Beth's Health Care Reform Blog

[roxybeast]

Dems May Have 60 Votes to Stop Filibuster & Force Majority Vote

The Democrats don't need 60 votes to pass a health care reform bill. They only need 51. Which they have. They only need 60 votes to oppose a filibuster and force a vote on the floor. Which they may also have.

Dems Ramp Up Push For Colleagues To Block Filibuster On Health Care
by Sam Stein
Huffington Post, Sept. 23, 2009

Buoyed by news of a temporary replacement for the late Senator Ted Kennedy, Senate Democratic leaders are launching a renewed effort to get all 60 members of their caucus -- even those who might eventually vote against health care legislation -- to at least commit to blocking a Republican filibuster.

After that, the bill itself could win passage with only a simple majority.
Proponents of the strategy say it is being actively discussed both on Capitol Hill and within the White House -- "every day," said one Democrat who is actively involved with both branches when it comes to passing health care legislation. "That's the whole conversation. At the end of the day we don't need them to vote for the bill. We need to get them to get to cloture to end the debate."

As former DNC Chair Howard Dean summarized: "If you are a member of the Democratic Party you have an obligation... to vote with the party on procedural issue. I would expect that regardless of what Senators think they about the public option, they should be there for cloture."
On the Hill, Sen. Bernie Sanders, (I-VT) has been one of the chief proponents of the commit-to-cloture strategy. And increasingly, senior aides say, he is getting the backing of the party's leadership.

"I think there is growing support for the understanding that if, for whatever reason, some of the conservative members of the caucus choose not to support a public option or vote for final passage that is fine," said Sanders. "We can live with that. What we do need is a united caucus to say to the republicans and say, 'sorry you are not going to sidetrack health care reform and we are going to go forward.'"
"You will have 50 votes for a strong public option" if we get there, Sanders added. "I do believe that."

Meanwhile, there are new moves to get potential fence-straddlers on the public record about cloture. One major union is pushing the idea to reporters. Democracy for America, meanwhile, has launched an "America Can't Wait" campaign with similar objectives. "It is based on the concept that it is possible right now to pass a bill through both houses of Congress with majority vote," said Charles Chamberlain, political director for the group that was launched by former DNC Chairman Howard Dean. "Public comments from a lot of different senators indicate that the votes are there on cloture."

Right now, there is no exact count as to how many of the senators in the Democratic caucus who would oppose health care reform -- if, say, it included a public option for insurance coverage - would nevertheless be willing to allow it to come to an up-or-down vote. Sen. Ben Nelson (D-Neb.), one of the most vocal skeptics of his party's health care legislation, has nevertheless indicated that he would support cloture even if he ultimately votes against the bill.

And Sen. Arlen Specter (D-Penn) told a crowd of progressives in mid-August that he thought there were enough votes to stave off a filibuster. "We can get cloture on health care," the Republican-turned-Democrat said. "There will be, I predict, and I predict confidently, which I don't ordinarily do, that there are 60 votes for cloture. I think there are 61. I put [Maine Republican Sen. Olympia] Snowe in there."
Several weeks after Specter's remarks, Sen. Kennedy succumbed to a yearlong struggle with brain cancer -- in the process decreasing the number of caucusing Democrats to 59. But a vote by the Massachusetts Senate on Tuesday to allow the state's governor to temporarily fill that seat should push that number back to the critical 60.

And yet, questions remain. For starters, where do other senators such as Mary Landrieu, (D-LA) and Joseph Lieberman, (I-Conn.) -- come down on cloture? Equally important is the health of the Senate's longest-serving member, Robert Byrd (D-WV), who was rushed to the hospital earlier in the week after a fall.

Still, strategist within the party say the push for getting all caucusing members to back cloture may be the most promising legislative path forward. For starters, it would allow Democrats to pass a more robust reform package than they could likely get through reconciliation -- the parliamentary procedure that also allows for an up-or-down vote but restricts the language of the bill to a five-year budget window.

The commit-to-cloture path also immunizes party members from being tagged with trying to ram a nearly $1 billion piece of legislation through Congress through non-traditional procedural means. And while some conservative Democrats could be criticized for casting votes in favor of considering health care reform, they could temper the hit by ultimately voting against the bill's passage.

"People have lost seats on procedural votes," said Tad Devine, a long-time Democratic strategist. "That is what happened in the 1994 election, when President Clinton's economic package went into law and a number of Democrats in the House lost their seats... But if you are talking about one or two people who are well established, they can oppose legislation on the merits but allow it to come to a vote and I don't think that's enough to cost them a seat."

Source: http://www.huffingtonpost.com/2009/09/2 ... 96421.html

[roxybeast]

<center>NO IS NOT AN OPTION!
by Beth Isbell</center>
Time to update the health care blog! Well, since the last post, the Senate Finance Committee finally voted on their bill, rejecting the public option in the committee vote, but freeing the legislation up to move to floor debate, tomorrow, and then to conference. The four other committees in the House and Senate that have put out health care legislation proposals all include the public option, so there is plenty of fight left in the dog, ... the yellow dog.

Reid Says Public Plan Will Be In Final Bill
by Sam Stein,
Huffington Post, October 1, 2009

Senate Majority Leader Harry Reid, who will have wide control over reconciling two versions of health care legislation in the Senate, told local constituents on Thursday that the final bill will include a public option for insurance coverage.

The remarks, first reported by the Las Vegas Review-Journal are destined to bring a wide smile to the faces of progressives who view the melding of health care legislation by leadership in the Senate -- and the subsequent melding between the Senate and the House versions -- as the best chance of ensuring the public option's passage.

Reid had been skeptical of getting a government-run plan through Congress in recent days -- though aides say that the provision remains his personal preference. And after the defeat of two public option amendments in the Senate Finance Committee it seemed that the policy proposal was all but pronounced dead.

But on Thursday Reid reportedly told a conference call of Nevadans that: "We are going to have a public option before this bill goes to the president's desk."

"I believe the public option is so vitally important to create a level playing field and prevent the insurance companies from taking advantage of us," Reid added.

Source: http://www.huffingtonpost.com/the-news/ ... /sam-stein

So the public option lives on despite claims of its premature death.

Meanwhile, to show how committed they are to workers and families, instead of greed and profits, big insurance announced that they are cutting their own employees benefits while paying their CEOs tens of millions in salary, encouraging those same employees to lobby against health care reform, and even rewarding employees for finding ways to drop policyholders who developed expensive conditions (aka rescission) ... wait, that doesn't sound right ... but alas, as this first article points out, it is true. Yes, to protect our profits we are going to cut your benefits. We could be looking at ways to improve our product, improve sales, enhance customer loyalty, and lots of other ideas for improvement that would allow us to show our commitment to our loyal and hardworking employees so that we won't have to cut your benefits. But no, that would be inconsistent with the way we handle any of our customers benefits and claims, so we'd just rather be consistent and cut your insurance benefits too, ... not our excessive salaries mind you, just your lowly peon benefits. Don't you just love corporate greed!

WellPoint Cuts Workers' Health Insurance Benefits
by Rachel Weiner
Huffington Post, October 5, 2009

WellPoint health insurance company, which has encouraged its employees to lobby against health care reform, is now cutting their benefits.

The insurance giant plans to raise deductibles and premiums for some of its employee health benefits. "Your cost per paycheck will probably increase," said a memo to Wellpoint employees that was obtained by Bloomberg News.

The company blamed the recession for the cuts. "Like many employers in today's economic environment, we are looking at all aspects of our business," including benefits, "and making adjustments to ensure we can continue to operate competitively in the future," wrote Chief Human Resources Officer Randy Brown.

WellPoint's CEO, Angela Braly, made nearly $10 million in 2008.

WellPoint illegally pressured California employees this summer to fight health care reform, according to Consumer Watchdog. "Regrettably, the congressional legislation, as currently passed by four of the five key committees in Congress, does not meet our definition of responsible and sustainable reform," said the company's Anthem Blue Cross unit in a company e-mail. The proposals would hurt the company by "causing tens of millions of Americans to lose their private coverage and end up in a government-run plan."

A House investigation found that WellPoint also rewarded employees for finding ways to drop policyholders who developed expensive conditions -- a practice known as rescission.

Source: http://www.huffingtonpost.com/2009/10/0 ... 09716.html

I love this next article by Paul Krugman and he's right, the GOP seems driven by the need to defeat the President at any cost, even if it means abandoning traditional GOP ideas in favor of ideas even their conservative god Ronald Reagan clearly rejected. Like their current position of opposing any efforts to streamline and improve Medicare by cutting unnecessary and wasteful spending. Reagan opposed Medicare altogether, and prior GOP bills have tried to cut Medicare spending. But now that Obama suggested it, the idea must be defeated at all costs.

The Politics of Spite
by Paul Krugman
New York Times, October 4, 2009

There was what President Obama likes to call a teachable moment last week, when the International Olympic Committee rejected Chicago’s bid to be host of the 2016 Summer Games.

“Cheers erupted” at the headquarters of the conservative Weekly Standard, according to a blog post by a member of the magazine’s staff, with the headline “Obama loses! Obama loses!” Rush Limbaugh declared himself “gleeful.” “World Rejects Obama,” gloated the Drudge Report. And so on.

So what did we learn from this moment? For one thing, we learned that the modern conservative movement, which dominates the modern Republican Party, has the emotional maturity of a bratty 13-year-old.

But more important, the episode illustrated an essential truth about the state of American politics: at this point, the guiding principle of one of our nation’s two great political parties is spite pure and simple. If Republicans think something might be good for the president, they’re against it — whether or not it’s good for America.

To be sure, while celebrating America’s rebuff by the Olympic Committee was puerile, it didn’t do any real harm. But the same principle of spite has determined Republican positions on more serious matters, with potentially serious consequences — in particular, in the debate over health care reform.

Now, it’s understandable that many Republicans oppose Democratic plans to extend insurance coverage — just as most Democrats opposed President Bush’s attempt to convert Social Security into a sort of giant 401(k). The two parties do, after all, have different philosophies about the appropriate role of government.

But the tactics of the two parties have been different. In 2005, when Democrats campaigned against Social Security privatization, their arguments were consistent with their underlying ideology: they argued that replacing guaranteed benefits with private accounts would expose retirees to too much risk.

The Republican campaign against health care reform, by contrast, has shown no such consistency. For the main G.O.P. line of attack is the claim — based mainly on lies about death panels and so on — that reform will undermine Medicare. And this line of attack is utterly at odds both with the party’s traditions and with what conservatives claim to believe.

Think about just how bizarre it is for Republicans to position themselves as the defenders of unrestricted Medicare spending. First of all, the modern G.O.P. considers itself the party of Ronald Reagan — and Reagan was a fierce opponent of Medicare’s creation, warning that it would destroy American freedom. (Honest.) In the 1990s, Newt Gingrich tried to force drastic cuts in Medicare financing. And in recent years, Republicans have repeatedly decried the growth in entitlement spending — growth that is largely driven by rising health care costs.

But the Obama administration’s plan to expand coverage relies in part on savings from Medicare. And since the G.O.P. opposes anything that might be good for Mr. Obama, it has become the passionate defender of ineffective medical procedures and overpayments to insurance companies.

How did one of our great political parties become so ruthless, so willing to embrace scorched-earth tactics even if so doing undermines the ability of any future administration to govern?

The key point is that ever since the Reagan years, the Republican Party has been dominated by radicals — ideologues and/or apparatchiks who, at a fundamental level, do not accept anyone else’s right to govern.

Anyone surprised by the venomous, over-the-top opposition to Mr. Obama must have forgotten the Clinton years. Remember when Rush Limbaugh suggested that Hillary Clinton was a party to murder? When Newt Gingrich shut down the federal government in an attempt to bully Bill Clinton into accepting those Medicare cuts? And let’s not even talk about the impeachment saga.

