A week of twists and turns in health-reform debate

The same day that Democrat Al Franken was sworn in as Minnesota’s junior senator, U.S. Senate Majority Leader Harry Reid visibly started rethinking the need to make a health-reform bill palatable to Republicans in a filibuster-proof Senate.

Reid, D-Nev., reportedly sent a note to Finance Committee Chairman Max Baucus of Montana to drop a proposal to tax employer-based health insurance benefits and to push on with a public option, a plan opposed by Republicans. That was Tuesday.

But by Thursday, Roll Call reports, Reid met privately with four Republicans on the Finance Committee to “assure them he was committed to a bipartisan deal.” Later, he told reporters that he “could envision a nonprofit medical cooperative plan of some sort being acceptable substitute for a government-run insurance option.”

“We’re going to have some type of public option — call it co-op, call it whatever you want,” Reid said. “We’re trying to work something out and have not drawn any lines in the sand.”

In the House, new objections from the Blue Dog Coalition — a group of fiscally conservative Democrats including Minnesota’s Collin Peterson — are expected to delay the legislation, according to Roll Call:   

“Forty Blue Dogs signed a two-page letter communicating a series of demands ranging from more aid to rural areas to more cost-cutting to protections for small businesses.

But the fiercest opposition is to a public plan option based on existing Medicare reimbursement rates.”

No need to play nice?
But with a filibuster-proof Senate, Democrats no longer necessarily need to play nice, various news media pointed out this week. Tough talk might even result in bipartisan cooperation on health reform, according to The Treatment blog at the New Republic.

“The more that Republicans believe Democrats are willing to pass reform on their own — either by maintaining enough party discipline to break a filibuster or by trying to use the budget reconciliation process, in which legislation can pass with a simple majority vote — the more likely Republicans are to compromise. It’s possible Reid’s show of pique could actually strengthen Baucus’s hand for dealing with [Iowa Republican Charles] Grassley, while also strengthening the hand of those on the right — be they individual lawmakers or special interest groups — who would prefer a modestly unacceptable bill to one they really hate.”

Still up in the air is how to pay for health-care reform, and observers are worried about Congress being able to reach consensus and pass a bill by Aug. 7, when a month-long recess begins.

This week, Vice President Joe Biden announced that hospitals had agreed to contribute $155 billion to health reform, joining a list of industries making concessions. But what are the expectations behind those concessions?

Hidden costs of concessions
The New York Times looks at the hidden costs, noting the bottom line of retailer Wal-Mart, which said last week that it would support an employer mandate for big companies to provide insurance for workers. “In exchange, Wal-Mart said it wanted a guarantee that the bill would not ‘create barriers to hiring entry-level employees’ —  in effect, code words to insist that lawmakers abandon the idea of requiring employers to pay part of the cost for workers covered by Medicaid, the government insurance plan for the poor.”

The tradeoffs are of concern to Congress, including the chairman of the Senate’s health committee, Sen. Christopher Dodd, D-Conn., and Sen. Olympia Snowe, R-Maine, considered a critical swing vote. 

“I’m delighted to hear that people are stepping up to help reduce costs,” Dodd says in the Times story, “but I want to know what the ask is, and the ask sometimes can exceed the value of your cost savings.”

Snowe has not signed on to any of the White House deals. “It’s one thing for the president to reach that agreement, but it’s another thing for Congress to reach that agreement,” she says. “We have yet to evaluate what are the specifics and particulars. So it’s uncertain. It could be helpful. I just don’t know.”

Obama and public option
Though President Obama was overseas this week, he tried to reassure advocates of a public option that he’s still in their camp with what Slate calls an “out-of-the-blue two sentence statement”: “As I’ve said before, one of the best ways to bring down costs, provide more choices, and assure quality is a public option that will force the insurance companies to compete and keep them honest.”

Slate asks, “Why does the president have to issue a statement from several time zones away reiterating something he’s already said? Because his supporters worry that in order to achieve comprehensive health care reform, and to win support from some Republicans, Obama will trade away his support for a public option. Alternatively, they worry that he will redefine public option beyond recognition.”

The Washington Post offers some perspective on the week’s developments: “No single development appeared likely to kill Obama’s signature domestic agenda item, but the relentless barrage of challenges that seemed to hit hourly served to demonstrate why no president since Lyndon B. Johnson has been able to enact large-scale health legislation.”

Michigan plowing a path to reform
Meanwhile, some legislators in Michigan aren’t waiting for national health reform to try to stop practices that deny insurance coverage and charge more for chronic health problems, the Detroit Free Press reports.

State Sen. Tom George, R-Kalamazoo, a sponsor of Republican legislation, thinks chances of passage this year are “fair to good.”

The Free Press says George’s plan “would require businesses — including self-insured enterprises such as General Motors Corp. and Chrysler Group LLC, now exempt from state regulations — to pay to expand health care for poor people.”

Though any tax increases are opposed by the Detroit Regional Chamber and similar groups, Michigan stands to lose federal matching money if it doesn’t require businesses to help pay for the programs, George said.

“Why wouldn’t we want the government-run General Motors and Chrysler to help us with this problem?” he tells the Free Press. “It’s aimed at their former employees.”

Time magazine sums up what’s ahead for the nation: “The next few weeks will bring some hard decisions for everyone involved in the health reform debate. But the bottom line will come down to one crucial question: Is it riskier to push for health reform — or to be seen as having stopped it?”  

Casey Selix, a news editor and staff writer for MinnPost.com, can be reached at cselix[at]minnpost[dot]com.

