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Thursday, February 25, 2010

Health Care Summit Live Part 2

February 25th, 2010

After watching our leaders for the past six and a half hours, I am signing off. I am more on board with the President than I was before. Do I want a "public option?" Yes. Can we as a nation accept nothing rather than a flawed bill? No. In my estimation, we can wait no longer.
As a side note, I want to thank the people who have e-mailed me throught this live blogging experience. I am especially glad to have been of some service to those of you doing the 9 to 5 routine. Feel free to comment whether you agree with this or any other blog. It's America.

"After five decades of dealing with this issue" starting over when we are this close is ridiculous. I am putting that a little more bluntly than POTUS. The people "don't want us to wait. They can't wait five more decades."

Obama sums it all up pretty well. "Overwhelmingly, people say the insurance market should be regulated." In the simplest terms possible, he lays out the fundamental principles he believes will drive down costs. I agree with him. He just argued that an unregulated opening of interstate insurance purchase could lead to a "race to the bottom" likening it to the explosion of the credit markets through the eighties and nineties. Again, I find the reasoning sound. He admits that reform of malpractice law has traditionally been the territory of Republicans and offers less ground than he probably should. I am pleased that he's strongly against randomly set "hard caps" in malpractice compensation but we need to find some compromise on this issue quickly. "I didn't propose something complicated just to have something complicated." Indeed, Mr. President.

Rep. Nancy Pelosi (D- California) says "we have in our bill market oriented" devices to lower costs and raise availability of coverage. She also lambastes the behavior of the major insurers as "shameful." I think she is being too kind. She singles out Boehner to rebut his stoking the fears of the Pro-Life community by saying "no public funding for abortion is the law of the land and there is no funding for abortion in this bill." Go get 'em. I am no fan of Rep. Pelosi but, calling a lie about public policy a lie is a duty in a free Republic.

The old gentleman, Rep. John Dingell (D- Michigan) reminds the group that young adult coverage past the age of 18 under parent's plans was an idea originated in Republican circles. He also points out that in spite of so many Republicans declaring their agreement with dismissing the very concept of pre-existing conditions it is a principle not found in the Boehner bill. FINALLY. He asks "if there is something wrong with a simple 51 vote majority I'd like somebody to tell me what it is."

Rep. Charles Rangel (D New York) follows his introduction by the President with the quip "Thanks for saving the best for last." He plainly states that we "can't start over." "Why can't we take what we agree to" and get it done? This is the most important question of the day. Why indeed? Great passion in measured tones. "I don't care if you're a Democrat or a Republican. If you're sick, you're sick."

Sen. Patty Murray (D- Washington) just said that she came to hear if any of the oppositions proposals would really protect as many people as the Democratic bill. She is followed by Sen. Tom Coburn (R- Oklahoma) who argues that we have be better "purchasers." It's not clear if he's referring to public or private money or both.

Sen. McConnell is discussing polls. Whatever ambivalence I have with portions of the bill, I am really tired of being told that I am against it because I am an independent. It really does semm that he and McCain and Boehner would accept that we do nothing.

Sen. Ron Wyden (D- Oregon) cites the Lewin Group, who are widely respected on both sides of the aisle, and their study that shows incremental reform is far less effective and far more expensive than comprehensive initiatives.

Rep. Joe Barton (R- Texas)is a charmer. "I will say that never before have so many members of the House and Senate behaved so well for so long." He then gives the standard "free-market" will fix everything speech. He accuses the Democrat bills of only paying "lip service" to tort reform. In touting the malpractice reforms in his own state, he conveniently forgets to mention that Texas has 2.6 million of our nation's uninsured.

Another fabulous moment comes in the form of Sen. Chris Dodd (D- Connecticut) remarking that if you can't afford a lawyer when charged with a crime, the government provides you with a lawyer regardless of the crime. He asks, as I have, how history will judge a society that can do that and not provide medical assistance as readily.

Obama: "The people who are left in the cold are the working families that make too much for Medicaid" and still can't afford private insurance. The President again makes his case for the exchanges provided for in the bill.

