How Progressives Have Shaped Health Care Reform
We’re now in the final stretch of the health care reform battle. Within the month we’ll either have a vote or the Democrats will give up on health care reform for the near term (or make some tiny improvements). President Obama is out giving a strong defense for the need for health care reform (many of us would have liked him to be this forceful earlier). Now that it’s in the final push, we need to make sure that our legislators know that we want health care reform and not let the argument get dominated again by the forces of crazy.
Chris Bowers at Open Left has a post about how progressives helped shaped health care reform for the better. Don’t lose sight of the fact that despite the fact that progressives lost a battle (public option), overall we’re winning the war. We can’t win the final war without pushing the bill over the finish line.
By comparing the current state of health reform legislation to the most conservative proposals that were passed out of Congressional committee, a healthy list of concessions progressives forced out of the right-wing of the party becomes visible. If there were no alterations from the most conservative health reform proposals that were passed out of Congressional committees in 2009, then the current state of health reform legislation would have:
1. $125 billion less for Medicaid, CHIP and exchange subsidies (total across all three programs);
2. Numerous exceptions to Medicaid eligibility even for people below 133% of the federal poverty level (FPL from here on out);
3. No minimum medical loss ratio for health insurance plans, instead of an 85% minimum medical loss ratio;
4. The Stupak amendment, instead of the Stupak state opt-out that is in the Senate bill;
5. No extra money for federally funded Community Health Centers, instead of increased funding to provide primary care to 16.2 million patients annually;
6. An excise tax on high end insurance plans would start in 2013 (giving most unions no time to renegotiate contracts), and a lower threshold (making it less progressive);
7. No 2.9% tax increase on unearned income, making the funding mechanism for the overall bill less progressive;
8. A stronger individual mandate and fewer responsibilities for employers;
9. No national exchange, instead of what appears to be both a state-based and a national exchange in the proposal form the White House.
Bowers has a scorecard of sorts over the big fights that occurred in the health care reform bill. Here’s his list of the top 10 fights and their results:
1. The public option – conservaDem victory
2. Repealing the health insurance industry’s anti-trust exemption – conservaDem victory but pending (repeal has passed the House)
3. Instituting a minimum medical loss ratio for insurance policies – mostly progressive victory
4. Expanding primary care in low-income areas through Community Health Centers – mostly progressive victory
5. Medicaid expansion – even
6. Exchange subsidy levels – mostly conservaDem victory
7. Tax structure for funding the bill – mostly conservaDem victory
8. Insurance exchange structure – unclear
9. Reproductive rights – mostly conservaDem victory
10. Mandate – mostly conservaDem victory
Tags: Health Care Reform
Kucinich just announced he’s willing to be the deciding vote *against* health care reform.
Okay… so how does Kucinich get his version of HCR passed? I know he supports single payer (as do I) and if he has a plan – and the votes – for making SP a reality I’m all ears. Look, I understand what everyone wants. What I’ve yet to see is how we actually make that happen.
UI- that is unfortunate, to say the least. Just yesterday sites like FDL and DKos were filled with hope that the Senate would provide a sidecar fix and the House would vote in the Senate Bill. Who would trust the Senate to follow through?
Here’s a recent tweet that probably describes where DK is coming from
ggreenwald
Digby, on the demands that everyone join together to praise the Senate HCR bill, and those who don’t are deeply flawed http://is.gd/a29YB
What’s unfortunate?
The current path has Pelosi doing two things right now: 1) Rounding up votes for the Senate bill and 2) writing the Senate’s reconciliation bill. Apparently she will send the reconciliation fixes to the CBO for scoring and look for public commitments from the Senate to vote for it. Sort of a Trust but Verify exercise.
They still may not get there, but Pelosi is working to get it done and apparently setting up the Senate to take the fall if it doesn’t.
The most important thing to keep in mind is that, by far, the biggest progressive victory is the fact that we’re on the cusp of passing the biggest piece of progressive, social legislation in most of our lifetimes! It’s sad that this basic fact gets too often overlooked by many of the same people who should be celebrating the realization of a long-held Democratic priority. Is this bill perfect by just about anyone’s reckoning — no. Not by mine, either. But it’s far better than the alternative, which is no bill and a continuation of the unsustainable status quo. This is something that I think too many people forget.
Gee Cass, you listed all kinds of things that Pelosi is doing but elided the point of my comment ‘unfortuate’: that Dennis Kucinich has decided to ‘fall on his sword’ for HCR.
