TPMDC

Rockefeller to Baucus, Conrad: Co-ops Are a Sham, Public Option Is a Must

Spread the word and support this article by retweeting it!


Sen. Jay Rockefeller (D-WV) and Sen. Max Baucus (D-MT)

Share

Twitter Facebook Fark Reddit Send to a Friend

Send to a friend!

To email:    Your Name:    Your email:

When it became clear several weeks ago that negotiators on the Senate Finance Committee were planning to pursue a private co-op model instead of a public option in their health reform bill, Sen. Jay Rockefeller (D-WV)--a senior member of that committee, and chairman of the Senate Commerce Committee--undertook a study into the history and effectiveness of health insurance co-operatives.

As part of that study, he asked the Government Accountability Office to bring together all of the research it had done over the years into the effectiveness of co-ops in the insurance market. Today, he sent a fairly scathing letter to Finance chairman Max Baucus (D-MT) and chief co-op advocate Kent Conrad (D-ND) regarding the results.

Rockefeller, who says he regards the public option as a "must," writes, "there has been no significant research into consumer co-ops as a model for the broad expansion of health insurance. What we do know, however, is that this model was tried in the early part of the 20th century and largely failed."

He adds that "consumer health insurance cooperatives identified by the USDA and NCBA operate and function just like private health insurance companies....This further substantiates my point that health insurance co-ops are not a real alternative to private health insurance and they are not a substitute for a strong public plan option, and we should not suggest to the American people that they would be."

"It seems to me," he scolds, "that, if you are proposing to implement consumer health insurance co-ops on the scale contemplated by the Finance Committee, then you certainly should know what has been the experience with them so far.... I believe it is irresponsible to invest over $6 billion in a concept that has not proven to provide quality, affordable health care, when we know that a public health insurance option will rein in costs and save taxpayers billions of dollars."

You can read the entire letter here.

Yesterday, Rockefeller announced that he can not support Baucus' health care reform proposal without significant changes.

Join the Conversation!

84 comments

Recommend Recommend (5)

September 16, 2009 3:41 PM   

As the Washington Post explained yesterday, “under the Baucus plan, subsidies would be offered to people who earn up to 400 percent of the poverty level ($43,000 for an individual or $88,000 for a family of four)… The credit would be calibrated on a sliding scale to ensure that people at the bottom of the income range paid no more than 3 percent of their earnings for premiums while those at the top would be liable for as much as 13 percent.” “That would amount to more than $700 a month for a family of four making $66,000 a year — significantly more than most people at the same income level now pay, according to research conducted by Linda Blumberg, a senior fellow in the Health Policy Center at the Urban Institute.”

http://wonkroom.thinkprogress.org/2009/09/16/baucus-rockefeller/

Reply | Flag Abuse

Are you sure this comment violates TPM's Terms of Service?

September 16, 2009 3:47 PM    in reply to Indie Pro

plus, I think the plan, as it is, is for up to 300 percent, not 400 percent

Reply | Flag Abuse

Are you sure this comment violates TPM's Terms of Service?

September 16, 2009 4:51 PM    in reply to Indie Pro

That's the problem. 400 Percent really isn't enough, but it's just good enough to not put this shit on the backs of the middle class.

Reply | Flag Abuse

Are you sure this comment violates TPM's Terms of Service?

September 16, 2009 4:59 PM    in reply to theone718

I think even at 400%, given the study I cited above, it is going to be on the backs of middle America.


even then, since subsidies to the Insurance Industry is the basis for all this, it will still be on the backs of middle America in the form of taxes as well.

The more I read about the affects of this bill, the less I like it.

Consider this, if Massachusettes is the model, and healthcare costs went up, and are the most expensive there, then what does that say for the affects of this plan? subsides? taxes?

not to mention, due to the debt, taxes will be raised. Will need to be raised. Dems just have to strike at the right time, according to elections. Ugly but true. The debt will need to come down.

I don't know. Things to consider, in my opinion.

Reply | Flag Abuse

Are you sure this comment violates TPM's Terms of Service?

September 16, 2009 3:49 PM    in reply to Indie Pro

I'd like to know how much you think such a family SHOULD pay. Also how much you think they'd pay under the public option. And where you come up with these numbers. This is a serious question.

Reply | Flag Abuse

Are you sure this comment violates TPM's Terms of Service?

September 16, 2009 3:52 PM    in reply to mans_best_friend

significantly more than most people at the same income level now pay, according to research conducted by Linda Blumberg, a senior fellow in the Health Policy Center at the Urban Institute.”

from this link:
http://wonkroom.thinkprogress.org/2009/09/16/baucus-rockefeller/

Reply | Flag Abuse

Are you sure this comment violates TPM's Terms of Service?

September 16, 2009 4:09 PM    in reply to Indie Pro

Just cutting and pasting stuff from someone else's article sounds a lot like "I don't know."

Here's what I do know:

A rather run-of-the-mill employer-based group policy costs about $1000 per month. Individual policies cost significantly more than that (unless you get a really crappy policy). Unless, of course, you're doing an apples-to-oranges comparison by equating the full cost of an individual policy to the employee contribution cost of an employer-based policy. Try to find any kind of health insurance policy for $700 per month. If you do, you'd do a great service to everyone by letting people know where.

