The Baucus Health Care Bill: A Work in Progress

Mandates without a public option. A pure giveaway to the insurance industry.
An industry that, predictably, still complains about the bill.

Despite Baucus’ brave face this is DOA. He made concession after concession to “his good friends” across the aisle and got nothing but humiliated.

That’s presuming he actually wanted a good bill and that is hardly in evidence.

One last thing, seeing that spineless Harry was for it until he was told that it hurt Nevada was script-perfect.

Thanks KT: a few questions from an ingoramus:

- why is the CBO cost figure (approx $775 billion) much less than the originally anounce cost ($850 billion or so)?

-speaking of costs, how much of that total figure would be spent in the coming years anyway if nothing is enacted? Shouldn’t the net costs be the important figure, not the overall sticker cost?

- on what basis does the CBO say it will save money if they have basically ignored the CO-ops as a way of reducing costs (which I understand they have). is there any way to build on that?

- does a bill have to come out of the finance committee before anything can be voted on in the whole senate?

- is there any way in which this bill is a stalking horse for the administration? putting something – anything – out there to set a marker down to see what is and isn’t acceptable?

KT- for your reading pleasure. Are you like Charles Gibson who amazingly claimed he didn’t know anything about an ACORN scandal. Congrats on everyone at TIME boycotting this story.

http://www.politico.com/blogs/glennthrush/0909/House_votes_to_block_ACORN_funding.html

This whole saga is a sad joke. Once Reid saw his re-election bid in Nevada affected by the Baucus Bill he took to the microphone to express his opposition.. Don’t look for integrity from the Democratic Party’s Senate leader or some others like Ben Nelson.

The market responded to Baucus yesterday with insurance stocks soaring. That tells us all we need to know about the Baucus bill.

trifecta speaks the truth (not that there was any question about that)
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http://www.marketwatch.com/story/health-insurers-up-as-new-health-bill-unveiled-2009-09-16?siteid=yhoof2

way too simplified answers:
1. it has mostly to do with how you count some medicare cuts.
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2.Remember: CBO only scores costs to the government, which essentially means to programs like medicare and medicaid. It does not measure the costs of the health care system as a whole, which are really the point of this whole exercise. That’s their baseline. But doing this will be more expensive – in the short term – than not doing it, from the government’s standpoint. That’s because of the cost of covering people who now just show up at emergency rooms.
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3. From a cost standpoint, the co-ops are all but irrelevant. They are in there for political reasons. The savings come largely from squeezing Medicare, in one way or another.
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4. Pretty much yes. Finance is the only committee with jurisdiction over taxes, Medicare and Medicaid. I suppose there are ways to run something to the floor from Harry Reid’s office, but I don’t think they are looking at that.
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5. My White House sources consider the Baucus bill the leading vehicle to get them to final passage. But they also acknowledge that it is going to have to undergo some revisions. Potentially some signficant ones.

The Krug’s latest actually leaves me with a sliver of hope. I’m sure I’ll awake to more doom, but I’m going to sleep on the hope for now. Oyasuminasai

Karen are you saying that he is now paying the price for leaving his fellow democrat committee members out of this?

Senator Rockefeller is very upset and my understanding is they can only lose one democrat to get the bill out.

I think they just want to get the bill out so they can fix it.

I am not ruling out the Public Option in the final bill because one version scored very well in the house and maybe adding it to some of Baucaus medicare cuts will make it better.

Olympia Snow has a big problem to vote against the Public Option as I think there will be a poll coming out today that says Maine loves the option.

more “some people say” crap from KT…
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“Health policy experts say an excise tax could help curb health spending overall by discouraging the purchase of lavish plans that lead to overuse of the health care system. “
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who are these experts?
What is the mechanism by which an excise tax could “curb health care spending overall”?
How much do these experts think will be “saved”?
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In most cases, these “gold plated” plans low/no co-pay or deductible plans that provide full coverage for not just traditional medical care, but mental health services, dental care, and eyeglasses. Please explain to us all HOW providing DENTAL care is going to “curb health care spending overall”, Karen.

Simple question for Democrats considering a trigger, where are the votes you are going to lose on the Left going to come from? At the moment there isn’t a single Republican supporting the “compromise bipartisan” bill. Given the lack of support he has for his compromise bill I wouldn’t let Baucus negotiate the sale of lemonade.

“I suppose there are ways to run something to the floor from Harry Reid’s office, but I don’t think they are looking at that.”
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Yeah I think that’s a safe bet that Harry “the pillow” won’t be leading in anyway.

Democrats need to stop hurting the president and chances of reform by blowing up on this bill. It was always intended as a work in progress, a barometer to see if Republicans could support the most conservative bill possible. They won’t, so it’s obviously back to the drawing board to get a Dem bill.

http://www.political-buzz.com/

How can savings achieved through medicare be considered when the CBO is scoring a bill’s impact on the federal budget deficit?
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operating deficits for medicare are funded by the medicare trust fund, not the overall federal budget — and until that trust fund runs out of money, medicare operating deficits have no impact on the annual federal budget deficit.
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In other words, savings acheived by medicare accrue to the medicare trust, not the overall federal budget — and Karen is simply shilling for a game of three-card monty here run by blue dogs and insurance industry parasites.

