The Senate can pass affordable health reform - with a strong public option. The House will make sure they do.
This is
the moment when Senators Max Baucus and Majority Leader Harry Reid (and
President Obama) should make history by producing a Senate health reform bill
that ·
makes health insurance
truly affordable for all Americans, ·
creates a strong
public option to give private insurers real competition, ·
and doesn't destroy
Democratic re-election hopes by taxing hard-won middle class health
benefits. Last week
the Senate Finance Committee became the last of five Congressional committees
to pass a health reform bill - this one by far the weakest of all the
bills. Almost immediately a small group of Senators - Majority Leader
Harry Reid, Finance Chair Max Baucus, and acting HELP Committee Chair Chris
Dodd - huddled with a White House team led by Chief of Staff Rahm Emanuel to
begin the mysterious process by which the more progressive HELP committee bill
will be melded with the product of Baucus's mostly fruitless negotiation with
Senate Republicans, only one of whom, Maine Senator Olympia Snowe, deigned to
vote for the final Finance bill.
Reid and
even Baucus say they personally support a public option, but they repeatedly
point to the so-called "moderates" in their own party whose support
is necessary to get to the 60 vote majority needed to pass a health reform bill
in the Senate. With a smart legislative strategy, the 60 Democratic votes
(which, with Snowe would total 61) could be called upon just to overcome a
Republic filibuster, clearing the way for a 50 vote majority to pass a strong
health reform bill -- while letting more conservative Democrats vote against
it. [More on this anti-filibuster unity strategy in columns to come.] Most importantly, Reid and Baucus need to
realize that even "moderate" Democrats are rethinking their positions
on health reform right now. Concentrating their minds is the realization
that they are about to vote to force every American over the age of twenty five
to purchase health insurance. Moderate Democrats are the ones most
receptive to the demands of the insurance industry, and the price the insurance
industry is demanding in exchange for insurance reform (like preventing
companies from discriminating against people with pre-existing conditions) is
the "individual mandate" - which means voters are forced to buy
insurance, whether they can afford it or not. At this moment, all Democratic politicians,
even the most conservative, are realizing that their voters will blame them,
not the insurance companies, if the policies the voters are required to buy are
so expensive that premiums consume over 20 percent of those voters' annual
incomes. Suddenly, more generous tax subsidies to cover middle-class
premiums seem like a good idea. And if the public option can bring down
the cost of premiums those subsidies have to pay for, then the overall size of
the reform price tag can be kept under control - a long time demand of moderate
Democrats. Everyone knows that the three House bills
contain more ample subsidies, two of the three have a strong public option,
and they don't tax hard-won worker health benefits. On
Friday the Congressional Budget Office reported that most progressive of the
House bills produces more affordable premiums, while coming in around the ten
year cost of $ 900 billion goal set by moderate Democrats and President
Obama. Here's the headline on Lori Montgomery's story: CBO
Estimates House Health Bill at $905B or Less. On the Health Care for America Now Blog,
Jason Rosenbaum does a nice job of teasing out the implications of these
findings at this moment when moderates are figuring out how to achieve their
fiscal goals, while avoiding being blamed for bad outcomes: As a refresher, the bill being considered in
the House is a much better bill than what Finance passed on Tuesday. It has a
public health insurance option, it asks employers to pitch in their fair share,
it is fairly
financed, and it has much more generous subsidies (read: tax credits) to
make health care affordable for everyone. So, why, with all that good stuff in there,
does it look like the will CBO say the House bill still covers millions more
people and costs just as much, while remaining deficit neutral?
Because things like employer responsibility, fair financing, and the public
health insurance option save
money. That's right. The public option saves money. The
CBO has said so before, and it looks like they're saying it again. Combine that with raising money by taxing
households that make over $350,000 per year instead
of the middle class, and asking employers to chip in for their employees
health care, and you've suddenly got a lot more money to work with. Which means
you can give middle class people more generous subsidies than the anemic
Finance bill. Which means you and I won't be on the hook for 16.5%
of our income paid towards health care costs, the level a typical middle
class family would have to pay under the Finance bill. Harry Reid and Max Baucus (and the White
House) should step up to the plate and borrow the strongest parts of the HELP
bill to write the final Senate health reform legislation. If they don't,
the US House of Representatives, led by Nancy Pelosi and the Progressive
Caucus, will force them to strengthen their bill in conference committee.
