Et Tu Howard Dean?
Howard Dean caused quite a stir when he said “kill the bill.” A lot of people trust Howard Dean and the reaction from the White House was anger. Dean appears to have had a change of heart. He’s still not a fan of the bill, but he’s saying that the manager’s amendment has improved the bill and let’s see what happens in the House/Senate conference.
This morning, Howard Dean walked back from earlier statements encouraging Democrats to “kill” the Senate health care bill. On Thursday, Dean wrote that “this bill would do more harm than good to the future of America,” but during his appearance on Meet The Press, Dean argued that yesterday’s manager’s amendment significantly improved the legislation. “My position is let’s see what they add to this bill and make it work,” Dean said:
Well, let’s start with the positive things. Over the last week, there were things that were improved. There were some cost containment mechanisms that were gutted. They got restored. I would certainly not vote for this bill if this were the final product, but there are, the House bill is quite a good bill. This bill has improved over the last couple of weeks, I would let this thing go to conference committee and let’s see if we can fix it some more…so there are a lot of things that need to be fixed, but if they are fixed you may actually get the foundation of a bill, coming out of the House. If most of the House provisions survive, then we can have a bill that we could work with…I don’t think this is the compromise that has been achieved. I think we have yet to see the compromise that could be achieved.
To me this says that the focus from activists on the provisions that are left in the bill is working. If we keep up the pressure perhaps we can get something even better out of the bill. Keep working, keep up the pressure and let’s get the best bill we can get.
Tags: Health Care Reform, Howard Dean
The Manager’s Amendment includes new stuff or stuff that got put back in:
*Caps on insurance benefits are out.
*The Wyden Amendment is in.
*Insurers have to pay 85%+ of their premiums in care, with a mandated rebate to customers if they fall below the 85% threshold.
* Hospitals need to provide public info on how much their services cost.
*Insurers in the Exchange have to prove yearly performance data publicly.
*The 5% Tax on cosmetic surgery is gone and a 10% tax on tanning services is in. The White People Tax. I’m totally in support of this. 😉
Karen Tumulty over at Time writes about some of the cost containment measures added back into the bill via this Manager’s Amendment.
You can see the CBO report on the amended bill here.
The Godfather of the Public Option — Jacob Hacker — writes a defense of the bill without the Public Option in the TNR. Key points, but read it all:
OH NO!!! I just fear whatever they pass–those who don’t know healthcare–we will be stuck for A VERY LONG TIME with unintended consequences, gold-plated boon-doggle initiatives, and either rigid parameters of care, or floodgates of funding and reimbursement for oft confusing quality vs. quantity of life–or to others quantity vs. quality of life.
IMHO–Just legislate like the tax code–not all at once–and add as you go, and we run into pervasive problems. Start w/ public health issues…should citizens have the right to vaccines?…and free? From a PH standpoint yes…all agree…make ’em free then. Should citizens have access to all birth control methods?…and free?…again PH standpoint…all together now…make that free. Should citizens have organ transplants? Umm…..put that in the why you need health insurance pile. Health care is a resource—and a costly one–make your choices of what you are willing to pay for. Nursing home care—age is inevitable for a majority–pay for care (room, board,comfort services), you want resuscitative intervention?–put that in the health insurance pile TBD. I would go on and on that way. I hope Dean doesn’t lose his way. We may be a prosperous enough country to cover basic health coverage for our citizens, but the reality is our high tech, high demand, high complaint society needs to pony up for the health care specific to their choices of desired perceived outcome. Cover the well, and promotional healthy life-style. Get the insurance for the nasty stuff–your choice of afflictions, or the full buffet. And no pre-existing clauses…..
It is like some of you guys go out of your way to ignore substantive reviews of the sucky parts!
Dean means it when he and the union heads say that a few things are going to have to shift in conference. But it is looking like Reid’s crafted 60 won’t allow for any wiggle room at all. Who knows if House progressives will balk, hold out for deals like Nelson’s and Landrieu’s or just hold their noses and vote.
Many are calling this Senate deal on par with Walmart insurance – yes, everyone will get insured but not everyone will be able to afford to actually use the health care because there’s no controls on ancilliary costs. There are a lot of people out there whose earnings leave them no ‘cushion’. Best hope is to regulate hc insurance like a utility and barring that, keep trying to put progressive DEMs in the Senate and fix this down the road.
