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Obama Tells Congress He Likes Four GOP Ideas For Health Care


House Speaker Nancy Pelosi (D-CA), President Obama, and Sen. Harry Reid (D-NV)

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President Obama this afternoon wrote a letter to Congressional leadership detailing four areas where he thinks Republican ideas can be included in a final health care compromise and pledging to drop the Medicaid deals for Nebraska and Florida from what he proposes tomorrow.

The White House released the letter which Obama wrote to Speaker Nancy Pelosi, Senate Majority Leader Harry Reid, Senate Minority Leader Mitch McConnell and House Minority Leader John Boehner summing up his take from the health care summit last week. Obama said he came away from the meeting feeling the group agreed the cost of health care is a massive problem that must be solved.

"I also left convinced that the Republican and Democratic approaches to health care have
more in common than most people think," Obama wrote.

"No matter how we move forward, there are at least four policy priorities identified by Republican Members at the meeting that I am exploring. I said throughout this process that I'd continue to draw on the best ideas from both parties, and I'm open to these proposals in that spirit," Obama wrote.

Those areas are as follows:

1. Although the proposal I released last week included a comprehensive set of initiatives to combat fraud, waste, and abuse, Senator Coburn had an interesting suggestion that we engage medical professionals to conduct random undercover investigations of health care providers that receive reimbursements from Medicare, Medicaid, and other Federal programs.

2. My proposal also included a provision from the Senate health reform bill that authorizes funding to states for demonstrations of alternatives to resolving medical malpractice disputes, including health courts. Last Thursday, we discussed the provision in the bills cosponsored by Senators Coburn and Burr and Representatives Ryan and Nunes (S. 1099) that provides a similar program of grants to states for demonstration projects. Senator Enzi offered a similar proposal in a health insurance reform bill he sponsored in the last Congress. As we discussed, my Administration is already moving forward in funding demonstration projects through the Department of Health and Human Services, and Secretary Sebelius will be awarding $23 million for these grants in the near future. However, in order to advance our shared interest in incentivizing states to explore what works in this arena, I am open to including an appropriation of $50 million in my proposal for additional grants. Currently there is only an authorization, which does not guarantee that the grants will be funded.

3. At the meeting, Senator Grassley raised a concern, shared by many Democrats, that
Medicaid reimbursements to doctors are inadequate in many states, and that if Medicaid
is expanded to cover more people, we should consider increasing doctor reimbursement. I'm open to exploring ways to address this issue in a fiscally responsible manner.

4. Senator Barrasso raised a suggestion that we expand Health Savings Accounts (HSAs). I know many Republicans believe that HSAs, when used in conjunction with high-
deductible health plans, are a good vehicle to encourage more cost-consciousness in consumers' use of health care services. I believe that high-deductible health plans could be offered in the exchange under my proposal, and I'm open to including language to ensure that is clear. This could help to encourage more people to take advantage of HSAs.

He also drops the special deal made for Sen. Ben Nelson in Nebraska that had the federal government covering the cost of the state's Medicaid burden and a similar provision in Florida that he and Sen. John McCain discussed during the summit.

"My ideas have been informed by discussions with Republicans and Democrats, doctors and nurses, health care experts, and everyday Americans - not just last Thursday, but over the course of a yearlong dialogue. Both parties agree that the health care status quo is unsustainable. And both should agree that it's just not an option to walk away from the millions of American families and business owners counting on reform," Obama wrote.

Read the full letter here.

Comments (112) | Join the Conversation!

Recommend Recommend (1)

March 2, 2010 12:58 PM   

Yes! The DLC President demands that we protect the health insurance companies.

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March 2, 2010 1:34 PM    in reply to Richard L. Adlof

What a naive embarassment Obama has become. It's absurd how weak and submissive he is in the face of the Republican insults and attacks.

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March 2, 2010 2:47 PM    in reply to oleeb

Get a room.

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March 2, 2010 3:09 PM    in reply to Dorn76

What a joke.
Obama will stand up for ridiculous Republican talking points but won't back a Public Option.
I give up.

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March 5, 2010 11:46 AM    in reply to oleeb

Don’t get me wrong, I am all for a guy being thoughtful and open to conversations.

It is just that I am against a guy whose default position is siding with legal entities designed to deflect responsibility over creatures that breathe and bleed.

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March 2, 2010 1:51 PM    in reply to Richard L. Adlof

This is absurd. You posted this comment 2 minutes after this was posted. All your comment says to me is that you are interested in hurling invective without bothering to think anything through. It seems as though all you can see is "Obama agrees with Republicans" without giving any consideration for how central these areas of 'agreement' are to the bill in total.

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March 2, 2010 2:18 PM    in reply to MLDB

where is obamas agreement for the public option?

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March 2, 2010 2:26 PM    in reply to MLDB

You are correct about this respondent. His statement is ambiguous and general. What specifically in the four suggestions indicates that his statement is on point?

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March 5, 2010 11:24 AM    in reply to MLDB

1. Witch hunts against providers . . . And still no support of holding health insurance providers and big Pharma responsible . . .

2. Tort reform which holds bad actors responsible to be mitigated . . . Oh look, another hand-job to health insurance providers and big Pharma . . .