To be sure, $700 per month is a significant cost for someone making $66k/year, but other than blind faith I see no reason to assume a public option would be more than marginally cheaper without massive subsidy, which of course would make any coverage cheaper.

Reply | Flag Abuse

Are you sure this comment violates TPM's Terms of Service?

September 16, 2009 4:11 PM    in reply to mans_best_friend

you asked where the numbers came from.

if you don't care for the info I pass along, move along.

Reply | Flag Abuse

Are you sure this comment violates TPM's Terms of Service?

September 16, 2009 4:26 PM    in reply to Indie Pro

No, I asked how much YOU thought they should pay and how much YOU thought they'd pay under the public option.

Reply | Flag Abuse

Are you sure this comment violates TPM's Terms of Service?

September 16, 2009 4:32 PM    in reply to mans_best_friend

I misunderstood, " And where you come up with these numbers. This is a serious question."

my apologies.

Forcing someone to pay $700 a month on anything, under penalites is too much. Otherwise, We'll see when we get there.

Reply | Flag Abuse

Are you sure this comment violates TPM's Terms of Service?

September 16, 2009 4:39 PM    in reply to Indie Pro

Then if you require insurers to accept everyone, and prohibit insurance companies from varying premiums based on health status, how do you prevent people from waiting until they get sick to purchase health insurance? And how will health insurance be affordable to those who are sick if only the sick sign up for health insurance?

Reply | Flag Abuse

Are you sure this comment violates TPM's Terms of Service?

September 16, 2009 4:43 PM    in reply to jimbomoron

you don't even get that now:

they'll be varying premiums based on age. 5 times more!

and

“an actuarial-value standard on its own” would not prevent insurers from designing packages that would attract healthier applicants and deter “enrollment by those in poorer health.” “For example, insurers could offer a benefits design that omits or severely limits services needed by people with serious medical conditions, while offering richer benefits in other areas such as vision care or health-club memberships. In that way, an insurer could meet an actuarial standard while designing a package calculated to deter sicker people (by failing to cover basic services they need) and attract healthy ones.”

Reply | Flag Abuse

Are you sure this comment violates TPM's Terms of Service?

September 16, 2009 4:55 PM    in reply to Indie Pro

It's good you can copy and paste other people's comments. Now how about your own views?

Any bill is probably going to have at least some age variation. There's no way you can require a 27-year-old single guy to pay $550/mo. for a policy that has a $1,000 deductible and $5,000 out-of-pocket cap without sparking political backlash, which is what would happen if there was no age variation. So you to allow insurers to vary premiums by age by a limited amount. Now I agree a 5:1 community rating is too much. I think 3:1 is the max I would go, and 2:1 -- what is here in MA, and in all the bills passed by the four committees -- is optimal.

Reply | Flag Abuse

Are you sure this comment violates TPM's Terms of Service?

September 16, 2009 5:04 PM    in reply to jimbomoron

the 2:1 that is in the HoR bill is more reasonable than 5:1

and fuck you. I'll comment what and how I like.

Reply | Flag Abuse

Are you sure this comment violates TPM's Terms of Service?

rb6

user-pic

September 16, 2009 4:45 PM    in reply to jimbomoron

There are less drastic ways to incentivize people to buy coverage than mandating it. Most people WANT coverage -- If you studied employer groups, you might ask yourself, why do people join the group this year rather than when they get sick -- and you will be told, well, because requiring them to wait up to a year before they get benefits is a big enough penalty to get them to join now. That's a lot less confiscatory than mandating coverage.

Moreover, mandating coverage without making it affordable is obscene. If people are forced to buy insurance, insurers (and providers) have no incentive to reduce costs.

It is my firm conclusion, based on a lot of evidence, that insurers are incapable of reducing provider costs, and that only the government can bring that about. That doesn't make insurers superfluous, but it makes them insufficient agents of any true reform effort.

Reply | Flag Abuse

Are you sure this comment violates TPM's Terms of Service?

September 16, 2009 4:57 PM    in reply to rb6

Except a disproportionate share of the uninsured are young guys in their 20s who choose not to purchase health insurance because they think they are immortal. That, to me, suggests otherwise.

Reply | Flag Abuse

Are you sure this comment violates TPM's Terms of Service?

rb6

user-pic

September 16, 2009 5:10 PM    in reply to jimbomoron

Do you actually know this or are you winging it? What is a "disproportionate share," when something like 30% of people under the age of 30 are uninsured -- mostly because they can't afford insurance and don't have the kind of employment in which they are offered it.

However, if it is adverse selection that worries you, it's easy enough to take it off the table: Go single payer and pay for it with taxes. There. No free riding, no complicated intergenerational or underwriting games.

Reply | Flag Abuse

Are you sure this comment violates TPM's Terms of Service?

September 16, 2009 5:07 PM    in reply to rb6

It is my firm conclusion, based on a lot of evidence, that insurers are incapable of reducing provider costs, and that only the government can bring that about.

This is patently false. Large insurance companies routinely negotiate discounts of 30% and more from providers.

Reply | Flag Abuse

Are you sure this comment violates TPM's Terms of Service?

rb6

user-pic

September 16, 2009 5:13 PM    in reply to mans_best_friend

You don't know what you are talking about. First, provider concentration has made discounting substantially more difficult than in the past. Second, insurers have been hamstrung on "managing" care and utilization is exploding.

If insurers are so good at controlling costs why is it so expensive?

