Can the House Pass Any Health Care Bill At All?

by: Chris Bowers

Wed Oct 28, 2009 at 15:14


It is time to start seriously asking whether the House of Representatives can pass any health care bill whatsoever.

First, while the final meeting deciding the fate of the robust public option is taking place as I type this, the likely outcome is that a public option with negotiated rates will be included in the bill:

In the end, Pelosi, D-Calif., and other House leaders were unable to round up the necessary votes for their preferred version of the government insurance plan -- one that would base payment rates to providers on rates paid by Medicare. Instead, the health and human services secretary would be allowed to negotiate rates with providers and the program would be optional for states, the approach preferred by moderates and the one that will be featured in the Senate's version.

This is going to anger quite a few members of the Congressional Progressive Caucus. Some of them might not vote for passage now, because they consider the public option too weak.

This matters because there are around 18-25 Democrats who will vote against the bill from the right, pretty much no matter what at this point. With every Republican likely to vote against the bill, this means that opposition from 15-22 Progressives would sink the entire bill.

Even though all eyes are on the Senate, the House is far from decided. Right now, it simply is not guaranteed that there will be enough votes to pass any health care bill through the House of Representatives, due to opposition from both flanks of the Democratic Party.
Chris Bowers :: Can the House Pass Any Health Care Bill At All?

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Can the House Pass Any Health Care Bill At All? | 112 comments
of course (4.00 / 4)
if that happens all the pressure will be on the progressive bloc to vote for the bill 'for the good of the party' and the blue dogs get off scot free. Then when the bill doesn't pass the progressives get blamed not the blue dogs and repubs. 'If only you were more reasonable!' 'if only you weren't so hard line' yadda yadda, we've heard this song before. Any Dem who votes to make health care more expensive, and mandatory too, is a gibbering fool or a K street tool.
cpc better hodl the line for the working class (4.00 / 2)
hey ive emailed folks i know with cpc on this whole thing.  i m asking will cpc hold a s a block for the emdicare po? they said so this summer-60 did. woolsey said the other day it had to be in bill and the 8 needed would follow bc they would not vote against it over that. cpc has some decisions to make. im so not happy about this.
I want to believe you... (4.00 / 1)
But I doubt Pelosi would allow this kind of "filibuster" in the House. She'll say she gace progressives enough time to get Medicare+5 passed and they should be happy there's no trigger. Sigh, I guess we may be stuck with the state opt-out...

Want to save marriage equality in Maine? Ask me how! ;-)
It will pass... (0.00 / 0)
Progressives will suck it up for the greater good... Despite what people say here, even the crappy Senate Finance bill is a major improvement over what we have now.

The pledge block was never as strong as we made it out to be...

REID: Voting against us was never part of our arrangement!
SPECTER: I am altering the deal! Pray I don't alter it any further!
REID: This deal keeps getting worse all the time!

Really? (4.00 / 4)
A legal requirement to buy overpriced junk insurance, plus a new tax on employer benefits, is better for middle class families than what we have now? Do you think millions of newly mandated consumers will enjoy the annual rite of proving to the IRS that they qualify for the affordability exemption? And since the affordability cut-off changes from year to year, do you think they will be happy to find out they owe a penalty? Don't get me wrong: I support the expansion of Medicaid--but an individual mandate with inadequate subsidies and weak cost control is not progressive reform and is a dealbreaker.
[ Parent ]
But that's not what the bill will be (4.00 / 1)

[ Parent ]
As DTO said.... (0.00 / 0)
...there are a lot of misconceptions about the senate versions of the bills...

REID: Voting against us was never part of our arrangement!
SPECTER: I am altering the deal! Pray I don't alter it any further!
REID: This deal keeps getting worse all the time!
[ Parent ]
bmull described the Senate Finance Bill (4.00 / 2)
or at least the problems with it, the problems have been mostly rectified by combining it with the HELP bill, which made it better.

Not perfect, but better.

[ Parent ]
Don't you think Pelosi would have counted the votes? (4.00 / 3)
I genuinely believe Pelosi wanted Med+5. Maybe it was just an Academy Award (tm) peformance, but I think she really tried--unlike all the other top Democrats who clearly couldn't care less. Why would she bring a bill to the floor that isn't her first or second choice--and strongly hint that she isn't going to allow amendments--if she didn't have the votes? Just asking.
She did want it... but not for the same reasons we did... (0.00 / 0)
...the strong public option would have shaved another $100 billion off the price tag... That was her primary motivation for it.  So, she did want it and wanted it badly.  She did fight for it and publicly stuck her neck out on the line to do so...  Something happened along the way to undermine her... pick your conspiracy theory here.  

REID: Voting against us was never part of our arrangement!
SPECTER: I am altering the deal! Pray I don't alter it any further!
REID: This deal keeps getting worse all the time!
[ Parent ]
Nothing happened (4.00 / 2)
it was a DOA in the Senate and she couldn't get the rural Democrats to support it and was afraid of losing them even on a weaker public option.

Sometimes defeats happen.  

[ Parent ]
Except that she was led to believe that she had... (0.00 / 0)
...way more votes than she really had!  

REID: Voting against us was never part of our arrangement!
SPECTER: I am altering the deal! Pray I don't alter it any further!
REID: This deal keeps getting worse all the time!
[ Parent ]
Who led her to believe that? (4.00 / 1)
She was the one counting votes...Hoyer and Clyburn, who normally do count the votes, warned her not to jump the gun and she did.

I think, AND THIS IS MY OPINION, she was hoping if she sounded like she had the votes, the undecideds would come around and they didn't.

Or she does have the votes, like I mentioned yesterday, and it's just too close to 218 to risk it.

