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3/12/2010
Health bill maneuvering. What a mess.
Call your congressman. Now. Object to passing the Senate bill. Object to extreme House shenanigans. Object, of course, to massive deficits and a health bill that does nothing to control costs.
In both chambers, Democrats are preparing for a titanic battle that will involve politics and parliamentary procedure as much as health policy.
House Democrats are so skittish about the Senate bill that they are considering a maneuver that would allow them to pass it without explicitly voting for it. The Senate measure would be “deemed passed” if and when the House adopts rules for debate on the follow-up budget reconciliation bill. If the House approves both bills, the health care measure would be ready for signing by the president. But the budget bill would go to the Senate, where Republicans plan to propose dozens of amendments.
Rep. Paul Ryan says the Democrats are ready to ram a “shell” health care bill through the Budget Committee:
Ryan said that he expects Democrats to begin the complex process on Monday, under which they would have the Budget Committee approve a phantom bill by midnight, which they will then send over to the Rules Committee. At that point, the Rules Committee will strip out all of the language in the phantom bill, and insert the changes to the Senate bill that Democrats have negotiated.
"They don't have the votes right now, but they're creating the vehicle so that they can airdrop in whatever changes they want," Ryan said.
He said that Republicans are outnumbered 2-to-1 on his committee and don't have the votes to stop the bill there. Democrats will also be able to prevent Republicans from offering any amendments, but GOP members will be able to offer "motions to instruct" the Rules Committee, that Ryan said will be used highlight problems with the "unprecedented" step that Democrats are taking.
Ryan believes the “deemed passed” business won’t be possible.
President Obama must sign a health care bill into law before the Senate can change it through reconciliation largely renders moot the attempt by Rep. Louise Slaughter to shield members from a direct vote on the Senate health care bill. He said the idea would also violate Obama's call for an up-or-down vote. "That's not an up-or-down vote, that's sweeping it under the rug and into law," Ryan said.
Challenges, in addition to passing the huge Senate bill without voting on it:
- Dem members of the House (much less GOP members) haven’t seen the details of the reconciliation bill they will be asked to vote on. Speaker Pelosi has assured members they will have either 5 days or “at least one week” to review the “reconciliation bill” before having to vote on it.
- Signing the Senate bill (HR 3590) into law before any changes can be made remains scary for some house members – like mine.
- Unlike Rep. Ryan, some say passage of the “reconciliation bill” through the House Budget Committee will be tight and will require the support of 3 Blue Dogs and perhaps a Stupak supporter.
- No cost estimates of this new House “reconciliation bill;” bill would reduce tax on Cadillac health plans, would increase subsidies for purchase of health insurance by low-income households and would increase Medicare taxes (would be newly levied on investment income) to cover the resulting revenue gap.
- House vote being pushed for before March 26, before members recess and come home to their districts – you know what that might mean.
- Overhaul of student loan program (elimination of banks as purveyors of loans) is included in this reconciliation bill.
- Senate muss pass House "reconciliation bill;" GOP Senators will be allowed unlimited (unless VP Biden is able to stop them) amendments.
Stay tuned. Phone and or e-mail your congressman. Today.
Jo Egelhoff, FoxPolitics.net
COMMENTS
This is actually getting to the funny stage. Obama won the coveted super-majority and then he and the Dems fell apart. They found they had to perform and the insurance industry lobbyists wanted no health care fix at all. So Obama introduced the "bipartisanship" ruse to avoid having to do anything meaningful.
ObamaCare is truly terrible and should be voted down. And in its place we should install a Medicare-for-all system. But that's the last thing in the world the insurers want, and their $46 million speaks volumes to our chances of getting it.
Jack Lohman (Fri Mar 12 06:46:35 2010)
Yes, I will contact my congressman and tell him to do what is right. In my opinion that is passing the bill now. Remember that a majority of the House and the Senate approve of health care overhaul. Just like the numerous convoluted legislative tricks used to ram through the Bush tax cuts and Medicare part "D" the Dems are doing the same thing. Oh, and on the cost front , when was there EVER a serious cost constraint on Medicare part "D". It wasn't required to meet any cost test and in a most absurd manner the Fed govt. was specifically prevented from negotiating lower drug costs. And in additional absurdity there is the "donut hole" which deprives people of their prescriptions so the drug companies can maintain their high price monopolies. (blame the consumer again of course) So here we have a big bill that has to pass all sorts of cost tests. Seems like double standards to me. Ok, let's have a cost test after all those cost conscious legislators immediately repeal the anti negotiating rule in Med part "D".
