Some Thoughts on Healthcare

From the start, let me say I support sidecar reconciliation going forward–the passage of the Senate health care bill, tied to the simultaneous passage through reconciliation of some fairly substantive changes (eliminating most of the excise tax, inclusion of a public option, possibly with Medicare buy-in, elimination of the antitrust exemption, and drug reimportation) that would not only make the Senate bill palatable and much cheaper, but would constitute real reform.

With that out the way, let me just throw a few things out there on which I will base my further discussion.

Rahm’s trial balloon on a stripped down bill

On Wednesday, Rahm proposed a stripped down bill.

RAHM PITCHES STRIP-DOWN, reports Inside Health Policy’s Wilkerson, Coughlin, Pecquet and Lotven: “White House Chief of Staff Rahm Emanuel called House leaders Wednesday to sell a smaller health care reform bill with insurance market reforms and a Medicaid expansion, Democratic and Republican insiders tell Inside CMS. House Speaker Nancy Pelosi (D-CA) so far is not buying it, they say, and one Democratic policy analyst considers Emanuel’s pitch a trial balloon. … Pelosi was scheduled to meet with Blue Dog and progressive coalition members Wednesday (Jan. 20) afternoon and a full Democratic caucus meeting is scheduled for Thursday morning. ‘I would agree she’s not buying it,’ a Democratic policy analyst said, referring to Emanuel’s idea of a smaller bill. ‘We’re hearing that she’s trying to figure it out.’ … In the Senate, Budget Committee Chair Kent Conrad (D-ND) said that while he had opposed using the fast-track process for the health reform legislation ‘writ large,’ he believes reconciliation could be used as a way to make fixes if the House passes the Senate bill.”

Greg Sargent makes it clear that this doesn’t necessarily mean Rahm (or the White House) prefers such an option–he’s just looking into what is possible at this point.

After talking to insiders my sense is that the procedural issues at play are extremely complex, and White House advisers and Dem leaders really want to understand the full range of options before them, as limited as they appear to be, before leaning hard one way or another.

I’m also told that reports that Rahm Emanuel is pushing for a scaled-down bill are false. Rahm is actively involved in sounding out Congressional leaders to determine what’s possible, but hasn’t stated a preference, for the above reasons. This may not amount to a satisfactory explanation for many, but this, as best as I can determine, is what’s happening.

So for the moment, let’s just leave this out there as a trial balloon.

Within hours of Brown’s win, Max Baucus said reconciliation would be part of the solution

After saying for months that reconciliation wouldn’t work, Baucus has spun on a dime and said that reconciliation will be part of the solution.

“Reconciliation, I’m guessing at this point, will be part of the solution,” said Senate Finance Committee Chairman Max Baucus (D-Mont.).

Clearly, this is not the same as having one of the true obstructionists–Lieberman, Nelson, or Landrieu say this–in the Senate. But we don’t need them to pass a bill through reconciliation; we need the still significant majority we have in the Senate.

Note, Baucus’ quick concession that reconciliation would be needed to pass this bill ought to make all those who, before, said, “Reconciliation won’t work, you have to capitulate to Joe Lieberman” think twice about whether their earlier read of the situation was correct, and what Baucus’ quick concession says about the good faith of the hold-outs on the Senate side. If reconciliation is now possible, the only reason it wasn’t possible in the past was the political situation, largely created by the large number of people empowering Lieberman and Ben Nelson by saying “reconciliation won’t work, you have to capitulate to Joe Lieberman.” And that ought to make the same people hesitate before they cry again, “Progressives have to pass the Senate bill as is, without working to fix the bill through reconciliation.”

Votes (particularly through reconciliation) are easier to get in the Senate than the House right now

Here’s a detail many on the left seem to be missing when they call on progressives to just suck it up and pass the Senate bill: the numbers.

Check out the roll call for the passage of the House bill last year. The bill passed 220-215. But that 220 includes Bart Stupak and Joseph Cao, both of whom have said they would not be happy with Nelson’s anti-abortion language–they want Stupak’s own, harsher language (and Stupak says he’s got 10 more Democrats like him). And it also includes Robert Wexler, who has since retired.