OR the CPC screwed her. I hope it's not that because if it is, they've just lost any power they had.  

[ Parent ]
Nope, not at all. (0.00 / 0)
As speaker of the House, Pelosi decides what comes up for a vote and what doesn't.  She is the top Democrat - indeed, the top representative - in the House of Corporate Representatives.  If she really wanted something effective passed, she'd have twisted arms to make sure that something with teeth made it to the floor for debate and passage.  Instead, like Limp Reid, she's done nothing but let the right-wing of the Democratic party join with the GOP in gutting the House bills.  Actions, or lack thereof, speaker much louder than empty words.


[ Parent ]
Yeah that's exactly why (4.00 / 5)
she's been twisting arms for the past five days for a robust public option. that's exactly why she put her neck on the line and said she will get the votes for it.

Like a person who shoots themselves in the head to show you how a gun works.

I wish I lived in your world of ignorant bliss where people just do what the leadership tells them to do, no questions asked.

Sometimes Arm twisting DOES NOT work...I have news for you, it didn't work for LBJ either, otherwise he wouldn't have to accept the compromises he had to accept.  

[ Parent ]
Maybe not (4.00 / 1)
and if that's the case, then the Democratic Party cannot exist as a successfull coalition.

But they will, it just means there are going to be Democrats on the left and on the right who aren't going to be thrilled with the final outcome.

Deal with it...we did our best.  

if the White House had done their best (4.00 / 11)
it would be easier to deal with. Obama clearly has not been focused on getting the strongest possible bill out of Congress.

Join the Iowa progressive community at Bleeding Heartland.
[ Parent ]
It's possible he was working behind the scenes... (0.00 / 0)
...and this was the best we could get. MSNBC says that Obama's been working behind the scenes for months now.  Reid's recent fiasco may vindicate the White House in the end.  Maybe there really is no way to get anything better than crappy triggers that will never be pulled.  Unfortunately, there are just enough corrupt senators and congressmen to spoil the good work of the vast majority of good legislators who are working for the common good.

REID: Voting against us was never part of our arrangement!
SPECTER: I am altering the deal! Pray I don't alter it any further!
REID: This deal keeps getting worse all the time!
[ Parent ]
It's possible he hails from the Planet Transexual in the galaxy of Transylvania, but somehow I doubt it's likely. (4.00 / 4)
There's been no effort whatsoever to get a strong bill out of Congress.  In fact, there's every reason to believe that what the Huffington Post reported is 100% true: that he's been working behind the scenes to kill reform, not advance it.  This shouldn't have been surprising considering that his record as early on as his days in the Illinois state senate showed his willingness to gut health care reform on behalf of large business interests.  Why you insist on clinging to the lie that Obama has ever wanted or sought genuine health care reform instead of the sham he really supports is beyond me.


[ Parent ]
Obama, alone, couldn't do it (4.00 / 1)
Look, I know now is going to be the time to find someone to blame, but it is as riduclous to think Obama could've compeletly changed the outcome as it is to think adding another $200 billion to the stimulus would've magically turned the economy around (and don't laugh, I've seen this argument), there are many other factors at play here.

How do you believe this would've passed if Obama drew the line in the sand and said "only a bill with a Medicare +5 public option?" Do you think that would make a spiteful Joe Lieberman more likely to vote for it, would it make Olympia Snowe more likely to vote for it, would it have changed the minds of the dozens of rural Democrats who think Medicare +5 would bankrupt hospitals in their districts?

[ Parent ]
Two Words (4.00 / 1)
Signing Statement.

Didn't GWB show us that the unitary executive can pretty much rewrite any bill by issuing a signing statement? Don't like the trigger? Sign it away!

By citing the Bush precedent, President Obama could accomplish reform all by himself.

(of course I'm kidding?)

"It sounds wrong...
     ...but its right."

[ Parent ]
Oh yeah, he should DEFINITELY abuse his power (0.00 / 0)
like Bush did.

Besides, by issue a signing statement for a trigger, that doesn't reinstate a public option, it would essentially kill any chance of it ever happening anyway

[ Parent ]
One word (4.00 / 1)
Audacity

What are they gonna do? Sue him? Republicans don't believe in frivolous law suits ;)

When insanity is the way of the world you gotta start thinking BIG. Think: What Would Stun Cheney? Then double down. He could sign the statement as the highlight of the Super Bowl half time show after parachuting in strapped to GHWB (Bipartisanship at its best). Go for broke, man, you're only President once.  

"It sounds wrong...
     ...but its right."

[ Parent ]
Republicans can get away with, Democrats can't (0.00 / 0)
don't believe me? Work in the media for six years. They'll destroy him if he does that.

[ Parent ]
Obama could and should have... (4.00 / 7)
appealed to those millions of small donors and voters who supported his mantra of hope and change to march on Washington in support of the version of reform he was willing to fight for.

It's not like a minority of the public wants this.

Imagine what that may have done to influence those in Congress.

Instead, he did a few town hall meetings and acted behind the scenes, barely giving the signal or creating the momentum necessary to offset the opposition, some of which he actually partnered with.  I'm sure that send a clear message about his true intentions.

[ Parent ]
um, he did (4.00 / 1)
I don't know about you, but I got no less than a dozen e-mails and letters demanding I tell Congress what kind of healthcare reform I want, and quite honestly, since this whole thing started, the only time I've seen anyone, outside of the blogs, pay attention to this was when Joe Wilson went on his tirade, but by the next day, it was back to talking about Dancing With The Stars and week two of NFL football.

