Beth's Health Care Reform Blog

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<center>As Public Option Push Comes to Shove, House Slashes Price</center>

Speaker of the House Nancy Pelosi has demanded that Democrats on the fence about their stand on the public option to make a decision and report where they stand by Wednesday. http://www.huffingtonpost.com/2009/10/2 ... 27979.html

House Cuts Health Bill Price To $871 Billion: AP Source
by Erica Werner and David Espo
Huffington Post, October 20, 2009

WASHINGTON — House Democrats are aiming to scale back the cost of their health care bill to well below President Barack Obama's preferred price tag by giving the government a strong hand in selling insurance in competition with the private market.

Obama has sought to spend no more than $900 billion over a 10-year period. The initial cost of the House bill was more than $1 trillion. On Tuesday, House Democratic leaders received a new cost estimate of $871 billion from congressional budget umpires who measured a robust version of a so-called public option for health insurance, according to a Democratic aide.

The figures were preliminary because no final decision on the design of the public plan had been made, said the aide, who requested anonymity in discussing the bill because the deliberations were private.
House Democrats worked on their legislation as senior Senate Democrats signaled they intend to try to strip the insurance industry of its exemption from antitrust laws as part of an upcoming debate over health care.

Senate Majority Leader Harry Reid, D-Nev., and Sen. Patrick Leahy, the Vermont Democrat who chairs the Senate Judiciary Committee, announced plans to hold a news conference on the issue Wednesday along with Sen. Chuck Schumer, D-N.Y.

If approved, the change would bring the insurance industry under stricter federal regulation. While a 60-vote majority is likely to be required for passage, the decision by top Democrats to seek a vote underscores the antagonism that lately has sprouted between advocates of Obama's ambitious health care plan and insurance companies who are dissatisfied with key features of the legislation.

The House bill with the strong public plan would extend coverage to 96 percent of uninsured Americans and significantly reduce budget deficits.
A $871 billion bill in the House would be in line with the leading Senate bill, the $829 billion measure approved last week by the Senate Finance Committee.

House Speaker Nancy Pelosi and other liberal lawmakers have joined Obama in calling for a public insurance program as a way to drive down the costs of insurance. Republicans have opposed government-run insurance and vowed to vote against a bill establishing a public option.
Pelosi assembled Democratic lawmakers Tuesday night to try to sell them on her preferred version of the public plan, which would link payment rates to providers to Medicare rates, plus an additional 5 percent for doctors. Moderates have been concerned that those rates are too low and would hurt hospitals and other providers particularly in rural areas.

Several lawmakers said they were getting close to the 218-vote majority needed for the stronger version.

"That's certainly where a large majority of the caucus is," said Rep. Chris Van Hollen, D-Md.

Leaders in both the House and the Senate were trying to finalize bills in time to begin floor debate in the next several weeks. Whether Senate Majority Leader Harry Reid, D-Nev., would include a public insurance plan in the Senate version was not clear.

In the Senate, legislation giving doctors $247 billion in increased Medicare fees over the next decade veered toward collapse, a victim of bipartisan concern over growing federal deficits.

Key lawmakers worked privately on a far less costly bill that would avert a 21 percent cut scheduled to take effect on Jan. 1 and give physicians an increase of .5 percent in 2010 and 2011.

Sen. Kent Conrad, D-N.D., said he and Sen. Charles Grassley, R-Iowa, were discussing a possible compromise that would cost $25 billion over two years and – unlike the original measure – not raise federal deficits.
The nation's debt "doubled during the last administration and if we don't do something, it's going to double again in the next eight years," Conrad said.

Anything less than the 10-year bill would mark a defeat for the American Medical Association, which has made a priority of legislation to create a new program to assure doctors reliable annual fee increases. The organization has aired television commercials in several states at a cost of $1 million or more and dispatched top officials to the Capitol in recent days to lobby lawmakers.

"Congress needs to fix this problem once and for all," AMA President Dr. J. James Rohack said in a statement. "No more Band-Aids."

The developments occurred as Senate leaders and White House aides met for the second straight day in the Capitol in hopes of agreeing on comprehensive health care legislation. Participants in the talks said no decisions had been made about key issues, including proposals for government insurance.

Obama has made an overhaul of the nation's health care system a top priority. Speaking at a Democratic National Committee fundraiser in New York on Tuesday, he said Democrats tend to have their "intramural fights" but that the American people desperately need a good bill to pass.

"I want all the Democrats who are in the House to understand what a profound potential achievement this is and stay focused on the goal line," Obama said. To his Republican critics, he said he welcomed a fierce debate over the final details but added that he would not stand for "folks sitting on the sidelines and rooting for failure."

All the health overhaul bills on Capitol Hill would require, for the first time, that most Americans purchase insurance. Lower-income individuals and families would receive federal subsidies to defray the cost, and small businesses would receive government help to pick up part of the cost of covering their employees.

Legislation would also include consumer protections such as a bar on the insurance industry's current practice of denying coverage on the basis of pre-existing medical conditions. Obama also wants any bill he signs to rein in the nation's spiraling medical costs.

Source: http://www.huffingtonpost.com/2009/10/2 ... 27956.html

Assuming the House gets the public option through to the joint conference committee, will the White House's behind the scenes deals with the pharmaceutical industry or big insurance be it's death knell? Consider this insider article:

Weiner: Obama admin. 'half-pregnant' with health industries
By Jordan Fabian
The Hill, October 20, 2009

Rep. Anthony Weiner (D-N.Y.) said on Tuesday that the Obama administration is "half-pregnant" with health insurers and pharmaceutical companies, which may jeopardize the success of reform.

The congressman -- who is a leading liberal voice in the healthcare reform debate -- said that rumored deals the White House has struck with big pharmaceutical companies and insurers may guide them to abandon key elements of reform, such as a public health insurance option.

"The Obama administration is trying to be, I don't know how to put it, half-pregnant with the insurance industry and the pharmaceutical companies," he told WNYC Radio today. "They're to some degree the source of our problem."

The Energy and Commerce committee member also criticized the White House's effort to attract bipartisan support for healthcare reform, saying both efforts will water down provisions favored by liberals and turn the bill into a failure.
"I think the White House very much wants to have, even if it's just one person, the ability to say that this is a bipartisan outcome," Weiner said. "And my frustration is we are really as a party are flirting with the notion of minority rule here."

Senate Majority Leader Harry Reid (D-Nev.), Senate Finance Committee chairman Max Baucus (D-Mont.), and Senate Banking Committee chairman Chris Dodd (D-Conn.) are currently drafting a final bill along with White House advisers.

Individuals involved in the negotiations have indicated that a public option is still on the table to be included in a final bill. But some observers have indicated they may drop it because it may not attract a 60 senator majority need to break a potential filibuster.

Yet, Weiner challenged his party leaders to include the option, saying that Democrats are "perilously close" to failing to pass a healthcare bill that would reduce costs and cover enough uninsured individuals.

"Are we going to plow through this or are we going to keep worshiping at the altar of bipartisanship even when it only means essentially one Senator?"

The sixth-term lawmaker also called on his fellow Democratic lawmakers to stand behind a Democrat-only push to pass healthcare reform, saying that negotiations are now in a "post-Olympia Snowe period."

Though he favors a "strong" public option, Weiner made no secret of his support for a single-payer system under which the government would provide or pay for universal healthcare.

"For me a strong public option is a compromise position from my advocacy for single payer," he said.

Source: http://thehill.com/blogs/blog-briefing- ... industries

[roxybeast]

<center>Should Congress Consider a National Health ID Card?</center>

When examining the most effective components of health care systems in other leading industrialized countries to control medical costs, I noticed that one of the most effective mechanisms to control health costs was the national health insurance card used in France. To summarize, every French citizen is issued a national health card with a magnetic strip on the back that records and stores all of their personal health information and medical records. Every time a French citizen visits a hospital, or doctor, or pharmacist, they present their card and the health care provider is immediately able to access and pull up the patient's entire medical and prescription history. The health care worker then updates the card to include their new services and returns it to the patient at the end of their visit, so that it is completely up to date and accurate and ready for the next health care official as needed.

The information entered by the doctor or pharmacist is immediately transmitted to the patient's insurance company for streamlined billing and the bill is typically paid within 2-4 weeks. The information is also sent to a privately maintained encrypted secure storage site where it is kept highly private, confidential, and protected from unnecessary access. In contrast, in the current American system, medical records are kept in a highly haphazard and non-uniform way, with virtually every doctor, hospital, pharmacy, and insurance company maintaining different databases, different forms and records, with varying information, which are often not easily shared or accessible to other providers, even when such information may be critical to patient care.

Requiring every American citizen to carry a national health insurance ID card containing their entire medical and prescription history, and to make that card available for review & update by every medical provider they access for care, would by far be the single most effective method to control skyrocketing and out of control medical costs. It would result in better patient care and a substantial reduction in medical mistakes resulting from a doctor or pharmacist not knowing a patient's full history. It would also prevent the costly and largely illegal practice of doctor shopping and going to multiple pharmacies to fill the same prescription, which is also a primary source of illegal street narcotics.

Are Americans ready to enter the future of effective health care? A limited version of this idea is being considered as a means of reducing Medicare costs, and in my opinion, should be extended to all Americans. Technological trends seem to suggest that adoption of such a cost control mechanism is inevitable. Despite the obvious benefits of a national health ID card system, opponents will surely try to paint it as "big brother" invading and taking control of the intimate details of your personal life or perhaps even the beginning of the dreaded "mark of the beast." The next article provides insight into possible scare tactics.

Senior Citizens League Mailer The Holy Grail Of Elderly Scare Tactics
by Sam Stein
Huffington Post, October 20, 2009

A new mailer being sent to senior citizens warns that Democratic-considered health care reform would result in the rationing of care and the creation of a massive database that would endanger the privacy of personal medical information.

Authorized by the Senior Citizens League, the piece seems tantamount to the Holy Grail of health care reform scare-tactic mailers.

Sent out under a cover letter from former Congressman David Funderbruk (R-N.C.), the literature starts by raising the frightful specter of private medical data become widely accessible to the public.
"How would you like it if your doctor, your clinic, or other healthcare providers -- without either your knowledge or consent -- gathered up your, along with your family's medical history, and sent your most intimate conversations to a central data bank in Washington D.C. to become a part of the largest computer network ever created?" Funderburk writes.

Here is the mailer:

(Note--To view the mailer go to this site: http://www.huffingtonpost.com/2009/10/2 ... 27583.html )

The piece, which was passed along to the Huffington Post from a concerned recipient, goes on to make other dubious claims about health care reform. The author -- Senior Citizens League Chairman Dan O'Connell -- warns that doctors will have to consult the massive new database before they can provide care for seniors. "The theory," the mailer reads, "is that this new approval system will enable Medicare to deny claims because it will allow government experts to disapprove treatment, prescriptions, surgeries and other care they feel is inefficient or inappropriate -- and approve care they believe is appropriate."
The accompanying, seven-question survey, pushes many of these same points: warning seniors that their private medical information will be hacked, their care rationed and their medical priorities handed over to government bureaucrats.

Health care reform, of course, pushes no such rationing. Instead, Democrats along with the administration and even some congressional Republicans have argued that advance health information technology and coordinated care could cut down on unnecessary administrative costs -- in the process, allowing doctors to provide better, more efficient treatment.

The Senior Citizens League doesn't acknowledge these points. Instead O'Connell's claims are footnoted to former New York Lt. Governor Betsy McCaughey -- a highly partisan and largely discredited voice in the debate.

"One of the major savings the plan's creators are counting on is the imposition of rules by a new government health review board to approve the use of surgery, other treatments, diagnostic procedures, and medications ONLY when it is 'appropriate and cost effective'" the mailer reads.

"t will inevitably lead to a two-tier system of treatment - older patients will receive a lower level of care than younger, stronger patients who are expected to have longer lives ahead of them."
Asked for comment on the mailer, Shannon G. Benton, executive director at the Senior Citizens League, said the group was "concerned with issues related to patient privacy and how patient information will be used by Medicare to determine appropriate treatments."

"Those concerns have not been fully addressed by Congress or the administration," Benton added, "and it is our obligation to make sure that seniors don't suffer breaches of privacy or shortages of care."
As part of the process of protecting the priorities of seniors, the group appears to be planning a lobbying push in Congress. The mailer, O'Connell writes, "is the best and most effective way that Medicare beneficiaries can make their views known." The results, he adds, will be "rushed to Members of Congress, decision makers at the White House, policy makers in government and officials at Medicare..."

"If a significant majority of Medicare beneficiaries who complete this survey are clearly opposed to specific parts of the plan, then Congress, the Administration and the bureaucrats WILL respond."

"BUT, once the computer system and approval process is in place they will be virtually impossible to change."

The group also asks recipients for small donations of five, ten or fifteen dollars to help get the survey attention. "Remember," O'Connell writes in the postscript, "your future health, your privacy, and your security are at stake."

The Senior Citizens League, which claims to be "one of the nation's largest nonpartisan seniors groups" with 1.2 million supporters, has been accused of sending misleading mailers to seniors in the past. In July 2001, the organization denied -- in a congressional hearing -- being behind deceptive mailings that, among other things promised seniors government money in the form of slave reparations.

Source: http://www.huffingtonpost.com/2009/10/2 ... 27583.html

So I'm curious, where do you stand on this issue? And what do you see as the benefits, drawbacks and potential scare tactics that might arise?

[roxybeast]

Dems go after antitrust exemption for insurers
by David Espo
Associated Press, October 21, 2009

WASHINGTON – Democrats launched a drive at both ends of the Capitol on Wednesday to strip the insurance industry of its decades-old exemption from federal antitrust laws, part of an increasingly bare-knuckled struggle over landmark health care legislation sought by President Barack Obama.

If enacted, the change would put an end to "price-fixing, bid-rigging and market allocation in the health and medical malpractice" insurance areas, said Sen. Patrick Leahy, D-Vt., chairman of the Senate Judiciary Committee. Leahy said he would seek a vote on the plan when the Senate debates health care legislation in the next few weeks.

Leahy made his comments at virtually the same time the House Judiciary Committee voted 20-9 to end an industry exemption that dates to 1945. Three Republicans supported the move.

Senior Democratic officials in the House said the leadership was inclined to incorporate the measure into the broader health care bill expected to be brought to the floor for a vote within a few weeks. No final decision has been made, they added.

In response, an industry official said Democrats were targeting a problem that does not exist.