KT-I completely agree with pluk on this one. Did you interview Baucus face to face or did he just fax over some spin and you wrote it down?
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May be I being too harsh here and completely misreading this article, but I see absolutely nothing that constitutes a question or a challenge to the words of Baucus in any form any where in the article. It reads like PR damage control.
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After reading this no one would know that Baucus completely fumbled this, completely misread the opposition party and his own allies and gave what is becoming to be seen as an gift to the health insurance industry and done nothing to help stop Americans from paying more for less health insurance than similar countries. The stats are out there Stu posts them every single day. Use them in your next interview.
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In other words, even though he is a guy you can say “never gives up,” He screwed up from the begining and did not do a good job in the end. He has failed the American people, squandered valuable time and now someone else has to fix it. Or least try not to make it worst.

pluk’s suggestion that CBO does not score medicare in these bills would be news to the director of the Congressional Budget Office:
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http://cboblog.cbo.gov/?p=354

The fact that no one supports this bill will be seen as evidence that it is the best bill, by the trained centrist seals in the MSM.

Here are two experts I came up with in my first 10 seconds on Teh Google:
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http://www.pbs.org/newshour/insider/health/july-dec09/benefitstax_08-06.html

Gunny: I talked to him, about the point that is relevant at this moment (AKA: the “news”), which is that this bill is very much a work in progress, he’s catching hell from his fellow Democrats, and he is trying to adjust it to meet their concerns. Whether he screwed up getting here, or whether he can ultimately succeed, are other stories (that are being written extensively–please see the AP link). But these are new details, ones that I obtained exclusively, and I thought I should share them with my readers.

It’s important in discussions about the way forward to avoid ‘magical’ thinking. I still think people are way overestimating the amount of play in the system that would allow room for cost savings. Reform opponent’s fear-mongering relies on insistence that the bills simply can’t be what they have been described as and must therefore be something completely disasterous instead. But many proponents seem to want to ignore the fact that the entire structure, both before and after reform, has to rely on healthy people paying into the system to subsidize the sick. That’s how it works, and if you don’t include that ‘feature’ in the new system, collapse is inevitable.

KT: since you have been talking to Baucus did you ask him whether he consulted with his Democratic colleagues on his committee other than the beknighted 3? Given the committee’s composition why 3 Republicans and 3 Dems only? What is his idea of democracy? Is there a new party called The Bipartisans?

You see, the whole Baucus Plan was skewed from the start because it embraced a false premise: give the Republicans an equal say on the working committee and they will play. The Republicans never intended to do so; the news was repeating it every day and Baucus refused to listen/hear.

His plan deserves to fail.

Also who are the staffers who wrote this plan and do they have connections to the health insurance industry?

An unhappy majority leader, who faces re-election next year, quickly issued a statement saying he had a commitment from Baucus that the bill would be changed quickly. “Let me be very clear, I will not bring a health insurance reform bill to the Senate floor that is not good for Nevada,” Harry Reid said

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This truly says it all. It is not healthcare reform. Congress sees the writing on the wall in front of them. They are hearing daily from their constituents, and what they are hearing precludes them from hearing anything else. The fact that if they support this bill, which over 54% of Americans are against. Which over 85% of Americans, who have health insurance now, are truly happy with their current healthcare.
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Big Labor is against it because of the excise taxes on their “Cadillac” plans. Seniors are upset because of the deep cuts to Medicare in order to fund this plan.
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Progressives are upset because they cannot go back to their uninsured constiuents and say “see, I got you healthcare” or in other words “Vea pude conseguirle liberta asistencia sanitaria para acompañar su enseñanza gratuita para sus niños. Registre por favor y vote para mí.”
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I’ve talked to a number of the Dems on the committee, and they sure don’t think he did. Which is why yesterday’s session was so, shall we say, lively. And that is also why he is now having to look at rewriting parts of the bill, which was sort of the point of my writing the story. whether it will work, i don’t know, but the people I’ve talked to say it’s a start.

Karen, that’s what I’m talking about with the shell game — for the CBO to include medicare savings as part of the budget deficit is deceptive in the extreme — its the kind of lie that allows the wingnuts to claim that there is “nothing in the social security trust fund”.

“Say this for Max Baucus: He’s not one to give up easily.” When it comes to pleasing his masters in the healthcare lobby.

Nearly 45,000 people die in the United States each year — one every 12 minutes — in large part because they lack health insurance and can not get good care, Harvard Medical School researchers found in an analysis released on Thursday.
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“We’re losing more Americans every day because of inaction … than drunk driving and homicide combined,” Dr. David Himmelstein, a co-author of the study and an associate professor of medicine at Harvard, said in an interview with Reuters.
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Overall, researchers said American adults age 64 and younger who lack health insurance have a 40 percent higher risk of death than those who have coverage.
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But the important news is let’s give Max another chance.
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http://www.msnbc.msn.com/id/32882064/ns/health-health_care/

…good question about staffers, especially since many of Baucus’ former staffers became HC lobbyists. Remember this link?
http://www.sunlightfoundation.com/projects/2009/healthcare_lobbyist_complex/#baucus
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…and KT, welcome back. Alas, if you thought readers were cranky on weds. it got much worse on thurs. from Beck cover. Some readers are quitting the site – read comments to MS’ Beck cover post. I’m not quitting. Someone has to defend the public option if pirate insists on leaving. But at least hopefully YOU got lots of sleep yesterday, KT.

Having read the linked piece, I call shenanigans. There is practically no discussion of a reduction in “health care spending overall..by discouraging the purchase of lavish plans that lead to overuse of the health care system”.
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indeed, one of the panelists makes its clear that there is likely to be NO DIFFERENCE in how those who purchase lavish plans behave…
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PAUL FRONSTIN: Yeah, I guess I would add to that by saying it’s easy to go after the CEOs with Cadillac coverage. When you see that Goldman Sachs is spending about $40,000 for their top executives for health reform, people think that’s outrageous. Even if those benefits are taxed and others aren’t, I don’t know that we should expect CEOs to change their behavior when it comes to their health care. When you look at the kind of income that they’re making, it means they’ll probably continue to use health care at the rate they’re using it.
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in other words, one of your experts DIRECTLY CONTRADICTS you. The closest thing that either says that supports what you wrote is this…
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BETTY ANN BOWSER: I’m going to ask the last question, not as a viewer but as the health-care correspondent. If this idea were to take hold, what would it do in terms of health-care inflation?

