Today, President Obama will spell out his vision for health care reform before a special joint session of Congress. The president's speech marks the final phase of health care reform. This is Obama's last chance to recapture the momentum that Democrats lost to corporate-backed town hall hooligans and misinformation during the August recess.
The Uptake asks movers and shakers in Minnesota what they want to see from the president today (video above). Rep. Keith Ellison (D-Minn) says he wants to see the president explain why the public option is necessary to hold down costs, and reassure them that the public option will not threaten private insurance or lead to cuts in Medicare. "It's going to be the biggest moment of his presidency," Ellison tells the Uptake, "I hope he makes it a Roosevelt moment, a Kennedy moment, a Lincoln moment, because I think he has the ability to do that."
Devona Walker of New America Media on what Obama needs to do today: Explain the plan clearly, enforce party discipline, and convince the public that reforming health care is the only way to reduce deficits in the long run.
Brooke Jarvis of Yes! Magazine offers a history lesson on why so many presidents have tried and failed to achieve universal health care:
In each case, says historian Beatrix Hoffman, "the relentless opposition of medical, business, and insurance interests pushed reformers to design health care proposals around placating their opponents more than winning popular support. In turn, ordinary people had trouble rallying around complex proposals [that didn't recognize] a universal right to health care."
The root of the problem, Hoffman says, was that the proposals came from elites who sought to compromise with interest groups, where they believed real power lay, rather than to ally with grassroots movements.
In the Progressive, Cristina Lopez argues that, while everyone needs affordable high quality health insurance, Latinos and women are most in need of a public option because they are at greater risk of being uninsured and unable to afford private insurance.
Josh Marshall of Talking Points Memo wonders if the Democrats are courting disaster by forcing people to buy heavily subsidized private insurance with no public option to reign in costs:
Am I the only one who thinks that if the Dems pass a bill with mandates and subsidies for poor and moderate income people to purchase it but no public option or competition with the insurers, that it will be pretty much a catastrophe for the Democrats in political terms?
You 'solve' the problem of the uninsured by passing a law forcing them to buy health insurance which, by definition, most a) cannot afford or b) are gambling they won't need because they're young and healthy. Either you end up with low subsidies which still leave it onerous to buy, thus creating a lot of disgruntled people, or you get generous subsidies, which cost a lot of money.
The health care reform battled has created deep divisions within the Democratic Party. Tonight, the president will pick his side. Will he stand with the progressives for a public option, or will he back the Blue Dogs and their watered-down, politically risky compromise proposal? Keep your eyes on tomorrow's Pulse for the post-game breakdown.
This post features links to the best independent, progressive reporting about health care and is free to reprint. Visit Healthcare.newsladder.net for a complete list of articles on health care affordability, health care laws, and health care controversy. For the best progressive reporting on the Economy, and Immigration, check out Economy.Newsladder.net and Immigration.Newsladder.net. This is a project of The Media Consortium, a network of 50 leading independent media outlets, and created by NewsLadder.
Will healthcare reform include a public health insurance plan to compete with private health insurance? President Obama campaigned on the promise of a public option, but over the past week he and his top advisers have repeatedly signaled that they aren't willing to fight for it.
On Saturday, Obama told a town hall meeting in Colorado: "Whether we have it or we don't have it, [the public option] is not the entirety of health care reform. This is just one sliver of it, one aspect of it."
"I don't understand why the left of the left has decided that this is their Waterloo," an unnamed senior White House official gripes in this morning's Washington Post.
The White House is sorely mistaken if it thinks that the public option belongs in the "nice but not necessary" category. Josh Holland of AlterNet explains why the public option is the pillar of healthcare reform. Without it, there's little hope of containing costs or reigning in the power of insurance companies:
It may be just one "aspect" of health reform, but without it, the legislation promises to be a massive rip-off; a taxpayer give-away of hundreds of billions of dollars to an unreformed 'disease care' industry.
The industry would get millions of new customers thanks to generous government subsidies and a law requiring that (almost) everyone carry insurance. And that windfall would come without the structural changes needed to bend the medical "cost curve" in years to come -- without any provisions that might endanger the industry's bottom line.
In Salon, Robert Reich agrees. Competition between private insurance companies and the public option is the only hope to controlling costs. A public plan could bargain with providers to reduce costs and pass the savings on to taxpayers. The private insurance industry would have to slash its prices to compete.
Without a public option, "reform" would likely involve subsidies to private insurance companies, temporarily dulling the pain as premiums rise unchecked. That's the worst of both worlds.
Progressives shouldn't be surprised at the White House's noncommittal stance, though. Obama campaigned on a public option, but he has always framed it a darned good idea, not as a non-negotiable demand.
