As featured on p. 218 of "Bloggers on the Bus," under the name "a MyDD blogger."

Wednesday, June 17, 2009

Health Care: Progressive Movement Must Push Back On This Week's Lapses

It's early, and given the clear attention the President is paying to health care reform I ultimately believe something will get done. But without question, this has been a bad week for those who want to see a legitimate reform of the system. This article in The Hill captures some of the movement:

Despite having a popular president in the White House and comfortable majorities in Congress, the Democratic rollout on healthcare reform has encountered significant bumps in the road.

A cost estimate hanging a $1 trillion price tag on an incomplete bill, salvos from powerful interest groups and great uncertainty among key Democrats on what will actually be in the legislation that moves through Congress have emboldened Republican critics.

The Senate Health, Education, Labor and Pensions (HELP) Committee postponed the markup of its healthcare reform bill by one day, to Wednesday. On the eve of that markup, the powerful U.S. Chamber of Commerce publicly ripped the bill.

Senate Finance Committee Chairman Max Baucus (D-Mont.) initially planned to release his bill Wednesday, but he has pushed back his timetable because of cost estimate concerns.

“Will we have something out tomorrow? Not sure,” Baucus said Tuesday. “Thursday or probably Friday,” he added.

Perhaps more importantly, the unity that Democrats touted earlier this year has cracked. As conservatives lambaste Democrats, liberal healthcare groups are not rushing to their defense because so many questions about the legislation have not been answered.

Since then, the Senate Finance Committee postponed their markup until after the July 4 recess. And all kinds of compromise plans and half-measures are swimming around Washington. Apparently, centrists in the House from both sides of the aisle are meeting in secret to hash out one of them. Kay Hagan and Jeff Bingaman are refusing to sign on to the public plan in the Senate HELP Committee, delaying its inclusion in the bill, which is worrying advocacy groups. I'm assuming they prefer a compromise like Kent Conrad's out-of-left-field "health co-ops" plan introduced into the debate and sending a thrill up the leg of centrists last week. And today, old warhorses Tom Daschle and Bob Dole unveiled yet ANOTHER compromise plan:

Daschle, Dole and Republican Howard Baker released a bipartisan plan today that would tax some employer-provided health-insurance premiums, require individuals and large employers to buy health insurance, and create public insurance pools run by states instead of the federal government.

The proposals were put together over 15 months by the Washington-based Bipartisan Policy Center, which was started by Daschle, Dole, Baker and former Democratic Senate leader George Mitchell. Congress is drafting a bill to revamp health care, which President Barack Obama calls “the single most important thing we can do for America’s long-term fiscal health.”

Dole said the U.S. has a rare opportunity this year to enact a comprehensive health-care bill. “Let’s do it now,” he urged, saying it may be five years before lawmakers have a similar political opening.

The state-run insurance pools may run into some trouble due to economies of scale. A state simply cannot bargain the way a single payer federal government can.

There are basically two issues that have bedeviled reformers this week. One is the CBO scoring, based on an incomplete document that should have never been given to them, but causing moderate Dems to simply run for cover. This failure came about largely by the HELP committee offering an incomplete bill to try and get some bipartisan cover.

You might ask what the HELP Committee was thinking, sending Swiss cheese legislation to CBO. Well, the HELP Committee's expectation was that the CBO, in crafting its preliminary score, would assume something similar to the outline it had seen months before. The CBO didn't. In fact, it did the opposite. CBO ran its estimates with no employer mandate and an individual mandate with a laughably small penalty.

Members of HELP were thus shocked by yesterday's score. The specific provisions of the bill that the CBO examined did not look like the bill HELP intends to write. Which means that the numbers aren't correct. If HELP is writing a bill with a strong employer and individual mandate, and CBO scores a bill with no employer mandate and a weak individual mandate, that's not a useful estimate.

By Monday night, members of the HELP Committee were scrambling to give the CBO something closer to the final legislation to examine -- this time including rough details of the employer mandate and the individual mandate. They're hoping to have a new set of estimates by Friday, though that's probably ambitious. Either way, I wouldn't put too much stock in these numbers.

