Sunday, October 25, 2009

Health Care Sunday: time to be pissed Edition

It is looking more and more as if Obama is the roadblock to really substantive, cost-cutting reform.  His WH seems to have a fixation on Snowe bipartisanship, rather than getting the best bill possible through Congress.  He is actively working against the public option.  I sent him an unhappy note a few minutes ago - you might consider doing the same at 

Aravosis: Good update on Health Care Reform in today's (Saturday) Washington Post
A good read across the board for anyone wanting an update on the issue. These two paragraphs struck me as particularly interesting:
The Democratic leader pitched the opt-out idea to Obama at a White House meeting Thursday night and received a noncommittal response. Several senior Democratic sources said Obama is wary about alienating Snowe -- the only Republican so far to support a Democratic health-care measure -- and had already concluded that her plan for a "trigger" that would create a public option if private insurers don't offer affordable rates represented a satisfactory compromise.
Why is it a satisfactory compromise? The White House is again doing what it has often been accused of - caving in advance on an issue in order to avoid fighting for something better, something achievable. Why is it satisfactory to settle for less than you can get? The entire point of the "incrementalism" argument is that you can't always get a whole loaf, so sometimes it's better to get a quarter of a loaf today, another quarter next week, and so on and so on. I.e., it's better to get something than nothing. But that's not the dynamic here. It may have been months ago, but not now. Now we have the chance to actually get the whole loaf, and President Obama would prefer we take only half. That isn't incrementalism, it's defeatism, and even reeks a bit of fear. Fear of fighting for anything, ever.
Because a government-run plan would be dedicated to holding down costs and would lack a profit motive, congressional budget analysts predict that it could reduce the cost of expanding coverage to people who don't have it by as much as $100 billion over the next decade.
It's a bit mind-boggling that President Obama wants us to spend $100bn more than we have to over the next ten years on health care reform. Is Olympia Snowe's one vote, when we don't need it, really worth $100bn? Is $100bn so insignificant to this administration that they're willing to just throw it away in order to achieve some PR stunt, which is exactly what trying to get Olympia Snowe's one vote is.

Remember, this is the White House that wasted 40% of the stimulus bill - hundreds of billions of dollars - on near-useless tax cuts in order to get 3 Republican votes, yet today everyone thinks of the stimulus as a Democratic bill, not a bipartisan one. It does Democrats no benefit to blithely reinforce negative stereotypes about how we spend the people's money like drunken sailors. And more importantly, $100bn is a lot of money. The fact that this doesn't even seem to be entering into the administration's calculus on this issue is troubling. They seem rather determined to spend more on something less effective, President Snowe's magic "trigger." Wasting the public's money is not smart leadership, nor smart politics.
Digby: Bipartisan Fail 
The policy wonk who designed the public option explains why triggers are bullshit --- in great, convincing detail:
A workable trigger would, at a minimum, need to achieve three goals: (1) establish a reasonable and measurable standard for private plan performance that sets out clear affordability and cost-containment goals for a specifically defined package of benefits, (2) assess this standard in a timely fashion with information available to policymakers after reform legislation passes, and (3) if this standard were met, quickly create a public health insurance plan that would effectively remedy the situation.

The modifier “quickly” in the third goal is crucial: Runaway health costs are a grave and growing threat to federal and state budgets and to the health security of workers, their families, and their employers. Waiting longer than absolutely necessary for affordable coverage is certain to cause great harm. Indeed, it might actually compound the current crisis. Without an imminent threat of public plan competition, private insurers are likely to raise premiums in anticipation of the implementation of reform—as suggested by AHIP’s recent prediction of big premium increases if reform passes. Delaying a public plan may also jeopardize the cause of reform itself, because requiring Americans to buy unaffordable coverage has the potential to provoke a political backlash. (Polls show that Americans are more supportive of a mandate when they know they will have the choice of a public plan.)
There's more policy details at the link.

