Update: Daschle spokesperson tries to walk him back
Update II: Paul Blumenthal tracks down $1 million+ health industry business to Daschle-Dole-Baker law firm. Sam Stein has more at HuffPo.
Update III: The Hill, Centrist Dems unite to fight left on health care
If you want to understand how a so-called "bipartisan" health reform proposal can confuse just about everyone while giving away the store, just follow what’s happened since Mssrs. Dole, Daschle, Mitchell and Baker announced their "bipartisan compromise."
This is why I’m convinced scarecrows don’t have brains, because I can’t follow the emerging logic.
The argument starts with TNR’s Jonathan Cohn’s What Bipartisanship Actually Looks Like, gets picked up by WonkRoom Igor Volsky’s A Good Example of Bipartisanship, and settles with Matthew Yglesias’ How Many Votes Have Baker and Dole?
Cohn writes a piece noting some features that could be justified in a compromise, but he doesn’t consider the importance of what’s missing. Volsky quotes Cohn and half applauds the compromise, and Yglesias assumes they must be right, concluding "this would be better than what we have," but asking where’s the support from Republican Senators who actually vote?
Wrong question. Before liberals start whipping the vote for this mess, where’s the logic of how this makes things better? And what happens to the logic with the missing pieces, uh, missing? To unravel this mess, let’s go back to Cohn’s description and his argument that leads the flock over the cliff. First the description:
In its broad design, the bipartisan proposal looks a lot like the plans going through Congress. There is a requirement that businesses pay towards the cost of insurance for their employees, along with a requirement that everybody get insurance. To make coverage affordable and available to indivdiuals and small buisnesses that can’t get coverage now, the bipartisan group would set up an insurance exchange; there, insurers couldn’t deny people coverage or charge them more just because they have pre-existing conditions. People buying insurance through the exchange would also be eligible for subsidies, depending on their income levels.
Cohn then gives the plan the "good enough for bipartisan work" approval:
It’s not an ideal plan, from my perspective. Far from it. But it does demonstrate that when responsible conservatives want to be serious participants in the reform discussion, they can help produce reasonable legislation that would–at the end of the day–get pretty close to providing everybody with decent coverage while starting to restrain the rising cost of care.
I don’t have a clue how this can provide "everybody with decent coverage." But notice what’s missing? There’s no robust public plan that consumers can choose as an alternative to the private plans that would be eligible for purchase in the "exchange."
As I’ve said over and over, a public "exchange" is not a plan; it’s a market place where you choose between plans. It’s not one of the products, and it’s definitely not a public option product. You can only buy private plans in this exchange. So there’s no meaningful choice. Why is this so hard to grasp?
So what do we have left?
1. The insurance companies get the federal government to mandate that everyone must purchase insurance. (Insurance companies 1, consumers 0)
2. There are only private insurance plans available. (Private Insurers 2, consumers 0)
3. The federal government gets states who feel like it to create an exchange to help consumers shop for — and insurance companies sell — their private insurance. (Private insurers 3, consumers 0) [And insurance companies get an extra point in states that don't like federal intrusion]
4. The federal government then subsidizes consumers to help them pay the full premiums charged by the private insurance plans. Insurers win! 4-0!
Does this look familiar? Well, yes, because this is exactly what the private insurers proposed months ago, and are now salivating about. But that deal excluded what Obama and some Democrats proposed: a robust public plan option to compete with the private industry.
The so-called "bipartisan" proposal is exactly what the private industry developed to kill meaningful competion and avoid the possibility that consumers might actually leave the private insurance system and choose the public option.
And how does the insurance "bipartisan" proposal pay for the subsidies? Well since there’s no meaningful competition for the private industry, hence no incentive to cut costs by following the public model, the revenues get squeezed out of the public system and taxes:
They’d try to squeeze $500 billion out of Medicare and Medicaid, another $500 billion from new revenues including a cap on the exclusion for employer tax beneifts, plus $200 billion in some other effiency changes.
