Saturday, July 11, 2009

A Health Care Saturday

Rep. Keith Ellison does good in this video, and in Congress.
SGW: More Like "Yellow" Dogs
Ed Schultz just proved my point this evening when he challenged two Blue Dog Democrats in the House on whether or not they support a strong public option. As soon as he pressed them on the issue both of them folded up like cheat tents.

Nancy Pelosi and the rest of the leadership of the House should take a look at this video and realize that these clowns will NEVER vote against health care reform when it comes up for a vote. They are cowards and this is one time that it works in our favor!

TNR's Jonathan Cohn has a nice scoop, which offers good news to those of us who want to see a public option included in health care reform.

According to a pair of Capitol Hill sources, preliminary estimates from the Congressional Budget Office suggest that a strong public option -- the kind that the House of Representatives is putting in its reform bill -- should net somewhere in the neighborhood of $150 billion in savings over ten years.

The sources cautioned that these were only the preliminary estimates, based on previous discussions -- that CBO had not yet issued final scoring on language in the actual bill. But the sources felt the final estimate would likely be close.

One of the biggest concerns for policymakers is making the reform package affordable. If a CBO score shows a public option creating $150 billion in savings over 10 years, it's a very big deal, and will be hard for even Blue Dogs to overlook.

Indeed, word of this comes just as Rep. Loretta Sanchez (D-Calif.), a member of the Blue Dog Caucus, announced that she'll support a public option as part of reform. Sanchez told MSNBC this morning, "I am one of those people who believes that we should be required to have a public option because it will bring the costs of health care down."

Here's hoping she isn't the last "centrist" Democrat to come to this conclusion.

Ezra Klein: The CBO Tells People to Calm Down About the Public Plan

Jon Cohn reports that preliminary Congressional Budget Office estimates suggest that a "strong" public insurance option would save $150 billion over 10 years. His sources think the CBO will find the same thing when they score the House health-care reform bill. If so, that would be good news for supporters of the public-insurance option.

It's important to remember, though, that this really is preliminary. As I understand it, this is an expected score of the public option on its own. The final score will go up or down depending on the interactions between the public option and other elements of the final bill. If the Health Insurance Exchange is open to only the uninsured and small businesses, for instance, then fewer people will have access to the public option, and so there will be less savings. Conversely, if the exchange is large, and dominated by the public option, then CBO might decide to put all dollars spent in the exchange on the federal budget. That could increase the "cost" of health-care reform by trillions of dollars, making it look like the public insurance option is expensive, even as it's actually saving $150 billion. Thus does budgetary accounting rule our world.

If the $150 billion estimate is accurate, however, it's interesting proof of another point: the public insurance option is not the End of Days for private health insurers nor eternal salvation for consumers. Saving $150 billion over 10 years is saving $15 billion a year. On Wednesday, the hospitals voluntarily agreed to provide $155 billion in savings from reduced Medicare reimbursements. No one thought that a particularly big deal. It was probably a good thing, but it wasn't proof of final success or ultimate failure for health-care reform.

So too with the public plan. Conservatives saying that a policy that will save $15 billion a year will end American health care -- or, as Rep. Paul Broun would have it, "kill people" -- have jumped off the deep end. Liberals who have invested all their hopes in the public plan might also be a bit disappointed. The CBO score seems to imply the likeliest of all possible outcomes: The addition of a public insurance option is a good, but modest, change to the health-care system.

It's been a tricky week for health care in the Senate, with disputes over funding, filibusters, and whether Republicans are even worth engaging in negotiation. At least there's the House, where reform has been progressing fairly smoothly lately.

It's a shame that progress hit a pothole yesterday.

The plan was for House leaders to release a real, live draft of reform legislation last night or today. That schedule has been temporarily scrapped, in light of new concerns from a wide variety of Democratic factions.

On Wednesday and Thursday, House Democrats of every stripe filled the speaker's mailbox with a torrent of missives to make their case for what they do and don't want in the legislation -- all while tax-writers struggled to agree on ways to pay for it.

* Forty members of the conservative Blue Dog Coalition -- representing just enough votes to kill a party-line vote -- articulated their "strong reservations about the process and direction" of an early preview of the bill offered by chairmen of the Energy and Commerce, Education and Labor and Ways and Means committees.