In other words, just based on losing those three votes, you don’t have enough votes in the House to just “suck it up” and pass the Senate bill.

Of those who voted “no” last November, just two said they did so because the bill was not progressive enough: Dennis Kucinich and Eric Massa (and many people doubt Massa’s explanation on that count). Larry Kissell got elected on a progressive platform, but Kissell is, alone among many endangered freshman, doing well in his re-elect numbers (something that may or may not have to do with his vote against the House bill, which is still more popular among voters than the Senate bill).

In other words, just to get enough votes to pass, you’re going to have to do one of several things:

  • Convince Stupak to back down off his anti-choice stance and vote for the bill
  • Convince Kucinich, Massa, or Kissell to vote for a bill they didn’t vote for the first time
  • Convince some of the Blue Dogs who voted against the bill the last time to vote for it this time around

Those numbers alone ought to make it clear that you’re not going to pass the Senate bill through the House by haranguing progressives to pass the bill, because unless you convince Kucinich or Massa (I’m leaving Kissell out, who actually said he opposed the bill from the right), then you still don’t have enough progressive votes to pass the bill. Want to harangue someone? Harangue the Blue Dogs or Stupak, because they’re a more likely source of that 218th vote than Kucinich or Massa. Here’s Stupak’s number, in case you’re looking to whip votes: (202) 225 4735.

The Brown win

People will likely be arguing for years about how big a factor health care was in Brown’s win on Tuesday. But a few things are clear. Union members supported Brown over Coakley 49% to 46%. I’ve heard from a number of union people from MA who talked about the difficulty, having gotten unions to vote for Obama in 2008 at least partly because of McCain’s promise to tax health insurance, to now get their members excited about voting for Coakley so that their benefits would be taxed in the excise tax. Now, it may be that unions didn’t try to spin this early enough, or it may be that workers really care about this, but it’s clear that the excise tax is one of the things that played a factor in the Brown win.

The other thing that is clear is that a lot of the independents that voted for Obama voted for Brown, and a good number of Obama voters (especially the youth vote) stayed home. And while the numbers are mixed between those two groups, it is clear that both groups support a public option.

The math

Now, before I get into why I support sidecar reconciliation, let me address a scaled back plan–which has a lot to recommend it. Jon Walker lays out one scenario here, one that is not far off a scenario Ezra laid out the other day.

A number of people have complained that you can’t pass comprehensive health care reform piecemeal (Brian Beutler, Karen Tumulty, Jason with a comprehensive summary of the argument at Seminal). But look at the language these folks are using carefully–particularly the way it fluctuates seamlessly between discussing “health care reform” and “health insurance reform.” Some of these same people willingly admitted back in December that the Senate bill was not, in fact, health care reform, but health insurance reform.

But one of the problems with the Senate bill is just that–it succeeds in getting 30 million uninsured people insurance, but will leave a significant portion of Americans–perhaps as much as 19% of the total population–with insurance that they won’t be able to afford to use [note, some of these already have insurance they can’t afford to use; sentence changed per WO’s comment; figure changed to reflect that 2% of the 21% of MA residents who can’t afford care don’t have insurance]. It means it would not eliminate (though it would lessen) medical bankruptcies, it would not give employers much relief from rising health care costs, and it would not do much to rein in costs (until someone can explain why the behavior the excise tax incents hasn’t brought down health care inflation over the last three decades, I’ll consider that a big scam). One of the problems with the Senate bill (the House bill was better though still not great) is that it was about health insurance reform, and not only fell far short of health care reform, but might make health care reform less likely as it made the medical industry more powerful. (And all that was before Justice Kennedy gave them the right to buy politicians.)

