2 Democrats Spearheading Health Bill Are Split

[babylonsister]

2 Democrats Spearheading Health Bill Are Split

By ROBERT PEAR
Published: May 29, 2009


WASHINGTON — A significant split has developed between the two Democratic senators leading efforts to remake the nation’s health care system. They disagree over the contours of a public health insurance plan, the most explosive issue in the debate.

One of the senators, Edward M. Kennedy of Massachusetts, reasserting himself after months of treatment for brain cancer, made clear this week that he favored a robust public health care plan, a government-sponsored entity that would compete with private insurers.

As a starting point for his bill, Mr. Kennedy favors a public plan that looks like Medicare, the government-run program for older Americans created in 1965, when he was a young senator.

By contrast, Senator Max Baucus, the Montana Democrat who is chairman of the Finance Committee, has been working for months with the panel’s senior Republican, Charles E. Grassley of Iowa, in the hope of forging a bipartisan bill, which would probably play down the option of a public plan.

Mr. Grassley opposes creation of a new government insurance program and says “we cannot afford the public health plan we have already,” referring to Medicare.

President Obama has championed a public plan, saying it would help “keep the private sector honest,” though he has indicated he will be flexible on the details.

House Democratic leaders, including three committee chairmen drafting the House bill, are close to Senator Kennedy’s position.

more...

http://www.nytimes.com/2009/05/30/health/policy/30health.html?hpw

[Phoebe Loosinhouse]

1. "Compromise" is the word that will doom healthcare reform

It will be "compromised" right out of any real reform into a sop to the masses and a promise of doing better from the insurance industry.

Leadership from the top is nowhere near as strong as it could be - Obama "has championed a public plan, saying it would help “keep the private sector honest,” though he has indicated he will be flexible on the details." So far, it appears he's just staying out of it and letting the Committees draft the legislation. He CANNOT be flexible on the detail of a public plan.

Baucus, Grassley and Wyden are trying to compromise out any public plan at all with their plan to give the insurance industry YEARS to provide affordable healthcare with a public plan triggered if only certain goals are not met. This is what Baucus meant when he earlier referred to a public option as a "bargaining chip" with the insurance industry. Isn't it just great that he regards a public option as just another bargaining chip in the poker game with the insurance industry?

Then there's Kennedy, whose plan would widely open up Medicare to new enrollees (up to 500% of federal poverty levels) PLUS create a ne public option. Biggest question there is why create a new option when he's already expanding Medicare - why not just expand Medicare more?

Most insidious of all is Schumers plan to provide a pretend public option that is not really a public option at all - it will have no government funding and will be regulated just like one more private plan.It will be financially unsound from the getgo and will fail quickly. I have the least respect for this plan because of it wolf in sheep's clothing aspects.


The biggest issue is that the people drafting healthcare reform right now, their real purpose is not to reform at all. (I grant an exclusion to Sen. Kennedy in that general slam. I think he's to effect some real change, even if I don't totally understand it) The real purpose is to retain as much of the status quo as possible while still APPEARING to be reforming the system. The only major, real overhaul is HR676 which, as we all know, was taken off the table at the beginning. If you read the White House Healthcare forums on healthcarereform.gov you'll see it's all about the "stakeholders" and keeping our flawed system afloat with some minor tweaking that the American sheep will accept as reform.

[KharmaTrain]

3. You're Not Gonna Get Reform Without Compromise

I'm strongly in favor of a public option that that allows those who can afford to opt out and privately insure to so. It's can't be all of one or all of another...and this debate is a good thing. It puts all the options on the table, not just one or two.

From one whose dealt with Medicare in assisting my father's practice and in taking care of my parents during their last days, I've seen how a public system can be limited and abused. There's just too much money (even in a scaled down system) at play here and too many moving parts. While there needs to be checks on the abuses and greed of the insurance companies, there also needs to be a balance against a public system that can bog down if it becomes the sole conduit to health care in this country.

Compromise doesn't mean capitulation. It means this reforming from within as opposed to building a whole new system. Bottom line is that insurance companies aren't going to go away and there are many Americans who would prefer to handle their own health insurance and should have the option...or to purchase an umbrella policy. My bigger concern is to open up the health care system to all, not to bottle it up with a different cork.

Cheers...