The events coincided with a vote in the Senate to sidetrack legislation averting a 21 percent cut in Medicare payments for doctors in January and raising their fees by $247 billion over a decade. The 47-53 vote was 13 short of the 60 needed to advance the bill, reflecting concerns that the measure would have raised deficits. The result was a defeat for Democrats and an embarrassment for the American Medical Association, which had mounted a seven-figure advertising effort to assure passage of one of its top priorities.

Republicans grumbled that Senate Democrats timed the offensive on antitrust matters to obscure their defeat on the bill setting pay rates for doctors, a measure that GOP leader Mitch McConnell, R-Ky., called "the Senate's first vote on health care this year."

Even so, taken together, the threats to revoke long-standing antitrust protections reflect the fury Democrats have projected in response to recent insurance industry attempts to influence the shape of legislation. The events occurred less than a week after the insurers' trade association issued a report saying a measure in the Senate Finance Committee would produce sharp increases in premiums for millions of people who currently have insurance.

Democrats and the White House reacted angrily, attacking the study as flawed and politically motivated.

Responding to the day's developments, the industry said the legislation was based on a misperception of existing law. "We believe that health insurers have not been engaging in anticompetitive conduct and that McCarran-Ferguson does not provide a shield for such conduct," Karen Ignagni, president and CEO of American's Health Insurance Plans, wrote to Rep. John Conyers, the Michigan Democrat who chairs the Houses Judiciary Committee.

"Thus, the bills attempt to remedy a problem that does not exist," she wrote.

The McCarran-Ferguson Act of 1945 gives states authority to regulate the insurance industry for antitrust matters, and the companies are exempt from federal jurisdiction.

To buttress its case, industry officials circulated a paper from JPMorgan, the investment bank. "Ultimately, just using the terms antitrust and health insurers in the same sentence makes a great headline, but in practice given the narrow scope of the act, we doubt a repeal has meaningful implications for the publicly traded companies," it said.
The industry holds a large conference beginning on Thursday several blocks from the Capitol.

The White House had no reaction. Instead, aides pointed to Obama's statement last weekend that insurers are earning "profits and bonuses while enjoying a privileged exception from our antitrust laws, a matter that Congress is rightfully reviewing."

The developments came as Democrats struggled in both houses of Congress to enact Obama's call for legislation to expand health care to millions who lack insurance, provide greater consumer protections to millions more, and rein in the cost of medical care in general.

In the Senate, Reid, key committee chairmen and White House aides are at work crafting legislation the Senate can vote on later this fall.
The House is also on track for a vote this fall, although weeks of private negotiations among Democrats have yet to produce agreement on a bill.

Among the most controversial unresolved issues concerns proposals for the government to sell insurance in competition with private companies. The House bill is certain to include such a provision.

Although the rank and file have yet to come to an agreement on key details, officials said the leadership was counting carefully to see if it had the votes to establish a system that would pay doctors 5 percent more than they receive for treating Medicare patients. Hospitals and other providers would be paid at Medicare rates, without the additional 5 percent, they said.

It is unclear what type of so-called "public option" will be incorporated into the Senate measure, where Democratic moderates are wary of the idea, even though public polling consistently shows its popularity.

Until recently, the insurance industry has played a noncommittal role as legislative proposals developed in both houses of Congress. AHIP announced months ago it supported comprehensive health care reform and Obama called on Ignagni to speak at a televised White House event designed to showcase widespread agreement that the time had come to change the current system.

Essentially, industry offered a trade. It agreed to abandon practices such as denying coverage on the basis of pre-existing medical conditions if the legislation required nearly universal coverage, a step that would give it access to millions of new customers. At the same time, it vigorously opposes any legislation that would allow the government to sell insurance.

The tone began to change when the Finance Committee voted to excuse an estimated two million lower income Americans from a requirement to purchase insurance, at the same time it greatly reduced the penalties for those who were still covered, but refused to buy coverage.

Source: http://news.yahoo.com/s/ap/us_health_care_overhaul

[roxybeast]

<center>As A Final Vote Draws Near, Where Do They Stand?</center>
With an all important up or down vote on cloture on health care reform legislation looming and drawing ever nearer, where do key Senators stand? Here are several stories focusing on recent remarks about their positions by Republican Senator Olympia Snowe and key Blue Dog Democrats in the Senate. If the Dems can get 60 votes for cloture, i.e. to overcome a filibuster and force a floor vote on the actual final bill, then they only need a simple majority to pass the bill with Vice-President Joe Biden voting to break any ties.

First, the lonely stand of the lone Republican ...

Snowe Warns Reid On Public Option
by Jeff Muskus
Huffington Post, October 22, 2009

Sen. Olympia Snowe (R-Maine), the most likely Republican vote for the Democratic health care bill, told reporters Thursday that she would not vote to break a GOP filibuster if the bill put forth by Senate Majority Leader Harry Reid (D-Nev.) contains a public option.

"Would [inclusion of a public option] be enough for you to vote against the cloture motion?" a reporter asked Snowe on her way off the Senate floor Thursday afternoon.

"On the public option? I'd say I'm against a public option, so yes," Snowe said.

"But would it be enough for you to say, 'I'm not going to proceed to this bill?'" the reporter pressed. Snowe nodded on her way into the elevator.

Snowe said she also opposes the opt-out version of the public plan, which would allow individual states to remove their residents from the federal exchange. "I don't support that," she said.

Reid is still working with Finance Committee Chairman Max Baucus (D-Mont.) and health committee Chairman Chris Dodd (D-Conn.), along with representatives from the White House, to meld the finance and health bills into one.

Snowe's was the lone Republican vote for the bill in the Finance Committee, where it contained no public option. On the Senate floor, Snowe's vote alone might not make the difference. But besides the bipartisan veneer that her "aye" could offer a unified Senate bill, Snowe confirmed that she is in talks with conservative Senate Democrats like Ben Nelson of Nebraska. Should they present a united front, the public option would have a weaker chance of passage in the Senate.

Source: http://www.huffingtonpost.com/2009/10/2 ... 30120.html

Second, key Blue Dogs signal all Democratic Senators will vote in favor of cloture and against any GOP filibuster ...

Pryor: "I'm Open To A Public Option"
by Ryan Grim,
Huffington Post, October 22, 2009

A key conservative Democrat told reporters Thursday that he was "open to a public option" as part of the final health care reform package. Sen. Mark Pryor (D-Ark.) added that "it depends on how it's structured on whether I can support it... I just haven't decided."

The Senate health-care debate is unfolding on multiple levels. On one level, Democrats need 60 votes to overcome a GOP filibuster and proceed to a floor debate on the merged bill currently being pulled together by Senate leaders and White House representatives. The group gathered in Senate Majority Leader Harry's Reid's office Wednesday night and, aides say, the public option was the main topic of discussion, though no decision was made on whether to include it in the bill.

"My impression is they're working through what a public option would look like in the bill, if anything. I don't know if they know yet," said Pryor.

Once it's on the floor, the bill would again need 60 votes, after amendments, to defeat a GOP filibuster and proceed to a final floor vote. That final floor vote only requires 50 votes, with Vice President Joe Biden breaking the tie.

Pryor's openness to a public option is important not necessarily because he'll vote for the final bill, but because it means that even if he doesn't vote for final passage, he's unlikely to vote against his leadership's motion to proceed to a floor debate -- the key vote.

Indeed, that's just what he told blogger Mike Stark in a recent interview. "I don't think you'll see me or any other Democrats do that," Pryor said when asked if he'd join a GOP filibuster.

Sen. Mary Landrieu (La.), one of the few Democrats on record against the public option, also said that she'd rather not join a Republican filibuster. "I'm not right now inclined to support any filibuster," she told HuffPost.

The refusal of the GOP to participate meaningfully in negotiations has soured her on joining them in a filibuster. "For the Republican Party to kind of step out of the game is very unfortunate," she said. "I'm not going to be joining people that don't want progress."

Sen. Ben Nelson (D-Neb.), another public option foe, said it's too early to embrace the strategy laid out by Sanders and others. "I believe in playing chess, but that's about three moves ahead of me, and I'm not prepared to make those moves until I see some other moves in between," he told HuffPost.

Source: http://www.huffingtonpost.com/2009/10/2 ... 30328.html

Third, beyond the all important cloture vote, here's how key Blue Dogs and Independents currently line up on the public option ...

Key Senate Dems May Rebuff Obama On Health Care
by Charles Babington
Huffington Post, October 22, 2009

WASHINGTON — The Democrats' control of a hefty majority in the Senate – plus the House – would suggest that President Barack Obama is within reach of overhauling the nation's health care system this fall.
But the numbers mask a more complicated reality: Obama and Democratic leaders have modest leverage over several pivotal Senate Democrats who are more concerned about their next election or feel they have little to lose by opposing their party's hierarchy.

One is still smarting from being forced to abandon next year's election. Another had to leave the Democratic Party to stay in office. And some are from states that Obama lost badly last year.

These factors will limit the president's ability to play his strongest card – an appeal for party loyalty and Democratic achievement – in trying to muster the 60 votes his allies will need this fall to overcome a Republican filibuster in the 100-member Senate.

When lawmakers face a tough vote, their uppermost thought is "survival," said Alan Simpson, a Wyoming Republican who spent three terms in the Senate.

On a very few occasions, Simpson said, then-President George H.W. Bush asked him to cast a vote likely to cause him political problems back home. That was perhaps three times in 18 years, said Simpson, who held a GOP leadership post. "I swallowed hard and went over the cliff," he said.

But it's a sacrifice that presidents and party leaders should not count on, he said.

The Democratic leaders' limited leverage will complicate the push for allowing the government to sell insurance in competition with private companies. Some Senate Democrats who oppose the idea are from states that voted heavily against Obama last fall.

Democratic Sen. Blanche Lincoln faces a potentially tough re-election race next year in Arkansas, where Obama lost to Republican John McCain by 20 percentage points. She says she will base her health care votes on what is best for Arkansans.

Choice and competition among insurers are good, Lincoln said, but "I've ruled out a government-funded and a government-operated plan."
Sen. Mary Landrieu of Louisiana, where Obama lost by a similar margin, said she might be willing to let some states try "fallback or trigger" mechanisms that would create a public option if residents don't have enough insurance choices.

But she told reporters, "I'm not for a government-run, national, taxpayer-subsidized plan, and never will be."

Another Democratic senator, who also may prove wary of Obama's overtures, takes the opposite stand.

"I would not support a bill that does not have a public option," said Sen. Roland Burris, D-Ill. "That position will not change."

Burris' willingness to bend could prove crucial this fall if Obama and Senate Majority Leader Harry Reid, D-Nev., need every possible vote in crafting a compromise, such as a national public option that is triggered if certain insurance availability targets aren't met.

But Burris may be in no mood to play ball. Obama and other top Democrats sharply criticized his appointment to the Senate in December by an ethically tainted governor, Illinois' Rod Blagojevich, and they forced Burris to abandon hopes of winning election in 2010 by making it clear they would not back him.

In short, Burris, 72, has virtually nothing to lose by defying his party's leaders and voting as he pleases.

Sen. Joe Lieberman of Connecticut is another potentially crucial senator with tenuous ties to the Democratic Party's hierarchy. Rejected by Connecticut's Democratic voters in the 2006 primary, he kept his Senate seat by running as an independent. He now calls himself an Independent Democrat.

Lieberman has criticized the health care bill that emerged from the Senate Finance Committee, but it and other health bills are undergoing changes.

Another centrist Democrat whose vote is uncertain is Sen. Evan Bayh of Indiana, a political battleground state.

"I want to know what works for families and small businesses," said Bayh, adding that he might back public insurance options run by states, not the federal government.

It's possible that Obama and party leaders eventually will ask Democrats such as Bayh, in the name of party loyalty, to vote to block a GOP filibuster of a health bill even if they plan to vote against the bill on final passage. The strategy might enable Democrats to muster the 60 votes needed on a crucial procedural question and then pass the bill with a simple majority.

Bayh said that if a party leader "is asking some of us to enable the passage of legislation that we think would be harmful to the people of our state, I don't think that's a fair thing to ask."

It's possible that centrist Democrats are holding out for favors from Obama and party leaders, such as pet projects for their states or help in their next campaign. Obama already has lavished special attention on some of them.

He invited Bayh to the White House last week for a chat about health care and the deficit. In an interview that led to good publicity back home, Bayh told Indiana reporters that the president "was asking for my leadership on both of those issues."

Source: http://www.huffingtonpost.com/2009/10/2 ... 29708.html

Finally, this just in from ABC News: there are enough votes to pass the public option in the Senate!

Public Option: It's Back
by Jonathan Karl
ABC News, October 22, 2009

ABC News' Jonathan Karl reports:

The public option. The idea was believed to be dead. Liberals wanted it, but Senate vote counters insisted it simply could not pass the Senate. The dynamic, however, has changed. The public option may be back from dead.

I am told that Senate Majority Leader Harry Reid is leaning toward including the creation of a new government-run insurance program – the so-called public option – in the health care reform bill he will bring to the full Senate in the coming weeks.

Democratic sources tell me that Reid – after a series of meetings with Democratic moderates – has concluded he can pass a bill with a public option.

This is not because there has been a new groundswell of support for the idea. In fact, there are still a handful of Democrats who -- along with Olympia Snowe and every other Republican – oppose the idea. As recently as this morning, Senator Mary Landrieu (D-LA), for one, dismissed recent polls that show public support for the idea, telling NPR, "I think if you asked, do you want a public option but it would force the government to go bankrupt, people would say no.”

That would appear to be a problem because Reid needs 60 votes to pass a health care bill and there are simply not 60 Senators who support a public option. But Reid is now convinced that Democratic critics of the public option will support him when it counts – on the procedural motion, which requires 60 votes, to defeat a certain GOP-led filibuster of the bill. Once the filibuster is beaten, it only takes 51 votes to pass the bill.

And Democratic critics of the public option would get a chance to go on-the-record with their opposition by voting for an amendment to strip it from the health care bill. Under Senate rules, such an amendment would need 60 votes to pass. And while there may not be 60 votes in favor of a public option, there are also not 60 votes against it. So, it would remain in the bill.

The downside: The move would almost certainly cost Democrats the support of Senator Olympia Snowe (R-ME), the sole Republican who now supports Democratic health care reform efforts. Asked today if she would vote to block a bill with public option, Snowe told reporters, “On the public option? I'd say I'm against a public option, so yes."