Doesn't matter. The numbers are out there, and the Democrats are running away from them as fast as they can. OF COURSE the Republicans would use the CBO score as a permanent talking point no matter what was changed on the bill. Forevermore, it will be seen as costing a trillion dollars a year and not covering anyone - just check out this piece. Max Baucus essentially pulled his bill so he can cover costs and cut government subsidies.

The other problem has been this continued wrangling over the public plan, which I think a healthy bit of Democrats are simply desperate to torpedo. Hagan and Bingaman won't sign on to it in the HELP Committee, and now Kathleen Sebelius has, perhaps unwittingly, given a bad compromise oxygen:

"I think there is a lot of understanding that the private market has really failed to provide affordable coverage to Americans," Sebelius said. The industry has had "a lot of opportunities" to get rid of coverage restrictions and other unpopular policies, Sebelius said, and really "hasn't served Americans very well."

However, Sebelius stressed that Obama is open to compromise on the shape of the public plan, which doesn't have to be run by the government. She spoke positively of a compromise idea that envisions consumer-owned nonprofit cooperatives, like rural electricity or agriculture co-ops. They would get started with seed money from taxpayers but then compete without government control. The plan by Sen. Kent Conrad, D-N.D., may end up in a health overhaul bill to be unveiled by the Senate Finance Committee this week.

Obama did offer a pretty forceful defense of the public option to the AMA this week. And if he wants to throw his weight around, he could probably muscle something through. But will the desire to create a bipartisan solution, which is supposedly more "durable" than a successful solution, trump the public plan? Bill Clinton hopes not:

If he can’t get a good bill, I wouldn’t give away the store on that. If he can’t get a bill that’s genuine universal coverage, that genuinely is going to cut costs and make health insurers give up some of these unbelievable administrative burdens that they’ve put on people, and that really gets to the guts of the delivery system and does more primary preventive care and actually measures things that work, then I would go for the 51. But I would spend a little time trying to get to 60.

Nyceve has more on this meeting.

So we've had a bad couple weeks, with Democrats scurrying in fear from the cost and the public option clearly being used as a bargaining chip. Enough. Chris Bowers has a proposal:

For years, candidates for, and members of, Congress told us that we needed to elect and re-elect them in order to lower health care costs and provide universal coverage. And so, for years, we dutifully worked our collective asses off, delivering wide majorities for Democrats--who said they would lower health care costs and provide universal coverage--in both branches of Congress.
Now, when it comes time for them to deliver on health care by providing a public option--the care minimum required to reduce costs and provide universal coverage--what we are getting instead are backroom deals, flip-flops, and cop-outs.

Today, along with Health Care for America Now, Democracy for America and numerous blogs, a campaign is being launched to put an end to the backroom deals on health care. We made and delivered on a commitment to bring about wide Democratic majorities in Congress. Now, instead of negotiating in secret, this Congress needs to make a public commitment to us on where it stands on health care.
No more dodges. No more vague, open-ended responses. We need every member of the Senate--main obstacle to reform--to answer four questions on the public option:

Do you support a public healthcare option as part of healthcare reform?
If so, do you support a public healthcare option that is available on day one?
Do you support a public healthcare option that is national, available everywhere, and accountable to Congress?
Do you support a public healthcare option that can bargain for rates from providers and big drug companies?

As activists and as constituents, answering these questions are the minimum they owe us. We are entitled to specific, clear, written responses to all of these questions.

Email--don't call, but email--these four questions to your Senators now. Make it clear that you want a written response to all four questions. There needs to be as little room for interpretation as possible. The Senate is going to be the biggest hurdle on health care, as it has proven to the biggest hurdle on all legislation in 2009. That is where we must focus our pressure.

Here's the form to post where your Senator stands. We need a citizen whip count on the public option so we know where everyone stands. Only with this kind of clarity can we embolden, for example, the Progressive Caucus to demand a public option in any reform bill.

This is clearly the biggest domestic policy that will be tackled this year. We MUST not fail.

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