But it's also worth offering a more general reality check here: The public option is not now, and has not ever, been the core of the argument for heath-care reform. It is the core of the fight in Washington, D.C. It is an important policy experiment. But it was not in Howard Dean or John Kerry or Dick Gephardt's plans, and reformers supported those. It was not in Bill Clinton's proposal, and most lament the death of that. It is not what politicians were using in their speeches five years ago. It is a recent addition to the debate, and a good one. But it is not the reason were are having this debate.
Rather, what has kept health-care reform at the forefront of liberal politics for decades is moral outrage that 47 million of our friends and neighbors are uninsured. That medical costs are one of the leading causes of bankruptcy in the United States. That an unemployed machinist gets screwed by fly-by-night insurance schemes while a comfortably employed banker need never worry. That the working class ends up in emergency rooms with crushing chest pains because they didn't have health insurance and didn't get prescribed cheap blood pressure medications five years before.
Klein's exactly right in saying that finding a way to insure the uninsured is the ultimate goal for health-care reform...in Congress.
So, in DC, we've got politicians figuring out how to insure the uninsured. Right now, it's essentially by subsidizing premiums for those that can't afford it. Unfortunately, most of those without insurance, and who want it, probably still wouldn't be able to buy insurance, even with subsidies. Most folks in that category have preexisting health conditions or are at or near poverty levels; no insurer would take them. So Congress is pushing a community rating - essentially prohibiting insurers to refuse to discriminate in pricing or coverage folks with preexisting medical conditions. Unfortunately instituting a community rating means that insurance premiums will go up - insurers will now have to pay claims for people who are sick. So Congress is pushing mandatory insurance, to compel those without insurance and who don't want it - the young and healthy - to buy it, thus having healthy folks essentially cover the costs of insuring the sick.
But is that what's really driving this latest push for health care? Is that what millions cheered for when Obama promised them health care reform? Health care for all? Or is there some deeper dissatisfaction - the denied claims, the high deductibles, the byzantine paperwork - behind the push, creating this dissonance between DC and the heartland over the issue? I'd argue yes. Americans hate the way they pay for their health care.
Basically I think Congress - and Ezra Klein? - has got the premise of health care reform all wrong.
Here's an idea for dealing with one of the vexing problems with the health insurance business: Recision.
Your reform proposal should stipulate that: (A) If an H.I. Company opts to rescind a policy, then that company needs to return premiums paid, with the prevailing rate of interest for as long as the consumer paid premiums, back to a maximum period of 5 years from the date of the proposed recision. (B) Claims paid over that period are not deductible from the recision penalty .
This stipulation will make the company think twice about the short term profit they can make using this process, at the expense of a consumer who's paid premium in good faith for any number of years.
It will also prevent H.I. Companies from fraudulently accepting payments from consumers they may flag for recision from day one.
It will give consumers a pot of cash to deal with the catastrophic health care needs that usually prompt an H.I. company to rescind a policy.
And finally, the policy must remain fully in effect until the recision penalty is paid in full.
It's just a good idea.
But an even better idea is a government-run public option that takes the profit incentive away from those H.I. companies standing between me and my doctor. I need health care, NOT health "Insurance". Health insurance doesn't buy a dime's worth of health care . I would hope you would structure the public option in a way that will eventually steer the country toward single-payer health care over, say, a ten-year transition period. H. I. companies are not an "industry". Building cars, trains, farming, and creative endeavours are industries. H.I. is an anchor that produces nothing.
Our illustrious Congressman is pledging not to vote for any health care reform bill he has not read. This strikes me as being a bit like a baseball player betting against his own team and then throwing a game.
Pogie asks a good question: is Congressman Rehberg comfortable voting against the bill if he hasn't read it in its entirety?
Here's what I want to see: a video of our Congressman personally reading the complete bill.
Even better would be some kind of statement from the Congressman of what he will vote for. Montanans want to see health care reformed. Unlike our Representative, who is one of the richest members of Congress, a lot of folks here can't afford more delay and denial of fixing this system.
So put up, Congressman, and either pledge to read the full bill before voting either way or just come out and be honest with us -- you're with Senator DeMint's strategy of opposing reform at all costs.
Imagine that Baucus is, at best, bemused by the lobbyists and corporate chieftains autographing checks in a futile effort to purchase his affections. Why let them? Baucus is from Montana. It's one of the smallest states in the country. It has a cheap media market. And Baucus -- who faced no serious competition in his last campaign -- isn't up for reelection until 2014.
Baucus could have shut off his fundraising operation and avoided the appearance of any and all impropriety. Instead, on June 10, he held his "annual fly-fishing and golfing weekend in Big Sky, Mont., for a minimum donation of $2,500." Sometime this month he'll preside over "Camp Baucus," a "trip for the whole family" that touts horseback riding and hiking on the list of activities. The problem with this is not that it necessarily influences Baucus's thinking on health-care reform. It's that all this industry money reduces his credibility to make necessary concessions and hard decisions. And there's no reason for it. He doesn't need the money.
I will say that Klein is asking this completely out of context, as if Baucus hadn't been in office since 1978 and survived several close challenges and a long, dark conservative shift in state politics.
