Two public insurance options put up for a vote. Two public insurance options voted down by the Finance Committee.
The count was fifteen to eight against the first amendment, which came from Jay Rockefeller and would have allowed the public plan to set its payment rates based on Medicare. The vote was a bit closer on the second amendment. That proposal, which came from Charles Schumer, would have prohibited the public plan from setting reimbursements so low.
The difference was two Democrats, Thomas Carper and Bill Nelson, who voted against the Rockefeller version but for Schumer's scaled-back alternative. Three other Democrats voted against both proposals: Max Baucus, Kent Conrad, and Blanche Lincoln.
This is not the slightest bit surprising. But it's still frustrating.
The idea of a public plan makes sense substantively. The strong (Rockefeller) option could actually save a lot of money--money very much needed to help underwrite the cost of expanding health insurance. The weak (Schumer) option wouldn't save a bunch of money, but it would still help discipline private insurers while providing a reliable source of comprehensive coverage. There are reasonable objections to the public plan, for sure, mostly about the danger that a public plan would set prices so low as to starve providers. But the concern is overblown, particularly since advocates of the plan have come up with some pretty good safeguards.
The idea also happens to be popular. Most polls have shown the voters like the idea of having a Medicare-like option into which they can enroll voluntarily, although those who oppose it may feel more intensely. If the public plan didn't threaten the revenue stream of every major health care industry--and if the mis-apportioned U.S. Senate were remotely representative of the U.S. population--today's votes might have gone differently.
I've been among those urging people on the left not to make too much of a public insurance plan--that reform without such an option is still worth enacting. I still believe that. But I also believe the public plan is a good idea. And it's more than aggravating to see good ideas meet this fate.
Not that it's fate is sealed. Finance is but one committee--an important committee, to be sure, but one all the same. The bill from the Senate Health, Education, Labor, and Pensions (HELP) Committee has a public plan. So do the bills that came out of three House committees over the summer. Senator Harry Reid has indicated he probably won't include a public plan when he merges the Finance and HELP proposals, but there will be a chance to add one duirng the floor vote debate and then again during conference committee deliberations, assuming the House passes one.
The odds are against enactment, particularly for the Rockefeller amendment. But Schumer's, which is more or less identical to HELP's, may be able to get fifty votes. Then it becomes a question of whether moderate Democrats, even those voting against the public option, would break ranks and uphold a filibuster over it--and how much Democratic Party leaders, including the one sitting in the Oval Office, care about the one or two Republican votes they stand to lose over this issue.
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COMMENTS (3)
I've followed Hacher all summer-he's eloquent and decisive, but simply wrong.
First, from 1970, Medicare costs per patient have increased 33% faster than private insurance-they are not models of cost control.
Second, MedPac has piloted cost savings measures-including 15 for accountable care organizations. Their conclusion, ACO's raise costs.
Third, he doesn't understand Medicare-in his first paper on the issue (not the August 2009 one), he kept saying Medicare reimbursement rates are "negotiated", they're not. They're simply set under some arcane system not designed to judge quality or quantity-but simply to keep Medicare costs low.
Fourth, doctors are fleeing Medicaid ... view full comment
I've followed Hacher all summer-he's eloquent and decisive, but simply wrong.
First, from 1970, Medicare costs per patient have increased 33% faster than private insurance-they are not models of cost control.
Second, MedPac has piloted cost savings measures-including 15 for accountable care organizations. Their conclusion, ACO's raise costs.
Third, he doesn't understand Medicare-in his first paper on the issue (not the August 2009 one), he kept saying Medicare reimbursement rates are "negotiated", they're not. They're simply set under some arcane system not designed to judge quality or quantity-but simply to keep Medicare costs low.
Fourth, doctors are fleeing Medicaid now (you'll add 10 million here) and they're ready to flee Medicare if you cut rates (check Secretary Sebelius' opinon on this). So, you cut their rates more and more-they flock to privates and you don't have doctors (notice Hacher's political science ideas-all who are in now are in tomorrow unless they opt out).
Fifth, Baucus' bill doesn't reverse the current physician reduction law-over 10 years, it costs another $220 billion (he simply says, we cut them half in first year and then we figure it out). That's why, compared to HR3200, Baucus was cheaper. Add it back-then-Baucus is more expensive.