And all this dirty maneuvering? Get rid of the 1975 filibuster rule. Make the opponents of the bill stand on the floor day and night , reading passages from the Bible, holding up all other business. It was ever dirtier in the past with the bare knuckled fighting (literally and figuratively) lets get more bare knuckled. If opponents of comprehensive health care are so principled let them fight it out on the surface, ugliness and all rather than hiding behind the gentleman's rules of 1975. Bring on the blood and gore.(metaphorically of course)
dave allen (Fri Mar 12 07:20:10 2010)
I agree about the filibustering. Congress should have to do as "Mr. Smith Goes to Washington" did.
I do object to the caning almost to death of members, though.
Dave, were you calling for blood and gore filibustering while Geo. Bush was in office when his judical appointees were being filibustered? I'll bet not.
The government has already screwed up health insurance and medical care. What is it that you love so much about government meddling in everything? The best thing that could happen to this country would be if Congress would vote themselves a sabbatical without pay and then upon reconvening, they'd vote another sabbatical.
They cannot help themselves. They MUST meddle in everything, especially when they have constituents who don't wish to take care of themselves.
Compare the health care bill to our economic situation, part and parcel of the same thing, as far as I can see.
We're told we spent our way into this economic mess and we'll spend our way out of it. Just try that at home and see how it works out for you.
Where is the common sense?
C.R. Stevenson (Fri Mar 12 10:19:45 2010)
This is the explanation of the "donut hole" that I found. Please note that low-income people have their drug costs paid.
***A unique feature of the Medicare Part D drug benefit is the so-called “doughnut hole” — the gap in coverage in which Part D enrollees are required to pay the full cost of their drugs until they qualify for catastrophic coverage. The coverage gap was included because the cost of providing continuous coverage with no gap would have exceeded the budgetary limit imposed on the legislation when the Medicare drug benefit was established. Nearly all Part D plans will have a gap in coverage in which the enrollee pays 100 percent of total drug costs before catastrophic coverage begins. In 2008, the coverage gap totals $3,216 for plans offering the standard Medicare Part D benefit; by 2016, it is projected to exceed $6,000. Part D plans may have an alternative benefit design that helps cover at least some drug costs in the gap. Part D enrollees who qualify for the low-income subsidy, including beneficiaries dually eligible for Medicare and Medicaid, are generally not responsible for costs in the coverage gap.***
C.R. Stevenson (Fri Mar 12 10:32:23 2010)
What a contrast... a bleeding heart liberal who offers a helping hand and a compassionate conservative that prefers giving them the finger. I'll take the liberal view on this, though I actually oppose this bill because it doesn't go far enough.
CR, that Medicare D bill (complete with donut hole) was passed by Bush with the help of all Republican congressmen. A $780 billion giveaway to the drug industry by R's who now want to deny a fix to the healthcare system. And filibuster? 75% were carried out by R's.
Jack Lohman (Fri Mar 12 10:55:51 2010)
For those who think I'm a liberal or conservative. I am neither. I believe in results. The purer than thou people on the techniques the Dems are using simply forget that this is what happens when one side obstructs the majority on something the majority desperately wants. Our country cannot be paralyzed along side the road while other countries forge ahead. The current situation is an unpleasant result of our Constitution and the Senate rules. And as far as the government can't do anything right mentality that permeates much of this forum. Well, folks, put your actions where your mouth is. Voluntarily give up Medicare (if you're eligible). Drop your employer's health plan if you have one (because your employer is subsidizing you and being a barrier between you and the free market) and go it alone. Oh by the way, pray alot, you'll need it.
dave allen (Fri Mar 12 11:32:21 2010)
The insurance industry simply must be wrestled back into its cave! The money behind the lobbying proves this. There are still reasonable profits to be made by providing "perk" health insurance to executives as a talent retention tool.
Medicare-for-all would be logical and build upon a (more or less, but not perfect) system already in place in this country. How to expand it? It will take at the least much carefull work, an increase in the payroll tax to fund it, and taxation of employer-provided perk health insurance since that is actually compensation.
