By my count, Democrats have offered three different amendments that, if approved, would result in the adoption of a public health insurance plan. The first, proposed by Sen. Jay Rockefeller (D-WV) calls for the creation of a fairly robust public option much like the plan originally drafted by the House of Representatives. It would pay providers Medicare rates plus a small bonus for those practitioners who already take Medicare patients.
That will be a telling vote, but more telling will be the votes on the other two public option proposals. The first, sponsored by Sen. Chuck Schumer (D-NY) would create a so-called "level playing field" public option, which wouldn't be permitted to set rates. The second, offered by Schumer and Sen. Maria Cantwell (D-WA), would create a very similar public option, this one imported from the Senate HELP committee's bill.
Rockefeller's plan would please reformers and liberals, and substantively makes more sense on a cost control level. But what makes the other two amendments more politically interesting is that they put conservative Democrats--particularly Sens. Max Baucus (D-MT), Kent Conrad (D-ND), and Blanche Lincoln (D-AR)--on the spot. No longer will they be able to simply dismiss the public option by saying it doesn't have the votes to pass the Senate. And they won't be able to honestly oppose these plans on big government grounds.They'll actually have to go on the record one way or another. And a lot of eyes will be on them when they do.

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mans_best_friend
September 21, 2009 3:29 PM
The real crux of the public option is the rates they pay providers. Medicare rates are pretty low. While it's always nice to pay less for something, setting rates too low is not necessarily a good thing. This is one area where people have a legitimate concern. I don't think there's a "right" answer here - it's more a matter of finding a reasonable balance between cost control and making sure reimbursement rates too low.
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Larry Geater
September 21, 2009 3:39 PM in reply to mans_best_friend
Speaking as a medical office manager, I would argue that Medicare rates are not to low. If doctors could know that they were going to collect the Medicare allowable on every patient they would make it just fine. The Medicare allowable is only to low in the current climate where claims get rejected for superfluous reasons and have to be apealed, and doctors have to cost share to cover the expenses of the uninsured.
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mans_best_friend
September 21, 2009 3:48 PM in reply to Larry Geater
How do Medicare rates compare to the negotiated discount rates large insurers get for their network providers? These discounts can be pretty hefty for the largest insurers (30% or more), but I've always understood Medicare rates to be even lower.
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AnswerFrog
September 21, 2009 4:14 PM in reply to mans_best_friend
Since a large majority of doctors FAVOR a medicare type public option, my guess is medicare rates are not too low. Doctors seem to do just fine under medicare.
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ohyeathatsright
September 21, 2009 4:38 PM in reply to mans_best_friend
You're missing the key point here. That doctors, under a true universal plan or even a qualified public option, would not have to fear the insurance company denying their payment and the administrative cost of appealing.
If I were a doctor I'd rather place my bet on a lower payout, but relatively painless (administratively) and guaranteed treatment opportunity. The doctors hate the insurance companies almost as much as many of us do. It's too bad none of the rabble-rousers talking about rationing and doctor shortages are actually listening to those they say they're representing.
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714Day
September 21, 2009 4:39 PM in reply to mans_best_friend
Medicare rates are a bit lower; how much so depends on the region in which services are vended, what the services are and so on. Even so, it doesn't undercut private insurers providers discount rates by a great deal.
You illustrate yet another gross inequity in medical services, however. Uninsured patients are gouged with the full boat charge.
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mans_best_friend
September 21, 2009 5:04 PM in reply to 714Day
Not just the uninsured, but those with insurers who aren't big enough to negotiate hefty discounts. And if the provider you want isn't in the network, look out, because your deductible and co-payment are going to be much higher.
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Larry Geater
September 22, 2009 11:01 AM in reply to mans_best_friend
Most private insurers base their rates on Medicare rates they will pay between 110% and 130% of Medicare allowable for primary care for the most part, though a few pay more. Medicaid pays less. The rates for other specialties differ and I am not familiar with them.
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The Commenter Formerly Known as NCSteve
September 21, 2009 4:11 PM in reply to Larry Geater
Excellent point.
It's also one applicable to the broader insurance market. All providers overcharge because they're subsidizing the cost of caring for the uninsured and underinsured. When big carriers like BCBS muscle down provider charges, that means the providers increase what they charge people who aren't in group plans even more to subsidize the cost of covering the uninsured and underinsured. The irony being that the people who are taking an even bigger hit to subsidize the cost of treating the un/underinsured are, themselves, highly likely to be underinsured. Or even uninsured once their carrier finds grounds for recission.
Universal coverage removes a substantial factor driving up the cost of individual patients' bills and insurers can be counted on to use that fact t beat down provider charges more uniformly. Once everyone is in the equivilent of a group policy, it can be expected that providers will be epected to give very patient the benefit of group pricing, but with every bill getting paid they won't take a financial hit because of it.
The real question, then, becomes whether the insurers can be counted on to pass those savings on to the policy holders without being forced to. And the answer, of course, is HAHAHAHAHAHEHEHAHAAA!
