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Is Max Baucus the New Phil Gramm?

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Is Max Baucus about to do to America's health care system what Phil Gramm already did to the nation's banking system? Let's hope someone stops Baucus before it's too late.

Senator Phil Gramm, the Texas Republican, was a free market zealot who was more responsible than any other politician for the mortgage meltdown that led to the epidemic of foreclosures and the current economic recession. Now Senator Max Baucus, the Montana Democrat, is playing a similar role in the battle over health care reform. Although certainly more moderate than the right-wing Gramm, Baucus is nevertheless using his influence to undermine President Barack Obama's efforts to enact meaningful regulations that would require the insurance and drug companies to act more responsibly.

Just as Gramm argued that the banking industry could police itself without government rules and safeguards, Baucus is tying the hands of Congressional reformers who understand that we can't trust the insurance and drug companies to protect consumers and control costs. If Baucus is successful, health care costs will continue to skyrocket and hurt the nation's economic well-being, compounding the damage caused by Gramm's reckless role in stifling banking reform.

Gramm, who served in the Senate from 1985 to 2002, opposed any government regulation of the financial services industry, arguing that banks and other lenders could police themselves. As powerful chair of the Senate Banking Committee, and as the banking industry's chief spear-carrier in Congress, he was the key architect of the deregulation of the financial services industry. During the 1990s, Mother Jones magazine noted, "he routinely turned down Securities and Exchange Commission chairman Arthur Levitt's requests for more money to police Wall Street."

He was the major sponsor of the the Gramm-Leach-Bliley Act, passed in 1999, and the Commodities Futures Modernization Act, passed in 2000, which tore down the remaining legal barriers to combining commercial banking, investment banking, and insurance under one corporate roof.

Gramm's free-market fundamentalism made him a willing puppet of the financial services industry. According to the New York Times, "From 1989 to 2002, federal records show, he was the top recipient of campaign contributions from commercial banks and in the top five for donations from Wall Street. He and his staff often appeared at industry-sponsored speaking events around the country."

Gramm used his power as chair of the Senate banking committee to do the banking industry's bidding. Thanks primarily to Gramm, Congress wiped out the once stable and sound system of requiring banks to help homeowners buy homes rather than act like gamblers at a casino. The nation's ugly mortgage meltdown mess -- the escalating wave of home foreclosures, the growing number of bank failures, and the tightening credit crunch - is a direct consequence of Gramm's reckless actions. Washington walked away from its responsibility to protect consumers with regulations and enforcement. Operating without government rules and safeguards, banks and private mortgage companies indulged in risky loans and speculative investments.

They invented new "loan products"- including subprime loans and adjustable rate mortgages (ARMs) --that put borrowers, and their own banks, at risk.
The Times reported that Gramm "pushed through a provision that ensured virtually no regulation of the complex financial instruments known as derivatives, including credit swaps, contracts that would encourage risky investment practices at Wall Street's most venerable institutions and spread the risks, like a virus, around the world." These practices created the financial house of cards that predictably toppled and brought down the entire economy.

After he left the Senate in 2003, Gramm became vice chairman and chief lobbyist for UBS, the Swiss investment banking giant. In that role, he used his political connections to lobby for further bank deregulation. He was a key advisor to John McCain's presidential campaign last year until he was forced to resign for his intemperate remarks that the country had become a nation of whiners" in a "mental recession."

Max Baucus chairs the Senate Finance Committee, which is a key player in shaping health care legislation. His opposition to government regulation has made him the darling of the health insurance and pharmaceutical industries. Just as the banking industry filled Gramm's campaign warchest, the insurance and drug companies love Baucus and have rewarded him with huge political donations.

According to the Washington Post, Baucus is a "leading recipient of Senate campaign contributions from the hospitals, insurers and other medical interest groups hoping to shape the [health care] legislation to their advantage. Health-related companies and their employees gave Baucus's political committees nearly $1.5 million in 2007 and 2008, when he began holding hearings and making preparations for this year's reform debate."

In the last three years, for example, Baucus has received $63,350 from Blue Cross/Blue Shield; $45,250 from Aetna, and $46,750 from AIG. Health industry lobby groups have hired more than 350 former government staff members and retired members of Congress to lobby for them. Two of them are Baucus' former chiefs of staff.

During the Bush administration, Baucus was one of the few Democrats who sided with Republicans on tax issues and on a prescription-drug law that has predictably turned into a boondoggle for the pharmaceutical companies. In 2003 the drug companies and their trade associations deployed nearly 700 lobbyists to stamp out a proposal to permit the federal government to negotiate the cost of drugs for Medicare recipients. Instead, the Bush administration and the GOP-controlled Congress, along with Baucus, added a drug benefit to Medicare, but prohibited Medicare officials from negotiating prices with drug manufacturers. It also guaranteed that private insurance companies, not Medicare, would administer the drug benefit program. This dramatically increased Medicare costs for taxpayers. Seniors, meanwhile, wound up paying much more in out-of-pocket expenses for prescription drugs.

Now Baucus is taking charge of much bigger health care legislation, but operating with the same anti-regulation ideology.

In June, Baucus announced -alongside Billy Tauzin, the former Republican Congressman from Louisiana who now heads PhRMA (the drug industry lobby) - that the drugmakers had committed to cut prices on prescription drugs by $80 billion over ten years. But the deal is entirely voluntary - and it would preclude the federal government from negotiating for lower prices.

Baucus is particularly opposed to Obama's proposal for a "public option" - a government-run insurance plan which would allow citizens to select a Medicare-style alternative to private insurers. According to polls, 72 percent of the public and 90 percent of Democrats favor the public option. A public option would keep the insurance companies on their toes, and force them to provide better policies at a more reasonable price, or face an exodus of consumers. That's why they don't want it.

