Two Way Street?

Throughout the entirety of the health care debate, Republicans have decided to spread false claims to their constituents throughout the nation. Whether it be death panels or a mythical government takeover of health care, the Republican party has only offered fear in the face of a national crisis. When asked about a Republican health care alternative, Minority Leader John Bohner gave one of the most heinously convoluted responses I've ever heard, saying

We have a number of ideas that we would like to proffer in this process, and we’re not quite sure how the majority intends to proceed. And so until we understand how they intend to proceed, it’s pretty difficult for us to have a solid plan.

Well, I guess a number of ideas is sort of a plan, right? No? Damn. You were so close John, but I guess you couldn't fool the American people this time. Your buddy in the Senate though, Minority Leader McConnell, has his eyes locked in on killing the public option once and for all. And why you ask? Because according to Senator McConnell, the public option may cost you your life.

I think if you have any kind of government insurance program, you’re going to be stuck with it and it will lead us in the direction of the European style, you know, sort of British-style, single payer, government run system. And those systems are known for delays, denial of care and, you know, if your particular malady doesn’t fit the government regulation, you don’t get the medication.

And it may cost you your life. I mean, we don’t want to go down that path.

Senator McConnell, would you like to know what would actually cost someone their life? Lacking of health insurance. According to a study by Johns Hopkins University,

Lack of adequate health care may have contributed to the deaths of some 17,000 US children over the past two decades

Adults and children without insurance are far more susceptible to dying from curable illnesses than those with adequate health care coverage. Yet, according to Senator McConnell and his Republican colleagues, it is the government who will cause your death if health care reform has a public option. Shit, if I'm going to die anyway, I'd at least like to do it more cheaply than with my private insurance, since the public option would bring down premiums as well as cut costs across the board.

Why do the Republicans keep lying about a bill that will help bring an end to a national crisis in health care? Earlier this week, the Affordable Health Care for America Act was introduced in the House by Speaker Pelosi.

The Republicans wanted a deficit neutral bill. Done. The CBO estimates that the bill will reduce the deficit by $104 Billion over 10 years, and will continue to reduce the deficit in the future.

Republicans want to reduce costs over the long term. Fine. The House bill slows the growth of Medicare from 6.6% to 5.3% annually.

Republicans wanted to allow policies to cross state lines. Good, welcome to a national public option. National being the key word.

Of course Republicans wanted malpractice reform, since they hate the trial lawyers who give their money to Democrats. Even though I love lawyers, the House bill creates state incentives programs to encourage states to implement alternatives to malpractice litigation.

Senator McCain and Minority Whip Cantor wanted high risk pools for those patients who are, well, high risk for insurance companies. We might as well have elected McCain then, since the House bill creates an insurance program with financial assistance for those uninsured for several months or denied policy due to preexisting conditions before the health insurance exchanges are implemented. There's your high risk pool.

The faux Republican health care bill wanted to let young people remain on the health policies of their parents up to age 25. Thanks for pandering to me Republican Party, now the House bill will allow me to stay on my mommy's insurance policy until I'm 27!

Of course there should be no public money for abortion, right? That would be a deal breaker. Hell, it almost derailed the entire debate. Well thank the Lord Almighty Nancy Pelosi isn't forcing abortions on our young people, since the House bill prohibits abortion services from being made part of essential benefits package and prohibits federal funds from being used to pay for abortion.

Republican's wanted to protect small businesses, even though their economic policies contributed to the collapse of many small businesses. Ironic, huh? Well in any case, the House bill exempts 86% of businesses from the requirement to provide coverage. Businesses with payrolls below $500,000 are exempt while firms with payrolls between $500,000 and $750,000 would pay a graduated penalty. Small businesses would also receive a tax credit that helps cover 50% of their health care expenses. You're Welcome.

That same fake health care bill circulated by Republicans wanted to promote job wellness programs, and in the House bill you will be financially rewarded by your employer, if they choose, if you seek to achieve or maintain a healthy weight, quit smoking, and manage chronic illnesses like diabetes.

