November 23, 2009 7:55 AM

Give Me a Public Option or Give Me Death?

By
David Morgan
Topics
Health Care
(CBS)
Senate Democrats managed to pull together a 60-vote majority Saturday evening to pass a key vote keeping health care reform legislation on track, despite efforts by Republicans (and, prior to the vote, a few slow-to-the-table Democrats) to stall or kill the bill.

(Left: "Join, or Die," a 1754 political cartoon by Benjamin Franklin published in the Pennsylvania Gazette, is the earliest known pictorial representation of a colonial union produced in America.)

There are many health care-related issues being debated in Congress, from insurer abuse, preconditions and spiraling health costs to abortion funding and Medicare taxes. But the most contentious issue popping up continues to be the so-called "public option" — government-backed health care coverage — similar to Medicare but available to anyone who cannot obtain or afford coverage from private insurance companies.

"You have people on one side saying 'I won't vote for a final bill if it's in it,' and you have other people saying, 'I won't vote for a final bill if it's not in it,'" said CBS News political analyst John Dickerson, "and so as Harry Reid and the president try to mollify one group, they end up making the other group angry."

Dickerson said this morning he believed that Democrats will get some form of health reform passed, mostly because President Obama is "desperate."

"He cannot have this not pass," Dickerson told "Early Show" anchor Harry Smith. "And Democrats running in 2010 have to have something to run on. So something will pass. It may not look pretty, but something will pass. (video at left)

"This is the president's signature domestic policy priority. His chief of staff, Rahm Emanuel, has said failure is not an option — now that's the kind of thing you say in negotiations, but that's where they are. They need something to pass. They can't have spent all of this energy, campaign on this issue, and then come up with nothing. It would be too desperate for them."

Sausage-making was never like this: Liberal and moderate House members find themselves supporting a 2,074-page reform bill that prohibits federal funds in any insurance plan covering abortion procedures, while conservatives in the Senate are being asked to back a bill that would raise Medicare taxes on wealthier Americans.

"It's a problem for them, on several different issues: On the public option, on the question of abortion for some that is a very big deal, and then also on the cost," Dickerson said.

"And the problem also for them is, if the president is not popular — we see his approval ratings dropping — they don't get the political cover from a popular president that they would like, and that they need."

Patient Protection and Affordable Care Act (Text of Senate's Health Reform Bill)
What's in the Senate Health Bill for You?
CBSNews.com Special Report: Health Care

While Senate Democrats stood together Saturday evening, staying together may be the real challenge. Some moderates (including Sen. Blanche Lincoln, D-Ark.) said that while they supported debate on the bill, they could not promise their votes would be there at the end.

Sen. Ben Nelson, D-Neb., said on ABC's "This Week," "If there are a whole host of other items that are the same as they are right now, I wouldn't vote to get it off the floor."

Nelson and a handful of others are threatening to sink the measure unless massive changes take place, said CBS News correspondent Whit Johnson.

Sen. Joe Lieberman, I-Conn., is staunchly opposed to a government-backed program, saying it would be fiscally ruinous. "I don't want to fix the problems in our health care system in a way that creates more of an economic crisis," he said on NBC's "Meet the Press."

But supporters say this bill is critical to expanding health care coverage to roughly 31 million uninsured Americans. And they refuse to let a small group of Senators stand in the way.

"I don't want four Democratic Senators dictating to the other 56 of us," Sen. Sherrod Brown, D-Ohio, said on CNN's "State of the Union."

Reid added an opt-out of the public option for states which did not want it, to try to fend off opposition, but the opt-out hasn't won over conservatives — making liberals more frustrated.

"What we will say to the people from the more red, conservative states, 'Your state doesn't have to take it'; but don't make it so that my state, which would like a public option, can't take it," Senator Charles Schumer, D-N.Y.,

  • David Morgan

    David Morgan is a senior editor at CBSNews.com and cbssundaymorning.com.

Add a Comment See all 47 Comments
by ct-7846271 November 24, 2009 10:22 AM EST
Reductions In Hospitalizations for MDVIP patients are up to 65% for Medicare beneficiaries and up to a staggering 80% for those with commercial insurance. - http://shar.es/aKnYA

Source: MDVIP; Concierge Medicine Today
Reply to this comment
by ct-7846271 November 24, 2009 10:20 AM EST
As it relates to the primary care physician shortage, it is also important to note in this debate that according to Concierge Medicine Today's recently released research (Nov. 18, 2009) which analyzed concierge medicine specialties across the country for the past 12 months, over 66% of current concierge physician practices operating today across the U.S. are primarily 'internal medicine.'

Another surprising finding by Concierge Medicine Today is the quickly increasing rise of concierge 'dental' and 'pediatric' practices arising since February of 2009.

http://shar.es/azL1N
Reply to this comment
by ct-7846271 November 24, 2009 10:16 AM EST
It should also be noted that there is a new Concierge Medicine News Agency called Concierge Medicine Today (www.ConciergeMedicineToday.com). They have a wealth of resources for patients curious about the services, costs, delivery models, etc.

They also are educating traditional physicians about the various benefits, drawbacks, value, affordability, etc., if a doctor is interested in changing over to this type of practice.
Reply to this comment
by Ristudi November 24, 2009 3:25 AM EST
As the article points out, the "opt out" aspect of the public option should satisfy blue-dog democrat senators who fear that support of the option will hurt their re-election chances. Each senator can simply say that he or she will allow his or her state to decide for itself whether or not to allow the public option.