After hearing about my foolishness and naivete regarding the forest bill, I was interested to see this article by Pat Williams.
I mean, I'll take it as granted that Pat Williams might be, like me, a malleable sell-out scoundrel. He might also be Montana's most progressive lawmaker of the modern era. Potato, potahto.
Since writing about the forest bill, I've gotten a couple notes and had conversations with people very familiar with the forest bill's content and the process behind it. My understanding is that the "talkers" of the critics are either deeply misleading or, in some cases, just not true.
I've been struck during this process how amazingly similar the health care, global warming, and forest debates are. With health care, the question is private/public or single-payer. With global warming, the question is cap-and-trade or carbon tax. With forest, the question is Tester bill or complete wilderness protection.
Except those really are all fake choices that really say that the choice is private/public or nothing, cap-and-trade or nothing, the Tester bill or nothing.
Perfect: enemy of the good.
Again, this isn't to say that there aren't devils in the details to focus on, but the question at this point for much of the left is whether we're ever going to take yes for an answer.
The health care bills under consideration institute important insurance regulations like community rating and guaranteed issue, subsidize coverage for low-income families, ease purchasing through exchanges, and (hopefully) bend the cost curve over the long-term.
Cap and trade actually worked better than anticipated when instituted for sulfur dioxide and, while imperfect, will reduce carbon output in this country. Action by the U.S. will help stoke other nations to take steps as well, creating a positive feedback loop.
I still know less about this forest bill, but so far the voices I trust on lands management and conservation are increasingly telling me thumbs up on the bill.
While reading up on Steve Kelly's, let's say quixotic, run against Pat Williams in '94, I came across this piece. Interestingly, the piece basically recounts how efforts to shore up Williams' left flank also resulted in Williams moving to the right to prove his independence from the Clinton White House. Some of the quotes are marvelous, though:
With progressive
congressmen like this, Kelly asked, who misses the likes of Ron Marlenee?
[...]
"The Clinton administration was retreating from its campaign pledges to protect our public lands and Pat Williams played a key role in pushing them in that direction," Kelly told me. "Williams repeatedly voted against mining reform, grazing reform and measures to end subsidies to multinational timber companies. Worst of all, from my point of view here in Bozeman, Williams sponsored anti-wilderness legislation that condemns 4 million acres in Montana to logging and mining. Cy Jaminson's record spoke for itself. He never pretended to be anything but what he was: a voice for pillage."
[...]
"If these independent political campaigns cause some conservative Republicans to get elected, well at least we don't have to guess where they are on an issue," said Larry Tuttle, director of the Portland-based Center for Environmental Equity. "Frankly, when it comes to changing the incentives that lead to environmental destruction, evironmentalists often have more in common with the National Taxpayers Union than with many incumbent Democrats."
So that's the result of left vision, as near as I can tell: the '94 Gingrich revolution, Denny Rehberg, and George W. Bush.
I'm not interested in walking down that path. So, yeah, call me malleable.
I try to avoid posting too much on what I actually think on health care reform because my opinion doesn't really matter much (1 of 300,000,000 syndrome, we'll call it). But the DeLong framework strikes me as interesting, partly because it looks like something I suggested some time ago.
If we're serious over the long-term about health, cost reduction, and financial security, some mix of
universally provided (and heavily pushed) primary care through a NHS model
HSAs funded through refundable tax credits with auto-deposits into retirement accounts if money is unused and
a single-payer high deductible insurance system that insures everyone against financial ruin in the face of accidents.
would work pretty well. Biggest dangers here are that the primary care system would either be narrowed too far or expanded too much, but the principles of it make a ton of sense to me. They did years ago and they still do.
Of course, I haven't really thought through how this system would integrate with the ideas of health homes and other innovations beyond the fee-for-service structure that we're now discussing. It is possible (and quite believable) that the bills being discussed in Congress are better than this little system that I dreamed up at the age of 22.
As noted above, my opinion doesn't mean much, so I'll keep advocating for the Baucus/Obama/Kennedy/House framework that also strikes me as pretty smart, just as I would probably be advocating for single-payer if it had the momentum right now. Mark T called me malleable in comments as though it was an insult. I'm taking it as a compliment.
I had a post written last night about the CBO's scoring of the House health care reform bill, but I lost it. No idea where.
Here's the shorter version: the CBO found there'd be no net cost savings from the legislation, but that's in part a result of not making the public option available to many, as well as some other measures, including not capping tax credits for those holding employer-based health insurance.
Of the two points, guess which one Senator Baucus seized upon?
Curiously, Ezra Klein brings up Senator Ron Wyden's "Free Choice Act" as the possible savior of health care reform, which would essentially throw open the health insurance exchange - and access to a public option - to everybody.
I've spoken out against the cap on health insurance benefits before, but I'd gladly trade it for what Wyden's offering.
According to a pair of Capitol Hill sources, preliminary estimates from the Congressional Budget Office suggest that a strong public option--the kind that the House of Representatives is putting in its reform bill--should net somewhere in the neighborhood of $150 billion in savings over ten years.
Let's see. A strong public option is wildly popular...and it would actually raise revenue? Something tells me though that Republicans and conservative Democrats will still oppose it...