I see that this divide –as typical– is a featured DKos topic with over a thousand comments http://www.dailykos.com/storyonly/2010/3/8/844213/-Open-Letter-to-Michael-Moore,-Kucinich,-Jane-Hamsher,-Howard-Dean,-Arianna-and-the-rest:-UPDATE-3X
Blame blame and more blame.
I am fully in support of people who are writing about what needs to be fixed in the Senate Bill and fully support House members who would refuse to vote for the Senate Bill without a fix. Woman’s reproductive rights being thrown under the bus is a non-starter along with a myriad of issues that the Senate Bill brings to actual progressives.
My prayers will go to Pelosi on her ‘path’. The Senate can do this. The House can do this. DEMs can get beyond where the horrid process has brought us thus far.
I assume the “kill the bill” caucus thinks status quo is preferable to the current bill, even with the reconciliation fixes.
As far as I know the reconciliation sidecar strategy is still going strong. Right now Pelosi is having to whip votes in the House. However, if the progressives are going to hold out it will have to be the Stupaks and the other Blue Dogs. I’m not seeing how this makes the bill better.
No UI, you should absolutely not asume that. The ‘kill the bill’ crowd -if you mean Jane Hamsher, Markos M. and Howard Dean– are on-the-record in support of the Senate Bill with side car through reconciliation.
*
If by progressives hold ing out you mean Dennis, he is way farther out in left field than most and his statement made at this time is –i repeat– horrible or at the least, unfortunate.
I don’t have any problem with people fighting right to the end to try to fix the deficiencies in the bill. That’s great. There’s things I’d like to see changed, too. But realistically, we’re not ever going to end up with something that makes everyone happy. There’s far too much diversity in the Democratic Party today for that. But what everyone has to ultimately decide, when we get down to the end and we have a final product is, “Is this bill, with all its flaws, still better than what we have now?”
but elided the point of my comment ‘unfortuate’: that Dennis Kucinich has decided to ‘fall on his sword’ for HCR.
Gee, Nan, if you had made clear what you’re comment was referring to, all of us reading at home would have gotten it. It isn’t as though UI didn’t post up alot of information here.
The idea behind “killing the bill” is not to preserve the status quo, but to make the Dem establishment use their power to come up with something better.
The problem with that approach though, is that the Dem establishment prefers the status quo to a better bill. They would rather give up and blame progressives, than lift a finger for a public component to the bill. Dem leadership is playing a game of chicken with progressives.
It was perfectly clear as a response to UI’s comment immediately prior. Any logically-minded read-through would have affirmed that.
Cass, your premise is that there must have been something in the body of the post itself that would have evoked a comment like “that is unfortunate” from me?
WTF???
You and DD have thin skins and a real unseemly intolerance of the slightest retort or critique.
/keep on truckin’
I’m with you, Scott, fix what you can, get it all over the fence and start working on strategies to improve it now. Because the thing that gets lost is that this is still an election year, and one thing we should be asking Dems who want to be in Congress is what commitments they will make towards making the major fixes that will get this closer to what is needed.
AGREED – anon @ 10:04
I think there’s another important point that gets lost here, too. The House vote, the reconciliation vote, and the signing ceremony are NOT the end of the process. They’re the end of the beginning. Imperfect or incomplete parts of the bill can always be changed or augmented later. This is how social legislation usually grows. Get a good, solid basic program, then over time improve it. To me, saying you wouldn’t vote for this bill because of reproductive issues or the lack of a public option is like saying you wouldn’t buy a house you love just because the bathroom is a God-awful color of pink. Buy the house before you lose it to someone else, THEN paint the bathroom. (And maybe redo the tub — it looked gross.)
. Imperfect or incomplete parts of the bill can always be changed or augmented later.
In theory, yes. But now the insurance and pharma lobbies will be flush with taxpayer cash from tens of millions of new customers, which they will be free to spend on uprecedented levels of lobbying. I wonder if those two things were not a coincidence.
For an example of “Fix It Later FAIL” look at Medicare Part D. The left said “It helps lots of people, and we can always add price negotiation later.”
Now it’s “later.” And instead of enacting price negotiation, we are talking about filling up the donut hole with taxpayer money at full retail because “it helps lots of people.” And we are still arguing we will fix it later. It’s like the friggin’ Groundhog Day movie.
Since when is “it helps a lot of people” reason to run away? Yes, this bill helps a lot of people. If someone can show me that the final product, on the whole, on its own merits, does more harm than good, or can show me a workable strategy to get something better in the near future, I’ll join the “Kill the Bill” brigade.
The current hcr bill closes the Medicare Part D donut hole. Yes, we still don’t have negotiated prices. That’s something to keep working toward.
