MaxTax’s Medicare Reforms: Would They Really Reform Health Care?

The MaxTax is largely a Medicare bill attached to 39 pages of private health care reform. To show you what I mean by that, here’s roughly how many pages MaxTax spends on each topic:

Health care exchange and other means to make private care available to the uninsured: 39 pages (including several on preventing tax dollars from being spent on undocumented workers or abortions)

Extending access to the poor and underserved (including expanding Medicaid to 133% of poverty): 34 pages

Improving the efficiency of public health care systems (mostly Medicare): 120 pages

Revenue plans: 25 pages

Total: 223 pages

I make this observation as a way to raise an honest question about Ron Brownstein’s claim that "Baucus’ draft bill offers the most fiscally sustainable framework yet devised for expanding coverage."

About half of Brownstein’s support for this claim comes in a discussion of the changes the MaxTax makes to public health care delivery. To understand what those changes are, read paragraphs four through thirteen of his piece. Those paragraphs summarize the 120 pages of the MaxTax treating Medicare that do things like shift payment to reward the quality of service, rather than the quantity of it (these changes make the kind of changes proposed by Atul Gawande in this important New Yorker piece). 

Now, I’ll get to the other half of Brownstein’s support for his article in a second. But first, regarding the many admirable changes MaxTax advocates for Medicare, here’s my question.

What effect will those important changes in public health care delivery–made in a bill that specifically prohibits public health care solutions for the rest of the population–really have on the fiscal responsibility of health care overall?

That is, Brownstein rightly commends Baucus for implementing changes to Medicare that will probably have real impact on the cost the government pays for Medicare. But this is in a bill that–almost as an afterthought–dumps 30 million people into private care that includes no such changes (at least no mandated changes). The Federal government would, under MaxTax, be paying billions for health care that did not necessarily integrate the same changes that the government would incent in Medicare coverage.

So here’s my honest question. Do policy wonks believe that by rewarding or even mandating such changes in Medicare, the entire health care delivery system would change? Assuming the reforms succeeded in bringing down cost of delivery, would insurance companies embrace the same changes as the best way to make a profit? And if so, would insurance companies trying to fulfill the corporate imperative to increase profits pass on such savings to consumers and the government that would be subsidizing that care?

As you might expect, this is another area where MaxTax’s rejection of a public option seems particularly indefensible. If the most "fiscally sustainable" way to bring down health care costs is to have public insurance mandate changes in the way it delivers care, then wouldn’t the best way to bring down health care costs in general be to ensure that we use public insurance to mandate such changes at all levels of care, for those still working as well as those in retirement? 

Wouldn’t a public option be the best way to ensure that private insurers implement such changes as well–and pass on the savings to consumers?

If you’re going to laud the Medicare aspects of Baucus’ plan, it seems, you’ve also got to point out the inherent contradiction in the plan, one that says the best way to control costs is by mandating changes in public health care delievery, but then deliberately limiting public health care delivery systems.

And here’s a question about Brownstein’s second point: that the tax on Cadillac insurance would contribute increasing revenue as we get further out. As you recall, MaxTax generates revenue by taxing employer-based insurance–and only employer-based insurance–35% for plans that are deemed (in the near term, at least) to be overly generous.

The insurance tax also contributes to another major breakthrough in the Baucus bill. Earlier Congressional Budget Office analysis of the House Democrats’ health care legislation noted that while it was largely paid for in the first decade, the longer-term trajectory was much more precarious. In a July 26 letter to Republican Rep. Dave Camp of Michigan, CBO concluded that in its second decade the House bill’s costs would rise substantially faster than its revenue and offsetting savings, which meant the bill "would probably generate substantial increases in federal budget deficits during the decade beyond the current 10-year budget window."

But CBO reached precisely the opposite verdict about the Baucus bill. In its September 16 analysis of the proposal, CBO concluded that because Baucus’ funding streams (like the provision taxing high-end health plans) are tied more directly to medical costs themselves, over the bill’s second decade "the added revenues and cost savings are projected to grow more rapidly than the cost of the coverage expansion." So much faster that CBO concluded the Baucus bill over its second decade would reduce the federal budget deficit by as much as one half percentage point of GDP-a huge savings. "That’s very important, and it is a significant departure from the previous bills," says McClellan.