But that’s one of the reasons why Rahm’s trial balloon is so important–and, I suspect, why Baucus immediately became willing to discuss reconciliation. A plan like Jon’s–expanding Medicaid and allowing Medicare buy-in–would solve a great deal of the urgency surrounding health care, without giving the insurance companies millions of captive consumers. Rather than putting the industry in a much stronger position, it would put them in a weaker negotiating position, making it more likely that when we turn to the one urgent issue that must either involve insurance or single payer (the exclusion of those with pre-existing conditions), we will at the same time be able to demand real concessions on Medical Loss Ratio and/or actuarial values so that people can actually afford to use the health insurance reform would give them access to. Plus, the one great aspect of the Senate bill–the one part that is undeniably reform–is its Medicare-based delivery reforms, and we could do that in a smaller bill anyway. So while the opponents of piecemeal reform have a point, they also need to be clear that they’re talking about insurance reform, not health care reform, and they need to explain how they get from there to health care reform.

So I do think passing a stripped down bill that focuses on extending care to the 15 million who most urgently need it is preferable to passing the Senate bill without a guarantee it’ll be fixed through reconciliation.

But I actually do think–because the House, not the Senate, now has leverage–that the bill might get significantly more progressive through reconciliation. Max Baucus and all the other insurance company buddies in the Senate may now be willing to deal to preserve some expansion of the insurance companies’ base. And if it’s done correctly, they may be willing to accept the competition they dodged when the Senate had the upper hand.

The point is, to those clamoring for progressives in the House to cave, to think responsibly of what they’re doing. What you do now can result either in real reform, in expansion of care with minimal reform. Or, in passing the Senate bill that, based on the excise tax alone, may have been a significant factor in Coakley’s loss. Health care reform is important–which is why we shouldn’t accept just the Senate bill, because (except for the Medicare changes) it is not health care reform.

  1. jerryy says:

    Promises being what they are worth … just words until the actions take place, it would be a waste of negotiations not to insist that the reconciliation parts be passed and actually signed into law before the Senate bill is taken up by the House members. After all, they do have just under a year to consider the Senate bill.

  2. WilliamOckham says:

    Quick request for clarification. What does this phrase mean?

    perhaps as much as 21% of the total population

    in the context of this sentence:

    But one of the problems with the Senate bill is just that–it succeeds in getting 30 million uninsured people insurance, but for a significant proportion–perhaps as much as 21% of the total population–will give them insurance that they won’t be able to afford to use.

    Are you talking about 21% of the U.S. total population? If so, where do you get those numbers, because that doesn’t seem right to me.

    • emptywheel says:

      And I’ve added a link to my earlier post–should have done it before.

      That’s what I keep harping on. It is mathematically impossible for a lot of people to pay the premiums they’ll have to pay (even some eligible for subsidies) and to have enough left over to pay the required out of pocket expenses.

      Remember that the Senate bill only requires insurers to provide plans with 70% actuarial value for those getting subsidies. That’s a lot of out of pocket expenses, and they don’t get help on THOSE until they spend another huge chunk of their discretionary income.

      • WilliamOckham says:

        I basically agree with you on this issue, but your characterization is not quite right. A lot of people already have insurance with out of pocket costs that they can’t afford. The information from Mass. doesn’t distinguish between people with employer-provided care and those on the Commonwealth program. Until we move to a single-payer plan, I would guess the lowest possible figure you can get for that measure with any HCR (or let’s just call it what it is HIR, health insurance reform) plan is about 15%.

        • emptywheel says:

          I’m not sure what you mean. I agree that some of that 19% (leaving aside the 2% in MA who don’t have insurance and don’t get care) already had insurance in 2006. My point is that those pushing for the Senate bill, unchanged, right now, talk about getting 30 million HCI as if it’s a magic bullet, when in fact for those outside of the who might be included in a Medicaid 200% fix are precisely those who are most likely to be forgoing care in MA right now. (Though I admit that a lot of people on Medicaid can’t afford necessary care, either.)

          But isn’t it still true that so long as we look to a solution using insurance (particularly using insurance without doing anything to rein in both premiums and out-of-pockets) we’re not going to be delivering care to everyone.

          • WilliamOckham says:

            You said:

            But isn’t it still true that so long as we look to a solution using insurance (particularly using insurance without doing anything to rein in both premiums and out-of-pockets) we’re not going to be delivering care to everyone.

