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Tilting at Windmills

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July 29, 2009

WAXMAN, BLUE DOGS STRIKE A DEAL.... It wasn't easy, but House Democrats took a big step forward today on passing a health care reform bill. Roll Call reported about a half-hour ago:

House leaders, the White House and four Blue Dogs on the Energy and Commerce Committee reached a deal Wednesday on a health care overhaul. The Energy panel will be resuming a markup of the measure at 4 p.m. with plans to vote on the bill by Friday, according to Chairman Henry Waxman (D-Calif.).

Rep. Mike Ross (D-Ark.), head of the Blue Dog health care task force, said the deal would cut more than $100 billion from the Democratic health bill, increase exemptions for small businesses and prevent the public insurance option from basing reimbursements on Medicare rates.

The details are still a little sketchy on that last point, but it appears the Blue Dogs will let the public option remain in the House bill, so long as HHS negotiates rates with health care providers, as private insurers do. States will be permitted to craft non-profit co-ops, but Brian Beutler noted that they "would be in addition to the public option."

A delayed schedule, however, is apparently part of the deal. Waxman's Energy and Commerce Committee will be able to approve a reform bill this week, but the full House will not vote on reform until after the August recess.

The deal hasn't been endorsed by the entire Blue Dog caucus -- negotiations continue -- but Waxman and the leadership doesn't need all of them, at least not this week. Four Blue Dogs, including Ross and caucus co-chair Baron Hill of Indiana, endorsed today's compromise, meaning there will be enough votes for reform to pass the committee and advance to the floor.

Details of the compromise are still coming together, but it appears the deal includes an exemption from an employer mandate for small-businesses with less than $500,000 in payroll. Brian added that policymakers are getting the $100 billion in savings "by lowering by one percent the rate at which people living between 300 and 400 percent of the poverty level will be subsidized to buy health care in insurance exchanges."

For his part, Ross told reporters, "After two weeks of very long and intense negotiations, I'm proud to report that we've reached an agreement that will allow health care reform to move forward." As for the post-recess vote, he added, "I am confident we'll get health care reform done this year, but let's not rush it."

Steve Benen 1:40 PM Permalink | Trackbacks | Comments (26)

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Posted by: Andy on July 29, 2009 at 1:44 PM | PERMALINK

Excellent... maybe.

Posted by: sb on July 29, 2009 at 1:45 PM | PERMALINK

"let's not rush it"?

If elected officials were doing their jobs we would have had a decent health care plan decades ago.

One of these days people are going to wake up to the fact that, unlike what they've been told all these years, America does not, in fact, lead the world in much of anything anymore (except war spending). And it's stuff like this that is the reason why.

I think we should model our health-care system on that of France (the best in the world, iow). Can you imagine the howls of outrage?

I guess I'm just disgruntled at the prospect of caving on something this important to a handful of politicians whose views are entirely out of step with the wants and needs of the population at large.

Posted by: zhak on July 29, 2009 at 1:51 PM | PERMALINK

Reading Dan Boren's comments, it appears to me this compromise is the first step in the Blue Dogs efforts to kill the public option altogether, with the vote delay as a crucial part of their campaign.

Boren has made it very clear he sees the public option, any public option, as a threat to private insurance providers in Oklahoma. Be assured the other Blue Dogs from other states feel exactly the same way (and their contributor's lists bear this out). Given how insurance companies often have an effective monopoly at state levels (one company controlling 65% or more of a particular state market), and you can predict where this is going.

This is not good news, to me, in any way.

Posted by: Fallsroad on July 29, 2009 at 1:51 PM | PERMALINK

Sounds good, but the devil is in the details. The public option might be very important, but it is nothing to debase ourselves completely over.

Posted by: Kastanj on July 29, 2009 at 1:55 PM | PERMALINK

Every time Little King Georg stamped his feet and demanded immediate action on some legislation without amendment, all these Democrats rolled over and played dead. Just like wimpy dogs.

Now, with a Democrat in the White House who's trying to deliver on one of his biggest campaign promises (hey, I've forgotten--who won in November?) these pups are acting like Big Bad Dogs.

GAWD these people make me sick. Too bad I can't get affordable health care.

Posted by: Lifelong Dem on July 29, 2009 at 1:56 PM | PERMALINK

Is HHS going to be able to negotiate with each provider? That is a major expansion of that department since it will require a lot more people to negotiate and oversee the process.

Posted by: coral on July 29, 2009 at 1:58 PM | PERMALINK

That's a substantial step. Impressive.