Now, my question is more about the CBO’s assumptions than Brownstein’s per se.

The point Brownstein and CBO make is that, because the Cadillac tax is indexed to overall inflation and not medical inflation (that is, the increase in the amount of allowable insurance would grow at around 3% rather than 9% each year), more and more plans would come to be taxed, including plans that aren’t really Cadillac plans at all, but are instead Chevy plans. The MaxTax imposes a stiff penalty on some employer-based coverage, and over time, that stiff penalty would come to include more and more and ultimately all employer-based plans.

The CBO estimate seems to assume no response to this reality: not the obvious response from insurers (which would be to pass the tax onto those employers paying for the insurance). And not the obvious response from employers (which would be to drop health care coverage for workers–which largely because of the Cadillac tax, would become even more unaffordable). So the CBO estimate does not appear to factor in one likely (and, arguably, intended) consequence of the Cadillac tax: to move more and more people into the private individual insurance market, where there is no revenue stream to offset government subsidies, and where there are no cost controls.

The point being that the Cadillac tax only affects one segment of health care delivery: health care provided through employers. Since it is not imposed on all care, it invites the gaming of the system, and will predictably shift coverage from one area to another. 

So again: by controlling costs only in one or two segments of the system, aren’t you inviting insurers to recoup those costs in the one area in which there are zero cost controls, the individual insurance market?

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69 replies
  1. brendanx says:

    emptywheel,

    OT (NJ):

    This is a comment from an acquaintance:

    Republican committee members once again put off the confirmation of Paul Fishman for US Attorney in NJ, which was scheduled for yesterday. I’m wondering what the political angle is – the confirmation process has been postponed several times, and Fishman was nominated at the very beginning of Obama’s term. I suspect the repubs are trying to postpone his actually assuming the position at the USAO in NJ until after the gubernatorial election because of what he might find there, or because he will actually produce documents responsive to the outstanding FOIA requests.

  2. klynn says:

    Wouldn’t a public option be the best way to ensure that private insurers implement such changes as well–and pass on the savings to consumers?

    (snip)

    So again: by controlling costs only in one or two segments of the system, aren’t you inviting insurers to recoup those costs in the one area in which there are zero cost controls, the individual insurance market?

    (my bold)

    Marcy, you just left the opposition on the PO sputtering with this post. It is so nice when arguments drawn by the opposition actually validate the public option.

  3. Rayne says:

    Hey gang — if you want to encourage others to read the body of work which Marcy has compiled on the MaxTax to date, you can use this link:

    MaxTax

    The content is categorized with this label to make it easier to find in one spot.

    [Hello, mainstream media? That link’s for your use. You’re welcome.]

  4. readerOfTeaLeaves says:

    The point being that the Cadillac tax only affects one segment of health care delivery: health care provided through employers. Since it is not imposed on all care, it invites the gaming of the system, and will predictably shift coverage from one area to another.

    Bullseye!

    And yes, you’re inviting healthCos to game the costs in the place where controls don’t exist. Because under the laws of the land, the first fiduciary responsibility of a healthCo is to maximise profits for its shareholders (aka, “Wall Street”). It will have to get those profits out of the only spot it can.

    Brilliant synthesis.
    Thanks very, very much.

    • readerOfTeaLeaves says:

      The other factor not clear to me is what the projections are for the numbers of people moving to the individual market. That’s a tough call, but given past patterns, it’s definitely accelerating as businesses simply can’t underwrite health care costs company profits.

  5. fatster says:

    Keep pounding away at this Trojan horse, EW! Or would-be Trojan horse. It’s so obvious that even their best efforts to deceive are not working so well on the American public.

    You are ever the Champion.

  6. klynn says:

    OT

    I have been thinking, since the leak on intel spending this past week, how much waste (due to privatization) could be cut from the intel budget to cover a public option?

    After all, economic security is national security.