[Faryn Balyncd]

6. But all the options AREN'T on the table. So FURTHER compromise IS capitulation:

If Single Payer Medicare-for-All actually WAS on the table, then a REAL compromise might be a public option that allows younger Americans to opt in to Medicare, or keep their private insurance.

Such a compromise is somewhat similar to Kennedy's plan, except that Kennedy's plan has (at the insistence of insurance interests) already financially handicapped the "public option" by forcing it to pay 10% higher rates than Medicare, in order to protect the insurance companies from competition.

But with Single Payer OFF the table from the get-go, the insurance companies and their collaborators are fighting, not for a compromise with true Single Payer, but to either kill of further emasculate the ALREADY COMPROMISED and ALREADY PRICE HOBBLED (compared to Medicare rates) Kennedy plan.

The industry collaborators have already achieved, at this preliminary stage, their greatest goals.

Further compromise will result in a Kennedy bill that is so flawed that an affordable public option will not be viable.






In reality, as the Times reports, Baucus is now peddling the preposterous notion that the WYDEN BILL (which has NO public option whatsoever) is a "fallback compromise". Indeed, Wyden's work has been the greatest obstacle to support for a public option plan such as Kennedy's (the only plan on the table which IS a real compromise).






But Wyden, under pressure from long-time progressive supporters in Oregon (and perhaps his conscience), has indicated he will be open to a public option ONLY if HIS NO-PUBLIC OPTION plan STALLS.

So, does it not look like we have work to do?






What purpose does it serve (besides those of pampered corporate free-loaders) to aggressively push "compromise" at this early stage?

[KharmaTrain]

7. "At This Early Stage"...

That's the operative word here...and my point. To this point many have framed this debate as an all or nothing game...either it's single-payer or the status quo. There are options that fall within...parts of the debate that is just forming and, while not in the early drafts, will have their say as this debate unfolds.

This is more a political and PR campaign at this point than anything else. Of course the insurance companies and big pharma are getting the early lead, they're far better funded and organized. However, there has been an energizing of groups in favor of single payer that are gaining voice, money and momentum...thus let's see what develops.

Yes, a strictly single-payer system won't be the end result...and it's because there are people who want alternatives. Personally, I don't trust the government as being the sole conduit for healthcare in this country, just as I don't like them having control on education. It's important that ALL people have access to affordable insurance (nothing comes free...sorry) and that competition can drive down costs that make preventative as well as catastrophic care available to all. The best way to cut down on future costs is to keep people healthier.

There also needs to be reforms in what makes health care so expensive...including tort reform that would reduce the high malpractice insurance costs to both doctors and hospitals, a better prescription drug program and cutting out beauracracy rather than creating more.

Let's see how the debate shapes before one rules what is on or off the table...or that it's all or nothing. Yes, compromise will happen, it's what is done in a representative democracy.

[Faryn Balyncd]

8. Your comment "Nothing comes free...sorry" is condescending.....

It's a lot easier to pretend to be arguing against a straw man free-loader who you may wish to portray as desiring "free healthcare".




The reality is that it is the coddled insurance mafia that is free-loading - - and at the expense of patients, medical providers, taxpayers, and the productive industries that comprise our American entrepreneurial and industrial economic base.

The reality is that the same insurance industry that often limits its payments to physicians to the Medicare rate, has fought for (& already achieved) concessions in the Kennedy bill in which the "public option" program will need to pay 10% more than the Medicare rate. Industry lobbyists continues their efforts to castrate, and make economically non-viable, any such "public option".

The insurance industry, while claiming to represent "competition", in reality is attemtping, as usual, to avoid competition.

This is the same industry whose "competition" has created a perverse system of fantasy "regular rates" in which individuals who HAVE BEEN DENIED INSURANCE, are now billed phony inflated "full pay" rates 250-600% higher than insurance companies pay.





But it's much easier to pretend that the advocates of a public healthcare plan are freeloaders who want something that "comes free" (as you phrased it), than to deal with the difficult reality that we tackle the inflated "administrative" cut taken by the insurance industry for their mismanagement, in order to have the resources to apply to actual health-care.

And it's much easier pretend to mount defenses against those portrayed as wanting something that "comes free", than to objectively discuss these healthcare realities with healthcare PROVIDERS who support a Single Payer Medicare-for-All system (such as Physicians for a National Healthcare Plan, and the California Nurses Association), and those who support a viable, affordable public option.