JeanMarie (Fri Mar 12 12:04:04 2010)
With all due respect to all the talented and caring people who work in the health insurance industry... What exact net benefit does such an industry as currently constituted provide to the US in general. Someone please tell me what it is. I do not see such cost and levels of bureaucracy in other countries. The US health insurance industry has evolved hand in hand with our overall health "system". But why is it fundamentally valuable? If we fundamentally changed our health care so that it adopts the best practices of other countries would a health insurance industry be needed at all?
dave allen (Fri Mar 12 12:33:20 2010)
"For those who think I'm a liberal or conservative. I am neither. I believe in results."
OK Dave, show us your stuff.
If you believe in results ... and I have no reason to doubt that claim, show us ONE element of this proposed bill which will make the health care delivery system for Americans more efficient and more affordable.
Before you click on the Reply link, keep this in mind. Before you write a word, note carefully. YOU CAN'T.
Why, because you, the President, Harry, Nancy, and the member of congress that you undoubtedly called today have NO IDEA what will actually end up in the bill and what won't. Trying to get a grip on what the law actually IS would be like trying to grasp a hand full of Jell-o.
The House isn't going to vote for the Senate Bill, they're going to vote on a rule "saying" that they voted for the Senate bill, then pass that Rule along to the President for his signature. Is that even legal? I'm not a Constitutional Scholar, but even to my untrained eye it sure looks 'shady' at best and likely to be challenged in the courts.
OK - so let's say another 'sidestep' of a REAL straight Up or Down vote IS legit (you know, the old-fashioned majority in the House, Super Majority in the Senate process - then they sort out the differences in conference committee and vote again KNOWING what the heck is the final product before sending it to the President for signature ... gee, that's thinking is so 2008.) Let's say it DOES hold up - what's going to come out of the "Reconciliation"? So far we have the Senate voting for a Cow, the House voting for a Duck, and the final legislation AFTER the President signs and Reconciliation kicks in could be a Wombat!
You don't KNOW what you're getting and that's the WHOLE point to most people's opposition right now. I suspect I won't like what they come up with - but I can't say why, and that's EXACTLY what the power-brokers in Washington want. Unfettered ability to make it whatever they want ... public be damned. And guess what Dave, you'll have results but probably won't like them either.
Jeff Riedl (Fri Mar 12 12:40:09 2010)
Where is any mention of cost control? Absolutely critical. Ok, scrap the systems in the U.S. Fine. Then move to a system working very well for many employers here - controlling costs, controlling utilization. HSAs, MSAs - everyone in the system has a responsibility for payment to a certain level. Or however you believe individual customers, unleashed on the market, can effect cost control. Cost control - must be a part of every piece of this issue. Many Americans have figured it out, believe it or not Dave.
Jo (Fri Mar 12 12:46:10 2010)
>>> Dave: "What exact net benefit does such an industry as currently constituted provide to the US in general."
Dave, they fund our elections. Be thankful. If the taxpayers funded them it'd cost, oh, $5 per taxpayer per year.
Jo, you are hung up on the wrong thing. If we wanted cost control we'd go for the Medicare fee schedule which is "fair" reimbursement to physicians. But then, we'd have to also go for a socialized system with salaried physicians, and damn, we don't want that.
Oh yea, there's HSAs that offload much of the costs to employees. I see now.
Jack Lohman (Fri Mar 12 13:51:09 2010)
I am opposed to this heinous bill, mistakenly labeled as Health Care Reform. I am for REAL Health Care Reform. When the communists took over China in 1949, they had Land Reform. There were "sweet promises" made. The Land Reform left 40.7 million dead, and ended with government take over of the land; they kept 1/3, 1/3 given to the poor, and 1/3 used for communal farming. The farmers were left poorer than before the "Reform." I don't think it will take anyone too long to see the parallels to "Health Care Reform".
First of all I am opposed to this bill because of the bloodying of all American hands by funding abortion. Abortions are promoted for two reasons 1. Greed. 2. To give blood sacrifice to Satan. Of course it is coated with sweet sounding promises, like "helping the poor" "Women's Choice" (with Obama's Science czar around that may soon be changed to "force" like in China,) "Women's Reproductive Health Care Rights."
Secondly, I am opposed to all the deals made to pass this bill, the pork in the bill and the giving of favorable appointments to the person, or their relatives, if they will sign. Last summer the "snitch on your neighbor" program (Remember flag@whitehouse.gov?) This was similar to what happened in China. No internet, so it was a box in every community to snitch on your neighbor.
Third, We, the taxpayer, have to pay for these behind closed doors deals.
