Tuesday, September 29, 2009

Health Care Tuesday: superduper legitimacy Edition


Aravosis: Baucus bill would let private group, with ties to industry, write the rules for implementing the entire health care bill 
The Los Angeles Times has the story. Anybody have any thoughts about that?

Kurtz (TPM): Who's Legitimate Now?
Anything less than a superduper majority of 65 votes for health care reform in the Senate will not be legitimate, Sen. Ben Nelson (D-NE) tells voters back home.
For the record, Nelson first won election in 2000 with just 51% of the vote and won re-election in 2006 just shy of his new superduper legitimacy standard, with 64%.
  •  Greg Sargent adds: 

    It would be interesting to ask Nelson whether he sees the 65 number as a self-evident truth, rather than a bar he arbitrarily created himself. Keep in mind, this isn’t the first time Nelson has presented himself as a passive observer of the process, rather than an active member who’s declarations and actions influence what happens. He recently said that including a public option would cause reform to “implode,” without acknowledging that his opposition to a public plan would help make this outcome more likely.
    When you throw in Nelson’s declaration of opposition to reconciliation, this latest really is tantamount to saying that the majority shouldn’t rule unless an arbitrary number of Republican Senators greenlights it. Not sure how else you would read it.

Think Progress: New poll finds that public support for health care reform has substantially increased since the summer. 
During the summer, many on the right claimed that raucus meetings at town halls showed Americans had turned against health care reform. Politico reported, “Democrats lost the month of August — not just in the polls and at town hall events but also within their own caucus.” Rep. Jack Kingston (R-GA) said the GOP is “going to keep the nightmare going through the fall.” But today, the Kaiser Family Foundation released its latest poll of public opinion on health care reform that shows that voters are actually more enthusiastic about reforming our broken health care system than ever. The poll finds that 57 percent of Americans now find health care reform “more important than ever,” a marked increase since August:


Sargent: New Ad Bashes Insurance Giant Humana, GOP For Frightening Elderly
The battle over insurance giant Humana hits the airwaves in this entertaining new ad from a top White House ally, Americans United for Change, which slams Humana — and its Republican defenders — for misleading seniors about how reform would impact their Medicare:

The ad is running in D.C. and in Louisville, Kentucky, the home state of Humana and one of its leading Congressional defenders, Senator Mitch McConnell.
The spot tries to turn Humana’s widely-reported letter warning seniors about Medicare — which Dems have condemned as a scare tactic — into a symbol of broader insurance industry and GOP efforts to persuade the elderly that reform proposals represent a real threat to their health care, and by extension, their well being.
“Whether it’s the insurance companies, or their Republican allies, the case against health insurance reform always gets down to one word,” a narrator intones. Meanwhile, the screen flashes, in lurid, scary lettering, the word…
Sully: Republicans ♥ Medicare 
Tom Schaller questions the wisdom of the GOP's entitlement fear-mongering:

Are there not risks to this strategy? Specifically, does it not further cement the GOP's image as an aged, out-of-touch coalition? Also, how is the GOP defense of cuts to Medicare not creating at least some dissonance with the very protesters who turned out for town halls and the recent march on Washington complaining about a too-big government getting bigger? (I suppose I'm presuming that people complaining about big government are, in fact, able to identify such contradictions; surely, some are not.)
This was also something the Tories did as they reeled from the first term of Blair. They actually opposed any real cuts or reform in the welfare state in a desperate bid for some, any, votes. They were obsessed with tactics and forgot even a smidgen of strategy. It took them twelve years to have a shot at governing - and largely because of Labour's failure. The GOP is now defined entirely by opposition to Obama - regardless of the merits of his policies. If you want evidence that the tea-party message is pure phony, look no further. Even Mark "Freedom Or Tyranny" Levin won't risk offending seniors. (Leave it to Pareene.)

