Health Care Reform Must Not Follow Stimulus Path

After Senate Majority Leader Harry Reid announced that he would include a public option in the Senate health care bill, it didn’t take Sen. Joe Lieberman long to threaten to block the bill altogether.

In stating his opposition to a public health insurance option, Lieberman sounded familiar notes from reform’s opponents, calling it a “government entitlement program” that will cost the government more money. Neither assertion is true. The public health insurance plan would be paid into, not subsidized, and as the Congressional Budget Office has repeatedly stated, the plan would reduce both premiums and government costs.

Not only are these assertions false, they represent a major change in Sen. Lieberman’s own position on health care. During his reelection campaign in 2006, he highlighted his positions on health care, which included something similar to the public option.

What Lieberman’s objections may well signal now, however, is a potential threat to health care reform with a public option from a gang of Senate “centrists” despite overwhelming support for the public option in recent polls. And that is likely what Majority Leader Reid had in mind yesterday when he said “Joe Lieberman is the least of Harry Reid’s problems.”

Today’s Washington Post reports that the usual suspects of “centrists” in the Senate are “unsure about Reid’s public option”.

The New York Times reported:

Among the Senate Democrats who have not committed to supporting the bill are Evan Bayh of Indiana, Mary L. Landrieu of Louisiana, Blanche Lincoln and Mark Pryor, both of Arkansas, and Ben Nelson of Nebraska.

Including Lieberman, this new “Gang of Six” has the potential to significantly damage health care reform in insidious ways. For example, on the public insurance option, they could withhold support for a cloture vote on the entire bill unless it was further compromised into either an “opt-in” plan, separate state-based plans, or a bogus down-the-road-but-never-happening “trigger” plan.

But the Senate’s public insurance plan with the “opt-out” provision for states, agreed to by Reid, Dodd, Baucus and the White House, is already a compromise. In fact, it’s a compromise of a compromise of a compromise of a compromise of a compromise!

Enough! There can be no more compromises on the public insurance option.

But even if they lose on that key component of reform, the “centrist” gang could — if allowed — still severely undermine other features of the bill. Under the rubric of “deficit reduction” they could try to reduce the number of people helped through subsidies for insurance and reduce those actual subsidies as well. They could push to reduce employer payments for those not covered, putting more of the burden on the middle-class and working families. And they could try to build in additional safeguards to protect the markets and profits of the private insurers — all under the assertion of “reducing costs”.

The lesson for the Democratic leadership and the White House shouldn’t be too tough to have learned. One simply needs to recall the progression of events back in February as the final versions of the stimulus bill were taking shape. In a nutshell, a relatively small group of Senate “centrists” — then led by Senators Lieberman, Ben Nelson (D-NE), Olympia Snowe (R-ME) and Susan Collins (R-ME) — succeeded in cutting roughly $100 billion in actual economic stimulative funding from the bill, substituting a non-stimulative tax reduction for wealthier Americans, thereby significantly hampering the plan’s ability to generate a real recovery.

And all under the rubric of getting to 60 votes, meaning their votes.

Here’s how that brouhaha went down.

On February 5 The New York Times reported “There’s a new gang in town” and they were intent on impacting the pending Recovery Act.

The group was frustrating the Senate majority leader, Harry Reid of Nevada, who was trying to bring the debate over President Obama’s economic program and top legislative priority to a close.

“I have explained to people within that group, they cannot hold the president of the United States hostage,” said Mr. Reid, who added that he was willing to work with them if they intended to be constructive rather than obstructive.

Stimulus Talks Set to Continue After Centrists Push Cuts The Times then reported:

By early evening, aides said the group had drafted a list of nearly $90 billion in cuts, including $40 billion in aid for states, more than $14 billion for various education programs, $4.1 billion to make federal buildings energy efficient and $1.5 billion for broadband Internet service in rural areas. But they remained short of a deal, and talks were expected to resume Friday morning.