            Yes, that’s true. I’m just pointing out that that quality is also true of the House bill and Wyden-Bennett, and just about every other plan being discussed (except for some versions of single-payer that don’t have a snowball’s chance in a Houston summer of getting passed). The part of your original statement that I think is slightly off is the part where you say the Senate bill will give that 21% of the people the insurance they can’t afford to use. The Senate bill is only “giving” about 15 million people Medicaid (I think that’s the right number). It’s requiring another roughly 15 million people who don’t currently have it to get crappy insurance. 30 million people total is a lot less than 21% of the total population.

            • emptywheel says:

              Okay, I see your point and will do a fix of some sort.

              Though one point I was trying to make is that if you do JUST Medicaid expansion and Medicare buy-in, most of those people will be able to afford to use the care they get bc out of pockets are a lot lower.

              • WilliamOckham says:

                Absolutely. That would be better (and it would look better in Gruber’s model). If the Democrats were savvy (oh, the counterfactual nature of that assertion), they would realize that the Brown victory gives them the political cover to pull the reconciliation trick. Pass the Senate bill and then fix the excise tax (the stupidest thing about the Senate bill) through reconciliation. The excise tax is absolutely available for reconciliation because it’s a tax issue.

                • emptywheel says:

                  Yep. And I think the Senate is ready to do that (particularly since the excise tax champions are no longer so willing to back the claims on it they made, and since the unions sort of didn’t want to come out to vtoe for Dems).

                  Problem is, we’ve got to get all those who voted in November in the House including Stupak (or, short of that, getting Kucinich on board) to play along.

                  • WilliamOckham says:

                    I think Pelosi can pull this off (with some help from Obama, what is up with that dude, he’s the one who made HCR his signature issue). Some of the people who voted against it in November are people that Pelosi can arm-twist. Pelosi let a handful of folks vote against the bill because she knew she had the votes she needed. I even think she can promise Stupak another vote on his amendment to give him cover with the dead-enders.

                    • PopeRatzo says:

                      Pelosi can’t get it done. She’s just not that good at her job.

                      Seriously, does Speaker Pelosi strike you as a bright and capable person?

                      None of our leadership in congress is worth a damn, and I don’t really think Obama cares about getting a good bill any more (if he ever did).

                      I refuse to get exercised by this again. It’s silly to think that as progressives we have any influence in congress.

                      The only way to affect the outcome of anything in washington any more is to do what the teabaggers did: Get loud, get in their faces, be disruptive and get on television. We can’t compete with corporate donations and lobbyists. Our vote just gets nullified by Dem leadership. Calls and letters are ignored. The only thing that works is making them scared to appear in public the way the teabaggers did last August.

  3. Professor Foland says:

    A general comment on reconciliation…

    I find it hard to muster much excitement for reconciliation, because I keep coming back to, “Harry Reid cannot actually be as dumb as he has been looking.”

    I’ve had this terrible fear that not only are the votes not there for reconciliation, they aren’t even close. That various Democratic “moderates” have found it much more convenient to let Lieberman and Nelson take the bullets at 60 rather than take the bullets themselves at 50. (And that Lieberman and Nelson didn’t even particularly mind taking the bullets.) That Reid didn’t even threaten reconciliation from the beginning because the threat was so non-credible.

    So I understand that time, and pressure, and negotiating strength, might move some “moderate” Democrats, but I’m betting the votes are just too far away from 50 for even that to be enough.

    • emptywheel says:

      May be.

      The biggest concerns with reconciliation are, IMO. 1) Byrd and Feingold–who do support a PO–have expressed reservations about using reconciliation to pass this. That probably still leaves you over 50, but not by maybe only exactly. 2) Given how badly the Dems have messaged this, and given that Hatch is already demagoguing reconciliation (forgetting that Bush passed an awful lot of controversial leg through reconciliation), I’m not sure Dems are ready to make the political case for it.

      But if they do it, they’ve got to make sure it’s as popular as possible. Obviously, the best way to do that would be to tie stuff to Medicare, since THAT is popular. But it’s not clear that all those who support a PO support Medicare buy-in (though the briefly floated compromise suggests some anti-PO people might support Medicare buy-in).

    • emptywheel says:

      Interestingly, Mike Lux says he’s hearing more willingness on the Senate side to do what it takes to use reconciliation than from the House side.