3. California has been dragging reimbursement to providers for 180 to 270 days or more because our Republican Govenator ordered it for YEARS but health insurance providers just deny reimbursement multiple times. . .

4. Folk have to have money to save money . . . Forcing folk to pay their abusers AND saving non-existent money is . . .

Senator Lieberman exhorted the version of the bill outta the Senate that President Obama wants. While four more punches in the gut don’t matter much, there are other names for folk that do despicable thing for corporate money.

Is this post more thoughtful for you? I stand by my original assessment:

Our great and grand DLC President demands that we protect the health insurance companies at the expense of flesh and blood humans.

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March 2, 2010 1:00 PM   

Politically smart move. Box the repukes in.

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March 2, 2010 2:51 PM    in reply to Michael A

Exactly what I was thinking. If their ideas are incorporated, how can they be against it? It only looks political then and people will see through it.

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March 2, 2010 1:01 PM   

Great article, what 4 ideas is he referring to?

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March 2, 2010 1:02 PM    in reply to VictorLH

oops, ignore that, for some reason my browser cut off the letter - how odd??

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March 2, 2010 1:47 PM    in reply to VictorLH

Heh. Actually, your original post was pretty much spot on.

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March 2, 2010 2:20 PM    in reply to EastWest

Beat me to it!

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March 2, 2010 1:04 PM   

smart move. if they're really good ideas, take them. there are so few to consider from them that it shouldn't be difficult.

the gop will then oppose them and have absolutely nothing left to bring to the debate.

(not that they much care.)

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March 2, 2010 1:08 PM   

A good move to reassure conservadems in the House that he was willing to compromise with GOP, even though they weren't feeling the love back.

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March 2, 2010 1:10 PM   

All of these are small potatoes except HSA. HSA's, on their own, are fine. It's coupling these with high deductible insurance that creates the problem. HSA's obviously have a much higher benefit to high-income people since they get a bigger tax break. Coupling those with high deductible policies has the effect of shifting more of burden onto lower and middle income people, which is the essence of pretty much every Republican proposal ever put forward.

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March 2, 2010 1:46 PM    in reply to mans_best_friend

The fraud issue really isn't - medicare fraud DOES run into the billions - but the problem is, Coburn's idea isn't really that good.

For one thing - and you can thank the Clinton CMS for this - a lot of the fraud at the large provider level has already been eliminated. There are essentially ways for whistleblowers to get a part of the treble damages CMS will fine a provider.

Most of the remaining fraud happens in areas where there simply isn't another physician or administrator to report it -- it happens a lot with DMEs (Durable Medical Equipment), where the equipment provider essentially handles all the paperwork. It happens with self-referrals -- instances where physician has his own MRI equipment and simply reports a lot of phantom MRIs he never actually even performed.

There's a reason you see all these commercials for 'Rascals' or whatnot where they "guarantee" medicare approval -- it's easy to guarantee approval when CMS simply pays out submitted claims, sight-unseen, 95% of the time.

I'm not claiming to have an answer to that - and even when we're talking billions, it's important to remember that Medicare pays out something on the order of 125 billion a year in benefits - but Medicare does have a fraud problem when it comes to dealing with small providers.

A single equipment or single physician can very easily game the system if that's all they want to do, and the chances of getting caught are pretty slim.

One idea might be to let private citizens in on the largess... I don't know how you'd do it - we cannot all simply become O'Keefian vigilantes - but perhaps offering private citizens seek out a share of the whistleblower pie. If I - at age 36 and with no physical maladies - could get an equipment provider to submit a claim with no trouble and without providing some basic eligibility info, then let me go to CMS and get a slice of the damages they should rightly be finding that provider.

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March 2, 2010 2:12 PM    in reply to zonk

I agree, which is why I labeled them "small potatoes". The effect is minimal, at best, but OTOH, they do no harm. The HSA/high deductible idea can do significant harm, and so needs to be done very carefully.

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March 2, 2010 2:46 PM    in reply to mans_best_friend

You are against offering high deductible plans on the exchange? Why is that. if they are not a good deal then no one will choose them, right?

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mcc

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March 2, 2010 3:04 PM    in reply to mans_best_friend

I don't think you understand the idea of an HSA. HSAs are an established thing that have existed for years and HSAs are always paired with high deductible insurance-- there is no other form of HSA out there.

The idea of an HSA is you take the money you were going to spend on an insurance policy. Instead of buying insurance, you then put it in a special savings account, which is tax free; then instead of having the insurance company pay for things, you pay for things out of the savings account. (You also buy an extremely cheap, limited insurance plan, so that if something really catastrophic happens you do not go bankrupt.) The idea here is that the government traditionally gives you a tax break on your employer-provided health care, and they're simply transferring this tax break so that instead of a subsidy on buying insurance you're getting a subsidy on buying health care directly.

However let's imagine that you were allowed to use an HSA with a low deductible insurance policy. This would not be fair. This would basically mean that you were double dipping on the government's tax subsidy for insurance-- you would be getting a tax break on your full-cost insurance policy, AND you would be getting a tax break on the money you spend above insurance. I also think this would disproportionately benefit the wealthy, because these would be the people whose employers could afford to put money both toward an expensive "normal" insurance policy and also toward the HSA (with the government paying out a tax subsidy on both).

