No Guarantees for Senate's "Public Option"

(AP)  The focus of the health overhaul debate now shifts to whether Senate Majority Leader Harry Reid can persuade a handful of moderate senators to get behind his new proposal for a government-sponsored insurance plan.

That's no sure bet. Even Reid, D-Nev., didn't claim to have the 60 votes needed to pass his proposal when he ended weeks of speculation by announcing that the Senate version of sweeping health care legislation would include a provision for the government to sell health insurance in competition with private insurers.

CBSNews.com Special Report: Health Care Reform

The issue has been the biggest flash point in the health care debate, and government-sponsored insurance had been seen as unlikely to be included in Senate legislation because of opposition from moderates. The House's health care bill, expected to be released as early as this week, is certain to contain a strong provision for a so-called public insurance option, though details aren't final.

"I think it's the fairest way to go," Reid told reporters Monday.

"We have 60 people in the caucus," he said. "We all hug together and see where we come out."

Individual states would have the choice of opting out of the government plan under Reid's proposal. It still amounted to a victory for liberal lawmakers who have pushed for a public insurance option they contend would create needed competition for private industry and provide affordable choices to consumers.

The reaction from moderate Democrats - they fear a public plan could drive insurers out of business and take over the marketplace - ranged from muted to skeptical. The one Republican who has so far lent her support to Democratic health overhaul proposals, Sen. Olympia Snowe of Maine, said she was "deeply disappointed" by Reid's decision.

Snowe had supported allowing government insurance in individual states only if the private market wasn't providing sufficient choice and competition. But Reid said he wasn't sending that "trigger" option to the Congressional Budget Office for evaluation, as he did Monday with the opt-out proposal.

"We hope that Olympia will come back. She's worked hard. She's a very good legislator. I'm disappointed that the one issue, the public option, has been something that's frightened her," Reid said.

If Snowe doesn't come back, the fate of Reid's public option could rest in the hands of a few key moderate Democrats including Sens. Ben Nelson of Nebraska, Blanche Lincoln of Arkansas and Mary Landrieu of Louisiana.

Landrieu said in a statement that she's still "very skeptical" about a government plan run from Washington but would keep working with Reid to find a "principled compromise."

Nelson "is not committing how we will vote regarding any proposal Sen. Reid is advancing," said spokesman Jake Thompson.

Lincoln, who's up for re-election in 2010, said through a spokesman she intends to study the details and decide how to vote based on the impact on her home state.

The White House released a statement saying Obama was "pleased that the Senate has decided to include a public option for health coverage, in this case with an allowance for states to opt out."

Obama has long voiced support for such a plan but has also signaled it was not a requirement for a health care bill he would sign. He has also said he would like bipartisan support for the legislation - and Snowe appeared to be his best hope for that.

Changes on the public option - and numerous other provisions in the measure - are possible during a debate expected to last for weeks. If Reid's public option proposal is knocked out during the amendment process, liberals will at least have had their shot, possibly answering pressure from Democratic base voters.

The insurance industry was sharply critical of Reid's announcement.

"A new government-run plan would underpay doctors and hospitals rather than driving real reforms that bring down costs and improve quality," said Karen Ignagni, head of America's Health Insurance Plans.

Both the House and Senate are struggling to complete work by year's end on legislation extending coverage to millions who lack it, banning insurance industry practices such as denying coverage because of pre-existing medical conditions, and slowing the rise in medical costs nationally.

Officials said Reid had prepared several variations of key provisions so he could make adjustments in his bill at the last minute and still make sure he was within Obama's target of a $900 billion price tag over a decade.

Differences in bills passed by the House and Senate would have to be reconciled before any legislation reaches Obama's desk.

[jaw736]

An Open Letter to Congress on Health Care Reform

The last few decades have seen quite a mixed bag of attempts at health care reform. Some were enacted such as Medicare/Medicaid and Medicare Part D, others defeated such as the Clinton?s plan of the 1990?s. Surprisingly they all had one thing in common ? they were remarkably lacking in real reform. I believe that changing the basic paradigm of the health care industry is the only way to achieve the goals of reform, specifically cost containment and access for everyone.