Another important point: Reid’s version of the public option is different from the more liberal version advocated by Speaker of the House Nancy Pelosi in two key ways: 1) Reid’s version would allow individual states to opt-out of the program, giving public option critics the chance to say that their states retain the right to scrap the idea; and, 2) Under Reid’s plan, the new government insurance program would have to negotiate payment rates with health care providers. Under Pelosi’s, payment rates would be tied to the lower rates paid by Medicare.

This is not a done deal. I am told that Senate Finance Chairman Max Baucus (D-MT) – who worked for months to get Olympia Snowe’s support for the bill and has consistently said a public option cannot pass the Senate – was apoplectic when Reid told him he wanted to include the public option. “Baucus went to DEFCON 1,” said a source familiar with the negotiations, referring to the alert level the military uses for an imminent attack on the homeland.

UPDATE: Snowe gave an interview to Bloomberg TV today where she reiterated her opposition to the inclusion of a public option that would kick into gear immediately -- and said it may not be possible to finish a bill this year.

“A public option at the forefront really does put the government in a disproportionate position with respect to the industry,” Snowe said on “Political Capital With Al Hunt,” airing this weekend.

She added: “Christmas might be too soon. . . . We should give it the time it deserves.”

Source: http://blogs.abcnews.com/thenote/2009/1 ... -back.html

[roxybeast]

<center>Detailed Analysis of All the Pending Health Reform Bills</center>
If you want to take a closer detailed look at all of the various legislative proposals on the table, here's a good place to start:

A Crib Sheet on the Health Care Bills
By REED ABELSON
New York Times, October 21, 2009

If you’re interested in a reading a just-the-facts analysis of the health care legislation pending in Congress, here’s your chance. Health Affairs, the health policy journal, with support from the Robert Wood Johnson Foundation, has just issued a new policy brief looking at the various bills in the House and Senate, and their potential impact on the insurance market. The brief is not exactly light reading. But what document can be breezy, if it must parse insurance terms like “adjusted community rating?” The document does, though, offer some useful historical context for the current debate. And it provides a straightforward look at the pros and cons of different aspects of the legislation — all in eight pages, even if you count the footnotes.

Read the detailed analysis report here: http://www.healthaffairs.org/healthpoli ... ief_12.pdf

Source: http://prescriptions.blogs.nytimes.com/ ... are-bills/

[roxybeast]

<center>So Where Does Public Support for Reform Stand? The Latest Polls</center>
Here are the latest public opinion polls regarding health reform ...

Americans Remain Divided Over Health Care Proposals, Polls Say
By MARJORIE CONNELLY
New York Times, October 22, 2009

Two new polls shed light on the divisions among Americans wrestling with questions raised by efforts to overhaul the health care system.

Americans are evenly divided over whether to support Congressional proposals to revamp health care, according to the latest CNN/Opinion Research Corporation poll. But the latest USA Today/Gallup poll suggests that many Americans are reserving final judgment until all the details have all been ironed out.

In an interesting finding, twice as many blacks as whites support Democratic efforts to overhaul the health care system, according to the USA Today/Gallup poll, and more blacks favor a government-run insurance plan. But support among all Americans for a public plan depends on how it is described, the new data also suggest.

In the CNN/O.R.C. poll, 49 percent favor Mr. Obama’s plan to reform health care and 49 percent oppose it. But when asked whom they trust more to handle changes to the country’s health care system, half of those surveyed named Mr. Obama, while one-third preferred the Republicans in Congress.

A quarter of those surveyed in the USA Today/Gallup poll said they expect to support the bill that the White House and Congressional Democrats are working towards; one third said they plan to oppose it. Four in 10 Americans said their support or opposition depends on decisions yet to be made about substance of the bill.

CNN found just over half (53 percent) said the country would be better off if Congress were to pass a bill to change the health care system along the lines of what Mr. Obama has proposed, while 44 percent said it would be better if the current system were left in place with no changes.

At the same time, Americans would prefer the change to be more deliberate, the Gallup poll found. Fifty-eight percent said Congress should deal with health care reform gradually, over several years, while 38 percent would rather see Congress try to pass a comprehensive health care reform plan this year.

Polling about the public option appears to be sensitive to question wording. In the Gallup poll, respondents were asked: “If Congress passes a health care bill, do you think it should or should not include a public, government-run insurance plan to compete with plans offered by private insurance companies?” Fifty percent said the bill should include a public option, and 46 percent said it should not.

Higher support for the public option was found in the CNN/O.R.C. poll, which did not mention Congress. Respondents were asked: “Now thinking specifically about the health insurance plans available to most Americans, would you favor or oppose creating a public health insurance option administered by the federal government that would compete with plans offered by private health insurance companies?” Sixty-one percent said they favored it, and 38 percent opposed it.

In a follow-up question, 40 percent said they would support the bill only if the public option were included.

For purposes of analysis, blacks were oversampled for the USA Today/Gallup poll. Blacks were twice as likely to say they expected to support the health care bill as whites: 43 percent of blacks said they plan to support the health care bill, compared with 21 percent of whites. And while about half of whites said they opposed the public option, seven in 10 blacks said they supported it.

The CNN poll is based on telephone interviews with 1,038 adults nationwide conducted by Opinion Research Corporation from Oct. 16-18. The USA Today/Gallup Poll was conducted Oct. 16-19 with 1,521 adults nationwide. The margin of sampling error for both polls is plus or minus 3 percentage points.

Source: http://prescriptions.blogs.nytimes.com/ ... more-10825

And ...

Public May Expect Health Care Changes Sooner Than Congress Is Planning
By KATHARINE Q. SEELYE
New York Times, October 22, 2009

A lot of people are expecting big changes soon in the health care system, according to a new poll. But they are in for a big disappointment.

Even if Congress passes a bill this year, most changes are not scheduled to go into effect until at least 2013 or much later.

Many people do not realize that, according to a new tracking poll from the Kaiser Family Foundation, a health research organization.

Asked if Congress passed a bill this year when they would expect people without insurance to begin getting help buying coverage, 49 percent of the respondents said this year or next. Twenty-five percent said three years from now, and 11 percent said “further in the future than that.”

Asked how soon they would expect health insurance companies would have to begin accepting customers with pre-existing conditions, 51 percent said this year or next. Twenty-three percent said three years from now, and 9 percent said further into the future.

In reality, change will take a long time regardless of which version of health care legislation Congress passes. That is partly because of the complexity of the undertaking; health care accounts for one-sixth of the nation’s economy. But it is also because some lawmakers are hoping to push off implementing some elements so that an overhaul will not seem so costly.

“If they pass health reform, they get a big political victory without having to deliver results for several years,” said Drew Altman, chief executive of the Kaiser foundation. “But the poll shows that many people are expecting help from the legislation to be arriving much sooner than it will be.”

See the survey here, then post a comment below telling us what you think about Congress’s timetable.

Source: http://prescriptions.blogs.nytimes.com/ ... -planning/

And ...

Public Gloomier About Cost and Quality of Health Care if Congress Enacts an Overhaul
By DALIA SUSSMAN
New York Times, October 22, 2009

Americans are increasingly gloomy about the costs and quality of their health care if Congress passes health care legislation, according to the latest USA Today/Gallup poll.

The survey results underscore the political challenges for supporters of a health care overhaul, as few Americans see benefits for themselves in changing the system.

Only about 2 in 10 expect the quality and costs of their health care to improve. And the 49 percent who now predict their costs will get worse is up 7 percentage points since the same question was asked in September. The 39 percent who now say the quality of their care will be worse is up 6 points since last month. And 37 percent say their coverage will get worse, compared with 33 percent a month ago.

Americans are also more apt now than in September to say that insurance company requirements they have to meet to get certain treatments covered will get more stringent – 46 percent now, compared with 38 percent last month.

In a separate release on Wednesday, Gallup reported that 25 percent of Americans say they will support the final health care bill, 33 percent say they will oppose it, and 39 percent say it depends on some of the decisions that have yet to be made.

Among this undecided group – which is critical toward winning over a majority of the public – Gallup found more negative than positive expectations about the final legislation’s likely impact on the costs and quality of their health care.

But as Gallup’s news release about the poll notes, it is unclear whether supporters of a health care overhaul will need to convince Americans that their own costs and care will improve — or instead, if it will be enough to convince them that their health care will not get worse, as Congress attempts to extend coverage to tens of millions of people who currently have none.

The USA Today/Gallup Poll was conducted Oct. 16-19 with 1,521 adults nationwide. The margin of sampling error is plus or minus 3 percentage points.

Source: http://prescriptions.blogs.nytimes.com/ ... -overhaul/

[roxybeast]

<center>Harkin: Congress Will Pass Health Bill With Public Option by Christmas</center>
Will Congress provide a Christmas gift to the American public? Sen. Harkin thinks so ...

Harkin Says Congress Will Pass Health Bill by Christmas — With a ‘Public Option’
By ROBERT PEAR
New York Times, October 16, 2009

Senator Tom Harkin, the chairman of the Senate health committee, predicted on Friday that Congress would pass sweeping health care legislation before Christmas. And he said it would include a new government insurance plan — the so-called public option — which would compete with private insurers.

“The vast majority of the Senate Democratic caucus is for the public option we have in our bill,’’ which was approved by the health committee in July, Mr. Harkin said.

A competing bill approved this week by the Senate Finance Committee does not include a public insurance plan, but would set up private nonprofit insurance cooperatives across the country.

Mr. Harkin, an Iowa Democrat, said Congress would probably have to “go outside the health care system’’ to raise revenue to finance coverage of the uninsured. “That’s what the House has done,’’ Mr. Harkin said, and House leaders can “make a pretty strong argument’’ for that approach.

The main health care legislation in the House would impose a surtax on high-income people. By contrast, the bill approved by the Senate Finance Committee would raise revenue within the health care system — by imposing an excise tax on high-cost insurance plans and by requiring insurers and makers of drugs and medical devices to pay annual fees to the federal government.

Some Democrats have tailored their proposals to appeal to moderate Republicans. The chairman of the Finance Committee, Senator Max Baucus, Democrat of Montana, won support for his bill from one Republican, Senator Olympia J. Snowe of Maine.

But in response to a question, Mr. Harkin indicated that he was not overly concerned about getting Ms. Snowe’s vote for a final bill.

“It’s not so important who you get on the bill,’’ Mr. Harkin said. “What’s important is getting it done right.’’

If Congress decides to tax high-cost insurance policies, Mr. Harkin said, it should increase the thresholds in Mr. Baucus’s bill. Under the bill, insurance plans would generally be subject to the tax if premiums were more than $8,000 for individual coverage or $21,000 for family coverage.

The tax is expected to raise more than $200 billion over 10 years. Mr. Harkin has long been an ally of organized labor, and labor unions are fighting this proposal, which they describe as a tax on middle-class benefits.

The Senate majority leader, Harry Reid, Democrat of Nevada, is combining the bills approved by the Finance Committee and by Mr. Harkin’s panel, the Committee on Health, Education, Labor and Pensions. Mr. Reid said he hoped the full Senate would begin debate on the package later this month.

Though Republicans are overwhelmingly opposed to the legislation, Mr. Harkin sounded confident.

“We are in an irrevocable position,’’ Mr. Harkin said. “The momentum is there. We will not be stopped by obstructionists. We will have a bill on the president’s desk before Christmas. And yes, it will have a public option.’’

Insurance companies say that a government-run plan could drive them from the market. But Mr. Harkin said, “I do not expect them to lose business unless they have products that are overpriced for the value.’’

Source: http://prescriptions.blogs.nytimes.com/ ... ic-option/

[roxybeast]

Merging the Senate Bills
By DAVID M. HERSZENHORN
New York Times, October 19, 2009

Senate Democrats and White House officials met on Monday evening to discuss how to merge the two versions of the Senate’s health care legislation, and Democratic aides said they were aiming to have a combined bill “mostly baked” by the end of this week.

Once the bills are melded, the Congressional Budget Office will be asked to develop a revised cost analysis, a task that will take several days. At that point, provided everything is in order, the majority leader, Harry Reid of Nevada, will look to start the floor debate.

In the meantime, Democrats are focused on resolving differences on five main issues:

THE PUBLIC OPTION The Senate health committee included in its bill a government-run insurance plan to compete with private insurers. The Finance Committee did not include a public option, and instead proposed the creation of private, nonprofit health cooperatives.

AFFORDABILITY Some Senate Democrats are worried that subsidies to help moderate-income Americans buy health insurance are still not generous enough.

A “CADILLAC” TAX The Finance Committee bill includes a proposed excise tax on high-cost, or “Cadillac,” health insurance policies. The health committee has no jurisdiction over taxes, but some senators are concerned that the tax will hit too many middle-class workers, especially members of labor unions.

AN EMPLOYER MANDATE The health committee requires most employers to provide health insurance or pay a penalty of $750 a year for each full-time employee. The Finance Committee requires employers to contribute toward subsidies for employees who do not get benefits or pay $400 per full-time employee per year, whichever is less.

OTHER SPENDING ITEMS The health committee bill includes authorization for spending on numerous programs including prevention and wellness. But President Obama’s goal of keeping the cost of the legislation to about $900 billion means that some of those proposals must be curtailed.

Source: http://prescriptions.blogs.nytimes.com/ ... ate-bills/

[roxybeast]

<center>Steps You Can Take To Make Sure Real Reform Passes!</center>
Here are some concrete actions you can take to support real & meaningful reform:

Take 5 minutes out of your day to:

• Call or Write the President: 202-456-1414
&/or fill out this White House contact form and express your opinion: http://www.whitehouse.gov/CONTACT/

• Call or Write your Congressperson: 202-224-3121
Here's a quick link to help you find & contact them directly:
https://writerep.house.gov/writerep/welcome.shtml

• Call or Write your two Senators: 202-224-3121
Here's a quick link to help you find & contact them directly:
http://www.senate.gov/general/contact_i ... rs_cfm.cfm

• You can also send your Representative & Senators an e-mail or snail mail letter expressing your position on health reform: http://www.visi.com/juan/congress/

• Demand that they pass H.R. 3200 and accept no compromises!!!
Doctors support this bill. For more information on why you should too & how you can express your support: http://www.pnhp.org/amendment/

From Michael Moore: "Congress must join the civilized world and expand Medicare For All Americans. A single, nonprofit source must run a universal health care system that covers everyone. Medical bills are now the #1 cause of bankruptcies and evictions in this country. Medicare For All will end this misery. The bill to make this happen is H.R. 3200 (but only with Rep. Anthony Weiner's amendment). You must call AND write your members of Congress and demand its passage, no compromises allowed. Take just one minute on each of these calls to let them know how you expect them to vote on a particular issue. Let them know you will have no hesitation voting for a primary opponent -- or even a candidate from another party -- if they don't do our bidding. Trust me, they will listen."
Source: http://www.huffingtonpost.com/michael-m ... 29664.html

[roxybeast]

Momentum, Confusion, and Sticking to the Strategy
by Mike Lux
Huffington Post, October 24, 2009

The intensity is ratcheting ever higher as we move toward the final stages of the health care fight. It's been a good week for reformers overall. Pelosi and Reid are both whipping for strong bills, including a very strong public option (in the House) or a respectable public option (in the Senate). Progress is being made on other key components of the package including the affordability issue. Even traditional media sources like The Washington Post and the New York Times are waking up to the fact that even though they have been declaring health care reform on life support and the public option dead for six months, something decent might actually pass.