Posted by: Jon on July 29, 2009 at 1:59 PM | PERMALINK

Cautious optimism warranted. Keep your eyes peeled and your powder dry for varmints in the underbrush, though. It ain't over yet.....

Posted by: Curmudgeon on July 29, 2009 at 2:05 PM | PERMALINK

just to be clear, a bunch of rich, pampered (and dare i add publicly-insured) Congressmen get the feather in their cap of telling their constituents they made the free-spending commies in their party cut $100 billion from the health care bill. . . by taking it from the working poor?

Did I miss Dennis Moore becoming the Speaker of the House?

Posted by: zeitgeist on July 29, 2009 at 2:12 PM | PERMALINK

As long as it gets through that committee. Details can be reconciled later. Maybe these guys wanna delay through recess just to shakedown the insurance lobby a little bit more.

Posted by: Patrick on July 29, 2009 at 2:14 PM | PERMALINK

It's long past time to spay/neuter the Blue Dogs, and other dogs of any stripe who are preventing genuine health care reform while they enjoy secure health care benefits of their own.
Email Obama and urge him to veto anything that doesn't include a true, robust public option.

Posted by: Varecia on July 29, 2009 at 2:18 PM | PERMALINK

I don't see, why not just offer public health insurance to each person as paid by a payroll tax etc. instead of entangling employers in it. That seems to make much of the trouble.

Posted by: Neil B on July 29, 2009 at 2:24 PM | PERMALINK

This basically means that a public option will pass if the senate allows reconciliation, right?

Posted by: glutz78 on July 29, 2009 at 2:26 PM | PERMALINK

You look at the terms that bought off the Blue Dogs, and it becomes pretty clear that they had no coherent basis for their opposition:

Under the deal, they:
-- Protect reimbursement rates for providers
-- Reduce the number of employers who have to provide insurance
-- Reduce the support for people with lower incomes to buy their own insurance

Can anyone detect anything in here that promotes the general welfare, rather than just bailing out a few key constituencies?

Posted by: pa on July 29, 2009 at 2:27 PM | PERMALINK

I have to agree with Matt Taibbi when he observes "...these Democrats aren’t even pretending to give a shit, not really. I mean, they’re not even willing to give up their vacations."

I know Waxman would do it, but let's face it: it's Harry Reid (and his ilk) that don't really give a shit.

Sooo . . . it's up to us to make them wish they were still in DC. We need to make a lot of calls and ask what they've done to deserve a vacation and tell them that failure to craft real reform will end their careers (in politics, at least).

Posted by: bdop4 on July 29, 2009 at 2:31 PM | PERMALINK

More importantly, is the killing of seniors still in the bill?

Posted by: howie on July 29, 2009 at 2:38 PM | PERMALINK

I've come to realize that my excitement and happiness in the 2006 and 2008 Congressional elections was misplaced.

The Democratic party ostensibly won. But it did so by picking up many seats now held by rank oppurtunists. Theses newly-minted Democrats would have had no trouble joining the Republican party, but they knew where the political winds were blowing. Rather than joining the conservative party and potentially following it into the wilderness, they joined the Democratic caucus.

Now, they can sabbotage the party from within, joining ranks with the other rank-opportunists that have been wearing the D label for years. Granted, they will vote with Democrats much more than they would have had they been on the other ticket, but when it comes to key, genererationally important issues to Democrats (card check, financial reform, healthcare, etc), these Democrats are more than willing to scupper Democratic ideals.

So while the results of those elections (2006, 2008) were better than Republican wins, they were *NOTHING* like the victories I had imagined them to be.

Couple that with a fundamentally broken American political system, and we still have little chance at meaningful Democratic change in this country, in spite of the fact that Democrats have won office at all levels, and that the American people are solidly behind their policy proposals.

Not really optimistic about this country at all. Our problems, which grow by the year, can't be solved without eliminating the ridiculous power rural representatives have. In the USA, the urban and suburban centers, which make up essentially ALL of the country, are being held hostage by rural nobodies who represent tiny minorities, and whom are ridiculously easy for monied lobbyists to bribe.

What a joke.

Posted by: Tim on July 29, 2009 at 2:44 PM | PERMALINK

Too bad none are fiscally conservative. It's all a grandstand. Consider this, it is worth repeating:

Today's "fiscal conservative" is somebody that voted for 8 years with George Bush, helped create the largest deficit in the world, had no qualms about spending a trillion dollars on endless war, enjoys a publicly funded health care plan and entirely raises their family on tax payer money.

Seriously, that's where we are. Why can't we call them out on it?