There has been a lot of talk this week about the surprising move by Walmart to publically support President Obama’s health care reform plan, supposedly positioning themselves as a
leader in the fight to bring health care to all Americans. As we mentioned in a post on our blog
yesterday, this might be easier to swallow if Walmart had any history of leading by example. Instead, they usually do just the opposite.
Given
Walmart’s long record of trying to build a positive
reputation on ineffective work-arounds to health care coverage
for employee, the recent revelations about sacrificing quality for cheap perescription drugs, and their deceptive PR campaign that severely overstated their workers’ health
care coverage, it’s not hard to understand our skepticism. [get the details in the extended entry]
Reporting from Waukon, Iowa -- One is a thrifty soybean farmer from Iowa with a penchant for righteous speeches about government waste. The other is a Stanford-educated lawyer from a Montana ranching family who looks uncomfortable leading a debate.
Despite more than 60 years in Congress between them, Charles E. Grassley, the Iowa Republican, and Max Baucus, the Montana Democrat, are outsiders -- loners whose independent streaks make colleagues wary, sometimes even mistrustful.
But unlikely as it may seem, the partnership between these two slightly eccentric men may hold the key to overhauling the nation's sprawling healthcare system -- a legislative grail that has eluded the giants of the Senate for more than half a century.
In the face of strident criticism from colleagues in both parties, Baucus (chairman of the Senate Finance Committee) and Grassley (the panel's senior Republican) are laboring to fashion a series of compromises on healthcare that might win the support of a bipartisan majority on Capitol Hill.
(A) There will be no bipartisanship on health care reform, because the Republican party's goal is to sabotage any and all reform. I'm am completely flabbergasted by Baucus' continued attempts to rope Grassley into the process. It...will...not...happen.
(B) The report kept mentioning the "middle ground" in health care. Let's be frank. A fully accessible and robust public option for health insurance is the "middle ground" - among the American people. The "middle ground" batted so casually around here is the ground between right-wing Republicans and pro-corporate Democrats.
Senate Majority Leader Harry Reid (D-Nev.) on Tuesday ordered Finance Chairman Max Baucus (D-Mont.) to drop a proposal to tax health benefits and stop chasing Republican votes on a massive health care reform bill.
- you know you're really banging your head against a brick wall. I mean, it's not as if Harry Reid has been aggressively progressive on this issue...or any other issue for that matter.
A lot of folks who dislike Max Baucus' stance on health care often cite the amount of money our Senator receives from health care industries. I don't think it's the money. I think Baucus was being honest during his interview with John Adams when he said, "Money means nothing to me. I pay no attention to campaign contributions. Nothing. Makes no difference." I think it's who he talks to.
Lobbying disclosure filings for the first quarter of 2009 reveal that five of Baucus' former staffers currently work for a total of twenty-seven different organizations that are either in the health care or insurance sector or have a noted interest in the outcome. The organizations represented include some of the top lobbying organizations in the health sector: Pharmaceutical Manufacturers and Researchers of America (PhRMA), America's Health Insurance Plans (AHIP), Amgen, and GE Health Care.
The former staffers turned lobbyists include two former chiefs of staff, David Castagnetti and Jeff Forbes, and one former legislative assistant, Scott Olsen. Other former staffers working with health care portfolios include Angela Hoffman and Roger Blauwet.
The murky world of Washington is filled with enemies and lunatics, and I suspect those our lawmakers trust most are those people who have worked with them down in the trenches of political warfare, during their toughest times. The staffers. And these people are very bright, and they know a lot about issues, probably more than Baucus himself does. So when they come a-knockin', Baucus listens.
And I suspect that's why the "middle ground" is staked out on some barren turf, far, far from where everyday Americans stand on the issue.
Ironically, one of the reasons politicians like Baucus listen to these lobbyists and pursue the "middle ground" is that they're constantly running scared, looking over their shoulders at critics and always anticipating the next election. In Baucus' case - who's been in office since the 1970s and survived the long, long Republican infestation of Montana - that's doubly so. Staking out the "middle," thwarting progressives and appeasing business has been a staple in the Senator's electioneering playbook. And to be fair to his political strategists, it's been a winning formula.
But now there's health care. And Baucus is suddenly a prominent national figure for reform. He's getting a lot of attention, and he's setting himself up to be the one held responsible for whatever comes out of reform. He has a couple of options, as I see it, before him:
- He can fight for the kind of reform most Americans want. That is a public/private model of insurance with a robust public option available to all. Call this, "giving us what we want."
- He can compromise with private insurers, and create a system that accounts for the uninsured, has some minor progressive reforms that dull the edge of the current system, and implement policies to reduce, or slow, health care costs, and ensure that Americans don't feel much bite in the form of higher taxes. Call this, "fixing leaks without pain."
Based on this Ezra Klein post, and what I know about Baucus' plan, I'm guessing he's trying for the latter. No surprise: it's cautious and "moderate."
But the thing is, we're in a crisis. People are miserable. They hate the way they pay for health care. If most people are untouched by reform, reform will be seen as a bust. If you're cautious and "moderate" on this issue, you will be seen as a failure.
