Tag Archives: public option

The Democrats’ Lost Opportunity on Health Care

Writing in Kaiser Health News, Jonathan Cohn of the New Republic makes an important point about the process of health care reform. If Obama had not been so intent on winning bipartisan support, Cohn contends, the Democrats could have won the day without making the kinds of backroom concessions–including the so-called cornhusker deal in Nebraska–that have served to alienate even some supporters of reform. Here’s Cohn’s argument:

Remember how we got to this point–and how far President Barack Obama and the Democrats have gone to accommodate Republicans and the conservatives they represent. The plan Obama outlined on the campaign trail, the one Democratic congressional leaders endorsed, called for making sure nearly every American had insurance. But accomplishing that would have cost well over $1 trillion over 10 years and, by some estimates, closer to $2 trillion. That was more than conservatives could stomach. To get the price tag down below $1 trillion, they settled on a plan that covered far fewer people.

The original Obama and congressional plans all called for creating a public insurance option, into which people could enroll voluntarily. But that proposal, too, ran afoul of more conservative sensibilities–and was summarily dropped. (The House ended up including a public plan as part of its bill, but House leaders signaled long ago their readiness to drop it in order to reach a compromise with the Senate.)

These moves didn’t make health care reform more popular. If anything, they had the opposite effect. A plan that spent more money would have required finding more offsetting revenue or savings. But it also would have provided clearer, quicker benefits for middle-class people–many of whom now fear the bill does too little to improve their lives. As for the public plan, poll after poll has shown that it is popular. And the really crazy thing is that the Democrats might have been able to keep both features–with, at most, minimal compromises–if only they’d been willing to go it alone, the way the critics insist they did.

Under Senate procedures, the Democrats had the option of passing health care reform, or at least many of its elements, through what’s called the reconciliation process. In reconciliation, a simple majority of senators can pass a bill, without the threat of a filibuster. Rules limit what can and can’t be considered during the process, so it has definite drawbacks. But if Democratic congressional leaders were determined to pass something on their own–the way, say, Republican congressional leaders were frequently during the Bush years–they could have gotten much and maybe most of what they wanted.

But they didn’t–in no small part because they didn’t want to act in such a blatantly partisan way. Whether that was a matter of principle (i.e, they really believed bipartisanship is important) or a matter of perception (i.e., they thought voters would get mad), it ended up constraining them all year long. Instead of wrapping up negotiations and passing bills before the summer was over, the process dragged into the fall and winter. Over and over again, Democratic leaders (particularly Senate Finance Chairman Max Baucus) reached out to Republicans, only to be rebuffed. When that didn’t work, they were left trying to deal with the most conservative members of their own caucus–culminating in the negotiations with Nelson and the promise to cover his state’s Medicaid expansion. If Senate Democrats hadn’t needed Nelson’s vote to break the expected Republican filibuster–if they could have passed health reform with a “mere” 59-vote majority–they could have told Nelson to take a proverbial hike. 

Emanuel’s Deal with Lieberman: Another Step Down the Road to Tepid Health Care Reform

It wouldn’t take a rocket scientist to figure out that Harry Reid’s Medicare buy-in scheme would be DOA in the political mud of Washington. Still, that Rahm Emanuel would surface to order the Senate to cut a deal with  perennial spoiler Joe Lieberman, as Politico this morning reports, just confirms the snake oil salesman has been at the heart of this entire creeped-out process. Politico reports:

 Lieberman threw health care reform into doubt Sunday when he told Reid that he would filibuster the bill if it allowed Americans ages 55 to 64 to purchase coverage in Medicare. His comments on CBS’s “Face the Nation” set off a series of private meetings Sunday between the Senate leadership and top White House aides, including Chief of Staff Rahm Emanuel, who encouraged Reid to cut the deal with Lieberman, the official said. The White House declined to comment.

The idea that Joe Lieberman could singlehandedly block the big health care reform bill with a filibuster announced on a Sunday morning talk show is pretty preposterous. Everyone knows Lieberman is a spoiler and that  he will change his position at the drop of a hat—anything to enhance his political position. Emanuel is using him as a foil. 