The only down moment of the week has been the confusion caused by the White House on the Senate strategy. This whole muddled are-they-or-aren't-they backing Harry Reid or backing Snowe's trigger-designed-not-to-trigger mess was just a poorly handled distraction. I mean, look, anyone who has been in DC longer than a week knows that if you have a meeting at the White House with more than five people in it, that certain folks with their own agenda will start leaking stuff to the media, so whatever the intent of all that was, it was bound to undermine Reid and our overall momentum. The White House is now on the record denying that was their intent, and folks there have sworn to me they are backing Reid to the hilt, so I believe them and that's all good, but it was still a mess.

I think we're still moving forward, though. The next few days will tell us what kind of deals can be cut, but no matter what, I think the strategy for progressives remains the same as it has been from the beginning of this fight:

1. House progressives have to stay strong and united in pushing for a strong public option and more affordability for the middle class. Health care reform will not pass without the votes of the members of the Congressional Progressive Caucus, and they need to continue to say a big Hell NO to triggers that are written to never trigger and co-ops that are designed to never compete with the insurers. If House progressives absolutely refuse to fold, the final bill will have a solid public option and decent affordability for the middle class.

2. The 30 core progressives on health care in the Senate need to stay strong and stay together as well. They need to keep pushing Reid and the White House to reject the Snowe trigger that will never trigger, and they need to twist the arms of their last couple of colleagues who are holding out. The idea that one or two Senators are going to stop the entire rest of the Democratic party from delivering on the biggest issue in front of congress in 50 years is an outrage, and those Senators should be told in no uncertain terms that nothing they want will ever again see the light of day if they support the Republican filibuster on this issue.

3. Everyone in the broader progressive community needs to be 100% clear that the Snowe trigger written to never trigger is deader than a doorknob. To call this a compromise is actually pretty funny. Fundamental to health care reform is real competition and a check on the market power of the insurance industry. Without that, private insurers will continue to raise their rates and otherwise screw people over at will. The trigger as written by Snowe has a Catch-22 in it that makes sure it would never be triggered in real life, so it would provide no competition or check on insurance power whatsoever. Come on now: if you are going to ask progressives to compromise, don't give us something that is no compromise. Most progressives understand we need to compromise some, and in fact we already have compromised an enormous amount, but we aren't going to let you give us nothing.

I think we still on track to win this fight and get a very decent health care bill, and in fact the momentum is building. Nancy Pelosi and Harry Reid deserve an enormous amount of credit for continuing to push forward on a strong bill in spite of all the obstacles being thrown in their way. Progressives need to stick together and not allow themselves to get rolled on phony compromises. If they do, we are going to be able to celebrate a huge victory before the year is out.

Source: http://www.huffingtonpost.com/mike-lux/ ... 32628.html

And is single-payor still alive, at least as a states may opt for it basis?

Health Care Reform
by Sen. Bernie Sanders (Independent-Vermont)
Huffington Post, October 23, 2009

One of the reasons that I am a strong proponent of a single-payer, Medicare-for-all proposal is that it is much less complicated than what we are going to end up with in Congress. A single-payer approach saves hundreds of billions of dollars a year because you don't end up with thousands of different health insurance programs appealing to all different kinds of people and costing a fortune to administer. I am going to continue the fight for single-payer. I am cautiously optimistic that we may end up with legislation that will allow states to go forward with single-payer if they want to.

VIDEO of Sen. Sanders discussing single-payor option & where the various legislative proposals in the House & Senate stand now ...
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Source: http://www.huffingtonpost.com/rep-berni ... 32432.html

Finally, Rep. Anthony Weiner (D-NY) provides a very clear and concise explanation of what the public option is and means for you ...
<object width="425" height="344"><param name="movie" value="http://www.youtube.com/v/O55M1r1kFUA&hl ... ram><param name="allowFullScreen" value="true"></param><param name="allowscriptaccess" value="always"></param><embed src="http://www.youtube.com/v/O55M1r1kFUA&hl=en&fs=1&rel=0" type="application/x-shockwave-flash" allowscriptaccess="always" allowfullscreen="true" width="425" height="344"></embed></object>

Rachel Maddow provides a nice explanation of how the public option might pass both the House and Senate, since even if every GOP Senator supported a filibuster, they would still need at least one Democratic Senator to side with them to be successful and even if some Blue Dog Democrats are against the public option, they are also not like to support a Republican attempt to filibuster and prevent cloture ...
<object width="425" height="344"><param name="movie" value="http://www.youtube.com/v/jJoU6qE5DJo&hl ... ram><param name="allowFullScreen" value="true"></param><param name="allowscriptaccess" value="always"></param><embed src="http://www.youtube.com/v/jJoU6qE5DJo&hl=en&fs=1&rel=0" type="application/x-shockwave-flash" allowscriptaccess="always" allowfullscreen="true" width="425" height="344"></embed></object>

[roxybeast]

Message To Leadership: Rockefeller Re-States His Opposition To Triggers
by Sam Stein
Huffington Post, October 23, 2009

Read more at: http://www.huffingtonpost.com/2009/10/2 ... 31958.html

One of the Senate's foremost champions of the public insurance option re-asserted on Friday his opposition to a compromise approach that would establish a government-run insurance plan only if certain market conditions aren't met.

In a statement issued apparently in response to news that the White House is leaning towards the so-called "trigger" approach, Sen. Jay Rockefeller (D-W.V.) said the following:

"Historically, 'trigger' mechanisms have not been successful, and they are not a substitute for a strong public health insurance option, A 'trigger' simply delays price competition, which in turn will delay affordability for consumers and moves us farther away from the goals of health care reform. Already, we are seeing insurance companies threatening to game the system, by raising their prices in advance of reform. The only way to curb price-gouging by health insurance companies is with real competition on day one--that is the public option."

An aide to the senator said Rockefeller was merely registering his philosophical opposition to the compromise approach and not, necessarily, committing himself to voting against (or filibustering) the trigger-option if it came to a vote.

"He does not say either of those things," the aide says. "He is explaining why they aren't good. He opposes the creation of a trigger."
The aide also said that Rockefeller was still "looking into" the other potential compromise approach: creating a public option that states could opt-out of.

But the desire by the senator's office to re-state its opposition on a day when the Senate is conducting no official business says something about the current state of the health care debate. Right now, there are a slew of conflicting reports about what public option package has the blessing of leadership in both chambers of Congress as well as the president. Well-connected sources insist that Senate Majority Leader Harry Reid (D-Nev.) is pushing to get the vote for health care bill with an opt-out version of the public plan. But the confusion is obviously widespread enough to persuade one of body's foremost public option supporters to lay down a marker about where he stands on triggers.

Source: http://www.huffingtonpost.com/2009/10/2 ... 31958.html

[roxybeast]

<center>The Most Important Reason to Pass Health Reform: Our Children!</center>
Our children, the future generations, are the most important reason why passing comprehensive meaningful health reform now is critical.

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Can Children Get Congress To Protect Their Health?
by Marian Wright Edelman, President of Children's Defense Fund
Huffington Post, October 23, 2009

In 1931, Grace Abbott, the Chief of the U.S. Children's Bureau, gave a speech about her long and frustrating workdays in our nation's capital trying to advocate for children's needs. She said she felt all alone standing with her baby carriage on the sidewalk watching a great traffic jam moving toward the Capitol where Congress sits.

She saw all kinds of vehicles including the tanks and trucks the Army put into the street; "the handsome limousines in which the Department of Commerce rides...the barouches in which the Department of State rides with such dignity...[and] the noisy patrols in which the Department of Justice officials sometimes appear." And so she stood on the sidewalk watching, "because the responsibility is mine and I must, I take a very firm hold on the handles of the baby carriage and I wheel it into the traffic."

And so must we parents and grandparents and child care providers and educators grab the handles of our baby strollers and the hand of our children and walk into the traffic headed for Congress. We must make them hear and respond to the urgent, but still too ignored, needs of our 8.1 million uninsured children. We must break through the political den of powerful special interests like the insurance and drug companies with their fleet of well paid lobbyists.

On Wednesday, November 4th, the Children's Defense Fund is organizing a Champions for Children's Health Stroller Brigade in the nation's Capitol to send an urgent and clear message to our political leaders that real health reform for children must be enacted this year. Children's unmet health needs have been lost in the debate's "big" issues. Unless we act now, millions of children could be worse, rather than better off, as a result of pending health reform legislation.
D.C.'s stroller brigade will extend to Congressional districts across the country on November 6th through 8th where concerned parents, grandparents, faith, and community leaders will tell members of Congress back home to stand up and invest in an affordable, accessible, and comprehensive child health system. So far, stroller brigades are being planned for Arkansas, California, Florida, Louisiana, Minnesota, Mississippi, Montana, New York, North Dakota, Ohio, and Texas.
It is morally and economically indefensible for millions of American children to be denied critically needed health reform in the richest nation on earth claiming it lacks the money to protect its children.

We need to end the bureaucratic barriers that keep two out of three of the more than eight million uninsured children who are already eligible for either CHIP or Medicaid from actually getting the care they need. A simple, seamless enrollment process like older Americans have for Medicare would ensure our children are cared for and covered. We need to guarantee every child access to the full range of preventive and other health care services they need and that we now provide to all children in Medicaid but not to all children in CHIP or in the proposed Exchange. A child covered by CHIP has the same value as a child covered by Medicaid and all deserve comprehensive care regardless of the program they are in. And we need to provide an affordable national health safety net for children whose families make up to 300 percent of the Federal Poverty Level ($66,000 for a family of four) and eliminate the unjust lottery of geography. Whether a child's family can afford coverage should not depend on where they live. New York covers children up to 400 percent; North Dakota only to 160 percent; and Massachusetts and twenty-one other states, plus the District of Columbia are already at 300 percent. A child in North Dakota is no less valuable than a child in New York or Massachusetts.

The lives and health of millions of children depend on health reform this year. They will not get what they need unless you speak up and demand it. Children have no other voice but yours. Lift it high and loud. Grab your strollers, your scooter, or your walking shoes, and join our children's brigades on November 4th in Washington, D.C. and in other states across the country November 6-8th. In America, every child should have the health care they need - now. They have only one childhood. Together we can make it happen. To learn how to join a stroller brigade, create your own, or take action in other ways with simple steps, visit www.childrensdefense.org/strollerbrigade.

Source: http://www.huffingtonpost.com/marian-wr ... 31955.html

[roxybeast]

Leaderless: Senate Pushes For Public Option Without Obama's Support
by Sam Stein & Ryan Grim
Huffington Post, October 24, 2009

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

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

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

"Everybody knows we're close enough that these guys could be rolled. They just don't want to do it because it makes the politics harder," said a senior Democratic source, saying that Obama is worried about the political fate of Blue Dogs and conservative Senate Democrats if the bill isn't seen as bipartisan. "These last couple folks, they could get them if Obama leaned on them."

But with fundamental reform of the health care system in plain sight for the first time in half a century, the president appears to be siding with those who see the Senate and its entrenched culture as too resistant to change. Administration officials say that Obama's preference for the trigger, which is backed by Maine Republican Sen. Olympia Snowe, is founded in a fear that Reid's public option couldn't get the 60 votes needed to overcome a GOP filibuster. More specifically, aides fear that a handful of conservative Democrats will not support a bill unless it has at least one Republican member's support.

Indeed, the president's retreat on the public option leaves Reid as the champion of progressive reform -- an irony that is not lost on progressives who have long derided the Majority Leader as too cautious.
"Who knew that when it came down to crunch time, Harry Reid would be the one who stepped up to the plate and Barack Obama would shy away from the fight," emailed one progressive strategist.

Outside Congress, anger trumped confusion. On Saturday, the activist group Progressive Change Campaign Committee - which just days earlier had targeted Reid in a separate campaign - took out a new television advertisement in Maine accompanied by an "emergency petition." Titled, "Time to Fight," the spot featured a former Obama campaign volunteer pleading with the president not to abandon the public plan.

"If this once-in-a-generation opportunity to pass a public option goes down the drain after we were just a couple votes away in each house of Congress, everyone will remember exactly who was and was not willing to fight when it counted," said the group's co-founder, Adam Green, when asked why he aired the ad. "Our grassroots pressure is an attempt to get President Obama to live up to the mandate for sweeping change that was given to him in the 2008 election."

MoveOn.org rallied its base on Friday. "The President has said many, many times that a public option is the best way to keep insurance companies honest and lower skyrocketing health care costs. Senate Democrats are ready to fight for a public option--if the White House gives up now, it would be a tragic mistake," said an e-mail to the group's membership.

White House aides responded to the pressure not by embracing Reid's more aggressive stance, but by denying reports that he was discouraging the opt-out proposal.

"The report is false. The White House continues to work with the Senate on the merging of the two bills," said Dan Pfeiffer, a top White House aide whose portfolio includes health care. "We are making good progress toward enacting comprehensive health reform."

But the push-back, sources with direct knowledge of deliberations between leadership and the administration, does not square with Obama's private indications to Senate leaders. The sources say that the president has left little doubt about his apprehension with an opt-out approach.

It is not philosophical, one White House aide explained, but is a matter of political practicality. If the votes were there to pass a robust public option through the Senate, the president would be leading the charge, the aide said. But after six months of concern that it would be filibustered, the bet among Obama's aides is that Reid is now simply being too optimistic in his whip count. The trigger proposal, said Democratic aides, has long been associated with Chief of Staff Rahm Emanuel.

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

"If we're this close in the Senate and they're not helping us, I have a feeling they could screw us in the conference," said one.