Insurers can't control costs in the way they need to be controlled. Like I said, it doesn't make them superfluous but it makes them inadequate.

Reply | Flag Abuse

Are you sure this comment violates TPM's Terms of Service?

September 16, 2009 5:31 PM    in reply to rb6

Perhaps you'd like a few facts. I have Blue Cross/Blue Shield. When they pay a claim to an in-network provider (meaning one with whom they've negotiated a discount) the statement contains a "Billed Amount" and an "Allowed Amount". Typically the allowed amount is 30% or more below the billed amount. The provider is prohibited by their agreement with the insurer from trying to collect the difference from me. Most other large insurers have negotiated similar arrangements. This is why their coverage is higher for in-network providers than out-of-network providers. I'm pretty sure other people here will tell you the same thing.

These are facts, and as they say, facts are stubborn things.

Reply | Flag Abuse

Are you sure this comment violates TPM's Terms of Service?

September 16, 2009 5:41 PM    in reply to mans_best_friend

that is called Anecdotal evidence

Reply | Flag Abuse

Are you sure this comment violates TPM's Terms of Service?

September 16, 2009 5:58 PM    in reply to Indie Pro

Why do you think health care insurers differentiate between in-network and out-of-network providers? I've had CIGNA. I've had MetLife. I've had others whose names I can't even remember. They all get discounts from in-network providers. That's what makes them an in-network provider.

Reply | Flag Abuse

Are you sure this comment violates TPM's Terms of Service?

September 16, 2009 6:03 PM    in reply to mans_best_friend

you are still offering anecdotal evidence.

Wow, facts are stubborn little things!

Reply | Flag Abuse

Are you sure this comment violates TPM's Terms of Service?

September 16, 2009 6:43 PM    in reply to Indie Pro

Try googling "in network provider". Or is that anecdotal too?

Reply | Flag Abuse

Are you sure this comment violates TPM's Terms of Service?

September 17, 2009 10:43 AM    in reply to mans_best_friend

just your anecdotes are anecdotal

Reply | Flag Abuse

Are you sure this comment violates TPM's Terms of Service?

September 17, 2009 1:29 PM    in reply to Indie Pro

I don't have a dog in this fight, but I must say that just saying the same thing over and over is a pretty irritating way to argue. Just how old are you?

Reply | Flag Abuse

Are you sure this comment violates TPM's Terms of Service?

rb6

user-pic

September 16, 2009 7:39 PM    in reply to mans_best_friend

You base your conclusion on bills that you received for doctor's services. The plural of facts or anecdotes is not data. Go do some actual work and look at Health Affairs or some other reputable journal about health care trends.

Provider concentration in many -- not all -- markets has increased a lot making discounting arrangements less feasible. But the real evidence that you are a poseur is that you think a 30% discount from a charge number is evidence of cost containment. It isn't, and if you knew anything about the industry you would know why.

In addition, that discount tells you absolutely zero about controlling utilization.

Reply | Flag Abuse

Are you sure this comment violates TPM's Terms of Service?

September 16, 2009 4:44 PM    in reply to Indie Pro

Here's the thing. Mandates are part of every successful healthcare system in the world. Single payer is a mandated system - no one can opt out. Mandates are necessary because you need lots of healthy (read low-cost) people to pay into the system to support the unlucky few who get seriously ill. Without mandates the system is filled with mostly sick and elderly and the costs can't be supported. That's the fundamental basis of all insurance. You argue for no mandates until after costs are controlled, but you can't uncouple the two. You can't control costs without mandates and you can't have mandates without controlling costs.

Now I agree that $700 per month is a lot of money for someone making $66k/year, but there's no way around it - healthcare is expensive. It's unlikely a public option would be all that much cheaper. The only real way to lower the cost is for bigger subsidies, and you could argue for that, but it turns out to be A LOT of money, and it's not clear to me where that additional funding would come from.

Reply | Flag Abuse

Are you sure this comment violates TPM's Terms of Service?

rb6

user-pic

September 16, 2009 4:49 PM    in reply to mans_best_friend

Stop buying this insurance lie. Mandates are important more for assuring that providers (or others, in our case, states) do not have to assume a disproportionate burden of providing uncompensated care, or allowing individuals to be free riders.

No one has shown, because no one can show, that mandating the purchase of insurance, will have any effect whatsoever on costs, or more importantly, cost trends. It is a joke to think that getting a few additional healthy people paying into the system will reduce costs. For one thing, Baucus allows a pretty big disparity between the lowest and highest bands of risk -- meaning that the rating is much more consistent with their expected patterns of utilization than with cross subsidizing sicker individuals.

Mandating insurance will not bring costs down. This is the biggest knock against it -- it doesn't do what really needs to happen.

Reply | Flag Abuse

Are you sure this comment violates TPM's Terms of Service?

September 17, 2009 1:31 PM    in reply to rb6

I think mandating CAN bring the cost down, but only if the "mandate" is single payer.

Reply | Flag Abuse

Are you sure this comment violates TPM's Terms of Service?

September 16, 2009 4:35 PM    in reply to mans_best_friend

here's more from that link:

The Baucus bill requires insurers participating in the Exchange to offer plans in four different tiers. Each plan an insurer offers would have to meet a different actuarial-value. In the silver tier, insurers would have to cover 73% of the health care expenses of an average population; the remaining 27% would be picked up by individuals.