The political strategy for winning  the  timid health care reform now on the table  has depended from the beginning on Obama encouraging liberals by signalling  his backing for a public option or some co-op look-alike, thus laying out some raw red meat to be attacked by Dick Armey’s camp. Then as opposition mounts to rampant socialism, the Dems back down in seeming “compromise’’ or abject “defeat’’—take your pick–allowing the center right Democrats in the Senate to push ahead to victory with one or two Republicans in tow. 

Remember, from the very beginning Obama never committed himself to any specific form of legislation; he only said that he wanted some kind of a health reform bill. And sooner or later, that’s what we’ll get.

Docs Discover New Socialist Plot

It took a couple of days, but sure enough, the hospitals and doctors recovered their senses to see the Reid-proposed Medicare buy-in as, Oh My God, back-door socialism. In place of an enfeebled public option, now beaten to death in the back rooms of the Senate, the Dems are  proposing to make the biggest single-payer medical enterprise in the United States even bigger. Never mind that the buy-in would cost more than most people could afford; it’s still a step down the slippery slope to socialized medicine. As the Washington Post writes Friday morning:

The 10 moderate and liberal Democratic senators who negotiated the tentative agreement regarded the buy-in as a compromise. They dropped the idea, central to the health-care bill adopted by the House, of a government-sponsored insurance system. Instead, the buy-in would provide a new public alternative to people within a 10-year age span.

Some critics characterize this approach as disingenuous. “This was in the context of an alternative to a public program, when [Medicare] is . . . perhaps the biggest public program in health care in the universe,” said Richard J. Pollack, executive vice president for advocacy and public policy for the American Hospital Association, which sent out an alert urging hospitals nationwide to complain to their members of Congress.

AARP, health insurance mogul and self proclaimed voice of the geezer, nixed the idea. From the same article:

“I just don’t see it being that popular,” said John Rother, executive vice president for policy and strategy for AARP, an enormous lobby for people 50 and older.

He and others said it remains unclear whether the program would be designed with the same health benefits, co-payments by patients, or access to private health plans and supplemental coverage as the rest of Medicare. Depending on such details, Rother said, “it’s not even Medicare, but that’s a brand name everyone likes.” Still, he said, AARP always has favored the creation of a buy-in, as long as it would not worsen the Medicare system’s already shaky finances.

Then came the kiss of death. Yesterday, Nancy Pelosi came out for the buy-in.

Abortion Defeat and Liberal Cave-in Move Health Care Bill Towards Passage

With the Senate Tuesday afternoon rejecting tough anti-abortion rules passed by the House with a 10 vote margin, and the public option withering away, Obama’s spindly- legged health care reform may have broken through the barriers set up by the right. Needless to say, this required abject unconditional surrender of the liberals. Reuters reports the abortion vote with a note on the public option:

The amendment would have blocked people who receive federal subsidies from buying insurance plans that cover abortions and prohibited a proposed government insurance plan from offering abortion coverage in most circumstances.

The issue of a government-run insurance plan might be moot as Senate negotiators worked on a deal to substitute a non-profit plan operated by private insurers but administered by the Office of Personnel Management, which supervises health coverage for federal workers.The abortion issue and the government-run insurance plan, which some moderates had opposed, are the two biggest stumbling blocks to passage of a sweeping healthcare overhaul that is President Barack Obama’s top domestic priority.

Senator Ron Wyden: Public Option Now Meaningless

I have recently argued that the public option is now so weak and diluted that it really doesn’t amount to much. Trudy Lieberman of the Columbia Journalism Review, among the few writers to find her way through the blizzard of misleading press accounts on the subject, has done an interview with Oregon’s Senator Ron Wyden that includes his own takedown of the current public option. Here is what Wyden says:

The House public option would cover six million people and the Senate three to four million—roughly one out of eight people. United Healthcare has seventy million policyholders. Why haven’t the American people been told that under ten million would be eligible? How can six million people hold United Healthcare accountable? You never see the press writing how virtually nobody would be eligible…. I think people will be flabbergasted by the idea that the typical person is going to be virtually defenseless against the insurance companies.

The battle over the public option Wyden says, has become a meaningless political exercise, promoted by the media’s inadequate coverage of health care reform. “It’s all about the horserace and a lot of the rest is about personalities….[The press’s] idea is liberals for and conservatives against. It’s the clash on Capitol Hill over the public option. The public hasn’t been informed.”

