Blue Dogs: We Can Not Support House Health Legislation Without "Significant Progress"
Facing a deluge of letters from (mainly conservative) party members, House leaders have delayed unveiling their health care reform bill for at least a few days as they address a number of members' concerns. But the prime mover in their decision seems to have been pressure from Blue Dog Democrats, who delivered a letter to Speaker Nancy Pelosi and Majority Leader Steny Hoyer last night.
"From where we are today, significant progress on the draft tri-committee health care reform proposal needs to be made in order to address each of these concerns," the letter reads. "We cannot support a final product that fails to do so. "
The letter, which you can access here, was signed by 40 of the 52-member coalition. Their concerns include deficit neutrality (the Blue Dog hobby horse) but also, financing, and the public option--which they say should not be able to use Medicare, or Medicare-like reimbursement rates (about 20 to 30 percent below the private market) but ought to compete on a level playing field. "We also wish to reiterate our support for the recommendations previously made by our Coalition regarding how to appropriately structure a public option," the letter reads. "In order to establish a level playing field, providers must be fairly reimbursed at negotiated rates and their participation must be voluntary."
That's fairly gentle language, and pretty remarkable when you consider that, until recently, a number of Senate Democrats were vying to scrap the public option altogether. I'll have more on this later today, but my immediate read on all this is that the Senate--its rules and its political makeup--remains the biggest hurdle to health care reform.
Josh
Matt
Eric
Brian
Not allowing the use of medicare rates is probably not a problem, provided that there is a public option. As with the medicare prescription plan prohibition on using bulk purchasing power, this is the type of concession that can easily be rolled back later.
As it happens the medicate prescription plan savings from bulk purchasing are a major part of the money that is going to be used for this plan.
Long term the health care plan will be funded the sensible way - by eliminating a very large part of the Pentagon budget.
July 10, 2009 10:07 AM | Reply | Permalink
Your last statement sounds awesome, and I hope it happens, but I wouldn't hold my breath any time soon. But, for motivation: http://it.usaspending.gov/
How stupid how we are spending our money.
July 10, 2009 10:45 AM | Reply | Permalink
I share your pessimism. Decades of fearmongering and jingoism have deeply corrupted our culture. The pervasive military-worship in the contemporary US, which reminded me of Wilhelmine Germany, would shock even our grandparents' generation, let alone our forbears further back.
July 10, 2009 10:53 AM | Reply | Permalink
The Big Pharma 'deal' will up their prescription numbers because the savings ONLY apply to their drugs!
Call the blue dogs 1.800.828.0498..Tell them to get with the program...we need workable Healthcare not 'donut holes' and caving to the lobbyists for HMO's and Insurance companies and Big Pharma!!
July 10, 2009 10:51 AM | Reply | Permalink
Can you please help with the signees here? I can't tell who has sign off on the letter because of the scribbles of their handwriting
July 10, 2009 10:08 AM | Reply | Permalink
Blue Dogs and progress. Reminds me of the Republican Walk With God.
July 10, 2009 10:12 AM | Reply | Permalink
You know what I don't get? Our industries are getting killed by the deadweight cost and labor market rigidity of the employer-based health insurance system. And yet the corporate lobby (which plays the tune to which the Blue Dogs dance) continues to put ideology above self-interest and stands in solidarity with the parasitic insurers that are actually killing all the other corporations. If the business lobby simply acted out of naked self-interest we'd have had a French or German-style system long since. It's really weird. Is American capitalism just too stupid to live?
July 10, 2009 10:20 AM | Reply | Permalink
Yes. Robert Reich has said we need a new economy- he's right. Capitalism needs to die in order for the middle class to survive. True story.
Know who else is too stupid to live? Blue Dogs.
July 10, 2009 11:21 AM | Reply | Permalink
The reason big business opposes health care reform is because the cost of labor will inevitably go up. Many, many Americans are working at jobs they hate for less money than they should be paid for one simple reason: the health care coverage. If you give people an option that allows them to leave these jobs, they will leave. Millions of people will take different jobs, work part time, or just quit altogether. This means that business will have to pay more and stop treating people slaves.
This cost is probably greater than the costs of providing health care to workers.