As a physician who has practiced medicine for several decades, and supported my family through my profits, I find your comment "Nothing comes free...sorry", insulting.

Your implication that those of us who support Single Payer Medicare-for-All, or a public option system in which younger Americans have the option to buy-in to a Medicare-styled public option, are wanting healthcare to "come free" is a cheap, condescending, and incorrect implication.

[KharmaTrain]

12. Reality Is Condescending...

You don't need to prove squat to me, it's the legislators who are crafting this bill that counts. They obviously see this situation differently than you do. Thus it's them you need to pursuade.

Reality says there are expenses with health care...you're not going to eliminate them. Doctors will need to be paid, equipment will need to be developed and purchased, drugs will have to be developed and tested, hospitals need to be staffed and so on. These expenses have to come from somewhere. Some believe single payer to be a free or cheap system, it won't be. How is it funded? Through income taxes? Payroll taxes? Sales taxes? And can this system accomodate the same care for 300 million people and growing?

I've said I'm strongly in favor of Single Payer with optionS...not just one. But it's not an either or or fix...or one that will be done with one piece of legislation. Thus the need now to dialogue, to put ALL options so that the most people can be covered and to make it affordable to all.

[Faryn Balyncd]

15. It is the false implication that supporters of Single Payer are naively desiring "free" healthcare..

...that is condescending.

The truth is that physicians and nurses in Physicians for a Natl Health Plan and the California Nurses Association support Single Payer as the best way to reduce administrative costs, and achieve affordability.

Continuing to argue against a straw man (continuing to proclaim that there are expenses to be paid and stating that "some" believe Single Payer to be "free" or "cheap") distorts reality and misrepresents all the supporters of single Payer that I know.

Single Payer has the advantage, not of being "free" or "cheap", but of addressing excessive administrative costs by insurers who are, in fact, mismanaging the system.

For some reason our party is so desirous of "compromise" that one of our fine senators (Wyden) has stated repeatedly that neither Single Payer nor any public option is on the table, stating that neither would be acceptable to Republicans and the insurance industry.

Only after vigorous protest from folks in Oregon has Wyden finally stated that perhaps he would support a public option (not Single Payer) only if his plan stalls.

So it would seem to me, that if you are "strongly in favor of Single Payer with optionS...not just one." as you state above, that the way forward is not to agitate for "compromise" (and falsely accuse others of wanting a "free" plan), but to apply pressure to Wyden and Baucus, and let them know that the kind of NO-PUBLIC-OPTION plan that they are peddling is unacceptable.

Wyden has made it crystal clear: He will only support a public option plan, if his "no public option" plan that caters to the corporatists stalls. http://www.huffingtonpost.com/2009/05/26/wyden-open-to-public-heal_n_207638.html

[Phoebe Loosinhouse]

10. "Tort reform" makes little or no difference in healthcare costs when it's enacted

http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande?yrail
Annals of Medicine
The Cost Conundrum
What a Texas town can teach us about health care.
by Atul Gawande

skip

“McAllen is legal hell,” the cardiologist agreed. Doctors order unnecessary tests just to protect themselves, he said. Everyone thought the lawyers here were worse than elsewhere.

That explanation puzzled me. Several years ago, Texas passed a tough malpractice law that capped pain-and-suffering awards at two hundred and fifty thousand dollars. Didn’t lawsuits go down?

“Practically to zero,” the cardiologist admitted

I've always considered tort reform to be part of the conservative fog machine when there is any discussion of healthcare reform. It's 2 legs of Sean Hannity's 3 legged stool against healthcare reform. (His other leg is "government control" and "socialism" ooooh, better hide under the bed so the "socialists" won't see me)

As to bureauracy, Medicare adminstrative overhead is estimated at 3-5% while private insurers are anywhere from 20-30% according to different sources I have read. Some Government bureacracies actually have some great standards of effiencies - I never read about SS checks not getting cut, the IRS is pretty on the ball in general with their processing of hundreds of millions of tax returns, etc. Plus, the more people enrolled in a single plan, the greater efficiencies and economies of scale are possible.

The "Bureacracy" "red tape" type of dialogue is another one utilized often by those on the right as being an effective button pusher among many in the population. Please understand, I am not saying that you yourself are a closet right-winger or conservative or Sean Hannity fan. I have read and enjoyed too many things that you post here to think that. I completely agree that a better prescription drug program is necessary. But, I personally would put tort reform quite a ways down on the list of priorities and fear of bureacracy doesn't even make the list to me.