Likewise, the drug companies don't want a public option, which would expose how they inflate the cost of medicine that contributes to our expensive and inefficient health system. Drug prices in the United States are much higher than in Canada and other countries that regulate costs. But Baucus has apparently agreed to a drug industry proposal to bar consumers from buying US-approved prescription drugs from Canada and elsewhere.

In a recent cover story, "The Health Insurers Have Already Won," Business Week reported that, "The [insurance] industry has already accomplished its main goal of at least curbing, and maybe blocking altogether, any new publicly administered insurance program that could grab market share from the corporations that dominate the business.... [The industry] has also achieved a secondary aim of constraining the new benefits that will become available to tens of millions of people who are currently uninsured. That will make the new customers more lucrative to the industry."

Although Baucus' name was conspicuously absent from the Business Week piece, his fingerprints were all over the story.

Last month, the U.S. Chamber of Commerce wrote a letter to Congress voicing its opposition to any "new government-run insurance plan" as well an "any mandate" on employers to provide insurance to workers or pay a tax. It appears that the Chamber will like what Baucus is cooking up.

Faced with the possibility of a public option that will hold them accountable, the insurance companies and drug manufacturers are pledging to voluntarily trim their costs. If Baucus succeeds in removing a public option from the final health care bill, the insurance and drug companies won't have to worry about any competition If we've learned anything from the Gramm-inspired deregulation mania of the past few decades -- particularly how it unleashed an epidemic of irresponsible and predatory behavior by banks -- its that we can't expect for-profit corporations to police themselves on behalf of consumers, workers, or the environment.

Even former Federal Reserve chair Alan Greenspan had to acknowledge that unregulated markets don't work. But apparently Max Baucus hasn't figured that out.

Some observers argue that Baucus' anti-government stance isn't due to the massive campaign donations from the health care industry, but instead reflects
the individualistic leave-me-alone values of his Montana constituents. But Brian Schweitzer, Montana's popular Democratic governor, is a big fan of government oversight of the health insurance and drug companies. Last Friday, Schweitzer introduced President Obama at a town hall meeting in Belgrade, Montana. According to the Great Falls Tribune, Schweitzer's "ringing endorsement of Canada's universal health care system was well received by the audience" of 1,300 people waiting to hear from the president. "Did you know that just 300 miles north of here they offered universal health care 62 years ago?" Schweitzer asked the crowd, drawing enthusiastic cheers.


Baucus has so much influence because Senator Ted Kennedy, the Massachusetts Democrat who has championed health care reform for over 40 years and who chairs the key Health, Education, Labor and Pensions (HELP) committee, has been too ill to quarterback the legislative maneuvering in the Senate. Had Kennedy been healthy, he would have been able to use his personal relationships and legislative brilliance to neutralize Baucus and push for a progressive plan.

Instead, Baucus has rounded up five colleagues - Republicans Charles Grassley of Iowa, Olympia Snowe of Maine, and Mike Enzi of Wyoming, and Democrats Jeff Bingaman of New Mexico and Kent Conrad of North Dakota - to help him hammer out a bipartisan health care plan that eliminates Obama's public option alternative. (Critics point out that this group represents six states that have less than 3 percent of the nation's total population).

Baucus' opposition to regulating the health and insurance industry has made it impossible for the Democrats to take full advantage of their 60 vote majority in the Senate. He is not only leading the handful of centrist Senate Democrats against Obama's plan, but also empowering Republicans and right-wingers, including Rush Limbaugh, Bill O'Reilly, and Glenn Beck, to exploit the Democratic divisions.

It is entirely possible that Baucus' intransigence will lead to a stalemate, because his more liberal Senate colleagues, and the key House Democrats working on health reform, like Cong. Henry Waxman of California, won't buy what Baucus is selling. If that's the scenario, then we'll wind up where we were in 1994 -- after Clinton failed to health care reform -- with no bill that can win enough support to pass.

A second scenario is that Baucus will prevail, because he knows that Obama is so eager to pass a health care bill this year that he'll accept a compromise that is far from what he had hoped to win and try to save face by calling it a victory.

A third scenario is that liberal and progressive Democrats, and their allies among the labor movement, community groups, public health advocates, faith-based groups and others, will ratchet up their grassroots organizing and make Baucus - and his close ties to the insurance industry and drug companies -- the target. That was clearly why Obama traveled to Montana on Friday - to put pressure on Baucus in his own backyard.

Publicly, Obama praises Baucus. But Obama and the majority of the Senate Democrats are angry at Baucus for his obstructionism - more of a drug industry pusher and an insurance industry salesman than an advocate for real reform. Compare the insurance companies' big profits and outrageous corporate compensation to the tens of millions of Americans - including many Montanans - who can't afford health insurance, who can't get insurance because of pre-existing conditions, or who have policies that don't cover the things they need. Then challenge Baucus: which side are you on?

The crises in housing and health care are intertwined. A recent Harvard study found that high health care costs account for 62% of all bankruptcies, including foreclosures. Three quarters of them had health insurance that was simply too expensive.

After a Senate career shilling for the banking industry, Phil Gramm will always be known as the father of foreclosures. If Baucus prevails in carrying water for the insurance and drug lobby, he'll soon become known as the Senator who derailed genuine health care reform for a generation, a legacy that will wreak havoc for America's working families and for the larger economy.

One of government's important roles is to establish clear ground rules, and to regulate companies and industries, to save them from their own short-sighted greed. Government is necessary to make business act responsibly. Without it, capitalism becomes anarchy.

Gramm ignored that truism, and his actions led to an enormous amount of pain, suffering, and hardship. Will Baucus follow in Gramm's footsteps?


58 Comments

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Peter - Let me preface my comment by stating that I support a strong public option. I see its prospects not as hopeless, but increasingly unlikely, however, and expect that we may end up with a set of non-profit cooperatives instead, which might be almost as good or much worse depending on their structure and population base.