Sixth, Hacher doesn't understand revenue and profit. Please look to Commonwealth Fund evaluating a public option which covers most of Americans-physician income (even with all new patients) fall nearly 20% and hospital revenue also falls (a little less-wiping out all profits or surplus at for profit and non profit hospitals).
Seventh, Hacher is again dreaming-he thinks Medicare will be the testing ground for reducing costs. You Dems have had 40 plus years to do that-why not? You can't look to Europe for those mechanisms-they don't have them. Europe is simple: they ration almost everything and the regulate prices (working with non-profit insurers and provider associations to limit fees and costs).
Eight, if we really are trying to be like Europe, then let's reform the tort system (they don'thave our horrendous malpractice premiums and large defensive medicine expenditures). If Europe is the model, let's go for it all. However, this reform also saves $200 billion. Howard Dean has already told us why Obama and the Dems won't push back the trial lawyers.
However, Hacher's piece is just what we were worried about......he's simply saying.......the public option should become a single payer system without for profit insurance companies. Why take 30 pages to say that?
Finally, Hacher also questions why the public plan should have to establish provider networks and such-well, Hacher, because the Dems and Obama have been selling it as a "competitor" to the private insurance companies. They had to establish those networks.
I know that you can cover all the uninsured by eliminating private insurance-that cuts overhead and profit at the companies and reduces physician and hospital accounting staffs. Of course, that's $200 billion (that's all you need). So just say it.
You all thought the average American-the 56% who oppose Obama/Baucus/Schumer/Waxman/Hacher-were asleep. They aren't. They believe it when Obama said he wants a single payer system. They believe it when others have said the reforms and the public option are simply a path to single payer. We knew it. It might be nice if you're just a little more honest.
So, how do you provide cheaper health care? First, you ask doctors and hspitals to give up revenue. Second, you slowly (or quickly?), make it impossible for health insurance companies to compete and kill them off.
Rockefeller is my all-time hero Senator. When the chips are really down, he almost always steps up. He wades through the minefield of risky issues and he's got real bite when he wants to. He's had spine in the heath care debate and I sincerely thank him for representing the majority of us out here.
How many Democratic Senators can you say that about? I can't think of one who isn't scared shitless by this issue and showing their hindquarter - with a majority in both houses no less - every day so winger media jerks won't sic their fat armies of nutcases on them. Why are Democrats allergic to courage?
Rockefeller is awkward, owned by no one, highly moral, usually quiet with startling outbursts ... view full comment
Rockefeller is my all-time hero Senator. When the chips are really down, he almost always steps up. He wades through the minefield of risky issues and he's got real bite when he wants to. He's had spine in the heath care debate and I sincerely thank him for representing the majority of us out here.
How many Democratic Senators can you say that about? I can't think of one who isn't scared shitless by this issue and showing their hindquarter - with a majority in both houses no less - every day so winger media jerks won't sic their fat armies of nutcases on them. Why are Democrats allergic to courage?
Rockefeller is awkward, owned by no one, highly moral, usually quiet with startling outbursts of raunchy candor every few years. I just love him.
I do wonder why we're better off having Democrats such as Lincoln and Baucus in the Senate if their main contribution is to let Republicans off the hook for trying to sabotage something that will make life better in this nation of ours. When push comes to shove, all the GOP has to do is point out how "unpopular" reform is because so-called "Democrats" are against it too. It seems to me we'd be better off with 54 committed Democrats rather than 59 if the higher number includes people who share nothing of the party's or the nation's goals and undermine then from within. President Obama was elected on a number of platforms including this reform effort, and outside Montana nobody elected Bauc ... view full comment
I do wonder why we're better off having Democrats such as Lincoln and Baucus in the Senate if their main contribution is to let Republicans off the hook for trying to sabotage something that will make life better in this nation of ours. When push comes to shove, all the GOP has to do is point out how "unpopular" reform is because so-called "Democrats" are against it too. It seems to me we'd be better off with 54 committed Democrats rather than 59 if the higher number includes people who share nothing of the party's or the nation's goals and undermine then from within. President Obama was elected on a number of platforms including this reform effort, and outside Montana nobody elected Baucus.