But Sarah Lueck at the Center on Budget and Policy Priorities warns that “an actuarial-value standard on its own” would not prevent insurers from designing packages that would attract healthier applicants and deter “enrollment by those in poorer health.” “For example, insurers could offer a benefits design that omits or severely limits services needed by people with serious medical conditions, while offering richer benefits in other areas such as vision care or health-club memberships. In that way, an insurer could meet an actuarial standard while designing a package calculated to deter sicker people (by failing to cover basic services they need) and attract healthy ones.” Insurers could offer cheaper preventive services without any cost sharing but cover more expensive services only after a high deductible is satisfied.

Lueck concludes that “many enrollees still are likely to end up underinsured for key health services unless an actuarial-value standard is combined with…[the] requirement that all plans offer basic comprehensive coverage.” She writes that policy makers should establish “limits on the degree of variation in different benefit designs to prevent insurers in an exchange from creating benefit packages designed to deter less-healthy enrollees and attract only individuals in good health.”

Reply | Flag Abuse

Are you sure this comment violates TPM's Terms of Service?

September 16, 2009 4:44 PM    in reply to Indie Pro

See -- I thought this was different. I thought the House and HELP bills required insurance companies to offer the listed benefits of at least the minimum actuarial value and then could offer things not listed in the minimum benefits packages in addition to the minimum benefits package.

Reply | Flag Abuse

Are you sure this comment violates TPM's Terms of Service?

September 16, 2009 4:51 PM    in reply to jimbomoron

I think they are speaking specifically about the Baucus plan

Reply | Flag Abuse

Are you sure this comment violates TPM's Terms of Service?

Tim

user-pic

September 17, 2009 12:18 AM    in reply to mans_best_friend

I pay about $100.

My employer pays another $100.

I work in Korea.

People on their own, then, shouldn't pay more that $200.

Max Baucus is public enemy #1.

77% of the public want public option.

Corporations don't.

Corporations gave Baucus massive payola

Baucus gave the public a bill without public option.

Under "Payola" future dictionaries will have a nice big fat picture of Max Baucus.

He's thoroughly corrupt.

He's a traitor to the people of this country.

Since the people are sovereigns, Baucus is guilty of moral, if not factual, treason.

Plain and simple.

I say string him up and hang him in effigy in front of his own office, and in front of the people he represents.

I don't have much money, but I'll be sending $200 to his challenger next time he runs, and if I can, I will move to Montana so I can vote against him. I have a vendetta against him for his treasonous actions.

Reply | Flag Abuse

Are you sure this comment violates TPM's Terms of Service?

September 16, 2009 5:10 PM    in reply to mans_best_friend

I don't think they should pay anything beyond their regular income tax. That's the whole point of single payer. It works everywhere else in the world and it'll work here.

Failing that I think YOU should pay for it and THEY should not. This IS a serious answer.

But seriously, we can find $500 billion to pay for a stupid war with unfunded liabilities resultant topping $2 trillion, in Iraq and Afghanistan, where empires historically go to die, but we can't find any money for National Health Insurance. WTF?

I am going to go donate $25 to Rockefeller's re-election, now.

Reply | Flag Abuse

Are you sure this comment violates TPM's Terms of Service?

September 16, 2009 5:46 PM    in reply to runfastandwin

And this is a part of the problem - a mythical belief that if they just pass the right plan, everything will be free. Can you work the same magic with college tuition? Because my kid's tuition bills are driving me to the poor house.

In countries that have single payer it's not free. In countries with socialized medicine it's not free. You just pay for it indirectly, through taxes or through lower wages if your employer pays the tax.

There is no free lunch.

Reply | Flag Abuse

Are you sure this comment violates TPM's Terms of Service?

September 16, 2009 4:06 PM    in reply to Indie Pro

Something I should know but don't: is that 300% or 400% of gross income or AGI they're talking about? Most everything the feds do is based on AGI, but not everything. That would seem to be to be a pretty big deal once you get to the upper end of the thing.

Reply | Flag Abuse

Are you sure this comment violates TPM's Terms of Service?

September 16, 2009 4:15 PM    in reply to The Commenter Formerly Known as NCSteve

It's modified adjusted gross income. Most of the adjustments don't have much of an impact for middle-income taxpayers, so AGI is a pretty good approximation.

http://en.wikipedia.org/wiki/Adjusted_Gross_Income#Modified_adjusted_gross_income

Reply | Flag Abuse

Are you sure this comment violates TPM's Terms of Service?

September 16, 2009 4:40 PM    in reply to The Commenter Formerly Known as NCSteve

400%

http://www.cbo.gov/ftpdocs/105xx/doc10572/09-16-Proposal_SFC_Chairman.pdf

From page 2 of the CBO preliminary report --

Specifications Regarding Insurance Coverage ...the proposal would establish new insurance exchanges and would subsidize the purchase of health insurance through those exchanges for individuals and families with income between 133 percent and 400 percent of the federal poverty level (FPL).

Reply | Flag Abuse

Are you sure this comment violates TPM's Terms of Service?

September 16, 2009 4:13 PM    in reply to Indie Pro

If they're saying people pay less than $700 for a policy for their family that they buy directly from the insurance company, I don't believe it. I paid $300 month as a copay on a company plan; if the data includes those who get insurance through their employer, then, yeah, $700 is high, but it's apples and oranges. I'd look at the data but there's no link in the post to the study that's cited.