Obama did appeal to the millions of small donors and voters, some had better things to do, some did as little as they can, some bitched and moaned they weren't 100% happy with what he had say, and some of us lobbied Congress, him as well, and stood outside of our representatives offices in the rain with signs.

Do you remember that protest in which supporters blocked the entrance ways to insurance company headquarters? Do you remember when the netroots organized a 100,000 man march on Washington? No, neither do I.

If the teabaggers can organize without a President to tell them what to do, what the fuck is our problem?  

[ Parent ]
Emails and letters? (4.00 / 3)
Like the rest of the junk stuff that clutters our existence?

Eventually, it become white noise.

I'm sorry, I saw no call to action as I mentioned, such as where people take to the streets, on a special day proclaimed to be the day when people march, in Washington and even the nation.

That was how it used to be.  If health care is a human right, as civil rights once were, it should have happened.  It was Obama who had the organization.  He maintains the names.  He's the community organizer.

Notwithstanding what the other side does, it's a poor excuse to make comparisons.  How organized are the 40 million without coverage, or the poor.  No one lobbies much for them.

All I said was that Obama could have done much more with the goodwill he had from the start, and he could have helped more to increase the chances of real reform.  However, the fact is that he partnered with the natural opponents of reform, and sent a contradictory message in the process.    

[ Parent ]
What do you consider a call to action to be? (0.00 / 0)
I'm sorry, I saw no call to action as I mentioned, such as where people take to the streets, on a special day proclaimed to be the day when people march, in Washington and even the nation.

Where we you on September 13th? I'm gonna say not in Washington D.C. like me marching for healthcare reform at a protest I heard about through OFA.

Turnout was pathetic...everyone was told of it, and the blogs promoted it, and a couple hundred people showed up. The counter protest the day before was higher.


[ Parent ]
You are right. I was not there. (4.00 / 1)
but a few thousand miles away.

But the March on Washington in 1963 drew 250,000.  Why was it successful?  Where is the community organizing prowess?  Perhaps it was mainly an ability to mobilize the committed in some caucus states in processes where a democratic deficit existed.

When, exactly, has President Obama framed the issue as a human right, one that people from red states, blue states, purple states, etc. should stand up for similar to what they did with civil rights?  Have not heard much of that.

Back as a candidate in October, 2008, according to Forbes:

The way the candidates responded to Tom Brokaw's question on health care during this evening's debate says a great deal about their philosophy on government.

Obama says health care should be considered a right, echoing the 1948 Universal Declaration of Human Rights.

http://blogs.forbes.com/trailw...

Again, have not heard much of that election claim once he was in office.  You fight for human rights if you really believe in them.

Sorry, I see this whole thing as a charade, where Obama just does not want to be seen losing.  Bad for the image.  Bad for his re-election if he cannot claim he got it done, irrespetive of the contents and who actually gets the most benefit.  So he will just go along.  He has not led a fight, in my opinion, to achieve this human right.

[ Parent ]
Clearly you're going to see whatever you want to see (0.00 / 0)
but you asked why there wasn't a call to action, I showed you there was, so I ask again, why didn't you respond?

When, exactly, has President Obama framed the issue as a human right, one that people from red states, blue states, purple states, etc. should stand up for similar to what they did with civil rights?  Have not heard much of that.

Five days before the march, in front of Congress and the entire country...remember, that dude from South Carolina called him a liar?

[ Parent ]
You will do likewise (0.00 / 0)
Were you around in 1963?  I specifically used the march on Washington as a template to explain the type of mobilization necessary.  Yet you refer to something that I suspect most Americans did not even know was going to occur.  Obama took office in January.  There was plenty of opportunity to organize something similar, months in advance.  This is an issue for our time, yet he has not made it a true cause.

As I indicated, I was not in proximity where I could respond.  That is not the point.  I am not charged with the responsibility either.  I did not make a campaign claim that this is a human right, then not act as if it was.  That is what I voted for Obama to do, get this done according to what he said as a candidate.  In my opinion, he certainly could have done more than he has in a public way, with all his capabilities and position.

[ Parent ]
You do realize (0.00 / 0)
JFK didn't call for the march, Martin Luther King and other civil rights leaders did...as a matter of fact, the march happened in part because civil rights leaders, like John Lewis, thought Kennedy was ignoring them and letting the Civil Rights Act flounder.

So, again, what's our problem. They didn't need a President to call for a march in 1963, why do you?

[ Parent ]
I don't get your point (0.00 / 0)
You asked what Obama could have done and I answered.

Maybe JFK was ignoring them back then.  It was a different time.  He was not going around the country holding town hall meetings, was he?  However, Obama professes he wants this, does he not?  Yet it seems he will take what he can get.  If you think Obama has done everything he can, fine.  I don't think he has.  I think he knows he will get something to sign and then say he passed "reform."

Anyway, I am done going in this circle.  Later  

[ Parent ]
A cop out (0.00 / 0)
"I wasn't close enough to Washington to get there"

Find a way or shutup, 300,000 people got to Washington in 1963 when there wasn't the transporation system we have today...but they got there...there was buses, I was on one, and I met people who came from fucking Oregon. All I hear from you is excuses "Obama didn't call people to action" Well he did, "Oh, wah, Obama didn't make a hard enough argument for me to be satisifed enough to get up and do something about fighting for healthcare. He didn't say these words exactly. I'm just going to sulk" JFK was letting the Civil Rights Act DIE in Congress in 1963, it wasn't even on his fucking radar and STILL 300,000 people showed up. No one said "oh, wah, I'm not wasting my time going to Washington when President Kennedy isn't pushing legislation through Congress"

THEY SHOWED UP ANYWAY.