HSAs have a real use, they're just not for everyone. It's a different set of tradeoffs from normal insurance, and the high deductible plan is part of how that tradeoff works. The idea is that normal insurance benefits you if your insurance costs are very high or moderate, but is a crummy deal if your insurance costs are low and intermittent. HSAs benefit you if your insurance costs are either very low or very high but screw you over if things fall in the middle.

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March 2, 2010 3:10 PM    in reply to mcc

Some people want a DC plan, other people want a DB plan. There's no objective way to say one is better then the other.

Also the Federal Employees Health Benefits Plan exchange already has High deductible plans and I have yet to see the sky fall (unless you count 45 inches of snow in DC).

Once again the issue of how to design the exchange rears it's head. If only Dems had been focusing on this all summer instead of singing their one-note over and over. Where si the progressive movement to demand sufficient risk adjustment mechanisms on the exhange?

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DP1

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March 2, 2010 8:28 PM    in reply to mcc

Aren't HSA's also use em or lose em by 12/31? I seem to recall something like that from when I used to have affordable high quality insurance in Guam.

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mcc

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March 2, 2010 11:31 PM    in reply to DP1

No, those are "flex accounts", which are similar but different. Flex accounts expire at the end of the year, HSAs don't. As I understand flex accounts are being mostly abandoned in favor of HSAs (I think HSAs are a newer idea, they have only existed since 2003).

There's also something called HRAs that are somehow halfway between a flex account and an HSA but I don't know what the details are.

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March 2, 2010 1:13 PM   

lean anymore to the right, and this President will be prostrate before the GOP.

By saying No, refusing to work with the President, and fighting to kill his presidency the GOP wins more concessions from leadership. Liberals and progressives should take notice.

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March 2, 2010 1:24 PM    in reply to Indie Pro

I don't see these as concessions as much as adopting some decent ideas. The health courts could be a better approach to "tort reform" and should be at least looked at. HSA, I've never been a fan, but some folks are and if they want that choice why not give it to them. It is merely a choice. And Dr. reimbursements don't see the issue. And fraud again don't see the issue.

Finally this does box them in. Some clear ideas that came out of the meeting that Obama is will to include. The Republicans will say, of course, that doesn't matter we are still against it. Who looks bad here?

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March 2, 2010 1:27 PM    in reply to jsfox

This has been going on for a long time. Nothing new has happened.

Afterall, as Obama said:

I know you guys disagree, but if you look at the facts of this bill [Healthcare Senate Bill], most independent observers would say this is actually what many Republicans — it is similar to what many republicans proposed to Bill Clinton when he was doing his debate on health care.

These are not the first concessions. These are not the first capitulations. This is not the first attempt at bi-partisanship.

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March 2, 2010 2:15 PM    in reply to Indie Pro

You seem to be arguing against them for no reason other than the idea came from a Republican. Is there any actual reason you can give for opposing them?

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March 2, 2010 2:17 PM    in reply to mans_best_friend

you seem to be missing that what I'm saying is:


By saying No, refusing to work with the President, and fighting to kill his presidency the GOP wins more concessions from leadership. Liberals and progressives should take notice.

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March 2, 2010 2:22 PM    in reply to Indie Pro

If the ideas have merit, how are they "concessions"? If it makes sense it should be included regardless of where the idea came from. Honestly, you're as bad as the Republicans. You see everything through the lens of a hyper-partisan fight. The objective should be to get the best bill that can garner enough votes. But no, if it doesn't have a PO, bring the whole thing down!!!! Any ideas that come from someone you don't approve must be rejected, regardless of merit.

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March 2, 2010 2:25 PM    in reply to mans_best_friend

if it makes you feel better to attack me, then have at it. My point stands.

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March 2, 2010 2:50 PM    in reply to Indie Pro

Your point is that libs and progressives should start acting like whiney babies to get their way? Ummm, I think you tried that.

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March 2, 2010 2:52 PM    in reply to Indie Pro

Maybe you didn't notice that Obama's version of adopting a "Republican idea" was to make Medicaid more generous, and to provide more demonstration grants. In other words, OK, if you Republicans think we should spend more money, I'm all for it. Hiring under cover fraud inspectors and allowing people to choose a plan that they pretty much can already choose, for example on the Federal Employees Exchange is a form of capitulation.

Really, I think you read this completely wrong. This is the President telling the Republicans that their ideas suck, and I guarantee you that is how the Republicans will take it.

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March 2, 2010 2:59 PM    in reply to Economides

This is the President telling the Republicans that their ideas suck, and I guarantee you that is how the Republicans will take it.

that's interesting. I don't see it, though. I think it is more likely that this is supposed to give cover. We'll see what is in his plans that are to be released tomorrow.

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March 2, 2010 3:04 PM    in reply to Indie Pro

Well, watch the Republicans reaction. They are gonna treat it like he just put an ice cube down their shorts.