This is one of the rare political issues where you can't win by not losing.
Mr. Emanuel said one of several ways to meet President Barack Obama's goals is a mechanism under which a public plan is introduced only if the marketplace fails to provide sufficient competition on its own. He noted that congressional Republicans crafted a similar trigger mechanism when they created a prescription-drug benefit for Medicare in 2003. In that case, private competition has been judged sufficient and the public option has never gone into effect.
Mr. Obama has pushed hard for a vigorous public option. But he has also said he won't draw a "line in the sand" over this point.
Obviously, the trigger option is just another way of denying a public option. No one here believes the legislation for the trigger won't include the usual language and loopholes that will allow the insurance industry to essentially continue to operate as usual and indefinitely. Worse still, if legislation containing a trigger were combined with mandatory coverage, it'll be a boondoggle for private insurers.
Senator Schumer, on the other hand, said, "Make no mistake about it, the president is for this strongly. There will be a public option in the final bill." Of course, as to what form a public option will take is of paramount importance...
In response to the outrage over the threat to the public opion, Ezra Klein opines that the public option may be a distraction:
But [the public option] has captured the process. Its existence, or lack thereof, is how the left and right are both benchmarking their success. The only problem is that it's not necessarily a very good benchmark. The left may win a political victory by including it in the policy but find that it hasn't won a particularly large substantive victory at all. The right could give up a lot to block the public plan only to find their concessions worth more than their triumph.
In the post (which you should read), Klein identifies five elements of reform that "deserve a lot more specific attention than they're receiving." Among them is the "health insurance exchange." Klein explained it in an earlier post:
The central problem facing health reformers is a simple one: America's health-care system is a mess. But a lot of people rely on it very heavily. But how do you merge the need for root-and-branch reform with the public's fear of rapid change?
The answer, put simply, is that you don't institute rapid change. You don't take what people have. But you give them the option to trade up to something better. As the theory goes, if the current system really is so inefficient, and your alternative really is so much better, then the lure of lower costs and better quality will persuade Americans to switch to the new system of their own accord.
This was a little-noticed wrinkle in President Obama's speech to the American Medical Association yesterday. Traditionally, reformers promise that if you like what you have, you'll be able to keep it. Obama echoed that vow. But he also said that "if you don't like your health coverage or don't have any insurance, you will have a chance to take part in what we're calling a Health Insurance Exchange." That is, in effect, the opposite promise: If you don't like what you have, you'll be able to change it.
The vehicle for that promise is the Health Insurance Exchange.
Basically, it's in the exchange where we'd be able to purchase public insurance. Then it follows that the qualification for participating in the exchange is important. Allowing everybody to participate seems logical, and would no doubt be politically popular. After all, you'd be simply giving everyone more options for health insurance: a no-brainer, right?
But the numbers I've heard so far - and sorry, I can't find a link - imply that not so many folks will qualify for the exchange. You have to unemployed or have your employer-based coverage cost a certain percentage of your pay. (Twelve percent?) Which means that most of us would be stuck with the "coverage" we already have.
So not only do we need a robust public option, we need it to be available to all...
Al Franken was declared the winner of the 2008 Minnesota Senate race. Democrats now have 60 seats in the Senate. A "supermajority": enough votes to effectively avoid a filibuster. Right?
The persistent absences of two veteran Democratic senators because of serious illness, the varied ideological makeup of the Democratic caucus and the willingness of individual senators to break with the party if they do not get their legislative way make the new mathematical might of the Democrats a bit illusory.
"We have 60 votes on paper," Senator Harry Reid, the majority leader, said Wednesday in an interview. "But we cannot bulldoze anybody; it doesn't work that way. My caucus doesn't allow it. And we have a very diverse group of senators philosophically. I am not this morning suddenly flexing my muscles."
But for a party and a majority leader that has been whining that it can't get anything done because it doesn't have 60 votes -- well, now it does. In other words, that excuse is now laid bare. I mean, remember how we had to be nice to Joe Lieberman because he got us closer to 60? We laughed at that logic because he didn't get us closer to shit. He would still vote with Republicans half the time, whether inside our caucus or outside it.
So yeah, I know that the "60" mark is arbitrary, and like I said in that MSNBC appearance, a new invention since it didn't exist in the Bush years. In fact, no one has promoted that notion more than Harry Reid himself, afraid to be held accountable for the actions of his caucus. Well, he's no longer got cover. Any failures from here on out will be at his feet, and his feet alone.
Right now, of course, Democrats own health-care reform. If it fails, they lose. If it passes, but it's watered down, and it doesn't fix at least some of the problems everyday Americans are experiencing with their health care insurance, they lose.
The key to healthcare reform is that it be popular with the public. The Medicare prescription bill, for example, was generally popular because it provided a clear and concrete benefit. Broader healthcare reform, however, is going to have a harder time. If there's no public option, for example, and most people simply keep the employer-based healthcare they already have, then what's the selling point? Most people will just see higher taxes funding better coverage for the poor, and you don't have to be the world's biggest cynic to understand that this isn't going to be overwhelmingly popular. Helping the poor is all well and good, but like it or not, most of us want to know what's in it for ourselves if our taxes are going up. That's just life.
