipped his hand on this one...

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 ]
90% is actually progress (4.00 / 1)
The highest anyone was willing to go before this was 85%.

Shit that is great - I know (0.00 / 0)
when we were living through the Baucus Caucus it was 65%.  If we can really get 90% and enforce it - then we could be getting somewhere.  Loopholes, loopholes, loopholes.

[ Parent ]
Combine this with repealing the antitrust exemption (4.00 / 2)
and this is actually serious reform of the private insurance industry. I'm still not sure it's enough, but it's a big step in the right direction.

[ Parent ]
Is the antitrust exemption really going (0.00 / 0)
to make it through?  

[ Parent ]
I don't know what the status on that is (0.00 / 0)


[ Parent ]
I believe it is dead in the Senate bill (4.00 / 2)
that, unfortunately, was a concession to Ben Nelson.

It might still be alive in the House bill, which would give more cause to support a conference committee.


[ Parent ]
That asshole Ben Nelson again. (0.00 / 0)
Really doing his best to make the bill worse. Has he added anything of value to the reform so far? However, thx for answering this, Chris.

And could you pls pls pls delete my effing sigline?


[ Parent ]
Think I just deleted it (0.00 / 0)
Should be fixed now.

[ Parent ]
Yup, it's gone. Thank you very much, Chris! (0.00 / 0)
:-)

[ Parent ]
It has been offered as an amendment... (0.00 / 0)
The plan a few weeks ago was to have it voted on...  don't know the status now...

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 ]
90% is a HUGE, HUGE gain (0.00 / 0)
It would produce a much greater benefit than the public option would have. Right now IIRC the insurance industry spends about 18% on overhead, so that's an 8% reduction in healthcare costs right there. Plus, there's a lot of matching waste on the provider side coping with the paperwork demands, so there will be additional benefits there. Add in the 10% gain from giving the underinsured prompt treatment and we're looking at a 20% efficiency improvement - not too far from the 30% estimated for single-payer in California.

Essentially we would go from a weak public option to a moderate utility model.

Frankly, I think there has to be a catch. I don't see how the insurance industry would allow this through.


[ Parent ]
who defines "premium income"? (4.00 / 1)
the first thing that came to my mind were some deals that screenwriter friends of mine have been involved in, and the big question was always, are they points of the net or the gross? because as everyone knows, movies hardly ever make any net income. somehow. it's a funny thing.

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

[ Parent ]
I'm certain the insurers will find creative ways of accounting... (0.00 / 0)
...to turn this provision into a total farce. It's like evading taxes. There's always loopholes.

[ Parent ]
Chris I know you (4.00 / 2)
have been taking a rash of shit over the last week or so - ever since you have kinda of backed off the 'public option ledge' and have been trying to 'spin' the congressional iterations some way.  Here is my take - we all know that for the most part the 'congress critters' and even the 'White House' is bought and paid for by their respective corporate pimps.  BUT - in the end, our country will not be able to stand the 'greed' and insurance and pharma are slowing our progress now and will stall it year after year.  

So - YES we need to GET the best deal we can and lowering the Medicare age limit is and always as been a very smart idea.  We now must demand that it is not just for the uninsured 55-64 but for all 55-64 ... if not that then we need to demand that the age floor be lowered even more if only uninsured can get on.  

We need to expand CHIP to 26 (grad school or first 'real' job)

We (THE HOUSE PROGRESSIVES) need to push for 175-200% of poverty with respect to Medicaid so we will end up at no less than 150% ... The Senate knows the House is going to ask anyways.

Now next steps - we need to strategically remove critical obstacles to our long-term success ... so let's find a few congress critters and help show them the door.  


The problem with this: No competitive pressure on insurances! (4.00 / 4)
Correct me if I'm wrong, but ain't it right that the "exchange" are actually 50 exchanges, one for each state? This leaves countless millions of Americans, who live in states with a de facto monopoly of a single insurance company, without any chance to get a good deal on a plan. And the mandate ensures that they still have to sign up for one, no mattter how ugly it is. Do Dems really think only delivering for the voters aged 55 and older, and leaving the younger ones to pay th bill will be popular? I'm afraid this won't help the party in any way in 2010!

Plus, opening Medicaid for the 55+ customers will not be a bog problem for the insurance business, probably quite to the contrary. At this age, it becomes invcreasingly likely that there will be health issues, and so there are many "bad risks" among that group. The insurance companies wouldn't like having to offer a plan for those people, and so they won't be unhappy about Medicaid having to pay those bills. No surprise, then, that healthcare insiders see this "reform" as a victory for their side:

"We WIN," the insider writes. "Administered by private insurance companies. No government funding. No government insurance competitor."

http://www.americablog.com/200...

