Beth's Health Care Reform Blog

A humorously serious look at life’s trials & tribulations,
American politics, religion, and other social madnesses by Beth Isbell.

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Post by roxybeast » November 22nd, 2009, 2:01 am

Senate Votes To Debate Health Care Reform Bill (with VIDEO)
Huffington Post, November 21, 2009

WASHINGTON — Invoking the memory of Edward M. Kennedy, Democrats united Saturday night to push historic health care legislation past a key Senate hurdle over the opposition of Republicans eager to inflict a punishing defeat on President Barack Obama. There was not a vote to spare.

The 60-39 vote cleared the way for a bruising, full-scale debate beginning after Thanksgiving on the legislation, which is designed to extend coverage to roughly 31 million who lack it, crack down on insurance company practices that deny or dilute benefits and curtail the growth of spending on medical care nationally.

VIDEO: Final Vote on Cloture Motion:
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VIDEO: Senator Reid's Press Conference After Tonight's Vote:
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The spectator galleries were full for the unusual Saturday night showdown, and applause broke out briefly when the vote was announced. In a measure of the significance of the moment, senators sat quietly in their seats, standing only when they were called upon to vote.

In the final minutes of a daylong session, Majority Leader Harry Reid, D-Nev., accused Republicans of trying to stifle a historic debate the nation needed.

"Imagine if, instead of debating whether to abolish slavery, instead of debating whether giving women and minorities the right to vote, those who disagreed had muted discussion and killed any vote," he said.

The Republican leader, Sen. Mitch McConnell of Kentucky, said the vote was anything but procedural – casting it as a referendum on the bill itself, which he said would raise taxes, cut Medicare and create a "massive and unsustainable debt."

For all the drama, the result of the Saturday night showdown had been sealed a few hours earlier, when two final Democratic holdouts, Sens. Mary Landrieu of Louisiana and Blanche Lincoln of Arkansas, announced they would join in clearing the way for a full debate.

"It is clear to me that doing nothing is not an option," said Landrieu, who won $100 million in the legislation to help her state pay the costs of health care for the poor.

Lincoln, who faces a tough re-election next year, said the evening vote will "mark the beginning of consideration of this bill by the U.S. Senate, not the end."

Both stressed they were not committing in advance to vote for the bill that ultimately emerges from next month's debate.

Of particular contentiousness to moderates is a provision for the government to sell insurance in competition with private companies, subject to state approval – a part of Reid's bill expected to come under significant pressure as the debate unfolds.

Even so, their announcements marked a major victory for Reid and the White House in a year-end drive to enact the most sweeping changes to the nation's health care system in a half-century or more.

The legislation would require most Americans to carry insurance and provide subsidies to those who couldn't afford it. Large companies could incur costs if they did not provide coverage to their workforce. The insurance industry would come under significant new regulation under the bill, which would first ease and then ban the practice of denying coverage on the basis of pre-existing medical conditions.

Congressional budget analysts put the legislation's cost at $979 billion over a decade and said it would reduce deficits over the same period while extending coverage to 94 percent of the eligible population.

At its core, the legislation would create insurance exchanges beginning in 2014 where individuals, most of them lower income and uninsured, would shop for coverage. The bill sets aside hundreds of billions of dollars in tax credits to help those earning up to 400 percent of poverty, $88,200 for a family of four.

The House approved its version of the bill earlier this month on a near party line vote of 220-215, and Reid has said he wants the Senate to follow suit by year's end. Timing on any final compromise was unclear.

All 58 Senate Democrats and two independents voted to advance the bill. All 39 votes in opposition were cast by Republicans. GOP Sen. George Voinovich of Ohio was the only senator not to vote.

While timing made Landrieu and Lincoln the final two Democrats to announce their intentions, Sen. Paul Kirk of Massachusetts had a clear claim as the 60th vote.

Appointed to office this fall after the death of Kennedy, who championed health care issues for decades, Kirk said he spoke for those "who for so many years revered and loved and elected and re-elected (him) ... that I think they're all – they all, as we do, have him in our minds and our hearts tonight. ..."

Sen. Chris Dodd, D-Conn., echoed those sentiments later in the evening when he referred to Kennedy's "lifelong quest" for national health care and said "tonight and in the days to come we will pay him the highest compliment by fulfilling that" goal.

At a post-vote news conference, Reid said he had telephoned Kennedy's widow, Vicki, with the news.

In hours of debate before the Saturday evening vote, a few Republicans piled copies of the 2,0974-page bill on their desks while others criticized it as a government takeover of health care and worse.

"Move over, Bernie Madoff. Tip your hat to a trillion-dollar scam," said Sen. Kit Bond, R-Mo., likening the bill's supporters to the imprisoned investor who fleeced millions.

In her remarks, Landrieu said, "I've decided that there are enough significant reforms and safeguards in this bill to move forward, but much more work needs to be done." She also touted the $100 million included in the legislation to help her state cover its costs under Medicaid, the state-federal health care program for the poor.

Lincoln referred repeatedly to the political controversy surrounding the issue. She said $3.3 million has already been spent by outside groups advertising either for or against health care legislation, and said, "these outside groups seem to think that this is all about my re-election. I simply think they don't know me very well."

To finance the expanded coverage, Reid proposed higher taxes as well as cuts totaling hundreds of billions of dollars in projected Medicare payments. Hardest hit would be the private insurance Medicare plans, although providers such as home health agencies would also receive significantly less in future years than now estimated.

The bill raises payroll taxes on incomes over $200,000 for individuals and $250,000 for couples. Reid eased the impact of an earlier proposal to tax high-value insurance plans, which has emerged as one of the principal methods for restraining the growth in health costs.

The bill includes tax increases on insurance companies, medical device makers, patients electing to undergo cosmetic surgery and drugmakers.

___

Associated Press writer Donna Cassata contributed to this article.

Source: http://www.huffingtonpost.com/2009/11/2 ... 66598.html

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Post by roxybeast » November 22nd, 2009, 7:10 am

<center>Dems Got 60 Tonight, But Will Also Need 60 to Close Debate</center>
The Democrats got the 60 votes needed to open debate a move the bill forward tonight, but apparently they will need 60 votes again to close debate and call for a final vote on the bill. That may prove difficult, but let's hope that tonight's vote signals an agreement of 60 democrats to unite on not only tonight's vote, but all required procedural votes.
Reid Gets His 60 Votes, but Still Has His Work Cut Out
Katie Connolly

Newsweek, November 21, 2009

It's official: Harry Reid has corralled enough votes to bring his health-care-reform bill to the floor. Blanche Lincoln became the 60th Democrat committed to voting to allow debate to open on the bill, following her moderate colleague Mary Landrieu, who also announced today that she'd vote aye. But Reid still has his work cut out for him. This vote signals little about the ultimate viability of the bill. For all the furrowed brows and gnashing of teeth to get to today's 60 yes votes, this vote simply says that the Senate is prepared to have a debate on the bill. From here, the bill will be discussed and possibly amended. Then Reid must find another 60 votes to end the debate, and then he'll need at least 51 senators who want to vote the final product up. Clearly his work is far from over. This reluctance to even allow the bill to be debated—keeping in mind there will be two other opportunities to vote against it—illustrates the depth of moderate concerns.

Neither Lincoln's nor Landrieu's vote today comes with a guarantee that the senators will support the final bill. Both have expressed serious reservations about the legislation, particularly the inclusion of the opt-out public option. They might vote to amend the public option to a trigger version, or they might vote to strip it out of the bill entirely. It's unclear. But Landrieu offered one glimmer of hope to her liberal counterparts today, saying that on the public option she "would consider a principled compromise because I understand this is one of the issues we have to find a solution for or it could blow up the whole effort."

Reid also faces problems in the form of Ben Nelson, who will torpedo the bill if it doesn't contain stronger anti-abortion provisions, and Joe Lieberman, who said he'd join a Republican filibuster if the public-option provision isn't changed. So the bill still has a ways to go, but at least now the Senate will have an open debate about it.

Source: http://blog.newsweek.com/blogs/thegaggl ... t-out.aspx

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Post by roxybeast » November 22nd, 2009, 1:11 pm

If you want to review all the posts in this health care blog from the beginning ... which contains lots of great articles and studies concerning every aspect of health care reform from the beginning of this debate & documents the history of this legislation & the various bills ....

Click here: http://www.studioeight.tv/phpbb/viewtopic.php?t=16924

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Post by roxybeast » November 22nd, 2009, 1:54 pm

<center>AARRRGH!!! LIEBERMAN!!!</center>
ARRRGH!!! LIEBERMAN!!! ... as Jon Stewart would say. :),
Lieberman: 'I Don't Think Anybody Thinks This Bill Will Pass'
by Sam Stein

Huffington Post, November 22, 2009

Senator Joseph Lieberman (I-Conn.), reaffirmed on Sunday that he will support a Republican filibuster of any health care bill that includes a government-run insurance option.

Appearing on the "Meet the Press," the Connecticut independent said that neither he, nor anybody else believed the current version of legislation will get the 60 votes needed to stop debate in the Senate.

"I voted last night as 59 others did to go ahead with the debate because I want us to begin not only debating health care reform but doing something about health care reform," Lieberman said. "But I don't think anybody feels this bill, as Senator Reid put it down -- though he made a lot of progress blending bills together -- I don't think anybody thinks this bill will pass."

Digging a bit deeper, the senator explained what exactly he found so offensive about a government-run plan.

I don't want to fix the problems in our health care system in a way that creates more of an economic crisis, either short-term to inhibit businesses from hiring more people, creating jobs, or long-term to add to the debt. And I'm convinced the public option, a government-run insurance company, basically people don't understand what it's going to do. It doesn't offer free insurance. It won't get one more poor person insurance. It won't force one insurance company to give insurance to somebody who has got a pre-existing condition. It won't even lower the cost of health insurance, which advocates said originally it would because the Congressional Budget Office has now said to us the public option in Senator Reid's bill will actually charge more for insurance than the average charge by health insurance companies. I'll tell you one thing I'm sure it will do, if we create a government insurance company, it's going to run a deficit and it's only the taxpayers that are going to pay for it. I don't want to do that.
Lieberman is offering a deeply cynical reading of the legislation. The restrictions on who can access the public plan, for instance, were put into the bill as a way to placate members of Congress like himself, who were worried about legislation sapping the private market. And the reason the public plan may charge higher premiums is due, in part, to the fact that it will have to pay negotiated rates to providers instead of a fee tied to Medicare rates. This too was added to placate conservative Democratic lawmakers. If Lieberman finds these provisions objectionable, he should be directing his opposition at his fellow centrists. Instead, he's targeting the bill itself.

"[O]nce the bill is on the floor, amendments will be offered," he said on Sunday. "But essentially every amendment is subject to a filibuster and will take 60 votes to pass. My only resort, and every other senator -- and there will be others who feel exactly the way I do about the public option, if the public option is still in there -- the only resort we have is to say no at the end to reporting the bill off the floor."

In stating his willingness to support a Republican filibuster, Lieberman joins three centrist Democrats who could potentially trip up health care reform. Sens. Mary Landrieu of Louisiana, Blanche Lincoln of Arkansas, and Ben Nelson of Nebraska have likewise threatened to derail a bill unless major changes are made, specifically with regards to the public option.

Addressing these holdouts on Sunday, Sen. Sherrod Brown (D-Ohio), a government-run plan proponent, argued that it was unfair for four senators to have more sway than their 56 colleagues.

"I don't think they want to be on the wrong side of history," Brown told CNN's "State of the Union." "I don't think they want to say, 'On a procedural vote, I killed the most important bill of my career.'"

Source: http://www.huffingtonpost.com/2009/11/2 ... 66800.html

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Post by roxybeast » November 23rd, 2009, 10:40 pm

The emergency room bill is enough to make you sick:
A doctor is flummoxed by the costs when he becomes the patient.
by Steve Lopez

LA Times, November 22, 2009

Are you ready to play "How much was that visit to the ER?"

OK, so a weekend athlete is playing soccer with his pals in Santa Monica, tries to make a stop and butts heads with an opposing player.

Our warrior goes down in a heap, stands up, touches his head and realizes he's bleeding.

It's immediately clear that although the injury doesn't appear to be serious, our boy is going to need some stitches on his forehead, just under the hairline.

So Lance Budris, who happens to be a doctor, is out of the game and on his way to get patched up.

"I thought about calling a friend to stitch it up," said Budris, an anesthesiologist.

But it was Sunday morning, and he didn't want to bother a colleague on a day off for so minor a mishap. Instead, he had a friend drive him to a Westside hospital, where he walked into the emergency room in his soccer gear, holding a bloody towel to his head.

After a short wait, a nurse took his vitals, an ER tech washed the gash with a saline solution and he got a tetanus shot because he couldn't remember when he'd had his last one.

Then the doctor came in, draped the area and sutured the wound, a two-layer job that required 29 stitches. Budris was on his way roughly two hours after arriving at the hospital.

That was in July.

The bill arrived last month.

Go ahead, take a wild guess before you read the next paragraph. Are you ready?

Two bills, one for ER costs and one for the doctor's fee, totaled nearly $5,000.

Dr. Budris was floored.

As a physician, he's well aware that emergency room treatment is very expensive. But knowing the true cost of the limited supplies and labor required to treat such a minor wound, he found the experience more than a little disturbing.

For one thing, he could barely understand the bill sent him by the hospital, which he asked me not to name. I agreed after checking around and finding that the charges were not out of whack with other ERs. Budris' story isn't about one hospital.

Instead, it's a snapshot of a healthcare system gone mad, in which doctors are discouraged, hospitals go out of business and costs are inflated in a shell game between health insurance companies and medical service providers, while the patients who pay their bills get shafted.

But back to Budris' bill. It listed something called "M/S SUPPLY GENERAL," which came to $1,247. Then there was another $2,425 for "EMERGENCY ROOM GENERAL."

"I'm a doctor and I can't tell you what all of that means," said Budris when we met for coffee and went over the bill together.

Then there was $360 for "PREVENTIVE CARE VACCINE," the tetanus booster.

Budris knows exactly what the true cost was there, because he buys boosters for his own practice.

At $27 each.

The bill's explanation for insurance adjustments was virtually incomprehensible, which of course should surprise no one. Bottom line? Budris' Blue Shield PPO paid $2,200 -- or perhaps $2,409, it's hard to say -- and, after what looks like an unexplained additional "adjustment," he was left with a $1,066.43 bill, plus the additional $600 physician fee.

Budris called the hospital to complain about the whole shebang and ask for an explanation, as well as an adjustment, and he later got a remarkably incomprehensible letter of explanation informing him that although his request for a "patient liability reduction has been partially denied," his cost was being reduced to $659.04.

"Here it is," Budris said at the coffee shop. "This is our national debate right now."

He has a hard time understanding why there are forces in Washington and elsewhere resisting the overhaul of a system that is built for profit rather than health, costs vastly more per person than systems in other industrialized nations and still shuns "great segments of society."

Budris said he thought about his own billing practices and asked himself, "Am I a hypocrite?" He's not gouging patients, he said, but he's a player in a system where gouging is part of the game.

Budris wonders why there isn't a list of services and prices when you walk into a hospital. If you go to a restaurant, a law office or an auto repair shop, you're told in advance what you can expect to pay.

But when it comes to medical services, you don't know the prices or the rules of the game, and you always feel a little bit like Alice falling down the rabbit hole.

"The hospital says to the insurance company, 'OK, this is our number.' And the insurance company says, 'No, we don't pay that number. We pay this number.' "

And the cost of that game, which involves lots of paper shuffling, is all added on to the cost of healthcare.

Emergency rooms are extremely expensive to run and many of them lose money, said Dr. Marshall Morgan, chief of emergency medicine at the UCLA Medical Center. They have a large number of uninsured patients they are obligated to treat, and patients with insurance end up paying for more than the true cost of their own care.

"The bottom line is that hospital charges I see have little relationship to anything I can perceive as reality," said Morgan.

He said the current healthcare system has given health insurance companies "more money than God," with Big Pharma doing quite nicely, "and I'm not bad off myself." But we pay far more than we get back in healthcare, he said, and although he would like to see a national single-payer system that removes profit from the equation, he isn't betting on one.

"The insurance companies have huge amounts of money, and like everyone else," he said, "they buy and sell our Congress people."

Dr. Budris asked physician friends what they thought his ER bill was for his 2-inch laceration. They gave knowing smiles and guessed in the $5,000 range, or up to 10 times what the true cost of service might have been.

Lots of people are party to a dishonest and inefficient system, said Budris. He doesn't single out insurance companies, even though his wife, a critical care nurse, was dropped by her insurance company.

It claimed she had concealed an illness; the Budrises argued the condition was previously undiagnosed.

It's one crazy fight after another.

Source: http://www.latimes.com/news/local/la-me ... 540.column

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Post by roxybeast » November 29th, 2009, 6:09 pm

<center>My Favorite Health Reform Stories of the Week</center>

Slow news week, being Thanksgiving & all, so here's a collection of my favorite health reform stories of the week. And, Happy Thanksgiving! :)

Who knew that the land of the President's birth (Hawaii, not Kenya LOL) already has better health care than the rest of the USA? So much so, that they want a special exemption from the public option which they fear may actually worsen their own high medical care standards.
Hawaii Opting Out Of Health Care Overhaul
by BEN MARKUS

NPR, November 27, 2009

Hawaii wants out of the national health care overhaul because it already has one of the lowest uninsured rates in the country, thanks to its 35-year-old employer mandate system. Hawaii's congressional delegation inserted language into both House and Senate health care bills that provides explicit protection for the landmark Hawaii Prepaid Health Care Act of 1974. It's apparently the only state looking for such an exemption from major health care overhaul.

Source/Listen to NPR Audio Report Here: http://www.npr.org/templates/story/stor ... =120896275
Insurance Industry Antitrust Fight Headed To Conference Committee
by Ryan Grim

Huffington Post, November 24, 2009

The insurance industry successfully fought off a Senate threat to revoke its antitrust exemption as part of health care reform, but the issue lives to fight one more battle in the conference committee negotiations that will take place between the two chambers.

The issue surfaced in mid-October, shortly after the industry lobby, America's Health Insurance Plans (AHIP), pushed hard against the Democratic health care reform effort, claiming it would significantly raise premiums.

Senate Majority Leader Harry Reid (D-Nev.) responded by saying the industry should lose its cherished antitrust exemption -- implemented some 60 years ago by the McCarran-Ferguson Act -- and be forced to compete under the same rules as any other enterprise.

"Insurance companies have become so large they dominate entire regions of the country," he said. "They have become so powerful they block start-up businesses from entering the market, and they put smaller companies out of business. They have become so dominant that they dictate business practices. They are so influential that they exert tremendous influence over public policy."

House Speaker Nancy Pelosi (D-Calif.) seconded Reid the next day, twisting the knife and adding that "it is well known to the public that the health insurance companies are the problem." The following day Judiciary Committee Chairman John Conyers announced a hearing and a committee vote on revoking the exemption. It passed and was included in the House health care bill that passed two weeks ago.

The insurers recognized the politics at work and strongly voiced their opposition to the provision. "Health insurance is one of the most regulated industries in America at both the federal and state level. McCarran-Ferguson has nothing to do with competition in the health insurance market. The focus on this issue is a political ploy designed to distract attention away from the real issue of rising health care costs," AHIP spokesman Robert Zirkelbach told HuffPost.

A week before House passage, HuffPost reported that Reid decided not to include the repeal of the exemption but to go for it as a floor amendment instead. The move was seen as a sop to Nebraska Democrat Ben Nelson, an industry backer who had yet to offer his support for Reid's motion to proceed and who is a strong public supporter of keeping the antitrust exemption in place.

Asked by HuffPost if he had asked Reid to drop the measure in exchange for his vote, Nelson demurred. "That would come as a surprise to Harry Reid," he said of multiple reports that he had pushed for it to be left out.

But there's more than one way to push in the Senate and, regardless of whether Nelson raised the issue with Reid, even the Capitol cafeteria workers were aware of Nelson's strong position.

Nelson argues that repealing the exemption wouldn't hurt the big insurers because they're already so big they don't need to collude with each other. Repealing it, he argues, would only hurt the little guys.

But there are very few little guys left: one or two big insurers are dominant in almost every region of the country.

Nelson, now that he has voted to move the bill forward, is still threatening to filibuster a final bill if he finds it objectionable. Nelson and others want the public health insurance option stripped from the Senate bill, but if it goes to conference too friendly to the industry, the antitrust repeal is likely to be in the bill that comes back. For the industry, it's pick your poison.

Source: http://www.huffingtonpost.com/2009/11/2 ... 69293.html
Here are three more HuffPost articles/commentaries on the insurance anti-trust exemptions if you're interested ...

1. Tearing Down the Barriers to Competition http://www.huffingtonpost.com/rep-diana ... 38349.html

2. A Call For a Bipartisan National Campaign to Overturn Insurance Companies' Exemption From Anti-Trust Laws
http://www.huffingtonpost.com/miles-mog ... 23993.html

3. Conyers Introduces Bill to End Health Insurer's Anti-Trust Exemption
http://www.huffingtonpost.com/david-day ... 90637.html

As everybody knows, the Dems hung together long enough to open debate and get the Senate's version of the reform bill to the floor, but the big question is can they stick together? And the bigger question, will they get the 60 votes necessary to survive the impending Lieberman +GOP filibuster to the motion for cloture to end debate and vote on the final bill at the end of this debate process? Anybody have a crystal ball & care to share what you see unfolding? :)
Senate Opens Health Care Debate: Dem Coalition Fracturing Already
by Ricardo Alonso-Zaldivar, AP

Huffington Post, November 29, 2009

WASHINGTON — The 60 votes aren't there any more.

With the Senate set to begin debate Monday on health care overhaul, the all-hands-on-deck Democratic coalition that allowed the bill to advance is fracturing already. Yet majority Democrats will need 60 votes again to finish.

Some Democratic senators say they'll jump ship from the bill without tighter restrictions on abortion coverage. Others say they'll go unless a government plan to compete with private insurance companies gets tossed overboard. Such concessions would enrage liberals, the heart and soul of the party.

There's no clear course for Senate Majority Leader Harry Reid, D-Nev., to steer legislation through Congress to President Barack Obama. You can't make history unless you reach 60 votes, and don't count on Republicans helping him.

But Reid is determined to avoid being remembered as another Democrat who tried and failed to make health care access for the middle class a part of America's social safety net.

"Generation after generation has called on us to fix this broken system," he said at a recent Capitol Hill rally. "We're now closer than ever to getting it done."

His bill includes $848 billion over 10 years to gradually expand coverage to most of those now uninsured. It would ban onerous insurance industry practices such as denying coverage or charging higher premiums because of someone's poor health. Those who now have the hardest time getting coverage – the self-employed and small businesses – could buy a policy in a new insurance market, with government subsidies for many. Older people would get better prescription coverage.

Most people covered by big employers would gain more protections without major changes. One exception would be those with high-cost insurance plans, whose premiums could rise as a result of a tax on insurers issue the coverage.

