Lieberman not sold on health care compromise

Brian Beutler reports for TPMDC that last night's deal among Senate Democrats still may not be enough for Joe Lieberman.

"I am encouraged by the progress toward a consensus on proposals to send to the Congressional Budget Office to review. I believe that it is important to pass legislation that expands access to the millions who do not have coverage, improves quality and lowers costs while not impeding our economic recovery or increasing the debt.

"My opposition to a government-run insurance option, including any option with a trigger, has been clear for months and remains my position today.

"Regarding the 'Medicare buy-in' proposal that is being discussed, we must remain vigilant about protecting and extending the solvency of the program, which is now in a perilous financial condition.

"It is my understanding that at this point there is no legislative language so I look forward to analyzing the details of the plan and reviewing analysis from the Congressional Budget Office and the Office of the Actuary in the Centers for Medicare and Medicaid."

It's possible that the trigger in the compromise could bring over Republican Senator Olympia Snowe, getting Democrats to 60 votes even if they lose Lieberman. However, that's no guarantee.

Harry Reid never should have taken the budget reconciliation route off the table. I understand that there are drawbacks to that approach, but I would rather see our leaders push a stronger bill through with 51 votes in the Senate.

Update [2009-12-9 16:0:23 by desmoinesdem]: Beutler notes that the Gore-Lieberman platform during the 2000 presidential campaign called for lowering the age at which people are allowed to buy in to Medicare.

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Reid was right to reject "the trigger". This is war.

Even if Harry Reid knew he didn't have 60 votes locked up, Reid made the right choice. Even if the White House worried that he didn't have 60 votes, he made the right call. The corporate centrists in our Party have too long grown accustomed to winning through refusal. Their refusal to even allow serious discussion of a Single Payer plan was just one recent example.

We are essentially in a state of war regarding health care. About as many Americans die annually as a consequence of poor or non existent health care insurance as died during the entire Viet Nam war. Our adversary, many would say enemy, is the private health care insurance cartel. They run the system that is responsible for those deaths. Not only do they run it, they profit off it, which makes them war profiteers in my book.

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Earth to G.O.P. regarding Medicare's "failure".

This isn't the first time I've seen them try to slam Medicare as a failed program because it's "going bankrupt". From "The Hill", October 20th:

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Urge wavering House Dems to back robust public option

As Shaun Appelby discussed in his diary yesterday, the House of Representatives will soon bring a health care reform bill up for a floor vote. All three relevant committees have approved bills containing a public health insurance option. In August, Jacob Hacker explained one of the key differences between those bills (pdf file):

The versions of the House bill approved by the House Ways and Means Committee and  House Education and Labor Committee contain a Medicare tie-in that has two crucial  characteristics:
     1.  Providers participating in Medicare would automatically be considered participating  providers in the new public plan, although they would have the right to opt out.
     2.  Initial payments to providers would be set at Medicare rates plus 5 percent. After  three years, the Secretary of Health and Human Services could adjust rates. But  during the crucial start-up period, the public plan would be able to piggyback on  Medicare's payment methodology. 17    

     These are good provisions. They would be even better if they included an explicit  protection of providers' rights to join the public plan. Private plans (at least those that  participate in the exchange) should be prohibited from setting as a condition of participation  in their networks that providers not join the public plan.
      By contrast, the House Energy and Commerce Committee approved the House bill  with amendments that preserve only the first of these two elements. 18 Providers participating  in Medicare would be presumed to participate in the new public plan (but, again, allowed to  opt out). 19 However, rather than setting the rates the public plan would pay providers on the  basis of Medicare rates, the Secretary of Health and Human Services would have to  "negotiate" rates directly with providers. 20 These rates in the aggregate would have to be  between Medicare rates and private rates, but no other details are given. 21 This is a not-so-good provision that could drive up individual premiums and federal costs, burdening  Americans as health care consumers and taxpayers alike. It threatens the viability of the  public plan because it may require the government to pay providers higher rates than they would otherwise accept if the rates were set.