JONATHAN GRUBER: There’s no clear evidence on that. My estimate, based on the studies I’ve done, other things, are that it would clearly lower the level of health-care costs, not by an enormous amount, by a small amount.
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In sum, taxes on health care benefits won’t discourage those who engage in wasteful abuse of health care services, won’t slow down the increases in the cost of health care, and will wind up with a negligible impact on overall health care spending. (And this will be accomplished by forcing people into cheaper plans that provide disincentives to getting needed health care.)
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the actual purpose of taxing benefits is to RAISE MONEY — and the place where most of this money will be raised is on the backs of workers who negotiated low health care benefits that had low out of pocket expenses and included good coverage for things like dental care instead of wages because of the tax advantages.
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You want to make it seem like the tax is designed to reduce health care costs — that is flat out false…. but its the kind of propaganda that your GOP buddies will feed you in their handout, and which you are happy to repeat without bothering to check….

Thinkprogress is running a series on the campaign behind the scenes by Insures to kill any type of meaningful reform.
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REPORT: ‘Duplicitous’ Campaign Of Insurers To Charm The Public While Secretly Killing Reform.
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This week, ThinkProgress spoke with Wendell Potter, a former VP of communications at health insurance giant CIGNA, about exactly how insurance companies derail reform and preserve the status quo. Working in public relations for CIGNA, Potter had a direct role in multiple campaigns in the past to minimize public outrage at insurance company abuses, defeat legislation aimed at regulating insurers, and the massive effort to discredit Michael Moore and his movie SiCKO. In addition to enormous amounts of money spent in direct lobbying and campaign contributions, Potter spelled out exactly how insurance companies have prepared to defeat meaningful reform.
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Planned well before this year, insurance company CEOs, like Potter’s former boss at CIGNA (H. Edward Hadway), formed a group called the Strategic Communications Committee to develop effective messages and strategy for the industry. Organized through AHIP, the lobbying front for insurance companies, the committee would work with large public relations companies to devise a two-pronged, “duplicitous campaign.” Because insurance companies suffer from low public approval, Potter said, the industry would present itself as “for reform” to the public, yet at the same time label proponents of meaningful reform as “extreme.” The public campaign is for the most part positive, and largely delivered by industry representatives like AHIP chief lobbyist Karen Ignagni. Potter noted:
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It’s really a duplicitous PR campaign. They will talk about, in broad terms, how supportive they are of health care reform, but they will be working behind the scenes to kill very, very crucial parts of reform legislation like the public option.
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Potter then explained how insurers would use a variety of front groups, set up by PR companies like APCO, to advance a hidden attack campaign. The “dirty” campaign involved feeding talking points to right-wing media, like Rush Limbaugh and Fox News. It also includes the creation of front groups to run negative advertisements about reform and mobilize anti-reform “grassroots” groups. Finally, insurers would coordinate with, and sometimes fund, conservative think-tanks to produce academic-appearing reports to advance their cause. Leaked memos from the insurance companies — regarding the campaign against Moore’s SiCKO movie — not only support Potter’s assertions, but specifically describe every step of this process. More at link below.
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http://thinkprogress.org/2009/09/17/potter-charm-dirty-campaign/

the questions that you haven’t bothered to ask is “why is it a work in progress? Why did you spend nine months trying to keep right-wing republicans while ignoring the obvious concerns of Democratic senators and the voters that they represent? ”
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your failure to confront Baucus on his refusal to consider the views of Senators who represent mainstream Democratic opinion means that you functioned merely as a stenographer for Baucus.

pluk: did you read my story? baucus conceded that this would hit some union plans. i noted the argument that it would hit middle-income folks, like municipal workers. but the reform argument is nonetheless there. these guys just say taxing insurance companies isn’t as effective as taxing benefits directly. From the Lehrer show:
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Fronstin: the idea behind this is to – if you impose this tax on insurance companies with the high-cost plans, they’ll increase the premium of those plans. That’s the way they’ll pass along the tax. And that will result in fewer people taking those high-cost plans, which is ultimately the goal.

KT: since you have been talking to Baucus did you ask him whether he consulted with his Democratic colleagues on his committee other than the beknighted 3?
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actually, the gang of six consisted of only two other Dems he consulted, and Baucus himself.
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But don’t lay all the blame on Max — this was more Obama’s decision than baucus’s. Had it not been for Obama’s efforts to keep the focus on Baucus’s “gang of six” and OFF of the appropriate Finance Subcommittee and OFF of the Senate HELP committee and OFF of the entire House of Representatives and OFF of his promises of a transparent and open process, nobody would care what Max Baucus was proposing.
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We already know that the Baucus proposal was authored by Wellpoint and the Blue Dogs — and I strongly suspect that its real origins are in the White House. I mean, if you read what Baucus was originally proposing, you find this…
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Medicare Buy In. The Baucus plan would make health care coverage immediately available to Americans aged 55 to 64 through a Medicare buy-in.
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http://finance.senate.gov/healthreform2009/finalwhitepaper.pdf page 21
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That’s right — Baucus originally supported a “medicare buy in” provision. But he’s abandoned that, and most of the other good ideas that he had, in the face of parasite and white house pressure.