Story continues below

The public is ambivalent about the Democrats' legislation. While 58 percent want elected officials to tackle health care now, about half of those supporters say they don't like what they're hearing about the plans, according to a new Kaiser Family Foundation poll.

The Senate debate risks alienating more people because much of the discussion probably will revolve around divisive issues that preoccupy lawmakers.

"A large portion of the debate will be spent on issues that aren't important to the workability of health reform," said Paul Ginsburg, president of the Center for Studying Health System Change.

The debate should start off modestly, with each side offering one amendment. No votes are scheduled Monday.

But with more than 40 senators on the two committees that originated the bill, many more amendments are expected. Some likely subjects are limits on malpractice lawsuits, consumer choice, affordability, minority health and drug prices.

Reid wants to finish by Christmas; he may not get to.

He's hoping that Democrats will stick together on procedural matters, where Senate rules require 60 votes to advance. That would allow for different views to be heard on the underlying questions. But such an accommodation might not always be possible.

For example, the National Right to Life to Committee says unless there are big changes, it will count the procedural motion to allow a final up-or-down vote on the legislation as tantamount to a vote on abortion.

Of the many issues senators have to weigh, abortion funding and the option of a government insurance plan promise to be the most difficult.

On abortion, no compromise seems possible. On the public plan, a deal may yet be had.

The House adopted strict limits on abortion funding as the price for the support of anti-abortion Democrats. Abortion rights supporters are now backing Reid's approach, which tries to preserve coverage for abortion while stipulating that federal dollars may not be used except in cases of rape, incest or to save the life of the mother. Catholic bishops say they can't accept that because it would let federally subsidized plans cover abortion.

It might be easier to find a middle ground on the issue of a public health plan to compete against private insurers, though Sen. Bernie Sanders, a Vermont independent, said Sunday he would be "very reluctant" to support legislation without "a strong public option."

Reid's bill would create a national plan, but give states the choice of opting out. In any event, the Congressional Budget Office now estimates that the government would not be the bare-knuckles competitor insurers had feared, but a relatively minor player in the market.

Several moderate Democrats have served notice they can't support Reid's approach. The lone Republican to vote for the Senate bill in committee, Olympia Snowe of Maine, has said she could accept a public plan if insurers are given one last chance to deliver lower premiums in a competitive market. Combining Snowe's "trigger" with Reid's "opt-out" might be the answer.

If that's the case, it still would have to pass a final test: 60 votes.

Source: http://www.huffingtonpost.com/2009/11/2 ... 73010.html
Want to actually compare the current versions of the pending House and Senate bills, this site is for you: http://tinyurl.com/yeshhgv

And finally, a special article for all my right wing government takeover conspiracy theorist readers! :)
Like It or Not, Health Care Mandate Is Constitutional
by Ruth Marcus

TruthDig.Org, November 24, 2009

Is Congress going through the ordeal of trying to enact health care reform only to have one of the main pillars—requiring individuals to obtain insurance—declared unconstitutional? An interesting debate for a constitutional law seminar. In the real world, not a big worry.

“This issue is not serious,” says Walter Dellinger, acting solicitor general during the Clinton administration.

But it’s being taken seriously in some quarters, so it’s worth explaining where the Constitution grants Congress the authority to impose an individual mandate. There are two short answers: the power to regulate interstate commerce and the power to tax.

First, the Commerce Clause. Spending on health care consumes 16 percent—and growing—of the gross national product. There is hardly an individual activity with greater effect on commerce than the consumption of health care.

If you arrive uninsured at an emergency room, that has ripple effects through the national economy—driving up costs and insurance premiums for everyone. If you choose to go without insurance, that limits the size of the pool of insured individuals and—assuming you are young and healthy—drives up premium costs.

The clause empowers Congress “to regulate commerce ... among the several states,” which may not sound terribly sweeping. But since the New Deal, the Supreme Court has interpreted this authority to cover local activities with national implications.
In the 1942 case Wickard v. Filburn, the justices ruled that even though an activity may “be local and though it may not be regarded as commerce, it may still, whatever its nature, be reached by Congress if it exerts a substantial economic effect on interstate commerce.”

Thus, the court said, Congress was entitled to tell Roscoe Filburn how much wheat he could grow to feed his own chickens. Surely, then, Congress could require Filburn’s grandson to buy health insurance.

The court has narrowed the reach of the Commerce Clause in recent years—but also reaffirmed Wickard. The times it has found that Congress overstepped involved situations where the connection to interstate commerce was strained: carrying guns near schools or engaging in gender-based violence.

In United States v. Lopez, the court found that the Gun-Free School Zones Act “is not an essential part of a larger regulation of economic activity, in which the regulatory scheme could be undercut unless the intrastate activity were regulated.”

The individual mandate is “the mirror image of Lopez as a Commerce Clause case,” says Harvard Law School professor Laurence Tribe.

Granted, there is a difference between regulating an activity that an individual chooses to engage in and requiring an individual to purchase a good or service. Granted, too, there is a difference between making automobile insurance compulsory, as a condition of the privilege to drive a car, and making health insurance compulsory, whether an individual wants it or not.

But the individual mandate is central to the larger effort to reform the insurance market. Congress may not be empowered to order everyone to go shopping to boost the economy. Yet health insurance is so central to health care, and the individual mandate so entwined with the effort to reform the system, that this seems like a different, perhaps unique, case.

Congress clearly has authority to, in effect, require employees to purchase health insurance for their old age by imposing a payroll tax to fund Medicare. It’s odd for the same conservatives bemoaning a government takeover of health care to complain about requiring that people turn to the private marketplace.

Which brings us to the alternative source of congressional authority, the “Power to lay and collect Taxes, Duties, Imposts and Excises.”

The individual mandate is to be administered through the tax code: On their forms, taxpayers will have to submit evidence of adequate insurance or, unless they qualify for a hardship exemption, pay a penalty.

Yale Law School professor Jack Balkin likens this to Congress raising money for environmental programs by taxing polluters. “Congress is entitled to raise revenues from persons whose actions specifically contribute to a social problem that Congress seeks to remedy through new government programs,” he concludes.

Balkin cites a 1950 Supreme Court case upholding a tax on marijuana distributors. “It is beyond serious question that a tax does not cease to be valid merely because it regulates, discourages, or even definitely deters the activities taxed,” the court said. “The principle applies even though the revenue obtained is obviously negligible, or the revenue purpose of the tax may be secondary.”

Sounds like the individual mandate to me.

Source: http://www.truthdig.com/report/item/lik ... _20091124/

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roxybeast
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Post by roxybeast » December 10th, 2009, 8:08 pm

<center>Health Reform Plods Forward Without the Public Option</center>

While insurers drop hundreds of thousands of customers and pay off facebook advertisers to oppose reform, the Senate plodded forward with its version of the health reform legislation. In the process, they softened the strict abortion language passed by the house while Republicans contradicted themselves on Medicare reforms. But in the most shocking news of the week, it appears that they may have finally killed the public option. And with it the hopes of millions of Americans who actually wanted to see real & meaningful reform. What we are left with is some improvement regarding pre-existing conditions and portability, some subsidies for the poor, but at the price of required individual coverage so that we all can be at the mercy of big insurance.

Yippie! I "have to" buy a crappy policy from a typically non-responsive insurer more interested in profits than my health so that I can bail out their shareholders & pay their CEOs & executives excessive bonuses! Three cheers for legislators bought off by insurance & pharmaceutical industry lobbyists! Hip, Hip, Hooray! Hip, Hip, Hooray! Hip, Hip, Hooray! More cheers for your insurance company and/or employer dropping your coverage before the plan takes effect! Yay! Yay! Yay! Well, at least I might find some solace in the fact that the government might subsidize my purchase of crappy insurance, but given my luck and recent health history, they'll probably just fine me. Yippie! :)
Aetna Forcing 600,000-Plus To Lose Coverage In Effort To Raise Profits
by Sam Stein

Huffington Post, December 4, 2009

Health insurance giant Aetna is planning to force up to 650,000 clients to drop their coverage next year as it seeks to raise additional revenue to meet profit expectations.

In a third-quarter earnings conference call in late October, officials at Aetna announced that in an effort to improve on a less-than-anticipated profit margin in 2009, they would be raising prices on their consumers in 2010. The insurance giant predicted that the company would subsequently lose between 300,000 and 350,000 members next year from its national account as well as another 300,000 from smaller group accounts.

"The pricing we put in place for 2009 turned out to not really be what we needed to achieve the results and margins that we had historically been delivering," said chairman and CEO Ron Williams. "We view 2010 as a repositioning year, a year that does not fully reflect the earnings potential of our business. Our pricing actions should have a noticeable effect beginning in the first quarter of 2010, with additional financial impact realized during the remaining three quarters of the year."

Aetna's decision to downsize the number of clients in favor of higher premiums is, as one industry analyst told American Medical News, a "pretty candid" admission. It also reflects the major concerns offered by health care reform proponents and supporters of a public option for insurance coverage, who insist that the private health insurance industry is too consumed with the bottom line. A government-run plan would operate solely off its members' premiums.

Aetna actually made a profit in 2009 but not at levels that it anticipated.

"They were surprised by an acceleration in medical costs in 2009 which pressured their earnings," Josh Raskin, an industry analyst for Barclays Capital, told the Huffington Post. "In an effort to get back to a more profitable level, they are raising their prices to match cost trends. When you raise rates, you run the risk of losing your membership. Health insurance is a very competitive marketplace."

As Williams told investors on the call: "The pricing that we put in place for 2009 turned out to not really be what we needed to achieve the results and margins that we had historically been delivering."

Aetna is one of the largest insurers in the private market, covering roughly 17.7 million people according to its 2008 annual report. It is also a major player in the current health care debate and inside Washington D.C. The insurance company has spent more than $2 million on lobbying just in 2009, according to the Center for Responsive Politics.

American Medical News, which first reported the story, noted that this is not the first time the insurance giant has cut the rolls in an effort to boost profit margins. "As chronicled in a 2004 article in Health Affairs by health economist James C. Robinson, MD, PhD, Aetna completely overhauled its business between 2000 and 2003, going from 21 million members in 1999 down to 13 million in 2003, but boosting its profit margin from about 4% to higher than 7%."

A spokesperson at Aetna did not return calls and emails for comment.

Source: http://www.huffingtonpost.com/2009/12/0 ... 80130.html
Senate Rejects Abortion Restrictions 54 To 45
Associated Press

Huffington Post, December 8, 2009

WASHINGTON — The Senate has rejected an effort to stiffen abortion restrictions in the health care bill.

The vote was 54 to 45.

Democratic Sen. Ben Nelson of Nebraska and Republican Sen. Orrin Hatch of Utah wanted to ban any insurance plan that gets taxpayer dollars from offering abortion coverage. The stronger restrictions mirrored provisions in the House-passed health care bill.

The Senate bill currently allows insurance plans to cover abortions but tries to separate private funds from federal money. It specifies that abortion coverage can only be paid for with private dollars.

Majority Leader Harry Reid said the legislation is about access to health care, not abortion.

Source: http://www.huffingtonpost.com/2009/12/0 ... 84781.html
Breakthrough: Health Care Talks Advance In Senate
by Ryan Grim

Huffington Post, December 8, 2009

Senate negotiators emerged from a full day of meetings Tuesday saying they had made genuine progress toward a deal on health care reform.

They declined to outline the specifics of the agreement, but said that the measures they had been discussing will be sent to the Congressional Budget Office for cost estimates. Once the estimates are returned, the final deal will be put together.

"We have made a lot of progress. There's a lot of agreement. We have decided to take the next step and that is to ask the CBO to score what we've been discussing," said Sen. Tom Carper (D-Del.), one of five conservative Democrats negotiating with five liberals.

The discussion has focused on abandoning or greatly narrowing the public health insurance option. In exchange, people 55-64 would be able to buy in to Medicare and Medicaid eligibility would be expanded to people within 150 percent of the federal poverty line. And people within 300 percent of poverty would be eligible for a program pushed by Sen. Maria Cantwell (D-Wash.) modeled on her state's Basic Health. Cantwell is not one of the ten in the meetings but has stopped by to brief negotiators.

Senators, after the meeting, would not confirm which elements of the discussion were sent to CBO. Much will depend on the results of the CBO analysis.

Sen. Jay Rockefeller (D-W.Va.), one of the liberal members in negotiations, said that he was happy with where the talks had gone.

"I've got a smile on my face. I don't smile naturally," he said.

Carper, standing nearby Rockefeller, declined to answer questions until Rockefeller finished and leaned into the scrum to get closer. "I want to hear what he says," Carper said.

"We have a broad agreement," Senate Majority Leader Harry Reid (D-Nev.) told reporters, refusing to give any details on the talks, Reuters reported.

Reid said reports the government-run "public option" had been dropped were "not true."

"Not everyone is going to agree with every piece we sent over" to the Congressional Budget Office, he said, adding: "Is the end in sight? The answer's yes."

Reid's office subsequently released a written statement on the compromise:

I asked Senators Schumer and Pryor to work with some of the most moderate and most progressive members of our diverse caucus, and tonight they have come to a consensus.

It is a consensus that includes a public option and will help ensure the American people win in two ways: one, insurance companies will face more competition, and two, the American people will have more choices.

I know not all 10 Senators in the room agree on every single detail of this, nor will all 60 members of my caucus. But I know we all appreciate the hard work that these progressives and moderates have done to move this historic debate forward.

I want to thank Senators Schumer, Pryor, Brown, Carper, Feingold, Harkin, Landrieu, Lincoln, Nelson and Rockefeller for working together for the greater good and never losing sight of our shared goal: making it possible for every American to afford to live a healthy life.

As is long-standing practice, we do not disclose details of any proposal before the Congressional Budget Office has a chance to evaluate it. We will wait for that to happen, but in the meantime, tonight we are confident."

Public option supporter Sen. Tom Harkin (D-Iowa) told reporters "he didn't like the agreement but would support it to the hilt in an attempt to pass health care legislation," the AP reported. Likewise, Sen. Russ Feingold (D-Wisc.), who has aggressively backed a public option, said in a statement, "I do not support proposals that would replace the public option in the bill with a purely private approach. We need to have some competition for the insurance industry to keep rates down and save taxpayer dollars."

The New York Times reported on additional details:

Democratic aides said that the group had tentatively agreed on a proposal that would replace a government-run health care plan with a menu of new national, privately-run insurance plans modeled after the Federal Employee Health Benefits Program, which covers more than eight million federal workers, including members of Congress, and their dependents.

A government-run plan would be retained as a fall-back option, the aides said, and would be triggered only if the new proposal failed to meet targets for providing affordable insurance coverage to a specified number of people.

The agreement would also allow Americans between age 55 and 64 to buy coverage through Medicare, beginning in 2011.

Earlier on Tuesday evening, the Senate beat back an attempt by Sen. Ben Nelson (D-Neb.) to attach extremely restrictive abortion provisions to the health care bill now entering the final stages of negotiations.

The stronger restrictions were modeled after language pushed in the House by Rep. Bart Stupak (D-Mich.), a member of a secretive evangelical organization, some of whose members live together in a house on C Street on Capitol Hill.

Nelson routinely seeks out packs of reporters and speaks at length until questions are exhausted, but following Tuesday's 54-45 vote, he slipped out the back of the Senate chamber to head for negotiations between five liberal and five conservative Democrats going on in a room across from Majority Leader Harry Reid's office.

A few reporters waiting outside the door asked him how it would effect his decision on whether to support the final effort.

"I want to continue to work on this," he said, not ruling out his support, at least "not at this point in time. I want to continue to work on the project we're working on... This makes it harder right now [to support the bill]. We'll have to see if they can make it easier."

The Hill reported that Harry Reid "delivered a lengthy, emotional floor speech" arguing against the amendment.

"I don't believe that the Senate needs to go as far as this amendment would take us," Reid said. "No one should use the health care bill to expand or restrict abortion. No one should use the issue of abortion to rob millions of the opportunity to get good health care. This is not the right place for this debate. We have to get on with the larger issue at hand. We have to keep moving toward the finish line and cannot be distracted by detours or derailed by diversions."

Source: http://www.huffingtonpost.com/2009/12/0 ... 84846.html
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Republicans Forced To Reverse Course, Yet Again, On Medicare
by Sam Stein

Huffington Post, December 8, 2009

A new effort by Senate Democrats to expand Medicare coverage by opening it up to 55- to 64-year-olds has forced Republicans into an about face of sorts.

Republican Senators, who for weeks have been dogging their Democratic counterparts for pursuing what they describe as drastic cuts to the Medicare program, are now making the awkward shift from ostensibly championing Medicare to fighting against its expansion.

Senate Republican Leader Mitch McConnell (R-K.Y.) sent out a press release on Sunday, titled: "Cutting Medicare is not what Americans want." That was followed by a new press release on Monday. Its title: "Expanding Medicare 'a plan for financial ruin.'

"We already know that Medicare is going broke in seven years," McConnell told Fox News on Tuesday. "They are taking money out of Medicare in this health care proposal not to make Medicare more sustainable but to start a new entitlement program for a different set of Americans. In addition to that, now they are talking about expanding access to Medicare and Medicaid, both of which are already in terrible trouble. This is the worst kind of political deal-making in this frantic attempt to get to 60 votes."

Democrats contend that the logic is strained. For starters, they say, Senate Democrats are eyeing cuts in Medicare to eliminate waste in the system, not to destroy it. The money saved would go to alternative reforms. The so-called "new entitlement program" that McConnell mentions -- presumably the public health-insurance option -- would save money over time, not require it, according to non-partisan budget estimates. And the new arrivals in the Medicare program would be buying their way in, presumably paying for themselves.

McConnell's positions aren't strictly contradictory. Republicans may be in favor of protecting Medicare for seniors who are currently enrolled while simultaneously opposed to expanding the program for others.

"Apparently reading comprehension can be added to math as an unnecessary skill set for proponents of government run health care," a Senate GOP leadership aide emailed the Huffington Post. "If Democrats can't understand that cutting Medicare while simultaneously seeking to expand its role is disastrous they should not be advocating anything on behalf of the American people."

But, politically speaking, the GOP position on the government-run health care program certainly has become twisted, and then twisted again.

In August, Republicans came to the conclusion that they could win political traction by framing their party as a defender of the government-run system, despite having decried it for decades. RNC Chairman Michael Steele released a "seniors' health care bill of rights" and held a testy exchange with an NPR reporter to drive this home his Medicare support.

It seemed like opportunism then. Now, however, it has the potential to trip the GOP up. Having spent the last two weeks insisting that Democrats were destroying the bedrock of health care coverage for seniors, Republicans may soon be forced to explain why expanding Medicare coverage would be a bad thing. One Democratic staffer on the Hill said she was eagerly looking forward to seeing the GOP reverse course. Another health care advocate off the Hill summarized her thoughts as follows:

"The Republicans have to choose: continue their hypocritical attacks on Medicare or show their true colors and refuse to give older Americans the relief they need. Either way, their credibility is shot and they can't do either effectively."

Source: http://www.huffingtonpost.com/2009/12/0 ... 84680.html

Contradictory Republicans Still Flummoxed By Medicare
by Bob Cesca

Huffington Post, December 9, 2009

If it weren't for the fact that the Washington media establishment is gamed in favor of Republicans, it's very likely that they would have long since been relegated to nothing more than a LaRouche-style crackpot cult, handing out mimeographed pamphlets outside the post office.

How else, other than via the self-conscious deference afforded it by the press, do the Republicans get away with issuing the following two press releases within a single 24 hour span:

Sunday: "Cutting Medicare is not what Americans want."

Monday: "Expanding Medicare a plan for financial ruin."

In case you're wondering, these statements didn't come from one of the many far out wingnuts like Steve King, Michele Bachmann or Virginia Foxx (Medicare recipient). They were, in fact, dispatched from Senate Minority Leader (And Real-Life Albino Sleestak) Mitch McConnell's office. Yes, the highest ranking Republican in Congress wrote-up both headlines, ostensibly proof-read and unapologetically shoved into the public record.

Two press releases that exactly contradict each other. Yet I'm a little disappointed that Mark Halperin and Chuck Todd didn't fire off tweets about how the opposing headlines were "bad news for Obama." After all, every Republican gaffe is somehow "bad news for Obama." And so they get away with it.

As we have observed over the years, this Republican contradiction problem has been a feature of modern Bush Republicanism for a while now, but it's only during the past year that the gap between contradictory statements -- let's call it the Wingnut Gap -- has narrowed down to just 24 hours. Prior to this week, it took several years for, say, the Republicans to contradict their "criticizing the commander-in-chief during wartime undermines the troops" mantra, or for Glenn Beck to accuse the Obama administration of being Maoists then to inexplicably suggest that America needs to be "more like the Chinese."

Say nothing of the contradictions evident in Sarah Palin's America-hating commie Castro headgear:

(See picture in original post) ...

And don't give her the benefit of the doubt on this, either. She's not smart enough to wear it with deliberate irony.

But this is a dynamic that's most prevalent when the Republicans discuss Medicare. It really flummoxes them. After all, they despise socialized medicine. They despise single-payer health insurance. They despise government-run health care. They voted against the formation of Medicare during the high water mark of LBJ's Great Society. They ultimately would love to privatize (or drown in a bathtub) the whole thing and be done with it.

Yet at the same time, 55 Republican members of Congress are on Medicare. Congressman Weiner wrote up a list that includes Mitch McConnell. I could be wrong, but I also think proxy-Republican and anti-government-run-insurance drama queen Joe Lieberman, at 67 years old, receives Medicare. He's eligible. Additionally, I'm still attempting to ascertain how many Republicans get their primary care from the government-run Office of the Attending Physician. The office won't give me a partisan breakdown of their patients, but we can safely assume that, based on ideology, it's all Democrats, right?

Today, embattled Republican David Vitter spoke in favor of Byron Dorgan's Canadian drug-importation amendment and, in the process, praised the Canadian system -- which is, as you know, single-payer. However, Olympia Snowe said she doesn't support the Gang of 10's Medicare buy-in compromise, but she supports the Canadian importation measure. So she's siding with the rank and file Senate Republicans against single-payer health insurance on the buy-in, but she supports the single-payer system on the drug importation amendment. And it's not just Snowe and Vitter. The congressional Republicans are all toeing this upside-down We Hate-Slash-Love Medicare position.

No wonder the teabaggers and dittoheads are screeching in gibberish -- steam shooting from their ears. When it comes to Medicare, they have no idea what to support or how to support it. All they know is that President Obama should keep his government hands off their Medicare -- whether or not they understand that the government, in fact, runs Medicare. He just should. So there.

The fact is that if the Republicans really supported Medicare, they should also support the Medicare buy-in proposal for Americans between the ages 55-64. But they won't. Why? Because they hate Medicare. Even though many of them are on it. And even though many of them say they want to protect it from "ruin."

But expecting logic, reason and consistency from the Republicans is wasted time. (See also Fox News Channel's Rasmussen poll analysis showing a total of 94 percent of Americans think climate scientists falsified their evidence, while 26 think they didn't, thus indicating a total of 120 percent.)