      I wonder if it’s all about getting the one more vote in the House (Kucinich, Massa, Kissell, Stupak, or a Blue Dog).

  4. fatster says:

    And while, under the leadership of Harry Reid, the Dems have managed to wrench defeat from the jaws of victory, the America people continue to suffer from inability to access needed, affordable health care to increased homelessness because of the mortgage meltdown which has not been appropriately addressed to a rate of unemployment that accelerated last month in a majority of states.

    We are so screwn, but the corporatists’ gravy train to our national elected officials not only continues merrily along but now threatens to wreak unbelievable destruction on our nation. (Pls pardon the outburst.)

  5. freepatriot says:

    I’m bettin the rent on Impeachment in 2011

    I got faith that Democrats can fuck this up worse than anybody could have predicted …

    but I’m usually a year or two ahead of everybody else

    • scribe says:

      I’ve been saying that for a good 6 to 9 months; it’ll be because they’ll say he’s not a native-born citizen.

  6. bobschacht says:

    I agree with your opening paragraph, and have said so in comments before you posted this.

    Thanks for reporting on Rahm’s trial balloon, etc., too, and for your further dialog with WO on this and other points.

    But I’m a little confused by your last paragraph, where you wrote,

    The point is, to those clamoring for progressives in the House to cave, to think responsibly of what they’re doing.

    Doesn’t “caving” amount to doing what you advocate in the first paragraph?

    Bob in AZ

    • emptywheel says:

      No. Many of the calls for the House to pass the Senate bill demand they do so without, first, fixing it. It’s the same desperation that said you had to pass the Lieberman bill bc reconciliation wasn’t available although voila it is!

      Plus, many of the calls are accusing progressives in the House of tanking the bill, even though unless these bill champions can get either Stupak or Kucinich or Massa or Kissell or some Blue Dogs to change their stance, it doesn’t matter what the progressives do, because there is no bill.

      And, frankly, that vote math WAS ALWAYS the case in the House–bill champions have ALWAYS been overplaying how much harder this issue is to get through the Senate than the House.

      • bobschacht says:

        Many of the calls for the House to pass the Senate bill demand they do so without, first, fixing it. It’s the same desperation that said you had to pass the Lieberman bill bc reconciliation wasn’t available although voila it is!

        Well, now I’m even more confused. Perhaps I didn’t understand your lead sentence:

        From the start, let me say I support sidecar reconciliation going forward–the passage of the Senate health care bill, tied to the simultaneous passage through reconciliation of some fairly substantive changes (eliminating most of the excise tax, inclusion of a public option, possibly with Medicare buy-in, elimination of the antitrust exemption, and drug reimportation) that would not only make the Senate bill palatable and much cheaper, but would constitute real reform.

        If the House fixes the Senate bill before passing it, then it will require another vote in the Senate before going to the President’s desk, won’t it? Or maybe I don’t understand “sidecar reconciliation”, “tied to the simultaneous passage through reconciliation of some fairly substantive changes…”

        I thought what you meant was (a) passing the Senate bill, as is, so it goes immediately to the President’s desk without having to go back to the Senate, followed quickly by (b)reconciliation bills originating in the House and sent back to the Senate, with all those substantive changes.

        So I’m confused about what you’re actually proposing.

        Bob in AZ

      • PJEvans says:

        What I’m seeing in some places is appeals to pass the Senate bill because otherwise, it seems, the entire health care system will disappear as if it were made of fog.

        Not sure why they think that: certainly it won’t be improved for most of us, but many of us won’t get more, or better, health care if the Senate’s piece-of-crap bill does get passed. (The insurance companies will get richer and more powerful, though.)

  7. polarbear says:

    Precisely. Medicare and medicaid expansion (and possibly PO) through reconciliation. Rules & regs that we can’t get through reconciliation can be in the Senate version. We can do the House stuff first, Senate second, and Obama can sign the Senate stuff first and House second and Voila! a bill that actually helps Americans for generations on end.