In theory, yes.
This is way that this stays in theory is if progressives fold up their tents and go home if this thing passes. Which I gather is the current strategy. The really smart play here is to identify what you really want to change (make it a few big things) and start pressing 2010 candidates for commitments to make those happen. Altho those fixes aren’t likely to happen in the 2010 class, you’ve gotten set up to ask for commitments from the more important class — 2012 including President Obama. Right now is when you start working towards him showing up at NetRoots Nation to make a commitment to passing a real public option or whatever.
Cass.. so are you saying the onus for “fix it later” is on progressives? I think the onus is on those who are now telling progressives to sit down and shut up.
Without public health care, what victories can progressives look forward to? Health care and progressive taxation are probably the two biggest issues for progressives. If the tax cuts for the rich creep back in after expiration, there’s not much left for progressives to be happy about.
And it’s not like progressives are being purists. The public option itself is a compromise. And Obama never promised a completely clean expiration of the tax cuts for the rich (dividends are only partly rolled back).
At some point progressives will need to draw blood in order to be taken seriously.
Progressives should take comfort that the country is a lot more progressive than the political establishment. So there is plenty of room to push Obama and the Senate to the left, closer to where the House is, without damaging the Democratic party. In fact the party would be stronger with a good shove to the left.
The current hcr bill closes the Medicare Part D donut hole.
Liberal.
Yes, we still don’t have negotiated prices. That’s something to keep working toward.
Progressive.
Yes, we have a long way to go before the Democratic party is actually progressive, or I would add, liberal.
Here’s some incentive to get health care reform passed: “Limbaugh vows to flee the country if health care reform passes.” The country he named: Costa Rica.
EXCELLENT NEWS.
Maybe you should hear exactly why Dennis is opposing this bill:
http://rawstory.com/2010/03/defiant-kucinich-rips-health-bill-insurance-industry-bailout/
The Senate HCR bill without a public option isn’t “better than nothing” – it is worse than doing nothing. Go Dennis!
WMD 2002 = HCR 2010. Obomba lies while HCR dies.
You know, it really is too bad that you are completely ignorant of the history of Social Security or Medicare or even the effort by wingnuts to overturn Roe v Wade. Neither Social Security or Medicare are the same programs as originally passed. Each has gone through multiple rounds of improvements — some small and some big — but each program evolved because people who cared about making them better kept at it.
The wingnuts trying to eliminate Roe v Wade certainly have not folded up their tents and gone home when they couldn’t get that single goal done. What they don’t mind is nibbling at the edges and weakening laws and women’s rights. They take their victories large and small and keep working towards their goal.
Change is always and everywhere the responsibility of those who want it. And there are real lessons for progressives to learn in this thing. Which is why I am for getting this thing done and setting up a strategy to extract commitments for specific improvements from people running for office in 2010 and 2012.
Cass.. so are you saying the onus for “fix it later” is on progressives?
Unfortunately anon, the burden is always on the people who want change because the institutional advantages of the status quo are very high.
Unfortunately anon, the burden is always on the people who want change
That kind of chips away at the argument to sit down and shut up now. “Fix it later” should be a joint commitment, promised in exchange for progressive support now.
It won’t do to just say “Sure, go for a public plan later, knock yourself out.”
Hey, I’m for passing the bill and for “knocking myself out” for the Public Option! Actually, I think most “pass the bill” people don’t see this bill as a reason to stop fighting. I think we view it as a starting point in HCR, something to build on and something to keep fighting to make better.
cassandra_m and pandora, I’d love to agree with you about incremental improvement like you cite with SS and medicare, but this bill is a not even an incremental improvement. It is a bad bill for the reason Dennis cites and more. Extorting money from families by government mandate to fund insurance company profits, marketing campaigns, and lobbyists instead of going to pay for actual healthcare for people is repugnant and wrong. People will be forced to pay for insurance company profits even if they then can’t afford to get actual healthcare because they can’t afford the high deductibles. It seems to be lost in this debate that being forced to buy health insurance doesn’t guarantee that you’ll actually be able to afford health care.
Furthermore, Obomba, who campaigned on the public option, is not pushing for it now even though it has overwhelming public support and 37 Senators have signed on to supporting it through reconciliation.
I respect that you disagree, but I applaud progressives who are willing to kill this bill unless it contains a robust public option.
“I respect that you disagree, but I applaud progressives who are willing to kill this bill unless it contains a robust public option.”
But they won’t!
Seriously – in Obama’s plan what is the mechanism for providing coverage to all these 30 million or so people?