The fact remains that the private health insurance system is broken and America is being left behind by the rest of the world as we cling to the decaying wreckage of a failed healthcare system. Medicare is an obvious solution.

If Medicare works for senior citizens, then it can work for everyone else. Expanding the revenue base for Medicare by upwards of 2 million Americans with this buy-in plan, allowing a younger, healthier and, consequently, less costly population to buy into the system by paying the full, unsubsidized premiums, will only help to ameliorate Medicare's fiscal problems. Likewise, widening the buy-in window to include all adults would ultimately stabilize Medicare even further, because we'd ostensibly be adding even younger and healthier people to the pool, allowing chunks of their unused premiums to flow upwards to older, sicker recipients who need it.

And if you, Mr. and Mrs. Republican, are against a Medicare option for everyone, then you have to be against Medicare period. And feel free to be against it. You just can't have it both ways -- no matter how ridiculous and contradictory your congressional leadership is.

Source: http://www.huffingtonpost.com/bob-cesca ... 86492.html
Outline Of Senate Health Bill Agreement Emerging
by Ryan Grim

Huffington Post, December 9, 2009

Senate Democrats emerged from a caucus-wide meeting Wednesday evening tight-lipped about the elements of the "broad agreement" that has been reached on health care reform - in some cases literally so: Sen. Jeff Merkley (D-Oregon) declined to answer questions by pointing at his sealed lips.

There's a reason for the opacity. If details of the policy proposals sent to the Congressional Budget Office are leaked, the CBO no longer feels as if it needs to keep the analysis confidential. Keeping the many pieces secret for a few more days gives Senate Majority Leader Harry Reid (D-Nev.) the opportunity to share them first with colleagues and combine them in a way that gets all 60 members of the caucus on board.

Reid reiterated the importance of confidentiality during the meeting. Fortunately, HuffPost spoke to Sen. Ben Nelson (D-Neb.) before the gathering began.

He confirmed that at least four items had been sent to the CBO for an estimate known as a score: an expansion of Medicaid; broadening Sen. Maria Cantwell's (D-Wash.) Basic Health program to people within 300 percent of the federal poverty limit; the much-discussed national plans that would be run by the Office of Personnel Management and first reported here, and allowing people 55-64 to buy into Medicare -- first reported here. It's still unclear how the "trigger" for the public option, which is still on the table, will be designed. On Tuesday evening, TPMDC reported that the public option would be triggered into effect if private plans did not come into being. The details of the trigger are crucial: written by a public option advocate, a hair-trigger could bring a public plan into being on the first day; written by insurance companies, it would never be triggered, just as the trigger for Medicare Part D's prescription drug program has never been pulled despite soaring prices.

Nelson said that he'd have to wait for the CBO score, but he was open to supporting all parts of the agreement.

The purpose of the negotiations is to find a way to compensate public-option backers for the loss of their key policy objective.

Some liberals in the House, however, aren't sure they're going to go along with whatever deal the Senate crafts. Rep. Raul Grijalva (D-Ariz.), co-chair of the Congressional Progressive Caucus, said the group would be meeting Wednesday evening to craft a response.

Rep. Anthony Weiner (D-N.Y.), a vocal backer of the public option in the House, was on board, however. "Extending this successful program to those between 55 and 64, a plan I proposed in July, would be the largest expansion of Medicare in 44 years and would perhaps get us on the path to a single payer model," Weiner said in a statement. "Medicare provides health care to all Americans over 65 and has an overhead of barely 1 percent."

Source: http://www.huffingtonpost.com/2009/12/0 ... 86437.html
Lincoln, Landrieu Hint At Support For Revised Health Care Bill
by Sam Stein

Huffington Post, December 9, 2009

Two key conservative Democrats hinted on Wednesday that they support the health care reform compromises adopted by the party's leadership, including the dropping of a pure public option and the addition of a buy-in alternative for Medicare.

But in remarks to reporters during and outside of a forum on small business, both Sens. Mary Landrieu (D-La.) and Blanche Lincoln (D-Ark.) stressed that they would not make a final judgment about how to vote on reform until the Congressional Budget Office scores the bill.

Of the two, Landrieu seemed more receptive to the reported changes made by Senate Majority Leader Harry Reid (D-Nev.) to the Senate's version of health care legislation. The Louisiana Democrat said she thought the Medicare buy-in proposal was "a very good idea" in part because it was "paid for." "But because we don't have a score we can't tell," she added.

Lincoln was far more reserved, declining to weigh in on the Medicare buy-in proposal, saying: "There are a lot of things on the table still and, until we hear back from CBO it will be hard to say whatever I can support."

Asked what would happen if the CBO score showed the revised bill to be more expensive and less inclusive than Reid's original version, she replied: "Then we will go back to the drawing board."

The Arkansas Democrat did, however, applaud one aspect of the new version of reform: the decision to drop the public plan in favor of a non-profit system run by private insurers but regulated by the federal government.

"It takes the best of both words," she said. "Government creates an environment where private industry can operate but... it creates the environment in a way that private industry is providing a product that best suits the needs of the consumer. [Office of Personnel and Management] being the negotiator will help, I think, be able to bring the best product forward."

Both Lincoln and Landrieu have pledged to support a Republican filibuster of health care reform if the bill contained a public option for insurance coverage. So the decision by Reid and others to accommodate those concerns would, under normal circumstance, seem to be enough to earn their votes. But if one rule has been proven true during these negotiations it's that there is little to lose and much to gain when you're the 60th vote for cloture.

Source: http://www.huffingtonpost.com/2009/12/0 ... 86133.html
Dean: Senate Bill Is 'Real Reform,' A Needed Antidote To GOP Propaganda
by Sam Stein

Huffington Post, December 9, 2009

Former DNC Chair Howard Dean strongly endorsed on Wednesday the Senate's newest incarnation of health care legislation, declaring that it met the most fundamental definitions of reform.

In an interview with the Huffington Post, Dean acknowledged that he had problems with some of the emerging proposals in the Senate. But legislation, he argued, is neither a seamless process nor a perfect product. And there was much to hail about the compromise that had developed.

The former Vermont governor called the decision to allow consumers between the ages of 55 and 64 to buy Medicare coverage "a big step forward."

"It opens up Medicare and gives people a real choice," he said. "And secondly it does something that should have been done the whole way along: instead of creating a new bureaucracy it just uses the one we already have."

And while the public option for insurance coverage seemed, essentially, dropped from the legislative language, Dean had a positive take on the Senate's alternative approach.

"I'm not a fan of the private market, as you know. However, the private market does work in two countries, Switzerland and the Netherlands, and the way it works is by substantial regulation... If, in fact, this is basically going to be run as if it were the federally employee benefit plan, than this can work. The [Office of Personnel Management] knows how to run this plan and I've almost never heard anything bad of the federal employee benefit program."

"There doesn't have to be a public option in the bill because I'm some sort of ideological socialist," he said of his support for a government-run insurance provider. "There had to be a public option because the private sector doesn't work. And if they can make it work [without a public option], then let's see."

"The criteria that I use to evaluate the various proposals is; 'Is it reform?'" Dean concluded. "And this is reform."

An endorsement from the former DNC chairman could prove to be a big boost for reform's prospects in the Senate. A leading progressive voice and (more importantly) a respected thinker on health care matters, Dean has already played a large role in shepherding progressive support for the latest round of compromises. Sources in the Senate say Dean was the one who pushed the idea of expanding Medicare as a trade-off for watering down the public plan.

"I'm disposed towards this," he said. "It was part of my platform when I ran for president. But look at this. It makes sense. Why have two bureaucracies, including one who hasn't run this before [the Department of Health and Human Services]... when you can use Medicare?"

It wasn't just the policy of the Senate's version of health care reform that Dean liked. It was the politics. Democratic leadership is set to allow those 55 to 64-year-olds in high-risk insurance pools the option of buying Medicare coverage beginning in 2010 (three years before a proposed public option would come into existence). Which is vital for Democrats, he stressed.

"Because you have got to have people sign up for this thing in 2010 for political purposes. Otherwise we will take it on the chin in the election," said Dean. "If people are actually in insurance they can say, wait a second I'm on this insurance and haven't been brought before the death panel... Actuality is always the best antidote to propaganda."

There are aspects of the bill that Dean lamented and those which he hoped the Senate would improve. The former DNC chairman said that there need to be additional subsidies for those between the ages of 55 and 64 who want to buy into Medicare. He also worried that not enough regulatory reform will be put in place to compel serious changes in the private market. More than anything else, he was concerned that those under 55 will be left without sufficient options for insurance coverage.

"My view is that you try to convince more people as the process goes on that access should be broadened out," he said.

And then there was the question of whether even this type of reform would have the votes to pass. Dean said he did not expect Sen. Olympia Snowe (R-ME) to back the bill even though Democrats have jettisoned the public plan. Though he did say he thought conservative members of his own party would be on board.

"I have kept very close tabs on it and have been very straightforward with some of the senators about not getting hung out to dry on this," he said. "And I don't think they will. I don't think that is their intention."

As for the progressive community to which he is closely associated, Dean urged it to accept the fact that while reform may be delivered more incrementally than they desired, it was "incrementalism in the right direction."

"There will be people disappointed with it. There are parts that I'm disappointed with," he said. "But this is real and a big step forward."

Source: http://www.huffingtonpost.com/2009/12/0 ... 85543.html
Health Insurers Caught Paying Facebook Gamers Virtual Currency To Oppose Reform Bill
Business Insider, December 9, 2009

Health insurance industry trade groups opposed to President Obama's health care reform bill are paying Facebook users fake money -- called "virtual currency" -- to send letters to Congress protesting the bill.

Here's how it's happening:

Facebook users play a social game, like "FarmVille" or "Friends For Sale." They get addicted to it. Eager to accelerate their progress inside the game, the gamers buy "virtual goods" such as a machine gun for "Mafia Wars." But these gamers don't buy these virtual goods with real money. They use virtual currency.

The gamers get virtual currency three ways:

Winning it playing the games
Paying for it with real money
By accepting offers from third-parties -- usually companies like online movie rentals service Netflix -- who agree to give the gamer virtual currency so long as that gamer agrees to try a product or service. This is done through an "offers" provider -- a middleman that brings the companies like Netflix, the Facebook gamemakers, and the Facebook gamemaker's users together.
It's this third method that an anti-reform group called "Get Health Reform Right" is using to pay gamers virtual currency for their support.

Instead of asking the gamers to try a product the way Netflix would, "Get Health Reform Right" requires gamers to take a survey, which, upon completion, automatically sends the following email to their Congressional Rep:

"I am concerned a new government plan could cause me to lose the employer coverage I have today. More government bureaucracy will only create more problems, not solve the ones we have."

OMGPOP CEO Dan Porter spotted the survey and took a screenshot for us. (Click on the image at the right to expand it.)

What is this practice called?

Paying people to act like political supporters is called "astroturfing," because its fake grass-roots campaigning. So maybe this should be called Virtual astroturfing. Virtual-turfing? Astroturfing 2.0?

Who are the people behind this?

Get Health Reform Right describes itself as a "project of organizations whose shared mission is to ensure consumers continue to have access to employer-sponsored healthcare plans."

We are concerned about federal legislation that would create new government bureaucracies that would unravel the workplace healthcare system where more than 160 million people get their coverage.

Under the "Who We Are" tab on GetHealthReformRight.org, the following organizations are listed:

Association of Health Insurance Advisors
America’s Health Insurance Plans
American Benefits Council
BlueCross BlueShield Association
Council of Insurance Agents & Brokers
Healthcare Leadership Council
Independent Insurance Agents & Brokers
National Association of Health Underwriters
National Association of Insurance and Financial Advisors
National Retail Association
Who are the gamers filling out the survey and sending emails to Congress?

Facebook gamers tend to fall into two groups: women in their 30s and 40s and teenagers of both sexes.

Is this legal?

Astroturfing, which involves real money, is not illegal, We can't imagine virtual curreny astroturfing would be illegal either. Whether or not it's ethical is a different question.

Who is profiting from this?

According to OMGPOP CEO Dan Porter, the middleman facilitating this transaction in multiple Facebook games is called Gambit. Up until a few weeks ago, these games included big hits like Zynga's Mafia Wars and FarmVille. Zynga has since removed all offers from its games. On its Web site, Gambit says its clients include:

#1 MySpace Developer
20%+ of top 10 Facebook applications
SmallWorlds.com
School Vandals
Foopets.com
2 Top 100 websites
...and over 150+ more

One important thing to remember:

Gambit is just the platform here, bringing three parties together: gamers seeking currency, game-makers seeking monetization, and companies (and, apparently lobbying groups) looking for customers.

OMGPOP CEO Dan Porter tells us it's most likely the case that Get Health Care Reform agreed to pay an ad agency for every letter-writer it recruited. Dan supposes it was this third-party that bundled the above survey with several others and submitted it into Gambit's offer network.

Update: We reached out to Gambit CEO Noah Kagan for clarification. He told us:

"It's not that Dan is wrong. But we don't run hot political issues. You don't have any evidence that this is from Gambit. We don't condone this in our system. Sometimes stuff does happen, but we've been very proactive in making sure that there's not negative offers in our system."

To this, Dan replied:

"My point all along had little to do with the Gambit platform. We are testing it in house and will deploy it and it has controls for how conservative a partner wants to be. I wouldn't use them if I didn't think it would provide value for our users in a safe way. Gambit and every other offers company simply bundle in offers from outside vendors. The primary distributers of this fake activism are companies you will never know, like webclients.net doing business under eltpath.com. [They] distribute this stuff to sources all over the web from from freecomputer4u to sweepstakes promotions to offer providers."

The response from Get Health Care Reform:

We've also contacted Get Health Care Reform using an email address listed on their Web site. We received the following message back:

Google tried to deliver your message, but it was rejected by the recipient domain. We recommend contacting the other email provider for further information about the cause of this error. The error that the other server returned was: 553 553 sorry, that domain isn't in my list of allowed rcpthosts (#5.7.1) (state 14).

Source: http://www.businessinsider.com/health-i ... ll-2009-12
Health Care Reform: Compromise or Compromised
by Denise Dennis

Huffington Post, December 9, 2009

The Senate's latest proposal for health care legislation, as an alternative to the now watered-down public option, involves expanding Medicare to cover Americans beginning at age fifty-five. It also entails offering the same plans to Americans that federal employees--including members of Congress--receive. Under this proposal, the Office of Personnel Management would negotiate with insurers to offer one or more national health plans, as they do for the Federal Employees Health Benefits Program. This would be a non-profit, federally regulated plan.

Expanding Medicare to age fifty-five would a good, albeit limited compromise. The problem with having OPM negotiate with insurers to offer national plans, however, is that it could still leave the public at the mercy of the health insurance industry's arbitrary decisions.

This most recent proposal caught my eye because, in September, a retired federal employee called me to ask for help regarding her health care benefits. She had received a letter from her insurer--Blue Cross' Keystone Health Plan East--that for years offered the Federal Health Benefits Program, informing her that Keystone was canceling the federal employees program. The retired employee, whom I will call Mary, had read some of my Huffington Post pieces on health care reform and thought I might be able to get information for her about why the program was canceled--and what her options were for another insurer. Mary is a breast cancer survivor and was afraid that she would not be able to find another plan because her cancer would be considered a pre-existing condition, and because of her age.

The first time I called, Keystone denied that they had dropped the federal program and said the government canceled the partnership. When I called the Office of Personnel Management, they told me Keystone had canceled it. This dance of denial continued through several calls. Finally, I spoke with Keystone's public relations department and told them I was researching an article--and someone returned my call. It was then that I finally learned that Keystone had indeed dropped the program and that it was "a business decision."

Keystone had offered two choices, the HMO through which the federal benefits program was offered and the Preferred Provider Organization (PPO). They decided to "streamline plans" by dropping the HMO and offering only PPO.

Keystone's decision affects 15,000 members who are covered by the federal program. Mary and the other 14,999 members must now choose between a variety of plans offered by Keystone or the Office of Personnel Management. Mary called me again in November. Although she was given a Dec. 31, 2009 deadline to select another plan, every time she called both Keystone and the personnel office, she was put on-hold for up to an hour and then, either told to call again or simply disconnected. She was anxious that she would not have information about the alternative plans in time to make a decision before the deadline.

Keystone sent me a copy of the plans they are offering, which I sent to Mary. The plans are presented in a verbal matrix that is difficult for a younger person to decipher, let alone an anxious senior citizen. Anyone who has read through health insurance literature will recognize how confusing it can be.
Although Keystone told me that the plans they are offering would cost Mary less out-of-pocket than the federal benefits program, after reading the literature, Mary told me it would actually cost her $128 more each month--which is expensive for someone on a fixed income.

Yesterday, Mary finally reached the personnel management office and explained her predicament. They promised to send her literature about the plans they are offering that might replace the Keystone plan and promised, also, to give her a deadline extension for making her decision. They gave her nothing in writing, though, and she is not reassured by their promises.

The health care benefits offered by the Federal Employees Benefits Program, which Mary had during her nearly thirty-five years as a federal employee and her decade of retirement, have been excellent. The federal program offers a variety of affordable plans from which to choose, a marketplace of health insurance alternatives, so to speak. If the government can indeed offer a comparable program for Americans who are without health insurance--at low cost--it would be an improvement over private insurance or none at all.

In choosing this course, though, the Senate's "Gang of Ten" should consider Mary's experience. What will happen if the insurer offering the national plans decides to drop the program? How will implementing a program modeled on the current one prevent the insurers' virtual monopolies that now exist locally? What regulatory measures will be taken to make sure that insurers don't game the system? How will the Office of Personnel Management handle millions of new members? Will it be expanded? If so, what will the costs be?

A health insurance program modeled on the existing system and available to Americans who are without health insurance, coupled with an expansion of Medicare to cover people at age fifty-five would be a major step forward. The Senate committee needs to make sure, though, that in trying to find a compromise that appeals to progressive and conservative Democrats alike--they do not decide on a course that instead merely creates more members for private insurers--who are then left to cancel the national plans and offer their own, more expensive ones. It would be a travesty if the well-intentioned compromise created legislation that leave people compromised.

Source: http://www.huffingtonpost.com/denise-de ... 85310.html
Medicare Buy-In Filibuster-Proof? Senate Dem Deeply Concerned
by Sam Stein

Huffington Post, December 10, 2009

Democrats in the Senate may not have a filibuster-proof majority for the latest health care compromise after all.

Sen. Jeff Merkley (D-Ore.), expressed deep concern on Thursday that a new proposal to expand Medicare to those as young as 55 would seriously exacerbate health care-related problems already existing in his state.

"The basic challenge for Oregon is that a program that expands Medicare using existing Medicare rates would be of very little use in our state," the senator told the Huffington Post. "And the reason why is because the reimbursement rates are so low in the state of Oregon that doctors aren't taking additional Medicare patients... They can fill their agenda and their schedules with higher-paying patients."

One of the leading young progressive voices in the party, Merkley would not discuss how the Medicare buy-in provision will ultimately affect his position on reform, saying he had to wait for more details before making up his mind. But his objections complicate the notion that Senate Democrats now stand on the doorstep of historic legislation. The Oregon Democrat said he is going to work to make sure his state and others aren't disadvantaged by the newest wave of health care reform compromises. Medicare expenditures by the federal government, he noted, are 25 percent more (per person) in California and 38 percent more (per person) in Florida than they are in Oregon.

"We must succeed in repairing this broken system. But it doesn't get repaired by creating a major program that does not help states like Oregon," Merkley said.

Merkley complained about other aspects of reform negotiations, adding that many questions remain unanswered. The senator said that he was "enormously frustrated" by the unwillingness of his party's more conservative members deal with its progressive members on a public option for insurance coverage.

"There should have been the possibility to strike a deal given the flexibility that was expressed and obtained over opt-in and opt-out or the other issues," he said, in reference to the compromises he and other progressives were willing to make. "And no deal came forward."

And in light of the dropping of the public plan, he stressed that Democrats had to try and improve the negotiating power of the health care exchanges being structured in individual states.

Merkley also echoed concerns aired by Sen. Russ Feingold (D-Wisc.) that dropping the public option from the Senate's version of legislation could mean a drastic loss of potential savings in the health care system (the public plan could save roughly $25 billion over the next decade, according to the Congressional Budget Office).

"That would be a big problem," Merkley said, when asked if the CBO gave the Medicare buy-in a poor scoring, compared to the public plan.

Merkley, like others in the Senate, said he would reserve final judgment on the bill until that CBO score was final. Until then, he was relatively tight-lipped about his vote.

Source: http://www.huffingtonpost.com/2009/12/1 ... 87257.html
Pelosi Backs Off Public Option
by Ryan Grim

Huffington Post, December 10, 2009

The public health insurance option died on Thursday, December 10, 2009, after a months-long struggle with Senate parliamentary procedure. The time of death was recorded as 11:12 a.m. Eastern Standard Time.

Its death had been rumored numerous times over the past year, but the public option repeatedly and defiantly battled back. The Senate's insistence on 60 votes, combined with President Obama's decision not to intervene on its behalf, eventually proved overwhelming.

The public option leaves behind a Medicare buy-in for people aged 55-64, an expansion of Medicaid, a quasi-public option for those under 300 percent of the poverty line and a collection of national private plans managed by the Office of Personnel Management.

The one remaining chance for the public option rested with the House somehow forcing its will on the Senate.

But House Speaker Nancy Pelosi (D-Calif.) pulled the final plug in a press briefing with reporters Thursday.

She had often said in the past that a health care bill without a public option simply wouldn't have the votes to pass the House. She was asked about that claim Thursday, in relation to the Senate compromise, and pointedly told reporters that any bill could pass as long as it met certain broad goals.

"Well, what I said was a two-part statement: The president has said, we believe, the House believes, that the public option is the best way to hold the insurance companies honest, keep them honest and also to increase competition. If you have a better way, put it on the table. When we see something from the Senate, we'll be able to make a judgment about that. But our standards are that we have affordability for the middle class, security for our seniors, closing the doughnut hole, sustaining the solvency of Medicare, responsibility to our children and not one dime added to the deficit. And accountability of the insurance companies," Pelosi said.

In the hallway outside the press briefing, Pelosi was asked about a Senate plan that would have the Office of Personnel Management (OPM) oversee national private plans instead of a public plan. "Let's see what it is. It might come as a surprise," she said. "We haven't seen the paper from the Senate. There is certainly a great deal of appeal about putting people 55 and older on Medicare. That's something people in the House have advocated for for years."

On Tuesday, passionate public-option backer Rep. Anthony Weiner (D-N.Y.) said he was happy with what he'd heard of the Senate deal.

"Now, I need more clarification of what the other plan is--the OPM plan--Office of Personnel Management," said Pelosi. "But we've also said, if you want something like what the members of Congress have, this might bear some resemblance to the federal employee plan. I don't know, because I haven't seen it and I don't like to comment on what I haven't seen."