Advocates of a public option consider a "trigger" the equivalent of no public option at all. A trigger would implement a public option only if insurance companies failed to meet certain benchmarks over time and it would only be implemented in the regions of the country where those benchmarks weren't met. The Medicare prescription drug proposal passed in 2003 includes a "trigger," but the public provision has never been activated despite soaring drug costs. The industry can help craft the trigger language and can game its stats to prevent it from becoming reality.

"The current state of our health system should be trigger enough for anyone who's paying attention," said a congressional aide in the middle of the health care battle. "The American people pulled the 'trigger' in November."

The intellectual father of the public option, Yale Professor Jacob Hacker, told HuffPost that the trigger proposal is a betrayal.

"The trigger is an inside-the-beltway sleight of hand that would protect private insurers from the real competition that a strong public health insurance option would create," he said in an e-mail. "It is unworkable in the current Senate bills, unwise as public policy, and unwanted by the the substantial majority of Americans who say they want a straight-up public option."

Source: http://www.huffingtonpost.com/2009/10/2 ... 32844.html

[roxybeast]

Democrats push for health benefits to start by 2010
by Carrie Budoff Brown
Politico, October 25, 2009

Democrats are pushing Senate leaders and the White House to speed up key benefits in the health reform bill to 2010, eager to give the party something to show taxpayers for their $900 billion investment in an election year.

The most significant changes to the health care system wouldn’t kick in until 2013 — two election cycles away. With Republicans expected to make next year a referendum on health care reform, Democrats are quietly lobbying to push up the effective dates on popular programs, so they'll have something to run on in the congressional midterm elections.

Democrats are anxious to mix the good with the bad since some of the pain would be phased in early, including more than $100 billion in industry fees that critics say could be passed on to consumers.

“We want to be able, within the cost framework and the implementation framework, to have as much start as early as possible, even though we know all of it can’t,” said Sen. Debbie Stabenow (D-Mich.), a Finance Committee member who is working with other senators on the effort. “And the White House wants to have as much as possible to start.”

Under the Democratic wish list, senior citizens would receive discounts on brand-name drugs next year. Small businesses that provide insurance would see tax credits. And a $5 billion high-risk pool would cover people with preexisting conditions.

Democratic strategists expect the 2010 election to present a stark contrast between the parties, particularly if the health care bill receives minimal Republicans support. The front-load strategy could help blunt GOP attacks on the bill as a toxic mix of higher taxes, rising premiums and cuts to Medicare.

The strategy also could ease some of the disappointment among voters who expect more immediate reforms than the bill can deliver, including on the much-debated public insurance option. Democrats in both the House and the Senate are closing in on finding the votes to include some form of a public option in the bill, but a government-run insurance plan would likely be one of the last pieces to kick in fully, if it passes.

“Democrats will be the party that passed health care reform, and Republicans will be the party that tries to repeal it,” said Jim Kessler, vice president for policy at the centrist Third Way. “The challenge on health care has always been to demonstrate to the middle class that this bill is really for them and that it will provide them stable coverage that they can count on through thick and thin.

“It’s important to have a few things to point to that go into effect right away,” Kessler said. “This is a case where good policy and good politics coincide.”

Texas Sen. John Cornyn, chairman of the National Republican Senatorial Committee, said the strategy was a transparent attempt to paper over the less palatable aspects of the bill.

There are billions in new taxes on insurers, device manufacturers, and pharmaceutical companies that come due in 2010.

Starting in 2013, insurers that offer family plans worth more than $21,000 per year would pay a tax, which unions say would hit middle class families. Beginning in 2014, the penalty on people who do not purchase insurance would kick in. The changes to Medicare funding, which Democrats say is aimed at redirecting wasteful spending but Republicans say would hit senior citizens, would be implemented immediately.

“I can understand their desire to have some fig leaf to protect them against understandable voter concern about the fact that insurance premiums are going to go up. You are taking half-trillion dollars from Medicare and you are going to raise taxes on middle class families,” Cornyn said. “Those are unpopular positions, so I can understand their desire to front-load and show something for it.”

A Kaiser Family Foundation poll released last week showed Democrats risk disappointing voters with the delayed timetable, which lawmakers view as necessary given the complexity of implementing the reforms.

The survey found voters are unaware that the major components — $450 billion in subsidies to purchase coverage and a menu of insurance market reforms — wouldn't kick in for four years. Forty-nine percent of respondents said they expected people to begin receiving financial assistance to buy coverage this year or next. Fifty-one percent said they expected insurers to begin accepting customers regardless of preexisting conditions this year or next.

The Senate Finance Committee has already posted a one-page memo on its website titled “What You Get Right Away: Immediate Relief for Families and Small Businesses.” The Health, Education, Labor and Pensions Committee, which also passed a health care bill, prepared its own list of immediate benefits.

Both documents read like a blueprint of Democratic talking points for the 2010 elections.

“It helps to have more to run on in the midterms and to prime the pump for 2012,” said a senior Democratic aide of the front-load strategy. “Also, you want to have real, practical effects folks can feel right away so the issue is a clear tangible — not just rhetorical — victory. It’s a big part of this.”

Stabenow said she is working with other senators to influence the closed-door negotiations among Senate Majority Leader Harry Reid (D-Nev.), White House chief of staff Rahm Emanuel, Finance Committee Chairman Max Baucus (D-Mont.) and Sen. Chris Dodd (D-Conn.), who is representing the HELP committee. In several cases, the HELP bill offers earlier effective dates on key provisions — and Stabenow and others are pressing Reid to go with the more immediate approach.

“We want to have as much front-ended as possible,” Stabenow said.

The Senate HELP bill would immediately require family policies to cover young adults until age 26, while the Finance bill sets up a “young invincible” policy beginning in 2013.

Both Senate bills establish a reinsurance fund that protects early retirees from losing their health care coverage, but only the HELP bill kicks into effect immediately. Pushed by Stabenow and Sen. John Kerry (D-Mass.), the fund would cover catastrophic claims of retirees between 55 and 64 who receive coverage through employer-based plans.

Insurance companies would be required to report the proportion of premium dollars that are spent on items other than medical care. Hospitals would need to itemize charges so consumers could compare prices. States would be compelled to establish an insurance ombudsman office that would intervene with companies on behalf of consumers.

Under both bills, people who have been denied insurance due to pre-existing conditions or who have been uninsured for six months could seek coverage in a high-risk pool available in 2010.

Out-of-pocket costs for prevention and wellness programs under Medicare would be eliminated in 2010 under the HELP bill and 2011 in the Finance bill.

“Anything that we can do to realize reforms that won’t take money upfront and at the same time create real relief for families, we are for,” said New Jersey Sen. Robert Menendez, chairman of the Democratic Senatorial Campaign Committee.

Source: http://www.politico.com/news/stories/1009/28718.html

Reid Presses Forward With Public Option, But Trigger Vote Still Likely
by Sam Stein
Huffington Post, October 26, 2009

Senate Majority Leader Harry Reid (D-Nev.) appears poised to introduce a health care bill that will include a public option for insurance coverage with a state opt-out clause.

The move is a bold one on Reid's part -- going against the skepticism of the White House that such a provision can pass a Republican filibuster. But it doesn't mean that the most-often-discussed alternative -- a public plan triggered by economic conditions -- is now dead in the water.

There is a byzantine set of parliamentary hurdles that remain in the process of getting health care reform legislation passed. Should Reid introduce a bill with an opt-out (and all indications point to him doing so late Monday afternoon or early Tuesday morning) it would set a baseline for the Senate going forward. But high-ranking aides on the Hill note that it's still possible that conservative Democrats will introduce an amendment to the bill that would drop the opt-out provision and replace it with a trigger proposal (which is the preferred choice of the one potential Republican vote: Sen. Olympia Snowe of Maine). Indeed, it seems increasingly certain such a vote will occur.
As Sen. Claire McCaskill (D-MO.) told ABC's This Week -- and Democratic aides confirmed -- Reid will likely "end up... having votes on a number of choices" including a public plan that states could opt into, one they could opt out of, and a plan that would be triggered in "if these insurance companies don't manage to bring down costs within a certain period of time."

It is unlikely that 60 Senators would support such a amendment replacing the opt-out for the trigger (a progressive bloc would likely defect). But, even after that vote takes place, other critical hurdles remain. For starters, the Congressional Budget Office has to score the final bill. And once it does Reid will need to craft a filibuster-proof majority for the overall bill to come to an up-or-down vote (he is reportedly a handful of Senators short at this point). Once the Senate settles and passes a variation of health care legislation, it will have to merge the bill with the one passed by the House of Representatives.

This is, in the end, will be the critical moment. Those merger talks, Senate aides say, are likely to end up being even more heated than the ones currently being waged within the Senate itself. The White House, which has continued to work with Snowe on structuring a trigger proposal, will find an even greater uphill battle with the House, which is all but certain to pass some form of a national public option (not one with an opt-out provision for states).

Finally, considering that the House-Senate merger talks represent the last chance for lawmakers to tinker with the legislative product, there is wide expectation that the president's engagement will be far more aggressive than ever before.

"I really believe is that the time will come for the White House to get engaged," Rep. Jim Clyburn told the Bill Press Show last Thursday. "I do believe that if the president were to get engaged too much with the Senate, I for one would be a little concerned about him not allowing the House to be as creative as we can be. If he were to get involved in the House then the Senate would be upset. So I really believe that the time for the president and White House to be engaged is when both houses have finished their work and then we go into negotiating a final product in conference."

Source: http://www.huffingtonpost.com/2009/10/2 ... 33793.html

Support for the Public Option Keeps Getting Stronger
by Roger Hickey
Huffington Post, October 26, 2009

“New Life for the Public Option” is the headline of Dan Balz’s excellent article in Sunday’s Washington Post. It’s not an accident that this powerful idea has made yet another comeback. And it is not surprising that public and Congressional support, always strong, has surged again, just as the insurance industry has ham-handedly tried to manipulate the choices of key decision-makers in the US Senate. In the crucial next few days – and in the weeks to come – advocates of the public option will be arguing that the principle of majority-rule democracy should be allowed to work. And the insurance and drug industries (and Republicans) will be basing their strategy for stopping the public plan on an undemocratic procedure called the filibuster.

The public option has been part of the national health care debate since January 2007, when the Economic Policy Institute published Jacob Hacker’s Health Care for America plan. From that moment to this, many in the media and the pundit class have periodically dismissed its chances. But that was also the moment that Hacker, Diane Archer and I started having discussions with three essential audiences: leaders of activist citizen organizations, Congressional leaders, and presidential candidates. (For a record of that early organizing, click here.) Our message: a public insurance option is crucial to the success of real reform in America’s mixed system of private and public health insurance – especially if our government agrees to the demand of insurance companies that all Americans must be forced to buy insurance.

Those early conversations and the primary election campaign debates produced a consensus in favor of a public option, as first candidate John Edwards (in February 2007), then Barack Obama (in May), and (in September) Hillary Clinton all came forward with health reform plans based primarily on preserving employment-based health insurance for those who have it and reforming and expanding private health insurance for those who don’t. And all three Democratic presidential candidates called for a public insurance plan, like Medicare, that would give Americans choices – and give the private insurance companies real competition that could control health care premiums.

Even though some progressives were committed to a pure single-payer plan, leaders of many of the major organizations representing millions of Americans – unions, community networks, civil rights groups and health advocates – realized that private insurance companies would not soon be put out of business. Drawing on Hacker’s work, these groups came together around a plan for reforming the worst practices of the insurance companies, requiring all but the smallest firms to cover their employees, guaranteeing affordable coverage to everyone through an insurance exchange, and offering a public insurance option as one of many choices in the exchange. The Health Care for America Now! coalition, now representing 1,000 citizen organizations and millions of people, was built around these principles – and HCAN has consistently insisted that if you take away one part of the plan – whether it is affordable coverage, insurance reform, or the public option – and the whole enterprise of building reform on a mixed system might just collapse and end up throwing money at the insurance and drug companies without achieving real reform or universal coverage.
HCAN also formalized outreach to Members of Congress and candidates for House and Senate in the buildup to the 2008 elections – though thousands of town meetings and local accountability sessions. By the time of the election, over half of the new Congress had publicly embraced the HCAN health reform principles. And two candidates for executive office, Obama and Biden had also signed on to those principles. The growing support for the public option in Congress reflects HCAN’s steady and creative organizing – writing the new textbook for a citizen majority overcoming some of the most powerful special interests in America.

Support for the public option in the Congress has grown steadily as Members focused on the healthcare debate, and many single-payer liberals realized the public plan is the closest they can conceivably come in today’s Congress. But the latest surge of support has come from moderate Democrats and even Blue Dogs, who have come to the realization that if they are going to vote to force their constituents to purchase health insurance, they had better make sure they have a lot of choices – including an affordable public option. And they are realizing that if a public option can keep insurance premiums down, then the Federal government can afford to free up more subsidy funds to keep premiums reasonable for middle-class constituents, while keeping the overall cost of the health reform bill under a trillion dollars in the first 10 years.

As he overcame his conservative hesitations (and a lifetime of caution) and prepared to cast his vote for the historic 1964 Civil Rights Act, Republican Senator Everett McKinley Dirksen quoted Victor Hugo: “Nothing can stop an idea whose time has come.” And that helped get enough “moderate” votes to overcome a filibuster by Southern Democrats and conservative Republicans. Today Republicans are marching almost completely united in the opposite direction as historic reform. But, as the growing support for the public insurance option demonstrates, Democrats will find a way to unite in the Senate in support of the rule of democracy against the filibuster, and a strong and progressive health reform bill will pass the Senate with considerably more than a majority.

Once again, it is time to make history.

Source: http://www.huffingtonpost.com/roger-hic ... 33325.html

There's No Such Thing As A Republican Filibuster: It's Time to Deliver
by Andy Stern
Huffington Post, October 26, 2009

It is decision time for the United State Senate. The Senate Democrats have a moment of truth before them: given our new system of government by 60, what sort of health insurance reform will they deliver?

Will the Democratic team be held hostage by a handful of conservative Senators, who are willing to deny their teammates the right to even vote for a truly affordable healthcare plan? Are they willing to thwart the rest of the caucus, and most importantly, what the vast majority of Americans want?

Will the majority be asked to compromise even more to accommodate the minority of the Party, preventing a strong bill that would actually work? Will two or three holdouts stand with their fellow Democrats to allow a real vote on one of the most critical issues before our nation, or will they stand in the way of the change this country voted for last November?

SEIU members -- janitors, nursing home workers, child care providers -- have spent years knocking on doors, making calls, and donating their time and money to elect candidates who promised to deliver quality and affordable healthcare for every man, woman and child in America.