Rep. Peter Roskam (R- Illinois) is very polite and compliments Obama as a "gifted messenger." It is condescending. He describes Medicaid as "a house of cards." There is a certain sincerity in his misguided declaration that "Medicaid isn't working for anybody." I wonder how many poor, single mothers on family assistance through serevices of the Medicaid program live in his district? Trust me. I know his district. The answer is very few.

Obama ask Republicans what is provided for in Boehner's bill? He then challenged them to support the same provisions when found in the Democratic bill.

Obama takes Barasso to school on the limited availability of HSAs and turns it over to Rep. Henry Waxman (D- California). One of the big proposals by the Republicans has been to model some regulation of the insurance industry nationally on the current California system. Waxman points out that it's that current system that is unable to intervene on behalf of individuals who are being gouged by Anthem and their threat of a 39% increase.

It would appear Obama is even more offended by Barasso than I. That is saying a lot. They have a testy exchange regarding the income brackets that can take advantage of HSAs

Sen. John Barasso (R- Wyoming) who is a physician, is preying on the fears of seniors. His obtuse argument is a litany of his experiences at "town halls and senior centers" where he has asked them if "they believe" their costs and taxes will go up and the quality of care will go down. After a media assault by his party telling them that that is what is going to happen, regardless of the text of the legislation, he then tries to use their "belief" as an argument for killing the bill. They "believe" it because you told them to "believe" it.

Obama notes that the Republican plan would cover a total of 3 million currently uninsured. Over the past year, I think too little has been made of this fact. That's the best they can do? Out of 30 million uninsured they can maybe cover 10%?

BRAVO! Durbin challenges the opposition "if you think that what we are proposing is some sort of Socialist plot" please "drop out" of the official government health care they receive. He is spot on. If reform is socialism then so is the healthcare that our representatives have.

Sen. Dick Durbin (D- Illinois) is dissecting how little savings the CBO has found in the limited proposal put forth by the Republicans. He is exploding the myth of malpractice payments gone rampant. At last, someone is citing the fact that payments to patients due to malpractice have dropped 50% between 2003 and 2008.

As we approach the inevitable wrap up it is worth noting that a vast majority of the Republicans have been honest passionate and gracious. Even Sen. McConnell. But McCain and Boehner are absolutely shameful. They have been glib and dishonest as if they think smugness is a requisite of patriotism.

Total insanity! McCain begins again by saying the bill is "more than offensive" and within moments has made a totally random remark about how Arizonans hate californians because they "stole our water." I couldn't make this up. I can't wait to post that as a clip.

Rep. Jim Cooper (D-Tennessee) is thanking the President for forcing the open meeting and calls out colleagues who have sponsored measures within the bills and then abstained for whatever reason on the days those measures have come up for a vote. "Nobodies hands are clean on this" but "this bill is a great place to start." Remarkable candor. We should keep an eye on him.

Obama to responds Boehner by essentially calling him a liar. An amazing moment. He quietly and grimly describes Boehner's remarks as "just not true." It is pleasing to see Obama call him on his empty use of "talking points."

Hubris and an incredible disconnect from Sen. John Boehner (R- Ohio) "This will detroy America." "The American people want us to scrap this bill. "This, right here, is a very dangerous experiment." "We have the best health care in the world." It is one of the most profound examples I have ever seen of someone who, instead of listening, has been waiting to talk. There is very big difference.

Sen. Kent Conrad (D- North Dakota) Puts forth that Medicare will be bankrupt in 8 years without action and that the primary action has to be cost reduction and anti-fraud action. Both are very well addressed in the bills. " We are wasting money and getting worse outcomes" in the administration of chronic care. The average of the most severely ill 5% of our population takes an average of 16 prescriptions. He cites evidence both researched and anecdotal that on average they could drop 8 of them. A stunning figure, if in fact that averages to a $3000 per patient saving annually.

Here's something interesting. Sen. Grassley has been one of the loudest blow-hards accusing the Democrats of a lack of bi-partisanship. He just said that he learned "a lot in the 31 meetings with Max Baucus" that he attended formulating the Senate version of the bill.