The cover he is providing the democrats is that he is saying he's pretty confident he can convince the public that the republican's ideas suck; for example, the way he utterly dismantled the idea of using association health plans in lieu of an exchange at the HC summit last week.

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March 2, 2010 3:06 PM    in reply to Economides

They are gonna treat it like he just put an ice cube down their shorts.

I'm not sure that would be an accurate guage, as that is their reaction to everything the President annouces.

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bdh

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March 2, 2010 2:53 PM    in reply to Indie Pro

No, it doesn't. Your point was that the GOP is winning concessions despite its bad behavior. If there were in fact no concessions, then you have no point.

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March 2, 2010 3:01 PM    in reply to bdh

in the process of conceding, then.

like no PO, no repeal of the anti-trust exemption, the abortion language, the immigration language, no real regulation with teeth, no drug re-importation etc

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March 2, 2010 1:27 PM    in reply to Indie Pro

I agree with Goofy. These ideas are literally crumbs tossed to the Republicans and it will be difficult for them to say no to themselves, although, of course, they will. The Corporadems will be encouraged to vote FOR the damned bill now that it has "conservative, BIPARTISAN" measures in it. The ancient art of political Akido?

Even the HSAs and high deductible will have small effect, since a relatively small proportion of the population will be able to actually benefit from them. The main purpose of this letter is atmospherics. "Look! We've found compromise!" It's completely chump change and I imagine Mitch McChinless will be grinding his gums in frustration.

Now PASS THE BILL! And get on with reconciliation (aka majority vote)!

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March 2, 2010 1:31 PM    in reply to KeithL

The Corporadems will be encouraged to vote FOR the damned bill now that it has "conservative, BIPARTISAN" measures in it. The ancient art of political Akido?

Oh, I see. Now, after all the other things thrown in there for the conservadeams, like no PO, no repeal of the anti-trust exemption, the abortion language, the immigration language, no real regulation with teeth, no drug re-importation etc

now, now, this is what will encourage them. Ok.

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March 2, 2010 2:35 PM    in reply to Indie Pro

... no drug re-importation ...

BTW, does anyone here realize that no legislation is required for importing drugs from foreign sources?

Although the Dorgan-Snowe amendment was defeated in December, which would require allowing imports, existing law permits it if the Secretary of Health certifies that it is safe.

So all we need to have this happen is for Sebelius to write the appropriate letter of certification.

Sigh. But since the current administration took Big Pharma's dime-on-the-dollar bribe (to cut costs 80 billions dollars over 10 years, to prevent reforms that would cut 800 billion dollars over the same term), Sebelius's signature has been bought and paid for.

Good to know that we are being protected from those killer Canadian drugs!

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March 2, 2010 1:30 PM    in reply to Indie Pro

What country do you think this is? Do you think voters are too smart to fall for the Republican obstruction game? The quickest way to lose the majority is to overestimate the wisdom and patience of voters.

If liberals gathered in church every Sunday we might have a chance, but you can't win a national election by playing to that base. Keep the middle, build on small successes, make the other guys look radical and freaky...that's the proven, boring way to success.

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March 2, 2010 1:34 PM    in reply to darosenthal

The quickest way to lose the majority is to overestimate the wisdom and patience of voters.

Promise change and deliver none. That a quick way as well. There are many ways to lose the majority.

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March 2, 2010 2:51 PM    in reply to Indie Pro

Maybe if we lose the majority we will be able to do things our way...A 41-59 majority seems to be working for the repubs. Maybe we should try it, since 60-40 didn't.

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March 2, 2010 3:02 PM    in reply to stillidealistic

I'm sure you are working your way up to a point. Atleast, I hope you are.

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March 2, 2010 1:17 PM   

Some very minor concessions. When does the Republican whining begin? 5, 4, 3, 2, ...

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March 2, 2010 1:22 PM   

Just gives the fence sitters and bluedogs in districts McTurd won in '08 cover for voting for it. Not too bad an idea.

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March 2, 2010 1:23 PM   

These ideas fucking suck, except for increasing Medicare reimbursement rates.

The medical malpractice shit is a confirmed red herring. And setting up Coburn's 007 undercover investigative team to sniff out Medicare abuse is just flashy nonsense.

The Health Savings Accounts are the health care version of privatized social security. They do nothing to control costs, and will likely lead to underutilization of preventive care.

Another disappointing play by Obama.

This is fucking ridiculous.

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March 2, 2010 1:34 PM    in reply to pablito

I don't have a problem with the first 3, but the HSA's are a no go for me.

They will distort the pool, allowing healthier and wealthier individuals to buy out of the pool everyone else will be in.

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March 2, 2010 2:59 PM    in reply to pablito

Dude, that's the whole idea. Obama to Republicans: your ideas suck, and did I hear someone say we ought to be more generous with Medicaid not less.

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March 2, 2010 1:26 PM   

HSAs shouldn't be backed before the Canopy Financial problem is addressed with new regulation.

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March 2, 2010 3:13 PM    in reply to georgia99

C'mon, Should we suspend Medicare until someone returns the $47 billion that gets spent improperly every year.