But if the Democratic leaders in the Senate dare to lead, the House will back
them up - and even the most moderate Democrats will support them as they make
history by winning affordable health care for all.
The HELP bill is crapola too. Despite what many people believe, it does not contain a real public option. The $905 billion House bill is the first time we're seeing a reform that actually makes sense and conforms to the will of the people. True reform advocates--as well as anyone who doesn't want Democrats to get creamed in 2010--ought to unify behind the stronger House bill.
October 19, 2009 12:43 AM | Reply | Permalink
Comparison . . .
Always keep first and foremost in mind ...
The following is a comparison between what the Senate HELP bill offers relating to their so-called "public health option" and that of the House Tri-Committee version's "national public health option" . . .
Here is a simplified explanation from Kaiser Foundation's Health Reform Comparison Tool of the House Tri-Committee (HR 3200) version:
For additional information expanding on the above you may wish to read the following by Kip Sullivan, JD from PNHP's official blog:
And here is a simplified explanation from Kaiser Foundation's Health Reform Comparison Tool of the Senate HELP bill version:
For additional information expanding on the above you may wish to read the following by Kip Sullivan, JD from PNHP's official blog:
~OGD~
PS: I hope the formatting worked . . . If not ... blame TPM . . .
October 19, 2009 2:09 AM | Reply | Permalink
The House can't "make sure" the Senate will pass anything. Nice try, but nothing short of an unequivocal statment of support from the President and intense follow up by the White House will get the public option in the bill. This means Mr. Obama will have to spend political capital to get it done, and for whatever reason, he seems reluctant to do that here. I'm not sure what he's saving his bullets for, but whatever it is, it better be a big one (like getting the hell out of Afghanistan).....
I mean for Goodness Sakes, I loathed his policies, but at least George W. Bush understood that you need to make a few enemies to get things done in Washington.
October 19, 2009 12:21 PM | Reply | Permalink
Why are we willing to settle for a "public option" when it requires a person to buy insurance from a health insurance company.
How about a self-insurance option which would bypass the health insurance companies?
.
October 20, 2009 9:24 AM | Reply | Permalink
I heard NY Rep. Eric Massa say on Ed Schultz's radio show today that the House provisions would lead to only 5% opting for its public option provision.
True or false?
If true, would that be enough to have the desired effects of the public option? (I guess what Roger is saying in his post is: "yes!" I'd like to get at least one other, independent point of view on that)
In particular, what would be the projected composition of the public option pool under Massa's 5% assertion--would it be heavily weighted towards individuals with very high health care costs or would it be more reflective of the general population in the risk pool composition and therefore costs?
Even if the tax credits are generous, I confess to still feeling extremely uneasy about mandating people making $25,000 to spend 15% or maybe more, all up front and out-of-pocket, of their income on purchasing insurance. Are there any alternatives?
Is there a precedent for a forward-funded tax credit, contingent on providing proof of having purchased the insurance on the individual's subsequent tax return, and subject to small after-the-fact adjustments where the difference between the tax credit amount and the premium payment amount vary up or down from the projections? Would such an approach overwhelm the IRS's ability to monitor and enforce properly?
If anyone has answers to these questions or suggestions on best places to get them, I'd be most appreciative.
October 20, 2009 2:23 PM | Reply | Permalink
A government mandate that everyone must purchase private, for profit, health insurance is the same as requiring everyone to buy life insurance, or to buy a new car every year.
Come to think of it, requiring everyone to buy a new car every year would create thousands of new jobs in building the new cars and in recycling the materials in all those "old" cars.
This is a con job of massive proportions. A health insurance "reform" which does not contain a self-insurance option is a giveaway to the insurance companies.
October 21, 2009 7:36 AM | Reply | Permalink