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DaveW
September 21, 2009 5:13 PM in reply to mans_best_friend
There's no question that setting rates so low that it drives out providers would be wrong and stupid. But according to doctors I've talked to, Medicare rates are generally no worse than "free market" HMO rates, and waste far less of their time arguing with ignorant insuranceco droids. Let's compare apples with apples here.
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jason everett miller
September 23, 2009 6:30 AM in reply to DaveW
So who pays the 20% that Medicare won't pay? There is no magic bullet and creating a brand new public plan rather than fixing the one we already have is a waste of time and money.
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calchala
September 21, 2009 3:33 PM
I think Conrad and Landrieu will vote on the public option bills, thus killing them. They only need two, meanwhile, Baucus will vote for it in an attempt to shore up liberal support.
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calchala
September 21, 2009 3:35 PM in reply to calchala
Conrad and Lincoln will vote against it. In a 13-10 panel, two votes going with the republicans will kill any amendment.
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lapdogs
September 21, 2009 3:55 PM
We'll soon find out if the late John F. Kennedy, if he were still alive, will have any Democratic Senator to put in his book he is currently writing.
The Book Is Titled: "Profiles in Courage".
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creo13
September 21, 2009 4:14 PM
Is the public option deficit neutral?
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bluebell
September 21, 2009 6:22 PM in reply to creo13
Only the wars in Iraq and Afghanistan are deficit neutral. All wars are free.
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The Commenter Formerly Known as NCSteve
September 21, 2009 4:14 PM
My prediction is that Conrad and Landrieu will vote against all three amendments, claiming they were forced to do so because the amendments didn't have the votes to pass the Senate.
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willia451
September 21, 2009 4:34 PM in reply to The Commenter Formerly Known as NCSteve
Landrieu is not on the Finance Committee. Do you mean Lincoln?
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wbgonne
September 21, 2009 4:52 PM in reply to The Commenter Formerly Known as NCSteve
I won't vote for it because it won't pass because I won't vote for it.
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willia451
September 21, 2009 5:16 PM
It will be nice to have folks on the Finance Committee finally voting 'Yes' or 'No' on the public option.
That way we can support and send contributions to those who voted 'Yes'.
And pound on, donate to ad buys, and support primary challengers to those who vote 'No'.
Lincoln specifically (who's up for re-elect next year) needs to think long and hard about these votes. Unless her backup plan is to flip to the Republicans.
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theone718
September 21, 2009 5:32 PM
Vote against the public option...........It's over for you next election. PERIOD.
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witty1
September 21, 2009 5:36 PM
Senator Mark Begich got an earful in Anchorage this past weekend.
http://www.ktuu.com/Global/story.asp?S=11162645
I'm pretty sure he got elected so he could get the F!@#$ out of Alaska - after the huge fiscal mess he left behind in the Anchorage Mayor's office.
On average Alaskans pay 30% more for every single medical service (or product)... we simply have no choices, no community hospitals etc. they are ALL for-profit.
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go2goal
September 21, 2009 5:57 PM
Generally speaking, doctors who specialize make the big bucks. My neighborhood is a cardiologist and he even admits to being over paid. General practitioners on-the-other hand are under paid - hard to break even.
I'm a finance professional in a hospital. To say that medicare rates are too low is just not true. You have regional rate schedules and you also have treatment schedules. One thing that doesn't happen with Medicare that is a daily nightmare (almost minute by minute) is denial of service by an insurance company. I see this 1st hand - which is the single reason the Baucus plan is a terrible beginning. Who wrote that proposal? Baucus or some insurance company execs. Talk about guaranteeing a revenue and profit stream to corporations.....the insurance companies have struck it rich. So good ole Max is going increase the subsidies for lower income families.....in other words, tax payers will make the insurance execs even richer. And then the Repubs get to complain about socialization and communism. Baucus's plan is a HORRIBLE plan. Goldman Max should resign his chairmanship - he's never delivered anything. He's basically Grassley's little butt boy.
A Robust government option is a must - and it must set lower rates in the areas of specialized medicine. Prevention and GP's aren't over priced or over paid today. We also need to reform malpractice laws in a way that helps patients but also penalizes and removes poor performing physicians from practicing. Government must play a much more active role on this one......and across state lines.
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jason everett miller
September 23, 2009 6:33 AM in reply to go2goal
So who picks up the tab for the 20% that Medicare won't pay? Not arguing that the government doesn't have a roll to play nationally in this, but Medicare is not a magic bullet and is unsustainable in its current form. Mostly because of the way its finances are managed.
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neesy08
September 21, 2009 7:43 PM
Ok, it all sounds great, now, can we get this done? Good, Lord! People are dying and conditions are getting worse because of the squabbling!
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CareyInLA
September 22, 2009 11:19 AM
We need to forge an explicit link between the provisions that impose burdens on citizens (forced purchase of insurance, taxes on existing health coverage) and the public option.
Tto put it into the obligatory pithy sound bite:
"No mandates, no taxes, without the public option!"
Unfortunately political battles are won and lost with sound bites, so we need unleash our own arsenal.
Paralleling "no taxes without representation" this gives an easy-to-understand cudgel to pound our legislators with.
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