Tuesday, December 8, 2009

Health Care: Racism/Viagra/Deal Edition

QOTD, shortstop:
Joe Lieberman will officially begin his insurance/pharma lobbying career in January 2013. Unofficially, he's already started it. Everything -- EVERYTHING -- he does between now and then is a big wet kiss for the signers of his future paychecks and a big fuck you to the Democrats he thinks have betrayed him.
Aravosis: Rockefeller lets Conrad have it over health care reform

Rockefeller, good guy. Conrad, bad guy. Both Dems. From Ryan Grim at Huffington Post:

Rockefeller is leading the push for opening Medicare. When HuffPost told him of Conrad's objections, the West Virginia Democrat let loose.

"That's fine," said Rockefeller. "He probably ties it to everything he talks about. I mean, I'm really very tired of hearing about that from him. And it's always about North Dakota and it's never about any other part of the country. And I thought that, you know, that's what we were trying to do, we were trying to do the best thing for the country."
We are. Others aren't.
Shocking ad: "I guess I'm racist" Dec. 7: Rachel Maddow talks about a bizarre new anti-healthcare ad campaign with Princeton University's Melissa Harris-Lacewell.

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Think Progress: Boxer’s message to men who support abortion riders: How would you like it if we singled out Viagra?

Today, the Senate began debate on Sen. Ben Nelson’s (D-NE) amendment to prohibit federal funds from being used for abortions or for plans that include abortion services. Igor Volsky notes that Sen. Barbara Boxer (D-CA) stepped up and drew a parallel to help the amendment’s male co-sponsors better understand its repercussions. Since Nelson’s measure forces women to purchase special abortion riders — which require women to plan for unplanned pregnancies — Boxer challenged “the men who have brought us this” to “single out a procedure that’s used by a man or a drug that is used by a man that involves his reproductive health care and say they have to get a special rider”:

BOXER: There’s nothing in this amendment that says if a man some days wants to buy Viagra, for example, that his pharmaceutical coverage cannot cover it, that he has to buy a rider. I wouldn’t support that. And they shouldn’t support going after a woman using her own private funds for her reproductive health care. Is it fair to say to a man you’re going to have to buy a rider to buy Viagra and this will be public information that could be accessed? No, I don’t support that. I support a man’s privacy, just as I support a woman’s privacy.

Watch it:

John Cole: What Is The Next Step

Steve Benen, when discussing the fact that Democrats are looking at expanding Medicare, states the following:

The story of the day is not Ben Nelson introducing a Senate version of the Stupak language—the smart money is on it failing (I’d put the over/under at 43)—but rather a “sweetener” for the left, to make another public option compromise more palatable.

While Steve is focused on the Medicare angle, I think he is missing something rather big. What on earth can drama queens Ben Nelson and Joe Lieberman do to get in the news tomorrow?

If the two are feeling creative, I’m predicting a candlelight vigil with Nelson and Stupak on the Capitol steps complete with prayer beads, Randall Terry, and placards of fetuses. Because if we have learned anything, Ben Nelson doesn’t give two hoots in hell about health care reform, all he cares about is his name in the news and that sweet, sweet, succulent insurance industry money.

If they are not feeling creative, probably just another filibuster threat, which, after the first fifteen of them, have become rather passé.


The story of the day is not Ben Nelson introducing a Senate version of the Stupak language -- the smart money is on it failing (I'd put the over/under at 43) -- but rather a "sweetener" for the left, to make another public option compromise more palatable.

Sam Stein, Ezra Klein, and Brian Beutler are all reporting the same thing: an expansion of Medicare eligibility is on the table.

Senate Democrats are discussing the idea of expanding Medicare by lowering the age at which the elderly could enter the government-run insurance program, Democratic sources on the Hill tell the Huffington Post.

The proposal would lower the age of eligibility for Medicare from 65 to 55, though an age limit of 60 has also been suggested. Crucial details -- such as the timing of the implementation of such a reform -- were not provided due to the sensitivity and ongoing nature of the deliberations. A high-ranking Democratic source off the Hill confirmed that such discussions are taking place.