Source: http://www.huffingtonpost.com/2009/12/1 ... 87197.html

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Post by roxybeast » December 10th, 2009, 9:05 pm

<center>Public Option Dead, Unless You're Close to Death</center>
The Senate has killed the public option in favor of inadequate non-profit insurance alternatives offered by big insurance, but if you're over 55, there's hope that Medicare will be extended to you. Will it happen, probably not, ... but you can always hope ... after all, it is the Christmas season.
Public Option's Architect Intrigued By Medicare Buy-ln: 'The Original Idea'
by Sam Stein

Huffington Post, December 10, 2009

The intellectual father of the public option expressed enthusiasm on Wednesday for the decision by Democrats to push for an expansion of Medicare coverage to consumers as young as 55, calling it the "original idea" behind the public plan.

Jacob Hacker, a Yale University professor and leading health care theorist, did not fully endorse the latest incarnation of reform making its way through the Senate. Indeed, he was critical of some of the policy negotiations, in particular the decision to replace an actual public option with something run by private insurers and regulated by the government -- which he deemed "inadequate" and incompatible with the president's principles of reform.

But in a segment on PBS's Newshour, Hacker did call the proposed expansion of Medicare an "enormous positive development." And, in the process, he provided Senate Democrats with at least a modicum of intellectual cover as they try to patch together their final reform effort.
Well it certainly is a broad compromise, but I think it's a complex one. It has a lot of moving parts and a lot of details we don't know yet.

The way I would describe it is, in sort of Dickensian terms, is it's a tale of two public options. Public option one, the public option that was going to be within the exchange and available to Americans on day one to create competition for private insurance plans to give people a choice, that public option has been replaced, in my mind, with an inadequate substitute, a national system of private plans.

But public option two, which was never on the agenda before, a buy-in to the actual Medicare program for 55- to 64-year-olds, is an enormous positive development. It's actually the original idea, if you will, for the public option, simply letting people get into the Medicare program that provides broad, secure coverage at an affordable price.
<script type="text/javascript" src="http://www.pbs.org/wgbh/pages/frontline ... "></script>

It's worth noting that one of the provisions Hacker liked about the revised Senate effort was its immediacy. The Yale professor said that having the Medicare buy-in start as early as 2011 -- which appears to be the goal of Senate Democrats -- would be a major breakthrough, something "that is concrete, that people will be able to see it changing lives very early in the reform process." He also stressed that if the Senate drops the public option from its legislative language, it needs to ensure that strong regulatory incentives (triggers) are put in place to keep private insurers in check.
So, I'm strongly of the view that the way to strengthen this would be to say, look, OK, Office of Personnel -- and I just say and just want to say the insurance companies clearly think that this was a big win for them. There was an insurance industry insider who just wrote on a blog, "We win, administered by private insurance companies, no government funding."

Well, if they have won this round, the question is, can we put in place a trigger that says, if they don't perform up to expectations, then, in the next round, there's a public option that isn't restricted to people over the -- over 55?
Source: http://www.huffingtonpost.com/2009/12/1 ... 87673.html

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Post by roxybeast » December 11th, 2009, 4:06 pm

Pharma Deal Shuts Down Senate Health Care Debate
by Ryan Grim

Huffington Post, December 11, 2009

The White House, aided by Sen. Tom Carper (D-Del.), is working hard to crush an amendment being pushed by Sen. Byron Dorgan (D-N.D.) to allow for the reimportation of pharmaceutical drugs from Canada, Senate sources tell the Huffington Post.

As a result, the Senate health care debate has come to a standstill: Carper has placed a "hold" on Dorgan's amendment and in response, Dorgan tells HuffPost, he'll object to any other amendments being considered before he gets a vote on his.

Sen. Olympia Snowe (R-Maine) is a lead co-sponsor of Dorgan's amendment. She said she's confident that, as of now, they have the votes they need. "I think that's why we're not having this vote," she said, smiling. The amendment has the support of a number of other Republicans, including Sens. John McCain (Ariz.), Charles Grassley (Iowa), John Thune (S.D.) and David Vitter (La.).

Opponents of the amendment worry that many more Republicans may join the amendment not because they agree with it, but because they want to put the health care bill in jeopardy.

So the White House and the drug makers are trying to persuade as many Democrats as they can to oppose the amendment despite their previous support for it.

They've succeeded with Sen. Jay Rockefeller (D-W.Va.). "I don't think that's going to get my vote," he said when HuffPost asked about the reimportation amendment. He said that even though he is a supporter of reimportation, he is concerned that if it passes it could blow everything up.

"I'm not messing around with anything without 60 votes. Nothing," he said. "And I'm a co-sponsor of the amendment."

The dispute within the Democratic caucus is becoming personal. "Of course, with Dorgan, it's all about Dorgan," a senior Democratic aide told HuffPost, complaining that Dorgan was willing to blow up health care reform for his own glory.

Story continues below

Within a decade, reimportation would save consumers roughly $80 billion and the federal government $19 billion, according to the Congressional Budget Office. But that would mean $100 billion more in lost revenue than the powerful Pharmaceutical Research and Manufacturers of America (PhRMA) lobby agreed to bear-- in exchange for being supportive of the overall health reform effort.

Earlier this year, the administration struck a deal with PhRMA and the Senate Finance Committee limiting the industry's hit to $80 billion over ten years. The deal has never been officially confirmed, but the Huffington Post reported at the time that the White House agreed to oppose re-importation. The Senate Finance Committee bill, as well as the merged bill sent to the floor by Majority Leader Harry Reid (D-Nev.), stuck to that deal.

Along with its pledge of support, PhRMA offered to spend $150 million on ads backing reform. Most of that money stands ready to be used to kill reform, should it come to that. A Democratic aide said that the threat of PhRMA ads is being used by opponents of Dorgan's amendment as a reason to sink it.

Similarly, if Republicans end up providing the winning margin for the importation amendment, a source involved in the negotiations said the drug makers will come after the GOP "with a vengeance -- and not just on health care."

Grassley, a longtime supporter of reimportation, said that the amendment is running into trouble "ecause of the PhRMA agreement with the White House. This thing can pass and they don't want egg on their face with PhRMA. And I understand there's going to be a side-by-side [alternative amendment] and it's probably one of these issues where it will obfuscate the issue, but that not one single pill will get into this country if that side-by-side is adopted."

Thune, another co-sponsor of the amendment, said he was unsure how many fellow Republicans would come along. "It remains to be seen. Everybody's close to the vest on this and I think that's why the Dems don't want it voted on. They don't know how many votes their side has to deliver to defeat it. They've got a lot of people on their side that would normally vote for it," said Thune.

Did he think some Republicans would vote for it just to cause mischief, HuffPost asked.

"It's possible," he said.

Sen. Roger Wicker (R-Ala.) agreed it was a possibility, adding, "And some members of the Democratic leadership might vote against it even though they love the idea, because they've been so cozy with their new-found friends in PhRMA."

Wicker said he has yet to decide how he'll vote. "I've frankly been all over the map on that issue, so I'm being courted heavily," he said.

There's no certainty that PhRMA would walk away from the entire bill if the amendment passed, because it contains a basket of other goodies the industry won from the White House - not to mention about 30 million newly-insured consumers. "Who knows what people are going to do? It's hard to predict what's going to happen," Sen. Max Baucus (D-Mont.) said Friday.

Asked about the state of the amendment, he said: "Limbo."

The lobby is fighting the amendment as hard as it can, along with Carper, the senator from Delaware, which is home to a range of pharmaceutical interests.

Dorgan said that Carper's hold is unusual. "When somebody comes in and says, 'Let's have a vote,' it's generally, by consent, let's schedule a vote for 2:15," he said.

The hold causes problems for Dorgan and buys time for the amendment's opponents. "You can only beat a hold though after you file a cloture petition and wait two days and the cloture petition ripens and you get your vote," said Dorgan. "As a result of that [hold], I have also objected to them doing other business until I get my vote."

Ken Johnson, PhRMA's vice president, tells HuffPost the industry opposes the amendment for three principal reasons. First, he said, the Food and Drug Administration can't guarantee the safety of reimported drugs. Second, he says, it would cut into drug makers' profits - money it needs for research. And third, he says, the uncertainty around the origin of reimported drugs could tarnish the pharmaceutical brand, as people wonder about the authenticity of the drugs in their medicine cabinet.

Carper asked the FDA for its opinion on Dorgan's amendment and the administration wrote back on December 9 that it opposed it.

Publicly, President Obama continues to support reimportation, as he did during the campaign.

"The President supports reimportation of safe and effective drugs. He made that clear in his FY 2010 budget, which included $5 million to enable the FDA to begin developing policy options," reads a statement from the White House. "The Food and Drug Administration has raised safety concerns about the current proposal and will continue exploring policy options to create a pathway to importing safe and effective drugs."

Source: http://www.huffingtonpost.com/2009/12/1 ... 88895.html

And ...
Dems Say They'll Pursue Health Care Reforms After Legislation
by Sam Stein

Huffington Post, December 11, 2009

Senate Democrats are already lowering expectations for the final health care bill, insisting that there will more efforts at reform to come.

In a conference call with reporters on Friday, Sen. Sheldon Whitehouse (D-R.I.) and Debbie Stabenow (D-Mich.) both stressed that they will continue to try to tinker with changes to the health care insurance and delivery system and the pharmaceutical industry, even after legislation passes.

"This is fairly clearly the beginning and not the end of health care reform," said Whitehouse. "There is going to be an awful lot of oversight of the big programs, which is necessary. We have got to change the delivery system so it provides better health care to Americans with less... And the ongoing nature of this continuing effort to make the American health care system one we can be really proud of is one that will allow plenty of time for people to continue to advocate for their views. It is not as if, if you don't get your voice heard in this particular episode, or if you don't win the program or position that you wanted in this particular episode, you have to walk away for ever. This is going to be continuing."

Whitehouse is right in a narrow sense. Additional health care related legislation will be considered once -- or if -- the current round of massive reform becomes law. But his remarks seem aimed at diffusing anger (largely from the progressive community) over the concessions granted during the current process of reform. Both senators, for instance, said they are personally discouraged by the deal cut by the Obama White House to limit the government's ability to negotiate prescription drug prices in exchange for help from Big Pharma in passing reform. But Stabenow, for one, suggested that she was willing to swallow that disappointment in hopes of future action.

"All of us in the caucus are united to make sure that, even if there are things that we need to come back and work on later -- such as has been done with every other major reform that has ever passed -- we can't let anything get in the way of the larger goal," said the Michigan Democrat. "I'm hopeful we can do more on the prescription drug front. But if we can't I'm sure Sheldon and I will be back again."

Whitehouse and Stabenow didn't spend the entire call, hosted by the group Families USA, attempting to mitigate potential dissatisfaction. They also emphasized that various components of the reform effort are hugely important steps forward. And, in particular, they lauded the last-minute decision by leadership to expand Medicare coverage to those as young as 55.

"For a lot of Americans it will be viewed as more reliable, certain and secure," said Whitehouse. "It has lower administrative costs so you are by definition getting more medical payment per dollar you put in. And ultimately the subsidy that the bill provides for low-income folks can travel with them into this Medicare program... I think people are pretty optimistic that this will be a very credible alternative for those in the age group."

"For a lot of people in that age group the coming of age to qualify for Medicare is [like] finally entering safe harbor after years of stormy seas," he concluded. "And for people to be able to make that turn earlier, even as a relatively comparable price point, would still be a big plus."

Source: http://www.huffingtonpost.com/2009/12/1 ... 88951.html

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Post by roxybeast » December 14th, 2009, 11:28 pm

Senate Democrats Likely to Drop Medicare Expansion
By CARL HULSE and ROBERT PEAR

New York Times, December 14, 2009

WASHINGTON — Senate Democratic leaders said Monday that they were prepared to drop a proposed expansion of Medicare and make other changes in sweeping health legislation as they tried to rally their caucus in hopes of passing the bill before Christmas.


After a tense 90-minute meeting on Monday evening, Senator Max Baucus, Democrat of Montana and chairman of the Finance Committee, was asked if Democrats were likely to jettison the Medicare proposal.

“It’s looking like that’s the case,” Mr. Baucus said, indicating that the provision might be scrapped as a way of “getting support from 60 senators.”

Under the proposal, uninsured people ages 55 to 64 could purchase Medicare coverage. The Senate Democratic leader, Harry Reid of Nevada, floated the idea about 10 days ago as a way to break an intraparty impasse over his earlier proposal to create a government-run health insurance plan.

The signal from the party leadership came after the closed-door session to gauge sentiment for moving ahead with a pared-back measure that would not contain elements that liberal lawmakers had sought, particularly a public health insurance option.

Lawmakers and top aides said that the overriding view at the session held just off the Senate floor was that they had come too far in the health care debate to give up and that they should forge ahead with some legislation even if it was not all that they wanted.

After the meeting, lawmakers said they believed that chances were increased for completing a health care bill and that a final product would be a substantial improvement over the current system.

“If you compared it to the alternative, it looks good,” said Senator Sheldon Whitehouse, Democrat of Rhode Island, about the prospect of moving ahead with a measure that does not have a public health insurance option. “If you compare it to the possibilities, it looks pretty sad.”

Democrats were scheduled to meet Tuesday at the White House with President Obama to discuss health care. The party meeting in the Capitol came at a crucial time since the leadership must begin taking procedural steps if Democrats hope to reach a final vote on a health care plan sometime next week.

At a brief news conference after the caucus meeting, Mr. Reid refused to answer questions. He said: “This is like a steeplechase race. The last big puddle is in front of us.”

Senator Tom Harkin, Democrat of Iowa and chairman of the health committee, appeared to be laying the groundwork for a decision to abandon the Medicare buy-in.

“There is enough good in this bill that we ought to move it” even without the Medicare buy- in, Mr. Harkin said. Among the most important provisions of the bill, he said, are stringent new federal regulation of health insurance and coverage for a wide range of preventive health services.

Senator Evan Bayh, Democrat of Indiana, said, “If dropping the Medicare expansion is necessary, that’s what should be done.” He reported that “there was some disappointment by some members that some of the provisions could not be retained.”

The idea of expanding Medicare to cover younger members of the public ran into trouble this weekend when Senator Joseph I. Lieberman, the Connecticut independent, indicated he would not vote for that proposal. Given the need for Democrats to keep Mr. Lieberman in the fold, Democrats sought to find ways to ease his objections. Mr. Lieberman and Senator Ben Nelson, Democrat of Nebraska and another potential Democratic defector, were both in the private meeting but did not speak, lawmakers said.

Senator Arlen Specter of Pennsylvania, who switched parties earlier this year to become a Democrat, urged his colleagues not to let obstructionists stand in the way. “I came to this caucus to be your 60th vote,” he said to a round of applause, according to observers. Democrats need 60 votes to pass the health care bill over Republican objections.

Source: http://www.nytimes.com/2009/12/15/healt ... ealth.html
-AND-
Sources: Medicare buy-in likely to be dropped from health care bill
CNN, December 14, 2009

Washington (CNN) -- Senate Democrats are preparing to drop a compromise health-care plan that would allow 55- to 64-year-olds to buy into Medicare because of opposition from Connecticut Sen. Joe Lieberman, two senior Democratic sources said Monday.

"It's what the White House wants, and there aren't many other options that allow us to finish by Christmas," said one source.

Lieberman, an independent who caucuses with the Democrats, has emerged as the majority party's main obstacle to its efforts to get a health care bill through the Senate before Christmas. He ratcheted up his public opposition to the bill Sunday by threatening to join a Republican filibuster if the legislation contains either a government-run public health insurance option or a proposed alternative that would expand Medicare to people as young as 55.

"I think the danger always is you try to add too much onto a bill," he told reporters Monday evening. He said he supports the "core" of the bill, including tighter regulations on private insurers, but he wants Democrats to "take off some of this stuff that runs the risk of creating federal debt, and moves toward a government takeover of insurance, which I think would be bad."

Unanimous Republican opposition so far means Senate Democrats need all 60 votes in their caucus to close debate on the sweeping health care bill. Final passage of the bill would then require only a simple majority of 51.

Lieberman supported letting older workers buy into Medicare in 2000, when he was the Democratic vice presidential candidate, and as recently as September in comments to a Connecticut newspaper. But he said Monday that the idea was "no longer necessary," since the Senate bill includes subsidies to help people 55 and older buy insurance coverage before they become eligible for Medicare.

"I was suggesting various ideas for health care reform that did not involve the public option, and that was the focus at that time," he said. "But the important thing is I'm for health care reform, and if we get together, we're going to deliver a health care reform bill that will provide the ability to get health insurance to 30 million people that don't have it now."

Lieberman spokesman Marshall Wittmann said that now, "We have a huge national deficit and a program that analysts indicate is in dire fiscal straits in 2009."

Senate Democrats held an emergency meeting Monday night to discuss the issue, which threatens to derail the Obama administration's push for a sweeping reform of U.S. health insurance. Although a final decision was not made at Monday night's meeting, a second Democratic source said a final decision could be made at a White House meeting Tuesday between the Senate's Democratic majority and President Obama.

"I think there is a fundamental understanding of the direction we're going in," said Sen. John Kerry, D-Massachusetts.

Before the meeting, liberal Democrats Tom Harkin of Iowa and Jay Rockefeller of West Virginia indicated that the Medicare buy-in would likely be dropped. While they didn't like the idea, they suggested they would support a health care bill anyway.

Democrats "may have to do what Mr. Lieberman wants," Harkin said.

The Medicare expansion was part of a package of provisions announced by Reid last week as an alternative to a government-run public health insurance program, which lacked enough support among Democrats to break a filibuster. Negotiated by a team of 10 Democratic senators -- five liberal and five moderate -- the compromise package was hailed by Reid, Obama and others as an important step forward in the health care debate.

The package also would allow private insurers to offer nonprofit health coverage overseen by the government. But many senators have reserved judgment on the compromise proposal until the non-partisan Congressional Budget Office provides its analysis of how much it costs.

Senate Majority Leader Harry Reid would discuss no specifics of a bill after Monday night's caucus, telling reporters he would wait until the CBO finished its estimate of a revised bill's cost. But he said the measure "saves lives, saves money and saves Medicare."

"I am confident that by next week we'll be on our way to forward this bill to the president," he said.

Most Democrats support the public option as a nonprofit competitor to private insurers that would expand coverage and bring down prices. Republicans and some moderate Democrats, along with the health insurance industry -- one of the major employers in Lieberman's home state -- oppose a public option, calling it a first step toward a government takeover of the U.S. health care system.

Lieberman first expressed possible opposition to the health care bill in late October, saying he would join a GOP filibuster if the measure contained the public option. Asked about Lieberman's position then, Reid said: "Joe Lieberman is the least of Harry Reid's problems."

Another potential obstacle for Reid is moderate Democrat Ben Nelson of Nebraska, who said Sunday he cannot support the Senate bill without tighter restrictions on federal funding for abortion. The Senate last week defeated an amendment proposed by Nelson and two other senators that would adopt tougher language on abortion funding contained in the House health care bill.

A compromise on the abortion language is possible, said Nelson, one of 10 Senate Democrats who negotiated in private last week on the public option compromise.

If the Senate eventually passes a health care bill, its version will have to be merged with the version the House of Representatives passed in November, which includes a public health insurance plan. The final bill would then need approval from both chambers before going to Obama to be signed into law.

Obama and Democratic leaders have said they want the bill completed this year. The Senate would need to finish its work this week to leave a realistic chance of meeting that schedule.

Source: http://www.cnn.com/2009/POLITICS/12/14/ ... index.html

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Post by roxybeast » December 14th, 2009, 11:36 pm

<center>Lieberman's Giant Flip-Flop</center>
That's our Joe! ... Campaign: I support the public option! ... 3 Months Ago: while I did support the public option in my campaign, now I oppose it, because my idea is to allow a Medicare Buy-In for folks 55 & older ... Now: Medicare Buy-In, that's crazy, I oppose that!
VIDEO: Watch Lieberman Endorse Medicare Buy-In Three Months Ago
by Greg Sargent

The Plum Line, December 14, 2009

Here’s some video of Joe Lieberman only three months ago appearing to endorse the Medicare buy-in idea — in seeming contradiction of his decision to bail on the Senate deal.

Lieberman discussed the Medicare buy-in a meeting with the Connecticut Post in September, according to an article in the paper at the time, as TPM noted today. But the article only paraphrased Lieberman.

I asked the paper to send over the video, and it’s worth watching, because it gives you Lieberman’s actual quotes — which seem at odds with the Lieberman camp’s claim today that he has real problems with the approach:

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In the vid, Lieberman appeared to go further than the current Senate deal, which would expand Medicare to those aged 55-64, saying he supported the idea of expanding it to people aged 50 and over. Lieberman referenced his proposal along these lines during the 2006 campaign, and added:
“My proposals were to basically expand the existing successful public health insurance programs Medicare and Medicaid…

“When it came to Medicare I was very focused on a group — post 50, maybe more like post 55. People who have retired early, or unfortunately have been laid off early, who lose their health insurance and they’re too young to qualify for Medicare.

“What I was proposing was that they have an option to buy into Medicare early and again on the premise that that would be less expensive than the enormous cost. If you’re 55 or 60 and you’re without health insurance and you go in to try to buy it, because you’re older … you’re rated as a risk so you pay a lot of money.”
It’s not entirely clear that Lieberman was offering a full-throated current endorsement of the proposal, but his tone is clearly positive and approving. It’s yet another sign, as if you needed one, that Lieberman’s current opposition to the Senate proposal doesn’t appear to have any roots in a genuine policy disagreement.

Source: http://theplumline.whorunsgov.com/healt ... onths-ago/

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Post by roxybeast » December 22nd, 2009, 10:51 pm

<center>Roland Burris' "Twas the Night Before Christmas"</center>

This is great ... Sen Roland Burris (D. Ill) ... took the classic Twas the Night B4 Christmas & reworked it to discuss the current health care legislative crisis! ...

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Mr. President: It was the night before Christmas

It was the night before Christmas, and all through the Senate
The right held up our health care bill, no matter what was in it
The people had voted a mandated reform
But Republicans blew off the gathering storm
We'll clog up the Senate, they cried with a grin
And in the midterm elections, we'll get voted in
They knew regular folks needed help right this second
But fundraisers, lobbyists and politics beckoned
So try as they might, Democrats could not win
Because the majority was simply too thin
Then across every state there rose such a clatter
The whole senate rushed out to see what was the matter
All sprang up from their desk and ran from the floor
Straight through the cloakroom and right out the door

And what in the world would be quite so raucous?
But a mandate for change from the Democratic caucus
The president, the Speaker, of course Leader Reid
Had answered the call in our hour of need
More rapid than eagles, the provisions they came
And they whistled and shouted and called them by name
Better coverage, cost savings, a strong public plan [sic]
Accountable options. We said, 'Yes, we can.'
No exclusions or changes for preexisting conditions
Let's pass a bill that restores competition
The Democrats all came together to fight
For the American people that Christmas Eve night

And then in a twinkle, I heard under the dome
The roll call was closed, and it was time to go home
Despite the obstructionist tactics of some
The filibuster had broken, the people had won
And a good bill was ready for President Obama
Ready to sign and end health care drama
Democrats explained as they drove out of sight
Better coverage for all, even our friends on the right.