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March 2, 2010 3:15 PM    in reply to georgia99

HSA's = more medical bankruptcies

HSA's are for well paid people mostly

HSA's make the insurance pool smaller meaning transferring costs from high earners to low earners

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March 2, 2010 3:35 PM    in reply to njlib

HSA'a are a savings vehicle like a 401(K) that can be used for medical expenses. The health plan is usually called something like a HDHP (high deductible health plan). They have them onthe Federal employees exchange.

If this is a choice on the exchange and some people want to avail themselves of the choice, then why would it lead to more bankruptcies? Nobody is forced to choose this.

All plans have the potential for selection effects, so their needs to be an effective risk adjustment mechanism. that is true no matter what the choices.

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March 2, 2010 6:36 PM    in reply to Economides

I don't understand why risk adjuster mechanisms are important if companies are forbidden to cherry pick, as they are (I believe) in the President's plan. They must take any comer, regardless of pre-existing conditions, and can't drop them when they get sick. The exchanges are supposed to be community rated, right? So every insurer's looking at the same pool.

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March 2, 2010 7:55 PM    in reply to Tanjaoui

The risk adjustment is ex post. you adjust based on the pools that are actually enrolled. A firm can try to market itself to healthy young folks. Or a plan could offer an unusually good deal and attract "too many" sick people. It happens. In fact CBO was expecting it to happen to a public plan.

With an effective risk adjustment there's no real incentive for insurers to market to a specific segment, but rather to get as big a pool as possible.

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March 2, 2010 11:10 PM    in reply to Economides

That sounds close to price fixing: the insurers gang up to make sure that no single one of them can go out of business. Doesn't this mean they effectively enjoy a government guarantee?...Yes, I remember that about the public option. It would've offered a more 'cost effective' product, I suppose, or been less vigilant in denying claims and been run out of business by private insurers. It seems a rather perverse business model: one that is founded on not providing a service that is being paid for. Just sayin'....

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March 2, 2010 4:43 PM    in reply to njlib

Several have commented about HSA's and the problems they may cause. Maybe the problems could be address by adding a fee to any HSA options in the exchange, similar to the way anyone who chooses not to purchase insurance will get charged. The HSA option would reduce the penalty, but not to zero.

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March 2, 2010 1:32 PM   

One idea for increasing medicare reimbursement would be to amend the unemployment/COBRA/medicare legislation that Bunning is blocking to HCR

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March 2, 2010 3:15 PM    in reply to georgia99

They are talking about increasing Medicaid reimbursement.

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pol

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March 2, 2010 1:36 PM   

If Republicans are so hung up on Medicare reimbursements, why are they filibustering Medicare reimbursements to doctors as we speak?

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March 2, 2010 3:37 PM    in reply to pol

They are talking about increasing Medicaid reimbursement.

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March 2, 2010 4:48 PM    in reply to Economides

Yes, they're talking about increasing reimbursements, but because of Bunning's block, reimbursements may instead be reduced over 20%. That's probably a good reason to address the problem here. Get it done here and do an end-run around Bunning.

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March 2, 2010 7:58 PM    in reply to georgia99

Medicare payments to physicians were cut per existing law. Congress acts to nullify the cut almost every year, but Bunning interfered with the vehicle that did that. Obama's talking about medicaid

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March 2, 2010 3:43 PM    in reply to pol

Oh, and they only care about doctor's incomes, not medicaid recipients.

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March 2, 2010 1:37 PM   

President Obama stated in September 2009 in a national television address on healthcare:

One more misunderstanding I want to clear up -- under our plan, no federal dollars will be used to fund abortions.

The Senate bill provides federal subsidies for health plans that cover abortions, authorizes plans to cover elective abortions, and funds community health care centers without any abortion restrictions in sections 1303, 1334, and 10503.

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March 2, 2010 1:45 PM    in reply to SocialJusticeForAll

Good, women will still have the constitutional right of choice.

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March 2, 2010 2:11 PM    in reply to VictorLH

Where is your compassion for the rights of unborn women?

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March 2, 2010 2:18 PM    in reply to SocialJusticeForAll

Where is your reading comprehension? If someone buys a policy that covers abortion, the costs of abortion coverage has to be segregated and paid by the insured. No federal money goes to pay for abortion coverage.

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March 2, 2010 2:32 PM    in reply to mans_best_friend

However a public option should pay for abortions and vasectomies! They are much cheaper than raising children on welfare.

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March 2, 2010 3:38 PM    in reply to Captain Dan

Be careful about using future costs to justify killing the unborn, or anyone, that is a quick path to sink HCR.

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March 2, 2010 3:42 PM    in reply to mans_best_friend

I respectfully disagree. Sometime one needs to be truthful to one's self.

http://www.nrlc.org/AHC/NRLCMemoCommHealth.html

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March 2, 2010 2:19 PM    in reply to SocialJusticeForAll

Its not my compassion that matters, it is the choice of the women. But then, unlike yourself, I'm not one to impose my superstitions on another.

Why don't you stop trolling and move on to supporting some war or capital punishment.

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March 2, 2010 3:59 PM    in reply to VictorLH

52 million innocent Americans killed since Roe is a far greater evil.

3,400 killed each day in U.S. abortions versus 4,400 U.S. causalities in entire Iraq war.