* A pair of junior members of the House garnered 60-plus signatures on a letter siding with prescription-drug makers and President Obama and against the call of Energy and Commerce Chairman Henry Waxman (D-Calif.) to reinstate some price controls.

* A group of 22 wayward New Democrats expressed their hope that government-sponsored health coverage would piggyback on Medicare's pre-existing network, despite earlier opposition to the idea from caucus leaders.

* And finally, a mix of 20 rural and Western Democrats made their case for why the bill should fix inequities in the reimbursement rates Medicare pays to health care providers in "low-cost, high-quality" states.

Of particular interest are the concerns of the conservative Blue Dogs, because their numbers are strong enough to derail the overall effort. Their demands include, but are not limited to, significant changes to the employer mandate and, predictably, more outreach to Republicans.

Democratic leaders suggested these factions' concerns can and will be addressed, and will cause only a brief delay. Indeed, they said we can expect the rollout of the completed draft legislation as early as Monday, with an August deadline still in sight.

We'll see.


Rep. Paul Broun, a right-wing Republican from Georgia, spoke from the House floor this afternoon, to explore his opposition to a public option in health care reform. He concluded that a public plan would kill Americans.

"...and that's exactly what's going on in Canada and Great Britain today. They don't have the appreciation of life, as we do in our society, evidently. And, um. Dr. Roe, a lot of people are gonna die, this program of 'government option' is being touted as being this panacea, the savior of allowing people to have quality health care at an affordable price -- is gonna kill people."

There are bad arguments, there are blisteringly bad arguments, and then there's the nonsense Paul Broun spews.

In addition to the obvious problem of comparing reform efforts in the U.S. to creating a Canadian/UK system -- that's obviously not what's being proposed -- the argument itself is ridiculous. As the Media Matters Action Network explained, "Besides absurdly stating that the public option will 'kill people,' Rep. Broun's ham-handed transition between the health care systems of Canada, the UK, and the US is mind-boggling because those countries' systems are not a model for US health care reform. And in addition to being wrong about their health care delivery systems, Rep. Broun apparently isn't aware that Canada and Great Britain both enjoy a lower infant mortality rate and longer life expectancy that the United States."

If Broun's name sounds familiar, he is perhaps best known for telling reporters late last year that he feared that President Obama might establish a Gestapo-like security force to impose a Marxist dictatorship on Americans. He added at the time that Obama, of course, reminds him of Hitler.

Two weeks ago, Broun also insisted that global warming is "hoax," and cited a made-up statistic about the cost of ACES.

Peggy Noonan wrote this morning that we're in an era in which the nation needs "conservative leaders who know how to think" and a Republican Party that is "serious, as serious as the age, because that is what a grown-up, responsible party -- a party that deserves to lead -- would do."

She wasn't talking about Broun specifically, but it'd be great if he took this to heart anyway.


Most of the time, mainstream politicians from both parties are reluctant to publicly criticize programs like Medicare. It's a popular mainstay of American society, providing health care to retirees.

It was interesting, then, to hear Rep. Roy Blunt (R) of Missouri suggest yesterday that Medicare never should have been created in the first place.

"[Y]ou could certainly argue that government should have never have gotten in the health care business, and that might have been the best argument of all, to figure out how people could have had more access to a competitive marketplace.

"Government did get into the health care business in a big way in 1965 with Medicare, and later with Medicaid, and government already distorts the marketplace."

Blunt went on to argue that he'd like to see "people have many more options," just so long as those options are limited to unregulated private insurance companies.

It's a reminder of how the status quo can trip up GOP leaders. The current system already has the government playing a role in making health care available to the elderly, military personnel and veterans, the poor, and low-income children. None of these developments have ushered in the collapse of capitalism or a dystopian bureaucratic nightmare for consumers. It puts Republicans in the position of having to explain why it's fine for the government to play a health care role in some contexts but not others.

Or, conversely, as Blunt demonstrates, it puts them in a position of having to argue that even Medicare was the wrong way to go.

And who's Roy Blunt? He's not only the leading Republican candidate for the Senate next year, he's also the man leading the Houses Republican caucus' "Health Care Task Force."

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