Tom Tomorrow reminds us that less than seven months ago, the NYTimes had this to report on negotiations on the health insurance reform bill:
Hospital industry lobbyists, speaking on condition of anonymity for fear of alienating the White House, say they negotiated their $155 billion in concessions with Mr. Baucus and the administration in tandem. House staff members were present, including for at least one White House meeting, but their role was peripheral, the lobbyists said.
Several hospital lobbyists involved in the White House deals said it was understood as a condition of their support that the final legislation would not include a government-run health plan paying Medicare rates - generally 80 percent of private sector rates - or controlled by the secretary of health and human services.
"We have an agreement with the White House that I'm very confident will be seen all the way through conference," one of the industry lobbyists, Chip Kahn, director of the Federation of American Hospitals, told a Capitol Hill newsletter.
It is of interest that Republican members of Congress stake out positions that their base supports, and in so doing that base is energized, and vocally demands action on them.
Meanwhile, Democratic leadership doesn't even start with much of what the base supports, and then negotiates away the rest of it, leaving the base to not really give a shit about the final product.
And that's what we see today: the current health insurance reform bill is not supported by a majority of Americans, as the Republicans claim. Not because most Americans don't support a public option, access to affordable health care, and protections from bankruptcy.
No, Americans don't support the current proposal because it doesn't include those things.
The White House and House leaders on Tuesday pronounced the government-run health program dead even as some Democratic senators continued their effort to resurrect it.
The move is a clear indication that President Barack Obama and leading Democrats are wary of another intra-party battle on the public option. Last year, Democrats lost valuable time debating the issue, leading to many missed deadlines.
The number of Senate Democrats voicing support for including a public option in the final healthcare bill - and for using reconciliation rules to pass that legislation in the Senate - grew to 25 Tuesday. But that's still 25 votes short, with little to no chance of reaching the necessary 50.
The White House on Tuesday squelched any momentum the public option had attracted over the last week.
In case nobody noticed, I thought I'd point out that something truly Titanic has shifted in progressive health reform: Howard Dean has abandoned the Democratic Bill and has started telling the truth about what the core of it has been all along:
HOWARD DEAN: You're going to be forced to buy health insurance from a company that's going to take, on average, 27 percent of your money so they can pay CEOs $20 million a yearly and so they can return have return on equity in their shareholders. And there's no choice about that. If you don't get that insurance, you're going to get-you're going to get a fine.
So, this is-this is a bill that was fundamentally written by staffers who are friendly to the insurance industry. Held up so-and was friendly to the insurance industry by senators who take a lot of money from the insurance industry. And it is not health care reform. I think it's too bad it's just come to this. ...
DEAN: No, absolutely not. You can't vote for a bill like this in good conscience. It caused too much money. It isn't health care reform. It's not even insurance reform.
Take, for example, this-there's a lot of talk about people who have pre-existing conditions can get health insurance. Well, not exactly. The fine print in the Senate says about health care industry-the health care industry gets to charge you three times as much if you're older than if you're younger. And they get to write the rules. That's in the Senate bill.
This bill is no longer reform.
Later in the same Countdown program, Howard Fineman offers this assessment of the worth of promises made during the Obama 2008 political campaign,
O'DONNELL: And, Howard, quickly, it would be a bill filled with things that were not in the Obama campaign, filled with taxes that were not mentioned in the Obama campaign, an individual mandate that President Obama campaigned against and other items.
So, how do you score the Obama campaign promise versus the way this bill looks at this point?
FINEMAN:That's ancient history for all the Democrats now, Lawrence. They want a bill, almost any bill. If it has some of those core provisions in it, they'll gladly take it, if they can get it.
I'll be sure to quote that line to the next Democrat who makes a progressive campaign promise.
Progressive Change Campaign Committee and Democracy for Change have a new ad out targeting Sen. Olympia Snowe regarding her stand against the public option (link):
When you consider that 58% of Mainers favor "creating a government-administered health insurance option that anyone can purchase" (Daily Kospoll) and that only 35% favor a mandate requiring all Americans to purchase private health insurance without a public option (Maine People's Alliance poll), it brings into question just whom it is that Sen. Snowe is representing in Washington.
And even more of interest is that no one is bothering to target Sen. Susan Collins.