Reply | Flag Abuse

Are you sure this comment violates TPM's Terms of Service?

September 16, 2009 4:13 PM    in reply to Indie Pro

"That would amount to more than $700 a month for a family of four making $66,000 a year — "

Who the hell can have a family of four on an income of 66 grand a year?!

If you live in a large city on the coasts that amount of money is garbage. This whole bill is garbage.

Start over, expand medicare and make it availble for all.

Reply | Flag Abuse

Are you sure this comment violates TPM's Terms of Service?

September 16, 2009 4:34 PM    in reply to rbeats

http://www.census.gov/hhes/www/income/4person.html

Median income for a 2005 family of four in Wyoming was $62,933, in New York $72,170, in New Mexico $48,223. This should be obvious, but the cost of living varies widely state-to-state. $60,000 in Topeka is a lot different than $60,000 in Brooklyn.

Reply | Flag Abuse

Are you sure this comment violates TPM's Terms of Service?

September 17, 2009 4:16 PM    in reply to seanh

Did you notice there were no senators from populated states in the Gang of Six? I sure did. This is the un-representative Senate again screwing those of us who are urban dwellers.

Reply | Flag Abuse

Are you sure this comment violates TPM's Terms of Service?

rb6

user-pic

September 16, 2009 4:51 PM    in reply to rbeats

Hear hear.

Medicare needs to be reformed anyway -- why not pour energy into fixing Medicare for everyone who wants it?

Reply | Flag Abuse

Are you sure this comment violates TPM's Terms of Service?

September 16, 2009 4:15 PM    in reply to Indie Pro

I agree with everything in Rockefeller's letter but I can't help but be wary of his motives.

Besides the fact that, IMHO, he was always way too compliant/timid on the Intel Commitee, he is probably looking to sell his vote in exchange for future votes in support of the coal industry. You heard it here first...

Reply | Flag Abuse

Are you sure this comment violates TPM's Terms of Service?

September 16, 2009 4:21 PM    in reply to trblmkr

He represents West Virginia. He used to be governor. Go drive around there for a few days and then see if maybe you can comprehend what might be motivating him on this issue.

Reply | Flag Abuse

Are you sure this comment violates TPM's Terms of Service?

September 16, 2009 4:24 PM    in reply to trblmkr

Interesting point, and I don't trust anyone around here when it comes to coal mining, but Sen. Rockefeller to his credit has been promoting healthcare reform for a long time.

Furthermore, although he probably owns a bigger piece of corporate America than any other U.S. Senator, it does not appear that he has been a corporate shill. I too have had huge reservations about his protection of the telecom community with the warrantless wiretapping issues.

Reply | Flag Abuse

Are you sure this comment violates TPM's Terms of Service?

September 16, 2009 5:45 PM    in reply to trblmkr

I agree but will take allies where I can get them.

Reply | Flag Abuse

Are you sure this comment violates TPM's Terms of Service?

September 16, 2009 4:30 PM    in reply to Indie Pro

Would the raucous Baucus Caucus mock us, shock us or talk us to death?
Would Snowe know "no" is no go fo' sho'?
Would Reed indeed cede the deed we need to succeed?

Reply | Flag Abuse

Are you sure this comment violates TPM's Terms of Service?

September 16, 2009 3:50 PM   

Definition of Insanity: trying the same thing again and again, expecting different results.

Max has done his Duty---he's helping his bosses make money. Bet his constituents wish they were his Bosses, though....

Reply | Flag Abuse

Are you sure this comment violates TPM's Terms of Service?

September 16, 2009 3:50 PM   

May I respectfully ask, who gives a shit what Olympia Snowe thinks ? Just how much of the complexity of anything - ANYTHING - does this person understand ?

Reply | Flag Abuse

Are you sure this comment violates TPM's Terms of Service?

September 16, 2009 5:51 PM    in reply to rbe1

I fully agree, and may I add that we will never have a functioning and affordable health care system as long as we let everyone push their own agenda while pretending to re-invent the wheel.

There are well working systems in the world for about half of what we pay now. Copy one.

Reply | Flag Abuse

Are you sure this comment violates TPM's Terms of Service?

September 16, 2009 4:02 PM   

It seems like the gang of six really wasted a lot of time to come up with a piece of garbarge. Baucas and Conrad probably received a lot of lobby money...no words from Bingaman?

Remember last week when Baucaus also wanted the Climate Change bill? I can only hope that Reid gives him a resounding Hell NO...followed by a lot of other unprintable words.

I try to think through the method to see if there is a political upside and in this case, I see nothing for the DEMS.

Perhaps it is true, small state senators don't give a damn about the citizens of this country!

Reply | Flag Abuse

Are you sure this comment violates TPM's Terms of Service?

September 16, 2009 4:13 PM    in reply to afisher

he has the climate bill,

and it's something like 3 million in contributions going back some years, like last 3 to 5 years. I cn find the post about it if you need it.

Reply | Flag Abuse

Are you sure this comment violates TPM's Terms of Service?