Lowering the floor for Medicare is one of several ideas being discussed as a way to pacify progressives upset over the potential elimination of a public option for insurance coverage, one of the sources added.

Negotiations are, of course, still very much in flux, and all kinds of details would have to be worked out -- most notably, financing -- but in general, this will be appealing to many progressive lawmakers. After all, Medicare is a socialized, single-payer system that Americans know, love, and trust. Indeed, the starting point for many liberals is "Medicare for all." This, obviously, doesn't go nearly that far, but expanding eligibility brings that many more Americans into the system.

Ezra also helped connect this to the larger context of the talks: "The broader point is that the public option compromise is increasingly becoming a health-care reform compromise, and the focus is returning, usefully, to the goals of the bill. That's good for both moderates and liberals, as everyone who votes for this bill has a stake in seeing it work, and the intense attention to the increasingly weakened public option had begun to distract from the need to improve other elements of the legislation."

Think Progress: Howard Dean Pushes Medicare Buy-In Proposal: It ‘Must Be Available To Americans From Day One’

The Senate is considering expanding the Medicare program to Americans under 65 years of age alongside a public option compromise that would allow the Office of Personnel Management to regulate competition among private nonprofit insurers. Former Vermont Gov. Howard Dean “injected the buy-in concept back into the negotiations two weeks ago,” Politico reports. And “the turning point in the debate occurred over the past few weeks, as some progressives began to question whether the public option had been watered down too much for it to even be effective. Dean called Reid and Sen. Chuck Schumer (D-N.Y.) to suggest that they revisit the Medicare buy-in proposal, which he pushed during his 2004 campaign.”


Benen (Tuesday): ON THE VERGE OF A DEAL?..

A group of five center-left Dems and five center-right Dems -- they're apparently now called the "Team of Ten" -- began working in earnest over the weekend on striking kind of deal on the public option. The issue has proven to be the most contentious element of the health care debate, and Senate Majority Leader Harry Reid (D-Nev.) told the members engaged in the talks, "Time to get this done."

Any number of outcomes are still possible, but as of now, the participants are nearing a deal. As the framework takes shape, the public option is out -- but progressives have gotten quite a bit in exchange (no pun intended).

A potential deal took shape Monday that could eliminate the public option from the Senate health reform bill, as Democrats weighed big expansions of both Medicare and Medicaid in a bid to break an impasse over the government insurance plan. [...]

After five days of intensive talks among five moderates and five liberals, the outlines of a compromise aimed at appeasing both ends of the Democratic political spectrum were emerging: a plan designed to expand insurance coverage without creating a new government-run program.

Details, not surprisingly, are still rather elusive, but the deal would reportedly include the "OPM Plan," a national, non-profit health plan along the lines of the Federal Employee Health Benefits Plan, administered by the Office of Personnel Management, which oversees the plan for federal employees and has experience negotiating with private plans. This would, in effect, replace the public option.

But there would also be a Medicare "buy-in" for Americans 55 and older, and expanding Medicaid to cover people with incomes 150 percent above the poverty line.

Specifically on Medicare expansion, eligibility would likely be limited to those who would otherwise get their coverage through an exchange, but this is a key group -- as Jonathan Cohn explained, "People between the ages of 55 and 64 have a notoriously hard time buying coverage on their own, since their age and higher incidence of disease makes them the sorts of high medical risks insurers don't want to cover."

Could the deal fall apart? Of course it could -- these are Democrats we're talking about. But most of those involved seemed optimistic late yesterday, and even Sen. Ben Nelson (D-Neb.) conceded that the "discussions are going in the right direction.... To the extent that they continue to go in that direction is obviously very positive."

The Senate leadership wants to see a deal struck by this evening. Sen. Tom Harkin (D-Iowa) said the group may reach a compromise as early as this afternoon. Stay tuned.

Negotiating the public option
Dec. 7: The New Republican's Jonathan Cohn talks about the compromises Senate Democrats are considering as alternatives to a public option.

