A slew of fights left on health care reform

by: Chris Bowers

Wed Dec 09, 2009 at 18:11


Unless there is a "pin pong" maneuver that circumvents the conference committee entirely, the differences between the House and Senate bills means there are still a long list of fights left on health care reform.  These include:

Areas where the Senate compromise is better

  • 90% versus 85% The Senate bill dictates that 90% of all money received from health insurance premiums must be spent on health care.  The House bill only dictates 85%.  We need to push for 90%.

  • Medicare buy-in. The Senate bill has a partial buy-in to Medicare for Americans aged 55 to 64.  The House bill does not.  We need to push to keep the Medicare buy-in, and make it as expansive as possible.

  • Stupak amendment: The Senate compromise does not contain Stupak-amendment language.  The House bill, infamously, does.  Again, we need to keep the Senate version on this provision.
Areas where the House bill is better
  • Non-triggered public option.  The House bill has a non-triggered public option, but the Senate bill has only a triggered co-op.  The House bill is almost infinitely better on this front.

  • Medicaid at 150% or 133%?  The House bill expands Medicaid eligibility to 150%, while the Senate bill only expands it to 133%.  This is another public option discrepancy where the House bill is better.

  • Subsidies: 574 billion versus 338 billion: Through 2019, the House bill provides $574 billion in subsidies (pdf, page 5) to help people purchase health care, while the Senate bill provides only $338 billion.  The final number needs to be closer to the House bill.

  • Anti-trust exemption.  The House bill repeals the anti-trust exemption for health insurance companies, while the Senate compromise does not (thanks, Ben Nelson).  Another advantage to the House bill.

  • Rate of eligibility expansion for the exchanges.  The House bill expands eligibility for the insurance exchanges faster than the Senate bill.  This is also a public option fight, since it will determine who is eligible for the Medicare buy-in, and / or new public option program.  And the House bill is better.

  • National vs. State exchanges.  The House bill has a national exchange, while the Senate bill only has state by state exchanges.  Score yet one more for the House bill.

  • Taxing high-end insurance plans:  The House does not tax high end insurance plans, but the Senate bill does.  Personally, I don't think we should be weakening the health care coverage of union members in this bill,
There are at least nine major differences between the House bill and the Senate compromise.  To get as good a bill as possible, we need to score victories on as many of them as possible.

Some people will probably point out that the best way to succeed in these fights is to keep raising hell and call the overall deal unacceptable.  They may very well be right, since doing that over the past few months was probably the only reason we won the concessions we did.  In defense of my recent writing, I think there is an argument to be made that, in order to stay active, people also need to know their activism is producing tangible results.

In terms of measuring our success on the public option front of these fights, I strongly suggest that we measure how many people will be added to public health insurance plans above current law, rather than just the creation of a new public option.  We already have three federal public options: Medicare, Medicaid, and CHIP.  Expanding those would be just as good as creating a new, fourth public option.

Chris Bowers :: A slew of fights left on health care reform

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A slew of fights left on health care reform | 74 comments
It is about power (4.00 / 2)
"In defense of my recent writing, I think there is an argument to be made that, in order to stay active, people also need to know their activism is producing tangible results."

This is about power. You showed or DC decided that progressives Congress members you don't have any power. Now you are back at the starting gate like before the spring.  No one believes you will as a group do what you say you will do. Do you have that question about the right?

we won real concessions (4.00 / 3)
We got 4 millions more people covered by Medicaid, 1-2 million by Medicare, andthr Franken amendment.

Those are much bigger concessions than I can ever remember progressives getting before, ina ny other recent legislation.

More concessions is a sign of increased power.

[ Parent ]
We will see in your next battle what power, if any, you won (4.00 / 3)
Right now, where I am sitting, you said you wanted "X" and you did not get "X' and no where near "X" Indeed, you said that was your bottom line. Not the concessions you received. The other side said they wanted "Not X," and would not settle for anything less than "Not X." They won that.

Or, as one insurance insider emailed Ben Smith:

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

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

Concessions are not a sign of increased power unless they are one's that matter significantly to the other side.  

[ Parent ]
Actually I agree with you (0.00 / 0)
You are right--we will know how much power was won based on what happens during the next battle.

I honestly can't argue with that. We will see.