September 16, 2009 4:25 PM    in reply to afisher

When you come from places like Baucus and Conrad do, your concerns are much different than those who live in the major population centers of the country. If they can't put those parochial concerns aside when they do their work for the whole country, then they should think about getting into another profession. Of course, I know that's a pie in the sky statement, but it may go part way to explaining why they come out with the positions they do. It's up to the progressives in the Senate to pull them back the other way.

Reply | Flag Abuse

Are you sure this comment violates TPM's Terms of Service?

September 16, 2009 4:08 PM   

ROCKY!

Reply | Flag Abuse

Are you sure this comment violates TPM's Terms of Service?

September 16, 2009 4:18 PM   

From the CBO analysis of the Baucus plan:

By 2019, CBO and JCT estimate, the number of nonelderly people who are uninsured would be reduced by about 29 million, leaving about 25 million nonelderly residents uninsured (about one-third of whom would be unauthorized immigrants). Under the proposal, the share of legal nonelderly residents with insurance coverage would rise from about 83 percent currently to about 94 percent. Roughly 25 million people would purchase coverage through the new insurance exchanges, and there would be roughly 11 million more enrollees in Medicaid than is projected under current law. (The proposed co-ops had very little effect on the estimates of total enrollment in the exchanges or federal costs because, as they are described in the specifications, they seem unlikely to establish a significant market presence in many areas of the country or to noticeably affect federal subsidy payments.) The number of people purchasing individual coverage outside the exchanges or obtaining coverage through employers would decline slightly, relative to currently projected levels.

Yet more proof that co-ops are the solution to a political problem, not a practical problem.

I still think even a Baucus style bill would be a step even the right direction, and better than no bill at all. The CBO likes the Finance Committee's new reimbursement procedures, designed to control swelling health care costs. Assuming the CBO analysis is correct, I think there's lots to like in the Baucus bill, even if it's not everyone's ideal solution.

Reply | Flag Abuse

Are you sure this comment violates TPM's Terms of Service?

September 16, 2009 4:27 PM    in reply to seanh

Forgot the link.
http://www.cbo.gov/ftpdocs/105xx/doc10572/09-16-Proposal_SFC_Chairman.pdf

I hope critics are at least willing to read through the analysis, and consider it alongside the statements from public option advocates. I think Baucus has a point that winning a few Republican votes, not to mention all purple state Democrats, would go a long way towards securing any reforms for decades to come. Democrats are sure to lose some of their majority in 2010. Governing with the wide berth of the current party in mind will ensure Democrat dominance for years to come.

Reply | Flag Abuse

Are you sure this comment violates TPM's Terms of Service?

September 16, 2009 4:51 PM    in reply to seanh

Baloney. First, no one -- not even the currently insane Republican party -- will take away health benefits once conferred on American citizens. Second, the Dems will ensure political prosperity for themselves by passing an HCR bill that works. Coops don't work to contain systemic costs (which is precisely why the industry's stooges have proposed them); a public option will work (exactly why the stooges oppose them). The worst thing the Dems coud do --- politically-speaking -- is enact a half-assed bill that flops catastrophically by not containing costs.

Of course, this discussion is limited to politics, not policy. In a policy analysis, everybody knows that the public plan will contain costs. That is just why the health care industrial complex has been hell-bent on declaring the PO DOA. But the TeaParty/TownHall Hooligan strategy hasn't worked and I don't believe it will in the end.

Public option now!

Reply | Flag Abuse

Are you sure this comment violates TPM's Terms of Service?

September 16, 2009 5:24 PM    in reply to seanh

The worst thing the Dems coud do --- politically-speaking -- is enact a half-assed bill that flops catastrophically by not containing costs.

You haven't read the analysis if you're claiming the Baucus plan doesn't contain costs. You might argue that the public plan will do a better job containing costs, but any response that claims the Baucus plan has no cost saving measures, or any merits over our current system, is a purely ideological response, and an unnecessary dismissal of the CBO's careful empirical analysis.

Other components of the proposal would alter spending under Medicare, Medicaid, CHIP, and other federal health programs. The proposal would make numerous changes to payment rates and payment rules in those programs (the budgetary effects of which are shown in the enclosed tables). In total, CBO estimates that enacting those provisions would reduce direct spending by $409 billion over the 2010–2019 period. The provisions that would result in the largest budget savings include these: *Permanent reductions in the annual updates to Medicare’s payment rates for most services in the fee-for-service sector... *Setting payment rates in the Medicare Advantage program based on the average of the bids submitted by Medicare Advantage plans in each market... *Reducing Medicare and Medicaid payments to hospitals that serve a large number of low-income patients, known as disproportionate share (DSH) hospitals... The proposal also would establish a Medicare Commission, which would be required, under certain circumstances, to recommend changes to the Medicare program to limit the rate of growth in that program’s spending. Those recommendations would go into effect automatically unless blocked by subsequent legislative action.

Refer to pages 18-24 of the CBO report for an their preliminary report of the Baucus plan's cost savings measures. There are a bunch of other details I'm not including.

See the full Baucus bill for more details, especially changes to the Medicaid program, where a number of adjustments to the fee-for-service model (look for that language specifically) are proposed. Baucus spoke repeatedly about his bill's focus on bending the cost curve. The lion's share of his proposals are specifically designed to readjust incentives that pay providers for the volume of care, instead of the the quality of care.

http://finance.senate.gov/sitepages/leg/LEG%202009/091609%20Americas_Healthy_Future_Act.pdf

I like the public option too, but lots of Senate Democrats, and even our own President, are convinced that a public option can't pass. Maybe they're right, and maybe they're wrong. Maybe Democrats can pass the public option through the reconciliation process, but do a bit of reading about that issues, and it becomes clear that the reconciliation route is a treacherous one.