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Post by Doreen Peri » December 22nd, 2009, 11:00 pm

that was great... thanks for sharing it!

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Post by roxybeast » December 29th, 2009, 3:48 pm

<center>Historic! Senate Passes Health Reform Legislation,
Next Step Reconciliation
</center>

The Senate approved its version of the historic health reform legislation in a 60-39 party line vote. The many differences between House & Senate bills now have to be reconciled. Here is the New York Times coverage of this historic event:
<center>Senate Approves Health Care Bill
By ROBERT PEAR
New York Times, December 24, 2009
</center>

WASHINGTON — The Senate voted Thursday to reinvent the nation’s health care system, passing a bill to guarantee access to health insurance for tens of millions of Americans and to rein in health costs as proposed by President Obama.

The 60-to-39 party-line vote, on the 25th straight day of debate on the legislation, brings Democrats a step closer to a goal they have pursued for decades. It clears the way for negotiations with the House, which passed a broadly similar bill last month by a vote of 220 to 215.

If the two chambers can strike a deal, as seems likely, the resulting product would vastly expand the role and responsibilities of the federal government. It would, as lawmakers said repeatedly in the debate, touch the lives of nearly all Americans.

The bill would require most Americans to have health insurance, would add 15 million people to the Medicaid rolls and would subsidize private coverage for low- and middle-income people, at a cost to the government of $871 billion over 10 years, according to the Congressional Budget Office.

The budget office estimates that the bill would provide coverage to 31 million uninsured people, but still leave 23 million uninsured in 2019. One-third of those remaining uninsured would be illegal immigrants.

If the bill becomes law, it would be a milestone in social policy, comparable to the creation of Social Security in 1935 and Medicare in 1965. But unlike those programs, the new initiative lacks bipartisan support. Only one Republican voted for the House bill last month, and no Republicans voted for the Senate version.

Senator Olympia J. Snowe of Maine, a moderate Republican who has spent years working with Democrats on health care and other issues, expressed despair.

“I was extremely disappointed,’’ Ms. Snowe said. After Senate Democrats locked up 60 votes within their caucus, she said, “there was zero opportunity to amend the bill or modify it, and Democrats had no incentive to reach across the aisle.’’

Like many Republicans, Ms. Snowe was troubled by new taxes and fees in the bill, which she said could have “a dampening effect on job creation and job preservation.’’ The bill would increase the Medicare payroll tax on high-income people and levy a new excise tax on high-premium insurance policies, as one way to control costs.

The fight on Capitol Hill prefigures a larger political battle likely to play out in the elections of 2010 and 2012, as Democrats try to persuade a skeptical public of the bill’s merits, while Republicans warn that it will drive up costs for those who already have insurance.

After struggling for years to expand health insurance in modest, incremental ways, Democrats decided this year that they could not let another opportunity slip away.
As usual, lawmakers were deluged with appeals from lobbyists for health care interests who have stymied similar ambitious efforts in the past. But this year was different.

Lawmakers listened to countless stories of hardship told by constituents who had been denied insurance, lost coverage when they got sick or seen their premiums soar. Hostility to the health insurance industry was a theme running through the Senate debate.

Senator Sherrod Brown, Democrat of Ohio, said insurance companies were often “just one step ahead of the sheriff.’’

Senator Dianne Feinstein, Democrat of California, said the industry “lacks a moral compass.’’

“Premiums are out of hand,’’ Mrs. Feinstein said. “Chief executive salaries are out of hand. Administrative costs are out of hand. My bottom-line belief is that the health insurance industry should be nonprofit.’’

And Senator Sheldon Whitehouse, Democrat of Rhode Island, said the business model of the health insurance industry deserved to die.

“It deserves a stake through its cold and greedy heart,’’ Mr. Whitehouse said.

The bill would establish stringent federal standards for an industry that, since its inception, has been regulated mainly by the states.

Under the bill, insurers could not deny coverage because of a person’s medical condition; could not charge higher premiums because of a person’s sex or health status; and could not rescind coverage when a person becomes sick or disabled. The government would, in effect, limit the profits of insurers by requiring them to spend at least 80 to 85 cents of every premium dollar on medical care.

The specificity of federal standards is illustrated by one section of the bill, which requires insurers to issue a summary of benefits that “does not exceed four pages in length and does not include print smaller than 12-point font.’’

Another force propelling health legislation through the Senate was the Democrats’ view that it was a moral imperative and an economic necessity.

“The health insurance policies of America, what we have right now is a moral disgrace,’’ said Senator Tom Harkin, Democrat of Iowa, who noted that medical expenses had driven many people into bankruptcy. “We are called upon to right a great injustice, a great wrong that has been put upon the American people.’’

Costs of the bill would, according to the Congressional Budget Office, be more than offset by new taxes and fees and by savings in Medicare. The measure would squeeze nearly a half-trillion dollars from Medicare over the next 10 years, mainly by reducing the growth of payments to hospitals, nursing homes, private Medicare Advantage plans and other health care providers.

Republicans asserted that the cuts would degrade services to Medicare beneficiaries. But AARP, the influential lobby for older Americans, and the American Medical Association ran an advertisement urging senators to pass the bill, under which Medicare would cover more of the cost for prescription drugs, screenings and other preventive health services.

Karen M. Ignagni, president of America’s Health Insurance Plans, said the bill appeared to be unstoppable. But she added: “We are not sure it will be workable. It could disrupt existing coverage for families, seniors and small businesses, particularly between now and when the legislation is fully implemented in 2014.’’

The bill would set up insurance exchanges where people could compare health plans and buy insurance with tax credits to help cover the cost.

Whether such plans should be allowed to cover abortion is perhaps the most difficult issue that will face Senate and House negotiators.

Architects of the legislation said they wanted to move away from the fragmented fee-for-service health care system, toward one in which doctors and hospitals would coordinate care and take collective responsibility for patients, with payments based more on the quality of care and less on the volume of services.

Source: http://prescriptions.blogs.nytimes.com/ ... e-measure/
<center>Obama Praises Senate Bill, Heads for Hawaii
By DAVID M. HERSZENHORN
New York Times, December 24, 2009
</center>

President Obama, speaking at the White House before leaving to celebrate Christmas in Hawaii, praised the Senate for approving major health care legislation.

“In a historic vote that took place this morning, members of the Senate joined their colleagues in the House of Representatives to pass a landmark health insurance reform package, legislation that brings us toward the end of a nearly century-long struggle to reform America’s health care system,” Mr. Obama said.

Now that both the House and Senate have approved versions of the health care legislation, the White House is expected to step up its role in negotiating a compromise between the two bills.

There are major differences. The House bill includes a government-run health insurance plan, or public option. The Senate does not. The House and Senate each take different approaches to paying for the legislation.

Moments after the Senate vote, White House officials were already meeting with senior aides to the majority leader, Harry Reid of Nevada, discussing the next steps. Senator Max Baucus, Democrat of Montana and chairman of the Finance Committee, who was a lead author of the bill, said work on reconciling differences between the Senate and the House would begin right after the Christmas holiday.

Mr. Obama, however, emphasized the similarities of the two bills. And he praised Congressional leaders, including Mr. Reid and the House speaker, Nancy Pelosi, for getting the job done.

Here are the rest of Mr. Obama’s remarks:
Ever since Teddy Roosevelt first called for reform in 1912, seven presidents, Democrats and Republicans alike, have taken up the cause of reform. Time and time again, such efforts had been blocked by special-interest lobbyists who have perpetuated a status quo that works better for the insurance industry than it does for the American people.

But with passage of reform bills in both the House and the Senate, we are now finally poised to deliver on the promise of real, meaningful health insurance reform that will bring additional security and stability to the American people. The reform bill that passed the Senate this morning, like the House bill, includes the toughest measures ever taken to hold the insurance industry accountable. Insurance companies will no longer be able to deny you coverage on the basis of a pre-existing condition. They will no longer be able to drop your coverage when you get sick.

No longer will you have to pay unlimited amounts out of your own pocket for the treatments you need. And you’ll be able to appeal unfair decisions by insurance companies to an independent party.

If this legislation becomes law, workers won’t have to worry about losing coverage if they lose or change jobs. Families will save on their premiums. Businesses that would see their costs rise if we do not act will save money now and they will save money in the future. This bill will strengthen Medicare and extend the life of the program. It will make coverage affordable for over 30 million Americans who do not have it. Thirty million Americans.

And because it is paid for and curbs the waste and inefficiency in our health care system, this bill will help reduce our deficit by as much as $1.3 trillion in the coming decades, making it the largest deficit-reduction plan in over a decade. As I’ve said before, these are not small reforms. These are big reforms.

If passed, this will be the most important piece of social legislation since the Social Security Act passed in the 1930s and the most important reform of our health-care system since Medicare passed in the 1960s.

And what makes it so important is not just its cost savings or its deficit reductions. It’s the impact reform will have on Americans who no longer have to go without a checkup or prescriptions that they need because they can’t afford them, on families who no longer have to worry that a single illness will send them into financial ruin and on businesses that will no longer face exorbitant insurance rates that hamper their competitiveness. It’s the difference reform will make in the lives of the American people.

I want to commend Senator Harry Reid, extraordinary work that he did, and Speaker Pelosi for her extraordinary leadership and dedication. Having passed reform bills in both the House and the Senate, we now have to take up the last and most important step and reach an agreement on a final reform bill that I can sign into law. And I look forward to working with members of Congress in both chambers over the coming weeks to do exactly that.

With today’s vote, we are now incredibly close to making health insurance reform a reality in this country. Our challenge then is to finish the job. We can’t doom another generation of Americans to soaring costs and eroding coverage and exploding deficits. Instead, we need to do what we were sent here to do, and improve the lives of the people we serve. For the sake of our citizens, our economy and our future, let’s make 2010 the year we finally reform health care in the United States of America.

Everybody, Merry Christmas. Happy New Year.
Source: http://prescriptions.blogs.nytimes.com/ ... alth-bill/
Here's a quick summary of all of the major amendments to the Senate Bill ... http://politics.nytimes.com/congress/bi ... amendments

Here's a broad overview timeline chart of the legislatiion's history so far ... http://www.nytimes.com/interactive/2009 ... eline.html

Here is an in-depth comparison of what's in the Senate & House bills ... http://www.nytimes.com/interactive/2009 ... rison.html
<center>The Senate Majority Leader’s Oh-No Vote
By DAVID M. HERSZENHORN
New York Times, December 24, 2009
</center>

It was the pinnacle moment of his political career. The majority leader of the United States Senate, Harry Reid of Nevada, on the verge of making history by shepherding through landmark health care legislation, was called upon by the clerk to cast his vote.

And Mr. Reid, who has fought, night and day, nail and tooth, for months to get the health care bill adopted, looked up from his desk and said: “No.”

For a millisecond there was silence in the chamber. Had he lost it? Was he joking?

Within half a second, Mr. Reid had switched his vote to “yes.”

And after 25 straight days of bitter, partisan debate, senators on both sides of the aisle busted up laughing.

Mr. Reid, exhausted, briefly hung his head toward his knees. He smiled sheepishly. He gave a huge shrug. His colleagues continued laughing. The clerks moved on to Senator Jim Risch, Republican of Idaho, who voted “no” for real.

At a news conference afterward, Mr. Reid joked that his brief “no” vote was an attempt to create a spirit of bipartisanship – a reference to the unanimous opposition to the health care measure of Senate Republicans.

But, in fact, he had not been kidding. He had gotten lost in the moment, on the edge of accomplishing one of the most excruciatingly difficult tasks in modern American political history, uniting the entire Democratic caucus to pass the bill after decades of failed efforts to revamp the nation’s health care system.

“To be honest, I’d like to say I was trying to be funny or create some bipartisanship,” Mr. Reid said in an interview. “But I was just in dreamland, thinking about where we had come. Some said ‘oh bipartisanship or trying to be funny.’ It was neither quite frankly. It was just, I am bushed.”

“And,” he added, “I don’t mean George Bushed.”

Source: http://prescriptions.blogs.nytimes.com/ ... h-no-vote/


<center>Health Bill Benefits for the Impatient
By DAVID M. HERSZENHORN
New York Times, December 28, 2009
</center>

WASHINGTON — Some immediate benefits from the health care legislation advancing on Capitol Hill will ease the minds of parents who may have hit up against limitations of their existing health insurance.

Within six months, the Senate bill approved last week would allow dependent, unmarried children to remain on their parents’ policies until their 26th birthday; the House bill would allow an additional year of dependent coverage, until the 27th birthday. Right now it varies from state to state.

The Senate bill would also bar insurers from denying coverage to children under 19 years of age based on pre-existing medical conditions. And the House bill would require insurers to cover reconstructive surgery for children born with deformities.

In many cases, the requirements, including the extended coverage for adult children, would apply only to new insurance plans, though insurers could apply the changes to existing policies.

Many major provisions in the health care legislation would not take effect for several years. New federal subsidies to help moderate-income Americans afford coverage would not begin until 2013 under the House bill, and 2014 under the Senate bill. A new requirement that nearly all Americans obtain insurance would take effect at the same time that the subsidies become available.

On the flip side, many of the new taxes and fees that will help pay for the legislation would take effect much sooner. For this reason, some Republicans have criticized the bill as akin to legislation on a layaway plan: pay now for benefits later.

The concept, however, is not unprecedented. In 1965, when Medicare was created, the payroll tax began six months before the insurance coverage began for Americans age 65 and over.

Still, the lengthy gap between the expected completion of the legislation in early 2010 and the effective date of many major provisions has left Democrats working to answer the criticism with lists of “immediate deliverables.”

Here are some of the benefits that Democrats say would be available soon after the legislation is adopted:

No annual or lifetime limits Both the Senate and House versions of the legislation ultimately seek to prevent insurers from imposing annual or lifetime limits on coverage in new health policies. In the final package of amendments to the Senate bill, the majority leader, Harry Reid of Nevada, added new language giving the secretary of health and human services the authority to regulate annual limits from six months after the bill is enacted until the broader insurance provisions take effect in 2014. Such limits are a serious concern to people with chronic illnesses like cancer that can require expensive treatments within a relatively short period of time, and the change proposed by Mr. Reid was prompted by inquiries from the American Cancer Society.

Limits on insurance company profits Beginning in 2011, the Senate bill would set tight restrictions to force insurance companies to spend the bulk of their revenues on providing medical care to beneficiaries. The legislation would require insurance companies in the large group market to spend at least 85 percent of their revenues on care and insurers in the individual market to spend at least 80 percent of revenues on care. Critics of the private health insurance, including Senator John D. Rockefeller IV, Democrat of West Virginia, and Senator Sherrod Brown, Democrat of Ohio, said setting such requirements on what insurers call “medical loss ratios” was needed to tamp down on profiteering.

Short-term expansion of state high risk pools To help people who cannot obtain insurance because of pre-existing conditions, both the Senate and House bills would provide $5 billion to increase the availability of coverage through state high-risk insurance pools. This provision would take effect 90 days after enactment of the legislation, but many details remain to be worked out.

New financing for community health centers The House bill provides $12 billion in additional financing for community health centers, which serve needy populations, particularly in rural areas. Senator Bernard Sanders, independent of Vermont, won the inclusion of $10 billion in financing for community health centers in the Senate bill. The final dollar amount will be decided in negotiations between House and Senate leaders, but the money would be available for five years beginning in the current fiscal year.

Closing the Medicare drug “doughnut hole” The legislation would increase the amount of drug costs covered by Medicare by $500 in 2010. And beginning on July 1, 2010, the bill would provide 50 percent discounts on brand-name drugs and biologics that low- and middle-income beneficiaries have to pay for themselves once the coverage gap known as the doughnut hole begins.

Prohibition on rescinding existing coverage Both the House and Senate bills would bar insurance companies from rescinding existing coverage other than “in cases of fraud or intentional misrepresentation of material fact.”

Small business tax credits The Senate bill would offer tax credits to small businesses beginning in 2010 for up to 35 percent of premium costs. The full credit would be available to firms with 10 or fewer employees and average annual wages of $25,000. Reduced credits would be available to firms with up to 25 employees and with average annual wages of up to $50,000.

Patient protections For new health plans, beginning six months after enactment of the legislation, the Senate bill would prohibit insurers from requiring prior authorization before a woman sees an obstetrician or gynecologist. The bill would also require coverage for emergency care.

Discrimination protections for lower-income workers The Senate bill would bar group health plans from setting any eligibility rules for coverage that favor higher-wage employees. This provision would take effect six months after enactment of the legislation.

Cobra extension through 2013 Anyone currently paying for an extension of health benefits as permitted under federal law — for instance, after a loss of employment — would be permitted under the House legislation to continue Cobra coverage until the major insurance coverage provisions of the legislation take effect in 2013.

Reinsurance program for early retirees Both the House and Senate bills would provide federal financing for a new reinsurance program to encourage employers to maintain health benefits for employees and early retirees age 55 to 64.

Consumer assistance provisions Both the House and Senate bills would begin to impose new requirements aimed at making it easier for consumers to interact with insurers, including a requirement that health plans adopt uniform descriptions of plan benefits and appeals procedures and that they begin using identical forms.

Source: http://prescriptions.blogs.nytimes.com/ ... more-18175
<center>Expanding Health Coverage and Shoring Up Medicare: Is It Double-Counting?
By ROBERT PEAR
New York Times, December 28, 2009
</center>

WASHINGTON — At the heart of the fight over health care legislation is a paradox that befuddles lawmakers of both parties.

Separate bills passed by the Senate and the House would squeeze nearly a half-trillion dollars from projected spending on Medicare over the next 10 years. These savings would help offset the cost of providing coverage to people who are uninsured.

At the same time, federal accountants say the money would shore up the Medicare trust fund, so the program could continue paying hospitals to treat older Americans in the future.

In other words, Medicare savings mean both more money available to spend now and the appearance of more money to spend later on Medicare.

How is this possible?

The Congressional Budget Office tried to answer the question last week. In effect, it said, the same money cannot be used for both purposes without double-counting.

“To describe the full amount of hospital insurance trust fund savings as both improving the government’s ability to pay future Medicare benefits and financing new spending outside of Medicare would essentially double-count a large share of those savings, and thus overstate the improvement in the government’s fiscal position,” the budget office said.

But the clarification came too late to affect the outcome of debate over the legislation, passed Thursday in the Senate by a party-line vote of 60 to 39.

For weeks, Republicans had been saying that Democrats would plunder Medicare, raid it, use it as a “piggy bank” to pay for coverage of the uninsured under a new entitlement program.

Such fusillades frightened some older voters and prompted defensive maneuvers by Democrats, who said their bill would “save lives, save money and save Medicare,” while providing additional benefits to older Americans.

Senator Michael Bennet, Democrat of Colorado, offered an amendment that said nothing in the bill would result in a reduction of “guaranteed benefits” under Medicare. The amendment was approved, 100 to 0, on Dec. 3.

Richard S. Foster, the chief Medicare actuary, agrees with the Congressional Budget Office. He traces the confusion to different accounting rules used for the federal budget and for the Medicare trust fund.

The Senate bill would reduce the growth of Medicare spending and increase the Medicare payroll tax on high-income people. The combination of less spending and more revenue would lower the deficit, based on budget accounting rules, and extend the life of the Medicare trust fund.

However, Mr. Foster said, the same money “cannot be simultaneously used” to cover the uninsured and to extend the Medicare trust fund, “despite the appearance of this result from the respective accounting conventions.”

Senator Jon Kyl of Arizona, the No. 2 Republican in the Senate, summarized the situation with a pithy metaphor. “You can’t sell the same pony twice,” he said.

After issuing its clarification, the budget office reaffirmed its earlier estimate that the Senate bill would reduce the deficit by $132 billion in the next 10 years, compared with the deficits expected under current law.

The issue involves not only technical accounting matters, but also a huge political issue: the impact of a health care overhaul on Medicare and its beneficiaries, whose numbers are about to explode — to 60 million in 2019, from 46 million now.

On a purely technical level, the federal budget deficit — $1.4 trillion in the last year — is the difference between federal receipts and federal spending in a given year. It measures cash flows into and out of the Treasury. If Congress cuts Medicare spending, it reduces the deficit, assuming everything else stays the same.

By contrast, Medicare’s hospital insurance trust fund serves, in the words of the Congressional Budget Office, “primarily as an accounting mechanism.” Payroll taxes paid by workers and employers are credited to the trust fund. Medicare draws on this account to pay hospitals, nursing homes and certain other health care providers.

Under federal law, the Medicare hospital trust fund exists “on the books of the Treasury.” It may have a positive balance — enough money to pay expected claims for a decade or more — even though the government as a whole runs a deficit every year and borrows immense sums to pay its bills.

In one sense, money that “goes into” the Medicare trust fund cannot be used for other purposes. But it is part of a unified federal budget, which includes spending for dozens of other federal programs. So if Congress reduces Medicare payments to hospitals or private Medicare Advantage plans — and if everything else stays the same — the federal budget deficit will be lower and the balance in the Medicare trust fund higher than they otherwise would be.

The Congressional Budget Office says the Senate bill would cover 31 million uninsured people — about 10 percent of the population — while the House bill would cover 36 million. The budget office has not estimated the effects on total national health spending, but Mr. Foster, the Medicare actuary, has done so.

Mr. Foster estimates that the Senate bill would increase national health spending by a total of $234 billion, or 0.7 percent, in the decade from 2010 through 2019, while the House bill would increase it by $289 billion, or 0.8 percent.

If the savings in the Senate bill are achieved, Mr. Foster said, they would add nine years to the life of Medicare’s hospital trust fund, so it would be exhausted in 2026, rather than 2017.

But, Mr. Foster said, some of the estimated savings “may be unrealistic” because they assume increases in productivity that can probably not be attained by hospitals, nursing homes and home health agencies.

Source: http://www.nytimes.com/2009/12/29/healt ... ealth.html
<center>Health Lobby Takes Fight to the States
By DAVID D. KIRKPATRICK
New York Times, December 28, 2009
</center>

WASHINGTON — Like about a dozen other states, Florida is debating a proposed amendment to its state constitution that would try to block, at least symbolically, much of the proposed federal health care overhaul on the grounds that it tramples individual liberty.

But what unites the proposal’s legislative backers is more than ideology. Its 42 co-sponsors, all Republicans, were almost all recipients of outsized campaign contributions from major health care interests, a total of about $765,000 in 2008, according to a new study by the National Institute on Money in State Politics, a nonpartisan group based in Helena, Mont.

It is just one example of how insurance companies, hospitals and other health care interests have been positioning themselves in statehouses around the country to influence the outcome of the proposed health care overhaul. Around the 2008 election, the groups that provide health care contributed about $102 million to state political campaigns across the country, surpassing the $89 million the same donors spent at the federal level, according to the institute.

Any federal legislation is likely to supersede state constitutional amendments. But backers of the state measures say they want to send a message to Congress and also lay groundwork for fights about elements of the health care package that are expected to be left up to the states.

Some proposals floated around Capitol Hill, for example, would allow individual states to “opt in” or “opt out” of regional health insurance markets or government-sponsored insurers.