[ Parent ]
thank you, chris (0.00 / 0)
your coverage of this battle is by far the most helpful (and up-to-date) that i've been able to find. added bonus is that i agree with the majority of the strategies you agitate for. you should win a blog pulitzer or something.
[ Parent ]
that's a great idea (0.00 / 0)
But while we're waiting for that, Chris can have this:

He can wear it until he writes something dumb, then he has to wear this:


[ Parent ]
I agree that it's about power (0.00 / 0)
But I disagree that the right gets everything they want because of their tactics and therefore we should adopt theirs, which is what you've implied. The right has not succeeded on many issues including mandatory prayer in school, banning abortion, dismantling the Department of Education, turning Social Security into a Wall ST. investment program, and a number of issues. We on the progressive side need to do a lot of work to improve our tactics but we also need to stop perpetuating the meme that the right is so much more effective than they really are.  

Save Our Schools! March & National Call to Action, July 28-31, 2011 in Washington, DC: http://www.saveourschoolsmarch...
[ Parent ]
This is not about issues (4.00 / 1)
Even when they are not in power in DC- they are "in power." You name issues. I am discussing power. The two are not the same thing. People with power can lose on issues, but still be very powerful and influential. Dave can occasionally beat goliath. That does not change the odds.  
[ Parent ]
Of course (0.00 / 0)


Save Our Schools! March & National Call to Action, July 28-31, 2011 in Washington, DC: http://www.saveourschoolsmarch...
[ Parent ]
Of course (4.00 / 1)
I agree that the right is very powerful and influential even when they are losing on issues. But I think that Chris's diary is mostly about tactics that can achieve results that are beneficial to progressives and we should support those tactics even when it does nothing to shift the balance of power, which really is a much, much bigger issue. Tree vs. forest thing.

Save Our Schools! March & National Call to Action, July 28-31, 2011 in Washington, DC: http://www.saveourschoolsmarch...
[ Parent ]
No- they are about what he would like to happen (0.00 / 0)
Not how to get there. How to get there is for progressives to adopt the tactics of gaining power- branding, strong negotiation, etc.
[ Parent ]
Whoa Whoa (4.00 / 3)
Let's not get ahead of ourselves Chris, we have to finish losing the current fight before we consider losing all those future fights.  

Progressives can either stand up now or later.  Now might save HCR, later we'll be much further down the rabbit hole.  But we'll have to stand up, the current game being played in Congress assures we will slowly and inevitably lose everything we fought for the last 6 months.  Or do you still believe Joe Lieberman would agree to damn well anything that is true reform?

Gallows humor (4.00 / 1)
Let's not get ahead of ourselves Chris, we have to finish losing the current fight before we consider losing all those future fights.

Hate to admit this made me laugh...

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

[ Parent ]
If it makes you feel better (0.00 / 0)
When I wrote it I was either laughing or crying, still not sure which.
[ Parent ]
we have produced tangible results (0.00 / 0)
They've had to resort to extremely elaborate and clever devices in order to give us the runaround they were planning from the very beginning.

If it weren't for the efforts of activists, many of whom used the Internet to organize and coordinate, they'd have killed health care reform during the summer.

Now it'll take a little longer, but it will be killed nonetheless.

Yeah, so we didn't "win" (4.00 / 4)
we just lost less badly.
[ Parent ]
Incrementalism (0.00 / 0)
at its harshest.

"It sounds wrong...
     ...but its right."
[ Parent ]
Chris, if you keep on praising the bill... (4.00 / 7)
...it just gives Lieberman more room to complain and demand further concessions...  I'm being snarky, of course, but I really think that the key to keep conservadems onboard is for progressives to loudly hate everything in it, 'cos nothing is more important in their world than making sure that "liberals" never win anything.

That's why I was irritated at Weiner for praising the medicare expansion.  It's just going to make the conservadems keep demanding more and more concessions ad infinitum until it passes the litmus test--that all of us hate everything about it.  Only then will they be satisfied.

I'm sure this won't be the last "compromise" demanded from them... remember how they were all in on the opt-out?  

This process can't finish fast enough...

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!

The lord is right. Progressives should show they're not happy... (4.00 / 3)
...and stomp for a better reform. Showing you're satisfied with the outcome will only result in assholes like Lieberman coming to the conclusion that there have been too many concessions to the left wing.
[ Parent ]
Even MoveOn.org opposes this iteration - expanding Medicare (4.00 / 1)
to the 55-64 age group in lieu of a public option. I assume the reason is because the premiums will be expensive. See the figure quoted below ($600 per month!) in the excerpt from this AP story published around 6 p.m. Note that these premiums would be unsubsidized until 2014.

http://news.yahoo.com/s/ap/200...