Here’s what I got so far:
That sounds like the status quo to me – if you can’t afford insurance you don’t buy it.
Aren’t we all already eligible for such plans?
and…
A tax credit? Let me guess – a check cut directly to the insurance company?
What is the means test? How do you apply? Is this tied to the 8% of income thing, the people who are already exempt from the individual mandate?
Income based on what time period? A middle class head of household who gets laid off can be in dire straits while declaring relatively high income from the previous quarter. And then when you get a new job after a few months, you have to hurry up quick and shop around for some insurance or else probably get some kind of fine for staying on the subsidized plan. Your family better get used to swapping out the insurance cards in their wallets on a regular basis, and get ready for downtimes of being uninsured.
I know you’re going to be shocked to hear that Rush Limbaugh is an idiot that doesn’t know what he’s talking about. Rush Limbaugh’s chosen country of exile – Costa Rica – has universal health care.
But read this, from Limbaugh’s call:
So, basically he’s admitting he has no idea what’s going on in countries with universal health care systems?
I guess I’m still not getting the “kill the bill” logic. The insurance companies will be thrilled if the bill is killed. they make an enormous profit. Why would they fight the bill if they think it won’t hurt them, at least somewhat?
I’m sure Rush is on self-pay. He’s got like sixteen pre-existing conditions.
anon,
We’ll just have to wait to see the details of the bill to understand the enforcement mechanisms and the means testing.
This is big news, if true:
The insurance companies will be thrilled if the bill is killed. they make an enormous profit.
If the bill is killed they make an enormous profit. But if it passes they make a stupendously obscene profit. They can’t lose.
It is an old aphorism, probably true, that the insurance companies did just fine during the Great Depression.
If the bill is killed they make an enormous profit.
Not for long, though.
Desmond right on! Dennis Kucinch is the ONLY true progressive who stands up for the people. He has stated, “if there is no public option this bill is an insurance company giveaway and he will not vote for it”. So I wouldnt count Dennis in Pelosis numbers.
Did you know on page 59 re: your credit card or bank account tied to “co-pays” and services not covered by insurance? What the hell is that about. Why would anyone with a brain give their credit card number to a hospital?
There are now 37 or 38 Senators signed on to the public option…it aint dead quite yet, thanks to “bold” progressives. This morning in DC the Health Care for All Coalition and several progressive and labor groups surrounded the hotel where the “insurance company executives” were holding a meeting. They had arrest warrants with the names of the CEO’s on them. They surrounded the building preventing the conference go’ers the ability to go in. The police were there but told the demonstrators they had to keep moving, so they did in a big circle around and around the building. Waiting for an update on how it went. Some were prepared to be arrested. The “warrant” and the charges can be found on Health Care Now website. This is what “we the people” should be doing to the bankster/gangsters after finishing up with insurance robber barons.
Casandra: For profit insurance companies are going to make a killing whether the bill passes or not! Without a public option they continue to have free reign, with no regulations to keep costs from rising. So we should be pleased with “they cant throw you off insurance if you have it”, or “they cant decline you if you have a pre existing condition? And what about the blowback of decades regarding womens rights…are the dems going down with that one?
If the bill does not pass insurance companies won’t be making a killing for very long.
If the bill does pass, insurance companies have to get past regulations to spend 85% of premiums on actual health care, guaranteed issue and other items that currently let them make alot of money. They will make money (and will likely fool around with the price of employer-based insurance to try to make some of it up), but there is no doubt that some of the playing field they had to make lots of money will be quite restricted if this bill passes.
Why do you think insurance companies won’t be making a killing for very long if the bill doesn’t pass?
Because the number of people who have insurance continues to decrease, and in response, insurance companies are increasing their prices. There is a tipping point somewhere in their future where the price they have to charge for insurance will wipe out their remaining client base. And they are in no position to increase that client base since the insurance product is well out of reach for that client base.
looks like you’ve shaped it do death:
Cleaver: Obama doesn’t have the votes to pass health care reform (201 out of 216)
Kansas City Star ^ | March 8, 2010 | Steve Kraske
Congressman Emanuel Cleaver (D-Missouri) said today on KCUR’s “Up to Date” that President Barack Obama doesn’t have the votes to pass health care reform in the U.S. House.
“We’re not at 217,” Cleaver said, referring to the number needed to pass the bill.
Later, the three-term Democrat from Kansas City said the passage number could be 216 given vacancies in the House.
The count today, Cleaver said, is about 201 health care supporters.
That number, he added, could fluctuate significantly as a final vote nears.
Obama doesn’t have the votes to pass health care reform in the U.S. House.