July 10, 2009 11:26 AM | Reply | Permalink
In a healthy economy, yes, I think you have a point. Today, not so much- there isn't enough jobs to go around. We will be facing a short fall of at least 5.5 million jobs in a year and it's growing every month- not just by jobs lost, but by new job-seekers coming on to the scene.
People will hold onto their jobs in today's economy- no matter how much the hate it or how little health care costs.
July 10, 2009 11:29 AM | Reply | Permalink
Disagree. Some people are ready to leave right now and only keep their job because of the health care coverage it provides for their family. It is a common occurrence for one parent to keep a job that barely pays the cost of daycare simply because it comes with a health care plan. Take that benefit out of the mix, and that parent would just as well stay home.
July 10, 2009 11:51 AM | Reply | Permalink
I think that's probably right. However, I don't think finding someone to take the position will be a problem. Again, keep in mind the huge glut we have, and will continue to have, in jobs. Health care is spendy, yes, but there will still be many seeking full-time employment if and when universal health care is passed. Especially if you consider many of these jobs people hate or less skilled jobs. I doubt it will cost employers a thing, and may actually save them, if an employee that's been around for years for the benefits is replaced by a newbie (ie less payroll to pay out, less benefits to pay out). It's a win-win.
Even if big business does have to pay out more in wages to remain competitive, uh, why is that bad? It's long overdue imho. I can almost guarantee whatever increase in wages will be far less than what they paid for health care.
July 10, 2009 12:08 PM | Reply | Permalink
Oh, I agree with you, there will be plenty of people to fill jobs. And I also agree that if it pushes up wages, that is a good thing. But there is an intangible in the mix - the freedom to leave your job. It changes the dynamic. People will not be slaves to their jobs. This is bad news for big business.
But all of this just makes me doubt that any public plan will happen. Business is too powerful.
July 10, 2009 12:24 PM | Reply | Permalink
While big business opposed health care reform in 1993, I don't think there's much opposition today (outside the insurance and pharma industries). They've seen their costs skyrocket and most can see that it's heading toward an impossible situation. There's anecdotal evidence that people are taking jobs just for the insurance, and no doubt that occurs, but on what scale? I haven't seen anything to indicate that there are enough people who would stop working to significantly alter the supply-demand balance.
July 10, 2009 12:17 PM | Reply | Permalink
I do think that there are enough people working for health insurance that there would be a noticable effect on the labor market. I am not aware of any studies, so all I can really go on is anecdotal evidence, people I know, etc.
I do know that in our office of 12, it would be likely that two would leave if they could get health care coverage.
Also, my wife's dad would probably retire because he keeps working only for coverage.
I do think that the number is significant enough to worry business.
July 10, 2009 12:32 PM | Reply | Permalink
I think the number of people who would retire but who keep working for health care may be the larger one. This is going to be exacerbated by the trend toward discontinuing medical coverage for retirees. Even if a person is 65 and eligible for Medicare, the spouse may not be, so the person may have to keep working beyond 65 in order to keep health care coverage.
But at the same time, I'm not so sure this is a net plus for businesses. People in this age group are usually the highest-paid, so if these people were to retire and be replaced by younger people, there would be a net reduction in payroll.
July 10, 2009 2:50 PM | Reply | Permalink
You're probably right about this, but I think another reason is that executives think real health care reform will cause their taxes to go up, and many or most of them are anti-tax goofballs.
These industries are made up of corporations, and those corporations are run by these executives, who use them primarily for personal gain. That personal profit is largely uncorrelated with the health of the corporation or the industry, so the executives don't care if the corporation is harmed as long as their taxes remain obscenely low.
July 10, 2009 12:36 PM | Reply | Permalink
Nice analysis, Brian. You might even keep some of the more rabid among us from gouging out our own eyes and flogging ourselves over this setback....but I wouldn't bet on it.
July 10, 2009 10:31 AM | Reply | Permalink
Just gotta keep our eyes on the prize:
To someday not have to worry about money when a we or a family member gets sick and only worry about the important things, like getting better.
July 10, 2009 10:49 AM | Reply | Permalink
Can I ask- what is the point if, in the very least, we cannot save 20 to 30%? What's the point, if my parents cannot, in the very least, stop pay $1,000 a month and make it $700 instead. That's still outrageous and altogether too much and THEY'RE HEALTHY!!!!
July 10, 2009 11:26 AM | Reply | Permalink
I'm not sure what "the" point is, but one point is being able to get coverage at all. This from a person with pre-existing conditions that range from allergies to organ failure.