The only difference now is that the G.O.P. is in a weaker position, having lost control not just of Congress but, to a large extent, of the terms of debate. The public no longer buys conservative ideology the way it used to; the old attacks on Big Government and paeans to the magic of the marketplace have lost their resonance. Yet conservatives retain their belief that they, and only they, should govern.

The result has been a cynical, ends-justify-the-means approach. Hastening the day when the rightful governing party returns to power is all that matters, so the G.O.P. will seize any club at hand with which to beat the current administration.

It’s an ugly picture. But it’s the truth. And it’s a truth anyone trying to find solutions to America’s real problems has to understand.

Source: http://www.nytimes.com/2009/10/05/opini ... ugman.html

Is health care reform a civil rights issue? Well, civil rights groups seem to think so ... http://www.huffingtonpost.com/2009/10/0 ... 10006.html

As y'all know, I favor a strong public option in the final legislation that is signed into law. It is absolutely necessary to keep the insurance companies honest and we can see from the first article above, and loads of others in prior posts that their profits drive them more than any true concern for public health. This is an option. Not a requirement. Simply providing Americans with a choice of a plan where profits will not drive it's cost. Available to those that truly need help.

We should consider that the public option should not be subject to compromise - IT IS THE COMPROMISE. It is already a significant compromise from National Health Insurance or Medicare for All. And if it weren't an effective way to control big insurance, they wouldn't oppose it so vigorously and be spending so much to defeat the idea.

There are other compromises involving the public option being tossed around to try to pick up enough votes to secure passage, like insurance co-operatives, Olympia Snowe's trigger idea, or my favorite the "reverse-trigger" (i.e., pass a bill with the public option and if that actually gets big insurance's attention such that they clean up their act, we can eventually get rid of it if they show they are committed to making sure that all of the policies in the public option will be available). Well, here's another new idea being tossed around to compromise the public option compromise even further: a public option "opt-out."

The Public Option "Opt-Out" Compromise Is Reasonable
by Sahil Kapur
Huffington Post, October 5, 2009

A new compromise has been floated for the public health insurance option: it's not co-ops, it's not a trigger; it's a provision that allows defiant states to opt out of offering the program to consumers. This idea has its problems (namely the millions who will be excluded) but as far as public plan compromises go, it's the best one anyone has come up with.

Most of America should have the option of a plan it has strongly and consistently supported throughout this dramatic debate. Blue states like California and New York will undoubtedly go for it, and millions will see an immediate improvement in their lives. Red states like Utah and Wyoming will probably strike it down. Either way, allowing states to offer a public plan seems like the bare minimum that should result from this legislation.

After all, this isn't simply a government entitlement or a handout to the poor; it's a "self-sustaining, independent, self-financed entity," as Senator Robert Menendez called it, designed primarily to meet people's health care needs, rather than make a profit. Thus the argument that it'll drive up the debt is irrelevant to what's actually being discussed.

So let it happen. Let Red America whine about big government while Blue America gets quality health care people can afford. Let conservatives rant about socialism, communism, fascism and Nazism while more of them die and go bankrupt due to a lack of health insurance. Let them turn to Rush Limbaugh and Glenn Beck, who will likely blame gays, immigrants, and European socialists while more lose their jobs as businesses migrate to blue states, where they can afford health care for their employees.

Let Michael Steele, John Boehner and Mitch McConnell (or whoever the GOP leaders are in 2016) explain to their constituents why their insurance premiums have doubled while blue-staters are relatively unburdened of their health care woes after embracing Socialized Medicine.

If the GOP really believed its rhetoric about how awful and Socialistic the public plan (or nearly any other government program) is, the smart response would be to welcome the opt-out compromise, trusting that its failure over time will prove their point. But my prediction is that won't happen, because the smarter Republicans know their cynical antics are about political posturing -- just as when they defamed Medicare the same way.

That's why Republican lawmakers will still fight this compromise tooth and nail, as they would any kind of a public option for anyone, because they fear having to justify the eventual discrepancies to their base. But considering how close the Finance Committee vote on Schumer's amendment was, 13-10, this concession could pick up the crucial few flips necessary to turn the tables.

Of course, this isn't as good as offering a strong Medicare-like insurance option opposite private plans to everyone in America. But the advantage of the opt-out provision is not merely that it's more politically feasible; it would also offer a real-life juxtaposition of an America with a public option and an America without one.

The impacts of the compromised provision would offer a revelatory perspective, divulging the Republican Party's propaganda and lies, such as they've been. It would strip their ability to later vilify the public option as the source of all the nation's ensuing problems, as Exhibit B would reveal how much worse things are without the program.
Despite the far-reaching horrors of the failed health care system, Republicans (and some conservative Democrats) continue to treat the issue as a petty, point-scoring political game. Not only will the opt-out compromise expose today's conservative movement for the vacuous farce it has become, it'll serve as a critical step to helping America understand public health insurance for what it really is. The states that waver today will come around tomorrow after seeing the results, and it'll soon be a dead issue.

And years from now, during the next health care debate, some tea-bagger will barge into a town hall and yell at his Congressman to "Keep your government hands off my public option!"

Source: http://www.huffingtonpost.com/sahil-kap ... 08512.html

So where do Americans actually stand on the public option issue?

New Poll Shows Majority Favors Dem-Only Health Bill With Public Option Over Bipartisan Bill Without
Huffington Post, October 5, 2009

A majority of Americans prefer that Congress pass a Democrat-only health care bill that includes a public option over a bipartisan bill that does not, according to a new Daily Kos/Research 2000 poll.

http://www.dailykos.com/statepoll/2009/10/1/US/386

The poll found that over half the country would prefer Congress pass health legislation that includes "a strong public health insurance option," only supported by Democrats, over a bill with "no public option that has the support of Democrats and a handful of Republicans."

This finding holds true for most Democrats and many independents. Eighty percent of Democrats and 47 percent of independents place greater importance on the achievement of a public option than on bipartisanship.

Other polls have found that a majority would prefer a bipartisan bill -- but they asked the question in isolation, without exploring the potential policy ramifications.

Source: http://www.huffingtonpost.com/2009/10/0 ... 08078.html

You've got to love John Stewart telling it like it is ...
http://www.thedailyshow.com/watch/wed-s ... r-majority

And finally, as the Krugman editorial aptly demonstrates, the GOP has merely become the "party of NO!" Ergo, my new slogan for health care reform is:

<center>"NO IS NOT AN OPTION!"</center>

Pass it on, share it, use it, go out & create bumper stickers!!!

[roxybeast]

<center>An Open Letter to Churchgoers Who Oppose Health Care Reform
by Michael Moore</center>

For Those of You on Your Way to Church This Morning...
by Michael Moore
Director of the new documentary "Capitalism: A Love Story"

Friends,

I'd like to have a word with those of you who call yourselves Christians (Muslims, Jews, Buddhists, Bill Maherists, etc. can read along, too, as much of what I have to say, I'm sure, can be applied to your own spiritual/ethical values).

In my new film I speak for the first time in one of my movies about my own spiritual beliefs. I have always believed that one's religious leanings are deeply personal and should be kept private. After all, we've heard enough yammerin' in the past three decades about how one should "behave," and I have to say I'm pretty burned out on pieties and platitudes considering we are a violent nation that invades other countries and punishes our own for having the audacity to fall on hard times.

I'm also against any proselytizing; I certainly don't want you to join anything I belong to. Also, as a Catholic, I have much to say about the Church as an institution, but I'll leave that for another day (or movie).

Amidst all the Wall Street bad guys and corrupt members of Congress exposed in Capitalism: A Love Story, I pose a simple question in the movie: "Is capitalism a sin?" I go on to ask, "Would Jesus be a capitalist?" Would he belong to a hedge fund? Would he sell short? Would he approve of a system that has allowed the richest 1 percent to have more financial wealth than the 95 percent under them combined?

I have come to believe that there is no getting around the fact that capitalism is opposite everything that Jesus (and Moses and Mohammed and Buddha) taught. All the great religions are clear about one thing: It is evil to take the majority of the pie and leave what's left for everyone to fight over. Jesus said that the rich man would have a very hard time getting into heaven. He told us that we had to be our brother's and sister's keepers and that the riches that did exist were to be divided fairly. He said that if you failed to house the homeless and feed the hungry, you'd have a hard time finding the pin code to the pearly gates.

I guess that's bad news for us Americans. Here's how we define "Blessed Are the Poor": We now have the highest unemployment rate since 1983. There's a foreclosure filing once every 7.5 seconds. 14,000 people every day lose their health insurance.

At the same time, Wall Street bankers ("Blessed Are the Wealthy"?) are amassing more and more loot -- and they do their best to pay little or no income tax (last year Goldman Sachs' tax rate was a mere 1 percent!). Would Jesus approve of this? If not, why do we let such an evil system continue? It doesn't seem you can call yourself a Capitalist and a Christian -- because you cannot love your money and love your neighbor when you are denying your neighbor the ability to see a doctor just so you can have a better bottom line. That's called "immoral" -- and you are committing a sin when you benefit at the expense of others.

When you are in church this morning, please think about this. I am asking you to allow your "better angels" to come forward. And if you are among the millions of Americans who are struggling to make it from week to week, please know that I promise to do what I can to stop this evil -- and I hope you'll join me in not giving up until everyone has a seat at the table.

Thanks for listening. I'm off to Mass in a few hours. I'll be sure to ask the priest if he thinks J.C. deals in derivatives or credit default swaps. I mean, after all, he must've been good at math. How else did he divide up two loaves of bread and five pieces of fish equally amongst 5,000 people? Either he was the first socialist or his disciples were really bad at packing lunch. Or both.

Yours,

Michael Moore
MMFlint@aol.com
MichaelMoore.com

Source: http://www.huffingtonpost.com/michael-m ... 08948.html

[roxybeast]

<center>Helping to Clarify the Issues</center>

A Primer on the Details of Health Care Reform
By ROBERT PEAR and DAVID M. HERSZENHORN
New York Times, August 9, 2009

WASHINGTON — With the debate over the future of health care now shifted from Capitol Hill to town halls, supporters and critics of the Democrats’ legislative proposals are polishing their sound bites and sharpening their attack lines.

Increasingly, the battle looks like a presidential contest, with expensive advertising campaigns and Internet-driven efforts to mobilize local support. It can be difficult to sort fact from fiction, as angry protesters denounce the legislation at raucous public forums.

President Obama and his Democratic allies in Congress have made the health care overhaul their top priority, putting their political futures on the line. Democrats had hoped to spend the month whipping up support for the legislation, but instead find themselves on the defensive, responding to what Mr. Obama describes as “outlandish rumors” spread by critics.

Many Republicans view fighting the president as a smart political strategy, turning a potentially wonkish debate over Medicare reimbursement rates and subsidies for the uninsured into an ideological battle over the government’s role in health care.

Each side hopes to win ground by boiling down one of the most complex policy discussions in history into digestible nuggets. For beachside viewers who might be more interested in iced-tea service than fee-for-service, here is a guide to the main fight points.

KEEP IT OR LOSE IT?

Mr. Obama has said repeatedly, as he told the American Medical Association in June: “If you like your doctor, you will be able to keep your doctor, period. If you like your health care plan, you’ll be able to keep your health care plan, period. No one will take it away, no matter what.”

These assurances reflect an aspiration, but may not be literally true or enforceable.

The legislation does not require insurers or employers to continue offering the health benefits they now provide. The House bill sets detailed standards for “acceptable health care coverage,” which would define “essential benefits” and permissible co-payments. Employers that already offer insurance would have five years to bring their plans into compliance with the new federal standards.

The Senate health committee bill goes somewhat further by offering an “option to retain current insurance coverage.”

The legislation could have significant implications for individuals who have bought coverage on their own. Their policies might be exempted from the new standards, but the coverage might not be viable for long because insurers could not add benefits or enroll additional people in noncompliant policies.