For one, I'm extremely happy that at least someone is acting like a grownup, and developing a contingency plan, in the event that Senate vote counters determine the public option won't pass. Congress MUST produce some sort of meaningful reform this time around, and it would be foolish for Baucus not to be working hard on a centrist route to healthcare reform (even if that ultimately means just winning all the Blue Dog Dems, but no Republicans).

Reply | Flag Abuse

Are you sure this comment violates TPM's Terms of Service?

September 16, 2009 5:30 PM    in reply to seanh

I disagree. The Baucus Plan is an insurance industry gravy-train. The health care industrial complex got what it paid for. If the Dems can't pass serious HCR now, they never will. They will be proven irrelevant. Do it right or don't bother.

Reply | Flag Abuse

Are you sure this comment violates TPM's Terms of Service?

September 16, 2009 4:54 PM    in reply to seanh

That is the best thing about the bill. ALmost everything else is shit though. I always though his financing of the bill(no pun intented) was the one I agreed with most. Throw in the higher subsidies for the MC and a robust public option and this is a bill that could make some serious change in this country.

Reply | Flag Abuse

Are you sure this comment violates TPM's Terms of Service?

September 16, 2009 4:21 PM   

Max Baucus: I’ll Co-opt GOP on Co-ops, Who Gave Me No Co-operation
http://satiricalpolitical.com/?p=8849

Reply | Flag Abuse

Are you sure this comment violates TPM's Terms of Service?

September 16, 2009 4:48 PM   

Roland Burris says he will absolutely vote against any bill without a PO. I dislike him alot less today.

Reply | Flag Abuse

Are you sure this comment violates TPM's Terms of Service?

September 16, 2009 4:55 PM   

A $700 a month bill would absolutely kill the middle class family and any hopes they may have of owning a home, going back to school to further their careers, etc. Wages have been decreasing, remember...

Also, health care is not automatically expensive! Our system is disproportionately expensive and again, here we go passing along the huge costs of reform to the consumer and almost none of it to the corporations. Health Care is expensive right now because it is mismanaged.

Reply | Flag Abuse

Are you sure this comment violates TPM's Terms of Service?

September 16, 2009 4:59 PM   

Coops are just weak and could fail easily. PO will not have the problems getting off the ground.

Second, Baucus' bill has a minimal subsidy for compulsory health insurance. The House bills are better, and provide much more.

Bacusu' "cost savings" are on the backs of the working class.

Thank you Rockefeller!

Reply | Flag Abuse

Are you sure this comment violates TPM's Terms of Service?

September 17, 2009 4:22 PM    in reply to AnswerFrog

One of my favorite pieces of the Baucus bomb is that EMPLOYERS cannot buy through the co-ops. WTF? So employers get a Hobson's choice of a fine per employee or buying from the current, obsence illness insurance companies.

Good job, Senator Bought-Cuss.

Reply | Flag Abuse

Are you sure this comment violates TPM's Terms of Service?

September 16, 2009 5:11 PM   

Assuming we take your numbers as correct, what's the estimated cost if there is a public option? Given that health insurance plans have an average profit margin of 3.3% (see http://biz.yahoo.com/p/522qpmd.html), how much difference do you think public options will make?

Or are you just opposed to any mandates?

Reply | Flag Abuse

Are you sure this comment violates TPM's Terms of Service?

September 16, 2009 5:21 PM    in reply to OhioGuy

I'm not sure who your note was directed to but I'll take a crack at responding. A public plan will work because it will grow as needed, i.e., to the extent that private health care costs are not reined in. It is an organic fix, even if it is limited initially. If the public sector provides quality health care at lower price points, it is inconceivable that the plan won;t be opened to more Americas. On the other hand, if private industry more efficiently delivers health care then the public plan will wither or remain a niche provider. Including the public option is an experiment to determine what mix of public and private sources best delivers health care to Americans. The only people opposed to it are those who don't want to know the answer.

Reply | Flag Abuse

Are you sure this comment violates TPM's Terms of Service?

September 16, 2009 5:23 PM    in reply to OhioGuy

I'm not at all sure about that number. The 3.3% figure sounds closer to the medicare overhead number.

Oh, and your link is broken.

Reply | Flag Abuse

Are you sure this comment violates TPM's Terms of Service?

September 16, 2009 5:45 PM    in reply to admiralmpj

Sorry, it was meant to be a reply to Indie Pro, whose position I believe is fairly stated as "No Mandate without Public Option".

The link is ok as http://biz.yahoo.com/p/522qpmd.html
My mistake was putting it in parenthesis. Note though that I mean net profit, not overhead. Obviously that's much higher but I'm not convinced that a public option entity would have significantly different overhead than its private competitors, other than the profit. Medicare is much lower because of the way it operates, not because it's publically owned.

I do believe in a public option. I just think the benefits are overstated. By itself it won't restrain the costs from the medical service providers. It will keep the insurance companies more honest, I agree.

Reply | Flag Abuse

Are you sure this comment violates TPM's Terms of Service?