Many officials declined to discuss details, heeding an admonition that if they did, the Congressional Budget office would feel compelled to release preliminary cost estimates that lawmakers prefer to receive secretly.

Thus, there was no word on the cost of purchasing Medicare coverage, as an example, in the years before 2014, when federal subsidies would become available for lower- and some middle-income individuals and families.

Sen. Olympia Snowe, R-Maine, told reporters premiums would total about $7,600 annually until federal subsidies became available in 2014. That translated into more than $600 a month, far higher than the $96.40 paid by beneficiaries age 65 and up.

Despite the praise from Obama and others, there were critics across the political spectrum.

They included MoveOn.org., the liberal group, which issued a statement saying Democrats had "bargained away the heart of health care reform allowing conservative senators like Joe Lieberman and Ben Nelson to hold the process hostage and protect Big Insurance."

emphasis added.

Great for the Al Franken amendment - the requirement that 90 percent of premium dollar is spent on care, and the defeat of an amendment that would have included Stupak language, but still the problem is the cost of health care, which only a public option could (theoretically) bring down through viable competition.

Where did they get that $96.40 figure from? (0.00 / 0)
I read elsewhere on OL it was $110 for Medicare Part B.
[ Parent ]
Oops, it is $96.40 (0.00 / 0)
[ Parent ]
Looking up the details is smart of you (4.00 / 1)
By the time a Medicare enrollee pays for Parts B and D, along with a supplemental, that's about $200 per month. There are also co-pays in some cases. Annual physical exams, except for the first year, are not covered and that can cost $300. (When I worked, my employer-paid insurance covered "wellness.") The Medicare Advantage plans cover more - Baucus reassures seniors that they will not lose those benefits when he speaks on the Senate floor.

Costs vary for prescriptions - they are priced in tiers, with generic the least costly. Some brands with no generic alternate can be VERY costly. The Wiki article is long; but the annual handbook from Medicare, tailored to our own state because it lists all the plans available to the person, is 128 pages long.  

[ Parent ]
When we pass Medicare for All (0.00 / 0)
we're gonna have to make improvements to Medicare itself too.  Like covering more things - the only things that shouldn't be covered are things that aren't medically prudent like cosmetic surgery and such.  And I'd like it if all costs were paid through taxes so no one would ever have to pay premiums and would have to pay, at most, minimal co-pays.
[ Parent ]
That's my fault probably... (0.00 / 0)
I was quoting that number yesterday...  I thought the premium had risen to over $100 last year.  I was mistaken.

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 ]
$600 a month is cheap... (0.00 / 0)
It's easily twice that in the private market, if people can even find insurance at all....

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 the same as private insurance (0.00 / 0)
Sen. Olympia Snowe, R-Maine, told reporters premiums would total about $7,600 annually until federal subsidies became available in 2014. That translated into more than $600 a month, far higher than the $96.40 paid by beneficiaries age 65 and up.

$7-8K a year is how much Blue Cross employer insurance costs per employee these days. They charge an additional $200 to $300 a month per dependent. The total premiums for a family of four runs about $13K+ a year.

There's no real difference between the two. It's a con. I'm personally concerned that a screwed-up Medicare option could lead to accelerated rate increases in existing non-Medicare policies. Once you add the Pharma in, there's little or no benefit to anyone.

It's worthless.

[ Parent ]
"It's a con" (4.00 / 3)
That's what I was thinking.

And I just listened to Rep. Anthony Weiner, D-N.Y., talk on Rachel Maddow show about what a great idea it is to expand existing public health programs.

She didn't ask, he didn't talk about any details, like what would this look like in practice.

They basically congratulated each other that the Democrats had come up with a successful compromise to the public option.

[ Parent ]
Why we disagree (4.00 / 9)
I think Bowers, et al., who still defend this bill think that those of us who attack it as fatally flawed don't appreciate the gains that have been made.

That simply isn't true.  I appreciate small gains.  As a matter of political strategy, I think that striking with overwhelming force when you have momentum is superior to fighting incrementally.  But I also appreciate that getting something is better than getting nothing.  