It’s one thing to tap those sources within a package that includes a well-designed public plan to create competition and the model for how savings occur while maintaining quality. But it’s quite another to drain the public systems when there’s no meaningful way to draw consumers and their associated revenues away from the private system and into the public system. Follow the money.
So this becomes a real Trojan horse — to cut benefits for Medicare and Medicaid, while causing a $1 trillion wealth transfer, backed by federal subsides from tax payer and public systems to enrich the private insurance industry.
Folks, this is shaping up as worse than the bank bailout. At least the arrogant banks are trying to give the TARP money back to avoid cutting their executive compensation. But here it’s just a government guaranteed tranfer of trillions with no offsetting benefits to the public.
Thank the dogs, dday gets it
Mike Lux/HuffPo, Daschle is dead wrong
E.J. Dionne, Bipartisanship of Fools
NYT Leonhardt chart, via Ezra Klein, More Money, Less Results
Ezra Klein, ideas to save reform, Health Care Reform in Danger (welcome back)
Sam Stein, Daschle statement, and walkback



49 Comments




Because endless repetition has created even in progressive circles the notion that a public option would constitute “real” reform, I’m going to repeat this until I’m blue in the face or banned as a purity troll:
Even a so-called “robust” public option would constitute an enormous sop to for-profit health insurers. It will keep them in place and will inconvenience but not kill them for a host of reasons, foremost that Barack Obama has explicitly promised it won’t. And as long as they are not killed, resources that could save lives and avert personal bankruptcies will continue to be diverted to stockholder dividends, corporate salaries and bonuses, and the unnecessary infrastructure (on the insurer side) to deny claims and the counterinfrastructure (on the provider side) to process and appeal claims.
Public option means private-insurance perpetuation, and that is not real reform.
i agree, although i would add that even with “a so-called “robust” public option” resources will be diverted also to insurance industry lobbyists, etc to push for regulations to make the public option end up the dumping ground for the sick they don’t want to cover.
You may be right, but there’s no certainty on this critical point. Here’s a different way of looking at the public plan.
Assume we decided, tomorrow to adopt single payer. It will take some time to put all the accounting, billing systems in place (and change everyone’s software); set up the oversight/quality control mechanisms and define how they interact with providers/hospitals, etc; define the contents of the health plan covered by sp; establish the tax approach to collect the revenues and get businesses and/or individuals ready to pay those taxes, and so on. All this takes ??? 3 years? 5 years? But you can’t just turn the switch next January and it all works.
Part of that 3-5 year transition could be testing out various pieces. The contents of the sp health plan could be the contents of the public health plan — why would we want them to be different? You introduce the public plan, allow people to start choosing it; you either control the transition or open the gates and try to adjust as you do. Either way, creation of a public plan is a necessary step.
Stuff happens. Stuff you don’t expect. The funding/payment system gets screwed up; the software has glitches and cause delays, providers aren’t ready for the change-over, and/or they balk at being part of a system they may fear. All these things have to be worked through.
The issue that, IMO, is worth debating is whether there is a version of the public plan as option that is a necessary (or useful) step in the transition/changeover to sp. And is it better to say, on date X, 5 years from now, we will more overnight from what we have now to sp —- or, it is better to say, we will put in place intermediate steps that lead towards that date, 5 years from now, and one of those steps is open access to a public plan that has all of the health care elements of the eventual sp plan.
It’s not obvious to me which of these two approaches is better. Both carry risks, especially if this has to be done over major opposition from entities that have trillions at stake.
The health-cost shifting danger is real, which is why any systems that has both public and private options must have a set of accounting rules that avoid the cross subsidies and perverse incentives. Of course, Congress is not even focused on those essential rules; they’re stuck on lowering costs.
See the last Ezra Klein link.
i agree — except about the size of the wealth transfer.