Click here to download Hacker's full report, which includes analysis of the Senate HELP Committee's bill.

When the House Energy and Commerce Committee passed a watered-down bill to placate Blue Dog Democrats, most people assumed that this compromise would be the health care reform bill sent to the House floor. However, House Progressives have been rounding up votes for the stronger public option provisions, and yesterday Progressive Caucus co-chair Raul Grijalva claimed to have 210 votes supporting or leaning toward supporting the stronger bill. Speaker Nancy Pelosi won't bring that bill to the floor unless she is sure she has the 218 votes needed to pass, however. As many as 19 House Democrats have not decided whether they would support the "Medicare plus 5 percent" public option.

Chris Bowers published a pdf file listing 36 House Democrats who are either undecided, "lean yes" or "lean no" on the stronger public option. It's not clear who falls into what category. For instance, my own Representative Leonard Boswell (IA-03) is on the list, but his office has not yet clarified whether he is undecided or leaning one way or the other on the Medicare plus 5 percent public option.

You know the drill. If you live in one of these 36 House districts, your representative needs to hear from you. The "Medicare plus 5 percent" version of the public option is better policy, and if the House approves it, our negotiating position in the Senate will be stronger. I would call rather than e-mail, because phone calls are harder for staffers to ignore.

In related news, Boswell joined Representatives Bruce Braley (IA-01) and Dave Loebsack (IA-02) today in announcing final legislative language to change "the way Medicare pays healthcare providers for services, from its current fee-for-service system into a quality and value-based system." After the jump I've posted a joint press release explaining how this deal will affect Medicare reimbursement rates.

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Delay, Derail, Defeat

In a story over at Politics Daily about the failure in the Senate tonight to proceed on a bill to increase Medicare payments to doctors at a cost of $247 billion over 10 years, there is this tidbit:

Senate procedures give Republicans an array of tactical maneuvers that they have used to delay, if not derail, Reid's agenda. While the House has passed all 13 of its appropriations bills, climate change, and health care bills (at the committee level), the Senate schedule has lagged. When House Majority Leader Steny Hoyer was asked Tuesday why the House schedule was so light, he said that the Senate has not sent back enough legislation for the House to respond to.

As Republicans have succeeded in stalling votes, Reid's statements have escalated from terse to downright angry. Last week he accused Republicans of trying to kill health care reform, saying, "Republicans will do everything in their power to stop reform this time." When asked Tuesday why the Senate had not passed an extension of unemployment insurance benefits, Reid responded, "The word starts with an R.' Republicans. Republicans."

On Wednesday, Reid said the entire Senate agenda was falling prey to the GOP of past and present.

"I think it's too bad that suddenly, (Republicans) have gotten religion," Reid said after the vote, visibly frustrated. "They never worried in the past about all these tax cuts being paid for. They never worried about the drug manufacturers getting all the free stuff they got. They never worried about any of this. They suddenly are being very frugal, very frugal when they've figured out it's a way to slow down what we do here."

Even with 60 Democrtic votes, veteran political watchers acknowledge that Reid's task of holding together his unwieldy caucus is difficult, if not impossible. "It's difficult to move things in the Senate," Hoyer said. "I think Reid has the most frustrating job in American government."

How is it that the nation is being held hostage by a caucus of forty?

Nor is it terribly reassuring that the Majority Leader can't keep his own caucus in line. A dozen Democrats and one independent crossed party lines and voted with the Republicans on the 53 to 47 roll call. The Democrats who voted against the party leadership were Senators Evan Bayh of Indiana, Kent Conrad of North Dakota, Bryon Dorgan of North Dakota, Jon Tester of Montana, Russ Feingold of Wisconsin, Herb Kohl of Wisconsin Claire McCaskill of Missouri, Bill Nelson of Florida, Mark Warner of Virginia, Jim Webb of Virginia, Robert Byrd of West Virginia and Ron Wyden of Oregon. Independent Joe Lieberman of Connecticut also joined the GOP in defeating the measure.

Still it is more concerning that the Democrats are being outwitted tactically by Senator Mitch McConnell.

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