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WilliamPitt Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Sep-17-09 10:37 AM
Original message
Back to the Health Care Drawing Board (re: Baucus)


Mike Schmid at Cedars Sinai Medical Center. (Photo: Mike Schmid / Flickr)

Back to the Health Care Drawing Board
By William Rivers Pitt
t r u t h o u t | Perspective

Thursday 17 September 2009

Give some credit to Democratic Sen. Max Baucus of Montana, who unveiled his $774 billion health care reform bill on Wednesday, for being true to his word about wanting to craft a centrist, compromise piece of legislation. That's exactly what he did, and after revealing his bill, that's exactly where Baucus put us: in the middle of the road, right where all the squashed roadkill can be found lying on top of a long, yellow stripe.

It's a nonsense bill, to be blunt, tossed like a hand grenade into a debate already raddled with nonsense as it is. The far right Teabagger brigades want you to believe this reform effort will remake America into a socialist disaster zone where killing grandma is mandatory but insuring undocumented immigrants is only required. Thanks to the unutterably compromised mainstream (read: corporate) media's relentless pursuit of "equal time," each and every one of these shamelessly incorrect and morally bereft accusations have been provided with exactly 100 percent more air time than they deserve. The result has completely polluted the national debate on health care reform.

Now comes Baucus and his mixed bag of centrist, half-a-loaf goop, which was brought into being for three sad reasons: 1) President Obama all but disappeared from the debate over his own health care reform for weeks, which allowed the inmates to take over the asylum. This was a failure on the part of the administration that could have lasting, catastrophic repercussions for the White House; 2) In far too many instances, Democrats in the Senate are made up of what Richard Nixon would have described as "first-rate second-rate men," timorous, still somehow frightened by their GOP cohorts despite the Democrats' dominating majority, and totally unwilling to do anything that might annoy anyone, anywhere, ever, and; 3) An obsession with making health care reform a bipartisan process, which is the specific genesis of Baucus's bill.

This is not to say that the legislation proposed by Baucus is all bad. It isn't; as he correctly claimed, many parts of it are precisely what President Obama has been asking for. But there are a few crucial aspects of the original reform proposals that have been deleted from Baucus' proposal, and therein lies the make-or-break rub. The New York Times explained it this way:

The proposal would extend benefits to millions of people who are uninsured by broadly expanding Medicaid, the state-federal insurance program for the poor, and by offering subsidies to individuals and families with modest incomes to help them buy insurance. The proposal would also set limits on out-of-pocket health care expenses.

It would cap at 13 percent of household income the cost of health insurance premiums for middle-class Americans who just miss qualifying for the new government subsidies. Such families would also face additional cost-sharing, such as co-payments and deductibles.

Starting in 2013, it would require nearly all Americans to obtain coverage or face a penalty of up to $3,800 a year for families. The bill would create new state insurance marketplaces, or exchanges, where consumers could shop for insurance and compare plans.

The Baucus plan calls for the creation of private, nonprofit health insurance cooperatives to compete with private insurers, a compromise aimed at bridging the gap between Democrats who want a government-run insurance plan and Republicans who adamantly oppose that idea. As insurers, the cooperatives would offer their coverage plans on the exchanges and would have to meet the same requirements as private insurers.

And in a nod to the stiff Republican opposition, the proposal did not include a trigger calling for the creation of a public plan if the legislation fails to make affordable health insurance widely available, a compromise step that Mr. Obama has indicated he could accept.


Some good stuff in there, to be sure. But when you get to the part where it reads, "In a nod to the stiff Republican opposition," that's when the wheels come off.

No "public option" to balance the playing field and offer real health care alternatives to people who cannot afford insurance under this plan. Not even a "trigger" to activate some form of public option down the line if circumstances warrant. A pile of other important aspects that are critical to creating actual, workable, legitimate health care reform have likewise been excised by Baucus and his yellow-striped legislation proposal.

Why?

Because the president blew it by checking out of the debate he started.

Because too many Democrats in the Senate would fold in half if they weren't propped up by aides and staffers due their absolute lack of spine.

Because all these Democrats continue to cling to this mind-boggling desire to be bipartisan when it comes to crafting this reform legislation.

A health care reform bill without the crucial aspects Baucus choose to leave on the cutting-room floor would be worse than no bill at all. It would leave nearly 30 million Americans still uninsured; it would require millions more to pay for benefits they can't afford, or else be penalized with fines they can't afford, either.

Worst of all, it would come into being without the public option, which would be nothing short of a catastrophe. The reason the GOP - and far too many Democrats - do not want the public option involved is because they are paid employees of the health care industry and all the medical cottage industries that make their living by screwing sick and disabled Americans. These are the capitalists, mind you, cowering in terror over actually having to operate in a capitalist system, one with actual competition that would force them to (gasp) make less and provide more.