Overall, a majority of physicians (62.9%) supported public and private options (see Panel A of graph). Only 27.3% supported offering private options only. Respondents - across all demographic subgroups, specialties, practice locations, and practice types - showed majority support (>57.4%) for the inclusion of a public option (see Table 1). Primary care providers were the most likely to support a public option (65.2%); among the other specialty groups, the "other" physicians - those in fields that generally have less regular direct contact with patients, such as radiology, anesthesiology, and nuclear medicine - were the least likely to support a public option, though 57.4% did so. Physicians in every census region showed majority support for a public option, with percentages in favor ranging from 58.9% in the South to 69.7% in the Northeast. Practice owners were less likely than nonowners to support a public option (59.7% vs. 67.1%, P<0.001), but a majority still supported it. Finally, there was also majority support for a public option among AMA members (62.2%).
It's of interest to note that an additional 10% of doctors surveyed supported a public option ONLY - that is, Medicare for all. This brings the total of practitioners that public and/or private options up to 73%.
But don't tell Sens. Snowe or Collins that. They know what is best for all of us.
President Barack Obama "should take it off the table," said Sen. Olympia Snowe (R-Maine) on CBS's "Face the Nation." "It would give real momentum to building consensus."
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And Snowe said she could support a so-called "trigger" that would enact the government-run plan to compete with private insurers if the private insurance market fails to become more competitive.
"It is a possibility for bridging the gap at some point in the process," Snowe said.
Also yesterday morning, Sen. Collins was a bit more specific (h/t slinkerwink):
Wingnuttia rallies, Axelrod finesses, and Snowe leads her gang on Face the Nation
Senator Olympia Snowe (R-ME): I urged the president to take the public option off the table, because it's universally opposed by all Republicans in the Senate. And therefore, there's no way to pass a plan that includes the public option. So I think he's recognizing that, because it is a roadblock to building the kind of consensus that we need to move forward.
Let's first be absolutely clear about why any sort of public health plan is anathema and such a threat to Big Insurance and the politicians they own. It would divert their premium flow and possibly be run by people whose primary job is to pay the doctor bill rather than enrich their shareholders. It may not be "essential" to Sibelius and Obama, and it would be according to White House spokesman Axelrod "unfortunate" (though apparently not a deal breaker) to have a bill without it. What is extremely essential to Big Insurance is the public plan be killed.
Here's what bugged me about the health insurance speech given by President Obama on Wednesday. It was the way he lumped together and dismissed "left" and "right" reform as a "radical shift that would disrupt the health care most people currently have." Then he finessed his clear desire to drop the public option with rhetoric about keeping "insurance companies honest" while keeping the White House door "open" to "serious" proposals.
I read that as an invitation to submit ways to silence demand for the public option, like the triggers (Snowe's pet idea, but she says herself that's going nowhere) or co-ops, which look to me to be a sham.
Furthermore, the true meaning of this open door policy may be discerned, I believe, if you take a look at who is having trouble entering that door. Earlier in the week there was a story about a new letter to the president from the progressive, pro-public-option Congressional block. As Greg Sargent explained, that White House door has been elusive to the public option group: "Obama had originally promised a meeting to progressives, but mysteriously, it never materialized."
That said, what was the top news story generated by the speech? It was the "You lie" remark from a reactionary Congressman against Obama's assurance that undocumented persons would not receive health benefits under reform. This was leading the news as late as Thursday evening, and even Olympia was taking Congressman Wilson to the woodshed on Sunday.
In fact I find it pathetic that Obama trying to set the record straight about what really is a gutless capitulation on wingnuttia's pet health reform demon--that some undeserving shlub here contrary to status laws may be able to get a flu shot or a bone set--becomes the most important story. Alexander Cockburn aptly pointed out that what Congressman Wilson shouted was true, only about a different part of the speech:
Alexander Cockburn: Joe Wilson of South Carolina shouted out "You lie", when Obama said correctly that his plan wouldn't offer services to illegal immigrants. By so saying, of course, Obama was acknowledging that he had just lied when he declared at the start of his speech that adequate medical care is a basic human right. Are undocumented workers, who sustain America's agriculture and much of its building industry, not humans, or humans without rights like the captives Obama still wishes to classify as beyond the protections of the Geneva Protocols?
Here are previous posts that illustrate just how dead the public option is. Given the remarks by Snowe on Sunday, nothing discussed in these was changed due to the Obama speech:
The idea of a legislative trigger to get Congress to do later something that it doesn't want to do now is not new. Such triggers have an excellent track record of demonstrating resolve where none exists. But as a policy mechanism, they have nearly always failed.
The 1973 War Powers Resolution, the 1978 Humphrey-Hawkins Full Employment Act, the 1996 HIPPA Act, and more recently, the 2003 Medicare Part D triggers - all have never been pulled.
