Good! Pelosi Nixes Agreement With Blue Dogs, Pegs Public Option to Medicare
By Susie Madrak Wednesday Sep 23, 2009 6:00amThis is encouraging, because untying the public option to Medicare virtually guaranteed no significant cost savings:
Speaker Pelosi is nixing a deal she cut with centrists to advance health reform, said a source familiar with negotiations.
Pelosi’s decision to abandon the agreement that was made with a group of Blue Dogs to get the bill out of committee would steer the healthcare legislation back to the left as she prepares for a floor vote.
Pelosi is planning to include a government-run public option in the House version of the healthcare bill. She wants to model it on Medicare, with providers getting reimbursed on a scale pegged to Medicare rates.
"The speaker is full-steam-ahead," said a senior Democratic aide.
Blue Dog Democrats, many of whom represent rural districts where Medicare reimbursement rates are low, vehemently oppose tying the public option to Medicare.
Rep. Mike Ross (D-Ark.) and a group of fellow Blue Dogs had negotiated a deal with Energy and Commerce Committee Chairman Henry Waxman (D-Calif.) in July that would remove the link to Medicare. Under that plan, officials with the government-run plan would negotiate individually with providers.
That move, which drew howls of protest from liberal members, prevented the bill from getting stuck in committee. But Ross returned from the August break saying he couldn't support a public option under any circumstances, essentially withdrawing his support for the deal.
Pelosi is now effectively withdrawing her support. In leadership meetings last week, she said the public option in the House bill should be linked to Medicare.
Other Blue Dogs involved in the deal have said they realized the public option they negotiated was likely to change before it went to the floor.
Pelosi has also told her fellow leaders she still wants an income surtax on the wealthy, rather than a tax on "Cadillac" health plans, as a means to help pay the $1 trillion cost of the bill. The rest is to be made up with savings in Medicare by eliminating wasteful spending.
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that any meaningful health care bill will be passed that won't benefit the fascist insurance companies...they have our politicians in their pockets...
...........I think it's all a distraction and the Insurance Com. will win in the end. Great that Pelosi got off her knees for once, tho. She wants to 'eliminate wasteful spending' if that were the truth, she'd be weeding out the BUSHMOLES who drive up costs by wanton spending on their boat, car, computers, The Family, etc.
is to pass HR-676.
I hope that term isn't code for eviscerating Medicare.
But read the bill and don't make assumptions. If the bill is good it's good. If not, then don't support it.
I will read it when I can.
And if it sucks...no way will I support it.
I am cautiously optimistic. At least the rhetoric sounds good at this point.
We'll see if all this wonderful progressiveness actually makes it to the final bill.
If they clean up the waste in Medicare, does that mean we won't all get those little hover around scooters? What else is there left to look forward to in our somewhat tarnished golden years?
Have better health coverage than people who have any other insurance that I know of.
I deal with insurance ever day. Medicare is high end compared to Humana, Blue Cross, Aetna.... as well as all their carve-outs (Blue Options, etc.)
I'd pay the same for Medicare that I pay for my insurance now and be happy for the better coverage.
she's pissed off at Ross about this
http://rawstory.com/08/news/2009/09/22/rep-mi...
take back a portion of the hateful things I've said about her.
Not all of them, though.
BTW, Susie, a plea of sorts:
Please stop calling these Bribe-O-Crats "Centrists". They are anything but centrist, and in calling them by that label, you are perpetuating a propaganda point that is damaging to our collective paradigms (not to mention also according them a dignity and legitimacy they have neither earned nor deserve). By subscribing to the idea that these corrupt people are merely "centrists", we give them power to manipulate and harm us by making us willing to #1) accept them as if they and what they are doing were legitimate and #2) buy the bullshit they are trying to peddle.