[Mea culpa, I originally posted this as a comment instead of a reply. Ignore it below.]
July 10, 2009 8:46 PM | Reply | Permalink
"...my immediate read on all this is that the Senate--its rules and its political makeup--remains the biggest hurdle to health care reform."
The Senate has been the biggest hurdle to ANY progressive legislation since at least the Civil War. This problem has actually worsened with the apparent Senatorial worship of bi-partisanship and their "clubbiness". There needs to be a bit more fire in those chambers.
Here's my read. There have been upheavals in the makeup of the Senate in the past and another one is coming for 2010, 2012, etc. if the Senate continues being the poster child for obstruction. We've unelected long-time Senators before--and that will accelerate.
Unlike a lot of TPM writers, I don't buy into the theory that Obama is like the Pied Piper leading a bunch of lemmings. I view Obama more like a great athletic surfer who has caught a wave--and that wave is an energized and highly pissed off public who just happens to be in the majority. And that wave is broad throughout enough states to make a difference. If the Senate does not grasp this, then there will be election upheavals in the Senate until needed legislation is passed.
There's a bit too much complacency in the Senate that the problem is solely with the GOP--obstructionist Senators in the Democratic Party are in jeopardy (as Specter will discover and as Leiberman barely avoided). There is no protection these folks have from the great ire that is present out here in flyover land.
These Democrats either vote correctly and stop obstructing--or they will be replaced with other Democrats who are younger and more willing to make the hard choices. I'm tired to these older Boomers--and those even older than that. And I'm 60 and saying this.
July 10, 2009 11:36 AM | Reply | Permalink
The Boomers need to die. No offense intended, my parents are also boomers, but it's true. They've effed everything up since the day I was born in '79.
July 10, 2009 11:43 AM | Reply | Permalink
AH it was ever thus. There's nothing new under the sun Shorty...
July 10, 2009 11:52 AM | Reply | Permalink
I'll settle for out of power. :)
July 10, 2009 1:06 PM | Reply | Permalink
I'd say your parents effed up by having you at all.
Screw you and your ageist attitude.
BTW, the Boomers are NOT a "pig in a python." Every 5-year age cohort are the same size as the Boomers'.
Oh, and McNamara wasn't a Boomer. Rummsfeld and Cheney weren't Boomers. I'd love to know just what wonderful things you candy-assed 20-somethings have done. Oh, or are you 30-something already, poor baby.
July 10, 2009 8:50 PM | Reply | Permalink
I think you'll see a direct correlation between responsiveness to the anger and whether they're among the 1/3 up for reelection in 2010. You'll also see a lot more responsiveness from senators from states where it's historically hard to win reelection (*cough*Hagan*cough*) even if they've got the full six years before they have to run again.
The ones in their second or third or more term who don't have to stand for reelection again until 2014? Good luck moving them anywhere they don't already want to go.
July 10, 2009 11:56 AM | Reply | Permalink
I will guarantee that the Senators not immediately up for election may not feel any need to have their voters agree with them--in the mistaken notion that their voters will have "forgotten" their obstructionism by the time the next election rolls around.
So what's a good organizer to do? Consider this. These folks are very accustomed to deference, particularly in their home states.
I know nothing better to shake up these geriatric and rigid Democratic Senators than a crowd spanning ages and income levels at their home state offices--carrying negative signage of the creative sort. I would certainly expect heart palpitations among this well-fed Senatorial crowd--and that would not be pretty at the age most of them have attained.
Look, these Senatorial folk believe that "national polls" don't apply to "them". So a few well-placed local protests would certainly gather local press attention of the most negative kind.
July 10, 2009 1:15 PM | Reply | Permalink
So, you folks working up a conniption over this one, you're aware that, in many cases, private insurers have "negotiated" rates with physicians that are even lower than the applicable Medicaid/Medicare reimbursement rate? Right?
That's part of the problem. The only people who get charged the "full" rate are the people who are uninsured and the ones who have certain individual plans.
I have no problem with "competitive" reimbursement as long as "competitive" means "the public plan is free negotiate the price down as far as it can, just like the private insurers.