Right now, we're running the risk that the answer is "not much." Healthcare reform needs a little more obvious sizzle if it's going to survive the coming tsunami of conservative agitprop, and the bills wending their way through Congress don't have much of that left...
Just a reminder to Democrats everywhere. Yes, it's sporting to find a "bipartisan" solution - but then the Republican party's strategy to make you fail. Yes, it's quite popular with newspapers to appear as a "moderate" by working with major institutions, like the health-insurance and health-care industries. Yes, I know you're always running scared, thinking about the next election, thinking about what your Republican opponent is going to say about you. But the bottom line is, you must pass health-care reform that's effective and meaningful for everybody.
Or else you'll lose.
You've now got the means. Use it, even if you have to bloody your knuckles to do so.
I've tried to articulate this before, but most of the focus of Congressional health care reform has been on covering the uninsured and keeping health care costs down. But the New York Times has a report today that reminds us why we so desperately need a robust public option:
Health insurance is supposed to offer protection - both medically and financially. But as it turns out, an estimated three-quarters of people who are pushed into personal bankruptcy by medical problems actually had insurance when they got sick or were injured.
And so, even as Washington tries to cover the tens of millions of Americans without medical insurance, many health policy experts say simply giving everyone an insurance card will not be enough to fix what is wrong with the system.
As anyone who's ever held an insurance policy knows, having insurance isn't the same thing as having coverage.
There are those that don't realize this, like our state's only representative, Dennis Rehberg, who believes the problem with health care is limited to about 8 million Americans who don't have insurance. But then, if you're a multi-millionaire real estate developer with a nifty government-provided health insurance plan, your ignorance isn't all that surprising.
In essence, those that repeat the mantra, "single-payer, single-payer," are aware there's a difference between universal health care insurance and universal health care coverage, that a solution that gives the private insurance and pharmaceutical industries a leading role may not solve the problems we experience with health care. Will we still be bombarded with denial-of-claim slips every time we see a doctor? Will "pre-existing conditions" follow us to our graves? Will general practitioners still be driven out of business by the byzantine administrative requirements of insurers? Will we still have to work that crap desk job for that multinational corporation to keep our insurance? Will the insurers continue to abandon their promises in our times of greatest need?
Yes, it's fine that Congress is seeking to extend health care coverage to the uninsured. Yes, it's fine we're talking about health care exchanges that would allow consumers to buy the best coverage available at the best price. Yes, it's swell that Congress is looking at ways to reduce the cost of health care. But a health-care reform bill that doesn't directly address the pitfalls of private insurance and guarantees that insurance translates into coverage is a bill that doesn't address our nation's health-care crisis.
US Congressional candidate Dennis McDonald is today announcing his support for a single-payer health care plan. Over 100 million Americans are uninsured or underinsured, and when coupled with the high costs of health care it is clear that we can delay no longer in enacting comprehensive health care reform.
There is overwhelming public support for a single payer plan here in America. And as families continue to struggle financially across Montana, providing relief from high health care costs is a priority for McDonald.
One of the complaints (and rightfully so) of single-payer advocates is that single-payer health care is popular among Americans. Well, here's their chance to put that idea to the test: a single-payer candidate.
That position, of course, is in stark contrast to the incumbent, Dennis Rehberg's, who not only opposes any meaningful health care reform, but thinks the health care crisis is limited to about 1 in 50 Americans. (Maybe it is limited to 1 in 50 multi-millionaire real estate developers.)
I'm curious to see Tyler Gernant's reaction to this news. If Germant plays it cool, and doesn't endorse single-payer health care, this could be the big issue in the primary...
One of the most frustrating things to watch in the entire healthcare debate is the discussion of "bipartisanship" raging in Washington, D.C. As I've written here before, the beltway media has an unhealthy fixation on whether or not proposals are drawing support from Republican members of Congress as a test of bipartisanship, as opposed to whether Republicans have access to the table (they do) and whether grassroots Republicans and conservatives support the proposals being written (they do).
Fortunately, there are indications that at least here in Montana, some of that beltway partisanship can be put aside. Look no further than Bob Brown's op-ed this morning for proof. I've tried excerpting it, but it just doesn't work that way. Go read the whole piece.
The statewide town hall that is being co-sponsored by a bunch of groups tonight, including Forward Montana, American Cancer Society Cancer Action Network, SEIU, and others, has Republican Sen. John Brueggeman as Master of Ceremonies.
And here's the thing -- I am nearly positive John and Bob and I don't see eye-to-eye on all of the elements of what should happen. But there's a fundamental reasonableness still present that makes quite a bit of difference.
The other bit of difference is life experience. Bob Brown relates a story of his perspective as a teacher watching hard-working independent contractors who lacked his employer and his union. John Brueggeman is someone who has worked union and also squeezed out a living self-employed. They're also not stupid. And, at some point, if you've seen how radically different the system treats two similarly hard-working people in different lines of work, you start to wonder just who created such absurdities.
I'm rambling now, but I want to applaud Bob Brown for standing up on this issue. Bucking your own party involves inviting some criticism (something Max Baucus knows well himself). But there is a time and place for political courage. And if ever there was a fight where we needed some courageous Republicans to buck their party in high-profile ways, it is in this fight for health care reform.