Sen. Chuck Grassley (R- Iowa) is trotting out wildly dishonest figures of across the board tax increases. Again it's "small business" "small business" "small business". Now he's saying it's un-Constitutional to create a mandate for coverage. "Do you think were going to sit around in rural America" and let you reduce benefits?

Rep. Xavier Becerra (D- California) Begins by saying "as we reduce the deficit, were not going to put the onus on seniors." He lays out a pretty clear argument for regulation of certain provisions of service. He should be cautious as these are the kinds of arguments that, when taken out of context, have led to nutty charges of "death panels." It seems to me that this is the trickiest part of reform to implement. Over-treatment and over-prescription are very subjective.

Here comes a belligerent McCain. And a hilarious moment ensues. John angrily snaps at Obama that "dropping 800,000" (meaning exempting) Floridians from one element of Madicaid reform to get Florida Congressional support is just wrong. He expects a fight. Obama simply says, "that's a really great point." McCain actually mumbles because whatever planned gotcha retort he had has been utterly deflated. The whole room laughs.

The floor has passed to Rep. Ryan. who seems to be dubious of whether or not CBO has had enough facts to accurately score the bill. His use of the phrase "smoke and mirrors" is a little unnecessary. He is making a very impressive cost breakdown of some of the more dubious deficit figures due to differences in the House versus the Senate's bills. "It just doesn't add up." His reasoning is fundamentally flawed because his figures are based on the current number of insured and disregards the positive momentum of the larger pool that will be created. "We want to start over." Again. As a mantra. Why don't we just fix the bill s we have? Because the forward momentum of the Right IS to do nothing in spite of their proclamations that they "get it."

Vice President Joe Biden is now likening the potential mandate to own insurance to Social Security which he rightly notes was "also a mandate." He points out that a third of Healthcare expenditure across the board is spent on non-healthcare related initiatives. He is at last addressing the issue of deficit reduction. "We can argue on the margins" but the Senate plan cuts administrative costs by as much as $3000 annually per healthcare worker according to the CBO analysis.

Rep. Blackburn seems more interested in semantics.

Obama is explaining how the existing pool has gotten older and sicker and the subsequent need to get coverage for younger and healthier citizens to stabilize the financial risk. "It makes sense for us to have everyody buy insurance." He also subtly prods the Republicans in the room who in the past have supported that very proposal as a mandate.

Rep. Marsha Blackburn (R- Tennessee) Argues forcefully for the removal of the state line prohibition and in the same breath says it doesn't require further government regulation. As if this were some simple anti-trust issue.

Rockefeller fights valiantly for consumer protection in ways that "they know it and feel it in their lives."

Sen. Jay Rockefeller (D- West Virginia) is finally speaking. It's a full broadside against the industry as a whole. "Their just in it for the money."He quotes the CEO of Wellpoint, "We will not sacrifice profit for membership." He quotes from a letter from the CEO of Cigna and it was an apology for lying to him during an inquiry. He likens the insurance industry to "a shark." Amazingly harsh presentation. I happen to agree. He rightfully singles out the fact that insurance employees are directly incentivized to remove the sick from their roles. "This is a rapacious industry that does what it wants."

Obama: "21 states have high 'risk pools'." He cites the figure that roughly 200,000 people are in those pools across those states.

Rep. Dave Camp (R- Michigan) is trying to genuinely explain the Right's differences with the plan. A lot of it seems to have to do with the general nervousness over "mandates." He has the virtue of honesty but his reaction to regulatory structures is sadly knee-jerk.

Harkin: The insurance industry is based on "segregating people based on their health." "It's segregation."

Sen Tom Harkin (D- Iowa) is ringing the bell of out of control costs. It's woth noting that not one person has taken profit-gouging to task. "We held over a hundred bi-partisan meetings" in the past year and the bill contains "more than 100 Republican proposals." But of course they were for it before they were against it.

Rep. Mike Enzi (R- Wyoming) discusses the alarm amongst seniors over their Medicare. He is skeptical of the broad value of HSAs. He likes the "exchange" programs. He's talking about his shoe business now. The battle to out-folksy one another resumes.

The players are back from lunch.

1 comment:

  1. I really, really liked Harkin's comments!