    • readerOfTeaLeaves says:

      Shush!
      We’re not supposed to ask things like that, are we?

      ;-)))

      Speaking of the $3,000,000,000,000+ question…
      But I doubt we’re allowed to even whisper that such a question exists from here in the ‘cheap seats’ on the blogs 8-0

    • Mauimom says:

      I have been thinking, since the leak on intel spending this past week, how much waste (due to privatization) could be cut from the intel budget to cover a public option?

      Whenever I hear Repubs or ConservaDems bleat about the “cost of the public option,” [sic], I think about the $700 BILLION that they so swiftly threw down the TARP rathole merely a year ago.

      • SparklestheIguana says:

        Well, they balked at that too, declining to pass it until the public became antsy, IIRC. The difference is that now we have a Dem president. At least then they could justify it because Paulson was urging it.

  7. behindthefall says:

    I don’t know if this is completely O/T or not, but …

    Remember how there was so much concern around the beginning of this year about the number of families who were losing their homes because of inability to pay? What ever happened to that? Did it stop getting coverage because the crisis stopped being a crisis? Or because the fickle finger of MSM coverage moved on to something else? Perhaps because the financial institutions got bailed out, so “everything is fine”, no matter that people are still having a hell of a time keeping a roof over their heads?

    • Rayne says:

      An O/T response — The other part of that question is the story right under their noses which they are failing to report: the attacks on ACORN by the right-wing under the guise of gotcha citizen journalism are really an attempt to remove from the field one of the largest defenders of foreclosed home owners.

      Another wave of foreclosures is bound to hit as unemployment monies dry up and an insufficient number of jobs are created. And ACORN won’t be there to fight for many of those people.

      Ever notice how nothing came of investigations into subprime lending? They took out the best champion, now they’ve taken out ACORN. What’s next?

      • SouthernDragon says:

        Nobody’s taken ACORN out. ACORN got along before they starting getting money from the govt and they’ll make do now. FL vice chairman was on my radio day before yesterday. They’ll have a tighter budget but they’ll be out there. Every big organization hires a few boneheads, to use the vice chair’s label, and ACORN isn’t an exception. Congress may have cut off their funding but nobody’s shut them up or restricted their activities. Go ACORN! Wanna help make a difference, contact ACORN and get involved.

      • behindthefall says:

        We’ve been looking for a house, and things being as they are at the moment, we have found ourselves often looking at homes that turn out to be “short sales”, that is, they are being sold by the owners, ostensibly, but in practice are being sold only on the say-so of the bank which holds the mortgage. There is more owed on the mortgage than the house will bring on the open market, hence, the sale leaves the bank “short”.

        These “short sales” are all over the place, and they seem to be a goodly fraction of the low end of the price range — that place where first-time buyers, newlyweds, and retired couples may be looking. However, realtors find them impossible to move, because while a prospective buyer may make an offer, the bank dawdles for months, even years. Now, the banks are not saying much about _why_ they don’t want to accept offers from the realtors’ clients, but the suspicion is that they are waiting for “investors”, i.e., speculators to circle around and bid the prices up. (Since these are not supposed to be open auctions, it is, ahem, “unclear” how this ‘upping the bids’ is supposed to work, but everyone is free to use his or her imagination.)

        No realtor I have dealt with in the Northeast or Florida has ever seen a “short sale” actually sell, certainly not to one of their customers.

        These properties could be rehabilitated (they’re often deserted — the poor folks just walked out, leaving kids’ toys on the floor — and their condition is not improved by neglect), but since you can’t buy them, how is that going to happen?

        Who, I ask myself, is accumulating what must be thousands of properties across the country, and to what end?

          • behindthefall says:

            What puzzles me is what value these properties have if they do not participate in the market. So some group owns 5,000 low-end properties: what do they do with them? Use them for tax writeoffs? (Huh. Maybe that’s not a stupid idea, but it’s ‘way out of my field, such as that is.)

            The pity is, though, that unoccupied houses bring down the value of neighborhoods and invite criminal activity. Also, that the FHA has a perfectly good rehabilitation program that works. But first some family has to be able to own the property, and a family can’t get a “short sale” to the closing table, it seems.