My larger point, though, is that a public option or co-op alternative is a feature of healthcare reform that is less important than many other elements. What is more critical is that insurance coverage be mandated for all (with a few exceptions), and that insurers must satisfy several criteria: inclusion of all essential medical services in any plan, acceptance of all applicants, no discriminatory charges on the basis of health status or pre-existing conditions, and no limit on annual or lifetime coverage.

Once these conditions are satisfied, insurers will not be able to engage in "cherry-picking" or to cut costs by denying services. Under these circumstances, they will be forced to compete on the basis of more or higher quality services and/or lower premium costs for the essential ones. This system appears to be working reasonably well in the Netherlands, where most medical services are covered exclusively by private insurers -
http://en.wikipedia.org/wiki/Health_care_in_the_Netherlands

Notice that the goal of a public option, competition, is retained under these circumstances. The private insurers compete by attempting to negotiate favorable rates with hospital and healthcare providers, and at the same time, a conspicuous comparison mechanism is established in the Netherlands to permit the public to rate one provider against another, and switch if necessary.

As the healthcare debate races toward critical votes in Congress, I believe it's important for all of us to push vigorously for the basic reforms that are being promoted, because if we quarrel with each other to the point of unwillingness to work for reform, we risk losing those valuable reforms in search of others that may be unobtainable.

I continue to believe we should push for a public option, since it may still be possible to turn the tide in its favor. To achieve it would be better than to have something less. At the same time, we should keep that desire in perspective as we fight reform opponents in order to achieve a transformative moment in American society for the better, with or without a public option.

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No, no no! If it becomes a mandate that everyone MUST contribute to the profits of insurance companies, then I will consider any reform as a colossal failure. And don't tell me that if I can't afford it, I can get help. Why should the taxpayer/government contribute to the profits of the insurance companies and the inflated salaries of their executives?
A better option is to mandate that all doctors and hospitals have to treat you (if you choose to be treated) whether you have insurance or not, and they cannot charge you more than they would charge you if you had insurance. Now THAT would make sense.

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Hmmm - I don't think you read my comment carefully, nor visited the link to the Netherlands healthcare system, which covers most medical care exclusively via private insurance, with apparently excellent results and no evidence of price gouging.

It's important here to base conclusions on evidence rather than ideology. The proposed reforms, with or without a public option, would represent an enormous leap forward toward the type of healthcare available elsewhere in the major democracies. No-one is arguing that a public option should be ignored - it would clearly be valuable - but even without it, the evidence tells us that the reforms that remain would be an extraordinary accomplishment, deserving of our vigorous support.

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Fred,

Agreed that this system would probably accomplish the goals of Health Reform. But here are several elements of the Dutch system fro the wiki article:

*The same premium is paid whether young or old, healthy or sick.
*It is illegal in The Netherlands for insurers to refuse an application for health insurance, to impose special conditions (e.g. exclusions, deductables, co-pays etc or refuse to fund treatments which a doctor has determined to be medically necessary).
*The system is 50% financed from payroll taxes paid by employers to a fund controlled by the Health regulator. The government contributes an additional 5% to the regulator's fund.
*The regulator has sight of the claims made by policyholders and therefore can redistribute the funds its holds on the basis of relative claims made by policy holders.
*The competition regulator is charged with checking for abuse of dominant market positions and the creation of cartels that act against the consumer interests.

How many of these features do you seriously think stand any better chance of passing the US Congress than the public option? The co-op fiasco is instructive: Republicans and their allies, like Baucus, pushed the co-ops as an alternative to the public plan. As soon as Obama threw the public option under the bus and expressed openness to co-ops, the Repblicans started attacking the co-ops.

The Republicans don't oppose the public option, per se, they oppose any reform that will hurt the profits of the insurance industry.

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I hope you're right, Fred, but I have serious doubts whether any reform that doesn't include a public option - even if, as you say, it appears to include competition - will really work as well as you anticipate.

Think of the wireless phone service providers, for instance. There are several of them, and the number of wireless customers has increased significantly in the last several years, which should have brought prices down and improved service as the result of competition, right? But they all still charge fairly high monthly rates for plans that limit the number of minutes you can speak, and all tie you into mostly 2-year agreements with significant penalties for pulling out before the full two years.

If competition among for-profit companies always resulted in the benefits you anticipate from health care reform sans a public option, we'd see far better rates from the wireless companies, and contracts not unlike our wired telephone companies, wouldn't we?

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Hi Wordie - Without belaboring the point, I favor a public option. However, the experience in the Netherlands tells us that competition among private insurers can provide good service at affordable rates provided that certain other conditions are fulfilled. These include mandated coverage, clearly defined essential benefits that must be included, no refusal to accept subscribers or to charge discriminatory rates based on health status, and no limits on annual or lifetime coverage. Then, in addition to all that, there must be a clearly visible resource that the public can visit to compare insurers and providers, rate them, and provide feedback for prospective future subscribers. It's this combination of transparency and accountability that keeps the private insurers honest.

Having said that, I might be asked why I still think the public option has any importance at all. My reasons are twofold. First, it discourages private insurers from running up excessive marketing and advertising costs, something they might do if merely competing against each other. Second and more important, the U.S. is larger and more heterogenous than the Netherlands. Here, there might be regions of vigortous competition among insurers, but other regions where few insurers would bother to compete, leaving the field open for a monopoly in the absence of a public option.

So yes, I want to see a public option pass. It is absolutely essential, however, to understand how valuable the remainder of the reform program is, so as to discourage efforts to deem reform a failure based on a failure to achieve a public option.

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You clearly omit two important factors:

1. Competitors.
2. Universal risk pools.

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You assume a significant degree of competition, but the latest report indicates that there is little or no competition in most states. Here in Montana, BC/BS controls 75% of the market and one other company, New West, controls an additional 10%. That is not a competitive market, but rather a near monopoly.