Wyden thinks this pitched battle has distracted attention from the real issue, which is that for the “typical consumer,” health reform will change things “very little.” He believes that even if a reform bill is passed, millions of people will still not be able to afford decent insurance–with or without a public option, and with or without the proposed federal subsidies. This is because lawmakers are unwilling to seriously regulate the costs incurred by insurance companies and the rest of the profit-driven health care industry. So the entire “reform’ is ending up as a subsidy to the insurance industry. Wyden says this:

RW: If you don’t have cost containment, you can’t get affordability. Lack of cost containment flows from an unwillingness to make the special interests hold the costs down. If you don’t have real cost containment and just tell the special interests we’re going to guarantee markets and subsidies, you’re in a vise. The [comprehensive] benefits are not there.

TL: Will people still be underinsured when illness strikes?

RW: Nobody has guaranteed all Americans good quality, affordable health care. There’s no question that, under the bill, underinsurance will remain a very substantial problem. Bankruptcies will still continue. People will be paying nineteen percent of their income out-of-pocket on health care—even people with subsidies. This is going to take a toll when you’re falling farther and farther behind every year. I’m very, very concerned with the issue of underinsurance.

Ignagni v. Obama: Another Victory for the Health Insurance Industry

For months, even as other Democrats fell by the wayside, Nancy Pelosi has been saying she wouldn’t put through health reform without a “robust” public option. Instead, she this week agreed to a provision that would make any public plan weak to the point of meaninglessness.

In announcing the House Democrats’ health reform plan, Pelosi made it clear that she has abandoned any ideas that the public option’s payment rates should be based on Medicare rates, or otherwise standardized and set by the government. Instead, the government-run  insurance plan will negotiate rates with doctors and hospitals, just as the private insurers do.

What this means is that plan rates under the public option will be pegged to those of the insurance industry, eliminating any real chance that the public option will bring down health care costs by “competing” with the private companies. There is no waffling here. Just complete capitulation to private industry.

Pelosi apparently gave in under pressure from members of her own party. But the real winner in the health reform debate are not the so-called moderate Democrats, or the Republicans, and certainly not Obama or Pelosi or Harry Reid. It is Karen Ignagni, president and CEO of America’s Health Insurance Plans. She called the politicians’s bluff—and won.

She knew from the very beginning, as did most of Washington, that the profit-making industries who control the American health care system would emerge victorious. Billy Tauzin, mouthpiece for Big Pharma, whined about Obama’s duplicity but sat tight, knowing the drugmakers had in the end gotten a sweet deal. Ignagni, likewise, didn’t make threats. She waited, then executed her own double-cross and  amidst  liberal yelps ran right through the opposition without a scratch.

Could anyone have blocked Ignagni’s breakaway run? Not in this crew, that’s for sure. LBJ would have stopped her. Liberals scorn Johnson because of Vietnam. But LBJ had a domestic program that he never lost sight of, and that he refused to concede enitrely to the power of corporate America. It was Johnson, after all, who got the bill creating Medicare through Congress, over the objections of the AMA and a lot of other powerful interests. Neither Pelosi nor the  oh-so-clever Rahm Emanuel has Johnson’s dealmaking abilities–or his spine. 

“Billionaires for Wealthcare” Serenade the Insurance Industy

Remember the Billionaires for Bush? They’re back, reincarnated under the new title Billionaires for Wealthcare, with the stated mission:  “We’ll do whatever it takes to ensure another decade where your pain is our gain.”

In their best stunt so far, a group of well-dressed moles from BFW infiltrated a meeting of the industry shill group America’s Health Insurance Plans (AHIP). In the middle of a speech, they burst into song, in an homage to the public option scored to the theme of the Broadway show “Annie.” They managed to get to the end of their song before they were escorted out of the room. Here’s their performance, with commentary from Rachel Maddow:

You can find more videos at the BFW web site. In this one, the billionaires stage a mock counter-protest at a pro-health care reform rally in New York, carrying signs that say things like “Survival of the Richest” and “If We Ain’t Broke, Don’t Fix It”—and never once breaking character.

And here they are arriving in a stretch limo at a “tea party” in San Diego—where they turn out not to be the most outrageous members of the crowd.