Visit msnbc.com for breaking news, world news, and news about the economy

A few days ago, when Senate Majority Leader Harry Reid (D-Nev.) was putting together the "Team of Ten," he specifically extended an invitation to Sen. Joe Lieberman (I-Conn.), making him one of the five center-right members of the caucus in a position to shape a public-option compromise.

Lieberman decided not to show up. Roll Call reports that the Connecticut senator just doesn't want to get in the game.

Senate Democratic centrists and liberals have been working feverishly since last week to craft a compromise on the public health insurance option, but one invitee has been curiously absent. [...]

Senate Democratic aides said Monday that Lieberman's decision to skip meetings that could prove crucial to Reid's ability to pass a bill may suggest that Lieberman's vote is out of reach.

Lieberman's office said Monday that the self-described Independent Democrat has not attended in person because he feels he has been unambiguous about where he stands.

But that's not much of an explanation -- nearly all of the other nine senators have also been unambiguous about where they stand. But they agreed to show up, engage in good-faith talks, search for common ground, and work on a solution. It's what lawmakers do.

It's always best to keep expectations low when it comes to Lieberman, but I am a little surprised about his refusal to engage. Part of his schtick is his alleged ability to leverage his independence to "bridge the gaps" and "bring disparate people together." But in the biggest policy fight of the year, Lieberman has decided he prefers the sidelines.

This not only undermines his image, it also denies Lieberman a chance to grandstand. The 10 senators doing the heavy lifting are the ones who'll get the credit for resolving the problem (if they're successful, that is), while Lieberman will be remembered as the one who decided not to try.

Meanwhile, as talks continue, it's unclear how Lieberman feels about the state of the debate. Maybe he'll like the proposed compromise -- it lacks a public plan that he finds so offensive -- or maybe he'll find new reasons to justify his opposition. (Lieberman's good at that.)

Either way, there's growing talk that the 60th vote may come from Sen. Olympia Snowe (R-Maine), not Joe Lieberman. One senior Democratic source told Roll Call, "Snowe's all about the policy, but she's aware of the politics. Lieberman is all about the politics, but he doesn't seem to be consistent on policies considering where he was in the past."

Ezra Klein: Freshmen senators spending too much time on issues, not enough time chasing headlines


Though there haven't been any impressive coalitions of Republicans and conservative Democrats coming together to improve the bill's cost savings, Sen. Mark Warner (D-Va.) has rallied his fellow freshmen behind a set of common-sense improvements to the delivery system side of things. You can download the full list Frosh Package Section-by-Section (12-6-09).pdf (pdf), but I want to focus on Section 10004: "Revisions to National Pilot Program on Payment Bundling."

This section would modify the new CMS pilot on Medicare bundled payments created by the Patient Protection and Affordable Care Act. It would expand the number of health conditions tested under the pilot and give the Secretary authority to expand the duration or scope of the pilot after January 1, 2016 if the CMS Chief Actuary determines it would reduce Medicare program spending while maintaining or improving the quality of care.

In other words, this helps the Medicare bundling pilot become a policy. And that's a big deal: The bundling efforts might be the most unjustly neglected element of health-care reform. The graphic above comes from the New England Journal of Medicine (pdf), and shows the consensus of most experts I've spoken to: Bundling has more potential to lower costs and improve care than any other delivery-system reform in the bill.

Lots of people say they want to move past the fee-for-service paradigm, in which hospitals are paid for selling you more procedures just as Best Buy salesmen are paid for selling you more televisions, but bundling is the bill's most direct step in that direction. The way it works is simple enough: If I come down with something or other, the hospital that treats me gets a lump-sum payment for, say, 60 days of treatment for all issues related to something or other. If they treat me, and 15 days later, I'm back in for complications relating to something or other, they don't get more money.

"It's a big deal because you're trying to take a fragmented delivery system and force it to work together," says health economist Kenneth Thorpe. "In today's world, hospitals don't need to worry about re-admissions. It's just more revenue for them. When the patient leaves the hospital, the hospital’s job is to wait for the next person to come in."