What I believe that Bowers fails to properly appreciate is that there are costs to this bill beyond just "not going far enough".  Our side has given up all of our leverage.

What leverage?  Too many liberals were late to realize that the insurance and pharmaceutical companies WANTED this bill.  This wasn't 1993.  They didn't want to kill it outright.  They wanted provisions that could never be passed alone:  Overly generous patent extensions and the individual mandate.  But once we give away those chips, they are NEVER coming back to the table.  We need to think long and hard about what we are getting in return.  And I am not buying that this Medicare b.s. is worth it.  Max Baucus floated the idea over a year ago and I didn't hear any liberals enthralled at the time.

It is worth noting that a public option and increased Medicare enrollment were essentially the trial balloon offers made by corporate-stooge Baucus back when the carriers feared single-payer.  It is no exaggeration to say that the present bill is far, far worse than what the industry corporations would have agreed to 12-18 months ago.  There hasn't been "compromise."  There has been constant backpedalling.  They've forced the progressive caucus to drop their pants and stand naked and humiliated.

I would much prefer to walk away from this deal and renegotiate with new leadership.

I am inclined to agree (0.00 / 0)
The Pharma deal Obama made months ago nags at me - the part that says the government in a public option would not negotiate for prices. Pharma is too big a piece of health care costs to give a blank check.

And I think the medical device manufacturers are getting a really good deal in this bill.

We really, really have to question this outcome if the industry side is happy with it.

I agree the Congressional Progressive Caucus essentially folded, although the bill that came out of the house wasn't that bad, except for Stupak.

The only positive thing one can say is this fight isn't over yet.

[ Parent ]
When? in 2023? (0.00 / 0)

[ Parent ]
Your question suggests (4.00 / 2)
that if this bill died that it wouldn't be revisited for at least another 10 years.

I don't believe that to be the case.  I do not believe that there is some magic rule that prevents health care reform legislation from being considered more than once per decade.  I do not dispute that it took over 15 years since the Clintons failed to pass it the first time, but that was atypical of the legislative process.  More typically, when there is pressure on Congress to address an area of interest the pressure does not not diminish until something is passed.  In fact, it is when Congress typically passes legislation that they put it away and do not revisit it for some time.  

My analysis is that there is a greater risk of Congress passing a deeply flawed bill and not attempting to fix it before 2023 than there is of Congress passing nothing and not being pressured to try again.   Part of the reason, as I already said, that "fixing" this flawed bill is so unlikely is that we will have given the industry corporations everything they want.  Whereas if we kill the bill now, we will be able to entice the industry players back to the negotiating table with the carrots that are in the current bill.

[ Parent ]
The explain for us (4.00 / 1)
how we get to revisit this issue in the near future with "new leaders"

first we would need elections to replace our leaders, and the earliest possible time that would occur will be 2013, assuming we can hold Congress while primarying the leaders successfully, and get our leaders changed, and hold the Presidency after defeating Obama in a primary.

Since that's unlikey to happen, thte next realistic time would be 2017.

[ Parent ]
The history of healthcare reform (4.00 / 2)
has not followed the pattern you suggest.

National, comprehensive health insurance was first proposed in 1912.  It has failed over and over, and a ten to fifteen year break between attempts is typical.

http://www.nytimes.com/interac...

[ Parent ]
Let's flip this answer back to you (0.00 / 0)
If you support the incrementalist approach, how long until the nation, the congress and the WH will get togther and start improving the bills that "get the foot in the door"?

We all hear estimates about how long it will be if the current effort fails to pass legislation - anywhere from 10 - 30 years - before we get another chance.

How long until the incrementalism kicks in?

If this is the first step on the slippery slope leading to single payer - can you lay out the timeline for how long it will take to slide down that slope?


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

[ Parent ]
This is better than nothing (4.00 / 5)

 But it's thin gruel indeed.

 That said, I am aghast at how the Democrats are acting like they literally want to throw next year's election. This compromise of a compromise of a compromise hands the Republicans a platterful of easy talking points -- "the Democrats are FORCING you to buy EXPENSIVE insurance that doesn't cover ANYTHING". And because many of the young people who got onboard with Obama last November are going to lose ground with this "reform", a significant percentage of them are going to be a lot less psyched about voting Democratic in 2010... or in 2012.