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I am ready to buy into the concept that making insurance companies all-comers would drive the insurance companies to find less expensive options for the most expensive conditions.

But there is a glaring problem that I haven't heard address by anything other than the non-profit public option available to every American no matter where they live.

If you make it mandatory and then provide subsidies to make up what people can't pay I don't see a cost control mechanism. If the premiums WILL BE PAID, whether by the insured or the coverage subsidy then where is the incentive to keep premiums lower? And how can the insurance industry at large justify higher premiums? Get requirements that insurance companies cover more costs without respect to medical utility. The bigger the health care price tag, the bigger the insurance slice.

So, without a public option but with a guarantee that premiums will be paid, can someone tell me where the cost control mechanism comes from?

I want a public option, but I'm willing to consider alternatives. Please help me understand what mechanism will control cost without the competition provided by a public option.

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Without a public option we remain stuck with a system that, in a way, meets the definition of price gouging - pricing above the market price when no alternative retailer is available.

According to the latest Harper's Index, since 2002 health insurance permiums have increased 70% while health insurers profits have increased by 428%. The alternative to health insurance is no health insurance, which is hardly an alternative.

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Your post is an accurate summary of Gramm's history of influential realpolitik.

I would caution though that such a comparison fails to take into account that Gramm was not sole agent in the deregulation debacle of 1999.

President Clinton-chief federal executive, Robert Rubin-treasury and previous co-chairman of Goldman-Sachs, Sanford Weill- Citigroup lobbyist all played key parts in FACILITATING the passage of the Financial Services Modernization Act of 1999.

We would need to identify the other potential "obstructionist" of health care reform to make a valid comparison.

I do find your thesis plausible in anycase.

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Corp,

add Sen. Chuck Schumer to that mix. (along with many other Democrats)

But Gramm (along with the entire Republican party) was the driving force.

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RE: "If Baucus prevails in carrying water for the insurance and drug lobby, he'll soon become known as the Senator who derailed genuine health care reform for a generation..."

MY COMMENT: The 'crime of the century'? Or is
that destined to be the Iraq fiasco? Stop the 'highway robbery'!

SEE: "Loophole in government program to buy toxic securities could cost taxpayers", By Ralph Vartabedian, 08/15/09

(EXCERPT) A controversial $40-billion government program to buy toxic securities from ailing banks has a flaw that law enforcement and financial experts say could allow traders to illegally profit from inside information.

Critics of the program say that without adequate safeguards, traders could use the tens of billions of dollars provided by the government to manipulate prices and exploit the price swings in other trades.

Because the government is providing 75% of the program's money -- $30 billion -- the manipulations could lead to significant losses by taxpayers...

ENTIRE ARTICLE - http://www.latimes.com/news/nationworld/nation/la-na-toxic-assets14-2009aug14,0,3865656.story?track=rss

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There will no significant improvement in the behavior of the health care industry without a public option and government regulation.

The welfare of these corporations is at loggerheads with the welfare of most of the citizens of the United States.

The only people who will gain anything significant from the capitulation of the Democrats and the collaboration of "Senator" Baucus are the stockholders whose interests he seeks to protect.

By the way, are you telling me that some of the money I pay in premiums is used to influence legislation rather than to provide health care? I'm shocked, I tell you, shocked!!!

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Thanks to Peter Dreier for this informative article.

It's looking more and more like this whole ordeal is headed for a compromise. I know that's a terrible word for advocates of the public option. Nevertheless, Peter's point is well-taken: the politics of Mr. Baucus and others will constrict toward a settlement with the insurance industry on the immediate future of health care in America.

Therefore, the pragmatic approach that Fred proposes makes good sense. By replacing the "public option" (which town hall opponents associate, erroneously, with socialized medicine) with these components:

1.) inclusion of all essential medical services in any plan,
2.) acceptance of all applicants,
3.) no discriminatory charges on the basis of health status or pre-existing conditions, and
4.) no limit on annual or lifetime coverage.

...we can simplify the presentations made to citizens in public venues. Furthermore, these four basic planks can be simplified, for educational and promotional purposes, to four basic words, or phrases:

1.) Inclusion
2.) Acceptance
3.) Non-discrimination on Pre-existing
4.) Lifetime coverage.

These for elements simplify the bare bones necessity of the reforms that need to happen. They do not, however, address the issue of how things get paid for. Unfortunately, that's a matter that future sessions of Congress will have to address. But one thing is for sure:

The status quo is not lowering the costs of health care. We need something to inject competition into the system.

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To simplify even further, legislative outcome must restore:

1.) Competition among companies, to include:
a. Inclusion
b. Acceptance
c. Non-discrimination on Pre-existing
d. Lifetime coverage.

I submit that this is a platform that the American people will generally accept.

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You are listing elements of an insurance policy. No where does your list include a guarantee that the care will actually be provided by a competenet physician in an adequate clinic or hospital located within a reasonable distance of the patient.

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A through D is not a list of competition.

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Fred has a great deal of faith in the government's capacity to regulate the insurance industry. Given it's inablility to regulate the financial industry (isn't insurance a part of the financial industry?) I fear we are getting little more than faith based healthcare.

All "essential" services will be covered? Yeah. Right.

The biggest problem with this whole mess is the utter lack of commitment on the part of the party establishment.

We have abandoned support of universal heathcare. We are now championing only "insurance reform". That is a tepid contingent commitment ripe for being gamed away bit by bit as Americans are held hostage to policies they can't afford which will give them second class healthcare. "Essential" care. Will your knee replacement be "essential"? After the legion of insurance industry attorneys have exploited the loop-holes snuck in at the last minute we'll see what's left of essential and how many ways they have figured to get out of covering even those.

We don't know what we're getting. We do know what we are losing: a commitment that all Americans be provided healthcare. That is not the same thing as a mandate that all Americans must buy an insurance policy. That policy will not provide an urban clinic and it will not provide a rural doctor. It will only require the urban poor and the rural poor to buy an insurance policy.