KT…
please explain why it is a goal to force people out of plans that provide full coverage for their health care needs — because THAT is what the union plans do…. and what your so-called ‘expert’ is saying is a good idea.
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That’s the way they’ll pass along the tax. And that will result in fewer people taking those high-cost plans, which is ultimately the goal.
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why is that the goal, Karen? Your “experts” admit that the overall reduction in spending because of the tax would be negligable. They admit that the tax would have NO impact on health care inflation.
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reducing the number of people who have plans that have no copay/deductible certainly doesn’t lead to better preventive care — if the first $250 of your health care expenses are NOT covered, you’re not going to go in for that annual check-up because EVERY PENNY of it will come out of your own pocket. Not covering dental care isn’t exactly a great idea either. SO WHY IS IT A GOAL?

pluk: did you read my story?
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yes I did Karen, and what I challenged was this assertion…
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Health policy experts say an excise tax could help curb health spending overall by discouraging the purchase of lavish plans that lead to overuse of the health care system.

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your own experts acknowledge that the savings would be minimal, and made it clear that taxing the truly “lavish” plans (like those for Goldman Sachs execs) would make NO DIFFERENCE in how those execs consumed health care services.
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Is it your contention that the plans negotiated by middle class workers that allow them and their families access to preventive care with no co-pay or deductible is “lavish”? Are you telling us that its a good idea to tax plans that provide dental care because dentistry is a luxury?
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Baucus obviously didn’t give a flying f*** about working americans when he originally presented the bill, otherwise those provisions would not have been in there. He’s only now backtracking because of pressure from Senators from the Democratic wing of the Democratic Party.
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Meanwhile, you do your best to make Baucus appear like a good guy for finally taking into consideration the needs of working people — and he’s only doing it because he’s being forced to.
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This is another example of why access journalism sucks so badly. Baucus presented a plan that screwed american workers, and in order to get the next “exclusive interview”, you hide the fact that his plan completely sucks.

..the idea behind this is to – if you impose this tax on insurance companies with the high-cost plans, they’ll increase the premium of those plans. That’s the way they’ll pass along the tax. And that will result in fewer people taking those high-cost plans, which is ultimately the goal.
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Flawed reasoning. First, most companies don’t have a wide selection of plans to choose from; even union plans have reduced the number of options.
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Second, what makes anyone think that the cost of the tax will only be passed on to the high-cost plans only? Much more palatable to spread that cost across all of the policies…and if/when people stop taking the expensive plans, what mechanism is in place to roll back those increases?

KT: p_luk schooled you on taxing the “gold-plated” plans and on the CBO scoring Medicare savings.

Gunny: You can expect crickets from KT on the p.r. campaign. In fact, given that Dick Armey is a former Swamplander and Swampland has systematically avoided delving into his ties to the astroturf teabaggers, I think we should assume that Time and Swmpland are an integral — and willing — part of the “duplicitous campaign” until proven otherwise.

From KT, in comments:

3. From a cost standpoint, the co-ops are all but irrelevant. They are in there for political reasons.

Gunny: Clearly the press is well aware of the “duplicitous campaign.” They just don’t care. Or have strong incentives not to care.

Karen, just one quibble: Shouldn’t your article’s headline read, “Insurance-Industry Shill Baucus Open to Changes in Health-Care Bill to Meet ACTUAL Democrats’ Concerns”?

The whole Baucus Committee is a surreal experience. We knew the game was rigged. We knew the product will be health industry driven. Yet we find our journos treating Baucus as if he just delivered a tablet, with a genuflection to the word “surreal”. I don’t know what “straight” reporting is any more. As for probing questions and scepticism: that is exemplified by an off hand caveat here and there. Murray and Kornblut at the Post have this down to a fine art.

“But one place where Baucus does not appear to be so flexible is on the question of adding a government-run “public option” to the measure as an alternative for providing coverage to the uninsured. While some liberals in the Senate have gone so far as to say they will not vote for a bill that does not include a public option, Baucus says it would not pass on the Senate floor. He did, however, say that one “live possibility” is the idea of adding a so-called “trigger” that would create a public plan if private insurance companies fail to do enough to bring down costs and make coverage available to enough Americans.”

The “trigger” (referenced on the above quote from the article) which would create a public plan if private insurance companies fail to do enough to bring down costs seems to be a good idea.
When the details are hashed out regarding the said “trigger”– if it turns out to be real and not just a political ruse in the plan lacking any real enforcement bite– should be supported by the Democrats.

At this point, I can only hope that Democrats can read the handwriting on the wall which says they will do this on their own or not at all.

Also, I completely agree with those who say the bill does not go far enough since it reduces the former “poverty level proposal”, the proposal which would have provided assistance for those earning up to 400% of the poverty level (or a family of four making $88,000).
I hope they can reach an agreement or at least middle ground on this proposal as well. A family of four making $88,000.00 a year needs assistance with Healthcare.

Lastly, the Democrats are so divided that it is increasingly difficult to feel optimistic about this Healthcare bill. If it is passed it might be just window dressing—an effort to show that something was done to reform Healthcare– and not the vigorous and indepth reform the system so desperately requires…

LM

http://theblindspotsofgod.wordpress.com/

Fifty-six percent (56%) of voters nationwide now oppose the health care reform proposed by President Obama and congressional Democrats. That’s the highest level of opposition yet measured and includes 44% who are Strongly Opposed.

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http://www.rasmussenreports.com/public_content/politics/current_events/healthcare/september_2009/health_care_reform
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Overall, 48% of voters say they at least somewhat approve of the President’s performance. Fifty-one percent (51%) now disapprove. Over the past week, the President’s ratings bounced to their highest level in two months but have now retreated to earlier levels.

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http://www.rasmussenreports.com/public_content/politics/obama_administration/daily_presidential_tracking_poll

Waterloo! Waterloo!