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March 2, 2010 6:34 PM    in reply to SocialJusticeForAll

OH PLEASE! A clump of cells is not a human being. It might be fun to imagine all sorts of superstitious magic nonsense in your own mind but please remember that what you personally imagine is not at all what others might hold true. You have every right to express your fantasy perfect world but you have no right at all to insist that yours must be enshrined in the law. It is entirely reasonable for other living breathing adult human beings to decide for themselves what sort of perfect world they choose to reproduce themselves in. It is entirely unreasonable for you to overpopulate the world with your superstitious mumbo-jumbo.

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March 2, 2010 7:19 PM    in reply to hollywood

All human beings are clumps of cells, born and unborn. Human beings have unique DNA that make them an individual at conception.

All human beings, everyone, needs to be supported and nutured by other human beings to live, before birth primarialy by the mother, and after birth, preferably by a supportive family or by compassionate members of our human family.

One more note: Martin Luther King Jr.'s niece speaks about how abortion hurts blacks.

http://www.lifenews.com/nat6062.html

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March 2, 2010 2:19 PM    in reply to SocialJusticeForAll

Typical anti-choicer; doesn't give a shit for anybody's rights or well-being AFTER they're born.

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March 2, 2010 3:32 PM    in reply to Steve LaBonne

Agree that today’s children (on all social economic fronts) are, sadly, often abandoned, if not by their parents—primarily the fathers—sometimes abandoned physically, sometimes abandoned emotionally. Your point in reference to pro-life people is WRONG.

It is NOT okay for anyone to deny the unborn the right to live because someone THINKS that they might be sad in the future or that they may cost too much money. Too much death panel logic...

This logic leap of no showing compassion to the born and the unborn is wrong and shows misplaced compassion.

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March 2, 2010 3:51 PM    in reply to SocialJusticeForAll

I'm a biologist, so unlike you I know there is no such thin as an "unborn person". Shove your "pro-life" horseshit where the sun don't shine. You're anti-woman, not "pro-life".

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March 2, 2010 5:45 PM    in reply to Steve LaBonne

Ad hominem comments lose. Abortion hurts blacks, women, and the unborn. Here are a few published research studies for you to study. These are about how abortion hurts women.

http://www.physiciansforlife.org/content/category/5/144/49/

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March 2, 2010 1:42 PM   

I distinctly remember how important bipartisanship was under Republican administrations -- why, they went so far as to change the Congressional rules so that, rather than waste the Democratic minority's time writing laws, the Dems were left outside of the entire legislative process so they could focus on their hobbies and families! What bipartisan swells those Republicans are?

Oh, did I say "swells"? I meant "assholes".

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March 2, 2010 1:44 PM   

Obama does not include a Public Option or Drug Reimportation which would save money and reduce the deficit...

Oh well...maybe someday he will do the people's work when it comes to health care.

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March 2, 2010 2:02 PM    in reply to Progressive Party

That's because he wants the bill to pass.

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March 2, 2010 2:34 PM    in reply to plynch22

that's leadership we can believe in....include my items and you have a bill that get results and move this country forward. where are counting votes anyway? No GOP or 60 majority votes needed now just some balls to be a leader!

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March 2, 2010 3:48 PM    in reply to Progressive Party

People who think drug reimportation can possibly work are self-identifying themselves as believers in the possibility of a free-lunch. It's the economic equivilent of a perpetual motion machine. If we allowed it, the Canadians would have to ban it to prevent drug shortages. They're certainly not going to keep ramping up the amount the Canadian government buys just so it can become the de facto drug price regulator for the U.S.

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March 2, 2010 4:20 PM    in reply to The Commenter Formerly Known as NCSteve

Canadian drug distributors would love more demand. It's not like the Canadian government buys drugs and hands them over below cost to anyone who asks.

The problem is that the pharmaceutical companies may then turn around and restrict deliveries, which would lead to Canadian government action. Now, that action may be to restrict cross border purchasing, or it may be to retaliate against the pharma companies by loosening restrictions on generic manufacturers.

It's fair to say that this would be the United States using Canada as a price regulator. But that's not a free lunch. It's certainly a situation that the pharmaceutical companies don't want to happen, and it's sustainable unless the Canadian government defers to industry or unless the pharma industry can't survive lower margins on whatever gets reimported.

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March 2, 2010 5:54 PM    in reply to Kevin Sutton

Lilly, Merck and the rest of the US pharma industry only sells cheaper to Canada because they have to sell to the government to get any penetration at all. The moment they saw their margins erode here to any noticeable degree they'd probably decide the relatively small Canadian market wasn't worth it, pull out and leave Canada with only domestic industry and generics from folks like Reddy's Pharma (big Indian producer).

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March 2, 2010 3:50 PM    in reply to plynch22

Drug reimportation being removed had nothing to do with helping the bill to pass. That measure had previously held wide support before democrats were encouraged to kill it. The GOP even voted for it. (For different reasons)

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March 2, 2010 1:44 PM   

These ideas won't really move the needle in terms of reducing fraud and waste - they're really about giving cover to bluedogs and outmaneuvering the republicans.