If in fact they were truely centrist, they would be single-mindedly dedicated to serving not only the People, but the Constitution and the ideals contained in the Declaration of Independence. I say this, because it is the People, the Constitution and the Declaration of Independence that are the true center, heart and soul of this nation. By their deeds and by the causes to which the Bribe-O-Crats give their allegiances and energy, it is clear that this true center of our nation is an irrelevency to them, an annoying obstacle that frustrates them from realizing their wholly self-serving goals. They do not deserve any help from us in realizing their agenda.
who often visits, I 100% concur with Paul. Blue Dogs are not "centrists".
They are using that label as cover for being corporate shills. Call them on it!
those blue dogs are republican(t)s in dems clothing... don't be fooled for one second. Their allegiance is to the GOP and the corporations. Eff them!! The people of the U.S. of A. overwhelmingly voted for change and a Democratic ruling party. Let's get on with it!
And as another poster commented, get those bush moles outta the government NOW!
The word "centrist" appears in the text she's quoting: it's not her language. If you want to make your point where it should be heard (and it has to be worth the try), you need to contact Mike Soraghan at The Hill.
it really is. However, I was referring to the name that Susie generally uses in all of her reporting of that group of politicians, whether quoting or writing her own material. I know it's nit-picky, but I also must recognize the power of words that are pervasively used to describe and name things. When the words used don't or fail to truthfully reflect the reality, it does no good.
When people of malign intent use words as devices of manipulation to shape and define an issue, and those words are repeated without due critical examination, bad things can come from it. The art of manipulating language in order to manipulate others' thinking can be so subtle, when done by those who know what they're doing, that the process of manipulation can unfold undetected by those who are being targeted for manipulation.
One example of the process comes immediately to mind: substituting the phrase "ethnic cleansing" for what was in fact genocide. The press latched onto the term almost as if it were manna from heaven, and then repeated the term over and over and over. I can't help but think that in subtly sanitizing the atrocity by simply changing the term used to describe it, a simple act that made the deed seem somehow less horrifying, that it prolonged our collective tolerance for the crimes that were committed and delayed a response from the nations that finally intervened to put a stop to it.
We habituate to a thing that is incessantly repeated in life. Words. Events. Whatever. Repeat it enough, introduce the repeated element quietly enough, and it becomes a part of our cultural paradigms...at which point we no longer question it. We accept it at face value. At that point it becomes a powerful determinant of what we do or don't percieve, and if we do percieve, how we perceive the thing.
I'm not always sure if journalists like Susie always understand how much power they wield.
Anywise, anwaya, nice catch.
Can we at least agree to start writing "centrist [sic]" when we're quiting somebody else's text?
.
I can't control what words reporters use in their stories.
Maybe, as they say, we're actually starting to take our country back...
Private insurance companies make $300 Billion a year not counted as a cost? All of those people can be reemployed, like auto workers (except the greedy execs, who can be fed to pigs for all I care) and the savings to the rest of us plowed into a national health-care system.
My math may be off a bit (or more) but whatever the number, the insurance companies' profits are a cost, and I don't see that being brought up anywhere near a microphone or other public mouthpiece.
You also don't see anyone talking about how $1 spent on private insurance would be $1.50 towards universal care. Or how limiting the cost of universal care ("deficit neutral") with a complicated system of taxes, deductibles, penalties and protections is in fact RATIONING.
If everyone can't have it it is not universal. If it can't be fully paid for it is going to be rationed because some won't be able to afford it.
HR 676
Exactly. And the "cost" of profit has to be continually maximized for the insurers, thus negating many efforts to cut costs, and creating an incentive to cut costs that create hardship for the insured.
Blue Dog acts like a Republican (b/c he is) and fights for a 'compromise' then refuses to vote for the bill anyway.
Pelosi does the right thing and tosses out the 'compromise'. The deal, shitty as it was, was that we give up something we want in exchange for a vote. You reneg on the vote, WHY SHOULD WE GIVE UP WHAT WE WANT?
It's a pretty simple lesson, but one Dems seem to have a hard time understanding.
Single-payer 676 is what the fight should be about, but this is a little bit encouraging.
!
Why the Dow is Hitting 10,000 While Everyone Else is Cutting Back, laying off, inflating prices, and giving us sheep lip service.