Whaddaya know? Rusty’s an Abba fan.
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I’m oddly unsuprised.

This is a very, very interesting thread.

I’m glad to see some folks finally, questioning KT’s role as well as the rest of the media’s role in the duplicitous campaign going on in health care reform. Yes the pr firms deliver talking points to fox and friends on the right, but they also shave a version for supposedly objective members of the mainstream press. Below is a classic example of their influence from KT’s most recent pose:
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“The savings come largely from squeezing Medicare, in one way or another.”
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Now tell me that’s not an industry talking point, even if it is coming from KT. Eliminating industry unwarranted subsidies is not the same thing as squeezing Medicare. No one in the in the administration would frame it this way since Medicare belongs to the Democrats and they don’t really have an incentive to trash their own program. We know that framing it that way is clearly the industry’s preference so KT where did it come from exactly? Frankly — I think you’ve got some explaining to do…

I love how the AP in their piece characterizes Max Baucus’ centrist ideological rigidity:

A political moderate by instinct, Baucus made concession after concession in bipartisan talks that stretched on for months.

It can’t be that Baucus –like so many of his Democratic colleagues– is just as blinded by his centrist ideology as the most rabid left- or right-wing activist, it’s that he’s driven by “instinct”, like a wolverine or a skunk.
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It’s funny how the simplest explanation for why some folks would constantly chop the baby in half (rather than let one parent have custody of the whole child) is discarded in favor of mind-reading.

gunny: I’m posting that link on my facebook. It’s something everyone should read. The more people aware of the forces behind all the misinformation, hype, anger and fear the better. I don’t think the general public has any concept of what’s going on behind the scenes. The release and consumption of this information on a large scale could really have an impact. That is, if the their attention spans are long enough to absorb it.

KT – a question of viability, if I may? In the past few days, we haven’t seen a lot of good signs that any Republicans are going to vote for the bill, regardless of how many concessions we make to them, and in the meantime, the concessions have lost us votes from the lefter hues of the spectrum. Do you think it would be more viable to try to further reconcile spinning plates with the Baucus bill and hope for Republicans and Democrats alike to be won over, or would it be more practical to blow off the Republicans and go for broke with the liberal criteria, and hope the time to filibuster nicely coincides with the kickoff for 2010 reelection campaigns?

Many journalists are comfortable with “centrism”. Our country is always “right of centre” (Ron Brownstein); compromise means Dems cave while Repubs stand firm. Dems make concessions: a must for our scribes and talking heads. Republicans make demands and are commended for being tough negotiators.

Have you seen a well thought out article which shows a journalist giving the public option serious treatment? Point it out to me, please. Thanks.

Krugman hath spoken:
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http://www.nytimes.com/2009/09/18/opinion/18krugman.html?_r=1&ref=opinion
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The Baucus Bill is crap, worthwhile only in that slightly less crappy legislation may be built off of it. So I’m glad we waited all summer for that.
(Thanks, jcapan!)

Also I heard something about a majority of doctors coming out in support of the public option. Any chance you could look into that for us, KT?

the questions that you haven’t bothered to ask is “why is it a work in progress? Why did you spend nine months trying to keep right-wing republicans while ignoring the obvious concerns of Democratic senators and the voters that they represent? “
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This.
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He played grab-ass with the GOP for the whole summer and finally produced a piece of garbage, and now we’re getting it crammed down our throats because “it will bend the cost curve.”

Are you seriously waiting for KT to give you any hope about the public option? You’ve got to be kidding? She’s the biggest hypocrite there is on this issue. Perhaps she doesn’t mean to tow the company line, but tow it she does. Perhaps her head is really filled with so much cynicism that she can’t even comprehend the differences between the current debate and 1993, but I don’t see any evidence of general confusion or mental defect. But let’s just all give her the benefit of the doubt any way right?
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KT is the worse kind of hypocrite on this issue. She pretends to be so fair and objective, but then framed the elimination of Medicare advantage, at best an industry giveaway, as squeezing Medicare. Now clearly that’s industry framing, right wing framing, any framing other than Democratic framing. How could any journalist with half a brain take a Republicans word on the political intention of Democrats regarding Medicare — a program they’ve been trying to gut and dismantle since it began. They just recently tried to turn it into a voucher program. During the campaign, McCain called it an abomination.
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How long will it be before you faux cynicism turns into faux admiration for the valiant effort of the administration not that the media narrative is starting to turn more positive. I suppose now that Chuck Todd has declared this thing on the 3 yard line KT can be a bit more optimistic in her assessment of whether reform is possible. But until they declare that some version of the public option is going to pass as well — Snowe’s trigger — don’t expect much from KT on the public option.

Dee – no I am not seriously waiting for KT report on that. Like you, I’ve noticed that KT’s narrative at every turn has been that health care reform is doomed, we can’t get a public option, the AMA hates health care reform and that dooms it, the CBO scores sounds its death knell, etc. etc.
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And yet somehow the public option has held on, and health care reform keeps going through.
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I’m asking her about the doctors because I know she won’t report on it. I’m trying to be irritating about it.

Thar be nothin’ left to do bu’ be irritatin’, Cliff, so good on ye fer tha’!
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TOMORROW, ME HEARTIES!
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Swampland – pr’pare t’ be boarded!
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Thar’ll be “prizes” (ye’ll have t’ be treatin’ yerselves if ye win) ‘warded fer th’ most colorful, fittin’ use o’ pirate invective! Say wha’ ye mean t’ say, an’ say it in Pirate!
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Rusty ye be nothin’ bu’ a scurvy quiverin’ mass o’ gelatinous rotted stinkin slimy maggot-infested kelp!
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An’ tha’ goes fer yer wee wormy pals spongy an’ texty, too!
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No’ in response t’ anythin’ partic’lar – I just be feelin’ li’ sayin’ it!
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YARR!