Yet the trigger is trotted out again, seen as a way to achieve compromise with conservatives that have no intention of compromising, and who understand that they have one - because again, the trigger will never be pulled.
The media fawns all over these serious policy makers, the media that is often owned by or beholden to an industry that will once again not suffer under meaningful reform.
And once again the average American yawns, since there are football games to watch, and NASCAR's Chase, and another season of vapid television series to follow.
The elites will have succeeded once again in enabling their corporate masters to earn even more money, right in plain view. That is really the genius of it all - it's not like any of this is a secret.
And in four or five years, during another campaign cycle in which candidates, spending money contributed to them by corporate interest groups, will once again wring their hands and lament of the sorry state of affairs, and point with their thumbs as they trumpet reform measures that will never come to be.
As my own legislative district's "response" to Obama's outstanding speech last night, I offer the most recent letter I've received from a constituent on this issue. The writer is an excellent weathervane for my district: somewhat libertarian, and neither very conservative nor very liberal.
Mainers will not be fooled by Congressional prevarication on this issue over the next few weeks. They want health insurance reform, and they want it now.
It is pretty simple to understand, which is why it is so frustrating.
If America's Affordable Health Choices Act of 2009 (H.R. 3200) is to be enacted in anything like its current former, but without a public option, it will only increase the cost of premiums while not providing more health care.
Or, in other words, a windfall for insurers.
Among other things, H.R. 3200 mandates three things that when combined together, will bankrupt our Treasury and crush our economy.
Sec. 111. Prohibiting pre-existing condition exclusions does exactly what the title suggests - no longer will insurance companies be able to deny coverage to their customers because the costly cancer or degenerative disease wasn't obvious when the policy was signed.
Sec. 122.b. Essential benefits package defined lists the minimum services to be covered. These include:
(1) Hospitalization.
(2) Outpatient hospital and outpatient clinic services, including emergency department services.
(3) Professional services of physicians and other health professionals.
(4) Such services, equipment, and supplies incident to the services of a physician's or a health professional's delivery of care in institutional settings, physician offices, patients' homes or place of residence, or other settings, as appropriate.
(5) Prescription drugs.
(6) Rehabilitative and habilitative services.
(7) Mental health and substance use disorder services.
(8) Preventive services, including those services recommended with a grade of A or B by the Task Force on Clinical Preventive Services and those vaccines recommended for use by the Director of the Centers for Disease Control and Prevention.
(9) Maternity care.
(10) Well baby and well child care and oral health, vision, and hearing services, equipment, and supplies at least for children under 21 years of age.
And in Sec. 301. Individual responsibility, every American is required to purchase and maintain "acceptable coverage," that is, insurance that provides all that described in Sec. 122. Some will claim that coverage isn't mandated, since there is an opt-out clause. Sec. 401. Tax on individuals without acceptable health care coverage defines it as:
a tax equal to 2.5 percent of the excess of--
'(1) the taxpayer's modified adjusted gross income for the taxable year, over
'(2) the amount of gross income specified in section 6012(a)(1) with respect to the taxpayer.
Just to be clear - a two and a half percent tax, with an exception for those whose income is less than the standard exemption (6012(a)(1)).
So why are Republicans and those Democrats that are beholden to corporations that donated hundreds of thousands of dollars to them willing to impose this system?
Money.
We can use Medicare Part D as an example as to what is likely to occur, except on a much larger scale. The New England Journal of Medicine studied the impact of Medicare Part D on medical spending, and concluded:
We found that Part D led to increases in overall pharmacy spending among all beneficiaries," said the study's lead author, Yuting Zhang, Ph.D., assistant professor of health economics at the University of Pittsburgh Graduate School of Public Health. "These increases were offset by decreases in spending on other medical care services in those with little or no drug coverage before they enrolled in Medicare Part D, which was one-third of the beneficiary population studied. The majority of Part D enrollees in our study population - those with relatively good prior prescription coverage - spent more on prescriptions as well as other medical services.
Medicare Part D specifically banned the Fed from bargaining with pharmaceutical companies to obtain lower prices. Rather than lower overall costs, use of medications actually increased, as did the amount spent on them.
The same will likely occur should H.R. 3200 be enacted without a public option, that is, without insurance coverage where making a profit (and increasing that profit) is not required. Since private insurers would now be required to cover more claims, they will demand ever increasing premiums, and Americans will have no choice but to pay - insurance coverage is mandated.