 Then I remember how upset James Carville was when the Democrats picked up their majorities in 2006, with his then-irrational-sounding insults of Howard Dean, and it's increasingly clear that the Democratic establishment PREFERS to lose elections, and this health-care "reform" is a critical step in achieving that goal.

 This is the high-water mark for the Democrats' presence in Washington, and THIS is the best they can do? They weren't even trying.  

"We judge ourselves by our ideals; others by their actions. It is a great convenience." -- Howard Zinn

Oh come on (0.00 / 0)
You can't say all those Democrats work their butts off to get elected because they want to lose the majority and their committee chairs.

Rather, they want to stay in the majority so they can pass corporate-friendly legislation.  Losing a few Senate seats won't be a big deal.

[ Parent ]
And what are they doing... (0.00 / 0)

 ...to attract enough votes to stay in the majority?  

"We judge ourselves by our ideals; others by their actions. It is a great convenience." -- Howard Zinn
[ Parent ]
Not much, but that doesn't mean that they're willfully trying to lose (4.00 / 1)
they're probably just ignorant.

In any case, it's highly unlikely that Democrats will lose enough seats to lose the majority in the Senate (don't know about the House).  If Republicans pick up seats but not enough to take back the chamber, that's the best of both worlds for ConservaDems - it'll be easier to pass conservative legislation, but they still get to keep their majority status perks.

[ Parent ]
Ben Nelson ignorant? (0.00 / 0)
Unpossible...

Self-refuting Christine O'Donnell is proof monkeys are still evolving into humans
[ Parent ]
Ben Nelson is a conservative (0.00 / 0)
He's acting based on his ideology, his vision of how society should work and government's role in it.

Carville is just a former head-eunuch, angry that he's not the big cheese in the palace any more.

[ Parent ]
Chris, won't the insurance companies (4.00 / 3)
be able to game the system on 90 percent or 85 percent for providing care? I predict that loopholes will allow them to categorize all kinds of expenses under providing care that are really administrative expenses.

Also, I have zero confidence in state insurance commissioners to enforce those provisions. In most states one or two insurance companies dominate, and they have purchased the politicians.

Join the Iowa progressive community at Bleeding Heartland.

What's next? (0.00 / 0)
Also, I have zero confidence in state insurance commissioners to enforce those provisions. In most states one or two insurance companies dominate, and they have purchased the politicians.

Maybe we should be mobilizing to make sure these commissioners are on our side.  

Politics is the art of the possible, but that means you have to think about changing what is possible, not that you have to accept it in perpetuity.

[ Parent ]
Lynn Woolsey is on my tv (4.00 / 4)
saying that she doesn't care if there is a public option, as long as their is competition.

We are so outgunned.

I understand the importance of competition. But making competition the goal rather than a means for ensuring health care for all is terrible politics.  

Pressure is important. But is there any way to ensure that our core allies in Congress can make the progressive case for reform, whether it's to point out how much we've already compromised or to make the case for what is still on the table?

Politics is the art of the possible, but that means you have to think about changing what is possible, not that you have to accept it in perpetuity.

We are so outgunned. (0.00 / 0)
Yup.

Self-refuting Christine O'Donnell is proof monkeys are still evolving into humans
[ Parent ]
It's going to be sad (4.00 / 1)
watching House progressives eat this shit sandwich.
[ Parent ]
We are so outgunned. (4.00 / 8)
TPM: Shh, Anthony Weiner -- The Moderates Might Hear You

Republicans say Rep. Anthony Weiner (D-NY) let the cat out of the bag on the Senate health care reform compromise today. After the ardent public option supporter extolled the virtues of the Senate compromise plan that expands Medicare coverage, Republicans seized on his comments as evidence that the plan was a backdoor to government-run, single-payer coverage.

Weiner told the New York Daily News that the Medicare buy-in plan under discussion in the Senate "would perhaps get us on the path to a single payer model."

"[T]his is one idea I like a lot," he told the paper.

Sens. John Thune (R-SD) and John McCain (R-AZ) seized on Weiner's comments when they stopped by the Senate press gallery to talk Medicare with reporters this evening. They clearly enjoyed attacking the fragile Democratic compromise with the words of one of the party's own.

Is there anyone who knows how to play this game? Jeebus...

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

[ Parent ]
that's where i disagree with woolsey (4.00 / 1)
Competition is nice. Gettibg more people on public rolls is better.