Here’s some information along those lines:
http://firedoglake.com/2009/12/20/david-axelrod-claims-health-care-bill-will-make-insurance-affordable-for-everyone-no-it-wont/
“As Marcy Wheeler has diligently demonstrated here, here, and here, that’s simply not true. Not only will the uninsured not be able to afford the insurance, affording medical treatment with that insurance, as Marcy notes, is a completely different matter.
And if Axelrod thinks the poll numbers are bad now, just wait until your average uninsured middle class family is forced to fork over a chunk of their income to the insurance companies, while the medical treatment they need will still be beyond their reach.
It’s also pretty irritating that Axelrod blames the GOP for holding the bill hostage while Lieberman and Nelson have been doing exactly that. Weak tea.”
And, if you haven’t read this hair-raising Harper’s piece…its some fucked up administration sell outs we have up in here.
http://www.harpers.org/archive/2009/12/0082740
Nancy,
I’m reading all I can about the bill. I think keeping up the substantive criticism is important because it’s helping make the bill better.
I agree we won’t see many changes in the bill in conference because it will still have to get through the Senate. I’m sure we’re going to preserve the status quo, that most of our health care will come through for-profit health insurance corporations but we were always going to. The public option that we might have gotten was very weak.
Just because we didn’t win this round doesn’t mean we won’t win later rounds. We have to keep pushing. I think the unexpected blowback on the Democratic leadership will have an effect. We’ve definitely moved the ball down the field and we have to keep fighting.
Another interesting post by Nate Silver at 538 which will no doubt cause a lot of controversy. He talks about how some progressive bill-killers have adopted rightwing frames in their talking points (Jane Hamsher in particular). Another illustration:
Al Giordano weighs in. I’m still processing his take.
Nate’s article is bang on the best analysis of where we are and the risks (and process) of all of the efforts to still add a Public Option to the Senate bill. The kill the bill group has a list of wants but no pathways to get there that don’t require a much more complex and much more risky pathway than the one that Reid mapped out.
And the post from Giordano is classic from him, but he too, is an old hand at organizing and knows that getting what you want means getting set up to ask for it ALOT.
I was just reading that pandora. It matches some of what I feel we’ve been seeing. Some people are angry because they wanted corporations punished.
Senator Feingold gets in some snark criticizing President Obama for the failure of the Public Option.
I still don’t get why the Democrats never seriously considered the bipartisan Wyden Bennett plan. Why do they hate real reform and bipartisanship which could have gained 75 votes? It is all about control. WB did not give the government enough power over our lives.
I doubt you’re actually interested in the answer to that question — after all, you supply your own, typically ignorant answer. If you’re truly interested, look it up — there’s plenty of thorough analysis out there. Mostly it boils down to the fact that WB would put Medicaid and SCHIP in peril, and that low-income people would face premiums they couldn’t afford — ironically, one of the complaints of those facing forced insurance payments under the currently debated plan.
Where do you people get the notion that Democrats want government to have power over people’s lives? Why are you so blitheringly stupid? I realize that hating government is one of the central organizing features of your life. It does not automatically follow that, because we disagree with you, we therefore must organize our lives around loving government. We don’t like it either. The difference is that we don’t love private business to the point of overlooking its shortcomings, as you “conservatives” do.
“Some people are angry because they wanted corporations punished.”
Is “punished” the same thing as “not rewarded”? Because I don’t care if they’re punished, but it pains me to see them rewarded as the price of extending health care to the uninsured. Read Glenn Greenwald on this for a thorough airing of the anti-corporatist argument and why this bill is anathema to progressives worried about corporate takeover of both parties.
Glenn is quite abit late to this corporate takeover of both parties. Barack Obama and many other Dems raised huge sums of money from corporations — some even from corporations that would normally be repub donors. NOT ONE of the people getting their anti-corporatist colors on found very little troubling about these corporations providing a river of money to a Democratic electoral wave.
Not to say that I approve of the fact that the corporatist were functionally able to buy 4 votes to stop a public option or even to buy enough votes on both sides of the Congress to water down what is going to be passed. But if you are not interested in a corporate take over of your party, you push back on the corporate funds that are helping you to get to some of your electoral goals too.
Geezer,
Those are legitimate criticisms. Unless we get some kind of public financing of campaigns it will be hard to combat. The current make-up of the SCOTUS is about to loosen campaign financing regulations a lot so I don’t see that happening. Progressives had hoped that they had found a new model with many small dollar donations to Obama but I still think the problem is that no one actually “speaks” for progressives so they just aren’t getting heard like other big money people.