            • fatster says:

              Immediate thought is they’ll just hold it until property values start going back up and demand for housing increases (this is assuming people will actually be able to find work to pay for those houses). I am not an expert on matters of real estate and short sales, etc. In a little while, I’ll try and find you info from experts.

  8. BayStateLibrul says:

    I’m taking the easy way out.
    I believe Ex-Gov Vt Dean.
    Everything he has said makes sense to me.
    The Baucus bill sucks…
    Move on to the other four….

  9. WilliamOckham says:

    I think there is exactly one outcome of the “Cadillac” tax. Employer-based insurance will cover less and less. No large employers will offer plans subject to the tax. They’ll just gradually cut back on the benefits covered and add HSAs. Baucus created the perfect Republican health reform plan. It has cuts to Medicare and Medicaid (some ‘good’ cuts and some very bad cuts). It shifts the burden of health care costs from companies to individual employees. It creates a mandate that individuals have coverage while offering miserly assistance with rules so complicated that few of those eligible will be able to get the assistance. It’s really awful.

    • bmaz says:

      That was exactly my thought; dead minimal coverage with reliance on HSAs. Is it also possible that some other “device” is created to offer surplus coverage, but that is not subject to the Cadillac tax. This thing stinks up front, just think how odious it will be when the little latent bombs explode and the details are exploited. I am starting to wonder how anything but single payer Medicare For All type of system can meet the fairness test. We have a clusterfuck here, and I do not see any way it can be made otherwise by miscellaneous tweaking.

      • WilliamOckham says:

        Well, if they really aren’t including employer self-insured plans, then the insurance companies will drive employers towards that. That would be a huge boon for my present employer, but there would be a strong incentive to be fairly evil.

    • Scarecrow says:

      I think there’s a differential effect. If you’re a well-paid executive with a cadillac plan, you’re probably not going to change much. You can afford to pay the tax on the increment over the limit, or your company can alter it’s compensation to cover your expected tax liability.

      If you’re middle-income and/or just happen to live in a high cost region, then the tax will bit and you’ll either pay what is now an middle-income tax or you’ll scale back your coverage to stay below the tax. As health costs/premiums rise, you’ll scale back coverage even more. You’ll self-ration health care above the coverage depending on your income versus your pain.

      Over time, the combined effects should reduce the amount of health insurance provided through work, which is, I suspect, the underlying motivation, rather than the argument that people are demanding too much care so we need to reduce demand by taxing it.

  10. MsAnnaNOLA says:

    I think the bill is crafted this way because they don’t care about changing the private healthcare system. If you are opposed to govt healthcare and for private healthcare no matter what shape it takes, you get this craptastic bill. Nothing good can come of the MaxTax bill.

  11. WilliamOckham says:

    ew,

    I’ve tried to read the bill, but I didn’t realize this. According Jay Rockefeller:

    Another issue is that 46 percent of the American people have health insurance from fairly large companies that self-insure. And they’re not included in the regulations. They have to have protection from preexisting conditions and lifetime caps and rescissions too. People hear that the regulations in the bill don’t apply to these companies and they think it’s not possible. But it’s true. And it’s almost half of the insurance market!

    • greenharper says:

      On the Ed Show this week, if memory serves, and after meeting with the President, Jay Rockefeller also noted that the Baucus bill would end the State Child Health Insurance Program, if that’s what S-CHIP stands for.

      Sen. Baucus would instead throw the millions of low-income S-CHIP kids on the tender mercies of the Exchange.

      Do all of those children’s parents own computers, or at least have access to them and know how to use them? Unlikely. Won’t it be hard to use the Exchange without computer access?

      Good way to drop some kids from coverage, it seems, if that’s what you’re after.

      Brilliant post, Marcy!

  12. fatster says:

    From the Brownstein article:

    “The bill would implement these ideas within Medicare, though advocates hope that if these practices prove effective, private insurers will adopt hem as well.” [emphasis added]

    It’s stuff like this that makes one cringe. Why wouldn’t such ideas be mandated for the private insurers? If We the People are to benefit from such huge expenditure of our tax monies, then the private insurers have to be brought into compliance with that goal.