Why is it so difficult to get a healthcare bill through the Senate with the supposedly filibuster-proof majority? The simple answer is that the Dems need 100% of their delegation to cooperate in order to break a filibuster. So, the Democrats have 60 seats in the Senate but no way to advance their agenda without capitulating to the conservative Blue Dogs. The Republicans can be counted on to filibuster whatever the Democrats come up with. Which means that conservative Democrats like Sen. Max Baucus (D-Mont.) hold the balance of power.
As Ari Melber of The Nation explains, Baucus and his Republican counterpart Sen. Chuck Grassley (R-Iowa) also rule over the powerful and conservative Senate Finance Committee, which has been tasked with writing the Senate version of the healthcare bill.
Also in The Nation, Tom Geoghegan argues that it's time to break the stranglehold by abolishing the procedural filibuster. Unlimited debate in the Senate is enshrined in the constitution. In an old school filibuster, senators simply refuse to shut up until the session ends and the bill dies without a vote. In 1975, a group of liberals wrote a rule of Senate procedure that effectively allows senators to "filibuster" simply by saying they want to. In the old days, a filibuster was a grueling public ordeal. Senators slept on cots and spelled each other off. Today, "filibustering" means signing a form. It's private, easy and cost-free. The Republicans can, and will, filibuster all major Democratic legislation without having to stand in public and risk being branded as obstructionists.
As a result, 60 is the new 50 in the Senate. Since it's just a rule, the procedural filibuster could be abolished by a simple majority vote. Friends of the filibuster defend it as a bulwark against tyranny. Abolishing the procedural filibuster would discourage frivolous obstructionism, but keep the filibuster for cases when legislators actually care enough to lose sleep over it.
Ever wonder why the strongest public option, single-payer, was never on the table? Maybe because even the strongest proponents of the public plan are taking money from the insurance and biomedical industries. Mother Jones Rachel Morris wants to know why UNITEDHealth consultant Tom Daschle was on Meet the Press Sunday. A former Democratic senator, Daschle is a senior adviser to Obama on healthcare reform and a leading advocate of a public plan. However, he recently resumed a private consulting arrangement with UNITEDHealth, America's largest health insurer. Even public plan champion Howard Dean is a strategic adviser on healthcare policy to the lobby firm of McKenna, Long, and Aldridge. Dean won't disclose his clients, but McKenna represents a number of clients in the biomedical and health science industries.
The prospects of a public option are dimming, but not necessarily because of any rapid about-face by the White House. The Senate bill is in the hands of the Blue Dogs, who say they won't have legislation until November. Obama won't put the screws to the Blue Dogs, but there's still plenty of time to for citizens to make their voices heard.
This post features links to the best independent, progressive reporting about healthcare and is free to reprint. Visit Healthcare.newsladder.net for a complete list of articles on healthcare affordability, healthcare laws, and healthcare controversy. For the best progressive reporting on the Economy, and Immigration, check out Economy.Newsladder.net and Immigration.Newsladder.net. This is a project of The Media Consortium, a network of 50 leading independent media outlets, and created by NewsLadder.
Progressives are demanding that Obama's healthcare reform package include a public plan, aka a government-administered health insurance option for all. A good public plan would cover more people while cutting costs and improving care. The key committees in the House drew up a bill with a public option, but the Senate is much less friendly to the idea. The real test of a healthcare reform plan is whether it can pass the Senate, as the House Dems have the votes to pass whatever health reform bill is put before them.
But not all public plans are created equal. There's a fine line between competing with insurance companies and coddling them. In the American Prospect, sociologist Paul Starr identifies potential pitfalls for a public plan. Since his days on the campaign trail, Obama scored political points by framing public health insurance an alternative to employer-based private coverage. It sounds non-threatening: If you like your coverage, keep it. If not, go public.
There's a catch, of course: Employers would get to choose to offer private health insurance as a benefit or go with a public plan.
Insurance is a boring form of legalized gambling. The whole system depends on healthy people paying into the system to cover a small minority of sick people. The higher the ratio of healthy people to sick people, the more widely the risk is spread and the cheaper the insurance will be.
Insurance companies love the employer-provided health insurance model because it's a built-in sicko filter. You're not even on their radar unless you're young and healthy enough to have a job. Employers with older, sicker employees pay more for private insurance. Starr predicts these employers will be more likely to drop their private health insurance if a public plan is available.
As a result, the sicker workers will join the unemployed and the elderly on the public plan, leaving the lucrative low-risk customers for the insurance companies. But the public plan needs a base of healthy payers in order to function as a self-sustaining insurance program.
Maybe we could overcome this obstacle if government were willing to use all its leverage to drive down costs, but most the proposals don't do that. Unless the government gets tough with vested interests, the public plan could end up subsidizing inflated healthcare costs while the private insurers make even more money.
How did employers end up providing insurance in the first place? Currently the tax system encourages employers to pay their employees in overpriced insurance instead of cash. Employees save on taxes if their employer pays for their policy, rather than giving them an equivalent cash raise. Some influential senators want to offset the cost of healthcare reform by taxing healthcare benefits worth more than a certain amount--about $17,000 per family per year, according to one proposal. So, if your health insurance was worth $17,500, you'd pay zero tax on the first $17,000 but you'd be taxed as if you'd earned that extra $500 in wages.