This plan is going to add more people to public health insurance plans than private ones.

[ Parent ]
but how can you contain costs (4.00 / 1)
if there is no competition?

Everyone else's premiums will keep going up at two or three times the rate of inflation.

Join the Iowa progressive community at Bleeding Heartland.

[ Parent ]
Doubtful (0.00 / 0)
[ Parent ]
Here's the key statement from the link as to why you are wrong (4.00 / 2)
"But crucially, this DOES NOT COUNT the subsidies, which is the entire point of affordability."

Subsidies do not address cost containment.

This argument is bogus if insurance cost increase at a rate that is much higher than inflation due to a lack of cost containment, and thus, eating up the subsidies.

More importantly, the economic waste that is costing us in GDP and competition will still be there. There will still be fewer jobs because of health care cost.  Like I said, this is a crap bill, but now you can hide some of the extra crisp crap under subsidies so the American people will not see it coming.

[ Parent ]
Howard Dean was wrong (0.00 / 0)
What is the "competition" for Medicare? We need to get out of the mindset that competition is the only means to the ends of cost-efficient healthcare.

Save Our Schools! March & National Call to Action, July 28-31, 2011 in Washington, DC: http://www.saveourschoolsmarch...
[ Parent ]
That's not the mindset (4.00 / 3)
The mindset is that if you are going to go with a set of options on the table, then you are going to have to implement each of those options according to its own terms. If you were going for single payer that would be one thing, but if you going to say we are going to do cost containment through the public option (public competing with private) then that means a set of other policies that must work together. In that context, understanding the nature of competition becomes crucial.  
[ Parent ]
Let me recontextualize (4.00 / 1)
When it comes to lots of healthcare issues, competition is absolutely not crucial to the outcome of better patient care. For instance, when it comes to infectious diseases in 3rd world countries, there's no competitive framework whatsoever because no one makes money off of malaria or sleeping sickness meds since the only people who need them are desperately poor. Same in our country with diabetes and obesity. Expanding Medicare coverage -- even if it is buy in -- is rally a better way to go than the PO even though the coverage is limited to a specific age group.

Save Our Schools! March & National Call to Action, July 28-31, 2011 in Washington, DC: http://www.saveourschoolsmarch...
[ Parent ]
Your comment is in context a non sequitur (0.00 / 0)
I mean it says nothing really about the question that is on the table. The question on the table is how do we pay for things and how much do they cost. It is not that your point is not important. It is that it is an avoidance of how do we pay for things and how much does it cost by saying "dont worry about it because it is health care." Well, yeah, but then why do other countries do it more cheaply and gain better outcomes. It must be something we are doing wrong. We are never going to get to your question without ansewring the cost question first.
[ Parent ]
I'm confused. More than half in "public plans?" (4.00 / 1)
This plan is going to add more people to public health insurance plans than private ones.

In your 'Making the case' post you itemized 4 million added to Medicaid and 1-2 million added via Medicare buy-in. Later in that post you reference "16-17 million more people entering public health insurance plans" and later still say "Covering 16-17 million more people on public health insurance than current law, among an overall decline in the uninsured population by 30-35 million"

What is the difference between the 5-6 million added to Medicaid/Medicare and the 16-17 million "entering public health insurance plans?" Are you counting those being subsidized with public money who are buying private insurance as being in a "public health insurance plan?" If so, that's at best very misleading, particularly stated as you did in the quote above.

To my reading, HCR will at best place 6 million in government run health insurance (what most would consider "public plans") and deliver 25-30 million into private insurance, half of whom will be paid in part or in full with government funds paid to private insurers. Subsidies paid to private insurers are not what most people would consider a "public health insurance plan."

What am I missing? How exactly are 16-17 million on "public health insurance plans?" Thanks.

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

[ Parent ]
Answered (0.00 / 0)
Answered here. Thanks, Chris

The CBO report on the bill passed by the House (PDF, page 11), and the CBO report on the bill that was sent to the floor of the Senate (PDF, page 20), both project that the bills will add 15 million more Medicaid subscribers than current law.  All of those 15 million are at 150% of the national poverty level or lower, and virtually all of them are currently uninsured.


