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Just received this from Healthcare-Now!:
We just got word from Congressman Weiner’s office that because of your phone calls, faxes, and demonstrations, Speaker Pelosi is keeping her promise to allow the Weiner single-payer amendment a full debate and vote on the floor of the House.
After nearly being shut out of the discussion completely, single-payer Medicare for All is being heard in the corridors of power as soon as this Friday.
Call now to ask your Rep. to vote yes on Rep. Weiner’s single-payer amendment.
This is the one opportunity for your elected officials to go on record as supporting the only universal, comprehensive, cost-effective solution to the health care crisis. There are currently 87 cosponsors of HR 676, but this vote will make it clear to the movement which elected officials are truly with single-payer, Medicare for All.
We need you to call today!
Ask your Representative to vote his or her conscience. Vote for the plan that most American people, nurses, and physicians want and so desperately need: Medicare for All.
Call now to demand your Rep. vote yes on Rep. Weiner’s single-payer amendment.
What Pelosi has not relented on is restoration of the Kucinich amendment to facilitate efforts by individual states to institute their own single payer systems. As I predicted,
The likelihood that leadership will bend on either of these requests is minuscule, but if they do bend at all, it will be to allow the purely symbolic HR 676 floor vote as a sop to single-payer supporters and take no action to restore the Kucinich amendment, telling progressives that one for two isn’t bad.
So by all means, let’s hit the phones to ensure that our progressive representatives are on board with this symbolic vote to register an ultimate preference for straight Medicare for All. But as I’ve maintained repeatedly, nothing worth having was worth trading away for this pyrrhic display.
The rage and demonstrations, such as the arrests earlier this week at Pelosi’s San Francisco office, must continue and intensify, both to register the need to restore the Kucinich amendment to the House/Senate conference legislation and to demand the de-emasculation of the public option through steps such as those I suggested here:
* Opening of the exchanges (and through them the PO) to all Americans not otherwise covered by public programs from year 1
* Redesignation of year 1 from 2013 to first quarter of 2011
* Restriction of income-based subsidies on the exchange to the public option only (one of the original Hacker criteria)
* Public option operated as an extension of the CMS infrastructure (another Hacker criterion for a truly “Medicare-like” PO)
* Medicare + 5% reimbursement rates on the PO
* Making physicians’ continued participation in Medicare, Medicaid, or SCHIP contingent on their acceptance of PO patients (so docs pay a price for attempting to duck out of seeing PO patients).
34 Comments
Thanks for the update. Wish it were better news, but I share your skepticism.
Oh, and before you get on the phone with your representative, check if he or she is one of the 60 signatories to the July 30 pledge to vote against any bill in which the PO lacks Medicare-based rates. If so, then remind your Rep that if Congressional progressives are ever to be taken seriously again (or perhaps more accurately, for the first time), s/he must vote against HR 3962.
As Kip Sullivan expertly explained, the tug of war over how public option rates will be determined is actually a red herring, so long as the PO remains too small to credibly compel providers to accede to below-market rates. But a pledge is a pledge, and this one came in writing, with signatures and everything. If Congressional progressives won’t hold firm even on a faux robustness criterion, how can we rely on them for anything truly substantive?
Pelosi is a scumbag. One of the worse Speakers we’ve ever had. So where’s that “robust” PO you promised, Nancy? This bill is a farce and it will come back to bite the Dems in the but once Americans realize they’ve been scammed.
don’t see the parliamentary means for the Speaker to allow this without allowing Grijalva’s amendment – anyone ?
What amendment are you referring to?
The HR 676 swap-out resolution is a free-standing piece of legislation, not an amendment. That’s why it’s permissible while further amendments to HR 3962 are not.
Is there anybody out there that can carry the message that the American people want a Robust Public Option that the ill-informed will trust, the fools of talk radio and Becker Heads will feel that they must let be, those that are so die hard republican but will be made to understand the importance of a RPO they will approve? I believe it is all of us. Just how much control does the Health Care Lobby have in Washington? These people must be humiliated with the truth in public.