    • aardvark says:

      Let me add an additional thought on Medicare and Medicaid. Every physician, plastic surgeon, internist, dermatologist, is schooled in basic medical care. They know how to diagnose and treat strep, etc., etc. And most of them have gotten their degrees at public institutions wherein the taxpayer funded half of their medical education. Most of them did residencies wherein the taxpayer funded their stipend. Why would it be unfair to expect these physicians to provide medical care to, say fifty Medicare and Medicaid recipients? Yes, they would get reimbursed and Medicare and Medicaid rates, which are far lower than what an oral surgeon commands, but to provide basic medical care to fifty Medicare and Medicaid recipients would require perhaps half a day a week, every other week. That is, one day per month. How is this unfair? And, I would include dentists, psychologists, and clinical social workers in this; anyone who got a health provider degree from a taxpayer supported institution or internship/residency. Why would this be unfair?

      • vegasboomer says:

        A related straw man pertaining to “low” Medicare and Medicaid provider reimbursement rates is that they would remain fixed at their ostensibly “below-cost” levels in the wake of true reform. That is by no means certain.

        (And, I would simply fold Medicaid into Medicare-for-all and abolish the former)

        My own doctor — and internal med practitioner with a significant proportion of elderly among his active patient panel — states without hesitation that his preferred payer is Medicare, notwithstanding that he agrees in principle with ideas like HSAs (i.e. that the very notion of “insurance” when it comes to health care is bogus). My late daughter’s Attending down in Culver City replied equally without hesitation 12 years ago that he and his colleagues’ favorite patients from a billing perspective were the “Medi-Medis” i.e., Medicare beneficiaries also poor enough to qualify for MediCal. Quicker and better aggregate net reimbursement with far less hassle.

        • Mauimom says:

          My own doctor — and internal med practitioner with a significant proportion of elderly among his active patient panel — states without hesitation that his preferred payer is Medicare

          Wow, I want to move to where you are, because I’m having a LOT of trouble finding a doctor who takes Medicare patients.

          • aardvark says:

            This is part of my point. Requiring all physicians to do primary care for Medicare recipients would help solve this problem of docs not wanting to take Medicare/Medicaid recipients. Incidentally, folding the two together would make much sense; but I am also an single-payer advocate.

            One of the elephants in the room is that physicians expect to make too much money. This in part reflects that most physician practices are run by MBAs who see providing medical services as a product.

  8. fuckno says:

    The American People are TBTF! Throw money at this miserable state of affairs (there’s plenty of it sloshing within a couple square blocks of lower Manhattan. Impose fees on the Corporations, and tax casino capitalism big time!

    Joseph Stiglitz in his Testimony to the HCFS paints a picture of failed capitalism on tax payers life support.

  9. DanRockridge says:

    Sounds to me like some of the Senators who said they were for the public option were lying because they figured they would never have to ACTUALLY vote for it. They knew the White House would kill it with help from lower life forms like Joe L. In any case, there is a much much worse scenario floating–use reconciliation for the tweaks that unions wanted–and that’s it. In other words, a final spit in the face of activists- a big old middle finger.

  10. vegasboomer says:

    Gotta love this:

    WASHINGTON [NY Times] – President Obama is reconstituting the team that helped him win the White House to counter Republican challenges in the midterm elections and recalibrate after political setbacks that have narrowed his legislative ambitions…

    Gonna reprise his role as Campaigner in Chief. Yeah, that’s Leadership. Go around giving rallies telling everyone how he’s gonna fight for you.

    • fuckno says:

      with all this windfall money, grace a SCOTUS, America will be in a perpetual election mode, governing? – who’s got time for fucking governing !?!

      • vegasboomer says:

        Copy that.

        As it is now, we pay for 4 years of President & Congress, but in effect get only one. Gotta pass all this major shit in year one, or everything substantively reformative goes essentially into hybernation while everyone scurries off for mid-terms, closely upon the heels of which comes the next ad nauseum Preznit campaign. Lather, rinse, repeat.

        The SCOTUS thing will only exacerbate that.

    • rach777 says:

      This brings to mind Obama always being in campaign mode. After he was elected, he kept referring back to the campaign which really sounded
      like he had one foot in OFA, and the other in the white house. It never seemed right.