And we all want to help those between 55-64. To young for Medicare, but starting to spend more on health care claims. Although expanding Medicare to those under 65, like you know, every other country does, the Democrats compromised with the Republicans and created a reinsurance program that helps to cover costly health claims for these older Americans.

10 Republican demands. 10 Democratic compromises. 0 Republican Votes. Shit.

Robust Debate

We keep hearing the term 'Robust Public Option' in the national debate over health care, but I'd like to know just what the hell robust actually means here.  According to Merriam-Webster, Robust means something is capable of performing without failure under a wide range of conditions.  Therefore, as long as the public option works well and doesn't immediately or eventually sink out health care system, it then should qualify as robust, right?

Look, I feel as if the debate over the public option has gone beyond beating a dead horse at this point.  We've begun to slaughter this horse.  Yet, this debate hasn't ended; in fact it isn't even close to over.  We've gotten to a point where the Barack Obama has been accused of working against the Harry Reid's effort to get the strongest version of the public option passed.  This is bordering on insanity people.  Barack Obama is not Michael Steele; he's not the cow on the train tracks preparing to be annihilated.  He's clearly working for the public option, since it was actually his idea to begin with.

At least we've come to a situation where a public option is all but inevitable, which is in itself a remarkable feat after the debacle of the August recess.  According to the Washington Post,

Senate Majority Leader Harry M. Reid (Nev.) and House Speaker Nancy Pelosi (Calif.) sought support Friday for expansive versions of the public option as they prepared to send reform legislation to the Senate and House floors. Their goal is to pass bills with similar versions of the public insurance option so that final talks between the two chambers can focus on other issues that could prove more difficult to resolve.

On Friday, congressional leaders marveled at how quickly the landscape has changed. "This is an exact quote: 'Off the table,' " House Majority Whip James E. Clyburn (S.C.) said, recalling the headlines earlier this month when the Senate Finance Committee rejected two versions of the public option in its reform bill.

Clyburn said the debate is no longer whether to include a public option, but "whether or not we will get this form of a public option or that form of a public option." 

We're now unlikely to be entrenched in a nightmare scenario in which the public option is stuck in legislative limbo.  The votes will be there.  The public option will pass.  Who really gives a damn how robust it is, when the actual point of a public option will be accomplished regardless: we will be offering near universal coverage while bringing down health care costs.  We're so close to the finish line.  While the GOP has continued to be irresponsible, the Democrats need to step up to the plate and pass a bill before January.  That would truly be robust behavior.

The House-ing Market

Remember when President Abraham Lincoln said, "A house divided is a house that cannot stand."?  Or when Luther Vandross told us all, "A house is not a home."?    Great lines by similarly great Americans, and they're unbelievably true.  We've been talking a lot about the Senate over the past months, specifically the Finance Committee, since they took nearly twice as much time as all the House committees to pass a bill.  Now we are at a critical juncture in the health care debate, and soon we will have two bills: one from the House and one from the Senate. 

Previously, I talked about the likelihood of the merged Senate bill containing a version of the public option, and that seems to be more likely than ever before.  Apparently, Senator Reid is leaning toward putting an opt-out version of the public option in the final bill.  Reid essentially holds the fate of the public option in his hands, since his decision will determine which side gets the strategic advantage. If a public plan is included in the Senate bill at the outset, opponents would have to find 60 votes to remove it from the bill, which is seemingly impossible.  

While Reid may hold a great deal of power over the inclusion of a public option in the final bill, Speaker Pelosi, who has held a lower profile recently, may hold the keys to creating the strongest public option possible as well as providing the most generous benefits and subsidies to average Americans.  Pelosi's bill not only has the stronger public option, but will do more to provide a permanent fix for our health care system.  According to Ezra Klein, the main differences between the House and Senate Finance Bill are clear.