In the Senate, yes (4.00 / 2)
I believe the exchanges are state by state.

Not completely sure if that is the case in the House.  If they have a national exchange, then one more reason for a conference committee.

Its true that most of the 16-17 million the people who will be newly covered by public health insurance as a result of this bill will mainly be people insurance companies didn't want to cover: poor people and the elderly. Still, its 16-17 million new people covered by public health insurance.  


[ Parent ]
Good for the 16-17 millions. But what about the others? (4.00 / 2)
What will they think about a refrom that FORCES them to sign up for a plan, even though in their state they have no real choice? How many millions will start to hate the Dems for this "reform" that leaves them not only in the cold, but also holding the bill?

Yes, sure, the Dems do a good deed helping so many Americans getting insurance. But do they really have to shoot themselves in the foot while doing so?  


[ Parent ]
Well, we can work to reduce the mandate penalty (0.00 / 0)
$750 / month is pretty stiff.  There might even be the votes to remove or lower it.

[ Parent ]
That penalty... (0.00 / 0)
...is per year, and only near the end of the next decade.

In 2014, the penalty is $95 a year.


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 ]
Whoops, yes (4.00 / 2)
I meant $750 / year, not month.  I'd work pretty hard to kill a bill with a $750 / month penalty.

Good to know the penalty only slowly increases, but still a bummer that it gets there at all.  On the bright side, in 10 years $750 will be like $500 today (or less).


[ Parent ]
Not unless standard wages go up. (4.00 / 1)
I'm sure you've seen the graphs Paul throws up in his economic diaries, so you should be well aware of the one that shows the 30 year flatline on wages/income for everyone but the rich.

All while inflation continues it's ever upward climb.

In 10 years, if we don't see some major economic improvements for low income people (read 90-95% of Americans), $750 is going to feel like $1000.

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 ]
isn't that the opposite of inflation? (0.00 / 0)
$750 should be like $700 even with 1% inflation.

New Jersey politics at Blue Jersey.

[ Parent ]
$750 a MONTH? (0.00 / 0)
when does that start? holy moley. i thought it was $95/year or some such.

who is the arbiter of the hardship exemption - the IRS, right? great. i am going to be so screwed by this.

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


[ Parent ]
My bad (0.00 / 0)
Late night typos. I really should go to bed.

You are right--it starts at $95 in 2014.


[ Parent ]
Much rather see... (4.00 / 4)
...people get something tangible for the penalty payment. At least some type of catastrophic coverage, limited Medicaid enrollment, something. $750 for nothing won't go down very well.

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

[ Parent ]
Yup, that's a good idea. (0.00 / 0)
However, I dunno what kind of insurance you can get for a mere 750 bucks per year. Is it possible to get "catastrophic coverage" for this?

[ Parent ]
Don't know (4.00 / 1)
Maybe with a really high deductible like $10K or higher. But even that might be the difference that avoids bankruptcy, losing a home etc. If not, I'd consider increasing the penalty in exchange for an essentially forced enrollment in some type of minimum plan.

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

[ Parent ]
Would be great. Mandatory enrollment is better than punishment. (0.00 / 0)
So, this will be more acceptable for the citizen. And some kind of "catastrophic coverage" would reduce the costs of ER treatment at the hospitals, and may result in lower prices for the paying customers. To reduce the distortion coming from unpaid ER bills would be good for those providers and be a fairer system for all. Sure a good idea.

[ Parent ]
Well, they don't hate them in Massachussetts... (4.00 / 1)
They have the same situation there... and the current system is actually pretty popular... this argument holds little water, IMO.  Most uninsured would welcome the chance to get subsidized coverage.

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's a point. (0.00 / 0)
However, MA isn't one of those states where a single insurer has a de facto monopoly, right? The situation is quite different once people have a choice.

[ Parent ]
Not really.... (0.00 / 0)
If you look at the MA exchange there are only a couple of companies with any offerings...

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 ]
There's still a difference between an oligopoly and a monopoly. (0.00 / 0)
And you can't deny that market failure in many states drove the premiums up. HCAN covered this:
After reviewing the report entitled "Premiums Soaring in Consolidated Health Insurance Market," David Balto, former Policy Director of the Federal Trade Commission and now a Senior Fellow at the Center for American Progress, sent a letter cosigned by HCAN - to the Department of Justice Antitrust Division asking for a comprehensive investigation into the health insurance marketplace.