My advise? It's especially important that you make your decisions based on a piercing analysis of the inner contents, not a superficial survey of the outer display.
Take it or toss it.
Medicare isn't paying doctors enough right now. My doctor's clinic, which I don't think is unreasonable or greedy, desn't take Medicare. If this new plan pays the same rates as Medicare, it will be broken even before it's launched. Medicare just doesn't pay the bills for the costs of doing business in Washington State.
According to the AARP, under the Bush Administration Medicare has not been paying doctors enough to cover the cost of providing services to Medicare patients. As a result, many doctors can’t afford to see Medicare patients, and many seniors can’t go to the doctor of their choice.
While the Bush Administration was cutting the fees it paid doctors, it gave subsidies to private insurance companies to offer add-on insurance known as “Advantage plans.”
Congress proposed paying for increased reimbursements for doctors by cutting subsidies to private insurance companies. Under the spending rules Congress adopted last, any new spending must be offset by cuts elsewhere. The cuts to Medicare Advantage will be used to close the gap to what doctors are paid for taking Medicare.
because doing so pulls the rug out from under the advantage plan, which was just another privatization scam.
Nine days after a 10.6% cut to Medicare physician payments went into effect (thanks again Bush), the Senate acted in dramatic fashion to replace the cut with a modest pay increase for the next 18 months.
The legislation (H.R. 6331), which passed both the House and Senate by veto-proof margins (which was a must because Bush threatened to veto it), extends the 0.5% Medicare pay increase in place for the first half of 2008 and gives physicians a 1.1% raise for 2009.
The bill relies on cuts to the Medicare Advantage program to fund the pay update, authorizes increased bonus payments under the Physician Quality Reporting Initiative (PQRI), and delays implementation of the Competitive Acquisition Program for durable medical equipment.
Take a look at Medicare Advantage versus Medicare. You will find that Medicare Advantage will pretty much be what the public option is to health insurance reform. The Republicans passed Medicare Advantage which essentially is funding provided by the government and ran by private insurance companies. It turns out we are subsidizing Medicare Advantage which actually is costing more than Medicare.
The next line of attack for the GOP is for them to appear to be protecting medicare. They are saying reforms will cut Medicare Advantage. Well, yes it will but it does not take ANY money away from Medicare. We must squash the latest GOP tactic NOW.
"Republicans Defending Medicare: Duplicity Beyond Belief"
http://pnhp.org/blog/2009/09/14/republicans-d...
The issue that gets all of the attention in the health care reform debate is how the money will flow, or more to the point, through whose hands it will flow, on its way from you the beneficiary and premium or tax payer, to the providers of actual medical services. Single payer would cut out the middleman, the public option would cut out the middleman for only the folks it covers, and getting universal coverage without either single payer or the public option would mean that we would funnel all of the premiums and tax dollars through the private insurers before it gets to the providers.
But there is another whole dimension to this debate that doesn't get the attention it deserves. Though we differ in exactly where on the spectrum we fall, our side tends to favor cutting out the middleman pretty predictably more than the other side, which would prefer to keep the private industry middlemen in place skimming off their 20-30% as much as politically possible. But there are skews all over the place in the case of the other, more obscure, dimension -- whether or not the payer uses his leverage to try to control how the providers treat their patients. Since the industry practices this managed care, as this control is called, and the current "socialized" medicine in the US, Medicare, instead pays on a fee-for-service basis, you might think that the alignment would be Right-to-Left in synch with the public-private continuum of the first dimension, how much or little private insurers are allowed to be middlemen in payments, and Dems would be fee-for-service, and Reps pro-managed-care. But managed care tends to be a darling pet theory of technocratic centrists, at least those whose theology tells them that greedy providers are the cause of high costs, and they must be controlled from outside by the payer. Obama seems to be such a technocratic managed care enthusiast, and managed care seems to be what he imagines will allow the public option to bend down that cost curve.
Now it would appear that Pelosi is a fee-for-service partisan. This is all good, as far as I'm concerned, as single payer fee-for-service, Medicare for All, is my idea of the best of both dimensions. But this should be noted as a rift among Dems that might grow wider and more important if both sides stick to their guns.