“We would be essentially telegraphing our intentions,” said State Senator Carey Baker, a Florida Republican and lead sponsor of the state’s proposal. “If there was an opt-in, we are essentially stating now that we are not going to opt in.”

Advocates of a sweeping overhaul by the federal government, on the other hand, say the magnitude of the health care industry’s contributions shows the dangers of leaving such a question up to individual states, where campaign finance and ethics rules vary from strict to negligible.

“The states are the next battle,” said Richard Kirsch, national campaign manager for the liberal advocacy group Health Care for America Now, “and the insurers and health care industry are primed up and ready to go. The industry has enormous power at the state level, and very few states have state-level consumer groups that are able to lobby effectively against them.”

Last year, for example, the drug industry poured more than $20 million into political contributions in states around the country. In California alone, the industry spent an additional $80 million on advertising to beat back a California ballot measure intended to push down drug prices.

Now, speaking on condition of anonymity because the pharmaceutical trade group is officially backing the federal overhaul, industry lobbyists say they are eyeing Congressional proposals that would expand a state’s Medicaid obligations, and are preparing to fight efforts to make some of it up by paying less for drugs. (A spokeswoman for the National Conference of State Legislatures said many states were contemplating just that.)

The idea of amending state constitutions to block the core of the federal health care legislation, including the requirement that individuals and businesses buy insurance, began at the conservative Goldwater Institute in Arizona, the state where the first such measure will appear on the ballot next year.

“The measures are an opportunity for people to make their views known in a tangible way, to generate some rumble at the grass roots,” said Clint Bolick, a lawyer at the Goldwater Institute who helped devise the idea.

From there, though, the concept was picked up by the American Legislative Exchange Council, a business-friendly conservative group that coordinates activity among statehouses. Five of the 24 members of its “free enterprise board” are executives of drug companies and its health care “task force” is overseen in part by a four-member panel composed of government-relations officials for the Blue Cross and Blue Shield Association of insurers, the medical company Johnson & Johnson and the drug makers Bayer and Hoffmann-La Roche.

The group adopted Arizona’s proposed amendment as a model, and it was introduced in 14 state legislatures around the country. Lawmakers in several others are reportedly considering it as well.

“We are trying to prepare, and trying to send a message that there is no reason for those decisions to get made at the federal level,” said Representative Linda L. Upmeyer, a Republican who is leading the council’s efforts in Iowa.

The states where the amendment has been introduced are also places where the health care industry has spent heavily on political contributions in recent years, according to figures from the National Institute on Money in State Politics. Over the last six years, health care interests have spent $394 million on contributions in states around the country; about $73 million of that went to those 14 states. Of that, health insurance companies spent $18.2 million, according to the institute.

In Florida, where health interests have given a total of about $32 million over the last six years, the state medical association has become an especially important backer of the proposed amendment. In contrast to the national American Medical Association, the state chapter has come out firmly against the current Congressional proposals, and a spokeswoman said the Florida group had embraced the proposed state amendment “to protect Florida from being forced into a federal government mandate that would hurt patients.”

Dr. Madelyn E. Butler, president elect of the Florida Medical Association, said, “We are trying to ameliorate the effects of national health care reform on the State of Florida.”

James Greer, chairman of the Florida Republican Party, said he too supported the proposal, which could be on the ballot in 2010 or more likely in 2012. Whatever its legal weight, Mr. Greer said, its mere presence on the ballot would give it political force.

“It will energize Republicans and independents who want to vote against Democrats and the policies of the Democratic Congress,” Mr. Greer said.

Source: http://www.nytimes.com/2009/12/29/healt ... lobby.html
<center>When Legislation Goes Into Overtime
By REED ABELSON
New York Times, December 26, 2009
</center>

Sometimes it ain’t over even when it’s over.

With Democrats having worked feverishly to pass sweeping Senate and House health care bills before year’s end, it is worth remembering that legislative success can be short-lived.

Few people outside health policy circles may recall it, but two decades ago, after Congress congratulated itself on the passage of another health care bill, a public uproar forced its repeal a mere 16 months later.
That legislation was the Medicare Catastrophic Coverage Act, which President Ronald Reagan signed into law in July 1988. The law’s intent was to give better financial protection to people enrolled in Medicare by limiting their out-of-pocket payments for things like hospital stays and doctors’ fees if they became very sick.

But this was not a free new entitlement, as Medicare beneficiaries were quick to realize. The new benefits would be financed by higher monthly premiums for Medicare enrollees and by a surtax paid by the more affluent enrollees.


What is more, many of the people being asked to pay more did not need the expanded coverage because they already had it through supplemental policies from their former employers. (That was back when companies tended to be more generous with health benefits for retirees.)

“It was a revolt of middle-class old people,” said Elaine Kamarck, a former adviser to Vice President Al Gore who is now a policy expert at the Kennedy School of Government at Harvard. If you were well enough off, she said, “you were getting a benefit you already had and suddenly your premiums were going up.”

The response was swift and ugly. And for a politician, it was a stark lesson in the perils of misreading your constituents. Dan Rostenkowski, a former Democratic congressman from Illinois who was chairman of the House Ways and Means Committee at the time, went home to Chicago — only to find himself surrounded by angry elderly voters protesting the new law. Mr. Rostenkowski, as documented by CBS News, was forced to beat a hasty retreat during one run-in.

Ms. Kamarck considers the entire episode a warning that any sweeping legislation affecting an area as critical as health care can have significant unintended consequences. In the case of the 1988 bill, Congress “didn’t get the consequences right,” she said, despite the legendary prowess of Mr. Rostenkowski. “You had a very skilled politician,” she said, “and it blew up in his face.”

The intensity of the response over the higher premiums persuaded members of Congress to scrap the legislation when they could find no other way to pay for the expanded coverage.

Historical Parallels

Some health policy experts see parallels to what is going on now in Washington. Because the current health care legislation is complex, with changes yet to come when the House and the Senate meld their bills, many members of the public may have a hard time seeing what is in it for them. But they may not have much trouble grasping the reality of higher insurance premiums or scaled-back Medicare benefits, if those are in the cards.

“What is similar is a lack of understanding,” said Jon Gabel, a health researcher who helped write a post-mortem of the repealed bill for the journal Health Affairs in 1990.

Another similarity, Mr. Gabel said, is in the built-in delay between the legislation’s passage and its effective date. People were being asked to start paying the higher premiums and taxes before the benefits would be delivered, he said, just as many important aspects of the current legislation, like the creation of new insurance exchanges, would not begin until years after President Obama signed it.

Such delay is “a political risk,” agreed Timothy S. Jost, a law professor at Washington and Lee University who has been closely following the proposals as they move through Congress. He said the legislation might not deliver soon enough to adequately discourage possible repeal, especially given the highly divisive debate around issues like a government-run insurance plan and coverage for abortion.

But Mr. Gabel predicted that enough benefits from the legislation would kick in soon enough — like the ability of people in their 20s to stay on their parents’ policies and the creation of high-risk pools so more people can find insurance — that their popularity would encourage public support for the whole package.

Lessons Learned

Some veterans of the late 1980s experience say its lessons have been well learned by members of Congress and proponents of the legislation, including the need to educate the public about the benefits of the new law.

“I don’t think history will repeat itself,” said John Rother, executive vice president of policy and strategy for AARP, the influential lobbying group for older Americans, many of whom are enrolled in the Medicare program.

He said members of Congress voting for the legislation would be acutely aware of the need to sell it back home, if it is passed. Mr. Rother also pointed to several clear benefits for individuals currently enrolled in Medicare, like more generous prescription drug coverage through a provision that would close the so-called doughnut hole, a gap in Medicare drug coverage that can mean beneficiaries pay thousands of dollars for drugs each year.

The support of groups like AARP is also a critical difference, said Thomas Rice, a health policy expert at the University of California, Los Angeles, who is also one of the authors of the 1990 Health Affairs piece. What is more, Mr. Rice said it was extremely unlikely that Congress could come up with enough votes to override an almost-certain veto by Mr. Obama of any attempt to repeal the law.

Back in 1989, President George Bush allowed the repeal to go through, despite his support of the law when he was vice president. As long as there is a Democrat in the White House, Mr. Rice said, any law that passes is likely to stand.

But Mr. Rice, for one, did not discount the perseverance of the Republican opposition, which could turn all of the energy now being expended to block the passage of a health bill into efforts to overturn it if it passed.

“The specter of repeal is going to be around for a while,” he said.

Source: http://prescriptions.blogs.nytimes.com/ ... -overtime/
<center>New York Times Editorial
The Next Step on Health Reform
New York Times, December 26, 2009
</center>

The Senate’s passage of a heath care reform bill over lockstep Republican opposition required every single member of the Democratic caucus to vote to override Republican filibusters. It will take equal political will to fuse the Senate’s bill with the more expansive reform approved by the House and enact a final version.

The House bill was approved by 220 to 215, and the Senate bill passed with 60 votes, the minimum needed to defeat a filibuster. The risk is that anything that upsets the balance of compromises in either chamber could doom the effort.

The Senate bill seems especially fragile. Senators — especially self-styled moderates — will have to forswear the posturing that weakened and almost derailed their bill. It is time to put the public interest first, because there are valuable features in each bill that warrant inclusion in the final product. The House bill, which is superior in many critical respects, does a better job of making health insurance affordable; the Senate bill has stronger provisions to restrain escalating medical costs.


The basic framework of the bills is the same. Both would require everyone to obtain health insurance — and all employers to provide it — or pay a penalty. Both would set up insurance exchanges on which small businesses and people who buy their own health insurance could choose from an array of private plans (but perhaps not a public plan, the way the winds are blowing).

Both would provide subsidies to help low-income people buy insurance on the exchanges and expand Medicaid to help the poorest. Both would impose new rules on insurance companies and force them to accept all applicants without regard to pre-existing conditions. Both would begin to move Medicare, and through its example the entire health care system, away from wasteful fee-for-service medicine toward coordinated delivery systems that improve quality and lower costs.

The House bill would spend $1.05 trillion over the next decade to expand coverage of the uninsured, a lot more than the $871 billion proposed by the Senate bill. The Congressional Budget Office estimates that the House bill would cover 96 percent of all citizens and legal residents below age 65 by 2019, while the Senate would reach only 94 percent. Both numbers would represent a substantial improvement over the current 83 percent. Neither bill would bust the budget; they would reduce the deficit over the next decade by comparable amounts in excess of $130 billion, according to the budget office.

Here are the major differences:

FINANCING The Senate bill has the better financing feature to help subsidize coverage of the uninsured — a stiff excise tax on the most costly employer-provided health plans. The tax would provide a strong incentive for employers and workers to shift to lower-priced plans. Organized labor is strongly opposed to the tax and the House is cool to the idea, but it should be retained. Health economists of all political stripes see the tax as the major cost-reduction element.

The main source of money in the House bill would be an income tax surcharge on the amount by which incomes exceed $500,000 for individuals and $1 million for couples. This is eminently fair given that the wealthy benefited enormously from the Bush-era tax cuts. The Senate rejected such a tax, but should agree to extract more money from the wealthy.

MEDICAL CARE REFORMS The House bill relies heavily on pilot projects within Medicare to determine which approaches to restraining medical costs might work best, but lacks a strong mechanism to drive successful reforms into widespread use. The Senate bill would empower an independent board to carry out successful reforms broadly within Medicare and recommend changes in private programs. The board is a crucial cost-control mechanism. It should be strengthened, by removing a 10-year exemption for hospitals and hospices.

AFFORDABILITY Under the more generous House bill, low-income people would pay substantially less and get better benefits than under the Senate bill. The House bill has far better subsidies to help lower-income Americans with premiums and cost-sharing. The Senate bill offers better subsidies for middle-income people. House staffers calculate that a family of four earning $33,000 a year would pay $1,521 in premiums under the Senate bill, which is $530 more than under the House bill. The same family would be exposed to as much as $4,100 in cost-sharing under the Senate bill, which is $3,100 more than under the House bill. Affordability is probably the most critical issue in winning popular support. The Senate needs to agree to more subsidies.

MEDICAID The House bill would expand Medicaid coverage to higher-earning people than the Senate bill does. It would raise Medicaid’s low payments to doctors in one crucial respect — paying primary-care doctors the same that Medicare pays. That would make it more likely that poor patients could find a doctor willing to serve them. The Senate should follow the House lead.

EMPLOYER MANDATES The House bill imposes higher penalties on employers who fail to offer coverage, a prod estimated to increase the number of covered workers by six million in 2019. The Senate bill has weaker penalties that would allow more employers to opt out, reducing by four million the number of workers covered. Under the House bill, employers would have to pay most of the premium and meet minimum benefit levels; the Senate has weaker requirements. The House bill is superior.

INDIVIDUAL MANDATE The House has stronger penalties on individuals who decline to buy insurance and would exempt fewer individuals on grounds they could not afford to buy coverage. Given that the reforms would work best with the greatest number of people insured, the House provisions should prevail.

EXCHANGES Analysts disagree over whether it would be best to set up a strong national exchange while allowing states that meet national standards to operate the exchanges (the House bill) or to let the states set up exchanges with federal government oversight (the Senate bill). A national exchange would ensure greater uniformity and probably impose tougher standards. State exchanges would know their local markets the best. Either approach could work. The more important issue is how the exchanges would operate.

EXCHANGE RULES The House bill would merge individual buyers and small businesses into a large pool that would spread the risks among sick and healthy patients so as to keep average premiums low. The Senate bill would fragment the risk pools to the point that they might not function well.

PRESCRIPTION DRUGS The House bill would close the notorious doughnut hole, a coverage gap that leaves many Medicare patients paying the full cost of their medicines; extract bigger discounts from the manufacturers; and allow the government to negotiate drug prices for Medicare beneficiaries. The Senate should yield to the House on the drug makers, who will be making enormous profits from tens of millions of new customers and ought to contribute more to reform.

PUBLIC PLAN The House bill includes a relatively weak public plan that might end up charging higher premiums than competing private plans because it would attract the sickest customers. Even that modest plan has no chance in the Senate. If it has to be dropped in the interest of passing a bill, that is a price worth paying.

ABORTION This is a choice of two evils. The House bill would prohibit any private insurance plan that accepts a single subsidized enrollee from covering abortion. That could effectively ban abortion coverage within the exchanges. The Senate bill would set up an extremely cumbersome procedure in which everyone buying an insurance plan that covers abortions on the exchanges (even men and post-menopausal women) would have to send two monthly checks to the insurance company, one covering most of the premium and a second tiny amount covering the estimated cost of abortion services that might be provided to some enrollees. This would discourage insurers from offering abortion coverage. The Senate would also let states ban abortion coverage.

TIMING The House bill would open the new exchanges in 2013; the Senate pushed the date back to 2014 to reduce costs in the first decade. Even 2013 seems a long way off. The Senate should agree to put up more money and open in 2013, if not sooner.


The final shape of the legislation will be constrained by costs and politics. Conventional wisdom holds that the final product will have to be close to the Senate version lest that fragile 60-vote coalition be ruptured. The Senate bill as it stands is a big improvement over the status quo, but if lawmakers truly want to serve their constituents rather than play more politics, they would include some provisions from the House bill.

Source: http://www.nytimes.com/2009/12/27/opinion/27sun1.html

And, now for some humor. In light of Sen. Burris' Twas the Night Before Christmas parody, the New York Times also ran a contest & here is the winner:
<center>Top Doggerel: The Winning Reader Parody
By TIM RACE
New York Times, December 24, 2009
</center>

People may get the government they deserve, but when it comes to holiday poems the people deserve a whole lot better.

Or so we at Prescriptions concluded, after an outbreak of Capitol Hill doggerel exposed a few senators’ falling woefully short as they tried to combine health care and the rhyme scheme of “The Night Before Christmas.”

We invited you, the Prescriptions readers, to give it a go. And some of you performed wonderfully. (A few, as always, didn’t seem to understand the assignment.)

A panel of Prescriptions judges — well, four of us who couldn’t get Christmas Eve off — read all the entries and voted. The nearly unanimous winner is named below. But first we must honorably mention a few of the others.

The short list included soheilj, from Montreal, whose verse began:

Twas the night before chemo, and all through the home,
The bills had piled high while the creditors phoned.
Stark, no?

Worth noting, too, was Anna Broadway, from the Bay Area, who obviously has a flair for this sort of thing:

Twas the night before Christmas, when all through the land
The people were waiting on 60 to band.
Nebraska had pledged to help make history
After Reid found a way to make just the right plea.
Our children were too young to grasp how they’d pay,
For Nelson’s refusal to cast his vote “Nay,”
But unemployed Daddy and overworked I
Were working the figures with sigh after sigh
When over on Twitter I saw something trending
About all the letters some voters were sending.
And that was simply the opening stanza.

One of our judges wanted to award the prize, for going rogue, to Kevin C., of Atlanta, who produced a haiku:

No Health care bill passed?
Insurers remain unchecked
and rates quickly rise.
But another judge suggested that Kevin, instead, receive a special citation: “Most courageous display of contempt for the editor’s instructions.” And that sounded about right.

Which brings us to our champion, Steve Harrell, a professor of anthropology at the University of Washington, in Seattle.

He and his wife, Barbara, had just returned home with Cornish game hens for their Christmas dinner, when word arrived from Prescriptions Central that he was the grand prize winner. For the grand prize, he can keep those hens, with our compliments.

“I am, needless to say, deeply and humbly touched by this great honor,” Mr. Harrell replied by e-mail.

“I am not a poet by training or any other route,” he continued, “but come from a long family tradition of doggerelists. I love Gilbert and Sullivan, whose songs I have frequently used for parodies of anthropology, academic pretense, and other easy targets. Maybe when I retire and have more time I can start doing this regularly on a bloggerel.”

We do believe he has a future beyond academe.

And now, ladies and gentlemen, your 2009 Health Care Doggerel winning entry, by Steve Harrell:
Twas the week before Christmas and all through the Hill
Not a solon dared say they would soon get a bill

Amendments were hung with meticulous care
In hopes that the 60 votes somehow were there

And DeMint with his smarm and Mitch with his bluster
Had just settled themselves for a good filibuster

When out on the Steps there arose such a clatter
They Sprang from the aisles to see what was the matter

Away to the window they purposefully strolled
And peered out on the city enveloped in cold

The moonlight reflecting on crafty Ms. Snowe
Gave a luster of hope for bipartisan show,

When what did their wondering, sleepless eyes see
But a shiny new, tire-chained black SUV

With a passenger skinny, determined, yet chary
They knew in a moment it must Saint Harry.

More slowly than snails his colleagues they came
And he schmoozed and cajoled them and called them by name

Now Joseph, now Evan, now Ben and now Blanche,
On Mary, on Bernie, on Max from the ranch

To the top of the Steps, to the top of the Hill
Don’t dash and don’t rush, we may still have a bill

As pols before public opinion do dither,
When they meet with an obstacle turn up the blather

To the heights of bad rhetoric senators flew
With a sleighful of pork that was theirs to pursue

As they looked for reporters a-hanging around,
Down the cupola Harry did come with a bound

His eyes how they darted, all absent of motes
His expressions so neutral, his brain counting votes

He said not a word, but went straight to his work
Let no epithets fly, though he thought “what a jerk!”

He filled all the socks with concessions and pork
For Ben and for Joe and for each smiling dork

As the very last stocking was filled that night late
He exclaimed “You’ve got 60, we’ll cut off debate!”

And laying his finger aside of his nose
With a sigh of relief to the dometop he rose

He crawled to his limo, collapsed in the seat
And they slowly drove off, Harry totally beat

But we heard him exclaim as he fled from the Hill
“Happy Christmas, Barack, I have brought you a bill!”
Source: http://prescriptions.blogs.nytimes.com/ ... er-parody/
Last edited by roxybeast on December 29th, 2009, 4:34 pm, edited 1 time in total.

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Post by roxybeast » December 29th, 2009, 4:32 pm

<center>Some of the Best of the Rest Media Coverage of Senate's Health Care Vote</center>

This is just a collection of articles, some pro & some con, leading up to and following the Senate's historic vote to pass health reform legislation last week ...
<center>'Kill The Bill' Debate Rages
Huffington Post, December 17, 2009
</center>

In a "Special Comment" Wednesday night, MSNBC's Keith Olbermann agreed with former Democratic National Committee chairman Howard Dean that the Senate health care bill, as it currently stands, should die.

"We have sustained a total and unmitigated defeat without a war," Olbermann said. "This is not health, this is not care, this is certainly not reform ... The 'men' of the current moment, have lost to the 'mice' of history. They must now not make the defeat worse by passing a hollow shell of a bill just for the sake of a big-stage signing ceremony."

Olbermann argued that without the Medicare buy-in or the public option or other reforms taken out of the bill, the health insurance mandate will just force people to buy expensive and exploitative plans. Calling Sen. Joseph Lieberman (I-Conn.) a "senatorial prostitute," Olbermann also criticized President Obama for not providing "the leadership his office demands."

Watch:

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Meanwhile, Dean continued to pursue his argument in a Washington Post op-ed.

New York Times columnist Paul Krugman, on the other hand, says progressives shouldn't take out their anger at President Obama by torpedoing the health care bill.
[T]he truth is that health care reform was probably doomed to be deeply imperfect. As Ezra Klein pointed out a few weeks ago, we're basically in a hostage situation: progressives really, really want to cover the uninsured, while centrists whose votes are needed can take it or leave it. So the centrists have a lot of power -- which in the case of Joe Lieberman means the power to double-cross and indulge his pettiness.

Now, in a hostage situation there are times when you have to just say no -- when giving in, by encouraging future hostage-takers, would be worse than letting the hostages perish. So the question has to be, is this one of those times? I don't think so, given the history: as Kevin Drum points out, health reform has come back weaker after each defeat. I'd also point out that highly imperfect insurance reforms, like Social Security and Medicare in their initial incarnations, have gotten more comprehensive over time. This suggests that the priority is to get something passed.

By all means denounce Obama for his failed bipartisan gestures. By all means criticize the administration. But don't take it out on the tens of millions of Americans who will have health insurance if this bill passes, but will be out of luck -- and, in some cases, dead -- if it doesn't.
Likewise, Mother Jones blogger Kevin Drum writes:
When big legislative efforts go down in flames, they almost never spring back onto the calendar anytime soon -- and that's especially true when big healthcare bills fail. It didn't happen in 1936, it didn't happen in 1949, it didn't happen in 1974, and it didn't happen in 1995. What makes anyone think it will happen in 2010?

If healthcare reform dies this year, it dies for a good long time. Say what you will about the Democratic leadership, but Harry Reid, Barack Obama, Rahm Emanuel, Nancy Pelosi, and Steny Hoyer all know this perfectly well. So do John Boehner and Mitch McConnell. (Boy do they know it.)
On the White House blog, White House communications director Dan Pfeiffer pushed back on the idea Olbermann and other angry progressives are advancing -- that this bill is a dream for insurance companies. "The insurance industry has been leveraging its considerable resources in a ferocious effort to defeat this bill ... because this bill will finally wrest power away from the insurance industry and put it in the hands of American consumers," he wrote, listing the legislation's reforms.