  11. fuckno says:

    Kill the Bill! Break off worth while sections and offer them up for passage as self standing bills or riders on must pass (fro Reps.) legislation or budget resolutions.

    Drug reimportation
    Medicare buy in 50 up

  12. Curmudgeon says:

    I went to the “California Coalition of Health Care for America Now!” demonstration at the Federal Building in San Francisco this morning at 11 am.

    I got there at 10:58. No one was there.
    3 minutes later one of the organizers showed up.
    3 minutes after that two more organizers showed up with two children–under 7 yrs.
    At 11:15 there were 7 people total, plus the two child.
    All that was missing was the wreath.

  13. bob5540 says:

    Good analysis by Emptywheel. But I still say Plan C (discussed under “The math”) is better than the sidecar.

    1. I think the Senate bill is such a mess that it can’t realistically be fixed in a sidecar — the abortion restrictions being an obvious and simple example.

    2. Even if it could be fixed, the result would be such a tangled mess that the American public, now very tired and cynical, wouldn’t understand, much less believe, that they got health care reform out of this process. The Democrats will get wiped out in November anyway.

    3. Call it “stripped down” if you want, but expanding Medicare and Medicaid is the core of health reform, the engine that drives the rest of reform, both present and in the future. It’s a stronger platform I’d rather build on than the Senate bill. It’s also much quicker to implement.

    4. Americans love their Medicare, whether they admit it or not — and for all the right reasons. It’s an easier sell.

    • bmaz says:

      I am kind of inclined to agree with that unless they are prepared to do some very strong things in the sidecar, which I have seen no evidence that they are.

  14. WVMJ says:

    Any attempt to improve life for the ordinary American is met with distortion, manipulation and outright lies to prevent it.
    Wedge issues are used only to gain power,to obfuscate, not to resolve the issue ever.
    The longer it is unresolved the better.
    Progress always dulls their weapons.
    Everyone is pro life. I am pro choice and I respect the living and the unborn.
    Your personal freedom to choose an abortion is always one between you and your Doctors. Who else would you allow in the room with you?
    That is also your choice.
    I have no desire to be used by others. There is no one that is pro abortion. They are only against being manipulated.
    Despite what they say no politician gives a rats ass about you and your freedom of choice. No politician gives a rats ass about who does what to whom in bed. They only use it as a weapon for political gain. There are rare exceptions .

  15. e27182 says:

    My prediction (now that nothing big can get passed) is that the Dems will try to quietly overnight dump the idea and pretend like it never happened or they will try to please the Republicans by making the bill covering “Bipartisan” issues.

  16. Kassandra says:

    All this is well and good, but how does it square with Obama getting ready to CUT SS, Medicaid and Medicare?
    I really don’t understand how Medicaid can be the vehicle to get care to the peoples if he intends to cut it and it sure looks like he’s gonna do that.

    Obama Cuts Deal To Reduce Social Security, Medicare, Medicaid
    What IS this? More of Obama’s bait and switch?
    Day by day, I’m more confused.

    • aardvark says:

      The proposed cuts to Medicare are to the Medicare Advantage plan, which is a private plan, run as an HMO, very profitable to the physicians, and costs about 16% more than the government run Medicare.

      Incidentally, it is worth throwing in here that most hospice are HMO’s, very profitable, and like all HMO’s, make their money by minimizing service.

  17. janinsanfran says:

    Way to go Emptywheel. Very sensible. Those of us on the left have to keep pushing for better and know enough to be glad for anything we do get. The people in power are not our friends; they are proper objects of our continual struggle.

  18. leab says:

    Is it not possible that the only reason some Senate Dems are now so keen on reconciliation is that they have absolutely no intention of ever using it?

    What are we doing here?

  19. papau says:

    I agree re Medicaid for 15 million as is already in the Senate bill, plus Medicare at age 55, plus elimination of the antitrust exemption, and drug re-importation are the only things that should pass – and they should pass via budget recon.

    The rest of the mess – including pre-existing – requires too much give away to the ins. co’s – heck, the ins premium subsidies needed can’t get pass the fiscal conservative Dems.