    Let’s stop hoping. Make it happen!

  13. perris says:

    here is my proposal that addresses the uninsured and over charged and it does not include “a public option”

    “anyone who is not covered by insurance, their health care bills will be payed from a pool payed into by the health care industry”

    there, give them that option vs the public option see which one they prefer

  14. TarheelDem says:

    There are two sections of the Baucus bill that are actually good. The first is the Medicare section (not all of it). The second is the specifics that spell out what an exchange is. Now the question is how those sections get translated into legislative language and how they align with the House bill. If the Baucus committee is doing it, there should be no overlap with the HELP committees jurisdiction–in principle.

    The first 39 page are the worst excuse for healthcare “reform” I’ve seen. It enshrines the status quo in federal law, taxes the middle class (specifically union workers and retirees) to pay for the inclusion of the uninsured, and provides no real means of making insurance affordable for those not qualified by income.

    • behindthefall says:

      How the bl***y h**l do they expect to tax retirees? And not instantly generate a new cohort of bankrupt and homeless, that is?

  15. Scarecrow says:

    Also, wrt to the different escalation in health care costs versus inflation, this tax will look like the Alternative Minimum Tax, which Congress annually adjusts to keep it from biting more Americans. If Congress does the same with this tax, which will be extremely unpopular, then CBO’s assumptions fall apart and there is no deficit neutrality.

    CBO’s Doug Elmendorf wants this tax; he’s lobbied/testified for it, so there was no way CBO was going to give it anything but a very positive rating.

  16. earlofhuntingdon says:

    If the most “fiscally sustainable” way to bring down health care costs is to have public insurance mandate changes in the way it delivers care, then wouldn’t the best way to bring down health care costs in general be to ensure that we use public insurance to mandate such changes at all levels of care, for those still working as well as those in retirement?

    One suspects that tinkering at the edges is the top Dems’ quid pro quo for not tinkering with insuresters’ profits and, in fact, increasing them, which further increases their hold over the government.

    Combine that with a noxious continuation of health insurance’s anti-trust exemption and a heavily lobbyist-influenced legislative and executive process, and the system virtually shuts out the governed from their government.

    The Dems seem to be approaching insuresters like a naive supplier approaches Walmart. Landing a big order looks fabulous, until you learn that that customer’s leverage and its demands are so great, it drives its suppliers into the ground. Nothing bipartisan or mutually rewarding there or in this bill.

    You hit the nail on the head. Reforming insurance and decreasing (or decreasing the growth in) health care costs requires national solutions that cover as many people as possible. Limiting reform to the system applicable to those over 65 mimics reform while preventing it, ensuring that later reform efforts will be stillborn. Not a paradigm for progressives to follow or one they should fail to call out as harmful.

  17. starrynight says:

    OT today on c-span dr. cortese ceo and president of the mayo clinic talked about the health care they provide. the best care and affordable. this is heathcare i want. why not bring the mayo clinic, dr. cortese to provide, design, replicate a health plan with real quality. a product with name recognition that may cross the party lines.

    • SouthernDragon says:

      Only on the health care threads. Other topics are relatively troll free, prolly because the reichwing hasn’t sent them any talking points to cover the other topics. The quality sure has gone down since the primaries and general. Ain’t no Juno’s in this bunch. Guess the reichwingers picked the dimmest bulbs and paid ‘em minimum wage.

    • starrynight says:

      trollike but notquite. max knows shit about heathcare. we need a heath plan. dr. coretese is running, right now such a plan, the mayo clinic

    • earlofhuntingdon says:

      FDL is getting more press and we’re getting down to the nut on whether legislation will reform health care or set in stone the insuresters lock on controlling access to it at the price of enormous profits for them. We shouldn’t expect the Rahmster not to fight back, should we?

      There are also all those many cubicles to fill, which I imagine lay underneath 1600 Penn, in addition to the tank traps and other post-9/11 whatnots that Karl and Rummy and Darth Vader had installed at a gazillion taxpayer dollars. (My shorthand for the hundreds of Bush-era Karl’s Klackers that hounded websites and appeared to be funded by an AEI new-to-literacy program.)