The Senate Finance Bill gets to 94 percent coverage. The House bill will hit 96 percent. The Senate Finance bill spends a bit over $450 billion on subsidies to help people afford insurance. The House bill will spend more than $700 billion. The Senate Finance bill doesn't have an employer mandate. The House bill does. The Senate Finance bill funds itself by taxing family health-care benefits over $21,000. The House bill funds itself by taxing incomes over $500,000. The Senate Finance bill expands Medicaid. The House bill expands Medicaid by more. The Senate Finance bill costs $829 billion. The House bill costs $871 billion. 

While the House bill may cost $42 billion more than the Senate bill, it covers more people through strong subsidies that allow for universal coverage.  Because of these subsidies, along with an employer mandate and the expansion of Medicaid, the slightly higher cost of the bill is far outweighed by both the long term and immediate impact of the bill.  Essentially, The House bill will bring us closer to universal coverage at a cheaper price for individual citizens. The combination of a strong public option as well as a individual and employer mandate allows the government and individuals to pay less for better coverage.

Although this is clearly the stronger bill, and would do more to reform our broken system, there's no chance in hell that it ever passes the Senate.  So why then have I spent my precious time advocating for a bill that will never see the light of day?  Because Nancy Pelosi is a political genius, that why.  We've all assumed, myself included, that Pelosi is doing all this to bring the strongest public option possible to the table.  Well, again we happen to be wrong. Ezra Klein breaks down Pelosi's game plan beautifully,

The part of Pelosi's approach that people haven't really picked up on is that she's paired the stronger public option with more generous subsidies and benefit packages, rather than leaving it on its own to dramatize the potential savings. There's a reason for that: If the Senate wants to weaken the public option, this gives her leverage to demand that they put money on the table to maintain the benefit levels that the strong public option made possible. In other words, the strong public option also gives her leverage to bargain for more affordability and better subsidies.

Nancy Pelosi and Barack Obama are more farsighted than you and I apparently.  Instead of being concerned with a policy proposal that could never gain the necessary amount of votes, the President and Speaker of the House have committed themselves to creating a bill that makes health insurance affordable to all Americans, regardless of the strength of the public option. Reid's opt-out public option may be able to do the job alongside Pelosi's strong benefit structure.  

Maybe our House of Cards wont collapse after all.

Country First

As I discussed last week, the health insurance lobby has essentially become big heath care (akin to big tobacco) in the health care debate.  President Obama and his Administration, as well as Senate and House Democrats, destroyed the health insurance industry report with gusto. Senator Kerry has actually used this AHIP report to advocate for the public option, since the insurance companies have shown their true colors and are clearly unwilling to work with the government.  Senator Kerry, the man who lost to George W. Bush, is being tougher on the public option than our very own president.  Who woulda thunk it?

Yes, President Obama has made it clear he desires a public option, but he hasn't demanded it be included in any health care bill.  This past Sunday, after the release of the ridiculous AHIP report, President Obama had the perfect opportunity to push the public option, and of course failed to do so.  As Igor Volsky stated, 

Obama could have responded to the industry’s self-serving report by arguing that reform must inject significant competition into health insurance markets. He could have used their new-found tone to argue that reform must hold the industry accountable. The American people, in other words, should not be compelled to buy private coverage from an industry that has just admitted that it would increase premiums by some 111% if reform passes.

But rest assured that Obama still believes the public option is “the best possible choice” to restore competition and improve affordability. He just refuses to fight for it. Why? The public option is not a liberal ideological baton, it’s a sensible compromise that builds on free market principles.

President Obama, in his heart of hearts, obviously wants a public heath insurance option.  Hell, he probably wants a single payer system just like I do.  We all know single payer isn't a viable reality, but a public option is.  Over 70% of people support the choice of a public option, and the majority of House and Senate Democrats approve as well, so why isn't the President pushing this harder?  He may not currently have the votes he needs, but if he doesn't strongly advocated for the public option, then he'll surely never get them.

Republicans may be right for once, and the Democrats may take the Finance Bill and push it left.  Politically, it's a winner for Senator Harry Reid, as he is looking weaker and weaker in his reelection campaign, and could diffuse the anger of progressives and unions in his home state of Nevada.  Inclusion in a final bill at the Senate floor would make it that much more difficult to strip a public plan from the bill. Regardless of whether or not Republicans make this a wedge issue again, adding the public option in a merged Senate bill simply makes sense for the country.  

