Health reform state of play, February 22nd

by: Chris Bowers

Mon Feb 22, 2010 at 11:45

Lots of happenings on the health reform front.  In the extended entry, you can find details on the White House draft health reform bill, the Senate whip count, the use of reconciliation to finish health reform, and the ongoing public option campaign.

Health reform state of play in the extended entry.

Chris Bowers :: Health reform state of play, February 22nd
White House releases health reform bill
The White House has released a draft health reform bill 72-hours in advance of Thursday's bipartisan health reform summit.  Some highlights:

  • Written to be passed as a sidecar "fix" to the Senate health reform bill through reconciliation (more on reconciliation below);

  • Does not include a public option of any sort (more on that below);

  • Is closer to the Senate health bill than the House health bill;

  • Increase penalty for employers who do not provide health insurance to employees;

  • Slightly increases subsidies for people purchasing insurance on the insurance exchange;

  • Removes special deals to Louisiana and Nebraska;

  • Keeps excise tax, but does not implement it until 2018.  Labor is still studying the proposal, and has not endorsed it yet;

  • Expands "high-income Medicare taxes to include investment income" to replace funding from excise tax;

  • Not scored by the CBO.
Many more specifics can be found here.  The White House is referring to this bill as an "initial offer."

Reconciliation appears to be a go
The draft bill released by the White House is designed to be passed through the budget reconciliation process.  This signals strong support for that procedural path for finishing health reform.

Senate Majority Leader Reid Harry has also declared that the Senate will use the reconciliation process to finish health reform "in the next 60 days."  That declaration was made on February 19, making April 11th the 60th day.

Speaker Nancy Pelosi had previously stated that passing health reform would be impossible without using the budget reconciliation process to fix the Senate bill.

This means that the entire Democratic leadership is now on board with the reconciliation process.  While out whip count still only shows 34 clear Senate supporters of reconciliation, and as many as 39 possible supporters when "maybes" are included," it seems clear at this point that at least an attempt at reconciliation will be made.  We can play a big role in making that happen by providing a public list of 50 Senators in favor of using reconciliation to pass health reform ASAP.

Public Option
The public option has regained a lot of momentum over the past week.  In addition to 22 Senators stating that they would like to pass a public option during the reconciliation process, and an additional 9 others currently listed as "maybes" (see whip count here), Senate Majority leader Harry Reid has stated that he will work to include a vote on the public option during the reconciliation process:

If a decision is made to use reconciliation to advance health care, Senator Reid will work with the White House, the House, and members of his caucus in an effort to craft a public option that can overcome procedural obstacles and secure enough votes.

If I may, allow me to suggest a Medicare buy-in as the best public option to include in reconciliation.  Such a buy-in has the following advantages:

  1. More support: As of December, it had the support of 57 Senators who are still in the Senate (everyone in the old 60 except Kirk, Lieberman and Ben Nelson), compared to only 50 for Chuck Schumer's level playing field public option.

  2. No procedural obstacles.  Unlike a public option, there is no doubt that a Medicare buy-in could pass the procedural hurdles for budget reconciliation in the Senate.

  3. It's better.  A public option that is tied to Medicare--or, rather, that actually is Medicare--is superior to the level-playing field public option (which is worse than the one that passed the House). We always wanted a public option tied to Medicare rates, and I can't imagine anything better than Medicare itself.
After the Lieberman backstab in December, my two regrets on the public option campaign were not whipping on reconciliation (which we are doing now), and not pushing for a Medicare buy-in instead of a new, fourth public option (three current public options: Medicare, Medicaid, and CHIP).

Since we have been given a chance to re-do the public option campaign, I don't intend to make either of those mistakes again.  The Medicare buy-in is the preferred public option.  I would like to see us start pushing for everyone to buy-in to Medicare, or at least for people 45 and older to be able to do so.

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Medicare buy-in is a winner (4.00 / 11)
Honestly they should drop the term public option altogether and go with that name "Medicare for All" that was briefly tossed around.

And being that medicare buy-in would just be increasing the pool of eligible participants it should be easy to sell to the public as well as get through procedural motions.

Have not seen any recent numbers, but I believe Medicare is still strongly net positive for approval (and is cost efficient compared to private insurance.)

For first time in months I am somewhat encouraged by how this has been moving.

only problem with it politically (4.00 / 2)
is that GOP will scare seniors by saying expanding Medicare to people under 65 will mean benefit cuts to those over 65. And Obama is explicitly proposing Medicare cuts, so that's not an implausible talking point.

Join the Iowa progressive community at Bleeding Heartland.

[ Parent ]
As below, sell it politically as _adding_ new funding, from new members. (4.00 / 5)
Its not just the same system with new users, its new members with new payments, and new subsidies as well. Its a growth of medicare that makes it more financially secure, not less.