Dallas L. Salisbury, president of the Employee Benefit Research Institute, a private nonpartisan group, said: “The president and Democrats in Congress are saying what they would like. Their promises may not be literally true because your health plan may change, and your doctor may no longer accept your insurance.”

SOCIALIZED MEDICINE

Or Uniquely American?

Republicans harshly criticize Democratic proposals to create a government-run insurance plan, or public option, to compete with private insurers. Republicans say the public plan would drive insurers out of business and lead to “socialized medicine” or a government takeover of health care. Democrats say they want a “uniquely American” system with public and private elements.

For now, the Republican criticism seems overblown. Major versions of the legislation all rely heavily on a continuation of private health plans, offered by employers and by insurance companies, subject to sweeping new federal regulations.

Whether a public plan would crowd out private insurers depends on details yet to be decided, including its premiums and its payment rates for health care providers.

The public plan is not even a certainty. To win bipartisan support for the overhaul, some Democrats have proposed private nonprofit health care cooperatives, instead of a public plan, to compete with private insurers.

The Congressional Budget Office has estimated that, under the House bill, the number of people with employer-sponsored insurance would climb to 162 million in 2016, which is 3 million more than expected under current law. Further, it said, enrollment in the proposed public plan might total 11 million, far lower than estimates cited by Republicans.

An additional 10 million people, most of them now uninsured, would enroll in Medicaid, the budget office said.

At any rate, the federal government already holds sway over the health care system through Medicare, Medicaid and various insurance programs for children, veterans, military personnel and other federal employees. The federal government will account for 35 percent of the expected $2.5 trillion in health spending this year, and that does not include subsidies built into the tax code.

BLAMING INSURERS

Or Ensuring Blame?

Democrats have unleashed a blistering attack on private health insurers as they try to convince the vast majority of Americans who already have coverage that the current system is tilted in favor of corporate profits, not patients, and that insurers are a main obstacle to passing legislation.

Insurers say they support some of the most important Democratic proposals, including a ban on denying coverage or charging higher premiums based on pre-existing medical conditions.

The insurance industry does oppose a government-run insurance plan and could eventually mobilize against the overhaul. But insurers appear to be less of an obstacle than public apprehension over such sweeping change and skittishness among lawmakers, including centrist Democrats from Republican-leaning districts.

Most Americans do not know the full cost of their employer-sponsored insurance. And it is easier for Democrats to paint insurers as greedy than to explain the complex math that shows current health care spending is unsustainable.

DEFICIT-NEUTRAL

Or Budget-Buster?

Mr. Obama has avoided dictating specific provisions of health care legislation. But he has insisted that the bill not add to the federal debt, leading Democrats to say that the overhaul will be “deficit neutral,” with the roughly $1 trillion, 10-year cost to be offset by reduced spending or new taxes.

The Congressional Budget Office has yet to issue cost estimates for the latest versions of the bill approved by three House committees. But it has warned that the legislation “would probably generate substantial increases in federal budget deficits” beyond 2019, in part because health costs are rising faster than the rate of inflation and proposed new taxes would not keep up.

Republicans use those warnings to cast doubt on the claim by Mr. Obama that the legislation will “bend the cost curve” by slowing the growth of health spending in the long term. Democrats say the overhaul will lead to savings that cannot be calculated under budgeting rules. At this point, it is difficult to know who is right.

Over the next 10 years, the budget office said, the House bill would “result in a net increase in the federal budget deficit of $239 billion,” partly because of an increase in Medicare spending to avert sharp cuts in payments to doctors scheduled to occur under existing law.

House Democrats say the higher doctor payments should not count in the cost because they fix a problem that predates the Obama administration and Democratic control of Congress.

EUTHANASIA

And Abortion

Conservative critics say the legislation could limit end-of-life care and even encourage euthanasia. Moreover, some assert, it would require people to draw up plans saying how they want to die.

These concerns appear to be unfounded. AARP, the lobby for older Americans, says, “The rumors out there are flat-out lies.”

The House bill would provide Medicare coverage for optional consultations with doctors who advise patients on life-sustaining treatment and “end-of-life services,” including hospice care.

The legislation instructs Medicare officials to propose ways to measure the quality of end-of-life care. Doctors would have financial incentives to report data on such care to the government.

On abortion, the situation is more complex. Opponents of abortion, like the National Right to Life Committee, say the legislation would use tax dollars to subsidize insurance that could cover abortion.

Under a bill approved by the House Energy and Commerce Committee, health plans, including the new government insurance plan, could choose to cover abortion. But they generally could not use federal money to pay for the procedure and instead would have to use money from the premiums paid by beneficiaries.

Douglas D. Johnson, legislative director of the National Right to Life Committee, said, “Under either the Senate bill or the House bill, the federal government would run a huge system of subsidizing elective abortion.”

Representative Diana DeGette, Democrat of Colorado, said the bill would keep current restrictions on the use of federal money for abortion, but “would not expand the prohibitions, as many Republicans want to do.”

CUTTING MEDICARE

Or Preserving It?

To help finance coverage for the uninsured, Congress would squeeze huge savings out of Medicare, the program for older Americans and the disabled. These savings would pay nearly 40 percent of the bills’ cost.

The legislation would trim Medicare payments for most services, as an incentive for hospitals and other health care providers to become more efficient. The providers make a plausible case that the cutbacks could inadvertently reduce beneficiaries’ access to some types of care.

The Senate Republican leader, Mitch McConnell of Kentucky, said Democrats would make “massive cuts to Medicare to pay for more government-run health care.”

Mr. Obama told AARP last month, “Nobody is talking about reducing Medicare benefits.” All the savings, he said, would come from measures to “eliminate waste and inefficiency in Medicare.” As an example, he cited duplicative tests ordered by different doctors for the same patient.

But some proposals could affect beneficiaries. The major bills in Congress would cut more than $150 billion over 10 years from federal payments to private health plans that care for more than 10 million Medicare beneficiaries.

Source: http://www.nytimes.com/2009/08/10/healt ... facts.html

[roxybeast]

<center>Health Care Systems in Other Leading Countries: Switzerland</center>

Swiss Health Care Thrives Without Public Option
By NELSON D. SCHWARTZ
New York Times, September 30, 2009

ZURICH — Like every other country in Europe, Switzerland guarantees health care for all its citizens. But the system here does not remotely resemble the model of bureaucratic, socialized medicine often cited by opponents of universal coverage in the United States.

Swiss private insurers are required to offer coverage to all citizens, regardless of age or medical history. And those people, in turn, are obligated to buy health insurance.

That is why many academics who have studied the Swiss health care system have pointed to this Alpine nation of about 7.5 million as a model that delivers much of what Washington is aiming to accomplish — without the contentious option of a government-run health insurance plan.

In Congress, the Senate Finance Committee is dealing with legislation proposed by its chairman, Max Baucus, Democrat of Montana, which would require nearly all Americans to buy health insurance, but stops short of the government-run insurance option that is still strongly supported by liberal Democrats.

Two amendments that would have added a public option to the Baucus bill were voted down on Tuesday. But another Senate bill, like the House versions, calls for a public insurance option.

By many measures, the Swiss are healthier than Americans, and surveys indicate that Swiss people are generally happy with their system. Switzerland, moreover, provides high-quality care at costs well below what the United States spends per person. Swiss insurance companies offer the mandatory basic plan on a not-for-profit basis, although they are permitted to earn a profit on supplemental plans.

And yet, as a potential model for the United States, the Swiss health care system involves some important trade-offs that American consumers, insurers and health care providers might find hard to swallow.

The Swiss government does not “ration care” — that populist bogeyman in the American debate — but it does keep down overall spending by regulating drug prices and fees for lab tests and medical devices. It also requires patients to share some costs — at a higher level than in the United States — so they have an incentive to avoid unnecessary treatments. And some doctors grumble that cost controls are making it harder these days for a physician to make a franc.

The Swiss government also provides direct cash subsidies to people if health insurance equals more than 8 percent of personal income, and about 35 to 40 percent of households get some form of subsidy. In some cases, employers contribute part of the insurance premium, but, unlike in the United States, they do not receive a tax break for it. (All the health care proposals in Congress would provide a subsidy to moderate-income Americans.)

Unlike the United States, where the Medicare program for the elderly costs taxpayers about $500 billion a year, Switzerland has no special break for older Swiss people beyond the general subsidy.

“Switzerland’s health care system is different from virtually every other country in the world,” said Regina Herzlinger, a Harvard Business School professor who has studied the Swiss approach extensively.

“What I like about it is that it’s got universal coverage, it’s customer driven, and there are no intermediaries shopping on people’s behalf,” she added. “And there’s no waiting lists or rationing.”

Since being made mandatory in 1996, the Swiss system has become a popular model for experts seeking alternatives to government-run health care. Indeed, it has attracted some unlikely American admirers, like Bill O’Reilly, the Fox News talk show host. And it has lured some members of Congress on fact-finding trips here to seek ideas for overhauling the United States system.

The Swiss approach is also popular with patients like Frieda Burgstaller, 72, who says she likes the freedom of choice and access that the private system provides. “If the doctor says it has to be done, it’s done,” said Mrs. Burgstaller. “You don’t wait. And it’s covered.”

While many patients seem content, the burdens fall more heavily on doctors, especially general practitioners and pediatricians.

Dr. Gerlinde Schurter, Mrs. Burgstaller’s physician, says she feels squeezed by government regulators and insurance companies that have fought to hold down costs — most recently with a 15 percent cut in lab fees that forced her five-member group to lay off its principal technician.

Dr. Schurter also fears a so-called blue letter, a warning from an insurance company that she is prescribing too many drugs or expensive procedures.

If doctors cannot justify their treatments, they can be forced to repay insurers for a portion of the medical services prescribed. And while prescriptions are covered, the government has insisted that consumers fork over a 20 percent co-payment if they want brand-name drugs, rather than 10 percent for generics.

Similarly, the government health office also lowered reimbursements across the board for medical devices in 2006.

These are among the reasons health care costs consume 10.8 percent of gross domestic product in Switzerland, compared with 16 percent in the United States, the highest level of spending among industrial countries, according to the Organization for Economic Cooperation and Development.

Still, along with lower costs and the freedom to choose doctors come bigger bills for individual patients. On average, out-of-pocket payments come to $1,350 annually. That is the highest among the 30 countries tracked by the O.E.C.D. and well above the $890 average for the United States, which comes in second.

Then there are the hefty prices of the insurance policies themselves, which can top 14,000 Swiss francs a year for a family of four in Zurich, or about $13,600. That is roughly comparable to the national average annual premium for a family policy under employer-sponsored group plans in the United States, but in high-cost American cities the figure can be much higher.

Direct comparisons are hard to make, however, because in the American system, employers and employees share the cost of premiums, which are also exempt from individual and corporate income taxes.

Nevertheless, Swiss citizens relish the lack of bureaucracy, especially compared with systems in Britain and Germany, even if their doctors grumble.

As in the United States, practitioners typically are paid on a fee-for-service basis, rather than on salary. But they make less than their American counterparts. According to the O.E.C.D., specialists in Switzerland earn three times more than the nation’s average wage, compared with 5.6 times for American specialists. General practitioners in Switzerland make 2.7 times more than the average wage, versus 3.7 in the United States.

That is partly because the Swiss health insurers are not shy about using their muscle with physicians.

Pius Gyger, director of health economics and health policy at Helsana, the country’s biggest insurer, cannot suppress a smile when asked about the effectiveness of the so-called blue letters.

“If there’s something strange, we knock at the doctor’s door,” he said. “For doctors, it’s an incentive to treat economically, but often perceived as a threat.”

He estimates that only about 3 percent of doctors get the letters and that fewer than 1 percent actually have to return money. Still, Mr. Gyger said, “it’s an easy exercise for us and it has an effect.”

Despite pressure on general practitioners, hospital physicians like Edouard Battegay at the University of Zurich say universal coverage also lowers costs by reducing emergency room visits.