So it was no surprise when President Obama once again embraced the cause, and I was encouraged by a sense that maybe this time attempts at meaningful reform might be the underpinnings of his plan. The President?s speeches were compelling and I was almost ready to drink the Kool-Aid when the Obama administration left all of the details up to Congress. The promise of the oratory devolved into a top ten list of the worst ideas of the last 40 years, David Letterman would have been proud. Real reform was strikingly absent, while single payer options using the HCFA (Health Care Financing Administration) model were dusted off and touted as reform. I?m just a citizen with reasonable intelligence and no health care or legal training, but I think that the following six ideas make sense and effect real reform.

1. Mandate that Insurance companies cannot discriminate against applicants with pre-existing conditions, and that all Americans must carry insurance. The increase in the pool of insureds coming from the healthy uninsured Americans should offset the risk from the pre-existing condition group and should not adversely affect rates.

2. Establish a national marketplace for health care insurance. By allowing insurance providers to match up with customers on a national scale should provide cost benefits on both sides of the transaction.

3. Encourage the citizens to get involved in their own health care decisions by mandating that the insurance companies split the savings with the insured for price reductions negotiated by the insured. For example, I recently had a test that billed $1,250.00, while my PPO negotiated price was $765.00, but if I paid cash and the provider didn?t have to bill the insurance company it was only $480.00. If this idea was in place, I would have paid cash, submitted the claim form myself, gotten reimbursed, and received a cash bonus of $142.50, half of what I had saved the insurance company.

4. Create a national computer database for medical records to reduce costs when changing providers and linked to ones social security number. The internet is already in place and HIPPA (health Insurance Portability and Accountability Act) already covers most of the privacy issues. Most patients would prefer signing a waiver to completing the same questionnaires on medical history over and over, not to mention the improved care resulting from complete drug and disease histories.

5. Restructure the role of the FDA as it applies to the testing and approval of drugs. If the FDA is doing their job, then they should have certified that all reasonable diligence had been done regarding safety testing prior to the rollout of a new drug. So if civil lawsuits arise questioning an FDA approved drug, then the defendant should be the FDA, and not the pharmaceutical companies. I?m sure that the savings from this immunity would be substantially more that the added regulatory burden. This could also be taken a step further with the establishment of a non-FDA approved class of drugs and treatments that are taken at ones own peril. Either way the abuses of an overly litigious society would be curtailed.

6. Capping civil malpractice claims and attaching some criminal jeopardy would go a long way toward reducing costs. Practitioners who are regularly being sued would be removed from their field, and insurance premiums would be lowered for the rest.

Some of the above thoughts, such as items 1, 2, and 3, can be enacted by fiat with no cost to the American taxpayer. Others, such as the national patient records database, might do well with a joint private/public venture. Since the internet architecture already exists, these costs are also probably manageable. The remaining ideas are more controversial and would depend on the will of the politicians (hopefully at the urging of the people) to set aside influence from special interest groups and do the job for which they were elected.

People in Congress, it?s time to begin a real dialogue with the American people before we must resort to the only true arbiter of reform ? the ballot box.

If anyone actually reads this and either likes something that I?ve said or has their own favorite idea, I urge you to write your Representative and both Senators advocating your point of view. Remember, Albert Einstein once observed that ?Insanity is doing the same thing over and over again and expecting different results?.

[jab712]

if the public option dosen,t work you must be able to PULL THE
TRIGGER on it. Better find out frist befor we,re stuck with it !

JAB4

[jefleshman]

The medical benefit in our military contract is also a benefit that all Americans should be entitled to in my opinion.

We pay for the lack of health care in so many other different ways that cannot be measured by dollars. As an example, a sick child goes to school and gets 3 other children sick because the parent(s) doesn't have health coverage. Bankruptcy, who pays for that? We do as the tax payers. I wonder how many people would have not gone bankruptcy because of health insurance? Imagine if small businesses didn't have to have insurance mandated for employees (if they have so many) they could use that money to increase salaries of their employees and so on!

As a compensation for military Service (since health care would not be an issue anymore), maybe adopt what some states have adopted already and sweeten the deal a little?For 20 years of service, you and your family (Spouse and children) get free college to any state university or college? If you do not retire and serve you still get the GI Bill. Plus your retirement check from the military is (health tax exempt).

Shoot I would still join at 17 for the above in my military contract and serve 20 plus!

