Last Chance to Influence Health Care Bill
Now it begins.
The Senate Finance Committee, the last of the five congressional committees with jurisdiction over health care reform, supposedly will finish its bill this month. The plan being engineered by Finance Committee Chairman Max Baucus through his bipartisan Gang of Six is so different in character from the bills already submitted by the other four committees that it is likely to reopen debate on the fundamental nature of health care reform.
The prospects are exceedingly dim that negotiations to hammer out final legislation for consideration in each chamber will produce a well-crafted plan that actually improves health care and controls rising costs for consumers and taxpayers. Yet it is a virtual certainty that some legislation will be sent to the floors of the House and Senate.
The ensuing free-for-alls there could result in total gridlock as Progressives try to rectify a watered-down plan that would generate hundreds of billions of dollars in new revenue for insurance companies, drug makers and hospitals while mandating that citizens carry expensive insurance coverage or face stiff fines.
As the AP reported today:
Senate Finance Committee Chairman Max Baucus, D-Mont., has promised a formal proposal within days and plans to convene a bill-drafting session the week of Sept. 21. The Baucus plan is important for two reasons: It's the only proposal that's been worked out in close consultation with Republicans, and it also seems to be headed in the general direction Obama wants to take."It's the logical starting point for negotiations," said Dan Mendelson, president of Avalere Health, an information company serving industry and government clients. An 18-page summary of an early version of the Baucus plan circulated last week.
His proposal is widely seen as making major concessions to industry. There's no government insurance plan to compete with private carriers, and no requirement on employers to provide coverage -- as legislation drafted by House Democrats would provide.
In another significant break with House Democrats, Baucus wouldn't raise taxes on upper-income earners to pay for health care. That should please tax-averse Republicans. Instead, he uses a series of "fees" on medical industries to help pay for his plan.
Needless to say, those fees the AP story mentions--as high as 35 percent--will eventually be passed on to consumers, exacerbating the inflationary spiral of health care costs. So much is wrong with the Baucus plan that I urge you to read the AP story in full.
So as I am prone to suggest: Phone, FAX and email your congressional delegation and flood the Washington office of Sen. Max Baucus before he creates a monster. One last thing, and this is important: If you are a member of another blog, repost this piece there.
The last battle for health care reform is upon us.
I don't have time to read this thoroughly right now, Rip, but you got ripped off this morning, so I'm giving you the rec and hopefully a shot at getting some traction on it. I know you've put a lot of effort into this...I'll get back to it later...
September 14, 2009 5:18 PM | Reply | Permalink
Thank you, Ripper, for reposting this. Sorry about the BS between us earlier on your other, important post. As you know, I'm not quite myself this week, LOL.
I'd like to add one thought here, about something I've been guilty of and perhaps others have as well, and that is: I live in a state where my Rep and my two Senators are already well aware of the need for good health care reform. And so, after a while, it seemed redundant to continue emailing and faxing them.
NOT SO. The more they know we support them, the more they will continue to fight the good fight. So if you live in a state/district with a Rep or Senator who's already on board the health care reform train, don't stop communicating your support and feelings and wishes to them.
Same goes for the White House.
September 14, 2009 6:30 PM | Reply | Permalink
Not yourself? What did I miss while I was gone?
September 14, 2009 7:19 PM | Reply | Permalink
Exactly, Lis. Lines are reforming and positions shifting rapidly as we speak. This is the wire coming up.
September 14, 2009 7:20 PM | Reply | Permalink
If the rumors are accurate, a proposal to relieve small employers of an obligation to cover employees would probably be a step backwards, although they don't have much more leverage even today to negotiate premiums than do individuals.
On the other hand, the plan to tax insurance plans rather than income is almost certainly a good idea, although whether it is best done by taxing high end plans at 35% or in a different manner can be debated. My own preference would simply be to make employer-provided health insurance taxable as income - it's now tax free.
Merely taxing the incomes of wealthy individuals, as in the House bills, is a very short-sighted solution. The reason is simply that health care costs are rising faster than income, and so income taxes would not keep pace. Ultimately, of course, we must reduce the growth of health care costs through restructuring of the health care system, but that will take a decade or more for even partial progress to become significant.
September 14, 2009 7:09 PM | Reply | Permalink
Good points, Fred, although taxing insurance plans directly doesn't seem particularly brilliant to me. My main point is, the board is being set and the next two weeks will largely determine the shape of final legislation in Congress. Scream now or forever hold your peace. Or piece.
September 14, 2009 7:24 PM | Reply | Permalink
I agree with the "scream now" part, but I also suspect that another time to scream will be after the House and Senate produce different bills that must be reconciled (a different meaning of "reconciled" from the one related to Senate rules). At that point, I suspect the House bill is very likely to include either a public option or some facsimile, while the Senate bill almost certainly will not, but may include some other emanation out of Senate Finance, such as non-profit cooperatives (Conrad), or a triggered public option (Snowe), with Baucus supporting one or another of those.
I believe Senate/House conferences can at times be fairly creative. They wouldn't literally be able to "split the difference" here, but could posssibly (one hopes) decide on something with enough government oversight to accomplish some public option aims, but without a formal federal management structure. I say this after being convinced by the various reports that a pure public option is unlikely to be in the final product. Conversely, something that allows all sides to claim victory might survive.
Any "screaming" at that point might reach the ears of the Senate/House conferees and help shape the final package.