($400 billion a year X 10 years) + $1 trillion = $5 trillion
Is your $400 billion figure net or gross. Is it the “excess” we pay via the inefficient private system, or the total?
i would love to see a public plan be part of an explicit transition to single payer. no stealth stuff though – all above board with the process transparent (even if tentative because, as you say, stuff happens).
maybe something like stark’s public option bill, hr 193? or maybe something else.
but the thing is, that obama and his team have now explicitly said that any public plan they support will NOT lead to single payer. i kinda believe them on this one (as always, hoping i’m wrong though).
yikes.
I agree almost entirely, although I think you overstate the difficulty regarding software and related informational infrastructure, since that’s already in place with Medicare and needs to be adapted and modified (simultaneously with the fixing of Medicare). That, of course, is precisely what HR 676 calls for.
Of course the transition can’t happen overnight and will be messy in both foreseeable and unforeseeable ways. The transitional system may well resemble “public option.” But the commitment to make the transition happen can happen overnight, and I have as Exhibit A, the fact the Obama and Sibelius have committed, overnight, to promising that it never, ever will.
My line in the sand is a public option structured so it can transition to single payer, along with a single-payer trigger — criteria that private insurers must meet by a date certain, or the public plan becomes all there is.
if i understand your question, it’s excess. the excess that we pay in national total health care expenditures because we have a private insurance system instead of a single payer. it might only be $350 billion a year though — i’ve seen both figures.
… this brings up something that gets confusing to me in discussions on costs. total national health care expenditures are something like $2.3 trillion a year. that number is growing on average at something like 4.4% a year. but our gdp, before our current economic crisis, was only growning on average at 2% per year. so while our current spending on health care may be something like 16% of gdp, that percentage is growing in a completely unsustainable fashion.
if we can control the growth of our total national health care expenditures, then that puts less pressure on the components of that budget — fed and state taxes, employer costs (to insurance), household budgets (insurance, copays, coinsurance, deductibles, self insure, etc).
of course we all end up paying somehow, either through our taxes, insurance premiums, direct fee for service, etc. but we still have budgets to keep track of – fed, state, employer and household and it’s because the total costs are so out of control that all those budgets are feeling pressure.
the confusing part, to me anyway, is that frequently i see fed budget numbers written about as though they were the cost numbers that matter. imo, it’s total national costs that matter the most when it comes to comparing different health care systems.
it’s probably obvious, but i should add that i’m only talking about comparing $ costs here. of course i think the number of uninsured and underinsured are where the quality of any health care system is measured.
lots more info on that $350 -$400 billion figure from pnhp:
http://www.pnhp.org/facts/sing…..ources.php
scroll down to “Health Economics and Financing’”
thanks. And your right about keeping the costs straight — Total and percent of GDP not the same as US budget for federally-sponsored health care.
Obama’s mantra is ‘our unique historical system’ and ‘tearing down 16% of our economy’; the ‘historical’ is disingenous and I’m sure someone,somewhere has an answer to the ‘tearing down 16% of our economy’.
I am so disgusted that words escape me for now.
I am not quite sure what may be more distressing right now than a bunch of very well-fed, beaming, rich, of course, white old men telling us all what we all need. Some of us of a certain age have seen that all of our lives…Eisenhower smiling over the golf course…Is that pic the local country club?
I recently reread The Tipping Point. It looks like one of the big problems here, as it is with most progressive social change, is that the Connectors, Mavens and Salesman are not experiencing the problem {shitty health insurance}. Worse, the opponents of real change have the ’stickiness factor’ working for them {governmant is incompetent}.
OT: Just saw Dan Froomkin was fired today. Does FDL have any openings?
Single Payer would provide
http://www.calnurses.org/resea…..y_2009.pdf
Send your FREE fax to the white House and Congress:
http://www.1payer.net/
Insist on CBO scoring of single payer.
http://www.pixelfish.com/produ…..s_cut2.wmv
You can’t expect progress or reform to come from those within government.
It can ONLY come from the people.