If only President Obama's slogan could've been Country First.  

A Rodney King Moment

Congress had a 'Rodney King Moment' the other day.  No, nobody was beaten within inches of their life, unless you mean the public option.  What I'm talking about is the fact that we were all able to just get along for a few moments, with Olympia Snowe crossing over to the Dark Side.  This is the first time in the health care debate there has been any Republican support for health care reform.  Most of them are still screaming 'MOO!!!' as some cow on the track trying to stop the freight train of health care reform.  Last time I checked though, and I haven't thought about this often, trains run over cows.  And it gets ugly.  

So, does Senator Snowe's vote mean much?  In a sense, yes.  The fact that the Democrats were able to keep their unwieldy caucus together, while gaining the support of the most liberal Republican shouldn't come as a surprise, but the disgusting nature of the debate up until this point has changed the paradigm.  The fact that Snowe is able to be sensible and support a bill that actually reduces the deficit is commendable, and as Igor Volsky says, "Snowe’s vote in gives key Republican moderates the cover of “bipartisanship” to vote for the bill on the floor."  It also seems that the insurance industry somewhat forced Snowe's hand.  After the debacle of a report the insurance industry released earlier in the week, The insurance industry attacked Snowe’s amendments to lower the penalties for Americans who don’t meet the requirements of the individual mandate and the senator harshly condemned the industry’s conclusions. “It wasn’t based on any valid assumptions.”  

Also, lets not forget this was just a vote in the Finance Committee.  Snowe is not required to vote for the final bill.  Yet, with Snowe's support and the lack of support from any other Republicans up until the point should empower Harry Reid to produce a progressive bill that will be tougher in the insurance industry and hopefully have some version of a public option, which would drive down costs even further.  The Democrats should be pushing for these progressive reforms, since it has become clear that no Republican outside of Snowe, and possibly Senator Collins and Senator Voinavich.  The House plan with a robust public plan has been scored by the CBO, which concluded that it would have nearly the same price tag as the Senate Finance Bill, but will drive down costs for the individual consumer of health care, while covering 95% of Americans.

The question now isn't if, but when.  Where do we go from here?  The Senate HELP and Finance Committee bills have to be merged, and it seems as if Senator Reid is finally taking this seriously,

Reid's office is serious about ensuring the process blends the two existing bills, rather than develops a whole new bill. That means that on an issue like the public option, you could see a new policy emerge, as one bill has a public option and one doesn't. Creating some sort of compromise would fit into the "blend" framework. But on issues that only are addressed in one of two bills -- revenues are only in the Finance bill, for instance, and biologics are only in the HELP bill -- you'll see a variant of what's already written into the bill. The negotiators aren't likely to dream up a whole new tax and plug it into the legislation. They feel that would be a perversion of the committee process.

There are many questions that will be answered in the merging process and some that will be left for the Senate floor.  Chief among these will likely be the public option.  As Ezra Klein states, 

If Reid decides to put a public option, or some sort of public option compromise, into the bill, then it would require 60 senators to remove it on the floor, and only 41 senators to defend it. Conversely, if he decides to leave the public option fight for the floor, then it will take 60 senators to add it into the bill, and only 41 to block it.

Hopefully Reid grows some cajones and puts a public option into the merged bill.  If not, the public option may in fact be as dead as a cow on the train tracks.  As I've stated here often, the public option is the best way to bring down costs in our health care system and is the easiest and most efficient way to stop the runaway spending of the health care industry.

Seriously though, at least we've made it this far.  In the almost six decades since President Truman took on the issue of health care, this is the farthest the process has ever gotten.  I'd also like to apologize to Max Baucus, Three months ago, the main storyline in the press on health care centered on whether Democrats would craft a bipartisan bill (yay!) or go it alone (boo!) Through his desire to reach an agreement with the Cow Party, Baucus proved beyond a doubt that serious Republican support for any health care reform was totally impossible. He deserves credit for not losing a single Democrat in this process, while simultaneously proving the Republicans are the obstructionists we thought they were.

