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Democrats scale back: Insufficient support for public-option, Medicare expansion December 16, 2009

Posted by Obi Jo in : health care reform, health insurance reform, politics, Public Health, Tax Policy , trackback

Here’s the scoop – Medicare pays so poorly that doctors are constantly evaluating their desire to even participate in the plan at all.  Therefore it is no surprise that the AMA, which has supported health reform efforts, suggested it will withdraw or modify its support if there is an expansion of Medicare.  Their view, shared in part by us, is that expanding Medicare to those over 55 and under 65 will be more of a bad thing.  Medicare historically is the worst payer, second only to Medicaid for physicians and hospitals.  In most if not all cases, physicians and certainly hospitals, loose money overall on Medicare patients, having to “make up”  the difference from patients with private insurance.  So one concern has always been that Medicare, if used as a model, would lead to higher overall taxation since its benefit and payment structure are insufficient to meet both demand and costs.  Thus we see the AMA’s position change in the face of this proposal.

Additionally, we can see how the fragile Democratic coalition can be fractured by their continuing to overreach and by their refusal to address core problems one at a time instead of going for the home run of an overall health system reform.  It now appears that the far left is ready to kill any bill that does not have some pubic option or Medicare expansion or both.  They are infuriated with Senator Joseph Lieberman (I-CT) and his decision to vote against any bill that contains a public option or Medicare expansion.  Meanwhile, President Obama, who stood by on the sidelines through most of the legislative process, now is acting as cheerleader for the Congress to get to the finish line – please, someone, somebody, cross the line with a bill, any bill – that seems to be his most definable political position on health reform at the moment.

We have proposed real health reform from day one.  We have argued that the real role of government was regulation as needed and oversight, not legislation that consumed, controlled or competed directly with the private sector.  We have argued that the vast majority of the problems with the health care system can be fixed in large measure by a more “out of the box” approach which would preserve the best of our market system, while eliminating the flaws that have allowed many to pay too much, get too little for their premium dollar, or not be able to get health insurance at all.  A bad bill, is NOT better than any bill.  Real health reform, even if accomplished piece by piece, via a process which considers each item and votes them up and down would be better than the “throw the blanket”over it concept the Democratic leadership has embraced. There is no shame in starting over.  We vote for start over . . . obi jo and jomaxx

Senate Democratic leaders appeared poised to abandon efforts to create a government-run insurance safety net in their push for health-care reform, as they attempted to close ranks around a bill they hoped would win the backing of all 60 members of their caucus. Democratic negotiators had already disappointed liberal lawmakers by jettisoning a full-fledged public insurance plan a week earlier. Last night, party leaders conceded that a key portion of the compromise they crafted to replace the public option — a proposal allowing people as young as 55 to buy into Medicare — also did not have sufficient support from Democratic moderates to overcome a likely Republican filibuster.

Senate health bill unlikely to include Medicare buy-in – http://www.washingtonpost.com/wp-dyn/content/article/2009/12/14/AR2009121401580.html

The White House is encouraging Senate Majority Leader Harry Reid (D-Nev.) to cut a deal with Sen. Joe Lieberman (I-Conn.), which would mean eliminating the proposed Medicare expansion in the health reform bill, according to an official close to the negotiations. But Reid is described as so frustrated with Lieberman that he is not ready to sacrifice a key element of the health care bill, and first wants to see the Congressional Budget Office cost analysis of the Medicare buy-in. The analysis is expected early this week.

White House to Harry Reid: Cut deal with Joe Lieberman – http://www.politico.com/news/stories/1209/30572.html

Prodded by President Barack Obama, Senate Democrats won tentative backing from one holdout and worked intensely to satisfy another Tuesday as they grappled with the last, lingering disputes blocking passage of health care legislation by Christmas. Obama said his congressional allies were “on the precipice” of a historic accomplishment that has eluded presidents and lawmakers for generations, adding the emerging bill includes “all the criteria that I laid out” in a speech to a joint session of Congress earlier in the year.  In the privacy of a presidential meeting, liberals vented their frustration at having to abandon the last vestige of a government-run insurance option in the legislation, a slow-motion concession made over many months, most recently to moderates including Sen. Joseph Lieberman, I-Connecticut. Two days after jolting the leadership by threatening to oppose the measure if it included an expansion of Medicare, Lieberman said with the agreed-upon changes, “I’m going to be in a position where I can say what I’ve wanted to say all along: that I’m ready to vote for health care reform.”  That left Sen. Ben Nelson, D-Neb., the only known potential holdout among the 60 senators who are members of the party’s caucus, a group that includes 58 Democrats, Lieberman, and Sen. Bernie Sanders, I-Vt. Nelson has already has won key concessions from Majority Leader Harry Reid, including an agreement to leave in place the insurance industry’s exemption from anti-trust laws. He also is seeking changes to increase restrictions on abortion coverage in a new insurance marketplace the bill would establish.

Upbeat Obama says Senate near health care passage – http://news.yahoo.com/s/ap/20091215/ap_on_bi_ge/us_health_care_overhaul

The notion of a public health insurance plan appears to be evaporating from the Senate’s healthcare reform bill, replaced in part with an expansion of Medicare — an idea that’s meeting resistance from doctor and hospital associations. A proposal to scrap the public plan to allow people as young as 55 to “buy in” to the Medicare program by paying premiums emerged from negotiations between five liberal Democrats and five moderate Democrats. They met earlier this week at the request of Senate Majority Leader Harry Reid (D-Nev.), who wants Democrats to reach an agreement that can get the 60 votes Reid needs to break a threatened Republican filibuster and pass the bill.   The American Medical Association (AMA), which supported the House healthcare bill, hasn’t yet offered a stance on the Senate bill, but it has opposed expanding Medicare to younger people. “The AMA is committed to legislation to expand affordable health insurance coverage to all Americans, but the AMA has longstanding policy opposing the expansion of Medicare given the fiscal projections for the future,” said AMA President J. James Rohack, MD. “We believe a health insurance exchange without an expansion of Medicare will provide more affordable choices and better access to care for Americans ages 55 to 64.”

Medicare Buy-In Plan Meets Resistance – http://www.medpagetoday.com/PublicHealthPolicy/Medicare/17462

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