You have hit on one of my reasons for thinking that Obama just doesn't get it, and is not likely to do so. And, that approach has never worked.
I do of course, wonder how much adherance to control approach is dictated primarily by how much money one accepts to buy imto that proposition.
...whether or not the public option does managed care, enough to pay anyone to be for it. Sure, the private insurers are plenty interested in being allowed to continue to practice their own version of managed care, which is mostly demand management (Old joke: You can only make money providing managed care insofar as you manage not to provide care.), but I don't see their motive in paying perfectly good money, that could be put to better use bribing a Senator in some other matter, for a result, like how the public option is managed internally, that won't make them any money.
All along there have been idealistic technocratic types who have bought into the idea of managed care, the idea that those scumbag first two parties, the patients and the doctors, aided and abetted by the moral hazard of having some third party paying all the bills, have been in a criminal conspiracy to raise the costs of medical care by ordering all manner of unnecessary services. Sure, this never made any sense in terms of the patients, who pay in human costs for unnecessary services (I have yet to meet the first patient who would conspire to steal a "free" screening colonoscopy, because it sure ain't free if it's your orifice being invaded.), made little sense as even a plausible temptation for most providers, assumed a blind patient compliance with "doctor's orders" that I have yet to see a single example of in my twenty years of practice (Try getting the average patient to his screening colonoscopy without a gun in hand.), and was always, as the industry implemented it, pretty transparently all about demand management. But somehow the technocratic idealists never seem to notice the moral hazard of letting the payer influence treatment decisions, or that this moral hazard actually has plenty more evidence that it determines industry behavior, than there is reason to believe that fee-for-service plays a big role in provider behavior. And so enthusiasm for managed care survives in academia and think tanks. Insofar as these people are aware that the industry just used the concept to intellectually launder abusive practices, these folks will tell you that they see the govt running some high-minded version of managed care, that will achieve affordability and quality by forcing best practices on the errant providers they still blame for poor quality and high cost. This is not, on the face of it, an obviously bad or wrong idea. I just think that it is a naive idea. The standard of care allows tons of variability because most of medicine does not lend itself to clear, dominant strategies, and where there is one clearly better way, providers are already way ahead of the managers. And while it won't realize legitimate savings, it offers the prospect of a layer of management pressured to make even inapporpriate interventions in the standard of care because they are charged with reducing costs. The payer should just be a payer, not a manager, charged with paying for any service called for by a standard of care that the payer cannot influence.
the payer isn't just a manager, it's also a judge, jury and sometimes executioner/murderer.
You refer to the best part of the whole arrangement that the industry has managed to buy for itself, well "best" in the sense of the most artisticly complete and uncompromising, is the ERISA provision they got through to protect them from any malpractice liability for the often muderous decisions they make to interfere with the standard of medical care that binds individual providers. They get to interfere in treatment decisions, but patients harmed by their decisions are categoricaly barred from recovering any damages from them for the consequences of their decisions. It is like the right to judicial murder, or a 00- license to kill.
I am very skeptical about getting real health care reform as well, but this is important: Everyone should e-mail Pelosi and you own rep and let them know that you support this, that you support Pelosi tying the Public Option to Medicare and tell you rep that they should support Pelosi and Obama if they want to show history that they are on the peoples side.
Health Care Reform could cement certain politicians place in history, for good or bad. It's important that enough of us try to show that perspective to our leaders
Can we PLEASE stop calling blue dog Democrats "centrist" Democrats? They are CONSERVATIVE Democrats.
To call them centrists is to capitulate to the right wing propaganda machine's 30 year effort to shove the Overton Window so far to the right that people who are in favor of no gun control at all, capital punishment, and no government involvement in commerce are now thought of as "centrists." If that defines a centrist, I don't know how you would define conservative.
The same propaganda machine that labels somebody like John McCain as being "too liberal," and REAL liberals like Ralph Nader or Dennis Kucinich as being "radicals."