Source: http://www.huffingtonpost.com/2009/12/1 ... 95449.html
<center>Illusions and bitterness
by Paul Krugman
New York Times, December 16, 2009
</center>

There’s enormous disappointment among progressives about the emerging health care bill — and rightly so. That said, even as it stands it would take a big step toward greater security for Americans and greater social justice; it would also save many lives over the decade ahead. That’s why progressive health policy wonks — the people who have campaigned for health reform for years — are almost all in favor of voting for the thing.

The argument about the evil of the individual mandate is,as Jon Cohn says, all wrong. It was wrong during the primaries, when Obama unfortunately used it to demagogue his rivals — helping set the stage for problems now. And it’s still wrong.

And the truth is that health care reform was probably doomed to be deeply imperfect. As Ezra Klein pointed out a few weeks ago, we’re basically in a hostage situation: progressives really, really want to cover the uninsured, while centrists whose votes are needed can take it or leave it. So the centrists have a lot of power — which in the case of Joe Lieberman means the power to double-cross and indulge his pettiness.

Now, in a hostage situation there are times when you have to just say no — when giving in, by encouraging future hostage-takers, would be worse than letting the hostages perish. So the question has to be, is this one of those times? I don’t think so, given the history: as Kevin Drum points out, health reform has come back weaker after each defeat. I’d also point out that highly imperfect insurance reforms, like Social Security and Medicare in their initial incarnations, have gotten more comprehensive over time. This suggests that the priority is to get something passed.

But what’s happening, I think, goes beyond health care; what we’re seeing is disillusionment with Obama among some of the people who were his most enthusiastic supporters. A lot of people seem shocked to find that he’s not the transformative figure of their imaginations. Can I say I told you so? If you paid attention to what he said, not how he said it, it was obvious from the beginning — and I’m talking about 2007 — that he was going to be much less aggressive about change than one could have hoped. And this has done a lot of damage: I believe he could have taken a tougher line on economic policy and the banks, and was tearing my hair out over his caution early this year. I also believe that if he had been tougher on those issues, he’d be better able to weather disappointment over his health care compromises.

So there’s a lot of bitterness out there. But please, keep your priorities straight.

By all means denounce Obama for his failed bipartisan gestures. By all means criticize the administration. But don’t take it out on the tens of millions of Americans who will have health insurance if this bill passes, but will be out of luck — and, in some cases, dead — if it doesn’t.

Source: http://krugman.blogs.nytimes.com/2009/1 ... itterness/
<center>Health-care bill wouldn't bring real reform
by Howard Dean
Washington Post, December 17, 2009
</center>

If I were a senator, I would not vote for the current health-care bill. Any measure that expands private insurers' monopoly over health care and transfers millions of taxpayer dollars to private corporations is not real health-care reform. Real reform would insert competition into insurance markets, force insurers to cut unnecessary administrative expenses and spend health-care dollars caring for people. Real reform would significantly lower costs, improve the delivery of health care and give all Americans a meaningful choice of coverage. The current Senate bill accomplishes none of these.

Real health-care reform is supposed to eliminate discrimination based on preexisting conditions. But the legislation allows insurance companies to charge older Americans up to three times as much as younger Americans, pricing them out of coverage. The bill was supposed to give Americans choices about what kind of system they wanted to enroll in. Instead, it fines Americans if they do not sign up with an insurance company, which may take up to 30 percent of your premium dollars and spend it on CEO salaries -- in the range of $20 million a year -- and on return on equity for the company's shareholders. Few Americans will see any benefit until 2014, by which time premiums are likely to have doubled. In short, the winners in this bill are insurance companies; the American taxpayer is about to be fleeced with a bailout in a situation that dwarfs even what happened at AIG.

From the very beginning of this debate, progressives have argued that a public option or a Medicare buy-in would restore competition and hold the private health insurance industry accountable. Progressives understood that a public plan would give Americans real choices about what kind of system they wanted to be in and how they wanted to spend their money. Yet Washington has decided, once again, that the American people cannot be trusted to choose for themselves. Your money goes to insurers, whether or not you want it to.

To be clear, I'm not giving up on health-care reform. The legislation does have some good points, such as expanding Medicaid and permanently increasing the federal government's contribution to it. It invests critical dollars in public health, wellness and prevention programs; extends the life of the Medicare trust fund; and allows young Americans to stay on their parents' health-care plans until they turn 27. Small businesses struggling with rising health-care costs will receive a tax credit, and primary-care physicians will see increases in their Medicare and Medicaid reimbursement rates.

Improvements can still be made in the Senate, and I hope that Senate Democrats will work on this bill as it moves to conference. If lawmakers are interested in ensuring that government affordability credits are spent on health-care benefits rather than insurers' salaries, they need to require state-based exchanges, which act as prudent purchasers and select only the most efficient insurers. Sen. John Kerry (D-Mass.) offered this amendment during the Finance Committee markup, and Democrats should include it in the final legislation. A stripped-down version of the current bill that included these provisions would be worth passing.

In Washington, when major bills near final passage, an inside-the-Beltway mentality takes hold. Any bill becomes a victory. Clear thinking is thrown out the window for political calculus. In the heat of battle, decisions are being made that set an irreversible course for how future health reform is done. The result is legislation that has been crafted to get votes, not to reform health care.

I have worked for health-care reform all my political life. In my home state of Vermont, we have accomplished universal health care for children younger than 18 and real insurance reform -- which not only bans discrimination against preexisting conditions but also prevents insurers from charging outrageous sums for policies as a way of keeping out high-risk people. I know health reform when I see it, and there isn't much left in the Senate bill. I reluctantly conclude that, as it stands, this bill would do more harm than good to the future of America.

The writer is a former chairman of the Democratic National Committee and was governor of Vermont from 1991 to 2002.

Source: http://www.washingtonpost.com/wp-dyn/co ... 01906.html
<center>Two cheers for Harry Reid
By E.J. Dionne Jr.
Washington Post, December 28, 2009
</center>

Punditry in the nation's capital has its own rhythms, and one common practice involves almost everyone beating up on the same politician at the same time.

Such assaults are rarely about ideology, though I have found that liberals or Democrats are often the object of these sustained attacks, perhaps because journalists are overly sensitive to charges of liberal bias. There's nothing like hitting a Democrat hard to "prove" impartiality.

For quite a while, House Speaker Nancy Pelosi was the target of choice. She was cast as a "San Francisco liberal" out of touch with the "real America." Everything about her, from her speaking style (fluid in small groups, stilted with larger crowds) to her taste in clothes (female politicians always face this), became the object of analysis and disparagement.

But the beauty of journalism is that reality eventually has to intrude on analysis. It has become quite clear that Pelosi is far less a "San Francisco liberal" than a "Tommy D'Alesandro Democrat." That would be a reference to her dad, the former mayor of Baltimore, a highly practical local politician more concerned with delivering the goods than with passing ideological litmus tests.

Pelosi is adept at doing whatever needs to be done to produce House majorities for Democratic goals. She is a liberal, of course, but she is the House speaker first. Her standing has risen to the point that Time magazine had her listed as a runner-up for Person of the Year.

With Pelosi off the hook, the Washington press corps needed a new goat, and along came Harry Reid. The Senate majority leader, it should be said, sometimes makes it easy for his critics. He can be irascible, and has no qualms about yelling at journalists. (It's happened to me.) He is not always careful with words. Earlier this month, he at least implied that Republicans were slow on the slavery issue, an odd charge since opposition to slavery was the passion that animated the founding of the GOP. (In those days, most Democrats were, as we might put it now, bad on the slavery issue.)

And, yes, Reid criticized my friend and colleague David Broder. It's true that Reid was hitting back, since David is not wild about Harry. Nonetheless, I dearly love Broder, as does everyone who has ever worked with him.

Still, there is a rote quality to the attacks on Reid that flies in the face of what he's accomplished. The simple truth is that Reid did what much of wise Washington thought was impossible: He united the entire Democratic caucus, from Joe Lieberman to Bernie Sanders, to support a health-care bill that is the most far-reaching piece of social legislation since the 1960s.

He confronts an unprecedented form of Republican obstruction -- yes, it's really unprecedented, you can look it up. Even Olympia Snowe, that most moderate of Republicans, refused to negotiate unless Reid postponed action on the bill, a delay that would very likely have led to its death.

You bet he made deals, including the now highly controversial buyout of Nebraska's extra Medicaid costs to win the 60th vote for the bill from Sen. Ben Nelson.

You should notice this about political analysis: When a writer admires a wheeler-dealer, he or she inevitably compares that politician to Lyndon B. Johnson and typically asks: Why can't others be more like LBJ? When a writer wants to condemn the same sort of horse-trading, LBJ recedes and some other metaphor -- the popular one now is "Chicago-style politics" -- is wielded to imply highly unprincipled behavior. With just a few keystrokes, shrewd pragmatism is transformed into terribly sinful activity.

Lord knows, I don't blame Republicans in the least for being mad at Harry Reid. He beat them at their own game. In our great republic, Republicans are free to call him any name they wish between now and the next election -- and they will.

Those who aspire to be nonpartisan, however, need to pause in their excoriations of Reid long enough to note that he pulled off something very big. Sen. Tom Harkin may have been a little over the top when he praised Reid last week for "the patience of Job, the wisdom of Solomon and the endurance of Samson." But for now, at least, credit him with the toughness of LBJ, the listening skills of Tip O'Neill and the canniness of Sam Rayburn. He deserves that much.

Source: http://www.washingtonpost.com/wp-dyn/co ... 01716.html
<center>After health care, we need Senate reform
by Ezra Klein
Washington Post, December 27, 2009
</center>

On Dec. 8, 1964, Mike Manatos wrote a letter that explains what's wrong with the Senate in 2009. This wasn't, of course, the subject of his letter. Manatos was no futurist; he was Lyndon Johnson's liaison to the Senate, and he was writing to update his bosses on Medicare's chances in the aftermath of the 1964 election. Surveying the incoming crop of senators, Manatos counted a solid majority in favor of the president's effort. "If all our supporters are present and voting we would win by a vote of 55 to 45," he predicted.

That letter would never be written now. In today's Senate, 55 votes isn't enough to "win," or anything close to it; it's enough to get you five votes away from the 60 votes you need to shut down a filibuster. Only then, in most cases, can a law be passed. The modern Senate is a radically different institution than the Senate of the 1960s, and the dysfunction exhibited in its debate over health care -- the absence of bipartisanship, the use of the filibuster to obstruct progress rather than protect debate, the ability of any given senator to hold the bill hostage to his or her demands -- has convinced many, both inside and outside the chamber, that it needs to be fixed.

This might seem an odd moment to argue that the Senate is fundamentally broken and repairs should top our list of priorities. After all, the Senate passed a $900 billion health-care bill Thursday morning. But consider the context: Arlen Specter's defection from the Republican Party earlier this year gave Democrats 60 votes in the Senate -- a larger majority than either party has had since the '70s. Democrats also controlled the House and the presidency, and were working in the aftermath of a financial crisis that occurred on a Republican president's watch. This was a test of whether a party could govern when everything was stacked in its favor.

The answer seems to be, well, not really. The Democrats ended up focusing on health-care reform's low-hanging fruit: the bill the Senate ultimately passed does much more to increase coverage than it does to address the considerably harder problem of cost control, it strengthens the existing private insurance system and it does not include a public insurance option. And Democrats still could not find a single Republican vote, which meant they had to give Nebraska a coupon entitling it to a free Medicaid expansion and hand Joe Lieberman a voucher that's good for anything he wants. If the Senate cannot govern effectively even when history conspires to free its hand, then it cannot govern.

To understand why the modern legislative process is so bad, why every Senator seems able to demand a king's ransom in return for his or her vote and no bill ever seems to be truly bipartisan, you need to understand one basic fact: The government can function if the minority party has either the incentive to make the majority fail or the power to make the majority fail. It cannot function if it has both.

In decades past, the parties did not feel they had both. Cooperation was the Senate's custom, if not its rule. But in the 1990s, Newt Gingrich, then the minority whip of the House, and Bob Dole, then the minority leader of the Senate, realized they did have both. A strategy of relentless obstruction brought then-president Bill Clinton to his knees, as the minority party discovered it had the tools to make the majority party fail.

Unfortunately, both parties have followed Gingrich's playbook ever since. According to UCLA political scientist Barbara Sinclair, about 8 percent of major bills faced a filibuster in the 1960s. This decade, that jumped to 70 percent. The problem with the minority party continually making the majority party fail, of course, is that it means neither party can ever successfully govern the country.

Jeff Merkley, a freshman Democratic Senator from Oregon and former speaker of Oregon's House of Representatives, spoke to this issue in an interview last week. "When you use the word filibuster," he said, "most of us in America envision it as the ability to speak at length and even delay progress by taking hours. I count myself among those Americans." He sighed. "But it's not a filibuster anymore. It's a supermajority requirement. And when that becomes commonly used, it's a recipe for paralysis."

Tom Harkin, the veteran Iowa Democrat who chairs the Senate's influential Health, Education, Labor and Pensions Committee, was even more dismayed by recent events. His efforts to curb the filibuster began in the 1990s, when he was in the minority. "People say I only worry about this because I'm in the majority," he said Tuesday. "But I come at this with clean hands!" Back then, his partner in the effort to reform the filibuster was Lieberman. "The filibuster," Lieberman said at the time, "has become not only an obstacle to accomplishment here, but also a symbol of a lot that ails Washington today." Lieberman has since stopped worrying and learned to love obstructionism. But Harkin hasn't.

This isn't just a Democratic concern, though Democrats, being in the majority, are the ones raising it now. In 2005, Senate majority leader Bill Frist nearly shut the chamber down over the Democratic habit of filibustering George W. Bush's judicial nominees. "This filibuster is nothing less than a formula for tyranny by the minority," he said at the time.

Potential solutions abound. Harkin would eliminate the filibuster while still protecting the minority's right to debate. Under his proposal, bills would initially require 60 votes to pass. Three days later, that threshold would fall to 57. Three days after that, 54. And three days after that, 51. Merkley has some other ideas. One is to attract Republicans to the project by phasing the filibuster out six or eight years in the future, when we can't predict which party will initially benefit.

There is real promise in Merkley's approach. The danger of reforming the Senate is that, like health-care reform before it, it comes to seem a partisan issue. It isn't. Members of both parties often take the fact that neither Democrats nor Republicans can govern effectively to mean they benefit from the filibuster half the time. In reality, the country loses the benefits of a working legislature all the time.

But members of both parties have become attached to this idea that they can block objectionable legislation even when they're relatively powerless. This is evidence, perhaps, that both parties are so used to the victories of obstruction that they have forgotten their purpose is to amass victories through governance. Either way, a world in which the majority can pass its agenda is a better one, a place where the majority party is held accountable for its ideas and not for the gridlock and inaction furnished by the Senate's rules.

Law professor Lawrence Lessig often compares the dysfunctions of the Congress to the woes of an alcoholic. An alcoholic, he says, might be facing cirrhosis of the liver, the loss of his family and terrible debt. Amidst all that, the fact that he drinks before bed at night might not seem his worst problem. But it is the first problem, the one that must be solved before he can solve any of the others. America, too, is facing more dramatic problems than the Senate rules: A coming budget crisis, catastrophic climate change and an archaic and inefficient tax system, to name a few. But none will be solved until we fix the dysfunctions of the Senate.

Source: http://www.washingtonpost.com/wp-dyn/co ... 01319.html
<center>A Less Than Honest Policy
By BOB HERBERT
New York Times, December 28, 2009
</center>

There is a middle-class tax time bomb ticking in the Senate’s version of President Obama’s effort to reform health care.

The bill that passed the Senate with such fanfare on Christmas Eve would impose a confiscatory 40 percent excise tax on so-called Cadillac health plans, which are popularly viewed as over-the-top plans held only by the very wealthy. In fact, it’s a tax that in a few years will hammer millions of middle-class policyholders, forcing them to scale back their access to medical care.

Which is exactly what the tax is designed to do.

The tax would kick in on plans exceeding $23,000 annually for family coverage and $8,500 for individuals, starting in 2013. In the first year it would affect relatively few people in the middle class. But because of the steadily rising costs of health care in the U.S., more and more plans would reach the taxation threshold each year.

Within three years of its implementation, according to the Congressional Budget Office, the tax would apply to nearly 20 percent of all workers with employer-provided health coverage in the country, affecting some 31 million people. Within six years, according to Congress’s Joint Committee on Taxation, the tax would reach a fifth of all households earning between $50,000 and $75,000 annually. Those families can hardly be considered very wealthy.

Proponents say the tax will raise nearly $150 billion over 10 years, but there’s a catch. It’s not expected to raise this money directly. The dirty little secret behind this onerous tax is that no one expects very many people to pay it. The idea is that rather than fork over 40 percent in taxes on the amount by which policies exceed the threshold, employers (and individuals who purchase health insurance on their own) will have little choice but to ratchet down the quality of their health plans.

These lower-value plans would have higher out-of-pocket costs, thus increasing the very things that are so maddening to so many policyholders right now: higher and higher co-payments, soaring deductibles and so forth. Some of the benefits of higher-end policies can be expected in many cases to go by the boards: dental and vision care, for example, and expensive mental health coverage.

Proponents say this is a terrific way to hold down health care costs. If policyholders have to pay more out of their own pockets, they will be more careful — that is to say, more reluctant — to access health services. On the other hand, people with very serious illnesses will be saddled with much higher out-of-pocket costs. And a reluctance to seek treatment for something that might seem relatively minor at first could well have terrible (and terribly expensive) consequences in the long run.

If even the plan’s proponents do not expect policyholders to pay the tax, how will it raise $150 billion in a decade? Great question.

We all remember learning in school about the suspension of disbelief. This part of the Senate’s health benefits taxation scheme requires a monumental suspension of disbelief. According to the Joint Committee on Taxation, less than 18 percent of the revenue will come from the tax itself. The rest of the $150 billion, more than 82 percent of it, will come from the income taxes paid by workers who have been given pay raises by employers who will have voluntarily handed over the money they saved by offering their employees less valuable health insurance plans.

Can you believe it?

I asked Richard Trumka, president of the A.F.L.-C.I.O., about this. (Labor unions are outraged at the very thought of a health benefits tax.) I had to wait for him to stop laughing to get his answer. “If you believe that,” he said, “I have some oceanfront property in southwestern Pennsylvania that I will sell you at a great price.”

A survey of business executives by Mercer, a human resources consulting firm, found that only 16 percent of respondents said they would convert the savings from a reduction in health benefits into higher wages for employees. Yet proponents of the tax are holding steadfast to the belief that nearly all would do so.

“In the real world, companies cut costs and they pocket the money,” said Larry Cohen, president of the Communications Workers of America and a leader of the opposition to the tax. “Executives tell the shareholders: ‘Hey, higher profits without any revenue growth. Great!’ ”

The tax on health benefits is being sold to the public dishonestly as something that will affect only the rich, and it makes a mockery of President Obama’s repeated pledge that if you like the health coverage you have now, you can keep it.

Those who believe this is a good idea should at least have the courage to be straight about it with the American people.

Source: http://www.nytimes.com/2009/12/29/opini ... rbert.html
<center>EDITORIAL
A Bill Well Worth Passing
New York Times, December 21, 2009
</center>

The health care reform bill that Senate Democratic leaders have cobbled together to win support from all 60 members of their fractious caucus — the filibuster-proof majority needed to ensure passage — has drawn scornful attacks from a united Republican opposition. It is causing anguish among liberals who fear too much has been given away to a handful of conservatives.

The bill, which is moving toward a climactic vote this week, has some imperfections but is worthy of support from lawmakers who care about health care reform.

There is a lot to like in the bill. The Congressional Budget Office estimates that it would cover more than 30 million of the uninsured and would, by 2019, result in 94 percent of all citizens and legal residents below Medicare age having health insurance. That is a big improvement from the current 83 percent.

It also estimates that the bill would reduce deficits over the next decade by $132 billion and even more in the following decade. Despite all the exaggerated Republican rhetoric that the bill will lead to fiscal disaster, it has been carefully and responsibly drafted so that it is fully paid for without busting future budgets.

Important elements of the bill have been strengthened during the struggle. An independent board and other new entities would be given greater powers than previously planned to test and implement cost-saving measures free of political lobbying. Tax credits to help small businesses buy coverage have been expanded.

Insurance companies will be deterred from jacking up premiums just before the reforms take effect, prohibited from imposing lifetime limits on benefits and annual limits will be tightly restricted. Insurers will also be required to spend more on medical care and less on administrative costs and profits than they currently do.

The two big concessions that were made in the Senate were unfortunate, but not fatal. The original bill would have created a new public plan to compete with private ones. That was replaced with a likely weaker alternative: a couple of private plans that would be supervised by an obscure government agency that administers heath benefits for federal employees. The reform package should include a public plan, but the absence of one is not a good reason to vote against the bill.

The Senate flirted briefly with a proposal to allow people ages 55 to 64 to buy into the Medicare program to create competition to private plans on new insurance exchanges. The buy-in idea was intriguing, but it was never vetted carefully enough to analyze how it would work in conjunction with other reforms. Its elimination does not make the bill worth opposing.

In another concession, the Senate bill would allow states to ban the coverage of abortions by health plans sold on the new exchanges. Those exchanges will allow people who buy health insurance to choose from an array of private plans, with subsidies provided to help low- and middle-income people pay the premiums.

This amounts to deplorable interference by state governments into decisions that should be made by a woman and her doctor — and abortion rights groups are right to object. The implacable Republican opposition to reform, and obstruction from a handful of Democrats, have made this bill less effective and less fair than it might have been. Still, the United States Senate has a chance this week to get past the bickering and haggling that have robbed it of Americans’ trust and pass a historic piece of legislation.

Source: http://www.nytimes.com/2009/12/22/opinion/22tue1.html
EDITORIAL
Can We Afford It?
New York Times, December 12, 2009

Republican critics have a fiercely argued list of reasons to oppose health care reform. One that is resonating is that the nation cannot afford in tough economic times to add a new trillion-dollar health care entitlement.

We understand why Americans may be skittish, but the argument is at best disingenuous and at worst a flat misrepresentation. Over the next two decades, the pending bills would actually reduce deficits by a small amount and reforms in how medical care is delivered and paid for — begun now on a small scale — could significantly reduce future deficits. Here is a closer look at the benefits and costs of health care reform:

STATUS QUO IS UNSUSTAINABLE More than 46 million Americans have no insurance, and millions more have such poor coverage that a severe illness threatens bankruptcy. Small employers are dropping coverage because of the cost. Those lucky enough to have insurance are struggling with higher premiums and co-payments, and worry that if they are laid off they could lose coverage.

Without reform, that bad situation will only get worse. The Commonwealth Fund, a respected research organization, warned that the average premium for family coverage in employer-sponsored policies would almost double in the coming decade, from about $12,300 in 2008 to $23,800 in 2020, with part paid by workers and part by employers. Premiums are also soaring for individuals who buy their own coverage directly.