Grijalva has spoken repeatedly in the last week about introducing Medi + 5 via amendment.
my question was really about parliamentary maneuvering and not about the amendments – don’t see how Speaker can allow Weiner without allowing Grijalva
and oh yes, I’m calling
I agree, Ralphbon. And I’d like to add one more concern. I’m ambivalent about a floor vote on the Weiner amendment that has not been preceded by committee hearings, especially if Pelosi is only going to allow 15 or 20 minutes for debate.
On the one hand, I agree that a floor vote on single-payer legislation is historic and will probably lend credibility to our movement. On the other hand, I’m concerned about a vote that has not been preceded by a helpful, educational debate where the arguments for single-payer can be laid out for all to hear.
Typically, a thorough, persuasive presentation of the evidence for a proposal takes place (if it takes place at all) during committee hearings, not on the floor. On the floor, only members of Congress can speak, and typically their allotted time is limited. In committee hearings, non-legislators can speak and submit documents along with their testimony. HR 676 never had a committee hearing, much less the three committee hearings that the Democrats’ bill has had.
If Pelosi limits floor debate on the Weiner amendment to 20 minutes, it’s going to be very difficult for Weiner or anyone else to make the case for 676 in a convincing manner. It’s bad enough that the Democratic “leadership” took 676 off the table. The least Pelosi et al. can do is guarantee Weiner adequate time to make his case — time that makes up for the time 676′s cosponsors were not given before the relevant committees.
I hope advocates of the Weiner amendment bang the table for adequate time to make the case for 676.
Kip
He may have been referring to the Managers’ amendment, which was finalized by Tuesday of this week. That was also the last-ditch vehicle for reintroducing the Kucinich amendment.
Unless Grijalva meant a free-standing floor vote like the HR 676 vote.
Thanks, Kip. Actually, Conyers got a token hearing before Education and Labor on June 10, and Quentin Young subsequently got what I called a kiddie seat at the table in Ways and Means, versus 16 non-single-payer “stakeholders.” But none of that constituted serious consideration of 676 in committee. It was calculated to be just enough to ward off a repeat of the Baucus hearing unpleasantness.
Yup, and none of it resulted in the sort of extensive and ongoing media coverage that would help the average person comprehend what’s in 676.
Well you nailed that one. Congratulations.
Thanks, ralphbon. I was so frustrated when they pulled Kucinich amendment and then hearing about the Weiner HR676. I will hit the phones harder! I just saw Gore on Charlie Rose, kind of shaking his head, and praising the power of the internet progressives but then saying they didn’t get very involved in health care, though I think he was thinking of the younger voters who went for Obama. He said that 80% of the money that Congress gets goes to 30 sec commercials and really puts them in the pockets of lobby corporations. That is why the state of the climate is minimized by our leadership.
Obama plays lucy and football, Pelosi plays the same game. Promises are so easily overturned in the name of feasibility and pragmatism and cronyism and group think for special interests.
I see Jim White in this diary; perhaps he caan explain how in the world a mandate requiring citizens to purchase insurance is constitutional? where is the ‘liberty and justice for all’ in such a mandate?
While you can’t enroll in Medicare until 65, there isn’t any law I know of the mandates you must enroll in Medicare when you turn 65.
It wouldn’t surprise me that this legislation ends up in court over the issue.
Thanks Ralphbon.
Could Weiner have refused being fobbed off with a LEADERSIP PROMISE of a floor vote. Was it put to him in such a way he had to accept the bird-in-the-bush offer? Now I can truly appreciate Kucinich’s apprehension for his chances with 676. Here in CA the health bill has been stimied twice on $chwarzenegger’s desk. At least, it gets through the legislature.
I guess I’m just going to have to imagine your “Brigadoon” kilt story, since I can’t foresee happier times. Maybe another lifetime?
Thanks for tracking this Ralph. It’s certainly better than nothing to get that vote. But not much better.
In addition to pitching the HR676 vote, it’s helpful to have this list of must-have measures to move the PO to something more viable. Linking to the CMS structure and saying, “if you treat Medicare, you also treat PO patients” is really important. Pelosi is trying to limit amendments — to fend off other stuff (anti-abortion, anti-immigrant, etc), but making these points now can’t hurt and may help later.
Hi, Lass. I think giving Weiner a full floor vote on 676 in exchange for dropping his amendment in Energy & Commerce was a win-win for Weiner (and to some degree, Medicare for All supporters) and Leadership:
Weiner and HR 676 advocates got a chance for a historic but doomed floor vote, along with the mixed blessing of a CBO scoring (yet to appear).