Self-refuting Christine O'Donnell is proof monkeys are still evolving into humans
[ Parent ]
She said she didn't care what they call it (0.00 / 0)
as long as it's competitive.  
[ Parent ]
"making competition the goal rather than a means" (0.00 / 0)
That's right, competition is just the leverage that has to be used to get premiums down, in absence of single payer. And I hope nobody misunderstood my recent comment where I criticized the near total absence of competitive incentives in the healthcare bill. I wanted to point out that if there's no single payer and not even a public option, AT LEAST the monopolies in the states have to be broken up. Of course, competition is only the means to achieve that. And while progressives shouldn't repeat the mistake of communism and stomp for a state-directed economy, healthcare is a different issue. Countless examples all around the world show that for profit systems produce dissatisfying results in that field.  
[ Parent ]
Lynn Woolsey was just on Olbermann (4.00 / 2)
talking tough, for what's that's worth, saying she was "mystified" that Anthony Weiner and Howard Dean have praised this compromise.

She slammed the compromise for the lack of competition it would introduce. And that should be the standard, yes? Not how many people are moved onto public plan but whether or not it would be--what's the word we used to employ a few goal post-moves ago?--"robust" enough to compete with and "beat" private insurance? (Although, to be fair, it hasn't been robust for a while.)

I haven't been commenting much on this because, well, I don't really understand it, but I do think it's striking, Chris, that you're now effectively to the right of the progressive caucus. If you're not careful, Lynn Woosley might be start lobbying you.

Wrap it up (4.00 / 1)
Another point I see, is whether continuing to push for the Public Option much past this point will bring any more gains.

I've been wrong before on this, so take me with more than one grain of salt but my sense is that it's time to wrap this thing up.

We need to take the admitted crumbs that have been offered, refuse to accept it as a victory and try to force Obama to also not gloat over it.  Accept it as it is, fight another day down the road on Health Care.

Because besides Health Care we also have the economy in general to fight over, as well as Afghanistan and global climate issues, gay rights, etc.  The energies that have gone to Health Care need to be transferred to these other fronts soon.

Maybe the lesson we learn is that we need to be more bloody-minded oppositional and less wonkish, and it's hard to be oppositional when you're asking for something.  Pulling the reins on Wall St. is more a pure oppositional play than trying to win a new social benefit.

We need to worry less about what Obama's doing and how he's making us feel and more about getting our agenda through.

sTiVo's rule: Just because YOU "wouldn't put it past 'em" doesn't prove that THEY did it.

Excellent point (4.00 / 1)
We need to take the admitted crumbs that have been offered, refuse to accept it as a victory and try to force Obama to also not gloat over it.  Accept it as it is, fight another day down the road on Health Care.

C'mon, face it people, the haves are not going to give the have-nots anything.

Therefore, we need to cut bait. I mean take the spin - Democrats pass historic health care reform - and run.

Do the least harm we can, call it health care reform, and...

Wait, that's insincere. That's not standing for Progressive values, etc.

Oh, you mean it's time to go underground. Whoah. How do we do that?

We are here at the future.

Next stop - climate change. More crumbs.

We don't stop climate change - worldwide food production slumps, prices rise; lack of access to health care continues, more people die.

We're here at the future. Not in my lifetime, right?

[ Parent ]
not giving the have not anything (4.00 / 3)
Except the fifteen million people, all of whom are at 133 percent of the povert level or less, and all of whom are currently uninsured, new health insurance through the public option known as Medicaid.

yep. Nothing at all.

[ Parent ]
You're right, Chris. But it's a deal. Insurers get the mandate for it. (0.00 / 0)
So, it has to be questioned if its a good deal. And we also shouldn't forget that it's not a done deal yet. Imho, those other commenters ar right when they argue that it's not helpful to show satisfaction with the temporary rsults so far is not helpful, because it weakens the negotiating position of progressives.
[ Parent ]
what happens to SCHIP in the Senate bill? (0.00 / 0)
The House bill eliminates it, right? Doesn't the House bill move families either into Medicaid or the exchange?

A while back I remember reading that Rockefeller would fight to keep SCHIP, because he worked hard to create it.

Join the Iowa progressive community at Bleeding Heartland.

Something I haven't seen yet (0.00 / 0)
Why doesn't Bowers or Markos have a poll asking people if the Senate HCR bill is still worth it or if it should be killed?  What exactly is the split amongst us?  30/70, 50/50, 80/20?  Would be informative to know where we stand and proceed as a block (if possible.)  