Die Insurance Companies, Die

Insurance companies oppose reform that will substantially reduce their profits?  And they say it will increase premiums and force health care costs higher? I thought that insurance companies were looking out for my best interests, not their pocketbooks!  This surely will be the report that kills health care reform for good, since you know, insurance companies really know how to take care of people.

Is this seriously news?  I mean come on.  Who in their right mind thought insurance companies wouldn't do everything in their power in order to keep their profits at record highs?  This is like tobacco companies releasing reports that there is no connection between smoking and lung cancer.  The least the insurance companies could do is tell the truth though.  Let's see if they in fact did that.  The answer might surprise you.

Most people would assume that people will react differently to a new policy, right?  Well AHIP and their accountants at PriceWaterhouseCoopers don't think that way.  A crucial problem with their report is that it assumes no behavioral changes in response to new policies.  In the world of this report, insurance companies would go bankrupt due to taxes, but as Ezra Klein illustrates, this report doesn't operate in the real world.

The tax on high-cost health-care plans will lead employers and consumers to demand cheaper plans that do more to control costs. In fact, PWC expects that, too. They just don't build it into their estimate. On Page 6, they say, "Although we expect employers to respond to the tax by restructuring their benefits to avoid it, we demonstrate the impact assuming it is employed." That's a bit like saying although I expect to eat doughnuts this morning, I will instruct my scale to act as if I had abstained.

Also, according to AHIP's report, health care costs have apparently become a constant, in that every dollar that a public program cuts from its payments to hospitals is a dollar the private health-care industry has to add to its reimbursements to hospitals.  As Klein states, this is simply untrue for any industry. Companies don't shift their cost burdens on customers because one company cut their costs.  That just doesn't happen in the real world, but apparently it does in the bizzaro world of insurance companies.

AHIP's report has one more fatal flaw and implausible claim according to Jonathan Cohn.  

By 2016, even some of the least generous plans offered through insurance exchanges would be subject to the new excise tax on high-value benefits. In other words, within a few years, the tax won't apply only to "Cadillac plans." It will apply to Chevys and maybe even some Kias, too.

But again, this claim is proven false and horribly misleading.  In order for AHIP and PWC to come to this conclusion, they assume that premiums in some parts of the country would be double the national average. But in fact, there is no data to suggest that this could ever happen.  In the real world, premiums exceed the national average by, at most, around 20 percent. The thought that this somehow could explode during a period in which reform will likely produce more nationalization of practices, is pretty hard to swallow.

So it has come to this.  Insurance companies have begun to use the same tactics of tobacco companies.  Sure shows you how much they care about the health and well being of their customers.

Congress, Don't Play with My Emotions

Oh Public Option, how I love you so.  Yes, similar to most other liberals, I have become enthralled by the public option issue and it's potential for both passage and success.  Yet, my hopes continue to go to to the Senate, where dreams go to die.  Regardless of the electoral realities of passing a public option, this minor aspect of health care reform has become the issue du jour for not only liberals, but conservatives attempting to kill any meaningful reform.  This issue is now one of the final points of contention in both the House and Senate, and Democrats continue to push for a public option, or at least a robust alternative.

So why is this so important?  Well in reality, most liberals don't want just a public 'option,' most of us would like a.... Single Payer System (GASP!!).  Although Max Baucus may have killed a nation wide public option, there are alternatives floating about, and even an amendment allowing states to implement something akin to a single payer system on a statewide level.  People may not even understand health care reform, or approve of it, but the majority of Americans want a public option and liberals have latched on to this in order to keep reform moving forward.  In fact, a majority is willing to allow Democrats to abandon bipartisanship in order to pass a bill with a public option. 

We as Americans need this option.  It saves us money.  It gives us the best coverage.  It gives our nation the best chance for future success.  We must end the status quo which has brought us inadequate care and a lack of choice at too high a cost.  Please Congress, stop toying with us and get it together.  If not for your political livelihood, but for the good of the people you represent.