Leadership got a chance to speed things along in a markup session where Weiner was already having way too much fun with his amendment to eliminate Medicare (forcing Republicans to vote against removing a government health insurance plan) and where the promise of a 676 floor vote may have helped assuage the guilt of progressive committee members who agreed to cave on Blue Dog demands for negotiated PO rates.
Relenting on Weiner rather than Kucinich was not only the safer choice for Pelosi, but also she’d clearly broken a promise to Weiner, whereas she never promised anything to Kucinich.
And oh, alright, I shouldn’t tease….
My senior high school musical was Brigadoon. In a dramatic fight scene, I struggled with the bad guy who was going to escape from Brigadoon and spoil the magic spell. We rehearsed the fight for weeks: he flips me, and I land on my back, supposedly unconscious. My stage fall was so convincing that people kept asking in rehearsals if I was OK.
The night of the performance, the fight scene goes off perfectly, and the audience gasps as I fall on my back unconscious. Unfortunately, my kilt hitched up to my waist in the process, revealing my jockey shorts (our commitment to Scottish verisimilitude extended only so far).
Despite being unconscious, my character’s arm quickly pulls the kilt back down over his legs. The audience explodes.
Glad I got that off my chest for you. Counting on an afterlife is way too iffy.
This is kind of like Baldwin’s transgender amendment to ENDA in 2007. It appears that ENDA will be inclusive this time. Perhaps that bodes well for the next steps. Moderate net immediate win win, more valuable as mid term investment.
thanks ralphbon. in addition to the kucinich amendment, i’d still like to also see all medicare and schip used to prepopulate the po (with appropriate subsidies) and of course all of congress and their staff as well as all administration personal with any involvement in overseeing the po or regulating the private insurance companies.
if wishes were ponies….
Kucinich Amendment was the only important thing in this 1900+ page bill. This symbolic vote is just that, all the Small State Blue Dogs + All the Republicans will Vote it Down.
Why is it important not to vote in the Kucinich Amendment?
One has to wonder, its a provision, an opening, an allowance. Not everybody will even notice it and only California has a bill ready to go to make it reality.
So what if “The Fruits And Nuts” want Single Payer?
We need to put in an email to Keith and Rachel to highlight this and make them put it back in it.
SB 810
http://www.californiaonecare.org/
Yep and this is 3rd time it will be brought to Arnold’s deck. If he doesn’t sign it, then we need to vote in somebody who will and I’m fairly sure its NOT Tom Campbell -
Please, let’s leave Medicare alone unless it is to improve it! It’s already hard enough when we have to pay 20% of *everything* with no maximum out of pocket; that’s why people buy Medigap policies if they can get them, but if you’re a dialysis patient and that’s the reason you have Medicare, you often cannot get one for any money. Since the weak PO at this point is not tied to Medicare rates or even Medicare +5%, but will have to negotiate from scratch with each provider, you’d wind up with it costing so much that many of us would wind up on MedicAID instead in a very short time indeed. Disability checks are not very large, and our medical expenses are rather hefty. The new bundling rules proposed by Medicare will add significantly to our cost burden. It’s bad enough. Leave us alone, please, rather than telling us we have to pay still more.
Yoiks! I’m close to 100% certain that selise mistyped and meant Medicaid. The idea, in trying to bring back the original Hacker principles, was to prepopulate a Medicare-like PO from the get-go with all uninsured and Medicaid patients so it starts life with a large patient base, one larger than Medicare’s. With that big a patient base, there would be no need to legislate Medicare-like provider rates; the PO would have the economic clout to demand them all on its own.
But folding Medicare into the PO was never part of that plan.
I would like to hear more about the bundling rules you mentioned. (Perhaps you’ve blogged on this already?)
KitsapRiver! i am 100% sure that ralphbon is 100% correct. that was my mistyping (i may try to ask a mod to correct it for me, it’s such a serious and potentially misleading mistake).
i’m so sorry, my comment should have been:
thanks for having my back. that was exactly what i meant to type (and i’d like to keep medicare away from the po, as it is a program that works and i’d hate to have the po weaken it — by undermining it’s single payer like aspects, etc).