Finally, the Baucus bill is a waste of ink for one bottom-line reason: nothing the Democrats put forth on health care reform is going to get any meaningful support from Republicans, no matter how much far-right compromising claptrap the Democrats wire into the thing. Maybe one Republican will vote for the Baucus bill, maybe two.

Is that enough reason to completely shred the reform process by turning it into a sop to the GOP?

President Obama has jumped back into the debate, which is a very helpful turn of events given his planet-shaking ability to move and motivate people. This should hopefully invest Democrats in Congress with the courage to come out from under their desks long enough to regain control of the debate.

But this bipartisan gibberish has got to stop, which is why Baucus's bill cannot be allowed to get any further than it already has. Instead, the whole debate needs to be reset and restarted, beginning with this absolute truth: there will be no bipartisan bill, no matter what, period, end of file, turn out the lights when you leave. The GOP won't vote for anything the Democrats come up with, because they don't care about reform. They want to shame the president and make sure their corporate check-writers are still paying and getting paid.

If that is true, and it is, there is no reason to even consider Baucus's proposal. President Obama and his people in Congress need to go back to the drawing board on health care reform, and come up with something that will pass with 218 in the House and 51 in the Senate, i.e. something that will actually help people and be worthy of the word "reform.". Then he needs to sign it, and the Teabaggers will just have to suffer the excellent health care provided in the wake of their defeat.

President Franklin Roosevelt didn't need bipartisanship to make this country a better, healthier place to live. President Obama needs to take a leaf from FDR's book, junk this whole blithering fool's errand, and begin again from the beginning. If they want bipartisanship, the Democrats can start a card game with the minority. That's the only place they are going to find it.

http://www.truthout.org/091709A
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ddeclue Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Sep-17-09 10:42 AM
Response to Original message
1. Absofuckinlutely! Flush HR3200 and pass HR676 instead!
This thing is a giant turd and it stinks!
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PA Democrat Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Sep-17-09 10:44 AM
Response to Original message
2. Just look at all of the supporters of the Baucus bill surrounding him as he unveils
his bipartisan bill.

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Cha Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Sep-17-09 11:30 PM
Response to Reply #2
8. Yeah, where are his fellow mug shots?
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WilliamPitt Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Sep-17-09 11:23 AM
Response to Original message
3. .
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madamesilverspurs Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Sep-17-09 11:31 AM
Response to Original message
4. Baucus is toxic to the process.
He expects us to pretend that it doesn't matter that he's taken the wheels off the car and removed the engine. And he did so at the behest of the same republicans who are now laughing their asses off at him.


There is no loyal opposition. There is no bipartisanship.

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BREMPRO Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Sep-17-09 12:30 PM
Response to Original message
5. Why was a weak Senator from a small rural state put in charge of crafting health care for
Edited on Thu Sep-17-09 12:33 PM by BREMPRO
the entire nation? He appears to be the epitome of a spineless, corporate compromised Dem. That said, as you acknowledge, there ARE good things in the bill that we should all support. I don' think we can or should start from scratch for that reason. There are requirements for covering pre-existing conditions, preventative care, health and wellness programs, and no lifetime caps. There are income indexed subsidies for those who can't afford insurance. The mandate may be unpopular with young people, self-employed and lower wage workers who choose to forgo insurance, but most of the time it's because they can't afford it. The mandate should help distribute risk and lower average costs. I support the mandate as long as they have affordable options- the 13% threshold seems reasonable.

Yes, there is no "public option" and the "coop" exchange would not be my choice- BUT being open minded here, if the coops are NON-PROFIT and have at least 4 or 5 options to choose from competing for members, and it would accomplish the same outcome as a public option without all the political rancor, and it's got to be REAL and not Faux competition to the for-profit insurance industry. and they offer affordable choices, THEN, I would support it.

We've heard from some Republicans, but not all- Snowe and Collins may end up supporting the final bill. That way we don't need to use reconciliation that could be cumbersome and cause procedural and political problems.

What I haven't heard about in the bill is all the other things that have been promoted by the president to lower costs- comparative effectiveness and best practices. The lesson of the MA plan was that you can't just have insurance mandate without looking at health care delivery costs> we will need more primary care docs, and change from a "fee for service" model to outcomes based medicine.

do you have a link to the 16 page outline of this bill?