July 10, 2009 12:01 PM | Reply | Permalink
I don't know if they're significantly lower than the Medicare rate, but they're certainly in the same range, so your point is still valid. (Medicaid is even lower, but that's part of the reason most practitioners don't take Medicaid patients.) These discounts are not uncommonly 25-30%. But it's only the big insurers that have enough weight to do this. Smaller insurers don't. One more reason for a public option - to level the playing field. It's true that the public coverage would immediately become the 900 lb gorilla with enough leverage to force reimbursement rates to levels that are too low, but they should pay at no higher than the lowest private rate.
July 10, 2009 12:12 PM | Reply | Permalink
Let's end this game of over billing, over testing so underpaying at 80% makes it come out even. Set a low baseline and then reward doctors and hospitals for best medical outcomes. Yeah it won't be easy when some of those outcomes, like counseling diabetics about diet don't show results for 10 years. But best practices resulting n best outcomes are known. Let's implement them. Unless we do we still have the same old tug of war between payer and provider with patients as the rope. Your wellness shouldn't be a market to be exploited by either side. They should all be paid to make and keep you as healthy as they can.
July 10, 2009 12:23 PM | Reply | Permalink
Actually, I believe that a big part of the problem is that best practices frequently AREN'T known. Tests and treatments are ordered using the shotgun approach. One of the key features of reform should be objective comparisons of various treatments to determine which are most effective. This is vigorously opposed by - guess who? - big pharma, who know full well that most of the stuff they're peddling would never pass the test. They want decisions on which drug to take to be based on TV advertising. "Ask your doctor about taking Sudamex!"
July 10, 2009 2:56 PM | Reply | Permalink
I can get you a Alzheimers drug that is 8% effective on 9% of the patients it's given to. Dad will remember you for approximately one day longer if he's in the 9%.
I'm not a doctor, I don't even play one on teevee but I know that's a waste of money.
July 10, 2009 4:55 PM | Reply | Permalink
Those f#cking assh*les all signed it in BLUE INK.
Too cute by half. While Rome burns...
Idiots!
July 10, 2009 12:25 PM | Reply | Permalink
Perhaps they should have used red?
July 10, 2009 1:48 PM | Reply | Permalink
This whole clown show is pathetic. They're debating whether to have a public option, and how to protect corporations from that public option, when in fact the public option should be the only option. We are a million miles from having efficient, fair, quality health care in this country, and whatever half-assed bill they pass this year won't change that.
July 10, 2009 12:40 PM | Reply | Permalink
The only reason why I support legislation- and ONLY legislation- that includes a highly competitive, non-crippled public option- as opposed to just waiting for the current mess to collapse (which can't be too many years off) so that there's no choice but root and branch restructuring- is that done right, a public plan could begin the process of sending for-profit health insurance down the path of the dinosaurs, without the widespread pain that would be caused by the collapse of the current mess.
July 10, 2009 12:55 PM | Reply | Permalink
The letter isn't very specific except in a couple of cases. What are the unique rural problems that aren't being addressed? Oxycontin addiction and better dental care?
Small Business Protection? That's just reiterating canned phrasing to pander and appear 'serious'? This will likely allow employees of small businesses to be able to purchase health insurance.
The bipartisanship they can shove up their ass. If you want to be in the other party then do so.
July 10, 2009 2:24 PM | Reply | Permalink
I'm not sure what "the" point is, but one point is being able to get coverage at all. This from a person with pre-existing conditions that range from allergies to organ failure.
July 10, 2009 8:44 PM | Reply | Permalink
Why don't we just acknowledge that this group of legislators has NO interest whatsoever in really changing the status quo.
Last night, on Bill Moyers, an industry executive said that the insurance companies' goal is a requirement that all be insured......and no public option.
In other words, a government requirement that the insurance companies be allowed to rape and pillage everyone.
great. just what you can expect from a government now totally bought and paid for by the corporations.
July 11, 2009 8:50 AM | Reply | Permalink
Doesn't public option mean "it's OUR freakin option". We wouldn't be at this point if the people or corps that turned this into a cash cow, didn't. Their greed is just coming back to haunt them.
What's synonymous, allowing the thieves, robbers & burglars to decide what they have to give back or how much? Letting busted dope dealers name their penalties? Trusting the private sector to do right by the public sector?
As a double plus, get healthy, stay out of the hospitals & don't rush to the pharmacy, forever!
July 12, 2009 12:00 AM | Reply | Permalink