And for decades now, Democratic Senators have raised campaign funds by promising that with 60 Democratic Senators, they could deliver real change for our country. Last fall, we were all repeatedly asked, "Dig deeper! We just need 60 - we have never been closer."

Well Democrats, it's show time. America elected the 60 you asked for, and America is waiting for results.

But here is the problem with reaching the magical 60: if Democrats can't deliver the meaningful reforms that they have repeatedly promised, then what's the point of 60? Why should anyone believe that knocking on doors, making calls, or donating another dollar changes anything if with 60 votes they cannot deliver real reforms?

The Democrats must not squander their 60-vote majority. And after the promises that were made to the American people, there is no excuse for a single member of the Democratic caucus to stand in the way of every member having the opportunity to vote for the health insurance reform this country needs.

Here's the bottom line -- there is no such thing as a Republican filibuster. Right now, the only ones who can stand in the way of giving the American people meaningful healthcare reform, like the bill in the House, are our elected Democratic Senators. Democrats cannot be the ones to destroy meaningful health insurance reform and the hopes Americans had when they voted last November; reform that guarantees the middle class isn't forced to spend 20 percent of their income for healthcare. Reform that makes the insurance industry compete by offering people real choices.

The White House, Majority Leader Reid and the Democratic caucus, and the House have an incredible opportunity: show the American people (and silence those naysayers) that they are willing to fight -fight to make healthcare truly affordable for the middle class, fight for a real public option that gives people actual choices and drives down costs, and fight to end the insurance industry's stranglehold on our healthcare.

The danger isn't that Democratic Senators will be criticized for failing to deliver bipartisan healthcare reform. The real danger is that they will be judged for failing to lead and for failing to deliver the change they have long promised. To state the obvious: this spells disaster in 2010...and even in 2012.

Real leadership does not govern out of fear - fear of losing the next election, fear of what might be used in an ad, fear of being too partisan. Leadership is not thinking about the next election - but the next generation.

It's decision time for the White House, Majority Leader Reid and each member of the Senate Democratic caucus: will they deliver?

Source: http://www.huffingtonpost.com/andy-ster ... 33743.html

Every Democratic Senator Must Vote to Allow an Up or Down Vote on Health Care
by Robert Creamer
Huffington Post, October 26, 2009

The Senate Democratic Leader, Harry Reid -- and a majority of Members of the Senate -- support the inclusion of public health insurance option in the Senate's health care reform bill. The debate over where the Senate of the United States stands on this question is now settled. The Senate -- like the American people, the House of Representatives and the president -- supports a public option.
What is not settled is whether the majority will be allowed to have an up or down vote on a health care bill that includes a public option.

The question is: will any of the Democratic Senators join with the Republicans to prevent an up or down vote on a bill containing a public option -- one that is supported by the overwhelming majority of the American people?

Will any of those Democratic Senators allow themselves to be used by the insurance industry to stifle the will of the majority of Americans who want to end that industry's stranglehold over the American health care system?

Sixty members of the Senate caucus with Democrats -- 58 Democrats and two independents (Joe Lieberman and Bernie Sanders). These 60 members share in the benefits of being part of the majority party, including committee chairmanships. Together they control enough votes to end a Republican filibuster aimed at blocking health insurance reform, and allow an up or down vote that this critical bill deserves. This should be a no-brainer. To their credit, many Democrats who are not strong supporters of the public option have in fact indicated that they would not stand in the way of an up or down vote. Yet several Democratic Senators have not yet committed to vote with the Democratic leadership and support a vote to proceed.

Remember that to pass a bill in the Senate you only need 51 votes -- or 50 votes plus the tie-breaking vote of the vice president. We do not need every Democrat to pass a bill. But every one of them must vote to end debate on a bill to allow an up or down vote to take place, since ending debate in the Senate requires 60 votes.

If some Democrats disagree with the content of the bill -- or oppose a public option -- so be it. They should vote no on final passage. But they should never side with the Republicans on a procedural vote to prevent an up or down, majority vote on the substance of the issue.

Frankly, if a Democrat votes against the party on a procedural vote and empowers the Republicans to block a vote on the party's top domestic priority, the caucus should strip that Senator of all of the power that comes from being part of the majority party -- including committee chairmanships.

It is one thing to oppose the substance of a bill. It's another to oppose the party leadership on a procedural motion and block the will of the majority. That kind of breach of party discipline makes it impossible for a majority party to govern. On procedural votes members of a majority party have to stick together or they might as well not be in the majority -- they hand the reins over to the minority.

In this case they would also be thwarting the will of the voters who -- very intentionally -- ended Republican control of Congress and put Democrats in the majority so they could make change.

By voting with Republicans on a procedural vote, a Democrat would, in effect, be handing the gavel back to Republican Senator Mitch McConnell. They would be allowing the minority Republicans and their insurance industry allies to set the parameters for the kind of change is even allowed to come to a vote in Congress.

That would be true on any issue. But it is especially true of the party's marquee issue, health care reform. By joining with the Republicans and preventing its leadership from calling an up or down vote on health care reform, a Democratic Senator would be engaging in a traitorous act. Not only would he or she be preventing implementation of a critical party priority. That Senator would also be politically endangering many of the swing seats held by House and Senate Members who are up for re-election next year.

That's right -- it is the swing district Democrats that would be endangered by the failure to pass President Obama's health insurance reform. Look at what happened after the 1993 failure of the Clinton health plan that was also the centerpiece of his presidency. In 1994, Democrats lost 54 seats. Of those, 36 were incumbents. It wasn't the members from strong Democratic districts, who had fought hard for health care reform, who lost. It was mainly members from swing districts, rural districts and southern districts.

The Clinton health care bill never came to a vote in the House, but only 11 of the 36 incumbents who lost had co-sponsored the bill. Many of the 25 others had opposed the Clinton health care plan. Didn't matter; they were the biggest political victims of the failure of health care reform.

History shows that when the popularity and job performance rating of an incumbent President drops, the odds of swing Democrats being elected to Congress drop as well.

And it wasn't just that swing voters lost faith in Democrats. Base Democratic voters failed to turn out. Republican base voters -- smelling Democratic blood in the waters -- turned out in record numbers.

The fact is that just as a rising political tide lifts all boats, when the political tide recedes those in the shallowest political water are most likely to be left aground.

Failure to take action on health care would be the most likely way to end the majority status for Democrats. Such a failure would massively damage the political standing of the president and the Democrat brand. That, in turn, would sink swing district Democrats. The Republicans know this. That's why they are fighting so hard to prevent the passage of health insurance reform. Any Democratic Senator who helps them is endangering fellow Democrats.

That is particularly true since polls show that the policy question at issue, the public option, is uniformly popular in swing, frontline and Blue Dog districts. The firm of Anzelone Liszt recently released the results of a poll it conducted in 91 Blue Dog, Rural Caucus and frontline districts. The poll found that 54% of the voters in these battleground districts support the choice of a public option.

In fact, throughout the country, giving consumers the choice of a public option is one of the most popular elements of the overall health insurance reform bill.

But what is more important is that Democrats in swing districts need a public option to convince voters to favor a health insurance mandate. Anzeloni and Liszt make clear in their polling report that in swing districts: "It's wrong to think about the public option in isolation from other elements of reform. Forcing an individual mandate without a public option is a clear political loser (34% Favor / 60% Oppose), and only becomes more palatable when a public option is offered in competition with the private sector (50% Favor / 46% Oppose)."

Turns out that a public option provides a political inoculation against backlash to a mandate. That's because people have no stomach for being herded into the arms of private insurance industry like sheep to the slaughter. They want to know that if the government is going to require them to get health insurance, that it also provides the choice of a not-for-profit public plan -- that they are not left at the mercy of private insurance CEO's.

It is fine for each Democrat in the Senate to vigorously advocate his or her own position on health care. But once the majority of the Senate has made up its mind, no Democrat should be allowed to side with the Republicans to block the majority will -- to block the Congress and the President from taking action. Not only would that be terrible for the country -- it threatens the majority status of the Democratic Party.

If a Democratic Senator votes to prevent his party from having an up or down vote on its top domestic priority, he is endangering the political lives of his swing district colleagues. That would be unforgivable.

Source: http://www.huffingtonpost.com/robert-cr ... 33634.html

AP: Health Care Bill May Cut Employer Mandate
by David Espo, Associated Press
Huffington Post, October 25, 2009

WASHINGTON — Businesses would not be required to provide health insurance under legislation being readied for Senate debate, but large firms would owe significant penalties if any worker needed government subsidies to buy coverage on their own, according to Democratic officials familiar with talks on the bill.

For firms with more than 50 employees, the fee could be as high as $750 multiplied by the total size of the work force if only a few workers needed federal aid, these officials said. That is a more stringent penalty than in a bill that recently cleared the Senate Finance Committee, which said companies should face penalties on a per-employee basis.
These officials also said individuals would generally be required to purchase affordable insurance if it were available, and face penalties if they defied the requirement.

The officials spoke on condition of anonymity, saying they were not authorized to discuss the private negotiations involving key Senate Democrats and the White House. They also stressed that no final decisions have been made on the details of the measure, expected to reach the Senate floor in about two weeks.

In general, the bill taking shape in private talks led by Senate Majority Leader Harry Reid of Nevada is designed to answer President Barack Obama's call to remake the nation's health care system. It would expand coverage to millions who lack it, ban insurance industry practices such as denial of coverage for pre-existing medical conditions and slow the growth in medical spending nationally.

Like a companion measure in the House, it would create a new federally regulated marketplace, termed an exchange, where individuals and families could purchase insurance sold by private industry. Federal subsidies would be available to help those at lower incomes afford the cost.

Subsidies would also be available to smaller businesses as an incentive for them to provide insurance.

Nominally, Reid's task is to meld bills already approved by the Senate Finance Committee and the Senate Health, Education, Labor and Pensions Committee. In reality, however, he has a virtual free hand in coming up with a measure, with a goal of amassing a 60-vote majority to overcome a threatened Republican filibuster.

Reid has told fellow senators he is strongly considering including a provision for a government-run insurance plan in the bill as a way to assure consumers have a choice and to create competition for private companies. States would be permitted to drop out under the plan.

That is a somewhat weaker version than the HELP Committee voted for, but the Finance Committee omitted any federal role in the sale of coverage in favor of nonprofit co-ops competing with private industry.
The issue is the most contentious in the effort to overhaul the nation's health care system, and it is not known whether Reid has the 60 votes for his plan.

Sen. Chuck Schumer, D-N.Y., a leading advocate for a government-run insurance provision, said on NBC's Meet The Press he thought the drive for 60 votes was close to success.

One critic, Sen. Ben Nelson, D-Neb., said on CNN he was not enthusiastic with the proposal, but did not rule out giving Reid his vote on a key procedural vote.

"Well, I certainly am not excited about a public option where states would opt out. ... I'll take a look at the one where states could opt in if they make the decision themselves," he said.

Numerous other issues are involved in the bill.

The requirement for individuals to purchase insurance would include provisions to exempt individuals or families unable to find affordable coverage. Those who are obligated to buy coverage and refuse would face a fine of perhaps $100 in the first year of the program.

There is no penalty for individuals in the first year of the program in the Senate Finance Committee bill, a provision inserted at the request of Sen. Olympia Snowe. The Maine Republican is the only member of her party in either house of Congress to vote for a Democratic-backed health care bill in committee this year.

The switch Reid is considering is an attempt to increase the number of people with insurance, a key goal of the legislation.

Officials familiar with the Senate negotiations said the bill is likely to maintain a federal health care program for lower-income children as a stand-alone program, rather than folding it into the broad national insurance exchange. Sen. Jay Rockefeller, D-W.Va., is an ardent proponent of the arrangement and did not announce publicly he would vote for the Senate Finance Committee bill until after his proposal was approved.

The legislation is also expected to include an option for states to negotiate with private industry to provide group coverage for lower income residents. The proposal is backed by Sen. Maria Cantwell, D-Wash., and patterned after a program in her home state.

Reid is also searching for ways to scale back a tax on high-cost insurance policies approved by the Senate Finance Committee.

Organized labor strongly opposes the proposal, and the House bill is not expected to include it.

Source: http://www.huffingtonpost.com/2009/10/2 ... 33308.html

Health Care System Wastes Up To $850 Billion Annually, Report Says
Politics Daily, October 26, 2009

According to a report by Thomson Reuters, the American health care system wastes between $505 billion and $850 billion every year, which is up to a third of the nation's total health care costs. "America's health care system is indeed hemorrhaging billions of dollars, and the opportunities to slow the fiscal bleeding are substantial," said the report, which was completed by Thomson Reuters' vice president for health care analytics.

The report highlights several key areas where the U.S. system excels at inefficiency:
-- Unnecessary care, such as the overuse of antibiotics and lab tests, to protect against malpractice exposure makes up 37 percent of health care waste.

-- Fraud makes up 22 percent of the wasted expenditures, or up to $200 billion a year in fraudulent Medicare claims, kickbacks for referrals for unnecessary services and other scams.

-- Administrative inefficiency and redundant paperwork account for 18 percent of waste.

-- Medical mistakes account for $50 billion to $100 billion in unnecessary spending each year, or 11 percent of the total.

-- Preventable conditions such as uncontrolled diabetes cost $30 billion to $50 billion a year.

Original Report By Maggie Fox, Health and Science Editor, Reuters:

WASHINGTON (Reuters) - The U.S. healthcare system is just as wasteful as President Barack Obama says it is, and proposed reforms could be paid for by fixing some of the most obvious inefficiencies, preventing mistakes and fighting fraud, according to a Thomson Reuters report released on Monday.

The U.S. healthcare system wastes between $505 billion and $850 billion every year, the report from Robert Kelley, vice president of healthcare analytics at Thomson Reuters, found.

"America's healthcare system is indeed hemorrhaging billions of dollars, and the opportunities to slow the fiscal bleeding are substantial," the report reads.

"The bad news is that an estimated $700 billion is wasted annually. That's one-third of the nation's healthcare bill," Kelley said in a statement.

"The good news is that by attacking waste we can reduce healthcare costs without adversely affecting the quality of care or access to care."

One example -- a paper-based system that discourages sharing of medical records accounts for 6 percent of annual overspending.

"It is waste when caregivers duplicate tests because results recorded in a patient's record with one provider are not available to another or when medical staff provides inappropriate treatment because relevant history of previous treatment cannot be accessed," the report reads.