I'm tired of hearing liberal cop outs and excuses. It's clear to me all you want to do is make excuses and place blame on people. Stop whining, it's pathetic.  

[ Parent ]
Don't tell me what to do... (0.00 / 0)
You do not have a clue who I am or what I do with my life, so perhaps you should be less condescending and refrain from stupid remarks.  Who do you think you are anyway?  You are just some idiot like me who spends too much time on a blog arguing with people and coming off as a know it all.  But at least I know what I am.  Got that?  

Despite your chastisement, what I do is not the issue anyway.  It is what Obama does.  That was the question YOU asked, was it not?  In this case he does not do enough.  That is my opinion.  It is as valuable as your own.  My actions, too, by the way, even if you think you know better.

[ Parent ]
oh and BTW (4.00 / 1)
if you want to know why I couldn't get any of my friends to show up;

Giants first game of the season vs. Redskins.  

[ Parent ]
Horse puckey. (4.00 / 2)
You did NOT do your best.  And no, we will NOT deal with it.  The Democrats on the right will be absolutely thrilled with the outcome, for they will have gotten their pretense of reform and the added bonus of having killed chances of genuine reform for at least another decade, if not a generation.  WE lose, and THEY win.  Had the left fought for the real thing instead of this fake reform, we wouldn't be talking about defeat.  We'd be celebrating a real victory, or at least the chance for one.


[ Parent ]
There isn't anything that would make you happy (0.00 / 0)
so we just stopped trying.  
[ Parent ]
You never tried to begin with. (4.00 / 2)
I'd have been thrilled had you bothered.  It would have shown that you were willing to at least try.  Instead, you decided you were perfectly content to support a fraud and call it the "best we can get" knowing full well that it's not, never has been, and never will be.


[ Parent ]
You're right, I never tried (0.00 / 0)
you're not worth it...but plenty of others have chosen to waste their time to appeal to people like you.

[ Parent ]
You're wasting OUR time, not just yours. (0.00 / 0)
And no, you never did try to push for single-payer.  If you had, you'd have given examples of what you did along those lines.  You're not going to convince me that you're serious about health care reform if you always browbeat those of us who actually, you know, advocate for it into accepting something we all know is unacceptable and which won't do the job.


[ Parent ]
oh, and you've done what? bitch on a blog? (4.00 / 1)
Where were you on September 13th when I was standing outside of the Capitol Buiding with a sign that says "No Single Payer? Public Option or Bust?"

Hmm?  

[ Parent ]
On Spetember 13th I was likely in class. (4.00 / 1)
Unlike you, I am not in a position to go down to D.C. and engage in a protest.  For that, I'd have to walk down there, and I haven't the time, energy, or money with which to replace my shoes.  So I use the resources I do have to try and push for single-payer.  I've been on the phone to my elected representatives, posted articles in support of it to help spread awareness, encouraged others to do likewise, and more.

SO before you go lecturing me, child, try to think about what you're writing and why.  Again, you're not going to convince me you're serious if all you appear to do is browbeat others into tossing their principles and their chances of genuine reform out the door without even trying to make an attempt to push H.R. 676 to members of Congress.  Have you tried getting into the offices of representatives and senators to discuss the bill and why it needs to be passed?  Have you tried gathering signatures to present to them letting them know that they'll receive no money or votes in their next re-election bid if they vote for anything less than single-payer?  Are you posting on here and other blogs describing ways in which to do these things?


[ Parent ]
What was the message of that sign? (0.00 / 0)
Like most of your posts it says little but looks like it says something.

On the whole you seem more interested in convincing people to give up and go home than anything else.

What's your point?


"It sounds wrong...
     ...but its right."

[ Parent ]
I'm wondering about opt-out (4.00 / 6)
A fair number of Congressional Black Caucus and Hispanic Caucus members represent districts in red states that would be likely to opt out. Are they willing to vote for this bill?

Join the Iowa progressive community at Bleeding Heartland.
damned good question (0.00 / 0)
damned good question. im callign right nw to see what they are about to say. gotta a friend there too
[ Parent ]
maybe compromise with medicare po > (0.00 / 0)
one friend on the hill tells me it may be a compromise-meicare rates plus 5 and negotiated after few yrs. this seems somewhat better. lets hop
That's no compromise... (0.00 / 0)
...that was in the original house bill.  The medicare rates were never permanent.

REID: Voting against us was never part of our arrangement!
SPECTER: I am altering the deal! Pray I don't alter it any further!
REID: This deal keeps getting worse all the time!
[ Parent ]
the leadership obama has shown on this is tremendous (4.00 / 1)
I don't know if I can go out as I fear I'll get burned by it
Progressives better not sink this (4.00 / 1)
That would just be stupid.  
What is stupid about not supporting a bad bill? (4.00 / 5)
If, indeed, the final bill will not accomplish the goals of reform - why not vote it down?


"It sounds wrong...
     ...but its right."
[ Parent ]
goals of reform, or put on a path to goals of reform (4.00 / 2)
Think about what, what would we be doing if we had a Democratic President and Republican Congress, which we almost certainly would've had in 2005 if Kerry or Dean had won.

We would not be doing any healthcare reform at all because, obviously a medicare +5 bill or single payer wouldn't stand a chance, or would we be working to build some kind of base to build on?

If it's the latter, then almost anything would accomplish the goals of reform and you get the most progressive one you can.  

[ Parent ]
It will accomplish many of the goals (4.00 / 1)
Would you rather have nothing get done and millions more people go without insurance?
[ Parent ]
What does the proposed bill accomplish? (4.00 / 5)
Will it lower health insurance costs? Will it reduce prescription drug prices? Will it provide effective competition to the for profit insurers that are responsible for the current mess of system we have? Will it free US workers from the tyranny of having their health insurance tied to their employment status?