"The HCAN report provides a much needed spotlight on health insurance markets, and what it found is a toxic marketplace where competition and consumers suffer," said Balto. "Unfortunately, antitrust enforcers have been asleep at the switch for the past several years and have permitted health insurers to acquire monopolies in dozens of markets.  Consumers have paid a steep price for this merger mania in higher prices, deceptive and fraudulent practices, and ultimately assembly line health care."


http://healthcareforamericanow...

Well, good that there's awareness about the distorted markets, but what shall the DoJ do about this as long as there is the effing antistrust excemption?


[ Parent ]
No one said the MA plan was cheap... (0.00 / 0)
...in fact, they are having cost issues as well...

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 ]
Well, and prolly the healthcare bill will have the same effect nationally. (0.00 / 0)
So, why should there be great joy and enthusiasm about this? From an economist view, this legislation doesn't do much to correct the horrible market failures that drove the costs to astronomical heights in the last years...

[ Parent ]
The House plan is a national exchange. (0.00 / 0)
It has a provision for allowing state-based exchanges in lieu, but only so long as they perform at least as well as the national exchange, IIRC.

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 ]
How shall this "performance" be measured? (0.00 / 0)
The plans won't be standardized, or will they? So how to compare the apples with the oranges?

[ Parent ]
Okay, fine. Make me look it up. (4.00 / 2)
Meanie.

Looks like "performance" wasn't the best word choice.  "Regulations" or "guidelines" would be better.  Offered for your perusal, unformatted, Sec 308(a)1:

(A) The State-based Health Insurance Ex-
change must demonstrate the capacity to and
provide assurances satisfactory to the Commis-
sioner that the State-based Health Insurance
Exchange will carry out the functions specified
for the Health Insurance Exchange in the State
(or States) involved, including-
(i) negotiating and contracting with
QHBP offering entities for the offering of
Exchange-participating
health
benefits
plans, which satisfy the standards and re-
quirements of this title and title II;
(ii) enrolling Exchange-eligible indi-
viduals and employers in such State in
such plans;
(iii) the establishment of sufficient
local offices to meet the needs of Ex-
change-eligible individuals and employers;
(iv) administering affordability credits
under subtitle B using the same meth-
odologies (and at least the same income
verification methods) as would otherwise
apply under such subtitle and at a cost to
(B) There is no more than one Health In-
surance Exchange operating with respect to any
one State.
(C) The State provides assurances satisfac-
tory to the Commissioner that approval of such
an Exchange will not result in any net increase
in expenditures to the Federal Government.
(D) The State provides for reporting of
such information as the Commissioner deter-
mines and assurances satisfactory to the Com-
missioner that it will vigorously enforce viola-
tions of applicable requirements.
(E) Such other requirements as the Com-
missioner may specify.


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 ]
Thx! I know, I could have googled this myself... (0.00 / 0)
..and I very much appreciate that you provide this.

Ok, however, this isn't about performance, in the meaning of offering a good deal, in this at all! Nothing about the price of the premiums. How shall this help in ensuring healthy competition?


[ Parent ]
No problem. (4.00 / 1)
I've got the pdf on my computer.  Makes searches so much easier.  (The hard part is translating the way we talk about these things into the legal/technical jargon used in the bill so I can actually find what I'm looking for.  And then reading the surrounding context.  The reading often takes longer than the searching.  Okay, it is a lot of trouble.  But I got curious, too, so no worries.)

I don't think I ever said this provision would help with competition or anything.  Chris wasn't sure if the House bill was national or not, and I just happened to know the answer.  But since you bring it up, without the Kucinich amendment, I think that if this provision doesn't do any harm, it'll be a miracle.  I just can't imagine a state-based exchange managing to do any better than a national exchange, so at best, we're talking the same net effect.  At worst...well, let's not go there.

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 ]
OPM national non-profits? (4.00 / 1)
Not sure how the senate OPM national non-profit plans fit in a 50 state exchange environment. Or does the new OPM addition mean one national exchange? BTW, Ezra's somewhat bullish on this element:

The national non-profits are not exactly like, but not that far from, the compromised public plan in the House version of the bill. They won't be publicly run, but with the OPM regulating them tightly and carefully choosing which offerings are accepted into the market, the impact might not be that different in practice. They have the advantages of offering a single product nationally and being freed from the profit motive, both of which were key to the theory of the weaker public option. Indeed, they're like publicly-regulated utilities more than private plans. These look a lot like the semi-private insurers that function well in Germany, Sweden and the Netherlands, among others.