Let the republicans continue to over-reach - we'll still get a bill that will fundamentally change our health care system. After this, it will be incremental change. At that point, as things get progressively better for Americans, Obama will have more leverage to address other issues that affect our lives.

Basically, Americans never vote their long-term financial interests - they're always susceptible to republican anecdotes of 'gettin the guvmint outta the way of hard-workin' Americans'. These are the constraints President Obama (I love saying that) has to work with.

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March 2, 2010 1:51 PM   

Now we will get exactly zero GOP votes on this thing... and 30 yrs from now the GOP will say with a straight face that Obama could never have passed HCR without them.

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March 2, 2010 3:39 PM    in reply to Vincent F

And that makes you upset?

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March 2, 2010 1:52 PM   

Not one Repub is going to vote for this thing. They've made that perfectly clear. So what does Obama do? Includes their ideas, presumably to reach "bipartisan" agreement. And still, not one Repub is going to vote for this thing.

Gotta love those negotiation skills.

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March 2, 2010 8:25 PM    in reply to EastWest

"Includes their ideas"

Did you even read the letter?

MM:so we're doing some demos cause we don't think it matters but it takes away your #1 talking point. And we agree with your idea to spend more money. Very republican idea.

Fraud: hey let's hire some new inspectors. Democrats hate exposing doctors who are cheating the system. And republicans love it when you hire more government workers. But hey it was Coburn's idea. Big score for the GOP.

Medicaid: Did i hear that republican dude say we should make medicaid payments more attractive so more docs will take medicaid patients. LBJ must be spinning in his grave.

HSA's: Already have 'em. You want i should list them on the exchanges like on the exchange that every member of congress gets. Wonder how many regular folks will pick 'em. Oh shit more choices, will this cause Milton Friedman to rise from the grave?


Total cave in!

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March 2, 2010 1:54 PM   

Okay. So if these four ideas are included, which Republicans will vote for the bill?

:crickets:

Maybe we should take up a collection to send Obama and the Democrats to one of those Negotiation 101 courses they used to advertise in in-flight magazines. ("You don't get what you deserve. You get what you negotiate.")

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March 2, 2010 1:56 PM   

I swear sometimes it seems as if there are nearly as many nattering nabobs of negativism on this side of the fence as there are on the other side. Just because you don't like someone doesn't mean ALL their ideas are bad.

This comment, for example, teed me off "And setting up Coburn's 007 undercover investigative team to sniff out Medicare abuse is just flashy nonsense." Really? Medicare costs around $400 billion dollars a year. Medicare FRAUD makes up an estimated $60 billion of that. Currently only about $200 million per year is recovered via current law enforcement efforts. This is low hanging fruit. You ought to look at it the same way as you would the IRS---audit the well-off because, like the bank robber said "That's where the money is." With Medicare, con-artists are stealing OUR money. It has to be reined in.

Ideally, the Democratic Party isn't ideologically driven so much as it is driven by an ideal of good governance. If something works, GO WITH IT. Even if some sleazeball on the other side offered it first.

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March 2, 2010 1:59 PM   

HSAs are an option, one of the choices in the healthcare cafeteria, not a requirement. Basically, this is Obama giving what he has already given to create the apperance of bipartisanship, and that is merely cover for reconciliation.

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March 2, 2010 2:08 PM   

Any Progressive ideas he'd like to enumerate that he would like to pursue? No? No shit.

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March 2, 2010 6:00 PM    in reply to CranialRectalLoopback

Eliminating discrimination based on pre-existing conditions

Eliminating lifetime caps on benefits

Covering 30 million more Americans

Gauranteeing a floor of coverage for all

Subsidizing premiums for working poor

Working to eliminate the "donut hole" for seniors on Medicare

Paying for it all without raising taxes on the middle class

Those are truly progressive ideas, even if the modern left which has misappropriated the name doesn't agree.

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March 2, 2010 2:10 PM   

Look, the bipartisanship thing IS NOT to get Republican politicians on board. It's for the sake of

(1) Conservative Democratic politicians. If there's an attempt to appeal to Republican principles, they might feel reassured that they're not being played for patsies by liberal partisans.

(2) Republican and independent voters who occasionally vote for Democrats. If they can see that the plan includes measures that speak to Republican principles, they'll be less likely to think that Obama is a doctrinaire liberal.

(3) Elite media who find the idea of bipartisanship almost physically arousing.

Getting actual Republican politicians on board is helpful but distinctly secondary.

I liken it to Bush having photo-ops with black children. Does that persuade black voters to support him? Bloody unlikely. But it helps assuage white voters who care a little bit about not looking like the Republicans are the party of racism and intolerance. (Of course they still _are_, but the moment is set up to create deniability.)

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March 2, 2010 4:12 PM    in reply to FlipYrWhig

Right on all points.

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March 2, 2010 2:12 PM   

Except the blank sheet of paper idea. That's the only thing the GOP wants now. Whatever they can do to run out the clock until they take over the House.