Take a look at those who were able to gain concessions during the bill writing process - did they get what they wanted by saying, "Oh, of course I'll vote for any bill in the end"? No.  They gained concessions by putting their foot down and daring to say "no". Even the progressive block only made what headway they did when they made it clear that a no vote was clearly a possibility.

If you'll accept any old bill just because you want to claim a "victory" on the health care reform you are making yourself irrelevant from the outset because you have no leverage what so ever.


"It sounds wrong...
     ...but its right."

[ Parent ]
More $ (4.00 / 4)
The major accomplishment is putting more $ in the hands of the insurance companies by taxing those who already have insurance.

The best bill would have been Medicare for all the newly insured.  With no taxes on existing insurance policies.  Cheapest and best.  And the insurance companies would not have lost a dime.  The uninsured by definition do not purchase insurance policies.

[ Parent ]
but it may not be nothing (4.00 / 5)
So we get millions more people who have to pay for crappy insurance.  That is somehow an improvement?  meanwhile, costs continue to go up at 10% a year and so do medical bankruptcies.

I'll be the first to admit that the devil is in the details, and it's possible that a bill with negotiated rates could be a net positive.  So I certainly am not saying let's start telling the progressives to vote against it.  But we need to understand the kind of corruption we're facing in Congress.  There is every chance that the final details will be a net negative.  If costs continue to rise and aid is limited to a small expansion of Medicaid, we're not gonna save lives.  We'd be better off leaving it like it is so it will be more obvious how screwed up things are.

a lot of people talk like this is just the first step.  I submit that they are deluding themselves.  Dems will lose seats in 2010 and if we don't do something more than a half-hearted stimulus, Obama's re-election in 2012 is in doubt.  It will be a decade before we can make significant changes again.  When an inadequate public option fails, people won't be saying fix it.  They'll be saying abolish it.

If we add a mandate without cost containment, the bill is a net negative.  More people will die over the next ten years than if we did nothing.

Want a progressive global warming novel, not a right wing rant? Go to www.edwardgtalbot.com for a free audio thriller.

[ Parent ]
Rural Democrats have a problem (4.00 / 2)
with Medicare +5 because they feel it will bankrupt their hospitals decreasing the already dwindling number of healthcare facilities in their districts.

and they have a point, it could very well do that if the reinburstment rates are similar to what they're getting with Medicare.

So maybe for some, Medicare +5 is worse than doing nothing.  

[ Parent ]
a reasonable point (0.00 / 0)
one that I can't argue against - you may be right.  My point was not to suggest that there are no valid positions other than say what I'd like to see.  If what you say is true, then a public option without major additional reforms that have never been on the table was always going to be worse than doing nothing.

Want a progressive global warming novel, not a right wing rant? Go to www.edwardgtalbot.com for a free audio thriller.
[ Parent ]
huh? (0.00 / 0)
what addtional reforms that have never been on the table?
[ Parent ]
Wasn't an extra $20 billion for rural hospitals supposed to be part of the deal? (0.00 / 0)

[ Parent ]
Don't you mean RURAL PEOPLE suffer AS WE ALL ARE? (4.00 / 1)
It's a long-standing problem that rural health care suffers from a lack of quality physicians who want to practice there. I know this from having worked as a reporter for a brief period in a rural area.

Rural Democrats will suffer as all politicians- with the question of what to do with high cost health care, mega-million Americans without health insurance and no clear path out.  

[ Parent ]
As I commented elsewhere. (0.00 / 0)
Boswell (my congressman) was part of a deal to address that.

http://www.openleft.com/showCo...

If that's (part of) what killed medicare +5, I'm going to have to have words with Mr. Boswell.

[ Parent ]
He sponsored a study (0.00 / 0)
a study isn't a fix, it's a study on how to fix it, so that wasn't going to save Medicare +5, that would just make it easier for rural Democrats to come on board in the future once the problem is fix and we revisit it.  
[ Parent ]
As a matter of fact (4.00 / 2)
this is probably what KILLED Medicare +5, if the best they can do is a study, it indicates they either don't want to do anything about the problem, or more likely, can't because to do so would significantly increase the price of the bill and no longer make Medicare +5 optimal anyway.

So the study is meant to kick the can down the road until either the study comes up with a cheaper way to fix the problem or the deficit is cut to a point where we can spend the money to fix it.

This might actually put the Clyburn trigger into a broader light.

[ Parent ]
This makes more sense. (0.00 / 0)
I was deluding myself into believing otherwise.  Stupid me.
[ Parent ]
Confirmation: (0.00 / 0)
Boswell released a statement on the House's HCR bill, today:

"The Affordable Health Care for America Act includes several provisions that will improve the lives of patients and providers in Iowa. As this legislation stands today, Iowa doctors and hospitals who participate in the public option would be able to negotiate their reimbursement rates with federal health officials instead of relying on the unfair Medicare payment formula. This, coupled with the Medicare reimbursement studies that I fought for, is strong first step to correcting the longstanding disparity between how rural providers and urban providers are paid that has plagued the state's doctors and pushed many hospitals into the red."

There was no reason to discard Medicare +5 over that.  It requires reworking the reimbursement formula, not killing the idea all together.

Time to see if Ed Fallon will make another run at the seat.

[ Parent ]
Which will increase the cost of the bill (0.00 / 0)
to where it is no longer deficit neutral, make it a red bullseye for the media and deficit hawks, eliminate any chance of using reconciliation AND probably killing to bill altogether.