Okay Cliff whew — I was scared for a minute there I thought I had lost a compatriate.

Commenters:
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Do any of the folks here who care about the public option support the version included in HR 3200?

Avast, wench, I be settin’ course for a mate’s weddin’ on the morrow, an’ will be missin’ th’festivities here on Swampland.

Stuart –
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Short answer:
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No, I don’t be supportin’ th’ version in HR 3200 – it be too limited t’ even be real’ called a Public Option. It be lookin’ li’ it almost be set up fer failin’.
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yarr.

Depends on which version. I support the public option but as you know I don’t support sacrificing all of reform for the version that is just open to the uninsured.

Dee:

the version that is just open to the uninsured

That would be HR 3200′s version.

A goal is to eliminate the preexisting-medical-conditions penalty from health insurance. But if people wait until they are sick, before buying health insurance, the premiums for everyone will go up markedly. Congress’s solution is to tax anyone who doesn’t buy health insurance, a silly and probably unconstitutional action. If people cannot afford health insurance, it’s hard to see how threatening them with a tax will improve their ability to buy it, and the Supreme Court probably would reject any tax having the sole purpose of advancing a federal law.

Here’s a thought for discussion: Rather than taxing people who don’t buy health insurance, why not reward people who do? What if the federal government gave every 18 year-old, who buys health insurance, an award of say $5,000. Nineteen year olds would receive say, $4,900. Each year the number would go down by some amount until a person turned 65, in which case he would receive Medicare.

Anyone who waited until he/she was sick, before buying health insurance, would forgo all those years of federal payments, a strong incentive to buy insurance early.

Health insurance companies would consider only age, when selling policies. Since policies for young people are less costly than those for older people, young people would wind up paying very little, or even making a profit on their policy premiums.

Yes, this wouldn’t be revenue-neutral, but who else will pay to insure the estimated 40 million uninsured and those with pre-conditions?

O.K. those are the broad brush strokes. Can you see any way to build on this? What are your thoughts?

Rodger Malcolm Mitchell
http://rodgermmitchell.wordpress.com

Rodger Malcolm Mitchell:

What if the federal government gave every 18 year-old, who buys health insurance, an award of say $5,000. Nineteen year olds would receive say, $4,900. Each year the number would go down by some amount until a person turned 65, in which case he would receive Medicare.

What if we gave them special securities redeemable immediately for less money than if they waited to redeem them at a later date?
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What if we then set up a special market for…
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I’m sorry, I’m being facetious here.
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The problem isn’t incentivizing young people to buy insurance, the problem is incentivizing insurers against running a maximum-profit enterprise.
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The way that it’s done in Japan –where they spend less than half of what we do on health care– is that insurers are regulated as if they were utilities. Profit margins for insurers are explicitly set, as well as premiums, deductibles and co-pays. There is no such thing as a “pre-existing condition exclusion” in Japan.
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The reason that insurers in that country can make a minuscule profit and continue day-to-day operations is that the government of Japan sets the prices in the entire country that health care providers, and drug manufacturers can charge for every single product and service related to health care, with rates renegotiated by the government with these vendors every two years.
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In this way, Japanese insurers don’t face the kind of hyper-inflation in health care prices the way that we do, and then are prohibited from passing on hyper-inflationary premiums to desperate, sick people.
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I think that the problem with our system isn’t that it fails to be complicated enough to incentivize the proper behavior in consumers or insurers, I think the problem is that we Americans have been experiencing a strange, almost war-time level of inflation in health care costs that no other developed nation pays.
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The question shouldn’t be “How do we get people, businesses and our government to pay more for more of the same thing?“, it should be “How do we go from paying $7000/per person per year to $3500/per person per year, like they do in Japan?”
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Here’s a link to the OECD’s numbers that back up my claims regarding the wild discrepancy between what we pay and what other developed nations pay for health care:
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http://stats.oecd.org/Index.aspx?DataSetCode=CSP2009

Everyone has their own statement of the problem. Maybe *that* is the problem.

I thought we were searching for a way to insure the 40 million (??) who are uninsured.

Your idea increases government control, sort of a first cousin to Medicare for everyone. Unfortunately Medicare, while good for us seniors, is destroying the health care system by underpaying doctors and hospitals, not paying for needed procedures, having large deductibles and not paying for drugs (outside of costly Part D).

Even with all those “nots,” Medicare soon will require deficit spending. The reason:

As bad as insurance companies may be, they don’t compare with the government when it comes to inefficiency. Compare the post office with FedEx.

That amount of government control would not get past the insurance lobby or the people who fear “socialism.” Politically, it’s dead.

Also, although lower prices would help, they don’t solve the problem for people who simply can’t afford insurance or the problem of being stuck in your job because insurance isn’t portable.

The pre-existing insurance problem involves people who won’t buy insurance until they get sick. The government’s plan uses penalties; my plan uses rewards.

Rodger Malcolm Mitchell
http://www.rodgermitchell.com

Rodger Malcolm Mitchell:

Everyone has their own statement of the problem. Maybe *that* is the problem.

Possibly, although “everyone” doesn’t seem to be having the kind of problem paying for exorbitant costs that we Americans do.

I thought we were searching for a way to insure the 40 million (??) who are uninsured.

No, we’re searching for a way to get sufficient quality health care to all Americans at a cost that’s sustainable and in line with what other developed nations pay.

Your idea increases government control, sort of a first cousin to Medicare for everyone.

So what? We’re not having a contest to see who’s political ideology is the smartest, we’re trying to do what we can see works in systems that have better results at a better cost than ours.