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

[ Parent ]
"freed from the profit motive" Just like BlueCross BlueShield? (4.00 / 1)
Some of their state plans are still non profit:
Prior to the Tax Reform Act of 1986, organizations administering Blue Cross Blue Shield were tax exempt under 501(c)(4) as social welfare plans. However, the Tax Reform Act of 1986 revoked that exemption because the plans sold commercial-type insurance. They became 501(m) organizations, subject to federal taxation but entitled to "special tax benefits"[7] under IRC 833. In 1994, the Blue Cross Blue Shield Association changed to allow its licensees to be for-profit corporations.[4] Some plans[specify] are still considered not-for-profit at the state level.

http://en.wikipedia.org/wiki/B...

Hmm, are those plans more attractive to the customers? Do the plan administrators act any different than their for profit competitors? Are the premiums lower? Somehow, I never read in the news that there are millions of customers who are very happy about their "non profit" plans. But I remember reading about lots of complains about BlueCross Blue Shield.


[ Parent ]
I think your quote... (0.00 / 0)
...sort of answers your question. They're at best hybrid for-profit parents with some non-profit subsidiaries. I'm no accounting whiz but me thinks there's plenty of room for profit siphoning hi-jinks here. Ezra seems to think the national non-profits will be fundamentally different from this. We'll see...

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

[ Parent ]
Prolly true. (0.00 / 0)
Sure, this hybrid construction isn't the same as stand alone nonprofits. However, those nonprofits will be very small in some less populous states. Without any economies of scale to speak off, they can't be very effecient, and I remain sceptical about them really being able to offer a significantly better plan than the insurance giants. However, even small competition is better than none at all, agreed.

[ Parent ]
If they're truly national... (0.00 / 0)
...in design and scale that would be very different from state-by-state stand-alones. There would be economies of scale. And, of course, there's be that ever present, looming, terrifying public option trigger, so... /snark

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

[ Parent ]
Huh? I thought that the triggered po is off the table? (0.00 / 0)
Lieberman won't have anything po, period. Sry, but are you really up to date on this, Steve?

[ Parent ]
Yeah, I know, Steve, it's prominently in Chris story. (0.00 / 0)
But I'm able to forget what I read just an hour ago. Evidence of Alzheimer just around the corner, I guess. Maybe more coffee is a cure for this...

Actually, this shoudl have raised my alarm bells immediately. There's "a triggered, federally-based public option" in it, so why does anybody believe Lieberman will vote for this?


[ Parent ]
Well I'm in the Federal Government plan (4.00 / 1)
administered by Blue Cross and it seems to work fairly well. On a per person basis, its cheaper than the plan my wife gets through the state University. I don't know if that's a function of the "non-profit" status, or the vastly large population in the Federal plan.

I can't compare in detail because we actually use very few medical resources - no prescriptions or chronic conditions.

I admit that its a bit strange that an insurance company can work as both a for profit and a non-profit entity. I guess that's a question for someone more in tune with economica nd business. The devil will be in the details.

Between Franken's amend. non-profit co's and application of anti-trust laws, this could reduce premiums. Maybe. Gotta watch out for loopholes.

I'm liking this result. Better than the watery PO. If all this survives in the final bill.


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


[ Parent ]
Competitive pressure - Medicare's superior bargaining power revealed (4.00 / 2)
Ezra makes another good point (same link as above):

Meanwhile, the Medicare buy-in lets people in the broader insurance market see what national bargaining power can do for individual premiums. Right now, Medicare's rates are largely hidden, as no one pays the full premiums, and so no one can really compare it to private offerings. But if the premiums become visible, and Medicare's superior bargaining power is capable of offering rates 20 to 30 percent lower than its private competitors can muster, we'll see how long it is before representatives begin getting calls from 50-year-olds who'd like the opportunity to exchange money in return for insurance as good as what 55-year-olds can get.


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

[ Parent ]
"calls from 50-year-olds" Hahaha! More jobs in indian call centers! (4.00 / 1)
Come on, this is ridiculous. Since when do insurance companies care about complains about high premiums? Why should they worry about that, if those customers are in a state where there's no competition? Let them complain all they like, they have no choice. Period.

Really, a smart guy like Ezra shouldn't engage is such wishful thinking when the ugly reality is plain to see for everybody.