Indeed, his E.R. is as quiet and efficient as a Swiss watch, and he still expresses amazement at what he saw when he worked briefly in Seattle.

“I’ve seen things in the U.S. that I’ve never seen here; it was a state of disaster,” he said. “Chronic disease management is better here. If you don’t treat hypertension, you treat strokes. Not treating patients is expensive.”

And even Dr. Schurter — who says her income has been flat for the last five years — praises the virtues of the Swiss system for patients struck by catastrophe.

When her daughter was found to have leukemia seven years ago, “I never worried for a second how and if she’d get treatment and if it would be paid for,” she said. “All was granted as naturally as the air we breathe.”

Source: http://www.nytimes.com/2009/10/01/healt ... swiss.html

[roxybeast]

<center>A Closer Look at Health Insurance Exchanges</center>

Health Insurance Exchanges: Will They Work?
By REED ABELSON
New York Times, October 5, 2009

It is the sleeper issue in the current health care debate.

Despite all the disagreement in Washington, every proposal now before Congress to overhaul the nation’s health care system includes creation of an insurance “exchange” — a marketplace that would operate something like a Travelocity Web site for insurance policies.

In theory at least, the exchange would fix a fundamental flaw in the present system by giving small businesses and individuals a broad choice of insurance policies at competitive prices. Right now, such buyers typically have few affordable options.

The idea of an exchange has support from the White House and many in Congress — from people who also advocate including a government-run insurance plan in the marketplace and from those who oppose letting the government compete with commercial insurers.

But policy experts say few lawmakers have yet paid enough attention to what that new marketplace should look like — and whether it would actually work as promised.

Without careful design and adequate rules of fair play, and without letting enough buyers participate to create a robust market, the exchange might not actually stimulate new competition among the nation’s health insurers. In other words: What happens if you build an exchange and insurers do not flock to it with new, well-priced wares?

The risk is that many local markets could end up looking much as they do today — with small businesses and individuals at the mercy of too few insurers wielding too much power in their regions.

“We may not be able to improve competition in the short run through the exchange,” said Len Nichols, a health economist at the New America Foundation, a Washington research group that supports an overhaul of the insurance market.

So far, the House proposal calls for the creation of a national exchange where someone in Iowa, for example, may have the same choice of health plans as buyers in Maine and California. Because insurance is now a state-by-state patchwork, such an approach would conceivably enhance competition by creating an interstate market.

But critics worry that the result may be a few big providers of one-size-fits-all plans, still leaving many small businesses and consumers with products that do not meet their needs or budgets.

Both Senate proposals, meanwhile, favor the creation of state-based exchanges, where a state may have the choice of deciding whether its residents can also buy from a national or regional exchange. The exchanges may have other wide variations, depending on the model chosen by a state or outlined in the legislation.

Some may mirror the one in Massachusetts, which actively screens the policies and negotiates with insurers on behalf of customers. Others may operate more like electronic yellow pages, where insurers list their offerings with little government involvement or oversight.

Another big question is whether there will be enough new customers to prompt insurers to actively compete for their business.

As currently outlined in the Congressional proposals, participation in the exchanges would be limited in some way — to only the very smallest employers, or to residents of a single state or to people who do not now have coverage through their employers.

Another limiting factor, policy experts say, would be whether Congress provides generous enough subsidies so that people who do not currently have insurance could afford it.

For all their potential drawbacks, the exchanges are meant to address a fundamental issue: the current lack of competition in many parts of the country.

President Obama, for example, in his recent speech to Congress, cited states like Alabama where the insurance market for individuals and small companies is dominated by a handful of carriers. As a result, he said, “the price of insurance goes up and quality goes down.”

A recent analysis by the Government Accountability Office notes that in more than a dozen states, including Delaware, Maine, North Dakota and Rhode Island, the largest health insurer offering coverage for a small business commands more than half of the overall market.

Some insurers argue that the strongest need for competition is among the hospitals and doctors, not the health plans serving as middlemen.

“There has to be competition within the delivery system,” said David H. Klein, the chief executive of the powerful Excellus BlueCross BlueShield in Rochester, a nonprofit insurer that is one of the major sources of coverage in that market. “In most of America, that just isn’t going to happen.”

But small business owners frequently complain they when they have limited choice among insurers, they have little bargaining clout. “It’s a ‘take it or leave it’ for some of the biggest carriers out there,” said Amanda Austin, a lobbyist for the National Federation of Independent Business, which represents small businesses.

At Smithfield Diesel and Transmission Repair in Rhode Island, for example, for years the choice of insurers has been limited to the state’s two biggest carriers — a Blue Cross plan and United Healthcare — said Joan Frattarelli, who runs Smithfield Diesel with her husband. This year, the company’s costs went up by 29 percent, to about $34,000 for coverage of four employees under Blue Cross.

Ms. Frattarelli said she worried that some proposals in Congress would continue to restrict her options to only those plans now available in Rhode Island, which would leave her no better off. “Competition is the name of the game,” she said, “I don’t care what industry it is.”

The hope in Washington, of course, is that an influx of tens of millions of newly insured customers will lure insurance companies to enter new markets. That is what happened a few years ago when private insurers flocked to offer prescription drug coverage after it was added to the Medicare program, said Ken Sperling, a health care consultant for Hewitt Associates.

But because of the restrictions on who can shop, and the question of whether the shoppers will be able to afford insurance, no one knows how many new customers there might be, especially in some in the least populous markets.

The big national insurance companies, like Humana, United Healthcare and Aetna, would not speculate on how the exchanges might affect their business plans. But some of the regional insurers say they could be tempted to expand, at least into nearby markets or states.

“It’s not off the radar screen,” said George C. Halvorson, the chief executive of Kaiser Permanente, the big California health plan. “We’re going to sit down and take a really hard look.”

Another deterrent facing new entrants is the fact that established insurers can negotiate the deepest discounts with the local hospitals and doctors, making it hard for a new player to compete on price.

“The big dominant insurer in any market has the providers pretty much sewn up,” said Timothy S. Jost, a professor at Washington and Lee University. “I think that’s the big problem, and I don’t know that the legislation addresses that very well.”

Congress must also decide whether the exchanges would have any authority to decide which plans are offered and at what price, said Paul Fronstin, a policy analyst with the Employee Benefit Research Institute, a co-author of a recent report on insurance exchanges. “The exchange can have a more active role if it negotiate rates,” he said, “but it is not clear what is going to happen.”

In Massachusetts, for example, the state’s exchange, called the Connector, negotiates directly with the state’s private insurance companies in offering a small number of state-subsidized plans — similar to what an employer does when it screens the policies offered to its work force.

“We work as an aggressive employer, offering managed competition,” said Jon Kingsdale, the executive director of the Commonwealth Health Insurance Connector Authority. He said the agency’s ability to negotiate on behalf of 180,000 customers who required state subsidies was a reason it achieved a 6 percent reduction in the cost of premiums this year.

But the Connector would be less effective if it had no say over which plans were offered on the exchange, said Mr. Kingsdale, who criticized the Senate Finance committee’s proposal, for example, as potentially creating little more than “an automated yellow pages.”

Because formulating an effective exchange is so difficult, some policy analysts are still arguing that only a new government-run competitor could create a powerful enough force in many parts of the country to offset the home-court advantage many insurers already wield.

“People don’t realize how hard it is to crack these markets,” said David Balto, a former official with the Federal Trade Commission who is now a senior fellow at the Center for American Progress, a liberal research group. “What you need to have,” he said, “is something that effectively disrupts the market.”

Source: http://www.nytimes.com/2009/10/06/busin ... hange.html

[roxybeast]

<center>New Study Shows Passing Meaningful Reform Will Substantially Lower Medicare Costs</center>

Extending Medicare coverage to everyone over the age of 51 may prevent a substantial amount of otherwise necessary Medicare spending. The reality is that earlier medical intervention, prevention and wellness, and adequate treatment and management of chronic conditions will save money and lives in the short and long term.

People Uninsured Before Medicare Have Higher Medical Bills, Study Finds
By KATHARINE Q. SEELYE
New York Times, October 5, 2009

Expanding health insurance to cover everyone over the age of 51 might help save costs to Medicare in the long run, according to a new study reported in the Annals of Internal Medicine.

People between the ages of 51 and 65 who have intermittent health insurance or none at all end up costing Medicare about $1,023 more per year when they turn 65 than people who have had coverage all along, the report says.

That is largely because those without coverage usually put off treatment until they get Medicare, and by then their problems have become worse. It is particularly true for those with cardiovascular disease and diabetes and those who delay surgeries for arthritis, according to the study.

Once they start receiving Medicare, the report said, those with heart disease or diabetes are 48 percent more likely to be hospitalized for complications than those who have had coverage all along. Those with severe arthritis are 86 percent more likely to undergo hip and knee replacements once they start getting Medicare.

Medicare pays $5,796 a year for those over 51 who have not had insurance before, the study found, while it pays $4,773 for those who have been covered.

Expanding coverage to these adults would cost $197 billion over four years, the report said. But it would reduce subsequent spending by $98 billion, meaning the overall net cost over four years would be $99 billion.

The report’s principal investigators were J. Michael McWilliams and John Ayanian, both of Harvard Medical School. The study was paid for by the Commonwealth Fund, which supports an overhaul of the health-care system but does not advocate for specific legislation.

Source: http://prescriptions.blogs.nytimes.com/ ... udy-finds/

[roxybeast]

<center>Mayo Clinic Chief Offers An Alternate View:
Extend the Federal Employee Multiple Choice of Providers Plan to Everybody and Eventually Phase Out Medicare</center>

Mayo Clinic’s Chief Finds Health Care Debate ‘Heartbreaking’
By REED ABELSON
New York Times, October 5, 2009

The White House has often held out the Mayo Clinic as a model for health care. But Dr. Denis A. Cortese, the clinic’s chief executive, says he is disgusted with the current machinations in Washington over how to overhaul the nation’s health care system.

“Look at all the time we’re wasting,” Mr. Cortese said in an interview Thursday, critiquing the congressional debate. “It’s pretty heartbreaking to watch.”

Dr. Cortese, who has shared his views with White House officials and some Congressional Democrats, argues that Congress has become too enmeshed in the details — discussing what the benefit package in a health plan should look like, for example. Instead, he says, Congress should try to draft legislation charting an overall direction toward better medical care for the nation, then leave implementation to, say, the Department of Health and Human Services.

In his view, Congress already micromanages the Medicare program and has proven itself unable to withstand the political pressure and blandishments of lobbyists. “All of us are paying for it,” he said, noting the spiraling costs of the Medicare program and its lack of emphasis on high-quality care.

Because Dr. Cortese contends that Medicare has had such a poor track record, he has not been shy in opposing a government-run health care plan, or public option, which many liberal Democrats favor. Instead, he would urge Congress to create a national package of health insurance options modeled after the Federal Employees Health Benefits plan.

That program, the same one available to members of Congress, allows people to choose from a wide range of insurance offerings, with dozens of health insurers participating. If people want more generous coverage, they would have to pay more. The plans are vetted by the government, which also restricts the amount of profit the insurers can make on the basic policies.

Dr. Cortese would go even further. He suggests the program should be used to eventually replace Medicare, with federal subsidies as needed to help older Americans pay for the coverage.

That way, he says, the health insurance companies would be much more motivated than they are today to keep people healthier — making sure the diabetes they get in their 50s, for example, does not lead to medical problems in their 70s. Under the current system, he said, private insurers foist the costs of long-term health conditions off on Medicare.

If commercial insurers still provided coverage after people turned 65, he said, “all of a sudden, the insurance companies make money keeping you out of the hospital your whole life.”

Dr. Cortese’s interest in Medicare is not merely academic. Age 65, he is retiring from Mayo next month.