BUT A TRILLION DOLLARS? Both the House and Senate bills would cover more than 30 million of the uninsured, and fully pay for it — in part by raising taxes (either on wealthy Americans or high-premium health plans and certain manufacturers and insurers) and in part by cutting payments to health care providers and private plans that serve Medicare patients.

A trillion dollars is still a lot of money, but it needs to be put in some perspective. Extending Bush-era tax cuts for the wealthy would very likely cost $4 trillion over the next decade. And the Medicare prescription drug benefit, passed by a Republican-dominated Congress, is expected to cost at least $700 billion over the next decade. Unlike this health care reform, it became law with no offsetting cuts and very little provision to pay for it.

YES, THEY OVER-PROMISED President Obama and his aides have, at times, made it sound as if health care reform was the answer to runaway deficits and soaring premiums. That is true in the long run, but not now.

The Congressional Budget Office projects that the vast majority of Americans, those covered by employer-sponsored insurance, would see little change or a modest decline in their average premiums under the Senate bill. It predicts that the bills would reduce deficits in the first decade by a modest $130 billion or so and perhaps $650 billion in the next decade — a small share of the burden.

Critics scoff that Congress will never carry out the required cuts in payments to Medicare providers. It is true that Congress has repeatedly deferred draconian cuts in doctors’ reimbursements. It has had no reluctance imposing other savings. The Center on Budget and Policy Priorities, a liberal analytical group, examined every major Medicare cut in deficit reduction bills over the past two decades. Virtually all of the savings imposed in the 1990, 1993 and 2005 bills survived intact. So did 80 percent of the savings in the 1997 Balanced Budget Act.

There is an easy way to stiffen Congress’s spine: it should adopt separate pay-as-you-go rules that would require that any concession to providers be paid for by tax increases or compensating cuts in other programs.

SHOULD WE GIVE UP ON SAVINGS? The House and Senate bills, and the stimulus legislation, have a lot of ideas that could bring down costs over time.

Electronic medical records could eliminate redundant tests; standardized forms and automated claims processing could save hundreds of billions of dollars; “effectiveness” research would help doctors avoid costly treatments that don’t work; various pilot projects devised to foster better coordination of care and a shift away from fee-for-service toward fixed payments for a year’s worth of a patient’s care all show some promise.

These reforms are mostly untested. And the C.B.O. is properly cautious when it says that it does not see much if any savings for the government during the next decade, in part because of upfront costs and in part because no one knows what will work. These efforts are unlikely to be tried on any serious scale without reform.

NO SINGLE FIX The debate is not over and sensible proposals are emerging in the Senate to strengthen cost control. Various amendments would increase the penalties for hospitals that infect patients, let Americans import cheaper drugs from abroad and modestly increase the powers of a new commission that is supposed to recommend ways to reduce Medicare costs. The House bill has cost-cutting measures that could be incorporated into a final bill, including authority for the government to negotiate lower drug prices for Medicare beneficiaries.

Aggressive testing of promising ideas should increase the likelihood of ultimate success. And millions of uninsured Americans should not be forced to wait until all the answers are found.

Source: http://www.nytimes.com/2009/12/13/opinion/13sun1.html
<center>Senate Democrats Pay Dearly For 60 Votes
by DAVID WELNA
NPR, December 20, 2009
</center>

This day is the year's shortest in terms of daylight, but it may also be one of the U.S. Senate's longest. For the third weekend in a row, senators have remained in session. Early Monday morning in a 1 a.m. procedural vote, the Democratic majority has a chance to show it really does have the 60 votes its leaders claim to have for moving landmark health care legislation to a final vote before Christmas.

Transcript of Broadcast ...

LIANE HANSEN, host:

This is MORNING EDITION from NPR News. I'm Liane Hansen.

For the third weekend in a row, senators have remained in session racing to finish health care legislation before Christmas. And the last holdout senator who had kept the Democrats from getting the necessary 60 votes now says he's on board. NPR's David Welna has this report from the Capitol.

DAVID WELNA: Senate Majority Leader Harry Reid waited until yesterday to unveil the package of deals he'd made with other senators to lock in the votes of all 60 members of his Democratic caucus. Asked whether he'd finally reached that filibuster-proof magic number, Reid sounded hopeful.

Senator HARRY REID (Democrat, Nevada; Senate Majority Leader): Seems that way.

WELNA: The last senator Reid had to win over was Nebraska's social conservative, Ben Nelson. Nelson had a lot of issues with the health care bill Reid rolled out last month. But more than anything else, Nelson wanted to keep federal tax dollars from being spent on abortion. He said yesterday he's now satisfied with tighter accounting rules and a requirement that each state have at least one federally supervised insurance plan that does not offer abortion coverage.

Senator BEN NELSON (Democrat, Nebraska): I believe in my heart of hearts that this handles the whole question of funding abortion, of banning of the funding of abortion by federal money, either directly or indirectly.

WELNA: And thus, Nelson became vote number 60 for the Democrats. It must've been a huge relief for President Obama, who'd staked the prestige of his presidency on getting a health care bill passed. Yesterday, he told reporters at the White House that, quote, "We are on the cusp of making health care reform a reality."

President BARACK OBAMA: With today's developments, it now appears that the American people will have the vote they deserve (unintelligible) reform that offers security to those who have health insurance and affordable options for those who do not.

WELNA: The president said the changes Majority Leader Reid made to the health care bill have made it even stronger, including measures projected to reduce the nation's deficit by $132 billion in the first decade and more than a trillion dollars the following 10 years.

Dick Durbin, the Senate's number two Democrat, trumpeted those numbers last night on the Senate floor.

Senator DICK DURBIN (Democrat, Illinois): This health care reform bill as amended, is the greatest deficit reduction bill in the history of the United States.

WELNA: Still, not one Senate Republican has declared any intention to vote for the health care overhaul. Minority Leader Mitch McConnell accused Democrats of trying to make the wrong kind of history.

Senator MITCH MCCONNELL (Republican, Kentucky): This bill is a legislative train wreck of historic proportions. But they are so eager to claim a victory, so eager to claim a victory, they'll simply do anything to jam it through in the next few days.

WELNA: And Georgia Republican Saxby Chambliss noted that Nebraska Democrat Nelson had gotten special treatment for his state through full funding of expanded Medicaid coverage.

Senator SAXBY CHAMBLISS (Republican, Georgia): It's pretty obvious that votes have been bought. I mean, whatever it took to get a vote, that's what the majority leader did.

WELNA: Majority Leader Reid readily acknowledged he'd made deals.

Sen. REID: That's what legislation's all about: compromise.

WELNA: For Senate Republicans, though, slowing things down is what it's all about. Here's South Carolina's Lindsey Graham.

Senator LINDSEY GRAHAM (Republican, South Carolina): We're going to talk about this until Christmas Day, so the American people will know the truth about what's in this bill.

WELNA: A final vote on the Senate bill is expected Christmas Eve.

David Welna, NPR News, the Capitol.

Source: http://www.npr.org/templates/story/stor ... h-20091220
<center>Rosa DeLauro, Key Pro-Choice Dem, Makes Case For Senate Abortion Language
by Sam Stein
Huffington Post, December 29, 2009
</center>

A key pro-choice House Democrat, working on health care in Congress, hinted on Monday that said she might be willing to support the Senate's abortion language.

Rep. Rosa DeLauro (D-Conn.) who has been tasked by leadership with helping hammer out a compromise on abortion between the two chambers, said she was not thrilled with either the House or Senate legislation's provisions. But in an interview with the Huffington Post, the Connecticut Democrat did say she would support the Senate's version of abortion-related language provided that she could confirm her belief that it did not go beyond current law.

"There are some questions I still have," DeLauro said. "And that's why I want to see this side-by-side with the language. It's not Stupak-Pitts [the House's language]. So, it's already [an improvement]. And it would appear to be current law. I would have to look at the questions that surround it, et cetera. But if it is current law then it would be something that was my goal at the outset: let's maintain current law and then let's pass health care."

DeLauro is one of the strongest champions for women's reproductive rights in the House; her blessing over the Senate abortion language represents a potentially major concession.

Under the Senate bill, states would be allowed to prohibit insurers operating in the soon-to-be-created health insurance exchanges from offering plans that cover abortion. Those people and businesses participating in the exchanges would have to purchase a separate plan to cover abortion. Meanwhile, those who receive federal subsidies to purchase insurance would be required to use their own money if they wished to purchase abortion coverage. The House bill goes even further, prohibiting insurers operating in the exchange from providing abortion coverage unless it's in the form of a supplemental plan that consumers can only purchase with private funds.

Both variations have been roundly criticized by women's rights groups as infringement on abortion rights. The National Organization of Women, for one, dubbed the Senate's bill "cruelly over-compromised legislation." DeLauro, likewise, acknowledged a certain misery in being forced to favorably champion existing law. "Who on the pro-choice side is excited about saying the Hyde language ought to prevail?" she asked. (The 1976 Hyde amendment bars the use of federal funds to pay for abortion.)

But legislation, especially health care reform, is defined by finding middle ground, she said. And at some point the impetus is simply about getting a bill passed. "I think the greater good will prevail," said DeLauro. "I also think that people will fight hard for what they believe in. This is not going to be a walk in the park. Hell, this is tough stuff and very complex."

In the Senate, DeLauro noted, it wasn't simply the pro-choice crowd that had conceded ground. The pro-life community wasn't pleased either.

"It's maybe a compromise where no one is that happy," she said. "It would appear that you've got the Catholic Bishops who aren't happy. But [Sen. Ben] Nelson (D-Neb.) found his way there as did Senator Bob Casey (D-Penn.) [both pro-life Democrats]. And the pro-choice side said, 'We don't like this as much as we would like to not deal with this language.' But, you know, we're not going to defeat health care."

So, the Huffington Post asked, if you could confirm that the Senate's abortion language upholds current law, you will be fine supporting it?

"That's right. That's right," Del And I would just say that with regard to the Catholic Bishops, they now have an opportunity to not hold health care hostage in the way that they did and tried to do in the Senate," DeLauro, a Catholic, said. "No one, no group, no individual should do that. 45,000 people die every year and have no health insurance. We've got to act."

Source: http://www.huffingtonpost.com/2009/12/2 ... 06043.html
<center>Landrieu Now Facing Anger From The Right, But Predicts Re-Election
by Sam Stein
Huffington Post, December 22, 2009
</center>

Under fire throughout much of the health care debate from the left, conservative Democratic senators are now getting an even harsher reception from the right.

The angriest accusation: that they sold their votes.

On Tuesday, Sen. Mary Landrieu (D-La.) was pilloried during an appearance on C-SPAN Newsmakers for the $300 million in emergency Medicaid funding that she secured for her state in the Senate's legislation. One self-identified Republican caller proclaimed that she had engaged in political prostitution -- trading her vote for the funds. Another called her "nothing but a Judas goat selling out for thirty pieces of silver" who would lose her next election.

"You know," Landrieu chimed in at that point, "being in public office isn't easy because we have to listen to situations like this.

"I'll say it again and I'll continue to say it, I did not vote for this bill because of [the Medicare funding]," she added. "I voted for this bill because it's going to lower costs for Americans, it's going to give the private market the boost and the reform it needs to do a better job for all consumers in our country. It's going to expand the life of Medicare for nine years, it's going to reduce the federal deficit, and it's going to bring efficiencies to a system that is wasteful, abusive and out of control. I know there are some people that don't believe that. Time will tell. And I'll tell that gentleman I've been elected three times to the United States Senate, and I will probably be elected again. Thank you."

Landrieu isn't alone. Both she and Sen. Ben Nelson (D-Neb.) have been called prostitutes by conservative radio talk show host Rush Limbaugh. The Nebraska Democrat also secured Medicaid funding for his state -- a legislative coup that was deemed either the "Cornhusker Kickback" or "Cash for Cloture" depending on the reporter or medium.

Nelson isn't up for re-election until 2012. Landrieu, meanwhile, runs again in 2014. So they have three and five years respectively before voters decide their fates. Unlike, say, Sen. Blanche Lincoln (D-Ark.) -- another swing-state Democrat who is up for re-election in 2010 -- both Landrieu and Nelson stand to actually benefit from the health care provisions they secured, rather than be blamed for the messy process that produced those provisions.

Source: http://www.huffingtonpost.com/2009/12/2 ... 00834.html
Is That So? Health Care Myth-Busting
by NPR, December 20, 2009

As the Senate continues to debate its health overhaul bill, we continue to check the accuracy of that debate. This time, we focus on assertions about abortion and the life of the Medicare program.

Transcript of Broadcast ...

LIANE HANSEN, host:

NPR's Julie Rovner has been fact checking elements of the health care debate. Here she is with another installment of our series, Is That So?

JULIE ROVNER: Although the bill is about health care overall, much of the debate has centered on Medicare, specifically the bill's plan to cut Medicare spending. Here's Georgia Republican Saxby Chambliss.

Senator SAXBY CHAMBLISS (Republican, Georgia): They are saying that even though they are cutting Medicare by a total of $450 billion-plus over a 10-year period, the solvency of Medicare is going to be extended. Now, they expect the American people to believe that somehow.

ROVNER: Well, actually, Senator Chambliss, that's exactly what cutting that much money out of Medicare would do. The less Medicare spent, the longer its money lasts. Now, whether cutting money from Medicare would hurt its providers or patients is another question. Democrats say the cuts wouldn't hurt. They're trimming waste and making the program more efficient. And big senior groups, including the AARP, agree.

Republicans, ironically, who have proposed large cuts to Medicare in the past, say they don't want to cut Medicare in this bill, but they also don't want to raise taxes. They'll have to do one or the other to shore up the finances of the program everyone agrees is financially unable to withstand the retirement of 78 million baby boomers.

Another hot issue in the bill is abortion, specifically what happens if abortion is banned in insurance plans that receive federal subsidies. At issue is whether women will be able to use their own money to buy separate policies, known as riders, to cover the procedure. Michigan Democrat Debbie Stabenow says right now in the five states that ban abortion coverage, but do allow insurance riders...

Senator DEBBIE STABENOW (Democrat, Michigan): Idaho, Kentucky, Oklahoma, Missouri, North Dakota - there is no evidence that there are any riders available in the individual market. So, even though technically colleagues will say, well, you could buy additional coverage, it's not offered.

ROVNER: So, is that so? Well, anti-abortion groups have challenged Stabenow's assertion. As evidence, they point to a quote from the head of none other than Planned Parenthood of St. Louis. Paula Gianino was quoted in a November 9th newspaper article as saying up to 10 percent of the abortions the organization performs were covered by private insurance, despite the state's ban. She said at the time it was because employers had purchased riders for that coverage.

But when I called Planned Parenthood this week, they said they'd done some more investigation and it turns out that's not the case. Rather, that private coverage more likely came from plans that are exempt from the state law. That's because they're governed by federal insurance law instead. So, as far as Planned Parenthood can tell, there are no abortion coverage riders available for purchase in Missouri. So, it seems what Senator Stabenow said on the floor is so after all.

Julie Rovner, NPR News, Washington.

Source: http://www.npr.org/templates/story/stor ... h-20091220
<center>How health lobbyists influenced reform bill - Former staffers of lawmakers from Harry Reid to Mitch McConnell push clients' agenda
By Andrew Zajac
Chicago Tribune, December 20, 2009
</center>

David Nexon had a big problem. An early version of national health care legislation contained a $40 billion tax aimed squarely at members of the medical device trade association he represents.

Nexon, a former adviser to the late Massachusetts Sen. Ted Kennedy, went to work. He marshaled 14 people like himself -- lobbyists who were once congressional aides, many of them from staffs of congressional leaders or committees that had a hand in crafting the health care overhaul.

When Senate Democrats unveiled their bill in mid-November, Nexon's handiwork was evident. The tax on device-makers was still large -- $20 billion -- but only half what it might have been without the efforts of Nexon and his fellow lobbyists.

Nexon's team is an illustration of how deeply the health care industry has embedded itself on Capitol Hill, using former aides of lawmakers and ex-lawmakers themselves.

An analysis of public documents by Northwestern University's Medill News Service in partnership with the Tribune Newspapers Washington Bureau and the Center for Responsive Politics found a revolving door between Capitol Hill staffers and lobbying jobs for companies with a stake in health care legislation.

At least 166 former aides from the nine congressional leadership offices and five committees involved in shaping health overhaul legislation -- along with at least 13 former lawmakers -- registered to represent at least 338 health care clients since the beginning of last year, according to the analysis.

Their health care clients spent $635 million on lobbying over the past two years, the study shows.

The total of insider lobbyists jumps to 278 when non-health-care firms that reported lobbying on health issues are added in, the analysis found.

Part of the lobbying pressure on current members of Congress and staffers comes from the powerful lure of post-congressional job possibilities.

"There's always a worry they may be thinking about their future employment opportunities when dealing with these issues, particularly with health care, because the stakes are so high and the breadth of the issues -- pharmacies, hospitals, doctors," said Emory University political scientist Alan Abramowitz.

Lobbyists' earnings can dwarf congressional salaries, which currently top out at $174,000 annually for lawmakers and $156,000 for aides, though committee staff members can earn slightly more.

In the health care showdown, insider lobbying influence has magnified the clout of corporate interests and helped steer the debate away from a public insurance option, despite many polls indicating majority support from Americans, according to Rutgers University political scientist Ross Baker.

"It imposes a kind of conservative bias on the discussion," said Baker, himself a former Senate staffer.

The lineup of insiders working for clients with health care interests includes at least 14 former aides to House Majority Leader Steny Hoyer and at least 13 former aides to Montana Democratic Sen. Max Baucus, the chairman of the Finance Committee and a key overseer of the health care overhaul.

Nexon, who is now senior executive vice president of the Advanced Medical Technology Association, is among at least a half-dozen former Kennedy aides lobbying on health care.

Nexon acknowledged the value of congressional connections, "but in the end, it's not who I know, it's what I know."

It makes sense to hire former staffers for the health care showdown because they tend to be "more generalists, dealing with a broad range of issues," something that is in demand for legislation that sprawls across at least a half-dozen federal agencies and encompasses issues ranging from tax policy to hospital reimbursement rates, according to Nexon. But specific issues also get specialized help. Earlier this year, the Christian Science Church hired a former Kennedy staffer, Carolyn Osolinik, and three of her colleagues at the Mayer Brown law firm, all veterans of Capitol Hill. The firm has been paid at least $110,000 so far to push a provision requiring insurers to consider covering Christian Science prayer treatments.

Phil Davis, a senior official of the church, said the church wanted access to decision makers. "The noise level goes sky high. It's hard to get in to talk to people," he said.

The largest insider lobbying cadre belongs to the Pharmaceutical Research and Manufacturers of America, or PhRMA, which employs at least 26 former congressional members and staffers, according to Medill/CRP research.

Two other drug interests, biotech firm Amgen Inc. and the Biotechnology Industry Organization trade group, with at least 24 and 16 insiders respectively, ranked second and fourth among reported hiring over the past two years of lawmakers' former staffers and members of committees considered in the analysis.

"The numbers shouldn't surprise anyone," said Ken Johnson, a PhRMA senior vice president. "Former staffers have a unique understanding of how the legislative process works. And when you are trying to advocate on behalf of smart public policies, you want smart people on your team."

But Bob Edgar, president of Common Cause, a nonpartisan, nonprofit watchdog group, had a harsher assessment, blaming "a toxic cocktail of insiders and money" for short-circuiting a government-run plan that would have competed with private insurers.

"We'll get a bill. And the president will sign it. But it'll be less than the country deserves," said Edgar, a former six-term member of the House.

Health care lobbyists increase their effectiveness by strategically targeting their campaign contributions or the donations of the interests they represent, Edgar said.

Health industry contributions to congressional candidates have more than doubled so far this decade, rising to $127 million in the 2008 election cycle from $56 million in the 2000 election, with disproportionate sums going to the party in power and to members of committees that oversee health care, according to the Center for Responsive Politics.

But lobbyist and former Kennedy staffer Andrew Rosenberg said political conditions, not big money or the predispositions of lobbyists sidelined a public option.

"You could see this coming from a long way off. The Democratic Party is now the big tent party. They have to get to 60 votes. That is the reality," Rosenberg said. "It was going to have to be something that appeals to moderates" opposed to expanding government-run health insurance.

Source: http://www.chicagotribune.com/health/ch ... rint.story
Why this bill will SCREW private insurers
by Mark Warner
The Daily Kos, December 20, 2009


Private insurers (and their lobbyists) had an interesting dilemna in approaching the healthcare reform debate. There were many possible outcomes, some that favored them, and some that hurt them. I'm about to argue that this outcome was the worst PROBABLE (not possible) outcome for private insurers, and this is why they're still screaming bloody murder against this bill. Here's my list of outcomes in ranking from worst for insurers to best. Let's go ahead and assume the constant in all of these outcomes of strong insurance reform (pre-existing conditions, annual caps, etc)...with the caveat that I'm not a healthcare wonk, just a dummy blogger!

Worst for private insurers: A strong national public option with a strong mandate

While there was only an outside chance of about 5% that this would pass (I think it could have passed if the economy had turned around quicker than expected causing Congress/Obama to be cockier), it is clearly the worst outcome for private insurers. A strong public option would not have the adverse selection problem, and it could have conceivably delivered cheaper premiums and better coverage (probably not, but possibly - most likely the premiums would be similar or more expensive with much better coverage with the public plan).

2nd worst for private insurers: This bill - no public option with a weak mandate

Dropping the public option forced stronger insurance reforms (and I imagine we'll see even stronger reforms after the conference as the House uses its leverage to demand low profile but important concessions). And without the weak public option, the insurance companies can't avoid the pools of sick people. The weak mandate will hardly enrich insurance companies, and many just avoid it. Here's a quote from Senator Franken, who seems to think that the bill is good enough, smart enough, and people should like it, doggone it:

Requiring insurance companies to spend 85% of premiums on actual health services -- not administrative costs, TV ads, or gargantuan CEO bonuses -- is a big victory.

2nd best for private insurers: The status quo

Insurance companies have decent (though not huge) profits right now, so they'd keep making those profits with the status quo as medical costs kept rising.

The best option for insurers: a weak public option with a mandate

A weak public option without strong negotiating power would have been a dumping ground for sick people. Insurance companies would have benefited from BOTH the mandate AND the public plan, as their coverage pools would have been healthier due to both.

I think it's close between #3 and #4. Arguably, the weak public option could have been expanded over time to crush insurers market share...but there's probably an equal chance that a public option filled disproportionally with a sick pool of people would have required government bailouts year after year (to keep premiums and benefits reasonable) and would have become a de-facto entitlement program.

Obviously the insurance companies' least risky strategy was to just scuttle the entire bill AT ANY COST. That mean making up lies about seniors losing Medicare coverage, making up lies about death panels, fueling a teabagger insurgence, and attacking even the weak public option (as a means for scuttling the entire bill).

My take is that insurance companies weren't terribly concerned about a public option ever passing. Their real fear is the current bill, which combines a weak mandate with insurance reforms. This will be a huge blow to the industry, as the government is now for the first time HEAVILY REGULATING private insurance. A heavily regulated private insurance industry is the second best thi

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