The next day’s report was Senators Reach Deal on Stimulus Plan as Jobs Vanish:

The fine print was not immediately available, and the numbers were shifting. But in essence, the Democratic leadership and two centrist Republicans announced they had struck a deal on about $110 billion in cuts to the roughly $900 billion legislation — a deal expected to provide at least the 60 votes needed to send the bill out of the Senate and into negotiations with the House, which has passed its own version.

On February 7 columnist Paul Krugman warned in “What the centrists have wrought”:

Now the centrists have shaved off $86 billion in spending — much of it among the most effective and most needed parts of the plan. In particular, aid to state governments, which are in desperate straits, is both fast — because it prevents spending cuts rather than having to start up new projects — and effective, because it would in fact be spent; plus state and local governments are cutting back on essentials, so the social value of this spending would be high. But in the name of mighty centrism, $40 billion of that aid has been cut out.

My first cut says that the changes to the Senate bill will ensure that we have at least 600,000 fewer Americans employed over the next two years.

But that wasn’t the end of it, as the competing House and Senate versions of the stimulus still had to be merged into a single bill.

But the competing bills now reflect substantially different approaches. The House puts greater emphasis on helping states and localities avoid wide-scale cuts in services and layoffs of public employees. The Senate cut $40 billion of that aid from its bill, which is expected to be approved Tuesday.

The Senate plan, reached in an agreement late Friday between Democrats and three moderate Republicans, focuses somewhat more heavily on tax cuts, provides far less generous health care subsidies for the unemployed and lowers a proposed increase in food stamps.

When it was clear that the Senate, with their 60 vote fetish, would likely win out, Paul Krugman wrote of “The Destructive Center”:

What do you call someone who eliminates hundreds of thousands of American jobs, deprives millions of adequate health care and nutrition, undermines schools, but offers a $15,000 bonus to affluent people who flip their houses?
A proud centrist. For that is what the senators who ended up calling the tune on the stimulus bill just accomplished.

On February 11 The New York Times reported the House-Senate “deal”:

The package of spending increases and tax relief, intended to spur an economic recovery and create jobs by putting money back in the pockets of consumers and companies, ended up smaller than either the House or Senate had proposed.

Even before final Congressional passage it had become clear that the stimulus package had been severely impacted by the Senate centrists, as The Times reported in “Details of a Trimmer Stimulus Emerge” on February 12:

Even before the last touches were put to the bill, some angry Democrats said that Mr. Obama and Congressional leaders had been too quick to give up on Democratic priorities. “I am not happy with it,” said Senator Tom Harkin, Democrat of Iowa. “You are not looking at a happy camper. I mean they took a lot of stuff out of education. They took it out of health, school construction and they put it more into tax issues.”

Mr. Harkin said he was particularly frustrated by the money being spent on fixing the alternative minimum tax. “It’s about 9 percent of the whole bill,” he said, “Why is it in there? It has nothing to do with stimulus. It has nothing to do with recovery.”

But even as Congressional leaders and top White House officials went through the package with a carving knife, it was clear that the three Republicans who agreed to support the bill in the Senate wielded extraordinary power, and along with conservative Democrats, had put a firm stamp on the stimulus package.

The lessons from the stimulus legislative process are clear. The question now, in the context of the current battle for health care reform and the public option, is whether the Democratic leadership and the White House have learned those lessons. Or will they allow the perverse conceit of the centrists to win out over the interests of the American people?

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Dodd: “We are going to get the public option”

Standing alongside Vice President Joe Biden and 4th District Congressman Jim Himes (D-CT), Senator Chris Dodd (D-CT) yesterday told a crowd of more than 400 supporters and guests how crucial the recovery program and health care reform are to the economy, then added emphatically: “We are going to get the public option” and received an extended, cheering ovation.

I can tell you because I was there.