Unfortunately Medicare, while good for us seniors, is destroying the health care system by underpaying doctors and hospitals, not paying for needed procedures, having large deductibles and not paying for drugs (outside of costly Part D).

Again, not to be argumentative, but that’s not the reason why Medicare is destroying anything. Medicare seems to be having a terrible impact on the health care system because it sets prices for the entire private market as well as the public, and those prices are much, much too high in comparison with the rest of the world.
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If you would kindly click on this link to the US Dept. of Health and Human Services http://tinyurl.com/rcru3c , you will find this information:

Health spending in the United States grew 6.1 percent in 2007, to $2.2 trillion or $7,421 per person. This was the slowest rate of growth since 1998 and 0.6 of a percentage point lower than the growth of 6.7 percent in 2006, according to a report by the Centers for Medicare & Medicaid Services. Health care spending, however, continues to outpace overall economic growth, which grew by 4.8 percent in 2007.

Do you see that, sir?
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In the slowest growth rate in nearly a decade, the United States spent $7,421 per person. That’s an outrageously high price compared to the rest of the world.
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How do we know that?
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If you would also not mind clicking on this link to this Washington Post piece http://tinyurl.com/msscpw , you will see in the fifth paragraph down:

The world champion at controlling medical costs is Japan, even though its aging population is a profligate consumer of medical care. On average, the Japanese go to the doctor 15 times a year, three times the U.S. rate. They have twice as many MRI scans and X-rays. Quality is high; life expectancy and recovery rates for major diseases are better than in the United States. And yet Japan spends about $3,400 per person annually on health care; the United States spends more than $7,000.

The OECD’s data (to which I linked in the above) on health care backs that up claim, Rodger Malcolm Mitchell.
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In fact, the OECD’s breakdown of health care costs per nation looks like this:

Total spending on health care, per person, 2007:
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United States: $7290
Switzerland: $4417
France: $3601
United Kingdom: $2992
Average of OECD developed nations: $2964
Italy: $2686
Japan: $2581 (2006 data)

(the minuscule discrepancies in those numbers between NHE and OECD data for US spending seems to be the result of slight differences in the methodologies of the breakdown of cost-to-GDP/and US headcount numbers)

So I’m very sorry to contradict you, sir, but the unimpeachable facts are that we just pay too much, as if there was a sort of housing bubble on health care costs that was unrelated to use or scarcity –just a plain old run up, as if speculation or corruption (or both) were involved.
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When you say “Medicare is destroying the health care system“, you are correct, but not because it doesn’t pay for things like hospitals and doctors well enough, or cover prescriptions drugs in a sensible way, or burdens seniors with unexpected costs –although those are problems– it’s because Medicare isn’t used correctly by the government to set prices for hospital stays, laboratory tests, medical procedures and drugs at rates comparable to the rest of the developed world.
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The problem is that here we’re paying $2 per apple, while the rest of the rich countries of the world pay $1. In cost of living terms, we live in health care Manhattan Upper East Side, while they live in health care Chicago.

Even with all those “nots,” Medicare soon will require deficit spending. The reason:
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As bad as insurance companies may be, they don’t compare with the government when it comes to inefficiency. Compare the post office with FedEx.

Sir, believe me when I say that I am trying to be helpful by asking “Who told you that wildly inaccurate information?”
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Medicare will require deficit spending, certainly, but not because of inefficiencies in health care delivery. It will go broke because “Health spending in the United States grew 6.1 percent in 2007, to $2.2 trillion“, which is the cost of a major war.
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The price of health care is growing much faster than the economy, don’t you see, Rodger Malcolm Mitchell? It’s skyrocketing inflation in prices that will kill Medicare.
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Remember John Kerry’s “I voted for the $87 billion before I voted against it.“, sir? That’s nothing compared to the $2.2 trillion dollars Americans spent on hospitals, laboratory tests, medical procedures and drugs in 2007. Don’t you see?
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If Medicare were a cheap government housing program, it would be breaking the bank because the housing bubble meant that home prices were in outer space. The health care price inflation bubble is worse, has been going on for almost 20 years now non-stop, and doesn’t seem to be about to burst any time soon.

That amount of government control would not get past the insurance lobby or the people who fear “socialism.” Politically, it’s dead.

…But that’s because folks aren’t informed about the price of health care the way they are about gas prices, for example. We experience it second-hand, so we don’t really get it.
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If everybody knew –like they know the price of a gallon of gas– that we were paying about $7,000 per person vs an average of about $3000 per person, then people wouldn’t fear words like “socialism” when they were dishonestly thrown around by insurance company-paid public relations campaigns.
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Now that it’s not 1993, and there’s the internet, more and more Americans can look these facts up for themselves, and so it’s not “dead”, as you see from current events.

Also, although lower prices would help, they don’t solve the problem for people who simply can’t afford insurance or the problem of being stuck in your job because insurance isn’t portable.

I think lower prices would help a long way toward solving those problems, but you’re right. Health insurers are a part of the problem, too. I just don’t blame them for doing what they should be doing, which is making a profit however they legally can. It’s our responsibility to make it illegal to make a profit how they currently make a profit, however, just like it’s illegal for people to sell themselves into slavery to pay off debts, or illegal to allow kids to work in coal mines, or illegal to lend money at $1000% interest rates (well, it appears from recent events we’re still working on that one).
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Also, health insurers don’t really add any value to the system. They simply redirect money from one place (premiums) to the other (payouts, administration, marketing and profits), and they’re not terribly good at doing so. I don’t begrudge people the profits they’re able to make from doing things better and cheaper –liberals are capitalists, you know– but that’s not the trend in health insurance these days, just like it wasn’t the trend just recently to minimize risk in the banking industry. Both are doing something perverted, wrong, against peoples’ interests and guaranteed to break down at the taxpayers’ expense.