The government has a defect: it's potentially democratic. Corporations have no defect: they're pure tyrannies. -Chomsky

[ Parent ]
Polling confirms this... (0.00 / 0)
Then this issue was polled in December, it had huge support form everybody BUT seniors, who hated the idea.  You'd think that Seniors would want to share their good fortune, but they are as selfish as anyone else!

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 ]
Seniors... (4.00 / 1)
Seniors bitching about paying for public schools should be proof enough that many only care about what's good for them.

[ Parent ]
Medicare for All - Tax the Crap Out Of Wall St (4.00 / 1)
Medicare for All has been the logical thing to do all along.  Want a new source of income which will also win the approval of the American public?  Tax Wall St.  

[ Parent ]
The way I think it should be sold as a SUPPORT for medicare, by funding it. (4.00 / 3)
This could add billions of dollars of personal funding to medicare, and the simplicity draws down costs while expanding services.

Since Canada's health system is similarly front funded, often with direct extra taxation, one province has a $1,000 near flat tax to top funding up, and everyone who pays taxes pays for the medical system, just like a mandate, but without a direct payout to profit.

Though many stakeholders in Canada's system make profits. Too many by me, but still, they are there.

I am a big supporter of this solution, and it will, with the figures presented here and elsewhere on potential votes.

Good call.



The government has a defect: it's potentially democratic. Corporations have no defect: they're pure tyrannies. -Chomsky

does this preserve SCHIP? (4.00 / 2)
Because if I recall correctly, the House bill basically eliminated the SCHIP program.

Join the Iowa progressive community at Bleeding Heartland.

... (0.00 / 0)
I support it.    It makes sense, it's much easier to implement, and combined with the panel idea, it should keep costs down.  Although I still wish they would just go the price regulation route, which would guarentee a controlling of costs.

obama version has cost control built in. (0.00 / 0)


The government has a defect: it's potentially democratic. Corporations have no defect: they're pure tyrannies. -Chomsky

[ Parent ]
Some... (0.00 / 0)
He has some... I'm not talking a group that can take action if they pull a BCBS... I'm talking price regulation...   Prices for service X, Y, and Z are set by the government.    

[ Parent ]
You are right Chris (4.00 / 4)
Just the word "public" dooms the the public option to a fierce fight by the right wing. It is much harder for them to makeup lies about something, Medicare, that most of them are on.   Secondly, all it would require is minor tweaking of an existing and popular program.  

The only real losers would be the insurance companies, because eventually they would become unnecessary.  Expanding Medicare has always made more sense.

"Oh. My. God. .... We're doomed." -- Paul Krugman

on the money (0.00 / 0)


The government has a defect: it's potentially democratic. Corporations have no defect: they're pure tyrannies. -Chomsky

[ Parent ]
While you may be right about the word "public" (0.00 / 0)
We've got to fight for our words.  We've already lost "government" and "liberal"; we can't keep ceding language.

[ Parent ]
We've only lost when we quit fighting. (0.00 / 0)
I'm a liberal and would be happy to kick anyone's ass who didn't like it.  The only thing more crooked than the government are corporate fascists.  After all, the crooked politicians work for pennies on the dollar.  You gotta stand up  for what you believe in.  Winning comes and goes.  

"Oh. My. God. .... We're doomed." -- Paul Krugman

[ Parent ]
re: initial offer (4.00 / 3)
The White House is referring to this bill as an "initial offer."

the initial offer of the democratic party should be 'medicare for all'


re: options (0.00 / 0)
(three current public options: Medicare, Medicaid, and CHIP).

medicare is not an option? isn't it mandatory?

No, it's not mandatory. (0.00 / 0)
My understanding is that inclusion is the default, so there's some red tape in opting out, but one can opt out if one chooses. The taxes are mandatory, so I have no idea why anyone would ever choose to opt out of the benefits.

[ Parent ]
Maybe some of these die-hard right-wing anti-government conservatives will opt out (0.00 / 0)
since they refuse on principle to take government benefits.


(cue halfhearted grumblings of assent from said conservatives)

[ Parent ]
public option (0.00 / 0)
"The president said from the outset he thought that was a great way to provide cost reduction and competition moving forward, but if that is not the choice of the majority moving forward, I think there are other ways to get there."

what majority are these bozos teaming about?

That's called "pandering." (4.00 / 3)
If he supported a public option, there would be some tangible evidence that he has done anything to make it happen. He clearly does not want a public option. If we get one, it will only come from grassroots activists steamrolling Obama.

[ Parent ]
Majority of Who? Lobbiest? Or America? (4.00 / 1)
America supports a public option.  Maybe the President can support America.