Here’s a link to the Glenn Greenwald article that Geezer mentioned. An excerpt:
the Obama administration has chosen the strategy of deploying regulated and subsidized private sector entities to achieve progressive policy results.
A taxpayer subsidy of corporations cannot be called a “progressive policy result.” At best it is old-fashioned liberalism: “throwing money at the problem” which rightly earned Democrats scorn from its former base (Reagan Democrats) and a thirty-year exile.
Progressives support social insurance over corporate subsidy because it it is a better institutional structure for delivering the result.
Cass: Glenn’s been writing about the issue since he first took up keyboard. I just wanted to direct eyes there because he sums up the anti-compromise position pretty well. Personally, I’m still undecided.
But it does kind of hack me off that, despite being willing to pay for this in higher taxes, I must also, in essence, pay off the insurance industry before they’ll let me pay more to help the poor.
Geezer-you make some provocative statements. I too agree this is not the time to seek the spirit of punitive damages of healthcare havoc, on the back of almost cooperative negotiating. Sometimes you just have to cut your losses, and go forward–committed not to redo what has been done before. Let big corp pander to the American public, of what they can offer in healthcare and at what price. Those who want govt. contracts can specialize that way if desired–like Unison, Prison Health Care, Amerihealth. However, I still say some coverage should be considered basic, driven to a public health, living in “America” model. It’s type of care and perceived outcome that people should be insuring. We provide mass transportation–Americans pay for the upgrade from there. Some physicians and patients are already coming to that decision–boutique practices, where patients pay a yearly premium to have that individualized, focused care and health management/navigation. They value timely appointments, and one “fixed” captain, hence are willing to pay for it above what the ridiculous capitation amount is given to the doctor. What people aren’t prepared for is healthcare is VERY EXPENSIVE to maintain at the levels this society DEMANDS. This is why, I think if you want it–you pay for it–or priortize your budget/spending to pay for it. But, I don’t agree w/ probably 60-70% of healthcare intervention in many areas–so I’m really not wanting to fund many of these big-ticket–end-of-life-heroic–Hail Mary–take me piece by piece–never have another good day of life these interventions cost. Everybody fights death, but dying costs a whole lot more than maintaining a comfortable living.
Geezer, I’ve been reading Greenwald for a veylong time and greatly admire his work. Nonetheless, the time to critize the money is when it is being raised and few do that until it suits. But it likely won’t surprise you that I don’t think that state of affairs will change any time soon. There is a job now and lamenting the current stste does not get you there. And the progessive job is if they can buy 4 votes, you have to buy 5.
As I noted above, the manager’s amendment adds more regulation — 65% ratio isNOT to be sneezed at — and some real beginning regulation is a good thing.
I read the funniest take ever on how progressives like Jane Hamsher are ‘taking right wing frames’ on DKos comments in reference to her ‘siding’ with right-leaning libertarians on auditing the Fed. Riiiiiiight.
Jon Walker has his rebuttals up. He deconstructed Ezra Klein’s wishing away Obama’s broken campaign promises.
He goes after Nate here: http://fdlaction.firedoglake.com/2009/12/21/removing-the-individual-mandate-would-reduce-the-cbo-score/
I read through Nate’s piece and laughed to read how he justified Bush’s use of reconciliation for a ‘popular’ cause claiming that health care is not popular. This from the stat man?
~
Nate claims that reconciliation was doable because “The Bush tax cuts were popular; health care is not” – wrong Nate.
Regardless, what health care reform polling reveals is beside the point!! The government knows that ‘doing the right thing now’ will not only stem a worsening affordability issue (and therefore accessibility issue) but it is key to the economy recovery.
Americans’ health vs health insurance profit is the issue.
Reconciliation is the right thing to do. It is a pity that pundits are throwing in with the HIGH DEMs so readily. So awkward.
Nancy, we can hope:
1) The House progressives refuse to go along with the Senate bill and they get a public option or Medicare buy-in put back in
2) The Dem leaders use reconciliation to get a public option or Medicare buy-in through quickly after this bill
3) Obomba actually develops a spine and some leadership as President
Unfortunately, all 3 are equally unlikely. I think Obomba and Reid are becoming the political equivalents of Bush and Delay for the Democrats.
comment is awaiting moderation.