Congress is washing its hands. It is turning the problem over to the insurance industry (just as it turned our financial well-beig over to AIG) and trusting them to abide by a few rules. Again, the rules do not provide healthcare. They only provide skeletal insurance policies.

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Bluebell - I believe you're conflating three issues that require separate attention - a public option, essential covered services, and universal healthcare.

It will be important for mandated insurance to offer essential medical services. These have not yet been spelled out, so our obligation now is not to protest but to ensure that what is essential will eventually be included.

If the package is inadequate, it would be inadequate in a public plan as well as private plans, because the plans are required to offer the same minimum package.

Universal coverage requires subsidies for low income individuals. That requires government expenditures that are matched by revenues to avoid increasing the deficit. If the subsidies are inadequate, the minimum benefits package will need to be downscaled to make it affordable with the subsidies that are available. Alternatively, Medicaid would need to be greatly expanded to include most of the poor (it now covers only 40 percent) - the states would find this hard to afford, so it's unlikely to happen.

Private insurance charges are not totally unrelated to this, but insurer profits represent such a small percentage of healthcare costs that a focus on them ignores the more important factors driving costs upward - factors responsible for the fact that Medicare and Medicaid expenses are rising faster than healthcare costs as a whole. These are the waste, inefficiency, and duplication within healthcare itself, driven by a fee for service paradigm that encourages excess. Until that is rectified, no reform will provide universal coverage at an adequate level and at affordable prices.

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Fred, I'm talking politics. I'm talking reality. I'm talking commitment. Public option is just a symbol really. It's asking for commitment. The commitment is not being made. The commitment has been withdrawn. When this bill went from Ted Kennedy's dream of universal healthcare to "insurance reform" the party dropped the commitment. We are no longer even talking about the real goal and without that goal they aren't going to do any of those things you want either.

You have a lot of faith in the theory of the bill but the theory is not going to be the reality. They are going to keep selling out. The essential services will be gamed. The money for those unable to afford the insurance will be inadequate. They are not providing the money that it would take to truly transform the healthcare industry to do what you'd like it to do. Even the VA, as hard as it tries to acutally provide healthcare to veterans, has a terrific problem with getting it actually delivered out to all the areas of the country where it must be available.

This bill is too little. It is too complicated. It's complexity makes it perfect for being gamed by the insurance industry players.

And no where in this is there a commitment to do the job. My progressive Senator still tells me she wants healthcare "more" accessible. More accessible than what and to who?

You are buying a pig in a poke.

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The money for those unable to afford the insurance will be inadequate.

Here, we agree, even though neither of us knows exactly how much money will be forthcoming. It will be inadequate because until healthcare itself is dramatically reformed over the course of 1-2 decades, the money needed will have to come mainly from new taxes. Furthermore, merely taxing the rich won't yield nearly enough, and so President Obama's promise of no middle class tax increases will have to be broken to find enough money to subsidize low income individuals.

Furthermore, the money can't come primarily from income taxes, because incomes are rising much less rapidly than healthcare costs. I favor the approach advocated by the most realistic economists, which is to tax the employer contribution to healthcare insurance premiums, since those will rise commensurately with healthcare costs. Politically, taxing the middle class is a tough sell, but if you want adequate coverage for all Americans, you have to push it.

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If this president and this fully Democratic Congress do not deliver true health care reform -- universal coverage and a vibrant public option -- the Democratic Party will have proved itself hopelessly useless. A half measure may well make things worse and will certainly waste a precious moment in history and retard real reform by draining the energy from the reform movement. I would rather have no bill and wait for courageous leadership, whatever its source.

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Yesterday, I pointed out the very valuable features of proposed reform that would move us forward even without a public option, and suggested that a public option may not be viable politically.

Today's news reinforced that impression, with Kent Conrad, among others, stating that a public option does not have the votes to pass, and probably never had. Other Democrats (Schumer, Sebelius, Durbin, et al) have also begun to emphasize the importance of reform even if a public option is not part of the package.

I would urge all reform advocates to continue pushing for a public option, because it's a good idea and would work well in our society if the politicians could get past the current obstructionism. Far more important to me, however, is the hope that reform advocates will conduct their advocacy fervently, vigorously, and persistently on the basis of what the final package is almost guaranteed to offer, rather than base their level of enthusiasm on what type of public component may or may not be included.

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You are buying the spin, and you have been buying it all along! We are not going to get "health care reform" that does anyone any good, any more than the "bankruptcy reform" did anyone any good!
And as others have said, the idea that "competition" brings down prices is the biggest lie ever, as anyone who has cable TV can tell you. What makes you think that price-fixing doesn't occur? Or that the government can or will do anything about it? Or that companies themselves don't divide up territories in order to have monopolies?
I really do not believe that all the insurance reform in the world will affect our health care one iota! Insurance reform (if such a thing actually happens) only affects insurance. Health care is something completely different--as you should certainly well know!

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They're reporting on Kos that Sebelius has put the public option under the bus.

To me it's a placeholder. It indicates whether the administration and congressional leadership are going to fight for a good bill or just any bill and be just as happy with a bill that is 2000 pages of swiss cheese.

You got to remember oh you of too much faith, that if they sell out on this, it's not going to be the only thing they sell out. It just indicates loudly and clearly that they will stand strong for nothing. It shows who is writing the bill: the insurance industry.

The bill will get worse as the lobbyists get their way in the final act. The sell out on public option is just the great big sign that says "We're for sale! Come one come all! Now's the time to request the insertion of your Trojan Horse in the fine print!"

There will be no insurance reform or reform of any kind until we reform Congress by voting out every single member who sold us down the river on this bill and others - EFCA, FISA the list will continue to grow.

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bluebell,

exactly. Without a public option the Republicans and the wingnuts will see it as a victory and be emboldend, and you can then see the pattern for all else Obama and the Dems propose; screaming, lying, exaggerating, dissembling.