Organized labor vehemently opposes taxing benefits because they say it would amount to a big middle class tax hike. Even so, as Josh Holland explains for AlterNet, if the money went to fund a good public plan that drove down costs through economies of scale, the net result could be more money in the pockets of working people. Wages have stagnated but labor costs have risen, partly because employers are paying ever-increasing rates for health insurance. If employers can cover their workers for less, that's money freed up for cash raises.
All sides in the healthcare debate claim to love competition. Opponents of public options warn that government solutions will hurt healthcare by undermining the free market. However, as Josh Marshall of TPM observes, the status quo is not a free market but an oligopoly:
This won't come as the slightest surprise to those versed in health care policy issues. But I fear it's only barely permeated the health care reform debate in the country, certainly in Washington. And that's this: the opposition to a so-called 'public option' comes almost entirely from insurance companies who have developed monopolies or near monopolies in particular geographic areas. And they don't want competition.
Steve Benen of the Washington Monthly agrees that despite their high-minded pro-consumer rhetoric, the health insurance industry opposes both choice and competition.
This week the Senate Health, Education, Labor and Pensions Committee (HELP) is circulating draft legislation for a nationwide, government-administered plan which would sustain itself with premiums, after an initial infusion of cash to get the program off the ground.
Under the HELP bill, unlike the House's healthcare plan, fees for healthcare providers would not be indexed to those offered under Medicare. Instead providers would be paid the average rate for a particular service based on the higher rates currently offered by private insurers. You're probably wondering: How are we supposed to save money if we lock into the same high fees that caused the problem in the first place? Good question! Medicare rates are lower because the government uses its massive bargaining power to get the best possible deal for the taxpayer. It's the CostCo principle: Buying in bulk saves money. But once again, special interest groups are refusing to let the government save our money.
Meanwhile, Sen. Kent Conrad of Senate Finance Committee is pushing for a private non-profit insurance-buying co-ops instead a public plan. The idea is that larger buying pools will be able to negotiate better deals on health insurance for their members. But if the goal is to leverage the bargaining power of a group, why stop at a co-op of just a few hundred thousand people? Why not put everyone into one huge, government-administered co-op for the best possible prices. Because, we're told, that would be single payer, or a stalking horse for single payer, and everybody in Washington knows that you can't pass a bill like that. The insurance companies and health care providers want to keep rates high.
Finally, Al Franken has officially won the Minnesota senate race. When Franken is seated, the Democrats will have 60 votes in the Senate, in theory a filibuster-proof majority. However, as Marie Diamond points out at TAPPED, the Democrats need every single senator present and voting to force cloture and break a filibuster. With Robert Byrd and Ted Kennedy in failing health and Blue Dog Democrats in failing loyalty, the Dems can't take a filibuster-proof majority for granted on any given day, even when Franken is seated.
This post features links to the best independent, progressive reporting about health care. Visit Healthcare.newsladder.net for a complete list of articles on healthcare affordability, healthcare laws, and healthcare controversy. For the best progressive reporting on the Economy, and Immigration, check out Economy.Newsladder.net and Immigration.Newsladder.net.
This is a project of The Media Consortium, a network of 50 leading independent media outlets, and created by NewsLadder.
Healthcare reform is back in the news, as Legislators and interest groups spar over the promised public component of Obama's healthcare plan. In very simple terms, this is a fight between groups with a vested interest in expensive healthcare and everyone else. This week, the American Medical Association warned Obama that a public plan could restrict patient choice. But for millions of Americans, getting a choice between healthcare and no healthcare wold represent a 100% increase in their healthcare options. Obama's public plan would also give people the choice of keeping their private health insurance. So, the public plan is an additional option, not a diminution of options.
That was quick: It took just three days for the titans of the healthcare industry to reveal the emptiness of their pledge to the Obama administration to save $2 trillion in healthcare costs over the next 10 years.
We've been noticing in the past week a little pushback from Democratic Senators on the public option for healthcare. Specter and Nelson flatout said they would oppose it, with Nelson saying he would actively get a coalition of centrist senators to make sure it wouldn't pass. You also had Chuck Schumer talking about watering it down (although i don't think this was as a big a deal as some) and Max Baucus reiterating his previous position that a public plan was not necessary to achieve halthcare reform.
It seems the Obama team may be getting the message and is becoming more assertive on this issue. First we heard the president in his press conference say that he was for a public plan and that republicans should not oppose entire healthcare legislation because of a public plan, rather they should find other places where they agree like malpactrice suits and so forth. It was important that he framed the public plan as an example of a philisophical difference that could not be bridged but that should not be a point of negotatiating either. He then went on to say that "the majority party will probably win out in cases were we simply have philosophical differences", which would mean a public plan would be included.
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