[ Parent ]
public option (4.00 / 3)
Adam Green of the Progressive Change Congressional Committee, which has been pushing hard for the public option, said that the PCCC, Credo Action and Democracy for America will be releasing a petition that tells Congress: "Americans want a good health care bill with a public option, even if it passes with only Democratic votes. We would rather have a good bill than a bipartisan one."

Polling shows that voters would rather have a strong bill than a bipartisan one.

"The White House is asking Democrats in Congress to shoot themselves in the foot in the name of bipartisanship. Congress would be wise to smile nicely at the White House and then pass the public option through reconciliation and win re-election," said Green.

if they were smart...

Plain and simple, I don't trust him. (4.00 / 2)
He is going to pass some pile that makes Republicans happy, and he is going to tell voters and his base to drop dead.  In return, Obama and the Democrats can drop dead. I don't want anything to do with obama's or the Senate's bills.  They are corporate owned.  

I agree completely (0.00 / 0)
Let's push like mad for including Medicare for All and settle for a PO if it becomes a dealbreaker.  Chris, you should start an online petition for a "Medicare for All" vote that we can all sign and start building heat behind the idea ASAP.

We should do just the opposite (4.00 / 2)
Since DFA and PCCC are pushing the PO letter to Senators we keep doing that and then when our Great President submarines the PO, demand Medicare which is easier to accomplish and is more acceptable to the people.

"Oh. My. God. .... We're doomed." -- Paul Krugman

[ Parent ]
You have a subtle and clever mind (0.00 / 0)
and I like it!  What a great idea!  How do we lay the groundwork for that to happen?  I'm in...

[ Parent ]
Bottom line question on HCR.. (4.00 / 1)
Whose asses will they ultimately cover, theirs or ours?

Looking back on the totality of the past 9 months through today's newest plan, the odds are 9:1 against the country  winning anything substantial from this Senate.

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

Remember the principle: Everyone who will be affected by the mandate should have a government insurance option. (4.00 / 2)
The law should not force anyone who would not otherwise choose to be under private insurance, into private insurance.

This means that if we have a Medicare buy-in, it has to be open, AT LEAST, to anyone of any age who is uninsured.  Setting eligibility by age brackets is folly because it forces those younger than whatever age into private insurance.

This means a Medicare buy-in for 55-64, as was proposed earlier, is not good enough.  Those under 55 years old aren't chopped liver for the private insurance industry.  Make the Medicare buy-in eligibility conditional on insurance status rather than age.

Or, if we want to have the best of both worlds, lower "regular" Medicare (that is, Medicare where you're automatically in, not a buy-in) eligibility to some age like 50 or 55, and on top of that add a Medicare buy-in for everyone else.

just so (0.00 / 0)
the Medicare buy-in that was floated during the Senate process is not an adequate substitute for a public option, let alone a better alternative. people under 55 need health care too.

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

[ Parent ]
There were two reasons it was proposed that way (0.00 / 0)
First because it is much harder for people over 50 years to get private insurance.  Secondly, it was just a start.  Getting your foot in the door and allowing the health care plan to include all the regulation already built into Medicare.

You are right, one system, inclusive for all would be best.

"Oh. My. God. .... We're doomed." -- Paul Krugman

[ Parent ]
Medicare for All flips indies in IA poll from 63% against to 60% for -- (0.00 / 0)
Desmoinesdem posted these poll numbers on TalkLeft yesterday, from a poll done in Iowa last week by Research 2000 for KCCI-TV.

QUESTION: Do you favor or oppose the health care reform bill passed in December by the U.S. Senate?
ALL 36% 57% 7%
MEN 32% 61% 7%
WOMEN 40% 53% 7%

DEMOCRATS 62% 24% 14%

QUESTION: Would you favor or oppose the national government offering everyone the choice of buying into a government administered health insurance plan -- something like the Medicare coverage that people 65 and older get -- that would compete with private health insurance plans?

ALL 61% 31% 8%

MEN 58% 33% 9%
WOMEN 64% 29% 7%

DEMOCRATS 87% 9% 4%
REPUBLICANS 32% 59% 9%
INDEPENDENTS 60% 29% 11%

Note the almost complete flip for Indies, from 63% against what's on offer by Obama/Congress to 60% in favor of something like Medicare for All. What's not to like?*

We're not going to get Repubs...until they have their Medicare for All and tell the government to keep its mitts off their Medicare for All. eh?

It's what people want, it's what they know, it's what will save money overall. Pleeeeeze, Dems, give us we need so desperately!

If Obama doesn't like it, just pass it and dare him to veto it!

Ya know, it just might save your jobs in Congress.

Medicare for All...with a robust private option.

*Well, maybe the Big Health Insurance Parasites might be ticked...Big PhRMA worried.... What's not to like???

My bolding.  


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