Obama simply has to find another way to appease the jackass triplets: Landrieu, Lincoln and Nelson --- and he has to rid himself of the idea that Olympia Snowe brings anything to the table if she refuses a public plan. Her objections are irrational and stupid if cost is her primary concern. And if bipartisanship is the White House's primary concern they should recognize that irrational, stupid Republicans are a dime a dozen and if that's what they want then there are a million ways to destroy health care reform with far more of them on board. Dealing only with Snowe guarantees that failure will completely laid at their doorstep. Why do it?
Nearly everyone watching the debate over health care reform was taken aback late yesterday, puzzled by the purported White House strategy on the public option.
By all indications, Harry Reid has done some impressive heavy-lifting this week, and is this close to locking up 60 votes for a public option with a state opt-out compromise. When Reid relayed the good news to the White House, the president, according a TPM report, not only wasn't thrilled, he began pushing back in the other direction, expressing skepticism about the compromise measure that's generating momentum and touting Olympia Snowe's "trigger" idea, which isn't nearly as good as the opt-out.
So, what's going on? Ezra Klein had a very helpful item yesterday afternoon.
On Thursday night, Reid went over to the White House for a talk with the president. The conversation centered on Reid's desire to put Schumer's national opt-out plan into the base bill. White House officials were not necessarily pleased, and they made that known. Everyone agrees that they didn't embrace Reid's new strategy. Everyone agrees that the White House wants Snowe on the bill, feels the trigger offers a safer endgame, and isn't convinced by Reid's math.
But whether officials expressed a clear preference for the trigger, or were just worried about the potential for 60 votes, is less clear. One staffer briefed on the conversation says "the White House basically told us, 'We hope you guys know what you're doing.'"
Now, it's worth noting the White House has tried to knock down the TPM report. Dan Pfeiffer, a top White House aide on health care policy, told Marc Ambinder, "The report is false."
We'll know more as this unfolds further; right now, there are enough players with enough competing strategies that it's hard to know exactly who wants what and why, and with what timeframe in mind.
That said, I think Jonathan Cohn gets this just right: "The White House wants a public option but it wants a bill even more. It remains convinced that keeping Snowe on board is the surest way to get that. And Snowe wants a trigger. The administration understands that the politics of the public option have shifted, so they are listening to discussion of alternatives. But they're asking a lot of tough questions of those proposing these alternatives. And they're not rushing to change their gameplan."
And as much as I hope the White House seizes the best available opportunity, I understand why the president and his team are hesitant here. The goal line is in sight, and they just want to cross it. Indeed, I'm not entirely unsympathetic to the White House's fears about getting a bill done. If the choice were between a) a good health care bill with a triggered public option; and b) watching the entire reform initiative die, it would be entirely reasonable for the president and his team to cling to what some have begun calling the "Snowe trigger."
But therein lies the point: that's not the choice here. By all accounts, Reid is on the verge of delivering the right bill with the right number of votes. Obama may not be sure that Reid can get and keep 60 votes -- it's what "We hope you guys know what you're doing" is all about -- and the skepticism is fair. But with a little help from the White House, the goal is well within reach.
Mr. President, take "yes" for an answer.
Aravosis: Sen. Harkin: “I’ve not been very happy with the White House’s lukewarm support of the public option" 
Senator Tom Harkin (D-IA) quoted in The Hill this morning:
“I’ve not been very happy with the White House’s lukewarm support of the public option,” [Harkin] said, articulating a gripe liberals have been making for months.

“I would hope the president would speak out more forcefully in favor of the public option,” [Sherrod] Brown said, adding “I expect he will.”
Harkin's quote is interesting because a Democrat is finally on the record saying that the President's support of the public option has been only "lukewarm." I've seen people continue to defend the President, arguing that he's firmly behind the public option. We now have a US Senator, who knows better than anyone the degree to which the President is truly supporting the public option, saying that the President is not.

Aravosis: Huff Post: Obama is actively discouraging Democrats from supporting public option in Senate 
From Sam Stein and Ryan Grim at Huff Post:
President Barack Obama is actively discouraging Senate Democrats in their effort to include a public insurance option with a state opt-out clause as part of health care reform. In its place, say multiple Democratic sources, Obama has indicated a preference for an alternative policy, favored by the insurance industry, which would see a public plan "triggered" into effect in the future by a failure of the industry to meet certain benchmarks.

The administration retreat runs counter to the letter and the spirit of Obama's presidential campaign. The man who ran on the "Audacity of Hope" has now taken a more conservative stand than Senate Majority Leader Harry Reid (D-Nev.), leaving progressives with a mix of confusion and outrage. Democratic leaders on Capitol Hill have battled conservatives in their own party in an effort to get the 60 votes needed to overcome a filibuster. Now tantalizingly close, they are calling for Obama to step up.