The House already did pass HCR.
Anyway, here’s the kicker:
It will pass.
This is what I always thought an Obama-led fight for the public option would look like in the Senate. I guess we’ll never know though.
I am going to do TWO unwelcome and contradictory things:
1. Link to Rush Limbaugh.
2. Praise Dennis Kucinich: When he’s right he’s right.
Now mind you I hope the bill passes with or without Kucinich, which I expect it will.
But dammit, why did Obama have to turn an HCR win into a bittersweet trauma instead of a celebration.
Obama and Reid could have avoided all this by ramming the House bill through the Senate last fall, instead of giving us their Pontius Pilate act.
To the dimwitted! Dennis Kucinch is THE most progressive democrat in Congress. Bold Progressives are standing with him because he is dead right. What the lame ass libs and blue dogs are delivering up as health care reform is nothing but insurance reform. Both these bills DO NOT give States the authority to create their own single payer systems! What these bills do is deliver $70billion a year windfall PROFITS to the FOR PROFIT health care companies! Is that YOUR idea of reform?
Absolutely not! This bill will come back to bite the demorats for years. Once this PRIVATE for profit SYSTEM is set up, it could 60 more years before real reform is accomplished. As Dennis says, “No effort, no fight has come forward by democrats to push back against the 150 republican amendments that watered the bill down so far its not worth the paper written on.
Last night, Marcos Malitos of Daily Kos vilifed Dennis Kucinch for his “standing with the people”, and went so far as to call for someone to “challenge Dennis in his next election”. Marcos is so filled with himself and his appearances on MSNBC am thinking this guy will say and do anything to undermine the people, while hoping he might get an “on air” reporting gig! See what a good teamplayer I am?
As Dennis says, the numbers prove if we go with this private for profit option, it will bankrupt Medicare and Medicaid quickly. There are simply no cost controls on pharma companies (continue to charge what they want), no controls on insurance companies using loopholes to continue to deny people with insurance the care they need when they have a catastrophic illness. There are literally NO regulations to hold these companies accountable.
We should not support this piece of garbage. Just like the bankster giveaways with no mechanism to get the money back, this time the bailout is to the insurance/pharma companies. The next one will be the Consumer Financial Protection Services which Chris Dodd is attempting to dismantle! He is a another crook who made millions while serving the public. There will be no independent commission, with its own director if Chris Dodd and the republicans have their way.
If you continue to believe these two parties are working for you, your a damned fool. Unless we get campaign finance laws on the books, and keep corporations from buying our representatives we have NO democracy, we have a corporate lobbyocracy.
I hope Dennis stands his ground and VOTES NO, Hell no!
Holding out for a public option is the principled thing to do, but quixotic, as many will be quick to point out.
Therefore progressives should hold out for removing the individual mandate instead. The individual mandate enjoys bipartisan unpopularity, hated by progressives and teabaggers alike. The only faction that likes it is the insurance industry.
For a progressive, the only way to justify voting for the current bill is if you believe we can start adding public components BEFORE the individual mandates kick in (whenever that is). In other words, “fix it sooner.”
But that is really drawing to an inside straight, which is usually a losing strategy.
Remember, the real purists are the Senate conservadems who refuse to vote for the House provisions.
I guess I’ll add the kos’s challenge – what are Kucinich’s legislative accomplishments? Just talking about perfect legislation that doesn’t exist makes him ineffective.
I do think progressives have a lot to build on with this bill. The hard part will be done – the regulation reform and the subsidies. Progressives did a decent job selling the public option – it’s quite popular.
In fact, I think we should all be pushing for the Grayson bill, which allows Medicare buy-in for everyone.
I guess I’ll add the kos’s challenge – what are Kucinich’s legislative accomplishments? Just talking about perfect legislation that doesn’t exist makes him ineffective.
There is value in being the conscience of the Democratic Party. True, Kucinich is an imperfect vessel, but Dems are a little short on conscience these days so we have to take what we can get.
Markos’s case against Kucinich (from 2007):
Labor threatens primaries in 2012 against Democrats that block reform:
What does any of that have to do with Kucinich’s position on HCR?
Kos is taking a page from our good friend A1 and bringing up a whole laundry list of charges real and imagined. Stay on topic, fellas.
I don’t buy into this theme that Kucinich is Congress’s conscience or that he’s the best progressive around. Kos’s argument was about why DK would never be president and why he wasn’t excited about his run. Markos repeatedly linked to it today and yesterday.
Personally I think some of it is unfair but DK’s pro-choice switch makes me trust him not at all.