[ Parent ]
Representatives (4.00 / 1)
I think he's talking about congress, not insurance companies.

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

[ Parent ]
Yup, ok. However, there won't be another reform for several years. (0.00 / 0)
So, those calls still won't have any short or middle term impact. And right now it looks like the Dems won't have the power to deliver any improvements before 2013 (after the 2012 elections) or even later.

[ Parent ]
the CBO report will be interesting (4.00 / 8)
wasn't it the public option that lowered costs and reduced the impact on the deficit? so now we have a big chunk of public subsidies, a mandated captive customer base for private insurance that leaves out those troublesome sick and old people, no antitrust exemption.... fine work. i'm sure they're all quite pleased with themselves.

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

Franken amendment and medicare extension will help (0.00 / 0)
probably a lot more than the proposed public option would have. The medicare extension will affect fewer people, but they tend to have a higher demand for healthcare, so that alone would probably be comparable to the public option in the bill.

We'll see when the CBO analysis comes out.


[ Parent ]
where's the cost containment? (0.00 / 0)
most of the reason health care costs so much here, and keeps costing more at a rate of increase way above inflation, is due to the costs of the treatments and the drugs. the insurance companies are a conduit for that - a lucrative one, granted.

Medicare already had trouble ahead because of rising costs. i'd say that's a good sign that whatever bargaining power it has, isn't enough. there won't be so many more people added to change that much, seems like.

changing how much of the passing buck gets shaved off by insurance will help, but won't that be a one-off? (presuming that it isn't dealt with through the magic of accounting...)

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


[ Parent ]
Yes, it's a one-off (0.00 / 0)
Costs are rising everywhere. There are problems with providers gaming the system (relatively fixable), and with increasing expenses due to more available treatment and an aging and fattening population (very hard to fix). But it's a big one-off, and, realistically, you can't fix everything at once. The rest will have to be addressed later.  

[ Parent ]
Shhhh!!!! (4.00 / 3)
If you let this out of the bag, the conservadems will demand to renegotiate AGAIN just like they did with opt-out!

Keep it on the down low!

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!


renegotiate what? (4.00 / 1)
They got practically everything they wanted.

[ Parent ]
They always want more... (4.00 / 3)
Remember how we had a deal with the opt-out?  Then they insisted on more compromise...

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 ]
They wanted the bill dead and gone (4.00 / 1)
Alot of the negotiation from the conservative side was done in bad faith

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


[ Parent ]
The Opposition Speaks (4.00 / 3)
And here's what the health care DC insiders think:

Insurance industry insider: 'We win'

With the Senate shifting sharply away from a "pure public option," an insurance industry insider who has been deeply involved in the health care fight emails to declare victory.

"We WIN," the insider writes. "Administered by private insurance companies. No government funding. No government insurance competitor."

Link here:

http://www.politico.com/blogs/...


You're absolutely Right -- We lost (0.00 / 0)
Basically Democratic leaders gave away the only thing that scared insurance companies.  The option is off the table and nobody will now attempt to revive it. But we didn't get anything in return.  All we got was a bunch of Candyland promises that are going to disappear by the time this thing gets through the senate, whittled away by the likes of Joe Lieberman who hasn't even agreed to the compromise.  Lieberman has only said that it's a step in the right direction.  But he is going to use his status as the 60th vote to fuck us all over so he can enrich the insurance industry which donates generously to his campaign and who his own wife professionally represents.  

Democrats made the same mistake we did at the start of this process by preemptively starting with a compromise 'public option' solution instead of a simple Medicare for all national healthcare coverage.  I have no problem with 'compromises' but you need to negotiate compromises with the people who actually have the power and ensure that they are binding.  You negotiate with carrots and sticks, not by incrementally abandoning your own interests in favor of your opponents.  


[ Parent ]
Only noticed this now: Will Lieberman support the ammendment? (0.00 / 0)
He is very vocal about not supporting (i.e. voting for cloture in case of the inevitable filibuster) if anything called a public option is in the bill. So, isn't this ammedment already dead even before it comes to a vote???

This is the "dangling delicious meaty treats" part of the program (0.00 / 0)
Go on Joe, do a trick... beeeeg...

[ Parent ]
excellent question (0.00 / 0)
This may be dead enough for him. Who knows? I gather he was not in the room for the deal because he did not show up to meetings.

New Jersey politics at Blue Jersey.