Think Enron, but on a nationwide scale.
Update: Rep. Chellie Pingree was on Hardball last night, and had this to say:
Recently, I find myself stuck in all the legislative details of what may or may not be included in health care reform. A public option, employer mandates, a "trigger" mechanism, rate negotiations, and the list just goes ON and ON.
And as the deliberations and negotiations slog on with the prospect of a public option dimming everyday, it becomes more and more important for us as progressives to remember the human face to our broken health care system. And it's important for us to take those stories and bring them with us into the fight for a quality, affordable health care for all.
It's time to remember and recharge.
Meet Aaron and Nicole from Skowhegan, Maine. Aaron and Nicole are examples of a couple that just fell through the cracks in our broken health care system. They didn't qualify for Medicaid yet could barely afford their health insurance. It got so bad that Nicole had to quit her job to qualify for coverage.
Ms. Snowe says she wants the public to understand that there is a serious problem, that the health care system is in crisis and that even people who are happy with their current coverage will not stay content for long, given rapidly rising costs and steadily shrinking benefits.
"They may say they are satisfied now," the senator said in an interview, "but it is going to get worse, given the skyrocketing increases that are only going to persist. Something needs to be done to remove the deep anxiety that people find themselves in because of the lack of health insurance."
As for the details, Ms. Snowe has been the rare Republican willing to show any interest in a public health insurance plan as an option, though she favors a trigger to institute such a government-operated program only if private health insurers do not make coverage more affordable.
She said Maine's experience with insurance exchanges to create more flexibility for consumers had persuaded her that for less-populated states, the exchanges had to extend beyond state borders. She also thinks the idea of a reinsurance program to have the federal government absorb the risks of some catastrophic health care costs in an effort to lower private premiums is worth exploring.
All of this means that Ms. Snowe, a senior member of the Finance Committee with a longtime interest in health policy, is the chief Democratic target. And with Senator Edward M. Kennedy's death leaving Democrats a single vote shy of the 60 required to overcome Republican procedural objections at least temporarily, their need to entice at least one Republican to cross the aisle has become more critical.
Again I'll ask, with 164,000 Mainers lacking health insurance of any kind (nearly 12% of the population), which is remarkable considering how many Mainers already qualify for Medicare and Medicaid, why isn't Sen. Snowe in full support of a public option?
When asked about the debate as to whether a public option ought to be part of any health insurance reform bill, Steve Rowe, who is a candidate for governor in 2010, wrote via email:
Maine and the nation need healthcare reform that gives every person access to affordable coverage that cannot be taken away. Our families and small businesses will not see a true economic recovery unless we can hold down healthcare costs. One important way to keep costs down is to provide the choice of a public coverage option to compete with private insurers. With one insurance company now covering 71% of Mainers, we have little choice and even less competition. A public option would give us the choices we want, while providing the competition that will help hold down costs for everyone.
(Don't forget to bang those phones! Call Senator - phone numbers - promoted by Gerald Weinand)
Last week, this diary was posted at The Great Orange Satan, my visit to Susan Collins' office, in which the writer, Angela Quatranno describes her attempt to determine Sen. Collins' position on the need for health insurance/care reform. She posted a document she says was given to her by a staffer - the veracity of this document was confirmed to me by another source. It reads:
I continue to have many reservations about the Obama Administration's health care policies, the bill reported by the Senate Health Committee, and the legislation approved by the House committees. The Washington-run public insurance plan that would be created by these proposals would have the federal government administer the plan and determine benefits, premiums, and payments to physicians and hospitals. Proponents of a public plan claim that it would challenge private insurers to compete on cost and quality. Opponents see it as unfair competition for private insurers and the first step down the path toward a single-payer system because a public plan most likely would lead to the collapse of the private market.
Collins' statement that "the federal government administer the plan and determine benefits, premiums, and payments to physicians and hospitals," is of interest, since currently Medicare does exactly this same thing (of course, for-profit insurers do the same thing, but they aren't part of our elected government). Also, the Veterans Administration hospital system goes even further than that, actually providing care to veterans and those who qualify. That Maine has one of the highest per capita counts of those aged 65 and older (2nd behind Vermont) as well as retired and active duty servicemen and women ought to weigh heavily in the balance for Maine's junior senator.
Apparently these demographic groups do not:
I oppose the Washington-run public plan proposed by the Administration. The nonpartisan Lewin Group has concluded that a public plan open to all and offering Medicare-level reimbursement rates would result in 119 million Americans losing their private coverage. This kind of mass shift would destabilize the insurance market and is also inconsistent with the concept of building on our current system. It also would run contrary to my commitment to ensuring that families are allowed to keep health care coverage that is working for them.