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March 2, 2010 2:18 PM   

I am going to repeat a refrain here, over and over again. Maybe if I do, you folks will begin to hear. Our health care system is not tweakable nor fixable. We are at 16% of GDP and this is WITHOUT universal coverage, compared to our national peers who range from 8% to 11% while providing universal coverage. My first point is, we are already paying enough! Reread the prior sentence. Dont ya get it, OMG, its so simple...we are already paying enough, waaaayyyy more than enough...so what we have to fix is where the money is going. Good grief.

Second point is...our problem is so complex - think about how complex this issue of cost really is, it is HUGE - and thus so un-tweakable, that the only chance we have to fix this is a National Health Service. England is that national peer who is at 8%...again, compare that to our 16% which is fast going to hit 20%, and then 24%...all the while working equally fast towards breaking the national bank.

Of course, we dont have a snowball's chance of making such a big change happen...UNLESS those who want reform speak with one voice. Hangin'on to the tweakin' doesnt help. You're just bringing more decades of suffering while risking a national financial debacle.

There is an added benefit to a National Health Care Service...perhaps it will bring a change in our culture. We allow ourselves to be driven nuts in this country by people intent on being mega-rich and mega-powerful. Most of us just want a good life, and funny thing about that is we have the technological expertise and natural resources to produce plenty to go around...except, you know, for the hoarding.

Another kinda funny about us is that we spend big dollars to go vacation in Europe to experience a certain less pressured lifestyle, which is provided by them not having to worry about health care, and pensions, and higher education, and child care (depending on which country, of course)...and then we come back here to be driven nuts. What's up with that?

Back to health care...lets keep our eye on the ball. To me the goal is to make health care a non-issue...meaning, wouldn't it be nice to get health care when we need it without having to worry about the cost, kind of like, say, Europe. No amount of tweaking is going to deliver that, is it? And we'll still be stuck at 16% of GDP and climbing towards national bankruptcy.

We are all part of a system we cannot get out of...we cannot separate ourselves and go carve out new territory...someone owns that land, and you're damned lucky they dont own you!!! Since we are all part of the system, the system ought to be configured to take better care of us. If you are born poor in this country, you are an economic slave. Dont give me that crap about the fittest survive. Well-off kids are not always the fittest, except for their education and other advantages they are born into, and they dont have to struggle to build their "strength" and "character".

We need a level playing field for this country to thrive. We need to raise the level of our culture, and we have the ability and the resources to do so...but do we have the will? Rather, it seems we have the will to tell someone...You don't deserve health care...You dont deserve a retirement...Your children don't deserve an education....but I will allow you to wipe my ass.

We are an immature country. Somewhere down the road, we will find ourselves more like Europe, and we will see the dog-eat-dog, survival of the fittest mentality as corrupt and evil as slavery. Lets not wait too long.


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March 2, 2010 2:22 PM   

Heck, why not kick it around a bit more. We got time. We'll get to the jobs thing eventually. How 'bout another "summit", say eh March 26, and then we'll eh "move forward" - with Senator Bunning's permission of course. Please don't get me wrong Senator. I would not dare try to finalize this Ins Care Bill w/o your blessing. I'm sorry, Senator, I promise, eh really promise it will never ....

What comes after "suicide watch"?

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March 2, 2010 2:33 PM   

I think including the Public Option in the exchanges should be the trade off for including High Deductible plans paired with HSA's in the exchange. Heck, you could even have the public option BE a high deductible plan paired with an HSA.

The problem with these is ensuring money is going into the HSA, I think the plans (especially if administered by the Gov't) should collect deposits made into the HSA and create what would effectively be additional individual accounts managed by Medicare. These funds would continue to stored in these accounts right up through retirement or until spent on qualifying medical expenditures (hopefully with a EBT card specific for this purpose).

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March 2, 2010 4:43 PM    in reply to Cy Guy

huh? You are trying to hard.

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March 2, 2010 3:13 PM   

This is not for the GOP you dopes. This is for the BLUE DOGS who support Obama needs! He's addressing the Blue dogs thru the GOP!

STAND STRONG FOR CHANGE OR FALL HARD FOR THE SAME!

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March 2, 2010 5:28 PM    in reply to Mike J

Excellent point.

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March 2, 2010 4:02 PM   

For Pete's sake. The administration isn't offering these because they think they'll attract Republican votes. The tactic is political -- show voters that Republican ideas are being incorporated, that Democrats aren't shutting them out, that Republicans won't accept anything other than killing the bill altogether. And this might attract a few stray Blue Dogs to vote for the package by giving them some cover. It's a sound tactic.

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March 2, 2010 7:04 PM   

Obama offering rethuglicans an opportunity to contribute has actually given rethuglicans a RESPONSIBILITY to contribute. The fact that they come up almost empty will not be lost on all voters. A "seat at the table" is really a spotlit stage for another BIG FAIL.

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March 3, 2010 7:47 AM   

Maybe someone can tell me what what the main differences are between Obama's plan and Germany's all- payer system, and the liklihood Obama's plan could gradually become Germany's all-payer system (which sounds like a stable, universal model that contains [or helps contain] provider and insurer costs). What would the insurers lose in such a system? Would they fight it?

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March 5, 2010 11:48 AM    in reply to Tanjaoui

Two words:

Pricing controls.

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