I explained why reworking the reimburstment formula is not possible at the moment, but you chose to ignore that...if Ed Fallon wants to win, he's going to agree with Boswell on this.


[ Parent ]
Obama's reelection is his own problem (0.00 / 0)
If he cant win reelection, that is his problem, but not ours.  Our problem is doing something with our Congressional majorities before they are gone and that includes passing a healthcare bill.  
[ Parent ]
A bad bill is worse than none at all. (4.00 / 3)
Remember: the "pass anything no matter what" mentality also serves as an excuse not to pass something good later on.


[ Parent ]
i would agree about Obama (0.00 / 0)
but my point was twofold:

1.We will never have a better chance to pass healthcare and conversely, we are not likely to improve on a bad bill anytime in the future given that fact and the anxiety which people have about the issue.

2.related to that, the reason I brought Obama into it was to point out that if he loses in 2012 that pretty much eliminates any chance of improvements in healthcare from 2012-2106.

Want a progressive global warming novel, not a right wing rant? Go to www.edwardgtalbot.com for a free audio thriller.

[ Parent ]
I have to disagree on your first point - (4.00 / 1)
We will never have a better chance to pass healthcare and conversely, we are not likely to improve on a bad bill anytime in the future given that fact and the anxiety which people have about the issue.

Trigger aside, if we pass something now with an at least moderately robust public option and it succeeds, it's quite likely that public anxiety will subside, paving the way for more improvements.

[ Parent ]
I'm skeptical about the "get it now, fix it later" strategy (4.00 / 2)
cuz we never seem to get around to fixing it later.

For example, are we gonna fix Medicare Part D so it's actually administered by Medicare instead of the drug and insurance companies?

And have we gotten around to fully funding NCLB yet?

Now there is an argument that we can elect more liberal members of Congress down the road.  Still, I'm skeptical about whether Congress will have the motivation to revisit and fix legislation later on, especially if there's no more public attention to pressure them to do so.

[ Parent ]
Good point (4.00 / 2)
And someone made a comment up-thread that IF WE KILL THE BILL, things will get SO MUCH WORSE, that the need for reform will be inescapable.
[ Parent ]
so we sacrifice more lives (4.00 / 1)
because we're unhappy with the compromise?

Gee, that makes sense.

"We need reform because people are dying, but this isn't good enough, so maybe if a few more people die, we can stop people from dying"

[ Parent ]
More lives will be sacrificed by passing a bogus reform bill. (4.00 / 1)
Get that through your head.  Half-assing it isn't going to do anything except make the problem worse.  Do it right or not at all.


[ Parent ]
How many lives will be lost by passing a poor bill? (0.00 / 0)
Relative to those that would be saved by a robust bill?

"It sounds wrong...
     ...but its right."
[ Parent ]
If "public anxiety" subsides (0.00 / 0)
what will be the impetus for more improvement?

Any revisiting of healthcare reform will be met with, "already did that."


"It sounds wrong...
     ...but its right."

[ Parent ]
If "public anxiety" subsides (0.00 / 0)
It takes away the opposition's claim that the government can not successfully reform health care.

This bill will not cure all the ills of our health care system. There will be plenty of impetus for improvement.
- costs will probably still be high
- people will have trouble complying with the mandate of purchasing insurance.

Maybe there will even be a law suit over this that will go all the way to the Supreme Court ---now that would be progress if the Supreme Court would rule on health care as a right rather than a privilege.

[ Parent ]
Both points can also be used by those in opposition (0.00 / 0)
to claim that the reform has failed to control costs and has leveled a tax on the populace.

Besides, the Dems will end up defending a potentially bad policy change if the reform is too weak.


"It sounds wrong...
     ...but its right."

[ Parent ]
If Obama hasnt passed healthcare by 2012 (4.00 / 1)
He almost certainly wont bring the issue up again even if he is reelected.  That is how Obama works.  If he gets burned on this issue, he will drop it like a hot potato.  
[ Parent ]
Um, every President is like that (0.00 / 0)
Clinton never brought it up again either.  
[ Parent ]
If people can't afford insurance, then (4.00 / 4)
 nothing changes, except they get screwed worse with mandates forcing them to spend lots of money on junk insurance that will not pay for drugs or doctor visits until some huge deductible is met.

Or pay fines to IRS for not having insurance.

This is called punishing the victim. Lots of that going around these days.  

[ Parent ]
Also, Pelosi wouldn't release a bill that couldn't pass (4.00 / 1)
if the CPC could kill the bill, we wouldn't be seeing it tomorrow.

Almost certainly the've given up...they fought a good fight.  

Surprise, surprise.... (4.00 / 2)
From the beginning of this whole sorry mess, I've been predicting that we're going to get a watered-down-piece-of-crap healthcare bill, because Obama and the Democrats cannot afford a defeat on this issue-- it would be politically catastrophic.  So they have to go ahead and pass something.

Assuming that some sort of healthcare bill does get thru Congress, I'm curious about the road ahead.  I wonder to what extent the healthcare system can be tweaked and improved via the legislative process?

Obama has to get healthcare done (0.00 / 0)
He cannot afford yet another failure on a key issue.  So far he has gotten almost nothing done and to go this far without a single accomplishment would be unacceptable.  
[ Parent ]
To go with just any old bill for the sake of political convenience is not the solution. (4.00 / 3)
Obama had every opportunity to push for something that works.  From the beginning, he has signaled that he doesn't care how many people are suffering and dying, so long as he can pretend he's done something while maintaining the status quo.  His success or defeat was always going to be decided by his willingness or unwillingness to get genuine reform passed.  He chose the latter path.


[ Parent ]
So what? (0.00 / 0)
Why should Obama's re-election chances dictate that we accept a half-assed bill?