Instead of helping the poor, I think the only ones who will benefit are the Chinese for the money we will borrow, and the Marxists who are taking over our country.
Fourth, I am opposed to the increased government beauracracy in the bill, including overseeing 'community clinics' by Kathleen Sebelius" She has a long history of blood money on her hands. Do you think more government beauracracy will really drive down health care costs?
We may sing, "God Bless America" but if we read our scriptures, we know He will not bless sodomy or our culture of death. I am expecting what happened to Sodom and Gomorrah to happen to us soon if we do not repent of these offenses against God.
Nancy J Kokstis (Fri Mar 12 14:13:16 2010)
Jack, is that how you choose peanut butter? Did I miss the federal schedule for auto pricing? Or my gosh, how do I decide what health club to join? Or what manicurist to do my nails? Oh my! The government has set a schedule - lucky me! How do I decide where to get my teeth cleaned, where to get my mammogram, where to purchase my eyeglasses? No Jack, I don't need the government to dictate prices when I can be fully informed of the cost and service. Big "if" in America's health care system. But not impossible.
Jo (Fri Mar 12 14:25:15 2010)
Fine, Jo. Say you need a CAT scan... do you pay more for a 64-slice or a 24 slice? Or go with the lowest cost? What if some things are better seen on a 24-slice scanner? Are you really that smart in all things Medical? Do you expect everybody to be that smart?
Jack Lohman (Fri Mar 12 14:46:25 2010)
Absolutely Jack. Emergencies no. Cost decisions are more difficult to make at those times - so let's except that for the time being. Absolutely - I expect to talk with my caregiver to understand the pluses and minuses of the cost vs. the results needed and make an informed decision. Absolutely. Why should the government make that decision for me? That's ridiculous. I have two examples of these kinds of decisions I've weighed - and was pleased to have had an opportunity to make informed choices.
Jo (Fri mar 12 18:28:45 2010)
Jo, you are foolish, but you have to live with it, I don't. You are going to listen to your caregiver about which test is best, when he owns the testing facility or device and is biased as hell? I have a bridge I'd like to sell you.
Jack Lohman (Fri Mar 12 19:51:48 2010)
Nancy,
Your post is bizarre. I guess Medicare is the train to the ovens and so are public schools etc. The list goes on and on. But here's something to think about. China and the Soviet Union based their system philosophically on the idea that Man should sacrifice for fellow Man and willingly will do so and that the individual will subjugate their will to the common good. This is a flawed reading of Human nature and their societies destroyed millions of people in attempting to force real people against their nature. I think you believe there is a rational Man, a hardworking Man, a healthy Man who responds to individual incentives, is capable of evaluating complex health care decisions and making the right decisions and we can have a private system without government interference that magically is synergistic with this Man and a good health care system results. Sorry, that mythical Man doesn't exist just like the Communist Man doesn't exist. Human nature being what it is and isn't just can't be bottled as a philosophy when it comes to making laws. The practical successful examples of other countries show us all that reasonably priced health care delivery is possible with a public/private system so long as the government sets clear boundaries.
dave allen (Sat Mar 13 08:40:30 2010)
I agree with Dave, and one key phrase is "common good." I don't think health care is a constitutional right, but I do think it would be a common good for the country.
But I also believe that people like Jo should have the right to opt out and do their own thing, though they'd still have to have Medicare taxes withheld from their wages.
Jack Lohman (Sat Mar 13 09:19:01 2010)
Jack, you are apparently not very experienced in pricing health care and/or conversing with your doctor and/or widely available medical information. (Why would you be? - perhaps you've had someone taking care of your health care for you your whole life - and now you have Medicare and the U.S. taxpayer is taking care of everything for you) - and apparently, you're not too self reliant. Ever been to an auto mechanic? Auto sales floor? Dentist? Optometrist?
Somehow folks figure out how not to get taken by their auto mechanic. Well, some folks figure it out. Does that mean the government should step in and make sure no one gets taken and that the proper repair is done at the proper price every time?
Jo (Sat Mar 13 09:56:18 2010)
You win, Jo. Hang in there with your beliefs and I'll stay with mine. I've had 40 years in health care and it hasn't all been sweeping floors. Pricing is not an issue if using Medicare and its fee schedule, for it is "fair" payments to all. The issue is whether the provider is using proper technology, and whether the patient even needs the test. But over-utilization can occur when the doctor owns the equipment and must make the lease payments, and increasing ordering helps him do that. Of course there are some patients who accept the reason blindly, and others who have become pseudo-physicians and are qualified to second-guess the physician without killing themselves or a loved one, so you and others are in a position to exercise your rights.