Some other findings in the report from Thomson Reuters, the parent company of Reuters:

* Unnecessary care such as the overuse of antibiotics and lab tests to protect against malpractice exposure makes up 37 percent of healthcare waste or $200 to $300 billion a year.

* Fraud makes up 22 percent of healthcare waste, or up to $200 billion a year in fraudulent Medicare claims, kickbacks for referrals for unnecessary services and other scams.

* Administrative inefficiency and redundant paperwork account for 18 percent of healthcare waste.

* Medical mistakes account for $50 billion to $100 billion in unnecessary spending each year, or 11 percent of the total.

* Preventable conditions such as uncontrolled diabetes cost $30 billion to $50 billion a year.

"The average U.S. hospital spends one-quarter of its budget on billing and administration, nearly twice the average in Canada," reads the report, citing dozens of other research papers.

"American physicians spend nearly eight hours per week on paperwork and employ 1.66 clerical workers per doctor, far more than in Canada," it says, quoting a 2003 New England Journal of Medicine paper by Harvard University researcher Dr. Steffie Woolhandler.

Yet primary care doctors are lacking, forcing wasteful use of emergency rooms, for instance, the report reads.

All this could help explain why Americans spend more per capita and the highest percentage of GDP on healthcare than any other OECD country, yet has an unhealthier population with more diabetes, obesity and heart disease and higher rates of neonatal deaths than other developed nations.

Democratic Senator Charles Schumer said on Sunday that Senate Democratic leaders are close to securing enough votes to pass legislation to start reform of the country's $2.5 trillion healthcare system.

Source: http://www.politicsdaily.com/2009/10/26 ... report-sa/

Christina Romer: Public Plan Can Reduce Costs, No Evidence Yet On Triggers
by Sam Stein
Huffington Post, October 26, 2009

One of President Obama's senior advisers argued on Monday that a national public plan would have a noticeable impact on lowering the costs of the health care system yet the evidence wasn't yet available to claim that a trigger-proposal would do the same.

Dr. Christina Romer, Chair of the Council of Economic Advisers, said that she had "personally been quite persuaded that the public option can be an important source of cost growth containment," during a speech at the Center for American Progress.

Romer cited a case study of counties in California where the introduction of a government-run plan helped bring down overall costs in the private market.

"One of the things I've learned is that if you look at the state of California for example, where people on Medicaid have a lot of the counties what they do is to contract with HMO to provide care to Medicaid patients," said Romer. "And there are a lot of what we call two-plan counties where there are two plans in each counties. And in some counties there are two private plans and in some counties you have one private plan and one publicly run plan. And the interesting thing is that cost growth in the counties with a public and a private is indeed slower than in counties with two privately run plans. It is a small sample... that is one of the things that is giving me a sense that it could be something that could genuinely slow the growth rate of costs."

The remarks reflect a consistent refrain from the administration that a public-run insurance option is an effective vehicle for lowering costs within the health care system while expanding coverage to those who are uninsured. Coming amidst reports that the president is working with Sen. Olympia Snowe, (R-ME) to implement a public plan that was triggered into existence by economic conditions, however, the statement could have political ripples. Romer would not make the same predictions of cost-containment when asked about the trigger, saying that there was insufficient data as to how it would work.

"As I said, the evidence even on public and private,I think, isn't all there still. It is something where we are still collecting evidence. Knowing what a trigger will do is, I think, beyond anything that we have a lot of evidence on. The other thing is I don't want to get out ahead of the legislative process.... other than saying this is something we are working through, Congress is working through, and we will see how it comes out."

In an effort to sell a more progressive reform package, House Speaker Nancy Pelosi (D-Cali.) has repeatedly cited Congressional Budget Office data that shows the public plan could save more than $100 billion in the health care system. That figure is reduced by $85 billion when legislation requires that the Department of Health and Human Services negotiate rates with providers -- a proposal favored by conservative Democrats in the House.

In addition to praising the public plan's ability to reduce costs, Romer also endorsed the proposal in her prepared remarks.

Another institutional structure that the president has emphasized as a potentially important source of cost containment is the inclusion of a public health insurance option in the exchange. Such an option would give individuals and small businesses the choice of a publicly-managed health insurance plan that competes on a level playing field with private insurers. Reports by the U.S. Government Accountability Office show that markets for health insurance are often highly concentrated, especially in rural states, giving insurers a high degree of market power and the ability to raise premiums. A public health insurance option would be a credible entrant in concentrated markets, and would serve as a competitive, alternative choice, constraining the ability of insurers to raise premiums, and thus containing the growth rate of.

Source: http://www.huffingtonpost.com/2009/10/2 ... 34043.html

McCain: Dems Will Pass Health Care, "Blue Dogs Bark But Never Bite"
by Sam Stein
Huffington Post, October 25, 2009

Sen. John McCain (R-Ariz.) predicted on Sunday that health care reform would pass, while a fellow Republican senator was more skeptical.
Appearing on CBS' "Face the Nation," McCain said that the man he battled for the presidency in 2008 had "the vote" now to get health care legislation through Congress.

"I think that Blue Dogs bark but never bite, so I don't think they have a problem over in the House side," said the Arizona Republican. "I think in the Senate, Democrats are very aware that they don't want a repeat of the Clinton failure in 1994. So I think it is likely they will get something through but it is not clear to me what it is."

McCain went on to whack the president for abandoning a campaign pledge to hold deliberations around health care in transparent, public settings. "The fact is there has been no change," he said. "There is a room where there are a few Democrats in it and some administration officials and they are writing this entire bill. I don't think the American people like that very much."

But the key takeaway from his Sunday morning interview was his belief that health care would pass -- almost assuredly with either one or no Republican supporters. Sen. Orrin Hatch, (R-Utah) wouldn't go quite as far as his colleague, predicting simply that Senate Majority Leader Harry Reid (D-Nev.) would bring the public option to a vote.

"We know that the process is going to go there," the Utah Republican told CNN's "State of the Union" with John King.

Source: http://www.huffingtonpost.com/2009/10/2 ... 33001.html

This is an example of what McCain is referring to ...

Why We're Breaking With the Blue Dogs on the Public Option
Rep. Jane Harman (D-Ca) & Rep. Loretta Sanchez (D-Ca)
Huffington Post, October 13, 2009

Throughout the congressional health care debate, considerable attention has focused on the Blue Dog Coalition - a group of House Democrats committed to fiscal responsibility and budget discipline.
We're Blue Dogs, too, and we believe in the group's core principles. But we've broken with our Blue Dog sisters and brothers over their lukewarm support for the public insurance option a concept we think must be part of a successful health care reform package.

Far from being an option of last resort or a government-funded takeover of the country's health care system, we see the public option as a critical market mechanism that will drive down costs, foster competition and expand Americans' insurance choices.

This is not just smart health care policy, it is smart economic policy.
A Gallup-Healthways survey has identified more than 290,000 uninsured people in our congressional districts alone. This is astonishing, and, according to the Centers for Medicare and Medicaid Services, their medical care cost local hospitals and other health care providers $65 million last year.

How can providers stay afloat in the face of such expenditures? By charging people who have insurance more. A recent study by the Center for American Progress found that more than 10 percent of the average Californian's premiums, approximately $500 each year, goes to covering the cost of caring for the uninsured.

Expanding coverage will greatly reduce the costs of uncompensated care and alleviate a major drag on the state and national economies. A public option is necessary to reach that goal.

If private insurers were already providing affordable coverage, there would be no need for this debate. But they are not. In fact, the profit motive has routinely trumped a customer's health and well-being. They set premiums at artificially high rates to compensate for the costs of the uninsured, drop people from their plans when they become sick, or use fine print to deny expensive but medically necessary treatments.

We understand the fear of many insured Californians that health care reform will take away their current doctors and coverage. However, the grim reality is that many more insured people will lose their coverage without reform.

In August it happened to Rep. Harman's 27-year-old son, who was dropped from his insurance after suffering a torn eardrum.

He's not alone. According to a recent report by the Treasury Department, without health care reform, nearly half of all Americans under 65 will lose their coverage at some point over the next 10 years. Additionally, health care spending in the United States will go from $1 out of every $6 spent to $1 of every $5 in the next decade.

Ultimately, our country and our constituents can't afford to wait for health care reform. Doing nothing means Californians will pay twice as much in premiums and out-of-pocket costs in the coming years and insurance companies will still call the shots, denying care to people with pre-existing conditions and walking away from families that need coverage the most.

The Congressional Budget Office estimates that 97 percent of all Americans would have insurance coverage if legislation that includes a public option becomes law. If this benchmark is reached, in our districts, more than 250,000 additional people would be able to count on quality, affordable health care coverage. Whether people choose a private insurer or the public option, all could count on a guaranteed standard and comprehensive set of benefits to ensure access to quality, affordable health care.

The health care debate in Congress will continue through the end of the year. The recent Senate Finance Committee defeat of two amendments to include a public insurance option in its health care reform bill is a disappointing setback.

Nevertheless, we remain hopeful that at the end of its process, Congress will have succeeded in passing a fiscally responsible health care bill that includes a robust public option.

This is our best bet to ensure Californians have access to quality, affordable health care without burdening future generations.

Source: http://www.huffingtonpost.com/rep-jane- ... 18743.html

Feingold: No Public Option A "Strong Reason" Not To Support Reform
by Sam Stein
Huffington Post, October 25, 2009

The major point of contention between the White House and congressional Democrats is now whether a public option for insurance coverage has the 60 votes needed for passage in the Senate. In reporting our piece on the state of play in the health care reform debate, Ryan Grim and I heard the same refrain from a number of sources: Majority Leader Harry Reid's office thinks it can get the support needed to pass a public option with an opt-out provision for states. The White House thinks that Reid's whip count is too optimistic.

Part of the administration's reasoning is that if you don't have Sen. Olympia Snowe (R-Maine) on board, you end up losing the votes of a handful of conservative Democrats. So White House officials are pushing an alternative proposal that would have the public plan "triggered" in by economic conditions.

But the equation is more complicated than that. Increasingly, there are senators on the liberal side of the spectrum who say they won't pass a plan that includes the trigger provision.

"To me that would be a very serious gap and it would be a very strong reason not to support it," Sen. Russ Feingold told CBS' "Face the Nation" on Sunday. "We need a public option. We need something that would cause some control over the abuses that have occurred in the insurance industry."

Triggers, Feingold added, are "just an invitation for the insurance industry to manipulate the situation for a couple of years just so they can avoid the trigger and so they can convince members of Congress to delay it again. We need to do something now."

Feingold did not say (nor was he asked) if he would participate in a filibuster of a bill that included triggers instead of an opt-out public plan.

And that seems likely to be the major question mark going forward.

While conservative Democrats may be comfortable allowing the broader effort to pass health care reform fail over their objections to the public plan, it's not clear if their progressive counterparts will make that leap.

Watch:
<embed src='http://cnettv.cnet.com/av/video/cbsnews ... r-dest.swf' FlashVars='linkUrl=http://www.cbsnews.com/video/watch/?id= ... &salign=tl' allowFullScreen='true' width='425' height='324' type='application/x-shockwave-flash' pluginspage='http://www.macromedia.com/go/getflashpl ... bed><br><a href='http://www.cbsnews.com'>Watch CBS News Videos Online</a>

Source: http://www.huffingtonpost.com/2009/10/2 ... 33012.html

What’s So Hot About Snowe? Obama's pointless bipartisanship.
by Howard Fineman
Newsweek, October 25, 2009

"There she is, the Party of One!" cried Sen. Barbara Mikulski when she saw Sen. Olympia Snowe outside the Senate chamber last week. Mikulski, in a wheel-chair because of a broken ankle, rolled closer to the object of her praise. "She is belle of the ball, because she has got so much on the ball!" Snowe gave an embarrassed nod. Sen. John Kerry hurried by, but stopped himself long enough to bestow upon Snowe a lordly embrace. "O, we love her!" he announced. Sen. Tom Carper testified to her brilliance. "Olympia's terrific, as you know," he said.

On Mount Olympus in Greece there were many gods, but on Mount Olympia in the District of Columbia there is one: Snowe of Maine, daughter of Spartan immigrants (yes, that Sparta). A Republican of the rarest type—a "moderate" willing to truck with Democrats—she is being feted, almost prayed to, by President Barack Obama and his party's leaders as they struggle in the Senate to amass a filibuster-proof 60 votes for "health-care reform." In the halls outside the chamber, every Democrat seems to have just come from, or be on the way to, another "meeting with Olympia"—if, that is, she isn't too busy talking to the president on the phone. Politically secure (she won her last race in 2006 by a 3–1 margin), and possessing the studious air of a graduate student, Snowe has the kind of celebrity that only the Senate could find riveting: her vote is entirely up for grabs. Despite a bit of grandiloquence and a habit of quoting Longfellow (who was, in her defense, a Mainer), she is likable and earnest. She was believable when she told me that she had not sought such a prominent role. "It's not me dictating anything," she said.

But the pursuit of Snowe is pretty close to obsessive, which is not a good thing either for Democrats or for the prospects of health-care reform worthy of the name. First, Snowe's exaggerated prominence is both the result and symbol of Obama's quixotic and ultimately time--wasting pursuit of "bipartisanship." In case the White House hasn't noticed, Republicans in Congress are engaged in what amounts to a sitdown strike. They don't like anything about Obama or his policies; they have no interest in seeing him succeed. Despite the occasional protestation to the contrary, the GOP has no intention of helping him pass any legislation. Snowe may very well end up voting for whatever she and Democrats craft, but that won't make the outcome bipartisan any more than dancing shoes made Tom DeLay Fred Astaire.

Nor would Snowe's vote mollify the GOP grassroots: they don't think of her as a Republican anyway. The notion that she is inspiring other Republicans to join the cause of reform falls apart when you see who is falling in line. A few prominent Republicans indeed said nice things about the Senate Finance Committee bill—the one on which Snowe was the only Republican vote. But that praise, from former GOP Senate lead-ers Bob Dole and Howard Baker and former HHS Secretary Tommy Thompson, loses its impact once you realize that all three of them work for major Washington law firms, whose clients include most of the big corporate players in the health-care industry. Theirs is rented bipartisanship, on retainer or billed by the hour.

In their stubborn belief that Snowe's blessing will stand as a testament to Obama's powers of inclusiveness, the president and his Democratic allies seem to have lost sight of the real point of all this flattery and praise: the need to pass a bill Americans can actually understand and that will make health care secure for all while also reducing costs. The symbolism of Snowe gets them no closer to that. (The final tally in the finance committee was 14–9. Snowe's "aye" vote, so hard won, was unnecessary.)