So a big thanks, Bob -- this kid from Billings thinks you done good.
Walmart, in one of their worst ways of prioritizing prices above qualities to date, turns to a foreign drug supplier, Ranbaxy Laboratories, LTD, who has repeatedly been investigated by the FDA and the DoJ for "inadequate" safeguards against contamination, falsification of records and submitting false information to the FDA.
On top of that, just eight months before the FDA inspected Ranbaxy's Paonta Sahib plant and found significant violations, Walmart awarded the company a "Supplier Award" for improving shipping times and performance.
In a new report on our website, we detail their multi-year spanning violations, DoJ investigation, Congressional Investigation, and list out all of the drugs made at the facility in questions. Additionally, we detail their recent violations below.
Competition from the public option must be unfair because government does not need to make a profit and has enormous pricing and negotiating powers. Besides, unless the point of a government plan is to be cheaper, it is pointless: If the public option conforms to the imperatives that regulations and competition impose on private insurers, there is no reason for it.
Believe it or not, Will is actually using this point to attack a public option. Yet he never explains why cheaper health insurance is a bad thing.
(Will also explains away the nation's 45 million uninsured as a "'snapshot' of a nation" where workers often change jobs. That is, to Will, these folks are only temporarily uninsured. Of course, temporarily uninsured or no, it's still a financial kiss of death for these folks to be ill...not to mention that insurance companies use this "temporary" period to ensure they don't pay claims when they are insured, thanks to the ol' pre-existing condition clause...)
IMHO, that's the essential difference between a contemporary conservative and a progressive: a George Will conservative will always oppose something based on theoretical grounds, even if the proposal in question will actually improve things. A modern progressive is pragmatic. If having a government-run health insurance option means cheaper health insurance...let's have it!
As Nate Silver points out, there aren't many goods or services that government provides better than the private sector. But the insurance racket is unique:
he profits the insurance industry is making, of course -- profits artificially boosted by an enormous backdoor tax subsidy -- don't seem to be buying the customer much of anything in terms of improved service or cost savings. On the contrary, health care costs are rising by as much as 9-10 percent per year, without any concomitant increase in the level of service. If JetBlue were raising the cost of its fares by 10 percent per year, they'd be out of business.
The reason the insurers are staying in business, though, is because barriers to entry in the health insurance industry are in practice quite high. Insurers benefit from pooling risk. The larger the pool, the better in terms of the insurer's ability to hedge its risk and build negotiating leverage with its providers. That makes it very difficult for a Five Guys or a JetBlue type of start-up to compete: they'll have trouble getting together enough customers to pool their risk adequately, and even if they do, they won't have as much negotiating leverage as the big guys. Health care providers may demand a better deal or refuse to accept them. As such, they'll never get off the ground.
Insurance, in other words, is a volume business, the main requirements for which are that (1) you have a lot of money pooled together and that (2) you've been around for awhile.
I'd also add that insurers increase profits, not by streamlining the production of insurance or making it with cheaper materials, but by decreasing the amount of claims they pay out. That is, private insurance is only bound to get worse...for consumers, that is. So you have an industry whose nature prohibits new competition, and the existing players one up each other by providing an increasingly worse product to their customers.
Whatever. A public option, if robust enough, would probably provide better coverage at a cheaper rate than current private plans. Plus it'd be portable, allow small businesses to compete for workers with larger companies, and encourage entrepreneurship.
To blithely label this as an argument of "capitalism" versus "socialism" ignores the myriad flavors of capitalism. If your flavor of capitalism must needs be an economic system dominated by monolithic multinational corporations, you're probably against the public option. If, on the other hand, you prefer a system where small, local businesses and the self-employed thrive alongside (or, better yet, dominate) big corporations, you probably support the public option.
So it's good to see that Obama today say that a public option is "non-negotiable." Ezra:
There were two ways he could have responded to the press corps' queries. The first would be a procedural reply: "All ideas are on the table," or something of that nature. But that wasn't his approach. Instead, he defended the plan's substantive merits. His answer was, in other words, an effort at persuasion rather than diversion. The implication was that he, at the least, is genuinely convinced by the case for a public insurer.
It's also smart politically, as well as policy-wise. And now - finally - there's signs in Congress that a public option will be a part of reform. The question now is, what will it look like?
Kent Conrad, for example, has moved away from his idea of small co-ops towards a coalition of co-ops that could negotiate health care prices as a single, national body, which is becoming ever closer to a public option. And even Conrad had his "wake-up moment" about GOP Senators: when the Republicans feared a public option because it would be competing unfairly as a subsidized body, they still didn't like it when the idea of a co-op without a subsidies was suggested. "They really don't want a competitive model," admitted the North Dakota Democrat, "at least some of them."
As dday pointed out, Democrats are now realizing that, "...like in 1993, (the Republicans') mission is to kill health care reform, period. Why Why anyone would think that any alternative would be true is beyond me, but Senate Democrats obviously needed to play Tic-Tac-Toe with the computer endlessly until they realized what a strange game it all is, and that 'the only winning move is not to play.'" Apparently some Democrats had considered "nixing" the public option in hopes that they would find Republican support for reform.