Jack Lohman (Sat Mar 13 12:01:29 2010)
Jo,
I know that you know how impossible it is for the average person in need of medical care to price these things out and then, make rational informed decisions about the prices under our existing system. This is exacerbated when the care needs to be delivered fast, in an emergency. Maybe you're a believer in the ideal Man that I talk about above and in an ideal health care system that doesn't yet exist. Clarity of pricing can only happen when it is forced. And then pricing should only be an issue when the patient has the skills and time to make the right decision. I know of someone (true case of a friend) who had a cost difference of $9000 between one hospital and another because of in-network vs out network on a heart attack. Do you think that is acceptable? Should he have shopped around I guess or preplanned what hospital to go to in that event. Do you thing that when his wife called 911 she should have asked the dispatcher which ambulance and hospital and called the insurance company to check? Nonsensical isn't it. Other people in other countries do not worry about this crap.
dave allen (Sat Mar 13 12:35:18 2010)
First Dave, I specifically exempted emergencies from my comments. When prices are posted, emergencies shouldn't be a problem; nevertheless, they're not part of the discussion here.
I guess we best not let the "average person," much less that person of lesser intelligence you infer knowledge of to purchase a car or eyeglasses or dental services. Let the government do it.
Yes, our system needs reforming - third party pay has killed it, with most not expecting to have to pay for health care, much less to have to pay a significant percent of their household income, much less have to make informed decisions about it. But that doesn't mean the government knows better than I do. Gosh, I get so tired of you guys relying on the damn government.
Yes, have the government establish firm rules, parameters, specifics for health insurance policies and for definitions of procedures. (Think FDA, USDA, a million other U.S. agencies.) Yes, regulate the financial health of insurers (which is already done). Yes, calculate insurers' administrative costs and post quality ratings for all to see. Yes, that all can be the public part. But keep the government out of pricing. We customers can do that. We must do that. And again, ALL Americans must recognize that health care costs money - a lot of money - and we all must be responsible for those costs - and to control those costs.
Now... I MUST complete the many tax returns I'm working on!
Jo (Sat Mar 13 13:26:15 2010)
You'd love India then, 5% insurance and 95% cash at the door. Of course they rank 112th versus our 37th in the world, and though neither are good I'll take America.
Jack Lohman (Sat Mar 13 14:11:02 2010)
Jo,
There is a far cry difference between purchasing eyeglasses (BTW which are often not covered by insurance) and getting just about any other medical product. Heck glasses aren't even medical technically as they aren't prescribed by an MD. In our fee for service economy it is impossible for you or anyone else to determine what the price is or should be for anything more complicated than a routine single service. So you're hospitalized for a non-emergency for a few days,something planned, lets say heart surgery for a coronary bypass. So do you honestly believe that even the hospital could tell what the cost will be? How many $10 tablet of aspirin, $50 IV bags, etc. Give it a try Jo, just call around and ask the question. Evan have a Dr. friend or two assist so you can get some of the codes right. What you're talking about regarding consumer capabilities is so much on the fringes and insignificant as to be mostly meaningless. The cost drivers like fee for service and cost shifting are so incredibly more significant and totally out of the consumers hands. I have tried to determine all the cost factors on some simple things and it is damned near impossible especially once you have to battle the insurance company. So your mythical empowered consumer is obviously much brighter than me and has lots more time in their schedule and much more savvy working the system than I am. I'll grant that possibility. Can I please hire them to help me out? There must be millions of them out there somewhere, lots of them are probably unemployed and without health insurance so they must have plenty of time and expertise figuring it all out. Please email me their numbers and I'll call em right up.
dave allen (Sat Mar 13 16:25:24 2010)
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• The PAC - too precious to fail. Day 3
• News follow-ups: Appleton West, Kagen at the White House
• Fox Cities PAC - too precious to fail - Day 2
• Fox Cities PAC - too precious to fail
• New Transit Tax coming your way
• Rep. Petri has his finger in the dike - I guess
• AASD Retirement Costs Burdensome
• Health care, health care, health care, health care
• Water rate increase was no slam dunk
• Education for all is just a bad dream
• New Year's resolutions from a parade snob
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| 2006 |
December
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November
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October
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September
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| 2000 |
May
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