And this just in: a joint message from Dennis Kucinich and John Conyers:
And that email from Kucinich (also posted as a Kos diary) came right on the heels of one from PDA calling on SP supporters to make frenzied last-minute calls in favor of the Weiner vote. At moments like these, one can only default to Amy Winehouse: What kind of fuckery is this?
when you first posted your comment @28, i almost replied with a “WTF?!?” couldn’t bring my self to do it though. now, however, that you’ve broken the ice….
WHAT THE FUCK?
Gaagh. Tried to read through the Kos comment thread on the Kucinich/Conyers letter. Half or more of the comments are on the Fort Hood massacre, the Goldstone report, or other OT issues. Of the comments about the Weiner vote, a lot still refer to it as the Weiner amendment, even though this hasn’t been an amendment for more than three months. Some folks express surprise that the CBO scoring on the bill came out poorly, when anyone who’s been paying attention already knew that was in the cards.
Jeez, I’m unemployed, and there’s not enough time in my day to slog through Kos threads. Who are these people?
In retrospect, I should have been more careful in referring to this as the “HR 676″ floor vote, since Weiner himself mentioned that he made modifications to the bill (how substantive, I’m not entirely sure) in the PDA conference call you can listen to here.
Various versions of “bundling payments” is, as I recall, mentioned in both the House bill and the Senate Finance Comm bill. Both bills would require the Centers for Medicare and Medicaid Services (CMS) to run pilot projects to determine if “bundled payments” cause doctors to order fewer services. This is part of the effort to recycle the HMO experiment without using the old HMO language. Instead of “capitated payments,” the new fad wiil be “bundled payments.” Instead of “HMOs,” the new language refers to “accontable care organizations.”
There are two types of “bundling” gaining attention in Congress. One would require doctors to be paid a fee per particular type of patient per some time period. For example, doctors who treat diabetics would be given a single payment covering that diabetic’s needs for the coming year. That’s not exactly like the old capitation (a fee per insured person per year), but it’s very close. And, in my opinion, it’s even weirder. How on earth will actuaries determine accurately the needs of particular types of patients for some period in the future? And what will it cost to hire all those actuaries to crunch all that data to set “bundled” rates for 300 million Americans every year or every month, or for even that portion of the population with a chronic disease (which is roughly a third, as I recall)? And what will happen to patients whose doctors are laboring under financial incentives to deny them care?
The other form of “bundled payment” proposed in the bills is payment made to “accountable care oganizations.” ACO pilot projects, run by CMS, are also proposed in at least the House bill, and I think in the Senate Finance Comm bill. ACOs would be agglomerations of clinics and hospitals that would enroll patients for a year at a time and receive a payment that is not being called a premium, but that’s precisely what it should be called. The ACO proposal is the old HMO proposal all gussied up in new terminology. The premium payment to the ACO would consist of all project payments for a given enrollee for a year.
Another trendy idea similar to ACOs is “the medical home.” The “home” concept probably won’t work, but it’s much less of a threat to patients than the other two forms of “bundled payments” I just discussed.
Recycling the HMO (aka managed care) experiment is a terrible idea. Encouraging the further consolidation of our medical care sector is a terrible idea. But that, plus managed care 2.0 (report cards on docs and hospitals and universal use of electronic medical records) is the establishment’s idea of cost-control. They prefer to recycle managed care over buckling down and enacting a single-payer system. We will be hearing a lot more about managed care 2.0 in the near future. In coming years, it may well play the role the PO has played in the last year — the great red herring that distracts attention away from real reform.
Kip
Thanks, Kip. Because I wasn’t sufficiently depressed already ;-).
From what little I know, I believe that proposals to reimburse physicians on a pay-for-performance basis could also create adverse incentives for primary care docs to prematurely divert sicker patients to specialty care, even when their own skill sets remain adequate for doing the best job possible.
Returning to the Kucinich/Conyers letter for a moment, all I can say is that they should never have waited this long to call off the dogs on the SP floor vote. I’m not privy to the communication they may have had over the last months with LCGHC leaders; maybe they tried in vain behind the scenes to rein in the Weinermania.
Still if they were going to buck the single-payer groups and publicly appeal to quash the floor vote, they should have done so weeks ago.
for what it’s worth, i’m off the fence: kill the bill