  20. midwestwife says:

    Thank you so much for all the effort that your blog has done to destroy the possible in hopes of the perfect future. I’m not a Hollywood producer. I’m just a mid-west bookkeeper hoping to hang on to my health insurance. My insurance isn’t real insurance. It’s just a card to get me into the doctor’s office. If I get really sick I know I’m out on the street, but just being able to get into the doctor’s office will probably reduce my chances of being really sick. But all you FDL people with outside resources and real insurance are more interested in driving web traffic than in actual health insurance reform. You are willing to toss me and fifty million other Americans under the bus so that your site will continue to have traffic because the perfect HCR hasn’t been passed. Thanks guys. Hoping for your continued good health also. God knows you’ll need it with friend like you.

    • masaccio says:

      I’m not sure what you think we’ve done besides point out to anyone who would listen that the Senate bill is a bad bill. We don’t have power to do anything but argue, which we do regularly and from a number of fact and policy based premises. In a number of posts, I have explained the financial side of the proposed legislation, and have demonstrated that the effect of the proposals is to radically increase the profits of insurance companies without providing an equivalent amount of health care.

      What you want us to do is shut up. We won’t.

    • bmaz says:

      What a bunch of pure unadulterated crap. If you want to comment here, please be a little better informed. First off, this is Emptywheel blog, we are not Hollywood producers either; secondly, nothing that has been advocated here, or at Firedoglake, is in any way designed to remove your coverage, but rather to improve your coverage and affordability in the future. Of course, if you had actually read any of the material so as to be minimally informed, you would know that; instead you come here to spew a bunch of uninformed and fraudulent garbage. Best of luck to you; maybe you can use your “card” to seek a cure for ignorance.

  21. revolutionary1 says:

    A political genius’s approach to turning the Obama presidency around:

    Step 1

    How to expand coverage to 40 million people with reconciliation:
    Expanding Medicaid to everyone below 215% of the FPL, and expanding SCHIP coverage to all uninsured children, should give roughly 30 million more Americans insurance for a cost of just under $800 billion.
    The Medicaid expansion could be structured to also work as a de facto extreme catastrophic insurance policy for people over 215% FPL. You could set it up so that if anyone suffered from a major medical emergency, which cost so much it effectively made their yearly income below 215% FPL, they would, at that point, be covered by Medicaid. This would effectively put an end to medical bankruptcy in this country.
    Early Medicare buy-in could be added for people without insurance who are between 47-65. This is the group who, even if they have money, tend to have the toughest time finding affordable, quality health insurance.
    Expanding Medicaid, Medicare, and SCHIP are all doable under reconciliation. A bill that does these three things would only need a simple majority in the Senate, would be cheaper than the current Senate bill, and probably be no more than 30 PAGES long.
    Have Wall Street fat cats and other low-lifes pay for it all.

    Step 2

    Monumental Infrastructure Bank for large job creation and investing in future productivity ( Krugman was right. You didn’t do enough the first time with the “stimulus” program). Have the professionals make all of the decisions and not pork-barrel politicians.

    Step 3.

    Put Elizabeth Warren in charge of new Consumer Protection Agency.
    Fire Summers, Geithner and Rhambo.
    Replace Bernanke with Volker.

    Step 4

    The United States Senate is a dumb, corrupt, dysfunctional institution that no longer serves the interests of the American people. Bypass it on energy. Use the full powers of the EPA to mandate change!

    Mr. President – you have allowed the Congress to create a 2000 page health care bill monstrosity and you call it a success. With respect, that’s Bull Shit! It’s time for you to descend from the clouds and walk upon the earth and make a critical decision. Are you for the people or against the people? The fate of the Democratic Party and the nation awaits your decision.

  22. hipparchia says:

    (and many people doubt Massa’s explanation on that count)

    do any of these “many” people have names, and can they credibly back up their opinions? or is fdl stooping to asking us to rely on anonymous sources, who may well be just parroting the ‘he represents a conservative district’ line? you can google it; massa ran on single payer in both his 2006 campaign [which he lost narrowly] and his 2008 campaign [which he won].