  18. Sufilizard2 says:

    I heard the governor of Minnesota publicly denounced Acorn and ended all Minnesota state subsidies to Acorn effective immediately. Of course Minnesota gives exactly $0 annual to Acorn.

    So he wins two points from the Republican base. One for loudly denouncing Acorn, and one for being so effing stupid.

  19. wesgpc says:

    Question: can some one help me with the following statement, which I am not sure I understand:

    “…a bill that specifically prohibits public health care solutions for the rest of the population–really have on the fiscal responsibility of health care overall?”

    How is this prohibition implemented in the bill? Where can I read in detail how it works?

    Thanks to commenter above for links to MW’s posts on Baucus.

    My opinion on whether changes to Medicare can produce changes in the rest of the system: Unless it concerns efficient mechanisms to collect payments, I do not see why what Medicare does should influence private insurers.

    There is a general vague opinion in health policy and research circles that Medicare has a big influence on the private market. But that is mostly based on the spread of the Medicare payment systems: the proceducre and DRG codes, bundled payments, capitated rates for units of service such as hosptial admissions. Those aspects of Medicare seem to have had a huge impact on private industry practices.

    But many of those systems were being developed before Medicare, or as Medicare was being passed. Procedure codes were being developed by regional medical associations to control extreme variations in fees by individual physicians and group practices. The idea of capitation and capitated carve outs for contracted services predcates Medicare.

    Because Medicare is a big program, its payment systems did provide a common standard that could be adopted by the private industry at little cost, and reduced coordination problems.

    So, I think it is reasonable to conclude that where Medicare provided a common standard that eased collecting MONEY, Medicare did shape, or at least speed, development of reimbursement standards and practices that dominate US healthcare. Other than that, I am not sure Medicare practices would have a big influence.

  20. alan1tx says:

    Excise Tax. The consequence for not maintaining insurance would be an excise tax. If a taxpayer‘s MAGI is between 100-300 percent of FPL, the excise tax for failing to obtain coverage for an individual in a taxpayer unit (either as a taxpayer or an individual claimed as a dependent) is $750 per year. However, the maximum penalty for the taxpayer unit is $1,500. If a taxpayer‘s MAGI is above 300 percent of FPL the penalty for failing to obtain coverage for an individual in a taxpayer unit (either as a taxpayer or as an individual claimed as a dependent) is $950 year. However, the maximum penalty amount a family above 300 percent of FPL would pay is $3,800.

    Does anybody think this is a good idea?

  21. jacksmith says:

    ATTENTION!! Congress Has The Votes Needed To Pass A Public Option – TODAY http://bit.ly/TCq7O

    Why A Strong Public Option Is Essential – By jacksmith – Working Class

    Robert Reich explains the pubic option: http://bit.ly/dDYSJ http://robertreich.blogspot.com/

    John Garamendi on the Public Option and the Grassroots: http://bit.ly/TJMty

    It’s not just because more than two thirds of the American people want a single payer health care system. And if they cant have a single payer system 77% of all Americans want a strong government-run public option on day one (86% of democrats, 75% of independents, and 72% republicans). Basically everyone.

    It’s not just because according to a new AARP POLL: 86 percent of seniors want universal healthcare security for All, including 93% of Democrats, 87% of Independents, and 78% of Republicans. With 79% of seniors supporting creating a new strong Government-run public option plan, available immediately. Including 89% of Democrats, 80% of Independents, and 61% of Republicans, STUNNING!!

    It’s not just because it will lower cost. Because a strong public option will dramatically lower cost for everyone. And dramatically improved the quality of care everyone receives in America and around the World. Rich, middle class, and poor a like.

    It’s not just because it will save trillions of dollars and prevent the needless deaths of millions more of YOU, caused by a rush to profit by the DISGRACEFUL, GREED DRIVEN, PRIVATE FOR PROFIT MEDICAL INDUSTRIAL COMPLEX!