The devil is in the final details.
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karynnj Donating Member (1000+ posts) Send PM | Profile | Ignore Fri Sep-18-09 08:31 AM
Response to Reply #5
9. Because he chairs one of the two relevant committees in the Senate
He is not crafting the ultimate bill. I hope he is not even crafting the ultimate Senate Finance committee bill. Some excluded Senators on that committee have said that changes will be made before they vote the bill out. Baucus' call that they not change much has no teeth. He can't credibly say that changes will lose the support his bill has - because there is little support to lose. He did not even get support from the majority of his gang. The 3 Republicans don't support it and Bingaman has been silent.

The mark up in that committee could be fascinating. Some of the excluded Senators have mentioned meeting with each other. It would be great if they worked out a substitute bill - maybe starting with what Rockefeller wrote. At any rate, they are speaking of amending Baucus' bill that seems strongly supported by just one Senator - Baucus - and maybe Conrad.
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Bluenorthwest Donating Member (1000+ posts) Send PM | Profile | Ignore Fri Sep-18-09 09:19 AM
Response to Reply #9
11. And he has that chair because of rules made by our caucuss
which they could change if they saw fit. He is not in that chair as a right, nor as a natural state of things, and not because of rules of the Senate, but because his Party allows him that status under rules they made themselves.
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karynnj Donating Member (1000+ posts) Send PM | Profile | Ignore Fri Sep-18-09 10:19 AM
Response to Reply #11
15. I quite agree
The rule of seniority is one of long standing. I suspect the other "advantage" (if you call it that) is that there is no need to argue the merits of the individuals. In addition, the caucus can push a Senator, who they deem not up to being the chair to waive seniority, though that is rarely done.

Think of the how much intraparty anger any alternative would cause. I would not want the party leadership picking all the chairs. By and large the leadership is from the centrist part of the party - and has been for years. They might have replaced people like Leahy (Judiciary) and Kennedy (HELP) years ago. The alternative of having each committee's Democrats vote their leader would likely lead to hurt feelings and animosity - even among possible leaders who were friends. Imagine if every Congress, there was a vote in each committee - with some mechanism to let Senators placing first in multiple committees to waive all but one.

One example of that would have been in 2005 in the Senate Foreign Relations Committee. Biden had been a competent ranking member (and chair when we had the majority) and had been on the committee for 26 years. But, Kerry had just nearly won the Presidency, keeping it close largely because of his incredible first debate on foreign policy. The Democrats on that committee then were - Biden, Sarbanes, Dodd, Kerry, Feingold, Boxer, Bill Nelson, Menendez, and Obama. If there had been no tradition of seniority rule, I could easily see Feingold, Boxer, and Menendez picking Kerry who they were more aligned with on policy. Obama might have also gone with Kerry - out of gratitude for the Convention speech and the fact that at that point he likely knew Kerry better. As it was, Kerry used his list in 2006 to raise money for Nelson in a tough general election - even in 2005, Kerry's ability and willingness to do this was known. I suspect that Dodd, Kennedy's best friend might have gone to Kerry as well, though I think he consider both Kerry and Biden friends. I know little about Sarbanes, so I will not comment.

Now, I respect and admire Kerry far more than anyone in the Senate (then or now) and think that he is the best chair SFRC has had in decades, there would have been unintended consequences. If that would have happened, Biden might not have been as strong in 2008, where his middle class background and his foreign policy knowledge helped Obama on both counts.
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Alcibiades Donating Member (1000+ posts) Send PM | Profile | Ignore Fri Sep-18-09 09:42 AM
Response to Reply #5
13. No public option and a fine for the uninsured
That's all you need to know. If these are the big selling points of this bill, can you imagine what is in the fine print? Ditch it, it's a dog.
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WilliamPitt Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Sep-17-09 04:17 PM
Response to Original message
6. Evening kick
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jannyk Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Sep-17-09 11:09 PM
Response to Original message
7. Excelled yourself with this piece Will. Bravo!! k+r
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dionysus Donating Member (1000+ posts) Send PM | Profile | Ignore Fri Sep-18-09 08:54 AM
Response to Original message
10. good write Will, but do you really believe baucus's piece of crap is going anywhere?
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uponit7771 Donating Member (1000+ posts) Send PM | Profile | Ignore Fri Sep-18-09 09:31 AM
Response to Original message
12. Unnn, Baucus did us a favor; no reThug sign ons = they don't want anything bipartisan and now we hav
...the ultimate excuse to ram through what we want in the bill via reconciliation and a good sledge hammer to use in 2010.

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Alcibiades Donating Member (1000+ posts) Send PM | Profile | Ignore Fri Sep-18-09 09:48 AM
Response to Reply #12
14. That would be nice
Who will sit on the Reconciliation Committee? Max Baucus?

We have had that excuse for some time. The Republicans have obviously been negotiating in bad faith, just as they did with the Paulson-Bernanke bailout. Why nobody ever brings up that bit of recent history in this context is beyond me.
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