There's much at stake in this issue.

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Speaking od Swiss cheese . . .

Comrade Krugman weighs in!

If we were starting from scratch we probably wouldn’t have chosen this route. True “socialized medicine” would undoubtedly cost less, and a straightforward extension of Medicare-type coverage to all Americans would probably be cheaper than a Swiss-style system. That’s why I and others believe that a true public option competing with private insurers is extremely important: otherwise, rising costs could all too easily undermine the whole effort.
But a Swiss-style system of universal coverage would be A VAST IMPROVEMENT on what we have now. And we already know that such systems work.
So we can do this. At this point, all that stands in the way of universal health care in America are the greed of the medical-industrial complex, the lies of the right-wing propaganda machine, and the gullibility of voters who believe those lies.

Happy days.

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First, I want to thank Carey Rowland above for succinctly summarizing the crucial elements in the reform package. I also hope interested readers will review the details of the Netherlands healthcare system (based on private insurance) to understand two things - first, that private insurance can provide good service at affordable prices, and second, that it won't do that if left to its own devices, but must be subjected to rigorous oversight. The link is
http://en.wikipedia.org/wiki/Health_care_in_the_Netherlands

Sufficient oversight would be difficult in a nation as large as the U.S., which is why I believe a public option would be useful in keeping the insurance industry honest.

Much more important, though, is the sobering reality that insurance is only the smaller part of the problem, and even thorough insurance reform won't make universal healthcare affordable. Bluebell suggests that rural healthcare currently lacks adequate facilities. That is certainly correct, and is one of the deficiencies the Blue Dogs, for all their faults, have been trying to correct. However, current healthcare already is unaffordable to the U.S. economy, and adding more facilities will make it even more unaffordable for the economy as a whole.

What is required is a fundamental overhaul of healthcare to eliminate the waste, duplication, and unnecessary tests and procedures. The proposed legislation, unfortunately, only makes small moves in that direction. Even though we must work hard to ensure the legislation passes, with or without a public option, the real challenge will only start at that point.

Finally, I'm encouraged that in the political sphere, the acknowledgment by key Democrats that a public option is nonviable politically has been matched by the statements by some Republicans that a substitute process - non-profit cooperatives - might be "a step in the right direction." As always, the devil will be in the details, which is one reason those of us desiring real reform will keep our eyes on the details.

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I will oppose ANY bill without a true and vibrant public option. Utterly non-negotiable. All the compromising that could be done WAS done when single payer never even made it into the discussions. I have been and am a big Obama supporter but he loses me forever if he caves on the public option.

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I read the piece in today's NYTimes by Richard Thaler -- http://www.nytimes.com/2009/08/16/business/economy/16view.html?_r=1&ref=business -- which is difficult to interpret as anything other than a repudiation of the public option. Since Thaler is close to Obama and Obama's economic team, it appears that the stage is being set for jettisoning a true public option. (Thaler's actual proposals are little more than political semantic exercises disguising a purely private system.) I say this now: If Obama abandons a vibrant public option, I will abandon him.

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Yes, this is absolutely the very last straw.

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I'm gratified by the fact that so many individuals, here and elsewhere, who care deeply about the need to reform healthcare, understand that current reform proposals, with or without a public option, would be a transformative event in our nation toward a truly excellent and affordable universal healthcare system.

I know that some will be disappointed by the absence of a public option (but hopefully one replaced by an effective non-profit co-op system). Most, however, have been willing to subordinate their personal frustrations to the needs of the American people, and will continue to work vigorously and enthusiastically to ensure the passage of reform legislation, striving additionally to ensure that it accomplishes everything that is politically realistic during our current recession.

This is an adult attitude that I admire, respect, and commend. It is also one that is desperately needed in the face of determined obstructionism by reform opponents.

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I won't be "disappointed" if there is no public option in the so-called health reform legislation: I will be unalterably opposed to any such bill and any political leader -- including and especially President Obama -- who attempts to foist such an abomination on us. And I do NOT agree that this will be a "transformative event" if there is not universal coverage and a public option. It will be a sham. There is a very popular, newly-elected Democratic president and there is an overwhelmingly Democratic Congress. This is NOT a time for weaselly half-measures. It is time to GET IT DONE.

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It's not only a sham, it's a sell-out on the very most important domestic issue. There is nothing the party can do to make up for selling out on healthcare.

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At least the Republicans stand on their principles. Unfortunately, their principles have proven uniformly wrong.

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The Democrats only function is to enable the Republicans principles to become policy. This won't be the last sell-out before the bill comes to a vote. It won't be the last sell-out from the Obama administration. I guess you can't expect him to be better than the party but I'm through with pretending that Lieberman and Baucus and Conrad and the rest of them who enable Lieberman and Baucus and Conrad to control the party have anything whatever to do with representing me. I've been trying to pretend for a long time that the party represents me. It just doesn't anymore on any issue that matters. War, labor, human rights, health -- what is there left?

The "progressives" enable the Blue Dogs who enable the Republicans who enable the wingnuts.

There is no opposition to the wingnuts. Who won the battle of the townhalls? The wingnuts of course. Democrats surrendered without a fight.

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Two commenters above have made their views known, but in my experience, those views are in the minority. I know they are in the minority among those who are thoroughly familiar with the proposed legislation.

I have spent 9-10 hours going through HR 3200, examining each section to determine what points it makes, and reading the complete text of some of the more critical sections. The legislation is impressive in the advances it would achieve toward affordable and universal healthcare, even without a public option. Where it falls somewhat short is in the relatively meager nature of provisions to restructure healthcare itself. It does, however, take a stab at this through Medicare incentives to increase primary care, and demonstration projects to evaluate the increased efficiency achievable by replacing fee for service medicine with a payment system based on value.