Posted by: Chris on July 29, 2009 at 2:44 PM | PERMALINK

My husband had "ambulatory surgery" yesterday, and while waiting I somehow got into discussion about health care reform with the older lady who was staffing the check-in/waiting room. Mind you, she WORKS at a non-profit health care provider which already has in place a number of the "reforms" President Obama is championing: preventative care, salaried doctors, computerized health records.

She said she "didn't know" about health care reform, because people would get it for free but have to pay high taxes for it. She had just gotten back from Europe, where "people paid 50 percent."

I tried to tell her that no one was really pushing for this kind of system (I didn't tell her that's what I'd prefer), but she didn't believe me. She admitted that 50 percent included all the taxes they paid INCLUDING for health care, and we started to add up how much we here in California pay in taxes, federal and state income, social security, and it was pretty close to 50 percent already. But that didn't convince her.

People need to be made to understand that when their employers cover their medical insurance, that's money they are NOT getting in salary. Although it's not "tax," it's money they are giving up.

Americans are so fixated on the word "tax" that they don't understand the true PRICE of their health care.

Posted by: Cal Gal on July 29, 2009 at 2:50 PM | PERMALINK

Cal Gal:

I have a similar anecdote. My sister-in-law is a Nurse Practitioner in an ER out in Denver. She is a strange mix of liberal viewpoints that are tempered with a lack of understanding of some issue, which makes for an interesting person.

For example, the other day she said "I just don't know about this whole health care deal. I mean, some people think that they deserve health care, like it's some kind of right."

I was, of course, aghast. Here's a woman who, day in and day out, sees the horror of an ER--not just from the standpoint of injuries and health ills--but the fact that many people she sees are only there because they have nowhere else to go and/or if they would have had preventive care, they wouldn't be there in the first place in many cases. Yet, she thinks health care is a privilege, and not a right. The mind reels.

Posted by: terraformer on July 29, 2009 at 3:00 PM | PERMALINK

Cal Gal:

This is why it is a giant tactical mistake for Democrats to NOT put forward a very leftist proposal somewhere (even if they have no intention of passing it).

The current plans are all very moderate or centrist by world standards. And yet, I have yet to talk to anyone (other than liberal bloggers) who didn't think of the current proposals as all out single-payer, eliminate-your-insurance, put-all-hospitals-under-control-of-the-government, and all-doctors-and-nurses-on-the-government-payroll socialized medicine.

If there were an ACTUAL leftist plan to point to, it would be much easier to point out that current thinking is quite damn moderate -- and still being watered down.

Instead, this already heavily compromised vision is painted as radical leftist, and gets moved rightward from there. To the point that we are now on the verge of passing pointless insurance reform that gets called healthcare reform, or worse, doing nothing. If they're not careful, this could kill the Democratic party. Because Republicans are doing a damn good job of keeping their COMPLETE obstructionism out of the public eye, yet the bills are still very much Democratic beasts.

A very stupid policy move -- or not stupid, if the Democrats in power don't really want real health reform.

Posted by: Tim on July 29, 2009 at 3:02 PM | PERMALINK

one percent from 300-400 percent of poverty level? what exactly does that mean? typical, the savings will come from poor people's pockets rather than businesses??? and no one has ever made clear exactly how the premium rates charged by insurance companies will be regulated or enforced. if they are allowed to charge more due to age, that'll be more money charged to the elderly who have fixed incomes???

unbelievable, tax hikes for the rich or on cadillac policies have to be carefully thought out, but hey taking $$$ from poor people and the elderly is an immediate done deal!

Posted by: klara on July 29, 2009 at 5:42 PM | PERMALINK

What the hell is the bugaboo about it being under a trillion dollars ? We will spend more than $35 TRILLION on healthcare over the next decade and these LOONS are frightened by a hundred billion dollars ?

We need a better class of stupid people.

Posted by: Joe Friday on July 29, 2009 at 8:33 PM | PERMALINK

" new mechanism designed to curtail the growth of Medicare over the next 10 years and beyond."

Got that from an AP article on this...and that mechanism shall be denial of benefits. An arbitrary statistical analysis of what's good for the patient versus what's expedient and least expensive for the plan as a whole will have us giving palliative care to people with diabetes or congestive heart failure, or emphysema or dementia instead of the hip replacement, chemotherapy, or heart valve replacement. And ten years from now, all the people who rammed this down our throats will be living on taxpayer dime with some of that "caddi" healthcare, including Obama.

Posted by: aj Horvat on July 29, 2009 at 9:45 PM | PERMALINK

The small-business exemption could be good for reform, as it means millions more people who will be enrolling in the public option, right?

Posted by: Nancy Irving on July 30, 2009 at 3:12 AM | PERMALINK



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