September 16, 2009 5:59 PM    in reply to OhioGuy

I've offered many compromises

Reply | Flag Abuse

Are you sure this comment violates TPM's Terms of Service?

September 16, 2009 5:41 PM    in reply to OhioGuy

It's not the profit margins but the administrative overhead that will allow a public option to be cheaper than private insurance. Typical overhead costs for private insurance are (depending on whose numbers you like) 20-30%. For employer-based group plans it's 12-14%. For Medicare it's 4-6%. One would expect a public option to have administrative costs somewhere between Medicare and employer-based group plans. Thus, for people buying individual policies, you could see a 10-20% savings.

Using the $700/month from the Baucus plan, a 15% reduction gets that down to just under $600, although probably higher since the subsidy would likely be reduced.

Reply | Flag Abuse

Are you sure this comment violates TPM's Terms of Service?

September 16, 2009 5:53 PM    in reply to mans_best_friend

What makes this overhead significantly less?

I assume the public body will have tight caps on executive compensation. I don't believe this will have more than a limited effect.

What else? No advertising? It won't be able to collect premiums through the IRS as Medicare does. There must be something here that I'm missing.

Reply | Flag Abuse

Are you sure this comment violates TPM's Terms of Service?

September 16, 2009 6:05 PM    in reply to OhioGuy

you guys make a compelling argument!!

even with a public option, at its best, this reform lacks good reform.

Reply | Flag Abuse

Are you sure this comment violates TPM's Terms of Service?

September 16, 2009 6:07 PM    in reply to OhioGuy

Economy of scale for one. More streamlined claims processing for another (despite what R's believe, there ARE some things the gov't does better). Advertising is a big cost for insurers. They also expend huge amounts of money screening applicants to weed out anyone who might actually get sick and trying to find ways to weasel out of paying claims when someone does get sick. That's part of the reason individual plans have so much higher overhead costs than employer-based plans that have to accept all employees. All those things cost money. There's probably other stuff I'm missing. And yeah, not having a collections department saves money too.

Reply | Flag Abuse

Are you sure this comment violates TPM's Terms of Service?

September 17, 2009 4:24 PM    in reply to OhioGuy

Is that "profit" before or after they pay their CEO's multi-million dollar salaries -- for REFUSING to pay for health care?

Reply | Flag Abuse

Are you sure this comment violates TPM's Terms of Service?

September 16, 2009 5:36 PM   

Get real TMP'ers!

Baucus was always a sham ....

This Senator Baucus (D-Mont) guy is certainly a time-waster. All his work and Republicans still not aboard, huh?

The health care industry is the problem–they like their business model fine– insure who they want–the healthy–and deny or limit coverage to all others. They also pay top-dollar to make sure our politicians see things their way.

The Obama “health reform” will deliver 30-50 million uninsured to the private health care industry. The government will subsidize these folks. The money to pay for all this will come out of the hides of Medicare patients–their services and payments will be reduced.

Result–insurers rake in more billions and the government foots the bill. Big, socialized government is OK as long as it takes from the poor and gives to rich.

There is a way out of this mess and it’s called Medicare for all (aka Single Payer) –let the rest of the country have the same fine federal government coverage that Senator Baucus has.

Reply | Flag Abuse

Are you sure this comment violates TPM's Terms of Service?

September 16, 2009 5:50 PM   

Wow, must have stumbled upon a pair of brass ones!

Reply | Flag Abuse

Are you sure this comment violates TPM's Terms of Service?

September 16, 2009 6:01 PM   

Co-ops suck. We need a public option that not only the uninsured have access to, but also people that work for big employers. The end.

Reply | Flag Abuse

Are you sure this comment violates TPM's Terms of Service?

September 16, 2009 6:59 PM   

Rockefeller for the win. tell max to go whipe his ass with that bill

Reply | Flag Abuse

Are you sure this comment violates TPM's Terms of Service?

September 16, 2009 11:12 PM   

Is Baucus crazy? He was in Congress when the catastrophic care addition to Medicare had to be rescinded and that bill only taxed a senior couple $800/year on a $40,000 income. People will not be able to pay for this health insurance; you can't get that kind of money from them because they have too many bills to pay now. This bill needs to be completely re-thougt. My cat could write a better healthcare bill and he hasn't been studying it for the past year.

Reply | Flag Abuse

Are you sure this comment violates TPM's Terms of Service?

September 16, 2009 11:31 PM   

Rockefeller should have headed up this senate committee but was left out on purpose, because he is an expert on health care reform. Hmmm.

Reply | Flag Abuse

Are you sure this comment violates TPM's Terms of Service?

September 17, 2009 2:53 AM   

Let's see: a universal mandate (with fines for failure to buy in) but no public option to even mitigate the cost.
And the Democrats are still going to have to ram it through without any Republican support. Way to lose Congress and (conceivably) the White House, assholes!
I've got an idea. How about people visit their doctor's office or hospital whenever they need to, and those institutions bill the government at fixed rates? The government then pays those bills out of general tax revenues.
What? Too complicated?
Everyone seems to agree the insurance companies are a major -- if not the major -- cause of this problem. Why does Baucus's bill propose rewarding them with an additional windfall?
Even the average American voter can see through that BS.

Reply | Flag Abuse

Are you sure this comment violates TPM's Terms of Service?

Leave a comment

Your response:

Follow us!

Most Popular

TPM Stories Now Surging on