I'd like to know how progressives are taking this, I know I'm soured on the entire deal and would like to see it dead until 2011.  The gains are too tenuous and the giveaways are much too broad.  I could easily see the benefit fittered away between now and 2013 while the mandate portion becomes etched in stone.  It's just a really bad, stinker of a deal.

Number of people with health insurance is not the only goal (4.00 / 2)
Chris is arguing that this bill is better than the current situation because it puts a lot more people on the public healthcare rolls. And there is some value in this -- especially for the people who get better healthcare.

But a critical aspect of this battle is which side ends up gaining more power. If the insurance companies get a lot more customers and hence a lot more money, then they are going to continue to game the system -- in fact, they may game it even more. Also, they can use their additional funds to lobby Congress and defeat progressives which means they will have a better chance of undoing all the crumbs we've won.

If we pass some kind of decent healthcare reform, then that bolsters our side. It excites and empowers people to think progressives are on their side and can win real victories. And those who get decent healthcare recognize that we gave it to them.

It is crucial that we actually win the political battle as well as get more people healthcare so we can continue to win political battles in the future. If the final bill is a watered-down piece of crap -- and that is where it is heading -- then the best way to win the political battle may be to defeat the bill, show progressive strength, and force Obama to address our concerns seriously.

Clinton pushing for NAFTA, deregulation, the end of welfare, and the Telecommunications Act of 1996 despirited progressives and allowed W to get selected in 2000. Healthcare "reform" that does not meet minimal progressive standards will lead to the same kind of defeats in the future.

"best way to win the political battle may be to defeat the bill"? Huh? (0.00 / 0)
Sry, I tend to agree with your other points, but letting the reform fail is NOT winning! It may be the less damaging defeat, maybe. But it's certainly NOT a victury, let's not get confused about it! If you start with a lot of brouhaha about how you're going to improve healthcare, and after almost a year of negotiating finally kill the whole thing, NOBODY will say you have won. It would be delusional to believe in this.

And Chris is right, too, the humanitarian side HAS to be considered. Letting tens of thousands die every single year until the next chance for a reform comes, maybe 2013, but most probably later, can NOT be called victory in any way.

No, imho the conclusion has to be to keep the pressure on now, to press for more concessions and to not show any satisfaction with the temporary outcome. Make it clear this isn't good enough, and that progressives are mad enough to go to the extremes of killing the ugly monster, if necessary. As has been correctly pointed out recently here, nobody involved really wants to be remembered as the asshole who prevented the most important legislation in this decade from passing, with all the horrible consequences. Not even Lieberman.

So, the progressives have to show they are the most fanatic folks in the room, even more crazy than loony Joe. Hey, folks like Franken and Burris, maybe some others, too, should be able to play that role! What about Conyers, btw? He criticized Obama recently, and he went so far as calling for impeaching Bush when this was simply seen as nuts by the "serious" people. He shouldn't have no problem convincingly playing the madman now!

[ Parent ]
Oh, and btw, progressives shouldn't simply accept the rules. (0.00 / 0)
We should keep pressure on Reid to abandon those useless negotiations with the die hard obstructionists, and go through reconciliation instead. Or, even better, go nuclear and kill the filibuster now. There are good arguments to do that, all evidence shows that Congress is increasingly becoming unable to pass anything at all, and it will get worse after 2010. This is a clear and present crisis. And Reid desperately needs a success to drum up support at home for another term. He may be inclined to run a higher risk to achieve that now.
[ Parent ]
Why would Medicare expand only to 55-64 yr olds? (0.00 / 0)
Why not expand Medicare coverage to everyone? What is the rationale for only expanding it to those over 55? We should be pushing for a complete expansion and either accept nothing less or get compromised down to 55-64 only in exchange for something else really valuable.
Why would Medicare expand only to 55-64 yr olds? (0.00 / 0)
Why not expand Medicare coverage to everyone? What is the rationale for only expanding it to those over 55? We should be pushing for a complete expansion and either accept nothing less or get compromised down to 55-64 only in exchange for something else really valuable.
Oops, please delete one of these double posts (0.00 / 0)

[ Parent ]
Imho you're mistaken searching for rationales in legislation. (0.00 / 0)
The results of negotiations between conflicting interest groups most often have no element of logic left in them. It's just a product of the different levels of power involved, not something that is designed to make much sense.
[ Parent ]
A slew of fights left on health care reform | 74 comments
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