The occasion was an event, featuring the Vice President, chosen to highlight transportation infrastructure investments flowing from the American Recovery and Reinvestment Act, at a site adjacent to a reconstruction project on Connecticut’s Merritt Parkway near Exit 46 in Fairfield.

Dodd’s remarks came as he and other Senate leaders prepare for expected health care bill merger sessions. That is assuming that the bill passed by the Senate Health, Education, Labor and Pensions (HELP) Committee — which has a public option — is to be merged with one yet-to-be-passed by the Finance Committee — which does not. A vote in the Finance Committee has reportedly been delayed again.

Reports keep surfacing that Finance chairman Max Baucus (D-MT) may not have the votes to pass his deeply flawed bill, which doesn’t control insurance costs, out of his committee.

If and when the Finance Committee ever does report their health bill (I won’t call it ‘reform’), the merger sessions will involve Senate Majority Leader Harry Reid (D-NV) and the White House, as well as Senator Baucus and leaders on the Senate HELP Committee. Senate sources report that both Senator Dodd, who as acting chairman during Sen. Ted Kennedy’s illness, led the health care reform effort in committee, and current HELP chairman Tom Harkin (D-IA) will be involved in the merger sessions.

Dodd and Harkin, those sources say, both intend to press for inclusion of the public insurance option plan in the merged and final versions of the Senate bill. Committee staff note national polls showing that the American people want the option of a public insurance plan, and that leading physicians’ groups agree. The public option included in the HELP Committee’s reform bill gives people choices, they note, creates a nationally portable program and puts people ahead of profits.

At a recent gathering of online writers and local bloggers in Connecticut, I had an opportunity to discuss the health care legislative process with Senator Chris Dodd. Specifically, I raised the idea, originally proposed by David Waldman, to name the public option for Ted Kennedy.

After a lively conversation in which he said “that’s a good idea” he went on to discuss some interesting process and jurisdictional points relating to the health care legislation in advance of the expected bill-merging sessions.

Thanks to ctblogger for the video.

At 3:48 of the clip Dodd anticipates some of the factors that may play out in those Senate bill-merging sessions:

“The Committee I was chairing [HELP] has much more jurisdiction over health care than the Finance Committee. Now, they have the jurisdiction over arguably the difficult parts, dealing with Medicare, Medicaid and (inaudible) and tax policy; but all of the prevention, all of the quality, all of the workforce issues and the coverage questions were legitimate matters of jurisdiction of the HELP Committee.”

These jurisdictional arguments will be one of many that, Senate sources say, Dodd and Harkin will use to press for the public option as well as other crucial components from the HELP Committee bill in the merged Senate version. If they succeed we will have a much better final bill.

You can help them succeed. Thank Senators Dodd and Harkin and tell them you support their efforts to put the public option in the merged Senate health care bill.

Call Senator Chris Dodd at (202) 224-2823 and
Call Senator Tom Harkin at (202) 224-3254

And join in Wednesday and call your two senators and your representative at 1-877-323-5246 as the AFL-CIO helps lead a National Call-In Day for health care reform.

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Foreshadowing from Finance?

On the third day of the Senate Finance Committee’s markup of the deeply flawed bill offered by chairman Max Baucus (D-MT) a vote on a key amendment may be a bad sign of things to come.

As Jon Walker reports at FDL an amendment to fully close the so-called “donuthole” — the insidious gap in prescription coverage in Medicare part D — was defeated by a 10 to 13 vote.

The amendment, proposed by Senators Bill Nelson (D-FL) and Jay Rockefeller (D-WV) would have expanded coverage and lowered drug costs for 44 million seniors. The amendment would fully cover the cost of filling the donut hole and provide an additional $50 billion in government savings. And it would be paid for through a pharmaceutical industry rebate for overcharging seniors eligible for both Medicare and Medicaid.

Toward the end of the debate on the amendment, chairman Baucus said he’d wished that its sponsors hadn’t brought up the amendment.