“Nonetheless, the time to critize the money is when it is being raised and few do that until it suits.”
This is a red herring. Do you really think Tom Carper votes against poor people and for corporations just for the donations? Don’t be silly — it really isn’t that much money. He would do it for free, too, because IT’S WHO HE IS. The folks Nancy likes to call “high Dems” are in it for the power and prestige, not the campaign donations. And if they couldn’t make donations, they would keep right on lobbying for their interests.
If the Democrats solidify their status as GOP Lite, you can kiss any progressive agenda goodbye.
It isn’t a red herring. Your party gets bought when the money gets raised. The usual suspects don’t spend their energies exhorting others not to vote for Democrats because they are bought by the corporations, but don’t mind asking Dems to kill a bill because they think it buys off a pol. If you are worried about corporate influence, now — just before a bill is ready to be passed it a bit behind the curve.
Um…I’m always worried about corporate influence, but I think campaign donations are the least of it. Seriously, do you think Carper does it for the money? I don’t.
I have consistently questioned what was being put together, and it’s pretty clear that industry has exacted a high price for our charitable impulse of wanting coverage for all. Pharma got a big gift for sitting out the fight, the insurers will come out of this better off than they went in. Meanwhile everyone must pay in, except not in the progressive manner they would via taxes — instead we get the regressive method of everyone, rich and poor alike, paying insurance premiums, amounts to be determined. Plus, naturally, passage comes at a high political price — no good deed goes unpunished.
Sorry, but that’s a lot to swallow for a program that will improve neither my health care nor my insurance. I don’t mind paying for the health care for others; I intensely dislike paying for inefficiency and corporate profit.
Also worth considering: Single-payer has to be off the table in a recession, because we can’t afford to lose the jobs. If this had happened back in the ’90s, those workers would have been absorbed by expanding companies. It’s not likely we would face the same economic conditions four years from now.
The whores will do what whores do; let’s not dicker over price. The question is what (if anything) we do in response. The question Greenwald raises is whether this sort of triangulation is particularly bad in this case at this time, and works against the progressive movement’s long-range goals. I think there’s a case to be made in favor of that position, which is not the same as agreeing with it.
Geezer, I am with you on this one.
More from Walker’s post above – the Wyden amendment does not control costs:
Sliver’s health care continuum shows a lack of detailed understanding of the subject. He ranks the Wyden-Bennett bill on par with single payer. This is simply a conclusion I don’t think can be reached looking at the facts available. (It is arguable that the Dutch or German health care system might be on par with single payer, but Wyden-Bennett lacks many of the critical cost control mechanisms found in those systems.)
Ignoring that most of Wyden-Bennett supposed “savings” come from failing to properly index the subsidies, its basic goal is to put every American on the FEHB exchange of private insurance plans. The problem is that the FEHB and private insurance companies are a proven failure at reducing cost. Health care costs on the FEHB have grown at the same rate as the rest of the market. On the other hand, it cost roughly 25% less to insure someone with Medicare than with private insurance. Wyden-Bennett might result in a minor reduction in health care spending. Medicare-for-all would cut our health care spending by roughly 20%, and do a better job of slowing our health care growth rates. There is no comparison.
If Silver thinks Wyden-Bennett is as good as single payer, it is no wonder he tries to diminish the importance of the public option. I think a public option is critical because all the data indicates public insurance has done a dramatically better job at controlling health care costs than private insurance. I think his continuum is all wrong. The reform bill with a truly robust public option (Medicare buy in) would rank dramatically above Wyden-Bennett. A Medicare buy-in that would be around 11-25% cheaper than private insurance companies. It would have a much better chance of reducing health care spending than any system of private insurances exchanges that lack a central provider reimbursement negotiator.
http://fdlaction.firedoglake.com/2009/12/21/removing-the-individual-mandate-would-reduce-the-cbo-score/
Last-minute limit on insurers:
http://www.samefacts.com/2009/12/uncategorized/medical-loss-ratios/
Hey John, can you tell me another business where the government acts as a collection agency and lets them raise rates to guarantee a 15-20% profit?
Can you tell me another investment that the government guarantees me a 15 – 20% profit?
And who says money spent on insurance lobbyists isn’t the best investment in the world?
“can you tell me another business where the government acts as a collection agency and lets them raise rates to guarantee a 15-20% profit?”
If I had to guess, I’d say car insurance — unless you’re counting that as the same business.