We are constantly expecting congress critters to represent the needs / will of the people. They don’t, they won’t and they will lie and put on dog and pony shows to get elected and then do exactly what corporations want: GIVE THEM YOUR MONEY.
According to Ezra Klein, there is no public option contained in the Finance Committee’s Health Reform Outline.
http://voices.washingtonpost.c…..mitte.html
If you have a Blue Dog or New Dem for your rep, get everyone you can persuade in his district to call and instead of asking for a strong public option, demand a single-payer system that will root out the insurance gouging. Our battle-cry now is “Insurance gouging”. That mantra has to be as much in public discourse as the insurance company-AMA line “government takeover”.
What do you want?
An end to war?
A Public Option?
What do you want?
Whatever it is, you WILL not get it.
Your response is to vote for more and better Dems.
IOW, to be a sucker.
Or to rebel.
From the April issue of Harpers (not online yet but at this link)
from the PNHP’s blog header
Aren’t all 4 of these guys unelected losers? Why do they have any say at all?
Actually, the public option should possibly be viewed as getting the nose of the single-payer camel under the edge of the corporate-greed-tent. That seems to be how the HMOs and the insurance companies view it. They seem to be terrified of actual competition from a large not-for-profit player being allowed into the health insurance business.
Also, the economic shock and dislocation of going from a private corporate health care system to a universal single-payer not-for-profit federal plan seems to be left out of any discussion that I have read on the progressive side. Hundreds of thousands of clerial workers at HMOs, insurance companies would lose their jobs. Can anyone please explain how this transition would be accomplished without it being another rude shock to our sad economy?
Tom Daschle seems to be happily capping his years of public service as progressive with a topping of whoring for the greedy private insurance companies. Heck of a job, Tom…
that’s just not true. for example, from conyer’s faq on hr 676:
I’m being brainwashed into believing George Bush had a better plan for healthcare.
imo, we need a general strike or a massive march on Washington. For me, universal health care is about economic justice and human rights for all Americans comparable to the civil rights struggle of the 1960s. I keep thinking of Martin Luther King’s “I have a dream” speech of August, 1963. The Bull Connors now are the political class in DC in both parties, and the Ferengi health insurance industry.
The number of people who die every year from lack of health care is equal to 62 9-11’s.
Corporate terrorism will continue under this plan.
I’m afraid that is what it will take, including a lot more civil disobedience. (And I’d say Cardassian more than Ferengi.)
The audacity of the con.
The numbers in the revised senate financing committee as forwarded by Ezra Klein’s column are indicative of unaffordable premiums and higher thresholds for subsidies. I guess they had to cut coverage and increase subsidies to make the whole deal come out to one trillion dollars over 10 years. Here’s the link:
http://voices.washingtonpost.c…..id=topnews
I am sorry but I could not get the link device to accept the above address.
“And I’d say Cardassian more than Ferengi.)”—-eggsactly
Absolutely. I stand corrected.
Exactly. If you start with a highly inefficient system, then to cut costs you have to cut coverage and/or subsidies. But see this view of how to avoid it, also from Ezra, via Yglesias:
http://yglesias.thinkprogress……reform.php
But also remember the point selise has been making. There are two sets of costs to worry about: the cost to the US budget, which has to cover medicare, medicaid, subsidies, etc and the costs to the total economy for health care.
What the Finance Committee is doing with its “cuts” is chasing the budget tail, but it’s hurting the economy dog.
It’s simply shocking that this isn’t just laughed out of the place. Man, you guys are fucked.
this is where i get confused…. if i understand matt and ezra, they are referring to the commonwealth report that shows, in figure ES-4, that only the stark plan lowers total costs. so i’m guessing that they are actually discussing the fed budget numbers and not total national health care expenditures?
or maybe i’m looking at the wrong report? or misunderstanding in some other way?
