Rep Lynne Woolsey (D-CA)--co-chair of the Congressional Progressive Caucus--said, emphatically, that when she and other liberal leaders meet with the President tonight, she wants to hear him say "that he supports a strong public option and he will take that over to the Senate." As for whether she can support the bill in the House with a somewhat weakened public option, Woolsey told me she needs to learn more.
"We're looking at what they've put in the bill to make up for it not being Medicare-plus-five, to see if it covers...our same goals," she said.
Democrats Optimistic, Progressives Coming To Terms, On Health Care Bill
"Medicare plus five" refers to the compensation for medical services that would be permissible by the public option. This particular compensation rate is tied to the rates that Medicare pays, and can't be more than five percent above those rates. That's a good price for most medical services. What the House bill will have instead are negotiated rates, in which the agency paying the bills negotiates the rates with the providers.
The "negotiated rates", by the estimate of just about anyone honest and knowledgeable in this area, are basically a way to make the government health insurance pay the same rates as private health insurance. Thus, they will do little to control the price of health insurance, and will be higher than they ought to be. Officially, the problem here has been that in rural areas, Medicare doesn't pay high enough rates for some medical care. This may or may not be true, but it's certain that not using Medicare rates isn't the best answer. If Medicare rates are wrong in rural areas, they can be adjusted. This would have been the sensible and straightforward way to deal with the issue. What happened instead? Something that benefits the health insurance industry. Go figure. It's also quite clearly going to cost the government more, as The Hill points out:
The negotiated rates plan is estimated to cost about $85 billion more than the Medicare-based reimbursements. To cut the number of uninsured without surpassing the $900 billion limit set by Obama, the bill will expand eligibility for the Medicaid healthcare program for the poor. The bill will also include an income surtax on the wealthy to pay much of the cost of the plan.
Pelosi Chooses Healthcare Bill With Public Option Favored By Centrists
Anyone who didn't think that the "moderates"' idea of fiscal conservatism was a smoke screen should be feeling ashamed of himself right now.
There are no doubt other problems with the bill, that will probably come to light over time. Jane Hamsher discusses one today:
[T]hanks to Representatives Anna Eshoo and Joe Barton, there will be no generic versions of [biologic] drugs [that treat breast cancer and rheumatism]. At least not for 12 years, if the House health care bill announced today passes. And because of an “evergreening” clause that grants drug companies a continued monopoly if they make slight changes to the drug (like creating a once-a-day dose where the original product was three times per day), they will never become generics. Instead of the Waxman-Deal amendment that granted much more reasonable terms to biologic patent holders, Speaker Pelosi chose the Eshoo-Barton amendment. And we could all be paying for that choice for the rest of our lives.
House Health Care Bill: A Death Sentence For My Fellow Breast Cancer Survivors
I can't wait for the excuses on that one.
Steve Benen explains the political bottom line:
House progressives put up a good fight. Indeed, it was their diligence on this specific provision that helped keep the public option alive when much of the establishment thought it was dead. But it became apparent this week that the votes weren't there for a robust public option, so House liberals are doing the right thing -- fight like hell, for as long as possible, and then go with the best bill you can pass.
Settling For Good Enough
Personally, I think a better bill might end up being none at all. That's about what this group of Democrats deserves - it's the perfect capstone to a year of failing to do the things that they needed to get done. The reason it might be better to have no bill is that this bill, as it currently stands, will require that all Americans buy health insurance. If the Congress and the President stick us with a requirement to purchase lousy health insurance, they will suffer for it in the voting booth. In fact, 2010 is shaping up to be a small disaster for Democrats. If they fail to provide a worthwhile bill, that could become a large disaster.
The plain fact is that the Democrats as a group don't want to offend the groups that want to keep the American medical system in the screwed up state it's in right now - the large medical care corporations, the drug companies, and the insurance industry. Yet they have campaigned for years on the promise that once they had a commanding majority, they would pass health care reform. It should have been obvious to any adult who has looked at the state of our health care system that these two goals were incompatible, and yet Democrats continued to act as though they weren't. In the end, when it came time to put up or shut up, they didn't do either. As I predicted months ago, they'll pass a piece of crap bill that they will loudly trumpet as health care reform, which will fix somewhere between little and nothing.
Still, there have been heroes in this fight, and it wouldn't be right not to acknowledge them. One of them, Rep. Raul Grijalva, who has been one of the few representatives who have been actively campaigning for a real public option, hasn't given up yet:
Rep. Raul Grijalva (D-AZ)--co-chair of the Congressional Progressive Caucus--was not in attendance at today's health care bill unveiling. But his office sends over the following quote, suggesting that he plans to continue his push for a strong public option, even though the base House bill doesn't go as far as he'd like.
"I am not rolling over. I will insist on a Medicare-plus-five amendment on the Floor so that the full Caucus can vote on it. We are hopeful that the Rules Committee will allow this amendment, which has tremendous public support, to be voted on for the record."
Grijalva has been leading the charge in the House for a robust public option, suggesting that progressives might defect from the final bill if the plan isn't tied to Medicare reimbursement rates. We'll keep an eye out for his next move.
Grijalva Continues Push For Robust Public Option
It gives me some hope that there are at least a few honest politicians like Grijalva left in Congress. Unfortunately, like Grijalva's hopes for a viable public option, my hopes that he can be joined soon by more such representatives seems far, far away right now.
There still is a chance, though. If you haven't written or phoned your congressmen yet explaining how you feel about health care reform, then you have only yourself to blame. There are sample letters here and many other places to use as a basis. There are also numerous online petitions that can provide some of the words. In the end, though, if your Representative and Senators don't hear from you, it's hard to expect them to carry out your wishes in Congress.
If I were writing my representative right now, what I'd be saying is that I want him to support any amendment that strengthens the public option on the floor of the House, particularly those that expand the coverage to anyone who is willing to pay for it, and those that make tie compensation rates for medical services to those of Medicare. I'd probably add that there's no excuse for not using Medicare rates - if they're really unfair, then Medicare rates should be fixed.
As I wrote previously, they need to know that we're watching, and we won't forgive failure. This is life and death stuff, and if they continue to fail at fixing it Democrats should pay for that failure with decreased power, or even minority status. Power is the only thing they really care about. They need to know it's in danger if they don't do what they said they would when we elected them.
Hmmm, think I know what I'll be doing next.
UPDATE: Added links to articles and an article quote about the relative cost of negotiated vs. Medicare plus five compensation rates, and to Jane Hamsher's article about breast cancer drugs.
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