The same propaganda machine that painted the health care Public Option plan as being the FAR LEFT alternative. In the REAL world, the SINGLE PAYER plan is the left plan, the Public Option plan is the CENTRIST COMPROMISE, and no public healthcare is the CONSERVATIVE version, NOT the centrist version.
Please stop enabling the right wing propaganda machine, and stop calling these conservative Democrats "centrists."
!
If anything, I would say you don't go far enough in resetting the Overton window in the dimension of who pays for health care. Single Payer, Medicare for All, should be considered every bit as centrist, maybe even right of center, as Medicare itself. What could be more conservative than wanting Medicare, this long-established and long-popular program, to continue and expand?
The point I was trying to make in my post above about this other dimension of the debate, managed care vs fee-for-service, in which I used the phrase "technocratic centrists", is that it doesn't line up on the same right-to-left axis as the question of who pays. There are folks way to the left on the "who pays" question who are fervent supporters of managed care, and some equally far out there to the left who think that the payer should not influence treatment decisions, but should pay for any service dictated by the standard of care.
I, for example think that the ideal best system would be a national health service, real "socialized" medicine, but I also believe that this health service should not dictate to its provider employees how they practice medicine. The standard of care should do that. My proposed national health service would carry a mandate to make available to everyone who might need them, the whole array of medical services that the standard of care says they need. It's important for people to understand that even having physicians as outright salaried employees of the government, would actually be less truly, "bureaucrat-run health care" than the plan they are mostly on right now, under which their private insurer can dictate sometimes significant deviations from the medical standard of care. I was an Army Internist for 20 years, and for most of that time that I drew a salary and was under literally military discipline, I never once had to cut back what I wanted to order for a patient because any bureaucrat was managing the care I provided. Well, not until we, for no discernible reason other than to let a private insurer make a profit off of the taxpayer, cut a private insurer into the middle of the care we provided. I retired as soon as possible after that
SCRAP the name PUBLIC OPTION and use the term MEDICARE. People below the age of 65 can pay to enroll in Medicare early. NEXT: change the law that says Medicare cannot negotiate prices based upon its large purchasing power, which will get much bigger after letting all these younger people into the program. The GOP cannot complain about Medicare without insulting the elderly without exposing their true purpose is to eliminate Medicare, and Medicade and social security.
CALL IT MEDICARE and NOT the public option.
I agree. By calling the public option "buying into Medicare early," you disarm most of the inevitable spin-doctor attacks that play on the language. "Public" is a word that's easily smeared by the right wing propaganda machine. Obama and his gang were smart enough to include the word "option," giving them the ability to say "why do you hate freedom of choice?" But they weren't smart enough to disarm the word "public" or to make the plan bullet proof by calling it Medicare.
So far Howard Dean is the only Democrat I've seen who was smart enough to do that.
It's just pooled insurance. HR-676 is Medicare, and that's what they should be fighting for.
Actually, with the exception of Alaska, Medicare pays more or less the same all over the country for services. There are some variations because the actual reimbursements are determined by the regional carriers.
Some examples: the reimbursement for an extended office visit (code 99215) in Dallas is $125.81, rest of Texas $118.96, Pittsburgh $121.29 and Alaska (thanks to Sen. Ted Stevens) 164.32.
You can look up any code yourself here:
http://www.cms.hhs.gov/PFSlookup/
So when people say certain areas pay less for Medicare, this is only what they think. Actually, what is going on is they compare it to what they get from private insurers and depending upon whether that is comparable or a lot or a little more than medicare, they judge how fairly they think medicare pays.
In some areas like Nevada, and the Philadelphia area, Medicare pays better than many private insurers, so they don't feel burdened by Medicare in those ares, and Medicare is paying about the same as in other areas of the country.
Doctors also seem to ignore the tremendous overhead required to even GET reimbursed by private insurers. This makes private fees smaller when this is factored in.
Dear President Obama: A Modest Medicare Proposal by Thom Hartmann
http://magginkat.wordpress.com/2009/08/20/dea...
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