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

[roxybeast]

<center>Senate Finance Committee Approves Rockefeller Amendment to Extend Children's Health Insurance Program (CHIP) Beyond 2013</center>

Projecting Costs of a Health Care Overhaul Is an Inexact Science
By DAVID M. HERSZENHORN
New York Times, October 5, 2009

For but one example of why senators are anxiously awaiting the nonpartisan Congressional Budget Office’s cost estimate of the Finance Committee’s health care bill, consider Mr. Rockefeller’s CHIP amendment.

In its late-night race to complete debate of the big health care legislation last Thursday, the Finance Committee accepted an amendment by Senator John D. Rockefeller IV, Democrat of West Virginia, to continue CHIP — the Children’s Health Insurance Program — which is set to expire in 2013.

The committee’s original proposal had envisioned moving children now covered by CHIP onto insurance plans offered through new government-regulated marketplaces. Mr. Rockefeller, though, was worried that the benefits for children would be reduced.

To help sell his amendment, he said it would save up to $25 billion, because the children would not need subsidies to purchase insurance. That money, he said, could then be used to exempt high-risk professions (like coal miners and police officers) from a proposed new tax on high-cost insurance plans.

But nothing is simple in federal budgeting for health care.

The projected savings did not take into account the full future cost of sustaining CHIP. Although the Congressional Budget Office has assumed future spending on CHIP of $5.7 billion a year from 2014 to 2019, Senate Democratic aides say the cost is likely to be much higher — more like the $12.6 billion allocated for CHIP in 2010.

For lawmakers and White House officials concerned about the overall cost of the health care legislation, that could pose an obstacle to Mr. Rockefeller’s plan surviving in the Senate’s final bill. Which is why so much is riding on this week’s budget office cost analysis of the entire Finance Committee package.

Source: http://prescriptions.blogs.nytimes.com/ ... t-science/

[roxybeast]

<center>The Legislative Process: Where Are We Now?</center>
A look at the work that has been done by the Senate Finance Committee:

Debating Done, Now Comes a Budget Work-Up Before Voting on the Baucus Bill
By DAVID M. HERSZENHORN
New York Times, October 2, 2009

It wasn’t pretty at times, but at 2:15 a.m. Friday, the Senate Finance Committee finished debating amendments to its sweeping health care legislation. The bill will now be delivered to the Congressional Budget Office for a crucial cost estimate. A final vote on the measure is expected next week.

And while the committee adopted a number of important amendments in its final marathon session, just as critical may be the issues that the panel chose not to address.

The outstanding issues could be handled when the majority leader, Senator Harry Reid, Democrat of Nevada, works to meld the Finance Committee bill with an alternate measure approved by the Senate health committee back in July. Or these issues could wait until floor debate by the full Senate later this month.

The Finance Committee’s work, in the end, is just a dress rehearsal for the floor debate. And many of the big amendments that failed in committee debate, including a proposal by liberal Democrats to add a government-run insurance plan, or public option, will probably be proposed again for the entire Senate to consider.

My colleagues, Robert Pear and Jackie Calmes, who followed the committee proceedings through the wee hours of the morning, report some of the crucial changes that were made to the bill in the final session, including an easing of penalties the new law would require for people who fail to obtain health insurance.

The committee, in its homestretch, also adopted a proposal by Senator John D. Rockefeller IV, Democrat of West Virginia, to retain the Children’s Health Insurance Program as a stand-alone benefits package — rather than shift children and families onto plans to be offered through new state-run insurance marketplaces.

Mr. Reid’s office has already started working on combining the two bills.
Attention will also now shift back to the House, where Democrats are still wrangling over their version of the health legislation.

That effort should get a lift from the completion of the Finance Committee’s work, allowing lawmakers to take into account with greater certainty the Senate’s position on crucial issues, particularly how to pay for the health care overhaul.

House Democrats are still proposing a surtax on high-income Americans as a way to generate revenue. But the Senate shunned that idea, choosing instead to tax high-cost health insurance plans.

That proposal, which is opposed by labor unions that have negotiated generous benefits packages for their members, is viewed more warily in the House — where organized labor is a crucial constituency for many rank-and-file Democrats.

House leaders are considering whether they can incorporate some version of the tax on costly insurance policies into their bill.

As the process wrapped up on the Finance Committee, Republican senators sought assurances from the Finance Committee chairman, Senator Max Baucus, Democrat of Montana, that they would have sufficient time to study the completed bill and also to review the cost analysis that will be prepared by the nonpartisan budget office.

Mr. Baucus said, “I will make, in good faith, make sure there is a reasonable time in which senators, staffs, the public, can review the score by C.B.O.” He also said senators would be able to review the bill while the budget office completes its work, which could take three to four days.

If the cost analysis produces an acceptable price tag – lawmakers are hoping for no more than $900 billion over 10 years, fully offset by new taxes or reductions in government spending – Mr. Baucus said the panel would vote to send the bill to the full Senate.

“If the bill scores, then we vote on the bill, if it scores well,” he said. “On the other hand, if we have got a problem. We’ll have to make some adjustments.”

The Finance Committee is next scheduled to meet on Tuesday.

As exhausted, bleary-eyed staffers looked on, Mr. Baucus applauded the panel for its work and cheered the outcome.

“We have a product here that accomplishes our objectives,” he said. “It’s fiscally responsible. We can all be very proud of what we have achieved here.”

President Obama who was traveling in Europe, quickly issued a statement praising the Finance Committee’s efforts. “Thanks to the unyielding commitment of Senator Baucus and members of the Senate Finance Committee, we have reached another milestone in our effort to pass health insurance reform,” Mr. Obama said in the statement.

Mr. Obama added: “We have a long way to go, but I am confident that as we move forward, we will continue to engage with each other as productively as the members of the Finance Committee, and will get reform passed this year.”

Senator Charles E. Grassley of Iowa, the senior Republican on the Finance Committee, warned that most if not all of the Republicans on the panel would vote against the bill next week. But he praised Mr. Baucus for conducting a fair process.

Keep an eye on Prescriptions as we begin to comb through all of the amendments and bring you more news and analysis of the Finance Committee’s work.

Source: http://prescriptions.blogs.nytimes.com/ ... ucus-bill/

So where does the Senate Finance Committee legislation now stand?

Panel Finishes Work on Health Bill Amendments
By ROBERT PEAR and DAVID M. HERSZENHORN
New York Times, October 2, 2009

WASHINGTON — After a marathon session that ran well past midnight, the Senate Finance Committee on Friday passed a major milestone in its work on legislation to remake the health care system and provide coverage to millions of the uninsured.

The committee completed work on the last of dozens of amendments to the bill, written by the panel’s chairman, Senator Max Baucus, Democrat of Montana.

Committee members plan to vote on the bill next week after they receive an estimate of its costs from the Congressional Budget Office.

The bill would require most Americans to have insurance, would offer federal subsidies to help pay the premiums and would significantly expand Medicaid. To help offset the cost, it would cut hundreds of billions of dollars from the projected growth of Medicare, impose a new excise tax on high-cost insurance plans and charge annual fees to insurers, drug companies and manufacturers of medical devices.

Before it finished work at 2:15 a.m. Friday, the committee voted to reduce penalties on people who go without insurance. The maximum penalty for a family was cut to $800, from $1,900, and it would be phased in gradually from 2014 to 2017.

In its final hours, the committee also voted to modify the proposed tax on high-cost insurance policies, so fewer people would be affected. The tax would apply to policies with premiums exceeding $21,000, but the threshold would be $5,000 higher for health plans covering retirees or people in certain high-risk occupations.

The committee also adopted an amendment by Senator Bill Nelson, Democrat of Florida, to protect several million older Americans against the loss of extra benefits they receive from private Medicare Advantage plans.

It approved an amendment by Senator John D. Rockefeller IV, Democrat of West Virginia, to protect children against the disruption of coverage they receive under the Children’s Health Insurance Program.

And it agreed to a proposal by Senator Blanche Lincoln, Democrat of Arkansas, that would prevent health insurance companies from taking tax deductions for executive compensation in excess of $500,000.

In addition, the panel voted to provide $1 billion in tax credits to encourage investments in new therapies being developed by biotechnology companies.

Mr. Baucus said he was confident that “the bill can pass the Senate.” He told the panel, “We can all be very proud of what we achieved here.”

But the Senate Republican leader, Mitch McConnell of Kentucky, said at a news conference on Friday that some Democrats were showing “queasiness about this bill” because it “takes a half a trillion dollars out of Medicare over the next 10 years and raises billions of dollars in taxes on individuals and corporations.”

As the committee finished its work, Republican senators sought assurances from Mr. Baucus that they would have enough time to study the final bill and review the cost estimate from the Congressional Budget Office.

Mr. Baucus said, “I will make, in good faith, make sure there is a reasonable time in which senators, staffs, the public, can review the score by C.B.O.”

Lawmakers hope the price tag will not exceed $900 billion over 10 years, fully offset by new taxes or reductions in government spending. If the cost exceeds that amount, Mr. Baucus said, “we have got a problem,” and the committee will have to make adjustments.

In an initial answer to Republican concerns about having enough time to review the bill, Mr. Baucus posted the revised legislation, including all the amendments adopted in the last week of debate, on the committee’s Web site shortly before 6 p.m. Friday

Source: http://www.nytimes.com/2009/10/03/healt ... ealth.html

[roxybeast]

<center>Director of "Sicko" Michael Moore's Take on True Health Care Reform</center>

Michael Moore press conference addressing health care reform.

VIDEO: http://www.youtube.com/watch?v=VwlsDN-Ilkc

Moore describes Big Insurance denying a claim for PTSD resulting from rape by taking the position that the rape itself was a pre-existing condition, agreeing that having healthy citizens is actually a national security issue, and this comment: "When people have coverage, they go to get help, and they are not doing that now."

That is exactly the situation I have now. You might have noticed a few less posts last two week. It's because I seriously injured my shoulder. Broke something or tore a ligament. I can't lift my left arm or even stretch it out fully. There is excrutiating pain when I try to use my arm to reach for something and it aches most of the time even when I don't. It's seriously hurt, but not an "emergency," so I would go to a doctor if I had coverage or enough money, but instead I just endure the pain, which sometimes is really really bad, and wish that I had care like the people in every other leading developed nation in the world.

Here is the list of 13 reforms that the Director of the California Nurses Association and Moore propose are necessary as discussed in the video:

Why the Current Bills Don't Solve Our Health Care Crisis
by Michael Moore & Rose Ann DeMoro
Huffington Post, September 29, 2009

Co-authored with Rose Ann DeMoro, executive director, California Nurses Association/National Nurses Organizing Committee

Now we know why they've stopped calling this health care reform, and started calling it insurance reform. The current bills advancing in Congress look more like rearranging the deck chairs on the insurance Titanic than actually ending our long health care nightmare.

Some laudable elements are in various versions of the bills, especially expanding Medicaid, cutting the private insurance-padding waste of Medicare Advantage, and limiting the ability of the insurance giants to ban and dump people who have been or who ever will be sick.

But, overall, the leading bills and the President's proposal are, like the dog that didn't bark, more notable for what is missing.

Here are 13 problems with the current health care bills (partial list):

1. No cost controls on insurance companies. The coming sharp increases in premiums, deductibles, co-pays, co-insurance, etc. will quickly outpace any projected protections from caps on out-of-pocket costs.

2. Insurance companies will continue to be able to use marketing techniques to cherry-pick healthier, less costly enrollees.

3. No restrictions on insurance denials of care that insurers don't want to pay for. In case you missed it, the California Nurses Association /National Nurses Organizing Committee uncovered data on the California Department of Managed Care website recently that found six of the biggest California insurers rejected, on annual average, more than one-fifth of all claims every year since 2002.

4. No challenge to insurance company monopolies, especially in the top 94 metropolitan areas, where one or two companies dominate, severely limiting choice and competition.

5. A massive government bailout for the insurance industry through the combination of the individual mandate requiring everyone not covered to buy insurance, public subsidies which go for buying insurance, no regulation on what insurers can charge, and no restrictions on their ability to decide what claims to pay.