"The leadership understands that this is a somewhat risky strategy, but we may be within striking distance. A signal from the president could be enough to put us over the top," said one Senate Democratic leadership aide. Such pleading is exceedingly rare on Capitol Hill and comes only after Senate leaders exhausted every effort to encourage Obama to engage....

"He's been so convinced by his political people from the beginning that we can't get a bill with a public option, he's internalized it. Even though it's now become obvious we can get a bill without selling out the public option, he's still on that path," said a top Democratic source. The White House, he said, continues to assure progressives it'll improve the bill in conference negotiations between the Senate and House, but advocates are unconvinced.

"If we're this close in the Senate and they're not helping us, I have a feeling they could screw us in the conference," said one.
To put this story in context, we learned earlier today that both Democratic Senators Tom Harkin and Sherrod Brown confirmed that the President is not doing enough to support the public option. Harkin called Obama's support "lukewarm." And Brown said he hoped the president would speak out more forcefully in favor of the public option. These are not anonymous sources. They're two Democratic US Senators we like and trust. And they're telling us, publicly, that the President isn't really supporting the public option, and isn't doing nearly enough to help.

It's time to be pissed.
Beutler (TPM): Dean Of House To Nervous Dems: If We Fail On Health Care, We Lose 
In a tense, closed door caucus meeting this morning, during which House Democrats were made to go on the record on the question of whether they'd vote for a health care bill with a robust public option, some of the caucus' most nervous members got a bit of perspective from its longest serving members.
"It was really fairly simple speech," said Rep. John Dingell (D-MI). "All I did was to remind the members that the Republicans are out there to beat us by seeing to it that we accomplish nothing during this Congress especially on health care. It's exactly the same tactic, the same strategy they used in 1993. And I reminded them that that tactic took control of the House from us, because, one of the principal reasons was, we were not able to pass a health insurance bill."
Dingell tells me, "I reminded them that Democrats were divided on the issue. And I told them that if they want to come back and control the Congress they should get behind this bill."
I pointed out that there are 47 million Americans--not 35--that would be able to draw benefits under this. That's not only a moral, but an economic necessity. Because we can no longer afford the cost of health insurance... I pointed out that by 2082 or thereabout two curves will cross on a graph. The first the cost of health care the second the United States GDP. We're going to confront a massive and frightening situation.
The more immediate point, though, is that these members have made the wrong political calculation. "I told them that this country will support members that do what they think is right and go home and defend it," Dingell said, reminding them that the real danger is not that some of the bill's provisions, particularly the robust public option, might be unpopular in their districts, but that they go home empty handed.
Dingell's optimistic. "I think we're going to win--I think we very well have to win."
And he's putting that onus on the freshman and sophomore members who are still sitting on the fence on a robust public option bill, despite a week of intense lobbying on the part of Democratic leadership. "I also pointed out something--that this leadership is working much harder, and much more effectively on this legislation than last time on health care. It failed by only one vote that time. I pointed out that I don't think any of us would want to be the one vote that pulled this bill down."
We'll know soon if they were listening. Other Democrats were.
One progressive Democrat who supports the "robust" public option was moved by the speech.
That Democrat said Dingell reminded members Congress couldn't get health care done in the 30s, 40s, '65 or '93, and specifically took the blame for the bill's failure during the Clinton administration.
Given the stakes and the margins, every little signal seems to matter.
[Harry] Reid's efforts got a boost Friday when two key Senate moderates signaled that that they were not inclined to block him.
"I conveyed to Leader Reid that a number of moderates still were extremely concerned about a government-run, taxpayer-funded, national public plan," Sen. Mary Landrieu (D-La.) said in a statement after meeting with Reid. "However, I am encouraged that the conversations taking place over the past week among Senators who back different versions of a public option could potentially lead to a compromise. I believe this compromise should happen sooner, rather than later, so we can get to work on other critical aspects of heath care reform."
An aide to Sen. Joseph Lieberman (I-Conn.) said that, while the senator does not favor a public option with a state exemption, he would not vote to filibuster the bill. This would put Reid closer to the 60-vote threshold.
Landrieu's ongoing confusion over what a public option is notwithstanding, these signals are encouraging. Up until fairly recently -- as in, a few days ago -- Landrieu and Lieberman were two of the senators who were most likely to side with Republicans on blocking consideration of the bill. Now, Landrieu is feeling "encouraged" about a compromise, and Lieberman is unlikely to side with GOP obstructionism.
This follows Sen. Mark Pryor (D-Ark.) recent observation: "I don't think you'll see me or any other Democrats" support a Republican filibuster.
I'm actually starting to feel optimistic. Of course, I'd feel better still if Ben Nelson, Evan Bayh, Blanche Lincoln, and Kent Conrad would express similar sentiments.
There's some momentum in the Senate for a health care reform bill with a public option and opt-out compromise. In the House, leaders are still eyeing a robust public option. Any chance we're headed for a showdown between the chambers on the kind of public option to make it to the final bill?
Probably not.
House Speaker Nancy Pelosi (D-San Francisco) said Friday that states might be able to "opt out" of any nationwide government insurance plan, a compromise that she suggested could unify congressional Democrats and enable President Obama to sign a healthcare overhaul bill later this year.
Pelosi remains a leading champion of the "public option," which would establish a federal health insurance program that would give consumers who don't get coverage through their employer an alternative to plans offered by commercial insurers. But she told reporters at the Capitol that she did not "think there's much problem" with the opt-out alternative, which had sparked interest among moderate Democrats in the Senate.
Specifically, asked about the opt-out measure, the House Speaker told reporters, "I don't think there's much problem with that." House Majority Whip James Clyburn (D-S.C.) added, "All they're debating is whether or not to allow states to opt out of it, but you'll still have the same public option."
Both prefer the robust public option, of course, but like some other progressive reform leaders -- Jay Rockefeller, Howard Dean, even Rep. Anthony Weiner (D-N.Y.) -- they've come to see the opt-out compromise as tolerable.
Part of this is important because it signals some key common ground between the chambers, which may eventually matter a great deal. But I'm especially interested in how it might affect negotiations regarding Olympia Snowe's "trigger" idea.
By most accounts, Harry Reid is close to lining up the necessary support for the opt-out measure, but let's not forget, Reid is also counting votes for a trigger, and probably has even more votes for that approach. It's why the White House is hedging -- it wants a bill and it has more confidence in the one that has more votes. The Senate leadership, as of last night, was still "considering" the various alternatives, and it seems many, if not all, of the Democratic senators willing to vote for the opt-out could just as easily vote for the trigger if it's the bill that comes to the floor.
It's why I wonder if the House approach may end up tipping the scales a bit. Pelosi doesn't have 218 votes for a robust public option, at least not yet, but she can almost certainly line up more than enough support for the opt-out, and her remarks yesterday suggest she'd be satisfied with this outcome. But if the Senate moves from the opt-out to the trigger, there's a problem -- it's a bridge too far for more than a few House progressives.
In effect, the Speaker's office has a compelling message to Reid and Obama: "I can pass the opt-out, but not the trigger, so let's go with the former*, lock down 60 votes in the Senate, and get this thing done."