It now appears reasonably likely that a major step forward will be achieved. The public option won't be part of it, although a non-profit co-op alternative is likely, and must be scrutinized to ensure it is strong enough to be effective.

The only danger now is that reform proponents won't support the legislation with the passion opponents are mustering to defeat it. The opponents realize how dramatic are the changes America would experience, and fortunately, I expect that the proponents, with only a few exceptions, will perceive that reality as well.

The next several weeks are likely to be critical.

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This so-called "reform" bill should die a quick and shameful death. I have already unsubscribed from the e-mail lists for Obama and the Democrats. I have already contacted the White House, my senators, and my Congressman. And I intend to actively defeat this bill. I am tired of my national leaders kowtowing to right-wing lunatics. This is our country too! And WE won the election!!!

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So this Senate bill is in the hands of three Red State Democrats and 3 Republicans. And as the man says, these 6 people represent 3% (9 million) of the 300 million Americans.

Representative Government my ass.

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I didn't work my ass off for Obama for THIS!

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I have read that Obama has been meeting with baucus and the finance committee so I imagine whatever they have cooked up will be what we get. And that means no public option.

HEALTH CARE SHOULD NOT BE A FOR PROFIT BUSINESS!!!

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Well, Fred, I don't know if you are the majority or not as you pretend to be. People has so much wool pulled over their eyes over the last three decades that most can't tell whether they even have eyes anymore. But it doesn't matter. What matters is that my side of the struggle keeps loosing, and you are giving out the recipe for continuing to lose.

Compromise is not the goal of politics. Winning is. You win by building a strong coalition and using the resources of the coalition effectively to push your goals as far as you can in order to show its strength. Then, at the end, just before showing the cards, you compromise. The quality of the compromise reflects the quality of the preparation. If you've built a strong coalition that frightens the hell out of the other side, you get the other side to sign a compromise in your favor. If you've built a lousy coalition, you get a lousy compromise. If you've built a coalition full of double or uncommitted agents, who win regardless of whether you win or you lose, you get a lousy compromise.

You say we have to bow to "political reality." There is no such thing as political reality in itself. Political reality is the end result of the work of organizing coalitions. You can't blame it for playing a lousy game. A lousy game is the sign of a lousy player.

The pre-condition to winning, before anything else, is understanding the game in the way that makes winning at least possible. You describe the game as an affair of experts sitting together in rooms with donuts and hammering out a deal, while other experts write newspaper articles (or TPM posts) or speak on TV to explain their work. The people is passive. Representatives, from Obama to the reps in Congress, can be trusted to get the best that is possible given an unfathomable political reality. Framing politics this way makes losing a foregone conclusion for all but the insiders, since the most important resources regular folks have, the anger of people who are denied what should be their right, and the clarity of the stakes that allow masses to make sense of it, are written out from the toolkit. To win, we must start from framing the contest as one in which the political system plays an ambiguous role, most of the time in cahoots with the experts and the corporate shills, and responding to us only under huge pressure, if at all. They don't need health insurance after all.

They say in Washington, if you want a friend, get a dog. Only once that saying sinks into the popular consciousness, only when the popular consciousness grasps that nobody, not even Obama, is a friend, we can begin to make allies, not friend, in Washington that, if the leash is kept short enough, would work in our favor. A lot of people get it already, but not apparently a majority of liberal voters.

We need it seems a few more defeats, a little more despair, before they are ready to let go of their illusions. So be it.

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Several of the comments reacting to my article are symptomatic of what's wrong with a wing of the American Left --

One reader wrote: "I didn't work my ass off for Obama for THIS!"

Another wrote: "If Obama abandons a vibrant public option, I will abandon him."

A third wrote: "I have already unsubscribed from the e-mail lists for Obama and the Democrats...I am tired of my national leaders kowtowing to right-wing lunatics. This is our country too! And WE won the election!!!"

My response: Who says politics ends when the election is over? Obama's election was a necessary but not sufficient step for advancing a progressive agenda. Obama explained this during the campaign. He doesn't have a magic wand that he can wave over the moderate Democrats. Big business will try to thwart attempts to challenge its power and profits. They still have a lot of power, and they are wielding it - on health care, on environmental reform, on labor law reform, on banking reform, etc.

If we want a good health care bill, we have to fight for it, organize for it, push the centrist Democrats like Max Baucus, Kent Conrad, Mary Landreiu, etc. Embarrass them for their ties to the drug and insurance industry. Run progressives against them in Democratic primaries. If we don't do that, then we can't blame Obama for not getting 60 votes for his legislative agenda.

Why are people so quick to call Obama a sell-out? This is a democracy. The people have a responsibility to create a political climate that makes it possible for Obama to be a successful president. It doesn't end on November 4.

Grow up.

Peter Dreier

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Bull. It is the president who should be pushing the centrist Democrats. Max Baucus doesn't give a rat's ass what I think. If Obama can't control his own party -- or isn't even willing to challenge his own party -- then he is not the president or the man I thought I was voting for. I've had it with spineless Democrats who are convinced that compromise means capitulation. If the Democrats can't get real things done with a newly and decisively elected president backed by an overwhelming majority in the House and 60% of the Senate then the Democratic party is worthless. Worthless.

The president I worked so hard for is selling me out on one of the two critical issues he got elected to address. The second -- energy/climate change -- will surely follow suit once it is clear Obama can be rolled so easily. Pardon me for being disgusted. But don't expect me to bust my ass for someone who won't bust his own.

Why won't Obama say: I will not sign any bill without a public option and then let him mobilize all his resources -- including me -- to make it happen. If he fails, at least he goes down fighting. But if he won't try, if he won't declare himself, then he can take care of the rest on his own. And good luck to him because it will be perfectly clear that a new president and a new party are required.

Further, I think your understanding of American democracy is flawed. We have a representative system; we do not have direct democracy. Our elected leaders are elected to lead.