But now I think Democrats are realizing they own health care reform. They no longer have any incentive, or reason, to find common ground with Republicans. There can be none. And if the push for reform fails, it will be seen as a Democratic failure. The sooner Congessional Democrats realize this, the better. And if they do band together and implement a Democratic health care reform bill, they might actually realize they are the majority power and are calling the shots. This health care reform could be the issue Democrats...well...start acting like Democrats And it's long past time for them to start acting in concert in DC. Who knows? This could be the start of a beautiful friendship...
You've probably already seen this, but the New York Times published a poll this weekend that showed overwhelming public support for a public health insurance option, and are willing to pay higher taxes for it:
Americans overwhelmingly support substantial changes to the health care system and are strongly behind one of the most contentious proposals Congress is considering, a government-run insurance plan to compete with private insurers, according to the latest New York Times/CBS News poll.
The poll found that most Americans would be willing to pay higher taxes so everyone could have health insurance and that they said the government could do a better job of holding down health-care costs than the private sector.
Yet the survey also revealed considerable unease about the impact of heightened government involvement, on both the economy and the quality of the respondents' own medical care. While 85 percent of respondents said the health care system needed to be fundamentally changed or completely rebuilt, 77 percent said they were very or somewhat satisfied with the quality of their own care.
Yup. Sounds about right. People want better insurance coverage, but are happy with their care. I know I've paraphrased Uwe Reinholdt on this topic a half-dozen times, but it's worth repeating here: the health-care crisis essentially is about how we pay for our health care, not with the care we receive.
Then, like me, you're probably frustrated by where health reform policy seems to be heading. Nate Silver:
The bottom line is that the health care debate is not really being played out in the court of public opinion. If it were, Congress would pass a robust plan with a public option that was funded by raising taxes on cigarettes, booze, and people making over $250,000, and we'd live happily ever after (or not). Rather, this is a behind-the-scenes fight at the committee level, where certain senators who have ample financial incentives to please the insurance industry have a disproportionate amount of control over the process.
I'm generally not one to carp about special interest money -- seeing politics through that lens is often an overly reductive formulation that serves as a catch-all excuse any time Congress does something you don't like. But on something like the public option, which has broad public support and which would probably reduce -- not increase -- the long-run bill to the taxpayers, it is just about the only way to explain what's going on in Washington.
Not that I believe that special interest money is solely at fault here. For example, Paul Krugman is right on when he writes:
The real risk is that health care reform will be undermined by "centrist" Democratic senators who either prevent the passage of a bill or insist on watering down key elements of reform. I use scare quotes around "centrist," by the way, because if the center means the position held by most Americans, the self-proclaimed centrists are in fact way out in right field.
And while he does categorize Republicans as "spoilers" betting all-in on the failure of health care reform, I think he underestimates the power that they wield in the Senate. Yes, we're all quick to blame Democrats for the imperiled reform, but isn't that the result of lowered expectations? If we had real, responsive representation from the minority party, we'd have a workable plan. It's the Republican intransigence that's putting the Ben Nelsons ad Kent Conrads in the driver's seat.
And digby noticed that Blanche Lincoln decried a public option because it would "ursurp" competition in the market - only Blue Cross Blue Shield owns 75 percent of the market in Arkansas. To which Krugman responds:
The truth is that the notion of beneficial competition in the insurance industry is all wrong in the first place: insurers mainly compete by engaging in "risk selection" - that is, the most successful companies are those that do the best job of denying coverage to those who need it most. But in any case, Arkansas is in effect a one-insurer monopoly state, with no competition at all - unless a public plan is created.
In fact, I may have a new hypothesis about the political economy of the health care fight. One thing that's obvious, if you look at the balking Democrats I chided in today's column, is that almost all of them come from states with small population. These are also, by and large (pdf), states in which one or at most two private insurers dominate the market.
So here's a suggestion: while the opponents of a private plan say that they're trying to defend market competition, what they're actually doing is defending lucrative local monopolies.
Didn't Matt already point out that Blue Cross Blue Shield controls 75 percent of the market in Montana?
Well, it's happening, apparently. I woke up at 3:30 this morning with health care reform on the brain and haven't been able to fall back asleep. Hopefully, this doesn't become a recurring pattern between now and passage of a bill because it may be a while.
If you've been reading the national health reform blogs lately, you already know: health care reform is in danger right now. This is for two big reasons:
Congressional Budget Office estimates are not coming in where we'd like them to. See Ezra Klein and Jon Cohn for more.
Republicans in the Senate are being giant jerks in this process. See Jon Cohn and E.J. Dionne for more.
My impression from talking to people closer to the fight and with more experience than me is that my feeling that we're seeing some of the worst elements of the '93 fight reemerge is correct.
In other words, we're starting to experience some of the things that derailed healthcare reform last time. This isn't surprising. Even moderate reform is extremely threatening to a number of interests, not the least of which is the Republican Party. Despite claims to the contrary, the Massachusetts plan has been fairly popular locally, as has Medicare Part D nationally.