John Cole: What Wall Street Wants, Wall Street Gets 
This is awesome:
Insurance brokers and benefits consultants say their small business clients are seeing premiums go up an average of about 15 percent for the coming year — double the rate of last year’s increases. That would mean an annual premium that was $4,500 per employee in 2008 and $4,800 this year would rise to $5,500 in 2010. The higher premiums at least partly reflect the inexorable rise of medical costs, which is forcing Medicare to raise premiums, too. Health insurance bills are also rising for big employers, but because they have more negotiating clout, their increases are generally not as steep.
Higher medical costs aside, some experts say they think the insurance industry, under pressure from Wall Street, is raising premiums to get ahead of any legislative changes that might reduce their profits.
This really is one of those things I never really thought about before the last year or so, but I still have no idea what exactly the health insurance companies offer this country. All they seem to do is sponge money off the top of what we pay for health care, make life a living hell for their customers and the medical community in the form of reams of paperwork, hand out lavish bonuses to their management, invest recklessly in whatever the Wall Street bad idea du jour is, and then raise rates when the fur-bearing trout farms don’t pan out and they need to cover their bad investments. Meanwhile, they don’t answer to the consumer and control congress, and are under orders from the Wall Street brokerages.
Do I have this completely wrong? Is there an actual fact-based (and that means you need to look somewhere other than the NRO or glibertarian sites) argument in favor of health insurance agencies? What service do they really offer? Why are these people who it appears add nothing so in control of the debate. I know I have turned into a pinko-commie, but right now this looks like nothing more than an elaborate and legal protection racket.

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