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The reality is the wingnuts have been motivated to attend the meetings and make a real stink. Leftists, sadly, aren't showing up at the meetings to counter the rightist nonsense with equally loud demands for a public plan. You can blame Obama (and he hasn't been very effective), but ultimately the problem seems to be that the right-wingers are better organized and more intense than the left-wingers.

We also can't underestimate the remarkable stupidity of the American populace. It isn't an accident that Bush was elected president twice.

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Umm, elected ONCE, actually. Unfortunately, it was the second time so your point is valid, nonetheless.

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It is a matter of how hard and in what manner one pushes. My own view is it is time for them to see competition from true progressives. At the moment they think they have none.

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Peter,

Your comment is symptomatic of what's wrong with the "centrist" wing of the Democratic party. You counsel "maturity" while you continually capitulate to a right wing that has no interest whatsoever in compromise or cooperation. If we wanted Republican policies, we would vote Republican.

Wake up!

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Someone asked earlier whether I represented the majority in stating that we can now expect a major step forward in the reform legislation that will eventuially pass, and that most of us enthusiastically support in our efforts to ensure that outcome.

The reason I believe I reflect the views of the large majority of knowledgeable progressives is that an increasing number of progressives are becoming familiar with the details, and consequently are aware that what will be included in the legislation is more important that what may be omitted. In particular, as someone who is familiar with details, I would state with reasonable confidence that a public option is such a minor component of the entire package that its omission, while disappointing, will exert little long term effect on the progress of reform.

I respect the views of others who have also studied the details of the legislation and are familiar with its multiple components, and who might have a different perspective. If there are any who are aware of this thread, I would look forward to their views. However, I don't believe our vigor in supporting the proposed reforms should be weakened by a few individuals who are placing their personal frustrations regarding a small part of the legislation above the welfare of the American people, when the people desperately the need the type of reform that is still likely to pass.

As an aside, an interesting political dynamic is now at work as healthcare reform heads towards becoming the law of the land. The proponents, who understand which parts are critical and which are not, are planning to hand the opponents something the latter can call "victory" so as to permit moderate to conservative Democrats, and probably one or two Republicans to support the final bill without being called traitors by conservative elements of their respective constituencies. In turn, we will achieve a reform that does almost all it originally set out to do while the opponents who are aware at what's happening vainly try to stop it.

Nothing is certain, of course. We could still lose, but only if we try hard. Otherwise, I expect something quite remarkable in the coming months.

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Tripe.

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It is late in the conversation, but here is Baucus' contact webform. Tell him what you think.

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When is Harry Reid going to get his caucus to remove him, Conrad and Nelson from their chairmanships? What the hell was the purpose of giving the Democrats the White House and Majoritys in both Houses if this is the governing we get? For crissakes use RECONCILIATION!! Get the bill WE want not what the Insurers,Pharmaceuticals, Hospitals and Chamber of Congress want! Why do they even have a seat at the table? Just like the banking systen is/was f'd up so is the health system! Just like the banking bailout permitting those that f'd it up try to fix it they have the health system profiteers telling them what they will take or not. F@#k them! Get a bill with every item from single payer to subsidies for those that can't pay and let them scream! They tried to derail Social Security from 1936 to the present. They tried to derail Medicare from 1964 to present. What makes you think this derailment will not continue through out the life of National Health Care if it gets passed. The more you have in it the more difficult it will be to derail it in the future. how many Republicans over 65, without golden parachutes, want Medicare or Social Security to disappear? Especially if they have troubling health conditions? Those spouting the bullsh!t that the people of the UK, Canada, Sweden and other countries that have a National Health System hate it are as full of it as a Christmas Goose! If Reid doesn't do something to corral these wayward Senators he should be replaced. Everybody but the politicians knew there wouldn't be bipartisan support and the Democrats have to do what the Republicans did when they were in power. Tell them to go sit in the back and be quiet, don't offer any ammendments and we'll tell you when it is time to vote. It won't make any difference how you vote we're going to pass it anyway. RECONCILIATION!, and get rid of Baucus, Conrad and Nelson. We need no recalcitrants during this Congress! They are more worried about re-election and contributions from the same people lobbying against health reform than getting a health bill to benefit EVERY American equally. Medicare treats everybody over 65 equally! Get the profit out of it by having a single payer system and go from there.

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You're right Peter! "The people have a responsibility..."

And here are some people who are mad as hell:

http://www.madashelldoctors.com

Check them out. They don't want the public option. They want single payer. And their video spells out quite clearly why it's the only option that will work to end this profit driven system some people call "health care."

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The only significant public option is being ignored by pundits, progressives and people who claim to care. Vote these self-serving bastards out of office! What is the good of having a Blue Dog if he is biting you?

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Well, if Baucus does succeed in killign the PO, be sure to play the fun new game:

BaucusBucks (TM)!

http://tpmcafe.talkingpointsmemo.com/talk/blogs/observer2/2009/08/baucusbucks-tm-1100-tax-increa.php

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I have had to listen to the wind whistle through the empty head of Max Baucus for longer than I care to remember. If you carefully listen to what he has to say, you will soon realize this man possesses the speaking eloquence of a rehabilitated drug addict, yet somehow, my fellow Montanan's are captivated by this shallow emptiness. It must be the seven month long winters with their howling winds. Misery loves company.

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I have a simple question. Why has the most critical work of this most central committee been turned over to an evenly divided group of six men, three chosen by a Bush lackey, and three chosen by the ranking Republican member, creating the aptly-named "Gang Of Six"?
America voted in a majority of Democrats. The rules in both houses give the majority party a majority of seats on EVERY committee and sub-committee.

So, to use military jargon, Whiskey Tango Foxtrot?

This arrangement appears rigged to guarantee obstruction. No wonder it hasn't produced a bill. No wonder it won't.
Let's move on.
"Leave the Baucus behind us.

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