That's not to say, of course, that the Massachusetts plan or Medicare Part D are great models. They're not. If healthcare reform is modeled on them and not fixed, not only will we have a ton of unnecessary confusion and difficulty in our healthcare system, we'll also have failed to take some of the stronger steps we need to ratchet down healthcare inflation.
But it is worth being honest that even a Massachusetts style system would be a significant improvement over the status quo -- and it would probably be a popular one. And popular policies are precisely what the GOP needs to derail.
Matthew Yglesias, one of the straight-up sharpest minds I think I've ever encountered, notes often that one of the features of American government is sheer number of veto points. It is way easier for policies to die in our country than to be passed. On health reform alone, at least five committee chairs have claim to jurisdiction, reconciliation may prove inadequate, multiple rounds of floor votes, filibusters, etc. A bill, to pass, must survive all of these points. A bill, to die, need only fail in one of them.
Where do we go from here? That's a good question -- and it means being honest about where "here" is. The Finance Committee is reportedly reworking its legislation. The HELP Committee is doing the same through mark-up. Those reworks will eventually emerge and be merged. Meanwhile, a separate process is moving through the House, a process that should give us a far more progressive bill.
Assuming legislation gets through each chamber, those bills will head for conference committee and the final package will reemerge. What will it look like? My crystal ball ain't telling me. What I do know is that if we can keep the process on track, we're going to be seeing the Finance Committee bill merged with not one, but two different more progressive pieces of legislation -- a fact that should give us progressives hope. And I also know that if we try to shut down the process now, we definitely all lose.
So, today, I think, we bite the bullet, put our head down, get our shoulders into it, and keep working.
Ezra Klein interviewed Sen. Kent Conrad (D ND) about his compromise to a public option. Essentially he's proposing a that a series of "federally-chartered co-ops" play the role as public health insurance in opposition to for-profit insurance. That is, they're not-for-profit health insurance alternatives that aren't controlled by the government.
Klein and Robert Reich both express concern that the co-ops "won't have any real bargaining leverage to get lower prices because they'll be too small and too numerous." Klein also thinks this compromise won't appease those seeking a full public option, "because, quite frankly, co-ops don't represent what they're looking for: A chance to test the thesis that government is a superior provider of medical coverage."
To put it most crudely, the available evidence appears to overwhelmingly indicate that governments can provide health insurance of equal quality at lower cost to the private sector. It's also true that a certain kind of ideological dogma says this can't possibly be true. The view behind the public insurance option is that the dogma ought to be put to the test through competition. Proposals that aim to do something, not that don't aim to put the dogma to the test, are not a compromise. Indeed, the idea of a "public option" is itself a compromise between ideological dogma and the evidence in favor of single payer. The health co-ops seem like an interesting idea to me, but anything that drops the public plan is a proposal to drop the public plan not really a public plan "compromise." That said, insofar as Congress is inclined to do this it ought to be done well.
Personally, as an avid supporter of a robust public option, I don't give a rat's *ss what proves whose theory. I just want access to portable, affordable, and reliable health insurance, which I ain't getting on the market. That is, if the public option is public, fine. If it's a federally-chartered co-op, fine.
In Yglesias' post, he quotes Ivor Volsky's requirements for such a co-op to ensure it's not set up for failure from the beginning - which includes making it a national co-op large enough to negotiate low prices.
Of course all this talk about co-ops could very well be moot:
House Speaker Nancy Pelosi told the Huffington Post Thursday that a health care overhaul that did not include a public option wouldn't make it through the House because it 'wouldn't have the votes.'
...Asked by HuffPost if she would allow a reform package without a public option out of the House, she responded: 'It's not a question of allow. It wouldn't have the votes.'
The bill would lack the votes because the GOP generally opposes Democratic reform proposals, and the 77 member Congressional Progressive Caucus -- rarely heard from on the Hill -- has been particularly vocal in its commitment to oppose any reform that doesn't include a public option. The public plan's popularity extends beyond progressives and is broadly popular with the Congressional Black Caucus, Congressional Hispanic Caucus and even two-fifths of Blue Dogs, the conservative Democratic coalition.
Pelosi, during the press conference, also rejected a compromise proposal by Sen. Kent Conrad (D-N.D.) to create private, nonprofit, regional health care cooperatives instead of a national public option.
Pelosi wasn't having it: "Not instead of a public option, no," she said.
Sometimes those of us that write about bills or reforms working through Congress forget there's another body other than the Senate, a forgivable error given the difficulty of finding 60 votes in the more conservative body to avoid filibuster. But it looks as if House Democrats are going to insist on real health care reform. Looks like we'll have an intra-Congressional tussle to watch...
Update: Naturally Ezra's already posted an interview with Rep. Lynn Woolsey, leader of the 80-member House Progressive Caucus on the group's insistence a public option be included in any health reform bill. Woolsey: "There are 80 members. And we have drawn a line in the sand. And we're serious about it."
Walmart, in one of their worst ways of prioritizing prices above qualities to date, turns to a foreign drug supplier, Ranbaxy Laboratories, LTD, who has repeatedly been investigated by the FDA and the DoJ for "inadequate" safeguards against contamination, falsification of records and submitting false information to the FDA.