Anyway, I disagree. If no bill passes, the pressure from the public to solve the problem will not evaporate. The next time 'round, the concept of "bipartisanship" will have been shown to be the down-fall of the bill.

Obama tried to gain votes from the right by compromising so much that he lost votes on the left and got nothing from the right in return.  What kind of fool would try that approach twice?

I think that doing healthcare reform correctly could be a huge issue in the 2010 mid-terms, rather than the Dems getting routed because they passed a bill that will hve no effect.



"It sounds wrong...
     ...but its right."

[ Parent ]
All this could have been avoided, Mr. Bowers. (4.00 / 1)
Had there been any serious effort to pass H.R. 676, we may very well be talking about the likely passage of this amorphous "public option" of yours - and a strong one at that - instead of something as watered down as it's likely to be, the passage of which remains doubt.


Right! (4.00 / 1)
Because single payer would have been much easier to pass!
[ Parent ]
Well, maybe we'd be compromising (4.00 / 3)
somewhere near the public option point, instead of what looks like triggers on the horizon.
[ Parent ]
Exactly. (4.00 / 1)
But let it not be said that the likes of Mr. Matson are honest enough to admit that.


[ Parent ]
Not said (4.00 / 3)
I used to play a stupid but fun game as a kid.  No one but me knew I was playing.  At pool side I'd pass a beachball back and forth with someone.  (That isn't the game.)  My goal was to pass the ball just close enough to them that they would lunge for it, but close enough to the pool that they would fall in.

I only got it to work once or twice.

My point is you can't just assume that if you throw the ball into the pool someone will jump in after it.  Or, er..  The point is you can't just arbitrarily start the negotiations at whatever extreme you want.  If you offer a car salesman $100 for a new car, she will just laugh at you.  It doesn't help at all.

Obviously, you want to start negotiations from the best possible position, but that does not necessarily mean the most extreme point on your side.

Now, the Overton window is a different matter.  And over the long run I somewhat agree with you.  But it will take years to get to that point.  If the groundwork was done better it might have been possible.  I'd love it if Obama could openly discuss the path to single payer and how we would go from where we are to where we want to be in the long run without disrupting the system too much.

And even the Overton window isn't that easy.  Look at climate change.  Clearly, there has been years of work getting people to worry about this and it still hasn't worked well.  Irrational risk aversion, where people guard against potential short-term losses to the detriment of long term, well thought out risk versus reward comparison,  is very hard to overcome.

[ Parent ]
That's car sales you're describing. This is politics. (4.00 / 1)
It's a whole different ballpark, with entirely different rules.  You go to the table asking for more than what you want and settling for the actual, more reasonable goal.  That is the art of politicking, and those who refuse to learn it are the ones who end up getting little or nothing.


[ Parent ]
The fact you think there's a difference (4.00 / 1)
shows what little you know about politics.

Mark's point is if you go in with an offer the other party won't even consider, they'll just laugh and walk away...that's true in politics too...or do you not read political history?  

[ Parent ]
That I KNOW there's a difference means I know not to confuse the two. (0.00 / 0)
Again, politics is not about selling something to people.  This mindset that it's like some corporate brand or product that needs to be sold to people is a major part of the problem inherent in politics today.  You really don't understand the actual art of negotiation.  You go in asking for more than what you want and then bargain down to something as close to it as possible.  Obviously there's going to have to be some give and take, but the trick is to get the other side to give more than you do.

Going into negotiations with the other party having already compromised your agenda only signals to them that you're willing to settle for crumbs instead of even half a loaf, and so they feel absolutely no obligation whatsoever to meet you half way - not when they know they can get pretty much everything they want by remaining firm.  That's what Democrats have been doing for thirty odd years, and as a result, the GOP has been ever more emboldened because the evil bastards know they need only stamp their feet and refuse to budge to get what they want.  They know Democrats will give away the entire store and its contents without so much as a squeak.

Follow your own advice and read up on the political history of the last thirty years.


[ Parent ]
Oh, but DTOzone is not finished conceding (4.00 / 1)
when they propose starting the negotiation with a compromised plan. At the first sense that someone on the right might be displeased with the result, the plan is to concede that "I tried" and give up.

Concession and caving are all DTOzone consuls. The only question is how fast.

"It sounds wrong...
     ...but its right."

[ Parent ]
Your points about negotations hint at Obama's (winning) strategy (0.00 / 0)
Going into negotiations with the other party having already compromised your agenda only signals to them that you're willing to settle for crumbs instead of even half a loaf, and so they feel absolutely no obligation whatsoever to meet you half way - not when they know they can get pretty much everything they want by remaining firm.  That's what Democrats have been doing for thirty odd years,

From the beginning of his presidency - not campaign promises, Obama talked about "goals" and "guiding principles" for health care reform, such as no reform that increases the deficit, and "bipartisanship." He never drew any specific lines in the sand, no points that could be attacked as non-negotiable, and no points that could be compromised.

I think it was a definite bait and switch from the campaign, but the strategy leaves the field wide open for, yes, get something passed. It ensures success, from a negotiating standpoint.

The question of whether or not what is passed can be improved upon, remains a question. It looks like we will have the opportunity to answer that question. I guess I think there's no revolution to be had here. Health care reform will evolve.  

[ Parent ]
Well, that's true (4.00 / 1)
but first off, single-payer isn't the "most extreme" on our side - socialized medicine, ala the NHS or the VHA, is.

Second, the ConservaDems want a health care bill passed badly just as we do - hence, why no Democrat besides Lieberman has threatened to filibuster.  Now if the choices were 676 or nothing, then yeah they'll probably choose nothing.  But if the choices are 676, a PO, or nothing, they might give the PO a better look since it's something that's not as extreme as 676.