September 14, 2009 7:47 PM | Reply | Permalink
I think House-Senate reconciliation might might get very complicated if the Senate bill has to go through the budget reconciliation process or otherwise get split up for first passage. So it seems to me, now is the better time to scream, while there are still some parts in play that can be changed.
September 14, 2009 8:06 PM | Reply | Permalink
How could government-run insurance bring down the price of drugs? Obama has guaranteed that negotiations will not surpass $80 billion, and yet, drug costs are nearly $200 billion in one year.
If Mr. Baucus' idea is so establishment-friendly, why are all or most Republicans opposed to it?
I would suggest that as Democrats, we ought to freshen up on the spontaneous order that markets can create. The non-profit co-operative -- networked broadly -- would generate a business model on a massive scale. That would give the non-profits the bargaining power we need. That's all we need. The non-profits can make that happen. Why not support it fervently?
Thinking long-term: a government-run solution could always be hijacked. But a patient-run solution could not. Let's all throw our weight behind the patient-run solution. What matters more: who has control over the industry or whether the service is universally affordable? If the Baucus plan can generate universality, why should it matter whether the cause is the government or non-profits?
September 14, 2009 8:44 PM | Reply | Permalink
A non-profit is just another a corporate vehicle over which the insured have no control. Blue Shield's problem isn't bargaining power, their problem is that the people running it like money just as much as the people running United Health. I'm not sure where you got the illusion that nonprofit means patient-run, but I haven't seen anything of that nature proposed. Maybe a link to what you are talking about?
But the reason why republicans are opposed to the Baucus plan is the same as why the oppose the House Bill which is also amazingly industry friendly - they came to the (rather public) strategic conclusion that if they can kill health care reform than they can again rule the universe. They will never vote for any health bill - even if it's made up of 100% tax cuts.
September 14, 2009 9:24 PM | Reply | Permalink
Your last point is a fair one. But it doesn't address the main concept.
No links; just logic. Non-profit health organizations are motivated by people's health, first and foremost -- otherwise they would be for-profit health organizations. That means that treatment and prevention are ends in themselves. Non-profit health practice is the only business model which does not view health as a means to another end.
Once these organizations co-operate/network, then the economy of scale would be tremendous! I'm not just speaking of bargaining power. I'm suggesting that the non-profit business model would be ample evidence for shift of paradigm. And that is the true meaning of re-form.
September 14, 2009 10:09 PM | Reply | Permalink
You make a common mistake regarding nonprofits. "Non profit" is a tax designation, it does not mean that the entity does not operate with the intent to turn a profit. There are some different organizational and reporting requirements compared to an S-corp, but when it comes down to it they are most often a vehicle the rich use to hide/move/generate wealth.
There is nothing "patient run" being proposed at the moment that I am aware of. If something specific comes up and you can give a link, I'm more than happy to consider the specific solution. Seriously, look at BlueShield. That seems to be a model of what they are talking about. As best I can tell, the problem there is corporate rot just like the rest of the industry. I don't see exactly what would change the paradigm here.
And while the government can be "hijacked", there is recourse in the form of voting to reclaim control over a public plan. What is the mechanism you propose that would give patients the ability to change the behavior of a non-proft that answers to a board of directors (which likely would be loaded down with people who love money)?
September 15, 2009 1:36 PM | Reply | Permalink
The definition of a cooperative (by the International Co-operative Alliance) is this:
An autonomous association of persons united voluntarily to meet their common economic, social, and cultural needs and aspirations through a jointly-owned and democratically-controlled enterprise.
September 15, 2009 6:04 PM | Reply | Permalink
As an interesting addition to the discussion, the media are reporting a poll of physicians on the relevant issues. 63% favor a public option, and an additional 10% favor single-payer, so that some sort of public insurance is supported by 73%.
I doubt this will have much effect on Senate Republicans in general, but if physicians in Maine can become vocal enough to exert pressure on Olympia Snowe and Susan Collins, it could sway one of them to make a public option filibuster-proof. I still see that as a long shot, but worth pursuing, and in any case, the pressure would push Snowe to compromise more in the direction of a pure public option than toward something less effective.
September 14, 2009 9:50 PM | Reply | Permalink
Video of the very brave Edward Kimmel at the Mall Tea Party. It took five policemen to get him through the crowd safely. Wow.
http://www.youtube.com/watch?v=0Q7XH8lfGMc
(hat tip, crooks and liars)
September 15, 2009 8:50 AM | Reply | Permalink
This maybe off topic but one problem I see is that Obama came into office too soon.
Let me expand on this. FDR did not come into office until way after the depression was well under way. Hoover did nothing...absolutely nothing after the collapse of Wall Street. Totally hands off. By the the time FDR got in the country was completely in the economic toilet. Hundreds of bans had failed or were on the verge of failing, unemployment was in the double digits and you could not even give stock in GM or RCA away.
FDR could have proposed legislation for the government to stop the sky from falling and it would have passed.
Obama's economic and social policies have only prolonged the current crisis and made it more difficult to him or any other liberal to pass any progressive legislation.
The system does not need to be propped up. Rather it needed to be left to collapse into dust and then rebuilt correctly.
C
September 15, 2009 2:47 PM | Reply | Permalink
Failing to prevent a second Great Depression from reaping lives and livelihood on a massive scale is not the most effective way to govern.
September 15, 2009 3:54 PM | Reply | Permalink