Sunday, December 20

Howard Dean Didn't just say "Kill The Bill" - He said use Reconcilliation

What he really said was this:

“This is essentially the collapse of health care reform in the United States Senate. Honestly the best thing to do right now is kill the Senate bill, go back to the House, start the reconciliation process, where you only need 51 votes and it would be a much simpler bill.”

I know that people are heavily invested in the public option and that daring to point out that we might not actually NEED it is dangerous, particularly on DKOS - but it has to be said.

Now, I've agreed with Dean on most of his comments - but his suggestion here is really problematic. The things he'd like to get via Reconciliation such as a Public Option or Medicare-Buy In You Can't Get through Reconciliation.

You can't ban Pre-Existing Conditions with Reconciliation.

You can't set a life-time limit of out-of-pocket costs with Reconciliation.

You can't ban Coverage Rescission and Unreasonable Claim Denials with Reconciliation.

You can't set the Medical Loss Ratio to 90% (Requiring 9/10 of every dollar be spent on actual care - a point that Dean gets wrong in his Countdown Comments)

You can't get the opening of the Office of Personal option to allow private individuals to immediately join a Federal Employee-like plan and gain major buying power via the Economies of Scale.

YOU CAN'T GET THE EXCHANGE via Reconciliation and without the Exchange, you don't get the Public Option either.

This is why you get *THIS* particular reaction from Senator Rockefeller to Dean's Comments.

Rockefeller: I want to get (Health Care) passed, that's all I care about.

Mitchell: How does it hurt to have the former Democratic Chair saying, who is a Doctor, "This is worth doing something - doing nothing is better"

Even though Dean Didn't actually SAY THAT!

Mitchell: What else is in this bill that makes it worth passing?

Rockefeller: There are several things that happen immediately such as Medical Loss Ratio - which is a fancy way of saying that Insurance Companies have to spend 85-90% of their revenue on Health Care - that's huge.

14.1 Million Children will continue to get coverage who wouldn't otherwise.

We close half the (Medical Prescription) Donut Hole that affects seniors.

I wanted the Medicare-Buy In, but it was shot down - so what do I do take my football home and sulk? You never get everything you want, you keep improving the bill - next year or the year after that.

This is the reason why the White House is more pissed at Dean than Lieberman - because having the Public Option or even the Medicare Buy-in isn't as valuable as having all the above.

This is what the CBO said about the Senate Bill Last Month even without either the Public Option or Medicare-Buy In.

The report by the nonpartisan Congressional Budget Office was released hours before the Senate began debate on the package, which would spend $848 billion over the next decade to extend coverage to more than 30 million additional people. The CBO said the legislation would lead to higher average premiums in the relatively small and troubled individual market, where the self-employed and others buy coverage directly from insurers. But that extra cost would buy better coverage, the CBO said, and hefty federal subsidies would drive down payments by nearly 60 percent on average for low- and middle-income families.

"This report alleviates a major concern that has been raised -- that insurance costs will go up across the board as a result of this legislation," Bayh said in a statement. "This study indicates that for most Americans, the bill will have a modestly positive impact on their premium costs. For the remainder, more will see their costs go down than up."

Dean consistently argues that without a public choice prices will continue to rise, but the CBO report refutes this. With 30 Million more customers the average cost will be spread wider and risk shared across a larger pool while demand stays largely the same (shifting from Emergency Rooms to Primary Care) you gain the advantage of catching disease an sickness earlier rather than later. In addition the 90% Med/Loss requirement will keep the Insurance Companies from charging their clients for spending on Lobbying, Advertising and coming up with more and more creative ways to deny coverage and claims.

Care will be Improved, people's lives will be saved while Overall Costs will go down, the Deficit will be reduced by $130 Billion in the first decade and $600 Billion in the second decade - 30 Million more people will be covered.

Yes, damnit, it could be better - MUCH - but if we don't pass anything, if we take NOTHING as an answer or pass something MUCH, MUCH WEAKER via Reconcilliation we probably won't get the chance to pass a better bill next year because the Republicans will take this as a VICTORY (The NRSC is already triumphantly re-tweeting Dean's comments) and use it to either take back control of the House and Senate or seriously whittle away at our current majorities.

I believe, despite the thunderclap going headlong for Public Plan or BUST - that what they current have is worth passing and worth Building Upon with further gradual improvements over time. As I said back in August The most important thing: is getting the Exchanges Up and Running - because that is where the power begins to be shifted from the Insurance Companies running around like Bandits in the Wild West to government oversight and management that protects patients. That's where the rubber first starts to meet the road where people can shop across many different plans and options and gain major bang for their buck by joining their purchasing power with tens of millions of other Americans.

Here again is what Joe Klein said back in August on this.

Klein: There's a 80-90% Chance that we'll have Insurance Reform this year, which will ban Pre-existing conditions, and you'll have Health Care Exchanges - which will lower the prices for small business and individuals.

Klein: The Public Option is peripheral to the really important stuff here.

Ed: It's not.

Klein: I've been covering this 20 years, you can have Universal Coverage without a Public Option. What does the Public Option do? It's give bargaining power to the public against the insurance companies - that is precisely what the Health Exchange Does!

Here's another thing, how many thousands of Americans who don't currently have health care or are under-insured are going to suffer and die while we go back to the drawing board or try to cram through a weak narrow bill that STILL won't really have what we want through Reconciliation?

Every year, EVERY SINGLE YEAR, more Americans Die for Lack of Health Care that we lost at 9/11 and during the entire Iraq War -- how much more of that can we stand?

IMO The Time IS NOW.

So, Let the flames fly!


Update: Dean V Landrieu on Hardball.

Allow the charging or 300% more for older persons is something that can be fixed. He's right about Insurances agencies being less efficent than Medicare, but the Med Loss Limit at 90% mandates them to get a lot closer - so they won't be able to grab 30% of your premium and spend it on things beyond health care.

I really don't think you can create Medicare-For-All through Reconcilliation, the 767 Page Bernie Sanders Bill that Republicans were causing a Filibuster with today - WAS Medicare for All. It takes more than just modifying the "Fine print". Bush pushed through his tax cuts with Reconcilliation, which actually *is* a budget issue and also got funding for war which was already authorized. These weren't "New Programs" or changes to existing Law, it was all about funding.

Dean doesn't want to "eliminate" the Private Market - he wants competition with it, Landrieu wrong there.

However Landrieu is technically correct that the President promised that they would create a program like the Federal Employee Benefit System - but that's the Exchange - not the Public Option or Medicare expansion. Federal Employees don't *have* a Public Option right now, and yes there is a Non-Profit Option in the Current Senate Bill.

Under the compromise developed by a group of conservative and liberal Democrats, the Senate legislation would no longer include a new government-run insurance program, or "public option," for Americans who do not get coverage through their employers.

Instead, the government would essentially contract with a nonprofit insurer to provide a nationwide plan that would serve as the public option, according to officials briefed on the discussions.

This was part of the same deal thought brought in the Medicare-55-Buy-IN, which was later dropped due to Lieberman - but this portion has Stayed IN. It's better than the Co-ops, but less difficult and time-consuming than rebuilding and entire new program from scratch. If the issue is primarily having an additional choice, that's a choice.