But instead, we offered them compromise bones like watered-down PO, co-ops, triggers and they snapped it up.  

Perspectives change depending on circumstances.  If I offered you some stale bread you normally would probably say no thanks.  But if I starve you for three days and then offer you the same bread you would greedily wolf it down.  The same idea could've been used for health care legislation - use Medicare for All to "scare" ConservaDems into accepting the PO.

[ Parent ]
Because Olympia Snowe and Joe Lieberman (0.00 / 0)
who aren't interested in a successfull healthcare bill, would be more accepting for a better public option if we started with single payer?

Please let me know where I can buy whatever happy pills you're taking.

[ Parent ]
Only true to an extent (4.00 / 3)
I can't speak as well to Snowe and Lieberman on this, but I'm pretty sure that Ben Nelson is rather, to put it bluntly, stupid.  I don't think he really has the intellectual firepower to actually grasp the detailed differences between Medicare for All, Medicare +5 PO, Level Playing Field, etc.  All he has is a reflexive impulsive instinct towards less government.

We saw this during the stimulus debate, when Nelson insisted on cutting a whole bunch of spending, not for any actual economic reasons but simply because it'd be less government.

If the choices are Medicare for All and Medicare +5 PO, he will go for the one with less government, which is the PO. (Or he could vote for nothing, but he, like all ConservaDems, wants a health care bill to pass.) Once you offer choices with less government, like LPF and triggers, he'll just grab at those.  Deny him those choices and he'll be amenable to solutions he wouldn't otherwise want.  Plus, throwing Medicare for All out there could "scare" him into accepting the PO, as I described above.

This could work on Lieberman as well, who seems to be motivated mostly by a desire for attention.  Conrad might be dumb enough to fall for it too.  Snowe seems a little sharper than the rest, and she has to deal with pressure from her fellow Republicans, so I don't know if this would work for her.

[ Parent ]
I fixed it for you (4.00 / 2)
All he has is a reflexive impulsive instinct towards less government helping regular people.

Neither Conservadems nor most Republicans believe in less government. They like plenty of government - as long as it helps the richest people and corporations. You'd be hard pressed to find Nelson opposing government expansion when to do so would have upheld civil liberties or reduced privilege.  

Who are the best keepers of the people's liberties? The people themselves. The sacred trust can be no where so safe as in the hands most interested in preserving it.
James Madison

[ Parent ]
If they are not interested in a successful bill (0.00 / 0)
why bother trying to please them?  

"It sounds wrong...
     ...but its right."
[ Parent ]
Because you need one of their votes (0.00 / 0)

[ Parent ]
And This Is Chris's Fault How, Exactly? (0.00 / 0)
[ Parent ]
He's helped it get to this point by starting out pushing for the compromised legislation without even trying to push for single-payer. (0.00 / 0)
All the effort wasted pushing for the half-loaf and then watching as it was broken up into tiny crumbs could've been better spent by pushing for single-payer and then signaling a willingness to accept the intact Hacker plan as the compromise.  By directing his efforts toward advancing the compromise right out the door (dismissing H.R. 676 as not being pragmatic without even having tried to push it), people who actually do pay attention to what he says and are inclined to act upon it wasted their efforts pushing for the compromise.  But all that does is let the opposition know that it can get us to give away even more, which it did.


[ Parent ]
why would progressives vote against it? (0.00 / 0)
The bill seems to meet the minimum demands, there is a "public option." I don't think this is going to be killed by progressives any more than cap n' trade was.    

New Jersey politics at Blue Jersey.
Synchronicity (4.00 / 3)
I think progressives found a compromise they could live with, and everyone knew it, which meant the conservatives in the House didn't feel the need to go any further.  Since everyone now knows we're getting the level playing field with opt-out, they don't want to go on record voting for something more liberal.
[ Parent ]
The Public No Option (4.00 / 3)
is a better word for it. I suppose it's good that you put it in quotes - because that's what's going on.  They are calling something a public option that 1) will only be a option for a sliver of the population and 2) may only be available to people who fall in that sliver if their state government decides to give them that option.  But calling it that won't make it so.

Where's the choice here?  Calling it a public option is nonsense - it's more like a new version of Medicaid.


Who are the best keepers of the people's liberties? The people themselves. The sacred trust can be no where so safe as in the hands most interested in preserving it.
James Madison

[ Parent ]
You've made an interesting comparison (4.00 / 1)
why would progressives vote against it?

The bill seems to meet the minimum demands, there is a "public option." I don't think this is going to be killed by progressives any more than cap n' trade was.

IMHO, The House passed cap n trade bill is shit.  

[ Parent ]
They did this to Clinton and were punished in 1994. They never learn do they. (4.00 / 1)
The 94 landslide had nothing to do with what Gingrich thought it did. It had to do with fucking up health care. They will get it twice.

Fuck me once, shame on you. Fuck me twice, shame on me.

And still they won't get it as they will blame someone or something else. But good. Now everyone knows congress is full of greedy stupids.

Proof, Much? (0.00 / 0)
I don't think so.

More vehement argument by assertion is still just argument by assertion.

"Senate passes expanded GI bill despite Bush, McCain opposition"

[ Parent ]
I hope your closing paragraph is correct. (4.00 / 1)
Better no bill at all than one which criminalizes single-payer attempts by states, doesn't provide universal coverage or serious cost savings (as single-payer would), and provides a "bonanza" for the worst actors in the for-profiteer system as a reward for their crimes.
Can the House Pass Any Health Care Bill At All? | 112 comments
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