The pre-existing insurance problem involves people who won’t buy insurance until they get sick. The government’s plan uses penalties; my plan uses rewards.

With all due respect, sir, your plan is much, much more complex than it needs to be to solve these problems, and it creates entire new avenues for waste, fraud and abuse.
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Unfortunately, so does the current legislation being considered by Congress, so you’re in good company there.
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If I could have a wish granted that you take away anything at all from what I’ve written here tonight, sir, it would be to ask yourself this question: If we Americans are paying around $7000 for health care, and the rest of the world is paying around $3500, then where is all that money going?
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Thanks so much for reading and considering this, Rodger Malcolm Mitchell.

Messrs Mitchell and Zechman: Thank you for engaging. At the core of our being we are steeped in the notion of American Exceptionalism. We are always better than everyone else. We have belittled valued friends and allies in Canada and Europe while discussing our health care issues.

Perhaps, now that we are hopelessly in debt, especially to China, we might cultivate some humility and actually make a serious attempt at studying other health care systems and learn from those that work well. I know it’s tough to be humble.

And, just maybe, we should ban lobbyists for the health care industry from Washington for year – a hopeless wish, I know.

translated to piratespeak thanks to http://www.syddware.com/cgi-bin/pirate.pl

I know t’ ignore ere who tries t’ compare FedEx t’ th’ US Post Office.
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Fer instance, say I want t’ send me mom a birthday card. I can do ‘t fer 44 cents wi’ th’ post office — th’ cheapest I can do ‘t wi’ Fedex be $11.65.
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But lets say I want t’ make sure ‘t gets thar on mondee. I can do ‘t wi’ th’ Post Office fer $4.95 (priority mail), but Fedex will cost me $15.77.
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Mr. Mitchell`s use o’ th’ Fedex/Post office comparison reveal ideological blinders that make ‘t impossible fer th’ lad’s t’ be considered a reasonable discussion partner.

Stuart,
Thanks for your criticism, but what is your plan? Our government is doing a poor job with Medicare, so simply mandating government regulation doesn’t seem to work, here.

Specifically, what would you do to make sure everyone — the poor, the ill, the unemployed — has affordable health care, while simultaneously encouraging more and better doctors, nurses, hospitals, equipment and drugs?
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Bitter,
Cheer up. The media have been crying that same “sky-is-falling” tune since 1979, when the gross debt was only $800 billion. Today its near $12 trillion — a 1400% increase in only 30 years — and the sky still is up there.

We are not “hopelessly” in debt to anyone. The government could pay all its debt tomorrow, and never borrow again, if it wished. No federal check ever has bounced, nor ever will.

I suspect that in the next 30 years, when the debt again is 1400% higher at $180 trillion, the media will continue to use exactly the same words.
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Pirate guy,
If the post office were efficient, FedEx and UPS wouldn’t exist.
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Thanks to all for your input.

Rodger Malcolm Mitchell
http://rodgermmitchell.wordpost.com

…but if th’ PO be t’ inefficient bucket o’ slop tha’ ye claim, how be it they deliver a letter fer 44 cents whereas FedEx canna do so?

A business person would understand. A pirate would not.

A business scallywag such as one at Lehman Bros. or AIG? Or GM? Or Thornburg Mortgage? Or Countrywide? Pirates make mighty good doubloons; we loot it from those who do nah deserve it. Ah wait, don’ banks ‘n ‘nsurance companies do th’ same thin’? But I d’gress. Since ye b’lieve we don’ understan’, I’ll call yer bluff: I dinna ken. How be th’ post cabin can deliver a letter fer 44 cents whereas FedEx canna do so?

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Rodger Malcolm Mitchell:
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I very much appreciate you having taken the time and effort to have read through that lengthy examination, and verified the facts from my included data sources.

but what is your plan?

I don’t know, sir.
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I don’t have all of the answers, I’m just a little American guy who works for a living, cares about his country, knows a bad situation when he sees one, and is familiar enough with technology to know that the answers are out there –even if our politicians won’t talk about them.
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I am actually working today very hard, so I apologize for the late reply, and the fact that I may have to put off getting some solution ideas into this excellent discussion you were so good to introduce into this thread.
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I have a few ideas, but, honestly, they’re incomplete at best, I am no policy expert, just someone who has spent more effort on finding out the facts than lobbying for my favorite political view on this issue.
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I will ask you though, sir, if you wouldn’t mind joining me in doing the due diligence of examining all assumptions and premises about government, the private sector, markets, prices and efficiencies –no matter how long you and I might have held them, and no matter how they may have worked to explain things in the past– for their value in accurately describing the realities of this issue.
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It’s imperative that we ask ourselves questions like “How do I know what I know about government? How do I know what I know about Medicare? How do I know what I know about the free market? How do I know what I know about health care?“.
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Of course, the question “How do I know what I know about what the bills floating through Congress will do or not do?” is also key, don’t you think, Rodger Malcolm Mitchell?
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I must get back to work now…

Stuart,
Your having an open mind puts you in the distinct minority. I agree with your suggestion about “examining all assumptions and premises about government, the private sector, markets, prices and efficiencies –no matter how long you and I might have held them.”

I have spent 15 years in that effort, which is why I so often find myself at odds with the popular wisdom of the day.

You can find a brief summary of what I’ve learned at:
http://rodgermmitchell.wordpress.com/2009/09/07/introduction/.

It’s a short post called “I believe.”

Rodger Malcolm Mitchell
http://www.rodgermitchell.com