But I suspect that once a public option becomes available, it will be extremely popular and successful, and not so easy to ditch. This is what happened in Saskatchewan, Canada, in 1962. Despite stiff opposition, socialized health care was introduced by a determined provincial government, and was so successful it was quickly embraced by the whole country.
Reply to this comment
by ct-7846271 November 24, 2009 10:21 AM EST
The majority of my family lives in Sask. They remember this quite well. Do you have more information (links) that you can send me about this?
by lakota2012 November 23, 2009 1:16 PM EST
Patients face bitter choice: Pay up or lose care

Premium-pay medical practices grow as doctors seek more control, cash

A growing number of doctors enact their own brand of health reform. These physicians are opting out of the system, with some doctors dumping insurance companies altogether and others forcing patients to pay thousands of dollars in cash to keep the care they?re accustomed to.

Doctors often tout this model as ?concierge? care ? you get more if you pay more. But for some patients, the flip side of this arrangement feels more like pay more or get less.

As many as 5,000 doctors nationwide have opted for full or partial concierge practices. Surveys suggest that number could quadruple within the next few years.

The result, critics say, is a segregated system that offers extra access for extra cash, even as it escalates a looming health care crisis for everyone else. And there?s nothing in the current health reform bills being considered in Congress to stop it.

?These practices exacerbate a fundamental problem in our health care system, which is this health care chasm between the haves and the have-nots,? said, Laura Weil, director of the health advocacy program at Sarah Lawrence College in Bronxville, N.Y., and an analyst of concierge care.

Here?s how concierge medicine works: Doctors charge anywhere from $1,500 per person per year up to $25,000 or more for a family. This fee acts as a retainer on top of all the insurance-covered services.

In some programs, those who don?t pay are forced to leave the practice. In others, they?re likely to see a nurse practitioner, a physician assistant or a newer, different doctor hired to handle the traditional patients.

The move to smaller, premium practices will worsen an already dire shortage of primary care doctors, creating an elite group of well-compensated physicians who see fewer and fewer upscale patients, dumping the rest on their increasingly harried colleagues, critics contend.

The U.S. is short by between 40,000 and 50,000 primary care doctors now, a figure that?s expected to top 125,000 by 2020, according to the American Academy of Family Physicians. That means people who don?t want or can?t afford concierge plans will have a harder time than ever finding a doctor.

?This is a multi-tiered health system and has been for a number of years,? said Darin Engelhardt, president of MDVIP, a network of some 300 concierge doctors based in Boca Raton, Fla. ?What we?re offering is simply a choice along the health care continuum.?

The movement toward concierge care has exploded in recent years. Five years ago, there were 250 concierge doctors in the nation, serving perhaps 100,000 patients. Today, more than 5,000 primary care doctors run retainer practices serving 500,000 patients, according to the Society for Innovative Medical Practice Design, a concierge association.

An additional 7 percent of doctors surveyed in 2008 by the independent Physicians Foundation plan to switch to a concierge practice within three years.


Is Concierge Medical Care Right For You?
Nov 7, 2008 ... Concierge Choice Physicians(TM) is a private company ... Concierge Choice Physicians offers the hybrid model of concierge medicine so ...
www.pr-inside.com/is-concierge-medical-care-right-for-r900863.htm
Reply to this comment
by Confidential416 November 23, 2009 1:00 PM EST
The GOP want to block health care reform - they do not want this administration to succeed. If they are able to force the fail - they will use it to send the message that this administration has failed - quite frankly if this health care reform bill fails it will be the failure of the GOP.
Reply to this comment
by lakota2012 November 23, 2009 12:51 PM EST
What they (republicans) are counting on now, and what they are hoping to inflame, is public doubt. Over and over again on Saturday, Republicans mentioned a new Quinnipiac poll indicating that while a healthy majority of Americans - 61% - are eager to see major changes in the health system, only 1 in 5 believes President Obama when he says that he can do it without raising their taxes. What the GOP Senators failed to note was that the same poll showed 59% faulting the Republican Party for not working in good faith with the Democrats to produce a bill.

http://www.time.com/time/healthcaredebate
Reply to this comment
by rocketjl November 23, 2009 12:04 PM EST
No problem. Pass it, as long as you guarantee that down the line, it will not be transformed into something that will harm Americans, such as rationing and so forth. Every human being should love the caption/phrase 'Health Care Reform'. The problem is that the folks who allowed the medical industry to get into this greedy state, was Congress, the same people that are saying the support health care reform. Bleeding hearts throw the title at everyone or a little old lady wanting treatment, but those same people are not looking at the cost or what else 'these' bills bring. Do it right.
Reply to this comment
by lorajeantn November 23, 2009 11:59 AM EST
We need health care reform, but it doesn't need to be done to the exclusion of all else. It is important, but it shouldn't be top priority. The president should be focusing on getting Americans back to work and stabilizing our economy. This health care legislation is very expensive, and almost as many people are against this particular plan as are for it. The bill is about as clear as mud, most people (including Congressmen) don't have the time or intestinal fortitude to read the entire document, and the cost going forward is enough to cripple this nation. And it STILL doesn't guarantee health care for everyone.
Reply to this comment
by truth-b-toll November 23, 2009 11:52 AM EST
It does not matter what bill is put forth to help americans.
The gop has decided that will just say NO !
Gop wants America to fail so it can re-gain POWER !
simple as that.
Never forget that the Bushie - gop almost destroyed our USA !
NEVER FORGET...
Reply to this comment
by rocketjl November 23, 2009 12:07 PM EST
Good point. Hope you will admit that Obama and the democrats are trying their best to finish the job. Odd isn't it, that every human being on one side is a republican and every human being on the other side is a democrat. Guess the independents are no better. It is clear Congress (any Congress) is not trying to speak for the people, but for the 'buck'.
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