6. No controls on drug prices. The White House deal with Big Pharma, which won bipartisan approval in the Senate Finance Committee, opposes the use of government leverage to negotiate real cost controls on inflated drug prices.

7. No single standard of care. Our multi-tiered system remains with access to care still determined by ability to pay.

8. Tax on comprehensive insurance plans. That will encourage employers to reduce benefits, shift more costs to employees, promote proliferation of bare-bones, high-deductible plans, and lead to more self-rationing of care and medical bankruptcies.

9. Not universal. Some people will remain uncovered, including those exempted, and undocumented workers, denying them treatment, exposing everyone to communicable diseases and inflating health care costs.

10. No definition of covered benefits.

11. No protection for our public safety net. Public hospitals and clinics will continue to be under-funded and a dumping ground for those the private system doesn't want. Public monies going to hospitals serving low-income communities will be shifted to subsidies for private insurance.

12. Long delay in implementation. Many reforms don't go into effect until 2013.

13. Nothing changes in basic structure of the system; health care remains a privilege, not a right.

We may be slow learners, but the rest of the industrial world has figured it out: Universal, single-payer or national health care systems. That's the reason why all those other countries cover everyone, have better patient outcomes, cause no one to declare bankruptcy or lose their homes because of medical bills, and spend less than half per capita on health care than we do.

We could do it too, by reducing the starting age for Medicare from 65 to
0. There's still time to act.

Call on your Congress member to support the vote coming up on the House floor on the Anthony Weiner amendment to protect, expand and improve Medicare for All. Senators have the same opportunity in a vote on Senate bill 703, being offered as a floor amendment by Senator Bernie Sanders.

Democrats must also ensure that whatever bill passes includes a provision enabling states to set up their own single-payer systems. These votes are the true litmus tests of the Democrats' commitment to guaranteeing health care for all, and finally solving our health care crisis.

Source: http://www.huffingtonpost.com/michael-m ... 02483.html

[roxybeast]

<center>The Tide May Finally Be Turning</center>

Several influential top-ranking GOP leaders have recently come out in favor of passing health care reform, even if it includes a public option. The Democrats discuss a public option opt-out, i.e., passing the public option, but allowing states to opt-out of offering it. And some great commentary on from Bob Cescas & Keith Olberman ...

Bob Dole: Health Care Will Pass, GOP Should Be Open To Reform
by Sam Stein
Huffington Post, October 7, 2009

Former Senate Majority Leader Bob Dole (R-Kans.) told reporters on Wednesday that opposition to the president's health care package was driven, in part, by knee-jerk partisanship and he urged Congressional Republicans to consider backing a version of reform.

The 1996 Republican presidential candidate also predicted, following a speech at a health care reform summit in Kansas, that "there will be a signing ceremony" for a reform bill sometime this year or early in 2010.
But the comments that seem likely to create the most ripples were those that dealt with Congressional opposition to the White House. Dole, according to reports, framed the pushback to Barack Obama's reform agenda as almost perfunctory in nature.

"Sometimes people fight you just to fight you," he said, according to The Kansas City Star. "They don't want Reagan to get it, they don't want Obama to get it, so we've got to kill it..."

"Health care is one of those things," he added. "Now we've got to do something."

In a statement to the Huffington Post, an aide to the former majority leader clarified that Dole "believed there is an opportunity to do something on health care" but that he wasn't urging Republicans to simply get on board a final package.

"He talked about bipartisanship and its relation to the major pieces of legislation with which he has been involved," said Mike Marshall, a spokesman for the former senator. "He has not endorsed any bill or told anyone to get on board any bill. He has just said what he has been saying, which is that he believes Congress should work this out in a bipartisan way. He would like Republicans to stay engaged on the issue."

Dole's comments come at a time when other major GOP figures - all from outside Washington - have also urged the party to approach the issue of health care in a more collaborative matter. The list includes California Gov. Arnold Schwarzenegger and former Secretary of Health and Human Services Tommy Thompson. But Dole's remarks went a bit further- not just lamenting the lack of bipartisan compromise on reform but calling out individuals inside his own party.

"We're already hearing from some high-ranking Republicans that we shouldn't do that. That's helping the president," Dole said, according to local reports. He later would point to a "very prominent Republican, who happens to be the Republican leader of the Senate" -- Sen. Mitch McConnell (R-Ky.) -- as his reference.

Dole said he did not know what a final health care bill would look like, even though he was confident it would make it to the president's desk. But just hours after he spoke, reports began to surface that Republicans in Congress were moving closer to accepting a key tenet of the Democratic agenda. As reported by RedState.com's Erick Erickson:

I am told quite reliably that in a meeting today on Capitol Hill, Republican Senators began to rapidly move toward concessions on health care because they are afraid they cannot hold their members. Some Republicans are now thinking of supporting a government program.

UPDATE: Sen. McConnell's office, in a statement to the Huffington Post, dismissed reports that Senate Republicans are poised to back a public option.

"There are no GOP Senators calling for a government plan, or for other proposals such as cutting a half-trillion dollars from Medicare, raising premiums or increasing taxes on working families, that Democrat leaders are calling for," said Don Stewart, a spokesman for the Senator.

Souce: http://www.huffingtonpost.com/2009/10/0 ... 12837.html

Dole's statement comes on the heels of California Governor Arnold Schwarzenegger's announcement that he supports the public option.

Schwarzenegger Latest Republican To Back Health Care Reform
by Rachel Weiner
Huffington Post, October 6, 2009

California Gov. Arnold Schwarzenegger has joined other prominent Republicans in supporting Democratic health care reform legislation. "As Governor, I have made significant efforts to advance health reform in California," he said in a statement. "As the Obama Administration was launching the current debate on health care reform, I hosted a bipartisan forum in our state because I believe in the vital importance of this issue, and that it should be addressed through bipartisan cooperation."

Schwarzenegger is only the latest in a series of well-known GOPers to express such conciliatory opinions. In an interview with Time magazine last week, former Senate Majority Leader Bill Frist said he would vote for the Senate Finance Committee bill. (He later qualified his comments with some criticism of the bill on MSNBC, but he did not take back his words.)

Former Republican (now independent) New York City Mayor Michael Bloomberg also praised the plan on Monday. "The health reform proposal that Congress will shortly consider is shaping up to merit broad, bipartisan support, incorporating Republican ideas and earning deserved support from Republican leaders," he said in a statement. On the same, day, President George W. Bush's Health and Human Services Secretary Tommy Thompson said the Senate Finance Committee bill "moves us down the path of providing affordable, high-quality health care for all."

Source: http://www.huffingtonpost.com/2009/10/0 ... 11015.html

If you still aren't yet on the reform bandwagon because you have insurance, you might want to read this ...

The Health Insurance You Have Now Sucks
by Bob Cesca
Huffington Post, October 7, 2009

Over the weekend, I took a rainy walk down Wall Street and through the financial district in lower Manhattan. As I navigated my way across the busy intersections and between the arrays of decorative sidewalk bollards, I noticed something really strange.

No protesters.

None, despite the fact that within that very space, the near destruction of the world economy was detonated, igniting one of the deepest recessions in American history and accompanied by 500,000 job losses every month.

Not only was the district free of protesters, but I spotted a gaggle of grinning tourists merrily gathered on and around the famous "Charging Bull" statue. One woman was having her picture taken while crouched down and cupping the bull's gigantic watermelon-sized brass testicles.

Actually, you could say that there was at least one tea bagger downtown. But, you know, the wrong kind.

As I marveled at the incongruous serenity of the financial district, I couldn't help but to wonder if all of this talk about massive job losses and a near-meltdown was an elaborate hoax, or whether Americans by-in-large simply don't give a rip, choosing instead to continue on their merry way, acquiescing to a failed system rather than lashing out against the horrors of deregulatory Reaganomics, and, consequently, taking action against the real killers. In other words, while political participation appears to be cresting a wave, there's still a considerable level of apathy about demanding accountability from the crooks who nearly screwed us all.

This apathy is especially evident in the health care crisis.

The president likes to say, "If you like the health insurance you have now..." The problem is that much like your utter lack of financial security in a system that's been gamed by corporate criminals, the health insurance you have now... sucks.

From the early 1980s, when Reagan began the systematic deregulation of corporate America and declared war on the middle class, and lasting through and including the 2008 economic meltdown, the American economy has always been a ticking time bomb held together mostly by trickery and gambling. We were always meant to pick up the filthy mess when the meltdown occurred. And we did. Not just through the bailouts, but also through the loss of our jobs and the loss of our personal financial security, both of which helped to keep the culprits in business -- bonuses and golden parachutes included.

Likewise, the health care system is in the process of melting down, and for too many Americans it already has. And as for the rest of us who think our health insurance policies are excellent and secure are, in reality, in serious denial. Even now, we're paying more and more of our own money towards keeping this broken system afloat, and when the health care crisis kicks into high gear soon, who do you think will be obligated to pay for the greed and corruption responsible for the crisis?

Meanwhile, your premiums are being systematically jacked up until, one day, they'll extend beyond your financial means. It's only a matter of time before an injury or illness isn't covered due to, perhaps, a mistake on your application or the whim of a corporate bureaucrat. It's only a matter of time before your policy is suddenly rescinded in lieu of your insurance provider's profit margins which, by the way, have increased by upwards of 350 percent in the last decade. Your premiums, meanwhile, have more than doubled over that same ten years while middle class wages have remained flat. Reaganomics illustrated. Health care costs are destined to finish off what remains of the American middle class. Around 60 percent of all bankruptcies are due to health care debt with 78 percent of those bankruptcies filed by people with health insurance. Again, the insurance you have sucks and it's only the beginning of the bailout. We're nowhere near the high water mark.

At the very least, and at this very moment, we're all paying a 30 percent private tax to our insurance companies. This tax isn't being spent on our family's medical care and general wellness, but instead on corporate bureaucracy and profit. For the average family contributing to around half of an annual $13,000 employer-based premium, this private tax amounts to more than a thousand dollars a year (and rising) for nothing. No guarantees against rescinding our policies. No guarantees of coverage in the event of a serious illness. No guarantees that we'll be covered for a pre-existing condition. No guarantees that our rates won't be randomly jacked up for no reason. Nothing.

Even if you work for a health insurance company, your health care sucks. WellPoint is in the process of entirely stripping a "small number" of employees of their health insurance via pink slips, and the remaining employees will have to kick in more of their paycheck towards their monthly premiums (along with the obligatory 30 percent private tax, of course). It's worth mentioning that WellPoint is under investigation for coercing their employees into lobbying Congress against health care reform. Oh, and the CEO of WellPoint earned $10 million last year. Good people.

I sometimes wonder how bad things have to get in order for us to demand real change in this country. It didn't take long after 9/11 for shark attacks and celebrity scandals to dominate the very serious establishment press again. And judging by the empty sidewalks (and the festive molestation of that bull statue) in lower Manhattan, a near economic meltdown wasn't quite enough to rally us into the streets with pitchforks and torches, demanding accountability from the banks and financial institutions responsible for it. (ACORN and the "czars," on the other hand, must be destroyed!)

Likewise, the list of very obvious grievances against the health insurance cartels apparently isn't lengthy and awful enough to spark much more than tepid popular support for reform even though 3,750 Americans die every month from a lack of health care. That's more casualties than 9/11 every 30 days. Maybe if we nicknamed the health insurance companies "evildoers" who need to be "smoked out" we'd make a little more progress. We'd certainly get a reform bill a lot more quickly, based upon the PATRIOT Act express lane turnaround time.

But Republicans don't want to do a damn thing if it means a victory for the president, while too many congressional Democrats would be happy to pass a shoddy bill put forth by a mostly unknown senator from Montana who is proudly attempting to legally require us to buy insurance from the criminal cartels responsible for this mess and without any public insurance option as an escape hatch. Naturally, this is the result of the fact that the health care industry is contributing millions to key senators including Mr. Baucus from Montana. Oh, and the Supreme Court is poised to allow corporations unlimited financial access to political campaigns -- a move that will surely exacerbate the health care crisis, among other things.