Ezra Klein: Is Medicare Advantage Worth It?
The argument over Medicare Advantage is pretty simple: The program, which allows private providers to compete for Medicare patients, was supposed to cost as much or less than traditional Medicare. It actually costs 114 percent of what Medicare costs. Democrats want to eliminate those overpayments and force private insurers to live within Medicare's budget, given that they're taking Medicare's money. Republicans say that will cut benefits for retirees, which is something they're suddenly very concerned about.
On some level, Republicans are right: The reform will change some benefits for a small minority of Medicare's beneficiaries. But will it change it by very much? Austin Frakt, a health economist at Boston University, has studied whether the Advantage program is spending its windfall on patients or profits. The answer? Profits, mainly.
Payment to MA plans has gone way up since 2003. Did the payment increase largely benefit beneficiaries or not? This is a current political and policy debate, about which much has been written in the media (both traditional and blogospheric). It turns out the answer is known and quantifiable. My work (with Steve Pizer and Roger Feldman) shows that for each additional dollar spent by the federal government (taxpayers) on the program since 2003, just $0.14 of it can be attributed to additional value (consumer surplus) to beneficiaries (see also: findings brief).
What do we make of the other $0.86? That goes to the insurance companies but doesn’t come out “the other end” in the form of value to beneficiaries. In part it is accounted for by the costs of the additional benefits and in part it is captured as additional insurer profit.
So, do higher MA payments produce little value to beneficiaries, as Obama claims, or are the benefits they fund important to maintain, as Republicans would have us believe? The balance of the evidence is on Obama’s side. In fact, it is a landslide: for each dollar spent, 14% of the value reaches beneficiaries and 86% of it goes elsewhere (profit or cost).
"Cuts to MA should be a no brainer," he concludes. This is a case, incidentally, where Republicans have lined up in favor of a wasteful government program, where their rhetoric relies on the inviolability of current and future Medicare benefits, and where they are opposing a reform that will improve the deficit over time. It almost makes you miss the purity of the Gingrich crew.
Aravosis: Dorgan will try to blow up Big Pharma backroom deal, let cheaper drugs import from Canada, will save $50 billion by eliminating 300% Rx drug tax
Dorgan's amendment would let cheaper drugs from Canada come into the US, so people like you and me would no longer have to pay a 300% to 500% mark-up on the prescription drugs we buy. The administration scotched this possibility in their secret deal they made with Big Pharma, that was subsequently exposed. It will be interesting to see which politicians vote to have you pay three to five times as much for your prescriptions simply because American pharmaceutical companies have a monopoloy in our market. One could almost call that a prescription drug tax, since it's simply a mark-up that you're paying. Will our members of Congress vote to sustain the 300% Prescription Drug Tax? Stay tuned.
GOP sees political opportunism in old foe Medicare   Senator Bernie Sanders, I-VT, joins Rachel Maddow to try to understand how Republicans can suddenly present themselves as champions of Medicare after actively opposing it for nearly half a century.

Congressional Democrats have made an effort of late to point out the fact that congressional Republicans, despite their "guarantees," have not come up with their own health care plan. Indeed, it's been 104 days since the leadership promised to deliver one.
Yesterday, the Republican Study Committee tried once again to mount a defense.
[T]he Republican Study Committee has tossed this back on Majority Leader Steny Hoyer's lap [Monday], cutting and pasting the GOP alternative, HR 3400, which was introduced July 30. [...]
Rep. Tom Price (R-Ga.), the chairman of the RSC, says Hoyer is "making the certifiably false claim that Republicans have 'not only failed to produce legislation, but they have yet to offer any real solutions or ideas' for health care reform."
Here's a radical idea: maybe the RSC can pretend to be grown-ups about this?
Let's be clear. Have assorted groups of GOP lawmakers presented health care reform proposals? Sure. But when observers note there is no Republican alternative bill, we're talking about legislation embraced by the caucus and its leadership. Price and the Republican Study Committee surely know this, which makes their latest claims, to borrow a phrase, "certifiably false."
There are 177 House Republicans. At this point, 44 of them -- not quite one-fourth of the caucus -- have endorsed the RSC proposal. Of the 44, how many are part of the House Republican leadership? Zero.
"Last time I checked, the House Republican Conference does not have a proposal," Hoyer spokeswoman Stephanie Lundberg said. "When the RSC becomes the leadership of the Congressional Republicans, let us know."
What's more, there's a very good reason most of the House Republicans and all of their leaders have steered clear of the RSC plan: it's truly awful. The proposal is built around tort reform and ridiculously inadequate $5,000 tax credits. Democrats would love for this to be the House Republican plan, and use it as proof of just how little credibility the GOP has on the issue.
But it's not the House Republican plan because House Republicans don't have a plan. In mid-June, they "guaranteed" a bill of their own, but have failed to follow through. Tom Price's whining won't change this.

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