"But this says if you're readmitted, we're going to ding you. So one thing to lower re-admissions is to have a transitional nurse working with the patient to implement the care plan. Right now, the hospital isn't linked to that nurse. This gives the hospital an incentive to pay more attention to what happens to the patient when they leave the hospital." Accelerating this transition is a good idea, and props to Warner for taking the reins on it. Health-care reform needs more legislators interested in bearing down on the dull guts of the policy, the stuff that doesn't get you quotes in the paper but will decide the success of the policy.
Sudbay: Catholic Bishops had sign-off on Senate abortion amendment

The Catholic Bishops really do have a lot more influence in Congress than they do over their parishioners. The Bishops got to approve the abortion amendment being offered today by Senator Ben Nelson (D-NE):

Casey, Nelson and other lawmakers worked closely with the U.S. Conference of Catholic Bishops to come up with language that would meet the church's requirements. In a letter sent to all 100 senators Monday, the bishops endorse the Nelson amendment.

The Nelson amendment is based on language authored by Rep. Bart Stupak (D-Mich.) and attached to the House-passed healthcare reform bill.
Most American Catholics ignore their bishop. Most Catholics around the world ignore their bishops. Yet, members of Congress kowtow to them. Amazing.

Yesterday, Senate Majority Leader Harry Reid (D-Nev.) put opposition to health care reform in a historical context. Conservatives' approach -- which he labeled "Slow down, stop everything and start over" -- isn't new, Reid said. We saw the same attitude from the right during the debate over the Family and Medical Leave Act, women's suffrage, the Civil Rights Act, and slavery.

Republicans are picking up on that last one and doing a fine job of pretending to be upset.

Republicans on Monday were quick to pounce on Senate Majority Leader Harry Reid, D-Nevada, for comparing the battle over health care to the battle over the legacy of slavery.

The National Republican Senatorial Committee purchased a Web ad on the popular Drudge Report asking readers: "Do you agree with Harry Reid?"

Those who click on the ad are taken to an NRSC Web site called "Health Care Task Force," which asks readers to sign a petition and "stand up to Harry Reid and his insulting remarks."

Atrios noted last night, "Hey, Republicans throw hissy fit. Media covers hissy fit. You'd think this would get old."

We should be so lucky. That Republicans aren't really offended, and are only throwing a tantrum because it's easier than debating health care policy, never seems to enter the picture.

If we're to believe the faux-outrage, the reference to slavery was the rhetorical element that went too far. But this, apparently, is a new concern -- the right has been far more direct in making the same comparison. Harry Reid was talking about key moments in history in which the right was wrong, but Michele Bachmann recently called the Democrats' legislative agenda "nothing more than slavery," and no one said a word. Indeed, conservatives routinely insist that the left is trying "enslave" America, and the political mainstream just shrugs its shoulders in response.

This is not uncommon. In 2005, Sen. Dick Durbin (D-Ill.) described the Bush administration's torture policies and system of secret prisons as being reminiscent of "Soviets in their gulags." At the time, the media and Republicans were apoplectic about Durbin's remarks, sparking a week-long frenzy. Several conservatives called on the Senate to censure Durbin, and Karl Rove, at the time a high-ranking White House official, argued that Durbin's quote was evidence that liberals are traitors. Durbin eventually offered a tearful apology.

But notice that just a few days ago, Sen. John Cornyn (R-Texas), a member of the Senate Republican leadership, called Medicaid a "health care gulag." Rep. John Shadegg (R-Ariz.) recently called Dems' health care reform efforts "Soviet-style gulag health care." Neither reporters nor other members of Congress batted an eye.

Also note, when Rep. Alan Grayson (D-Fla.) said Republicans are promoting lethal health care policies, it was a huge national controversy. When Sen. Tom Coburn (R-Okla.) said the same thing, no one seemed to care.

Part of the IOKIYAR phenomenon is the media's willingness to embrace the double standard, and part of it is the result of Republicans' more aggressive media operation.

But I also wonder if the instances of the GOP's rhetorical excesses don't generate as much attention because Democratic officials just don't care the same way. Isn't it at least possible that Dems just have other things they want to talk about, and Republicans don't?

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