This is about as serious as it gets. The health insurance you have now sucks. And it's only going to get suckier as time wears on unless serious change happens now.

Source: http://www.huffingtonpost.com/bob-cesca ... 13103.html

Keith Olbermann delivered an hour-long "Special Comment" tonight (October 7, 2009) on the urgent need for health care reform. Drawing on his personal experiences with the system, especially the ordeal of his father falling gravely ill and being hospitalized, Olbermann describes a decaying system that is failing to fulfill one of the most important priorities we have as a nation: taking care of our citizens.

Olbermann particularly targets the insurance companies, illustrating how their business models are more focused on making money than helping people, which leads to very perverse incentives. The insurance companies are concerned about profit, which is why they're fighting against health reform. Olbermann concludes, "The insurance companies are at war with America."

At the end of the show, Olbermann states that he is going to demonstrate his support for reform by donating money to help the establishment of free clinics in the capital cities of each of the states of the six senators who are blocking reform. He will offer further information on how other can participate.

Here's a link, which includes video for the whole show:
http://www.huffingtonpost.com/2009/10/0 ... 11125.html

So what is this new public option opt-out idea? Perhaps this will help ...

Dems Discussing Public Option With Opt-Out Clause: The Silver Bullet?
by Sam Stein
Huffington Post, October 7, 2009

Senate Democrats have begun discussions on a compromise approach to health care reform that would establish a robust, national public option for insurance coverage but give individual states the right to opt out of the program.

The proposal is envisioned as a means of getting the necessary support from progressive members of the Democratic Caucus -- who have insisted that a government-run insurance option remain in the bill -- and conservative Democrats who are worried about what a public plan would mean for insurers in their states.

"What folks are looking for is what gets 60 votes," said a senior Democratic Hill aide. "The opt-out idea is very appealing to people. It has come up in conversations. I know personally that a handful of members have discussed it amongst themselves."

In conversations with the Huffington Post, sources have said that while the opt-out approach to the public plan is in its nascent stages it has been discussed with leadership in the Senate. It was pulled out of an alternative idea, put forth by Sen. Tom Carper (D-Del.) and, prior to him, former Senate Majority Leader Tom Daschle, to give states the power to determine whether they want to implement a public insurance option.

But instead of starting with no national public option and giving state governments the right to develop their own, the newest compromise approaches the issue from the opposite direction: beginning with a national public option and giving state governments the right not to have one.

"It is being discussed," said one progressive strategist who has been working on reform with both the White House and Congress. "In the end obviously, the goal and near-term exercise is to get to the bargaining table and get to the conference committee between the Senate and House with the strongest position [on the public plan] possible."

How such a system would work is still being debated, according to those with knowledge of the proposal. But theoretically, the "opt-out" approach would start with everyone having access to a public plan. What kind of public plan isn't yet clear. States would then have the right to vote -- either by referendum, legislature, or simply a gubernatorial decree -- to make the option unavailable in their health care exchanges.

For conservative Democrats -- especially those from states with major private health insurance industry interests -- this concession could be key, allowing them to punt a vote on a public plan to local governments. For progressives, it would not be the hardest pill to swallow.

"It is clearly much better than triggers and [Carper's] opt-ins," said Richard Kirsch, executive director of the group Health Care For Americans Now. "A trigger option is a way to kill the public option and these opt ins are not effective because it leaves it up to state legislatures to set it up..."

Another Democrat working on reform legislation added, "If everyone gets a plan, and states have to affirmatively vote, preferably by referendum, to opt out. I really don't see a lot of states opting out, for one. And, for two, you get your national [public plan] available everywhere. If a few holes start appearing, it's not nearly as fatal as if you went with the Carper plan, which after a few years might mean 10 or 20 [state-based] public options. If you go the other way, you'll probably have like 47 states. It's a big difference."

Naturally, there are still major question marks about the opt-out approach. For starters, will all progressives be on board? With 60 caucusing members in the Senate, the argument has been made that the liberal wing of the party has already compromised enough to stop the Republicans from filibustering legislation. Moreover, the House of Representatives seems all but certain to pass legislation that includes a robust public plan. Would legislators in that chamber be willing to add a opt-out provision for the sake of picking up Senate votes?

Down the road there are also obvious concerns. As Kirsch notes, private insurance companies are major players in state politics as well as on the national level. A slew of lobbying campaigns could erupt to push state governments to opt out of a government-run plan.

Finally, there are still doubts that the opt-out approach would have the votes needed to pass through the Senate. As one somewhat exacerbated Democratic aide noted, "There are people who are very uncomfortable with the public option generally and this won't necessarily deviate their concern."

Source: http://www.huffingtonpost.com/the-news/ ... /sam-stein

Some more information on CBO cost estimates recently released ...

CBO: Baucus Bill Reduces Deficit By $81 Billion, Costs $829 Billion Over A Decade
By David Espo, AP
Huffington Post, October 7, 2009

WASHINGTON — Health care legislation drafted by a key Senate committee would expand coverage to 94 percent of all eligible Americans at a 10-year cost of $829 billion, congressional budget experts said Wednesday, a preliminary estimate trumpeted by the White House and likely to power the measure past a major hurdle within days.

The Congressional Budget Office added that the legislation would reduce federal deficits by $81 billion over a decade and probably lead to "continued reductions in federal" red ink in the years beyond.

The report paves the way for the Senate Finance Committee to vote as soon as early next week on the legislation, which is largely in line with President Barack Obama's call for the most sweeping overhaul of the nation's health care system in a half-century.

At the White House, spokesman Reid Cherlin said the analysis "confirms that we can provide stability and security for Americans with insurance and affordable options for uninsured Americans without adding a dime to the deficit and saving money over the long term."
Sen. Max Baucus, D-Mont., the committee chairman and principal architect of the measure, hailed the estimates within moments of receiving them.

"This legislation, I believe, is a smart investment on our federal balance sheet. It's an even smarter investment for American families, businesses and our economy," he said on the Senate floor.

Sen. Chuck Grassley of Iowa, the senior Republican on the panel, saw it differently. "A celebration of the deficit effects masks who pays the bills. This package includes hundreds of billions of dollars in new taxes and fees," he said in a statement.

The committee Baucus chairs is the fifth and last of the congressional panels to debate health care. The Senate Finance version has a decided middle-of-the-road flavor, shunning any provision for the government to sell insurance in competition with private industry. That provision, strongly favored by many Democrats and just as strongly opposed by Republicans, remains alive, though. It was included in legislation approved by another Senate committee, and is also expected to be included in the House bill.

The Finance Committee bill does not require businesses to offer coverage to their workers, either, although large firms that do not would be required to offset the cost of any government subsidies going to those employees.

While generally positive about the legislation's effects, the report contained important caveats.

One noted that the estimate does not include the costs of proposed payment increases for doctors serving Medicare patients, roughly $200 billion through 2019. Additionally, a so-called fail-safe mechanism to hold spending in line could result in cuts as large as 15 percent in federal subsidies designed to help the poor afford insurance, CBO said.

Beginning in 2013, the measure would require that millions of Americans purchase private insurance for the first time, and would set up a new marketplace where policies would be available. Failure to obey the requirement would result in penalties of up to $750 per family.

Federal subsidies would be available to millions of lower-income individuals and families to help defray the cost of coverage that would otherwise be out of their reach. The alternative to government-sold health care, a proposal for nonprofit co-ops that would compete with private companies, was judged largely ineffective by budget officials. Such arrangements "seem unlikely to establish a significant medical presence in many areas of the country," they wrote.

The legislation also would ban current insurance industry practices that deny coverage on the basis of pre-existing medical conditions, and restrict companies' ability to charge vastly higher premiums on the basis of age, gender or other factors.

The measure would be paid for through a variety of tax increases and spending cuts, including savings of hundreds of billions of dollars from Medicare, the federal health care program for seniors.

Democratic leaders are hoping to hold votes on health care on the floor of the House and Senate within a few weeks.

Anticipating approval by the Finance Committee this week, Majority Leader Harry Reid has already begun efforts to merge that bill with an alternative approved by the Senate Committee on Health, Education, Labor and Pensions.

Reid is subject to intense cross-pressures, not only from the members of the two committees, but also from the Obama administration and rank-and-file senators seeking to mold the legislation to their liking.
Reid also must take into account the likely need to amass 60 votes behind any legislation, the majority needed to overcome any Republican filibuster.

The Senate Republican leader, Sen. Mitch McConnell of Kentucky, dismissed the draft bill as a partisan blueprint and predicted Reid would replace it with "another 1,000-page, trillion-dollar experiment that slashes a half-trillion dollars from seniors' Medicare, raises taxes on American families by $400 billion, increases health care premiums and vastly expands the role of the federal government in the personal health care decisions of every American."

Baucus has expressed confidence he has the votes for his measure inside the Finance Committee, and the major lingering question there is whether Sen. Olympia Snowe, R-Maine, will break ranks with fellow Republicans and vote for it. She urged Baucus not to force a vote before next week, and remained noncommittal.

"On the positive side, just in looking at the number, $829 (billion) that's less than what we started with," Snowe said. But we have a lot to review."

Wednesday's report to Baucus from CBO's director, Dr. Douglas Elmendorf, stressed that the estimates were preliminary.

It said that by 2019, "the number of nonelderly people who are uninsured would be reduced by about 29 million," either through private insurance or by enrolling in federal programs. That would leave an additional 25 million uninsured, about one-third of them illegal immigrants who are not eligible for coverage under the bill.

"Under the proposal, the share of legal nonelderly residents with insurance coverage would rise from about 83 percent currently to about 94 percent," Elmendorf said. Elderly Americans are eligible for coverage under the federal Medicare program.

The report was released as House Democrats met privately to consider ways to hold the cost of their version of the legislation to the $900 billion 10-year limit that Obama has set.

Officials said one of the options under review would add as many as 7 million lower-income individuals to Medicaid, the federal-state health care program for the poor. It would be cheaper for the government to cover costs under that program than to pay subsidies designed to make private insurance affordable for the same group. Aides put the savings at about $25 billion over 10 years.
___
Associated Press writers Ricardo Alonso-Zaldivar, Julie Hirschfeld Davis and Erica Werner contributed to this report.

Source: http://www.huffingtonpost.com/2009/10/0 ... 13017.html

As HuffPost's Roy Sekoff points out, the tide may finally be turning ...

Health Care Reform Gaining Momentum (VIDEO)
Huffington Post, October 7, 2009

HuffPost's Editor, Roy Sekoff, appeared on the Ed Show along with Sens. Kent Conrad and Sherrod Brown to discuss the latest developments in the health care battle. "A funny thing happened on the way to the health care reform funeral," he said. "The momentum has definitely shifted." Sekoff pointed to the recent slew of Republicans speaking out about the need to pass health care reform, including Bill Frist, Arnold Schwarzenegger, and former Republican presidential candidate Bob Dole, who not only told Republicans they need to get on board with health care, but also said that those in his party opposing reform were doing so out of knee-jerk partisanship. "And he named names," said Sekoff, "he specifically called out Senate Minority Leader Mitch McConnell for his obstructionism."

Source: http://www.huffingtonpost.com/huff-tv/h ... 13302.html

WATCH: (Roy's first segment begins at 8:28, and then continues after Senator Brown at 11:25)

<div><iframe height="339" width="425" src="http://www.msnbc.msn.com/id/22425001/vp ... 0#33216140" frameborder="0" scrolling="no"></iframe><p>Visit msnbc.com for <a href="http://www.msnbc.msn.com">Breaking News</a>, <a href="http://www.msnbc.msn.com/id/3032507">World News</a>, and <a href="http://www.msnbc.msn.com/id/3032072">News about the Economy</a></p></div>

Breaking News ... Rachel Maddow reports that Democrat leadership may pull chairmanships from any Democrats who do not vote to overcome a filibuster on health care reform legislation ...