Generally left unsaid amid all the citations is that the Lewin Group is wholly owned by UnitedHealth Group, one of the nation's largest insurers.
More specifically, the Lewin Group is part of Ingenix, a UnitedHealth subsidiary that was accused by the New York attorney general and the American Medical Association, a physician's group, of helping insurers shift medical expenses to consumers by distributing skewed data. Ingenix supplied its parent company and other insurers with data that allegedly understated the "usual and customary" doctor fees that insurers use to determine how much they will reimburse consumers for out-of-network care.
This practice of providing bogus data seems prevalent in the for-profit insuance system, as Wendell Potter explained in his testimony to the Senatte Committee on Commerce. Collins' colleague, Olympia Snowe, sits on that committee - perhaps the two of them could get together at some point and have a little chat.
Collins' continues:
I also oppose having a single-payer system for our country. The experience in other countries with single-payer systems demonstrates that it causes many patients to face long delays in needed tests and treatments. For example, some Canadians are forced to come to American hospitals for treatment because they face lengthy delays in Canada.
Here Collins' repeats conservative talking points that have long since been debunked. First, it is important to remind her that our own Medicare system is a single-payer, and was used by Taiwan as a model for their own health care system. Secondly, those 46 million Americans that do not have health insurance face long delays as well, delays that often result in their ailments becoming acute, and requiring invasive - and expensive - care.
And while the Canadian system is not without fault (what system is), it is telling that Collins does what most opponents of single-payer do: not mention that France not only has a single payer system that covers everyone in that country, a system similar to our Medicare, but that it provides the best care in the world for half the cost that Americans pay (percentage of GDP).
Earlier today on MSNBC, Sen. Olympia Snowe told Andrea Mitchell that the "Gang of Six" senators from the Finance Committee have not been considering a public option:
ANDREA MITCHELL: So bottom line, Speaker Pelosi says they will not produce anything that does not include a public option, do you see any way that the "Gang of Six" would come out of the Finance with a public option?
SEN. OLYMPIA SNOWE: No I don't. We have not had the public option on the table. It's been co-opted in addressing affordability and availability of plans through the Exchange. Those are the challenges that we're wrestling with to ensure plans that there are affordable basic plans to offer Americans.
I think the key to all of this is thinking about who is uninsured, who is underinsured, and they're all working Americans - essentially 81%. So something has gone wrong with the current system.
So if you have health care, health care and insurance that you like, we want to make sure you can keep it, through your employer or otherwise, and that won't be the case in a few short years because of the skyrocketing increases.
And that's the kind of change we have to stop that's threatening and jeopardizing American families and employers from providing the coverage.
If you are a supporter of a robust public option, then you'll want to contact Sen. Snowe's office on Monday. You may want to contact your friends too - send them a link to this diary. You can call her:
As President Barack Obama continues to weigh national health care reform legislation that includes a so-called public option, Sen. Susan Collins is becoming increasingly skeptical over the likelihood of a bipartisan compromise that's currently before the House.
"It remains to be seen whether there can be a bipartisan health care bill, but that is certainly my goal," Collins said today at a news conference at the Portland Jetport, having just returned to Maine after a tour of Afghanistan, Iraq, Libya and Yemen. She says the House bill is simply too expensive.
"I am however opposed to the bill that the House has produced, which not only wasn't bipartisan, but is enormously expensive," she said. "The Congressional Budget Office has estimated that it would cost $1.6 trillion over the next 10 years. We simply cannot afford that."
Instead, Collins is backing an alternative that she believes would pass bipartisan muster. Rather than creating health insurance for all to cover current medical costs, she would support a bill aimed at lowering the costs of health care.
Sen. Collins doesn't seem to realize that providing health insurance coverage to all Americans while at the same time reducing the spiraling costs of care are not mutually exclusive goals - in fact, they are intertwined. The exact plan to which Collins refers is not clear - I haven't heard of it, but then, I'm just a blogger. I'll contact Collins office and ask them to provide more info.
She does say that she has "actually had 104 health care meetings since the beginning of the year, and later this week, or rather early next week, I'm going to be at a 'fiscal wake-up tour' that I'm sure will get into health care issues. It's sponsored by the Concord Coalition."
I could not find any alternative health insurance reform plan on the Concord Coaltion's website.
Uma Thurman
DIRIGO BLUE is available as an