Worse, the pursuit of Snowe isn't uniting Democrats; it is dividing them. Democrats who haven't been in the room with her as she bargains with the leadership bristle at her role, even as they personally like and admire her. She remains deeply skeptical of a publicly financed alternative to private insurance, in good part because of what she sees as the failure of Maine's version of the idea—and yet some form of a public option is favored not only by most Democrats in Congress but by most of the American people. If Obama and the Democrats really want such a plan, they may as well try to get tough. For inspiration, the president might consider a Longfellow aphorism. "In this world," the poet wrote, "a man must either be an anvil or a hammer."

Source: http://www.newsweek.com/id/219382

[roxybeast]

Reid: "The Public Option With An Opt-Out Is The One That's Fair"
by Ryan Grim
Huffington Post, October 26, 2009

The public option lives.

Senate Majority Leader Harry Reid (D-Nev.) announced Monday that the bill he will bring to the Senate floor will include a public health insurance option that individual states could decline to participate in.
"I've concluded --with the support of the White House, Senators Dodd and Baucus -- that the best way to move forward is to include a public option with the opt-out provision for states," said Reid, referring to the Senate health and finance committee representatives, respectively, Sen. Chris Dodd (D-Conn.) and Sen. Max Baucus (D-Mont.). "The public option, with an opt-out, is the one that's fair."

VIDEO of Reid's Press Conference:
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Reid has been pushing the so-called opt-out public option for the last several days and has spoken to nearly all 60 members of the Democratic caucus. He needs 60 votes to end an expected Republican filibuster and move the bill to the floor.

"We've spent countless hours over the last few days in consultation with senators who've shown a genuine desire to reform the health care system. And I believe there's a strong consensus to move forward in this direction," Reid said.

By including the public option in the bill before it goes to the floor, Reid is offering conservative Democrats a fig leaf of sorts. They can cast a vote in favor of ending a GOP filibuster -- when 60 votes are required -- but then vote against the public option later when the matter is debated on the floor, and only 50 votes are needed for victory. The move is also a gift to liberals, as the specific provision won't need to reach the traditional 60-vote threshold that is so often the death of genuine reform legislation.

Reid's move is a risky one, as a Senate Democratic leadership aide acknowledged Saturday to HuffPost. "The leadership understands that pushing for a public option is a somewhat risky strategy, but we may be within striking distance. A signal from the president could be enough to put us over the top," said the aide.

CNN reports that White House Press Secretary Robert Gibbs said in a written statement that President Obama is "pleased that the Senate has decided to include a public option for health coverage." CNN also reports: "An administration official went so far as to call Reid's move 'dangerous' but quickly followed by saying Reid knows his caucus better than anyone and will therefore have the support of the White House."

With high risk comes high reward, however. The public option's inclusion in the final bill would be one of the most significant progressive legislative achievements since the Great Society. The White House and centrist and conservative Democrats have been frustrated by liberals' strong demand for it, arguing that there is much more to health care than simply the public option and that only 10 to 12 million would be eligible to participate in it. Over the summer, Obama called it a mere "sliver" of reform.

Progressives, however, see the public option as the most realistic way to move the United States toward universal health care. Even those who are not eligible would benefit indirectly, they argue, as health insurance companies would be forced to reduce premiums to stay competitive.

The insurance industry sees the threat of the public option clearly. Karen Ignagni, President and CEO of the lobby group America's Health Insurance Plans (AHIP), blasted Reid's decision.

"A new government-run plan would underpay doctors and hospitals rather than driving real reforms that bring down costs and improve quality. The American people want health care reform that will reduce costs and this plan doesn't do that," she said in a statement. "The divisive debate about a government-run plan is a roadblock to reform. It's time we focus instead on broad-based reforms that will ensure the affordability and sustainability of our health care system."

But the public option is not just longed for by liberals. Recent polls have shown that roughly six in 10 Americans want a public plan that would compete with private insurance. Those polls were heard loudly in Congress. "All the national polls show a wide majority of Americans support the public option," Reid noted.

Reid appears to be within just a few votes of the 60 he needs. Putting the public option into the bill forces those holdouts to show their cards, and dares them to oppose their own leader on the party's most ambitious reform effort in nearly half a century.

Sen. Mary Landrieu (D-La.), a public option opponent, has said that while she disagrees with the policy in question, she isn't inclined to join Republicans in sinking the entire reform effort over it.

"I'm not right now inclined to support any filibuster," she told HuffPost last week. The refusal of the GOP to participate meaningfully in negotiations has soured her on joining them in a filibuster. "For the Republican Party to kind of step out of the game is very unfortunate," she said. "I'm not going to be joining people that don't want progress."
Sen. Ben Nelson (D-Neb.), another public option foe, wouldn't commit when asked last week. "I believe in playing chess, but that's about three moves ahead of me, and I'm not prepared to make those moves until I see some other moves in between," he told HuffPost.

Sen. Mark Pryor (D-Ark.), a conservative Democrat, sounded as if he could embrace Reid's strategy after meeting with the leader last week. "I'm open to a public option," he said.

Progressives oppose the opt-out provision that Reid intends to include to win conservative support, arguing that Americans in conservative states that may opt out are in just as much need of a public option as are residents of blue states.

Sen. Lamar Alexander, a Republican leader from Tennessee, said on the Senate floor Monday, in advance of Reid's announcement, that the opt-out provision isn't to be taken seriously. Medicaid, he noted, has an opt-out provision, but not one state has opted out. Public health insurance, in other words, is too popular for states to opt out.

At a meeting at the White House on Thursday evening, Reid told the president that he intended to push forward with the national public option with an opt-out provision. Obama, several sources said, indicated a preference for a "trigger" instead: the public option would only be brought into existence if the insurance industry failed to meet certain criteria in a certain period of time.

Yale professor Jacob Hacker, the intellectual father of the public option, however, dismissed the trigger.

"The trigger is an inside-the-beltway sleight of hand that would protect private insurers from the real competition that a strong public health insurance option would create," he said. "It is unworkable in the current Senate bills, unwise as public policy, and unwanted by the substantial majority of Americans who say they want a straight-up public option."

Source: http://www.huffingtonpost.com/2009/10/2 ... 34284.html

Durbin: Progressives Forced Our Hand On Public Option
by Ryan Grim
Huffington Post, October 26, 2009

Democratic leaders were forced to include a national public health insurance option as part of health care reform by progressive Democratic senators who refused to support anything less, Senate Majority Whip Dick Durbin (D-Ill.) said on Monday.

Durbin's assessment was made to a handful of reporters following the announcement by Senate Majority Leader Harry Reid (D-Nev.) that after weeks of talks with his colleagues he had determined that including a public option that states could opt out of was the best way to go.

For many years, it's been centrist and conservative-leaning senators who have been scoring legislative victories by digging in their heels, so this represented a quite dramatic turnabout. It is difficult to remember the last time that progressives won a legislative victory by laying down firm demands and sticking to them. In the House, the Congressional Progressive Caucus has found its feet, too, and is locked in a final battle with conservative Democrats over the shape of a public option.

At the end of last week, Sen. Olympia Snowe of Maine, the lone Republican that Democrats are still trying to woo, said that she couldn't support a bill that had a public option with an opt-out provision. Snowe preferred a public option that would be "triggered" into being by a failure by the insurance industry to meet certain benchmarks.

But Reid and the leadership faced this basic math: There is only one Snowe and there are 60 members of the Democratic caucus. If just a few Democrats abandoned the bill, it would fall short even with Snowe's support.

"It's a zero-sum situation," said Durbin, who is in charge of counting votes in the Senate. "If we thought that just putting the trigger in meant that we'd end with 61 votes," he explained, then that's what leadership would have done.

"But there were some [senators] that felt that that just didn't go far enough moving toward a public option," said Durbin, who is himself a backer.

"We have 60 people in the caucus," Reid said. "We'll all hang together and see where we come out."

Sen. Roland Burris (D-Ill.) had insisted he would oppose any bill without a public option and rejected the trigger as a compromise. Sen. Bernie Sanders, a Vermont independent and self-described democratic socialist who caucuses with Democrats, had come close to making such a threat but said he was "playing it day to day." Sen. Russ Feingold (D-Wisc.) said over the weekend that the lack of a public option was a "good reason" to vote against it.

Durbin said that he is confident the progressive wing in the Senate is satisfied with the opt-out compromise.

Snowe called Reid's decision "deeply disappointing", but the majority leader said he still hopes to win her support for the overall package. "I spoke to Olympia on Friday. I've talked to her on a number of occasions. And at this stage she does not like a public option of any kind. And so we'll have to move forward on this, and there [will] come a time, I hope, where she sees the wisdom of supporting a health care bill after having had an opportunity, her and others, to offer amendments," said Reid. "We hope that Olympia will come back. She's worked hard. She's a very good legislator. I'm disappointed that the one issue, the public option, has been something that's frightened her."

Source: http://www.huffingtonpost.com/2009/10/2 ... 34438.html

Public Option To Be Included In Senate Bill
by David Espo, Associated Press,
Huffington Post, October 26, 2009

WASHINGTON — Health care legislation heading for the Senate floor will give millions of Americans the option of purchasing government-run insurance coverage, Majority Leader Harry Reid announced Monday, although he stopped short of claiming the 60 votes needed to pass a plan steeped in controversy. Reid, D-Nev., said individual states would have the choice of opting out of the program.

His announcement was cheered by liberal lawmakers, greeted less effusively by the White House and noted with a noncommittal response by Democratic moderates whose votes will be pivotal.

Sen. Olympia Snowe of Maine, the only Republican to vote with Democrats on health care so far this year, issued a statement saying she was "deeply disappointed" in the approach the Democratic leader had chosen.

Reid said, "While the public option is not a silver bullet, I believe it's an important way to ensure competition and to level the playing field for patients with the insurance industry." He said a long-delayed Senate debate on President Barack Obama's call for an overhaul of the health care system would begin as soon as the Congressional Budget Office completes a mandatory assessment of the bill's cost and impact on coverage.

Changes on the public option – and numerous other provisions in the measure – are possible during a debate expected to last for weeks.
And officials said Reid had prepared several variations of key provisions so he could make adjustments in his bill at the last minute and still make sure he was within Obama's target of a $900 billion price tag over a decade.

Both the House and Senate are struggling to complete work by year's end on legislation extending coverage to millions who lack it, to ban insurance industry practices such as denying coverage because of pre-existing medical conditions and to slow the rise in medical costs nationally.

As in the Senate, attempts to complete drafting a measure in the House have been delayed by internal Democratic divisions on the details of a government-run option. Differences in bills passed by the House and Senate would have to be reconciled before any legislation reached Obama's desk.

In an appearance at a Florida senior center during the day, Speaker Nancy Pelosi suggested a new name for the same approach to ease the opposition. She suggested "the consumer option." Rep. Debbie Wasserman Schultz, D-Fla., appearing at Pelosi's side, used the term "competitive option."

Critics say that by any name, the approach amounts to a government takeover of the insurance industry.

In deference to moderates, Reid also said he was including a provision for nonprofit co-ops to sell insurance in competition with private companies.

Senate Democratic officials say the bill Reid envisions would require most individuals to purchase insurance, with exemptions for those unable to find affordable coverage. Large businesses would not be required to provide insurance to their workers, but would face penalties of as much as $750 per employee if any qualified for federal subsidies to afford coverage on their own.

The bill will also include a tax on high-cost insurance policies, despite opposition from organized labor, officials said. In a gesture to critics of the plan, Reid decided to apply the new tax to family plans with total premiums of $23,000 a year. The Senate Finance Committee approved a tax beginning at $21,000 in total premiums.

Nominally, the majority leader has spent the past two weeks melding bills passed earlier by the Senate's Finance Committee and Health, Education, Labor and Pensions Committee. But in reality, he has had a virtual free hand to craft a new measure in consultations with senior members of the two panels and top White House aides.

"I feel good about the consensus that was reached within our caucus and with the White House," he said at his news conference. And we're all optimistic about reform because of the unprecedented momentum that now exists."

Within minutes, the White House released a statement saying Obama was "pleased that the Senate has decided to include a public option for health coverage, in this case with an allowance for states to opt out."
Obama has long voiced support for such a plan but has also signaled it is not a requirement for a health care bill he would sign. He has also said he would like bipartisan support for the legislation – and Snowe appears to be his last, best hope for that.

She favors a standby provision for government coverage if there is not enough competition in the private marketplace. Reid said that was not in his bill. "We hope that Olympia will come back. ... She's a very good legislator. I'm disappointed that the one issue, the public option, has been something that's frightened her."

Sen. Chuck Schumer, D-N.Y., who has long backed a government-run insurance option, said the approach "has a new life because as Americans have learned more about it, they have come to see it is the best way to reduce costs and increase competition in the health insurance industry."

Ben Nelson of Nebraska, the most conservative Democrat in the Senate, "is not committing how we will vote regarding any proposal Senator Reid is advancing," said spokesman Jake Thompson.

Sen. Blanche Lincoln, D-Ark., a moderate seeking a new term in 2010, said through a spokesman she intends to study the details and decide how to vote based on the impact on her home state.

With the support of two independents, Democrats command 60 seats in the Senate, precisely the number needed to overcome any Republican filibuster.

Asked about the prospects for success, Reid answered, "We have 60 people in the caucus. ... We all hug together and see where we come out."

While the controversy over government-run insurance is the most intense, there are numerous other issues to be settled before legislation can win passage.

Obama has set a $900 billion, 10-year price tag for the legislation, and the program would be funded through cuts in future payments to Medicare providers and through higher taxes – an income surcharge on million-dollar earners in the House version and a new levy on high-cost insurance policies in the Senate.

Pelosi has said the House bill will strip the insurance industry of its exemption from antitrust laws, a provision that the Congressional Budget Office said during the day would have only a small impact on the cost of insurance to consumers.

The insurance industry was sharply critical of Reid's announcement.
"A new government-run plan would underpay doctors and hospitals rather than driving real reforms that bring down costs and improve quality. The American people want health care reform that will reduce costs, and this plan doesn't do that," said Karen Ignagni, head of America's Health Insurance Plans.
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Associated Press writers Julie Hirschfeld Davis, Ricardo Alonso-Zaldivar and Erica Werner in Washington, and Matt Sedensky in Sunrise, Fla., contributed to this story.

Source: http://www.huffingtonpost.com/2009/10/2 ... 34335.html