And it was clear why. The amendment challenges the limits on drug industry contributions to health reform costs that Baucus agreed to in a reported deal with PhRMA, the pharmaceutical industry’s powerful lobby.

When it came time to vote on the amendment, two Democratic Senators, Blanche Lincoln (D-AR) and Kent Conrad (D-ND) initially “passed”. All 10 Republican Senators on the Committee voted “No” — and they were joined by three Democrats: Thomas Carper (D-Delaware), Robert Menendez (D-NJ)… and the chairman Max Baucus (D-MT). At that point Conrad and Lincoln voted “Yes”, but even then the amendment failed 10 to 13.

There are still several key amendments yet to be brought up that could significantly improve the Finance bill by including a public option. Among them:

1. Rockefeller #C1 (Amendment 181)–Apply health insurance market reforms to the large group and self-insured market effective in 2013

2. Rockefeller #C7 (Amendment 187)–establishes a public option that is tied to Medicare plus 5% rates with the ability to negotiate drug prices, and has an “opt-out” provider network.

3. Rockefeller #C5 (Amendment 185)–creates one national exchange, and strikes state exchanges and regional exchanges.

4. Schumer-Cantwell #C2 (Amendment 267)–Public option as passed by HELP Committee

You can help support these amendments. Call and email the Democratic members of the Senate Finance Committee. A Daily Kos diary from slinkerwink has the full contact list.

Tell them to improve the bill with a public option and support these amendments.

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Name the Public Option for Ted Kennedy

For several weeks now it has occurred to me that the cause of achieving a real health care reform bill in Congress would be advanced if the public insurance option in it had a name — something more specific than “the public option”.

You know, how Medicare is called Medicare and Social Security is called Social Security? Giving things names helps imbue them with meaning, endows them with a more potent sense of reality.

That’s why I had one of those “Aha!” moments when I read David Waldman’s post last week at the Congress Matters blog “Name the public option, not the bill, after Kennedy”.

Following the sad passing of Ted Kennedy, a host of Democrats including the Progressive Change Campaign Committee and Senator Robert Byrd (D-WV) had begun very sympathetic and heartfelt calls to name the entire (but still far from finalized) health care bill for Senator Edward Kennedy.

For forty-seven years Ted Kennedy was the single strongest advocate for health care reform and for quality health care as a right, not simply a privilege for those who could afford it. His absence from the Senate during his illness this year still did not deter him from weighing in to support the public option:

“Kennedy has co-sponsored a resolution introduced by Sen. Sherrod Brown (Ohio) and 26 other Democratic senators that declares the healthcare reform legislation the Senate will consider this summer must include a public plan option people can choose instead of private insurance. Senate Majority Whip Dick Durbin (D-Ill.) also co-sponsored the resolution.”

David Waldman’s suggestion to name the public option for Ted Kennedy now makes both political and moral sense.

“Let the affordable health care coverage itself that the public option will make available be what carries Kennedy’s name. Like the (Sen. William) Roth IRA (established in a Republican reconciliation bill, by the way), (Sen. Claiborne) Pell grants, or (Sen. J. William) Fulbright scholarships, we and future generations of Americans should enjoy comprehensive coverage under the Kennedy Health Care Plan.”

As David correctly notes, versions of the bill itself may be weakened during coming legislative fisticuffs — especially if the Max Baucus Secret Caucus in the Senate Finance Committee has a lot to do with it. But the public option is in all the current House versions and in Senator Kennedy’s HELP Committee version, thanks to the leadership of Sen. Chris Dodd (D-CT) and his Democratic colleagues. Naming the public option for Ted Kennedy now would help establish its place in the bill, making it all the more difficult for any Democrat to oppose it.

Jane Hamsher at Firedoglake likes the idea too. How could Congress add the Kennedy name to the plan? David Waldman says it’s easy: “just put it there”. And if, in the end, the entire bill does measure up to the Kennedy standards for real reform, then the bill itself can be named for him even after it passes.

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