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[roxybeast]

<center>VIDEO: Olbermann Hour Long Special on Health Care Reform</center>
(Now that I've figured out how to post video on this site, I wanted to post the video for Olbermann's show, so you can watch it here ...)

Keith Olbermann delivered an hour-long "Special Comment" tonight (October 7, 2009) on the urgent need for health care reform. Drawing on his personal experiences with the system, especially the ordeal of his father falling gravely ill and being hospitalized, Olbermann describes a decaying system that is failing to fulfill one of the most important priorities we have as a nation: taking care of our citizens.

Olbermann particularly targets the insurance companies, illustrating how their business models are more focused on making money than helping people, which leads to very perverse incentives. The insurance companies are concerned about profit, which is why they're fighting against health reform. Olbermann concludes, "The insurance companies are at war with America."

At the end of the show, Olbermann states that he is going to demonstrate his support for reform by donating money to help the establishment of free clinics in the capital cities of each of the states of the six senators who are blocking reform. He will offer further information on how other can participate.

Part 1
<div><iframe height="339" width="425" src="http://www.msnbc.msn.com/id/22425001/vp ... 9#33217219" frameborder="0" scrolling="no"></iframe><p>Visit msnbc.com for <a href="http://www.msnbc.msn.com">Breaking News</a>, <a href="http://www.msnbc.msn.com/id/3032507">World News</a>, and <a href="http://www.msnbc.msn.com/id/3032072">News about the Economy</a></p></div>

Part 2
<div><iframe height="339" width="425" src="http://www.msnbc.msn.com/id/22425001/vp ... 6#33217296" frameborder="0" scrolling="no"></iframe><p>Visit msnbc.com for <a href="http://www.msnbc.msn.com">Breaking News</a>, <a href="http://www.msnbc.msn.com/id/3032507">World News</a>, and <a href="http://www.msnbc.msn.com/id/3032072">News about the Economy</a></p></div>

Part 3
<div><iframe height="339" width="425" src="http://www.msnbc.msn.com/id/22425001/vp ... 6#33217346" frameborder="0" scrolling="no"></iframe><p>Visit msnbc.com for <a href="http://www.msnbc.msn.com">Breaking News</a>, <a href="http://www.msnbc.msn.com/id/3032507">World News</a>, and <a href="http://www.msnbc.msn.com/id/3032072">News about the Economy</a></p></div>

Part 4
<div><iframe height="339" width="425" src="http://www.msnbc.msn.com/id/22425001/vp ... 6#33217446" frameborder="0" scrolling="no"></iframe><p>Visit msnbc.com for <a href="http://www.msnbc.msn.com">Breaking News</a>, <a href="http://www.msnbc.msn.com/id/3032507">World News</a>, and <a href="http://www.msnbc.msn.com/id/3032072">News about the Economy</a></p></div>

Part 5
<div><iframe height="339" width="425" src="http://www.msnbc.msn.com/id/22425001/vp ... 2#33217592" frameborder="0" scrolling="no"></iframe><p>Visit msnbc.com for <a href="http://www.msnbc.msn.com">Breaking News</a>, <a href="http://www.msnbc.msn.com/id/3032507">World News</a>, and <a href="http://www.msnbc.msn.com/id/3032072">News about the Economy</a></p></div>

[roxybeast]

<center>New Poll Finds Support for Health Reform Growing</center>

Health Care Poll: AP Finds Growing Support For Overhaul
by RICARDO ALONSO-ZALDIVAR and TREVOR TOMPSON
Huffington Post, October 7, 2009

WASHINGTON — The fever has broken. The patient is out of intensive care. But if you're President Barack Obama, you can't stop pacing the waiting room. Health care overhaul is still in guarded condition.

The latest Associated Press-GfK poll has found that opposition to Obama's health care remake dropped dramatically in just a matter of weeks. Still, Americans remain divided over complex legislation that Democrats are advancing in Congress.

The public is split 40-40 on supporting or opposing the health care legislation, the poll found. An even split is welcome news for Democrats, a sharp improvement from September, when 49 percent of Americans said they opposed the congressional proposals and just 34 percent supported them.

Anger about health care boiled over during August. Lawmakers returning home for town hall meetings faced outcries that the government was trying to take over the system, ushering in higher costs, lower quality – even rationing and euthanasia.

"It's very significant that there's an upturn in support for the plans
because after August there was a sense that the whole effort was beginning to decline and would not come back in terms of public support," said Robert Blendon, a Harvard professor who tracks public opinion on health care.

"Even with this," added Blendon, "the country is still divided over whether or not moving ahead is the right thing to do." A large number of Americans – 17 percent _say they neither support nor oppose the health legislation, suggesting many have unanswered questions.

Still, a shift has taken place. Behind it seems to be a growing determination among Democrats to move forward. Meanwhile, political independents don't appear as alarmed about the congressional proposals as they were just a few weeks ago. Still, opponents remain more passionate in their convictions than do supporters.

In a significant change, opposition among older Americans dropped 16 percentage points. Seniors have been concerned that Congress would stick them with the bill by cutting Medicare to pay for covering the uninsured. Among the most reliable voters, they were much more wary of the changes than the public as a whole. The gap has narrowed.

The poll found that 68 percent of Democrats support the congressional plans, up from 57 percent in early September. Opposition among independents plunged from 51 percent to 36 percent. However, only 29 percent of independents currently support the plans in Congress.
Among seniors, opposition fell from 59 percent in September to 43 percent now. Almost four in 10, 38 percent, now support it, compared with 31 percent in September.

Retiree Sandi Murray, 65, of Hesperia, Mich., said she doesn't have any concerns her Medicare coverage will suffer. "I think it will be A-OK," she said.

Murray said she thinks it's time to address the problems of nearly 50 million people without coverage. "We need to do something so that everybody has some amount of coverage for some reasonable amount of money," she said.

Republicans remain solidly against the congressional health care plans, with four out of five opposed. However, even 13 percent say they support the bills in Congress, a contrast with the mood of GOP lawmakers, who are all but unanimously opposed.

Americans overwhelmingly say it's important that health care legislation have the support of both parties, but Democrats are showing signs of impatience. Fifty-seven percent say Obama and the Democrats should pass a bill this year even if they are unable to win support from Republicans.

Blendon credits Obama's speech to Congress in early September and his blitz of media interviews and appearances since then for moving public opinion toward the positive column. What some have criticized as presidential hyperactivity, many Americans took as a sign that the president was taking ownership of the issue, Blendon said.

Before his prime-time speech to Congress, 52 percent disapproved of Obama's handling of health care. Now the public is split, with 48 percent approving and 47 percent disapproving.

"Getting more directly involved in the outcome is what people expect a president to be doing," said Blendon.

There's still deep skepticism that the government can fix the health care system to expand coverage and tamp down rising costs.

Andrew Newcomb, 28, who works in sales and lives near Destin, Fla., said he doesn't think taxpayers should have to take on the costs of covering the uninsured.

"I don't want my tax money to pay for some pill-popper to fake some injury and go to the hospital when I don't ever go to the hospital," said Newcomb, adding he can afford to go to the doctor and pay $60 for a checkup.

The congressional bills would require all Americans to get health insurance, either through an employer, through a government program or on their own. Tax credits would be offered for many of those who buy their own coverage but failure to comply could result in a fine.
"I don't think that the government should supply health care to the people," said Newcomb.

The AP-GfK poll was conducted Oct. 1-5, based on a nationally representative sample of 1,003 adults age 18 or older, contacted by telephone on land lines and cell phones. The margin of sampling error is plus or minus 3.1 percentage points for results based on the entire sample.
___
Associated Press writer Natasha Metzler contributed to this report.

Source: http://www.huffingtonpost.com/2009/10/0 ... 12151.html

[roxybeast]

<center>Make It Real</center>

Perhaps Kristof is right. If Senators and Congressman faced the prospect of having the same kind of insurance as their constituents, which is in a lot of cases none or inadequate, in the same percentages, if they voted against health care reform, would their opinions change?

Let Congress Go Without Insurance
By NICHOLAS D. KRISTOF
New York Times, October 7, 2009

Let me offer a modest proposal: If Congress fails to pass comprehensive health reform this year, its members should surrender health insurance in proportion with the American population that is uninsured.

It may be that the lulling effect of having very fine health insurance leaves members of Congress insensitive to the dysfunction of our existing insurance system. So what better way to attune our leaders to the needs of their constituents than to put them in the same position?

About 15 percent of Americans have no health insurance, according to the Census Bureau. Another 8 percent are underinsured, according to the Commonwealth Fund, a health policy research group. So I propose that if health reform fails this year, 15 percent of members of Congress, along with their families, randomly lose all health insurance and another 8 percent receive inadequate coverage.

Congressional critics of President Obama’s efforts to achieve health reform worry that universal coverage will be expensive, while their priority is to curb social spending. So here’s their chance to save government dollars in keeping with their own priorities.

Those same critics sometimes argue that universal coverage needn’t be a top priority because anybody can get coverage at the emergency room. Let them try that with their kids.

Some members also worry that a public option (an effective way to bring competition to the insurance market) would compete unfairly with private companies and amount to a step toward socialism. If they object so passionately to “socialized health,” why don’t they block their 911 service to socialized police and fire services, disconnect themselves from socialized sewers and avoid socialized interstate highways?

I wouldn’t wish the trauma of losing health insurance on anyone, but our politicians’ failure to assure health care for all citizens is such a longstanding and grievous breach of their responsibility that they deserve it. In January 1917, Progressive Magazine wrote: “At present the United States has the unenviable distinction of being the only great industrial nation without universal health insurance." More than 90 years later, we still have that distinction.

Theodore Roosevelt campaigned for national health insurance in 1912. Richard Nixon tried for universal coverage in 1974. Yet, even now, nearly half of Congress is vigorously opposed to such a plan.

Health care has often been debated as a technical or economic issue. That has been a mistake, I believe. At root, universal health care is not an economic or technical question but a moral one.

We accept that life is unfair, that some people will live in cramped apartments and others in sprawling mansions. But our existing insurance system is not simply inequitable but also lethal: a very recent, peer-reviewed article in the American Journal of Public Health finds that nearly 45,000 uninsured people die annually as a consequence of not having insurance. That’s one needless death every 12 minutes. http://www.pnhp.org/news/2009/september ... finds_.php

When nearly 3,000 people were killed on 9/11, we began wars and were willing to devote more than $1 trillion in additional expenses. Yet about the same number of Americans die from our failed insurance system every three weeks.

The obstacle isn’t so much money as priorities. America made it a priority to provide tax breaks, largely to the wealthy, in the Bush years, at a 10-year cost including interest of $2.4 trillion. Allocating less than half that much to assure equal access to health care isn’t deemed an equal priority.

The plan emerging in the Senate is no panacea. America needs to promote exercise and discourage sugary drinks to hold down the rise in obesity, diabetes and medical bills. We need more competition among insurance companies. And conservatives are right to call for tort reform to reduce the costs of malpractice insurance and defensive medicine.

But those steps are not a substitute for guaranteed health coverage for all Americans. And if health reform fails this year, then hopes for universal coverage will recede again. There was a lag of 19 years after the Nixon plan before another serious try, and a 16-year lag after the Clinton effort of 1993. Another 16-year delay would be accompanied by more than 700,000 unnecessary deaths. That’s more Americans than died in World War I, World War II, Korea, Vietnam and Iraq combined.

The collapse of health reform would be a political and policy failure, but it would also be a profound moral failure. Periodically, there are political questions that are fundamentally moral, including slavery in the 19th century and civil rights battles in the 1950s and ’60s. In the same way, allowing tens of thousands of Americans to die each year because they are uninsured is not simply unwise and unfortunate. It is also wrong — a moral blot on a great nation.

Source: http://www.nytimes.com/2009/10/08/opini ... istof.html