No, we’re on the same page. I think
Finance/Baucus is trying to get the impact on the federal budget down to $1 trillion or less. But to do that, he has to cut M&M more, reduce eligibility for subsidies of premiums for plans bought through the exchange, which will result in less coverage, because people can’t afford it. And without any strong federal push to make private plans to be more efficient, and their providers to reform their compensation model, etc, their costs don’t go down, they keep rising.
So while Baucus’ cuts reduce the effect on the budget, they hurt the economy by failing to control health care costs nationwide. That’s the argument I’m making. Budget numbers may look better, but the total economy numbers become worse, and that’s a foolish trade for the overall economy and consumers.
selise — note the summary tables comparing different plans for
1. Covering uninsured
2. Effect on budget
3. Effect on national health care expenditures
http://www.commonwealthfund.or…..erage.aspx
Yglesias picks up on this here:
http://yglesias.thinkprogress……reform.php
i completely agree.
yup. i think we’re looking at the same things.
1. matt’s post has the figure i was referring to, ES-4, that is included in a couple of diaries i’ve x-posted here from drsteveb:
DrSteveB: More Medical Bankruptcy – Have Insurance, Go Bankrupt
DrSteveB: Strong Public Option: 100% Coverage & Cost Control
the only thing i disagree with matt about is that stark’s plan isn’t just the best at controlling total costs – it’s the only one, of the plans included in the study, that controls total costs.
drsteveb posted some good background on that commonwealth study when it came out: The Most Complete & Honest Comparison of Health Proposals
2. and the table i think you are referring to, is in the first of drsteveb’s diaries above.
…..
i commented on another of your threads what i think we should be demanding congress get from the cbo:
Yes, all the proposals should be scored. But they should update the list to include Rockefeller’s.
The problem now is that these people think they have proposals, but most of them are not complete, and the missing pieces have major effects on the tradeoffs between budget vs national economy effects.
One example? Since employers are contributing to their employees’ premiums when they provide health insurance at work, what happens when a group of employees says, “we want the public plan” (or open access to Medicare). The employer would like to say, “fine, and I don’t have to contribute to that,” but Hacker is saying, “yes you do; otherwise we’ll have incentives to make uneconomic choice, cost-shifting, etc)
That disagreement appears under the name “pay or play.” It says to the employer, you must contribute to the health care (or insurance) costs of your employees. You can contribute to their premiums if your company has a plan, or you can contribute to the fund that pays for the plans your employees purchase elsewhere. Pay or play.
The senate Finance committee is debating this.
Single payer helps us think about this more clearly: everyone gets health care. There’s a cost, so we have to collect revenues, via taxes, etc. We can tax individuals and/or businesses via payroll taxes, tranactions, value added, whatever. Those are tax adequacy and equity questions, which can be completely separated from the health coverage issue. Once we attached them to employment, for any reason other than it being a simply collection method, we run into cross-subsidy problems, and that’s where the senate is stuck. Absolutely predictable.
The easy path:
Provide the care
Count the costs
Implement quality/cost control
Collect the revenues
Allocate to providers
Our Congress is insisting on making this an order of magnitude harder than it needs to be.
“Trojan horse” is the key name for Obama actually. He was vetted and groomed and then rolled into Washington. So far we got the finance sector coupled with corporations presiding over final takeover of the monetary system. As Kevin Baker’s says in his new essay in “Harper’s, we are seeing the final stages. After”gobbling up previously public sectors such as health care, education, and transportation” that the “new class”–the makers of the paper economy” achieved over the last 20 years, there is no way they are going to cede any ground.
For the education part of this final takeover read Bruce Dixon at Teachers File Racial Discrimination Suit
Shock Doctrine continues.
turns out that drsteveb has a great diary this week over at daily kos that addresses the point we were discussing re total costs, fed costs and the cbo report. wish i’d read it before, would have saved some head scratching.
anyway, here it is: The CBO analysis we really need
i’m going to cross post it here this weekend, but first i think i should post a diary with a bit of an intro re the gdp stuff in my comment @10.