Comments (9)

  1. Submitted by myles spicer on 07/10/2009 - 10:58 am.

    Obama’s ratings have shrunk from three publics: a) the Republicans who never liked him, and like him less as he appears weakened; b) many independants who are now growing impatient; and c) most importantly his liberal base who also are drawing away as he continues to compromise his campaign promises. His strategy on health care will be a defining moment for him with the liberal base. Should he compromise away his stand on healthcare, liberals will mitigate and be cautious in future support. On the other hand, should he go for the gold on healthcare, and lose because of Republican (or even Blue Dog)opposition, he will gain an even more vigorous backing from his liberal base. Lots at stake here for the Obama presidency.

  2. Submitted by Gregory Stricherz on 07/10/2009 - 11:29 am.

    I certainly wish journalists would stop saying the Democrats have a filibuster–proof Senate. They do NOT. There are 58 Democrat Senators and two Independents who often will caucus with the Democrats. But not on health care. Senator Lieberman has already expressed strong opposition to Obama’s “public option.”

    In addition, the idea that Obama’s public option offers anything close to what the American people really want is delusional. As one writer said, “All you need to really know about the Obama health ‘reform’ initiative is that it is being supported by retail giant Wal-Mart.”

  3. Submitted by John Roach on 07/10/2009 - 11:33 am.

    3 out of every 4 Americans want a Public Option in this bill. In the name of “bipartisanship”, the usual Washington insiders will produce something that doesn’t work and will be completely ineffective in controlling the behavior of the for-profit insurance industry.

    Not a single Republican will vote for it anyway and they will then complain that it was because the bill wasn’t “bipartisan” enough.

    It would sure be nice if the Democrats had control of the House or Senate. Then maybe we could get something done.

  4. Submitted by myles spicer on 07/10/2009 - 01:50 pm.

    Yes, but progressives are better with a scuttled plan than a poor one. If the Republicans actually block health care reform ti will be a dwad goose around their neck next election. They will come back and say “we offered and alternative”; their alternative in essentially NO plan, just some fakey tax breaks so folks can spend more on poor plans from the private insurers. Hopefully, this will be so blatant and transparent, the voters will see through it and rebel.

    The best approach for Obama — and the nation — is to go forward with a solid public option plan, and let the chips (votes) fall where they may.

  5. Submitted by Bernice Vetsch on 07/10/2009 - 04:56 pm.

    I believe that NO plan would be infinitely preferable to the proposed Massachusetts-plan clone that, like its model, would be punitive rather than helpful, would not achieve full universality, and would NOT reduce costs but increase them because it would add yet more layers of public and private bureaucracy through which to struggle.

    Unless the public option is strong, fair, cheaper than regular insurance, and available to all without conditions, it will fail. But will Republicans and Blue Dogs support it unless it is weakened to the point of uselessness? Probably not.

  6. Submitted by Richard Schulze on 07/11/2009 - 11:21 am.

    The fact that many people are without insurance, the fact insurance is not portable. Those problems all stem from a single cause. Which is that we rely on private insurers to provide health insurance. That’s a failed business model effectively for this enterprise.

    The private insurance companies imperative is to not sign up as clients, people who need medical care. They want to find healthy people or people who won’t need medical care.

    Much of their budget is devoted to identifying who is going to need care and then taking steps to exclude those people from their policy rolls.

    Another major part of their budget is based on aggressive efforts to deny reimbursement claims, so if you do have a policy and you do get a procedure and then you seek reimbursement for it. They have experts who get extra salary if they deny a higher proportion of claims.

    That is a failed business model for providing health care. That is called the adverse selection problem.

    That is why no other major economy provides health care along the lines of that model. Every other country has a universal access system that is roughly speaking a single payer system.

    I think the Obama administration will include a vigorous public plan. There will be a lot of uproar I’m sure if a bill comes out without one. Then there will be a chance for the public to choose.

    It will be a public plan that will take all comers, a public plan that you can carry with you where ever you go, a public plan that will not charge you a heavy premium if you have previous conditions. If people have access to that plan and for reasons of their own choose not to buy it, well and good.

    As long as that is part of the mix, I can think that the health care reform effort can be said to have done its job.

    We provide health care in the least efficient way of any modern industrial country. On average most countries spend half as much per capita as we do.

    People complain there are waiting lines in those countries and that’s true, in some there are. Then we could spend three quarters as much if we did it more efficiently and have no waiting lines.

    It’s up to us on how we want to spend the money. With a more elaborate plan with shorter waiting lines, or a cheaper plan with longer waiting lines.

    We have waiting lines now in effect. There are a lot of people who are denied care forever and that’s a waiting line

  7. Submitted by Tim Nelson on 07/11/2009 - 02:55 pm.

    Partisans on both sides of the aisle don’t seem to realize that moderates, and the Obama administration want cost cutting, and that they are in charge.

    The goal is cost cutting, period.

  8. Submitted by Bernice Vetsch on 07/13/2009 - 03:49 pm.

    Tim (#7) — But, like the privatized Medicare drug plan, the Obama/Daschle mish-mash will probably cost much more than it should because it is written to please the insurance companies and to leave them in charge of our health care. Just as the drug plan was written for (and mostly by) lobbyists for the drug companies.

    Far from hearing from “all” the stakeholders, the PEOPLE were not consulted. That would be the roughly 65 percent of Americans who favor single-payer universal health care (that would save $400 billion per her) over any other plan.

  9. Submitted by Tim Nelson on 07/14/2009 - 02:33 pm.

    Keep your eyes on the prize.

    Cost cutting on all three branches of health care, the providers, insurance, and drug companies.

    The American people versus costs, and the people what brung-em’. A centrist cause for centrist times.

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