[ Parent ]
Joe was bumped and they gave his spot ... to Carper. (0.00 / 0)
When Bernie Sanders was not made a part of the gang I felt we were about to capitulate..again.  55 Senators bowing down to any of those 5 in particular is getting pretty perturbing.
But Sanders and Brown seem to think we're on a better path than we were with the WEAK! Reid bill.

Better but still WEAK!

What a perfect Democratic party slogan.

Nationalism is not the same thing as terrorism, and an adversary is not the same thing as an enemy.

[ Parent ]
who enforces the 90 percent rule? (4.00 / 9)
If it's insurance commissioners in the states, I don't trust all of them to do their jobs properly. There could be widespread evasion of the Franken amendment rules, and no penalty paid by the insurers.

I am inclined not to support this bill as a whole package, but I want to hear more details.

Join the Iowa progressive community at Bleeding Heartland.


My sentiments exactly. (0.00 / 0)


[ Parent ]
true (0.00 / 0)
this is the place to patch as many loopholes as possible.

Seeing as they manged to write this bill without creating any new bureaucracy, maybe they can add some in to oversee such issues? Along the lines of a Public Utilities Commission - but dealing with insurance company compliance.


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


[ Parent ]
Health insurance companies Too Big To Regulate (4.00 / 1)
The 90% provision will prove to be nothing. It may generate a small amount of additional income for large accounting firms as they make up cooked books to show the insurance companies aren't in violation.

Regulation doesn't scale. That's why I find the "no pre existing conditions" and "no recission" regulations to also be worthless. I can think of ways around them and I'm not even in the health care business. I guarantee you they already have squads of corporate attorneys telling them how they can grief all these new rules.


[ Parent ]
state-by-state vs. federal regulation. (4.00 / 1)
I would to like to live under either A. My state's insurance regulation or B. Federal regulation if there is a real regulator. Some random state (like Utah, South Dakota, or even the Marianas Islands!) who deregulates to attract business is not acceptable.

For that reason, I'm a bit concerned about the federal exchanges. (The thread above was too confused to reply to directly.)


New Jersey politics at Blue Jersey.


How about the Wyden amendment (4.00 / 2)
Any word on that lately? The Wyden free-choice amendment could greatly increase access to the exchange.

Conduct your own interview of Sarah Palin!

Small Businesses Thrown Under the Bus (0.00 / 0)
I don't care what you may say about the "advantages" of the compromise, Senate Democrats have just thrown small businesses under the bus.  The only way for us to get a handle on health insurance costs was with a robust public option.  Nothing in the compromise deals with this issue.

The individual mandate brings in more healthy people, (4.00 / 1)
and the Medicare expansion removes sicker people. This should lower costs for small businesses, especially with tighter regulation like the 90% loss ratio. In the long term single payer is still the only solution, but this is an improvement. If small business owners aren't satisfied they will just dump their plans. There's no real employer mandate. The people who get screwed are those who don't want insurance at all, but their loss is limited to $95 in 2014, $350 in 2015, and $750 in 2016, with an index that will go up about $50 a year thereafter.

[ Parent ]
You are right (0.00 / 0)
Small businesses and those in the 27 to 54 bracket.  

[ Parent ]
Thanks for the cheer up, Chris... (4.00 / 1)
I'm still a little skeptical now, but at least I now think I can hold my nose and accept this kind of Senate bill. The public option isn't completely dead, and at least Harry Reid rejected the "Snowe never-to-really trigger" with some kind of forceful trigger that may actually allow for a stronger public option some time in the near future. And even if that public option doesn't come sooner, the rest of the bill is an improvement over the darkest moments during the summer, when we thought we'd be stuck with "Baucus Care".

I still wish my Senator were stronger in fighting for a better bill, but OTOH I now better understand the many problems associated with trying to corral a bunch of lame@ss ConservaDems who won't agree to anything that will actually help people and possibly hurt their corporate masters. And since Reid ended up delivering a better bill than even President Obama was asking for, I'll give him some credit for that.

I guess there's still a chance to remove the trigger, or at least make it even MORE likely to trigger a stronger public option sooner, in Conference. I hope the House Progressives mean what they say this time in making Nancy Pelosi play hardball in Conference.

Yes, Virginia, there are progressives in Nevada.


What did Obama ask for? (0.00 / 0)
And since Reid ended up delivering a better bill than even President Obama was asking for, I'll give him some credit for that.

He pretty much stayed out of the bill writing business - at least in public. the only consistent theme was that he wanted a bill and wanted it in this session of congress.

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


[ Parent ]
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