    It’s not just because every expert in every field, including economist, and Nobel laureates all agree that free market based healthcare systems don’t work. Never have and never will. The US has the only truly free market based healthcare system in the World. And as you all know now, IT IS A DISASTER!

    It’s not just because providing or denying medically necessary care for profit motivations is wrong. Because it is WRONG! It’s professionally, ethically, and morally REPUGNANT!, Animalistic, VILE and EVIL.

    THE REASON THE PUBLIC OPTION IS ESSENTIAL:

    The public option is ESSENTIAL because over 200 million of you are trapped in the forest of the wolves. Which is the forest of the DISGRACEFUL, GREED DRIVEN, PRIVATE FOR PROFIT MEDICAL INDUSTRIAL COMPLEX! With no way out except through needless inhumane suffering, and DEATH. While the wolves tear at your flesh, and rip you limb from lib. Then feast on your lifeless bodies like a dead carcase for transplant parts.

    At the most vulnerable times of your lives (when you were sick and hurting), millions of you have had to fight and loose cruel, but heroic battles. Fighting against the big guns of the DISGRACEFUL, GREED DRIVEN, PRIVATE FOR PROFIT MEDICAL INDUSTRIAL COMPLEX! in the forest of the wolves. All because you have no place else to go. You have no other CHOICE!

    But the PUBLIC OPTION will give you someplace safe to go. And it will give us someplace safe to take you. The public option will be your refugium (your refuge). Where the wolves cannot get at you when your down, hurting, and vulnerable. Where everyone who needs it can find rest, security, comfort and the care they need. Protected by the BIG GUNS of We The People Of The United States. THE MOST POWERFUL PEOPLE AND COUNTRY ON EARTH.

    This is why it is so critical that we do not lead another 50 million vulnerable, uninsured Americans into the forest of the wolves, without the protections of a Strong Government-run public option. We The People Of The United States MUST NOT LET THAT HAPPEN to any more of our fellow Americans. If healthcare reform does not contain a strong public option on day one. YOU MUST! KILL IT. Or you will do far more harm than good. And millions more will die needlessly. Rich, middle class, and poor a like.

    To those who would continue to obstruct good and true healthcare reform for the American people, and who seek to trap millions more vulnerable Americans in the forest of the wolves. We will continue to fight you. We are prepared to wage all out war against you, and will eagerly DESTROY! you. Time…is…UP! YOU HAVE BEEN WARNED! No Co-op’s! No Triggers! NO INDIVIDUAL MANDATES! without a Strong public option on day one.

    Healthcare reform can be the GREATEST! Accomplishment of our time and century. A time when future generations may say of us, that we were all, AMERICAS GREATEST GENERATIONS.

    BUT WE MUST ACT!

    I therefore call on all my fellow Americans and the peoples of the World. To join us in this fight so that we may finish becoming the better America that we aspire to be for everyone.

    SPREAD THE WORD!

    I have been privileged to be witness as many of you fought, and struggled to take your first breath, and your last breath on this earth. Rich, middle class, and poor a like. Life is precious.

    Whatever the cost. WE! MUST SUCCEED.

    God Bless You My Fellow Human Beings

    jacksmith – Working Class

    Things You Can Do To Help NOW! http://www.everydaycitizen.com…..die_n.html

    No Triggers! http://www.huffingtonpost.com/…..77910.html

    Triggers http://www.huffingtonpost.com/…..83583.html

    Krugman on heathcare (http://krugman.blogs.nytimes.com/2009/07/25/why-markets-cant-cure-healthcare/)

    Senator Bernie Sanders on healthcare (http://www.youtube.com/watch?v=RSM8t_cLZgk&feature=player_embedded)

  22. Erin65 says:

    Whatever changes Medicare reform may bring, seniors should know that whichever 2010 plan they select later this year, they will have coverage. The 1997 Balanced Budget Act included a provision assuring Medicare beneficiaries a smooth and uninterrupted transition in their healthcare coverage should Congress mandate any program changes in the future. For seniors having problems finding a Medicare plan or who need help with the choices available, a great tool is PlanPrescriber.com.

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