As you always say, Cheers!

[KharmaTrain]

13. Ever Seen A Cattle Call?

While assisting my father with his medical practice in his final years, we had several occasions where he was named in a suit by a patient (or more specific, a lawyer) who named everyone who ever treated the patient and was in or near the hospital during their stay. It was a needless waste of time and expense to fight these as in almost every case my father was called in by the patient's attending physician for a consultation and in the end was dropped from every suit. However, we had to hire a lawyer and his malpractice insurance rates would climb (even when he was released from a suit)...the money wasted far outweighted the amount he made on the consultation. There are millions squandered by needless lawsuits that can/should be adjudicated by an arbitration panel and the lawyers held liable for the costs if they decide to sue everyone on the planet and lose.

There's a major problem with adminitration of insurance...but that's not tort reform. I've long complained on how insurance companies play god by determining what procedures are covered or what a doctor can perscribe or even which doctor can attend to a patient. Those matters lead to hospitals keeping people on the outside and doctors afraid to do more than what's "safe". No smokescreen here...but it's not to be confused with malpractice that amounts to a large chunk spent by every doctor or hospital that is a major cause for high medical bills.

This problem is so nebulus that it needs to be pulled apart by the various people and expenses involved that will make it efficient and accessible. Understand, I want all people to have coverage and no one to ever be turned away from a hospital or the doctor of their choice...

Thank you for your very important and valid points...

Cheers...

[Phoebe Loosinhouse]

14. I don't mean to downplay the fact that the reality of malpractice

lawsuits is a very large concern for every health professional and absolutely drives "over servicing" where MRIs etc. are ordered for splinters, etc. as part of the self defensive practice of medicine. If I'm not mistaken, in the military system of healthcare there is no malpractice, per se. I don't know about the VA. There has to be some sort of workable (OMG! I am forced to use the word) compromise. :-)

What I reject is compromised compromise!!

[bobbolink]

16. What we get with COMPROMISE won't be Health Care For All.

[Selatius]

18. It depends on where the goalposts are.

If we're talking about an argument between two people where one wants to blow you away with a shotgun and the other merely only wants to hit you with a stick, the compromise will likely land you in a world of hurt where you wish not to get hurt at all.

[Iwillnevergiveup]

2. Bernie Sanders is our guy

PLEASE hit this poll he has up at his newsletter.

http://sanders.senate.gov

[Phoebe Loosinhouse]

5. He is our guy. I wish we could get tissue samples and clone a Bernie for every state. nt

[depakid]

4. Baucus and the Republicans

What a POS.

Were the shoe on the other foot, Republicans wouldn't stand for this sort of things. Baucus would be bounced out of that committee pronto.

Ironic that for all their ineptitude they're MUCH better and more successful in getting their policies and legislation passed than the hapless democrats.

[LWolf]

9. I'm glad to see TK back in action, and on the right side of this issue.

I didn't know he was a supporter of HR 676. :D

[Faryn Balyncd]

11. K & R

[babylonsister]

17. UPDATE: Kennedy and Baucus downplay reported rift

http://briefingroom.thehill.com/2009/05/30/kennedy-and-baucus-downplay-reported-rift/

Kennedy and Baucus downplay reported rift
@ 2:20 pm by Michael O'Brien


There is no rift between Sens. Ted Kennedy (D-Mass.) and Max Baucus (D-Mont.) on how to achieve healthcare reform, the two men said Saturday.

Kennedy and Baucus issued a joint statement denying a New York Times report claiming the two, who are spearheading reform efforts, have split over the size of the public plan option to be included in the package.

"For both of us, reforming the nation's health care system to cut cost, improve quality and provide affordable coverage remains the top priority on our two committees," the senators said. "We have worked together closely over many months and will continue to do so."

"We intend to ensure that our committees report similar and complementary legislation that can be quickly merged into one bill for consideration on the Senate floor before the August recess," the two added.

[Faryn Balyncd]

19. Why is Schumer supporting Big Insur efforts to continnu "pre-existing condition" denial and force...

.....any "public option" to devolve into a plan in which the taxpayers and patients get the shaft, while Big Insurance gets to continue to cherry pick?


http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=389x5749559