[slownewsday-05]

Good examples of the extra costs, jefleshman. Well put.

[Mortarman_29]

Dr. Robert Higgs, senior fellow at the Oakland-based Independent Institute, penned an article in The Christian Science Monitor (2/9/2009) that suggests the most intelligent recommendation that I've read to fix our current economic mess. The title of his article gives his recommendation away: "Instead of stimulus, do nothing -- seriously."

Stimulus package debate was over how much money should be spent, whether some should given to the National Endowment for the Arts, research sexually transmitted diseases or bail out Amtrak, our failing railroad system. Dr. Higgs says, "Hardly anyone, however, is asking the most important question: Should the federal government be doing any of this?" He adds, "Until the 1930s, the Constitution served as a major constraint on federal economic interventionism. The government's powers were understood to be just as the framers intended: few and explicitly enumerated in our founding document and its amendments. Search the Constitution as long as you like, and you will find no specific authority conveyed for the government to spend money on global-warming research, urban mass transit, food stamps, unemployment insurance, Medicaid, or countless other items in the stimulus package and, even without it, in the regular federal budget."

By bringing up the idea of constitutional restraints on Washington, I'd say Dr. Higgs is whistling Dixie. Americans have long ago abandoned respect for the constitutional limitations placed on the federal government. Our elected representatives represent that disrespect. After all I'd ask Higgs: Isn't it unreasonable to expect a politician to do what he considers to be political suicide, namely conduct himself according to the letter and spirit of the Constitution?

While Americans, through ignorance or purpose, show contempt for our Constitution, I doubt whether they are indifferent between a growing or stagnating economy. Dr. Higgs tells us some of the economic history of the U.S. In 1893, there was a depression; we got out of it without a stimulus package. There was a major recession of 1920-21; though sharp, it quickly reversed itself into what has been call the "Roaring Twenties." In 1929, there was an economic downturn, most notably featured by the stock market collapse, after which came massive government intervention -- you might call it the nation's first stimulus package. President Hoover and Congress responded to what might have been a two- or three-year sharp downturn with many of the policies President Obama and Congress are urging today. They raised tariffs, propped up wage rates, bailed out farmers, banks and other businesses, and financed state relief efforts. When Roosevelt came to office, he became even more interventionist than Hoover and presided over protracted depression where the economy didn't fully recover until 1946.

Roosevelt didn't have an easy time with his agenda; he had to first emasculate the U.S. Supreme Court. Higgs points out that federal courts had respect for the Constitution as late as the 1930s. They issued some 1,600 injunctions to restrain officials from carrying out acts of Congress. The U.S. Supreme Court overturned as unconstitutional the New Deal's centerpieces such as the National Industrial Recovery Act and the Agricultural Adjustment Act and other parts of Roosevelt's "stimulus package." An outraged Roosevelt threatened to pack the Court, and the Court capitulated to where it is today giving Congress virtually unlimited powers to tax, spend and regulate. My question to my fellow Americans is: Do we want a repeat of measures that failed dismally during the 1930s?

A more fundamental question is: Should Washington be guided by the Constitution? In explaining the Constitution, James Madison, the acknowledged father of the Constitution, wrote in Federalist Paper 45: "The powers delegated by the proposed Constitution to the federal government are few and defined. Those which are to remain in the State governments are numerous and indefinite. The former will be exercised principally on external objects, as war, peace, negotiation, and foreign commerce." Has the Constitution been amended to permit Congress to tax, spend and regulate as it pleases or have Americans said, "To hell with the Constitution"?

[slownewsday-05]

Are you capable of original thoughts, or just copy and pastes?

[isanyonefair]

This debate happened a while back. I think you missed it.

Basically the last Depression happened because we didn't do anything to stop it. So this time we trying a little something different.

Although, I suspect you will get another chance for your point of view. Given Congress is incapable putting together effective regulations against Wall Street we should have another crash in 4-5 years. At which point we will probably be too broke to stimulate anything.

[slownewsday-05]

"by Mortarman_29
Slow doesnt play well with others when he hasnt had his meds. "


Mort - again, what's your obsession with meds? Are juvenile responses all you can handle??

Oh, right.

[Mortarman_29]

Because we want you to be able to participate intelligently, Slow. We want you to be a part of the discussion and join in with some factual responses.

If you would just take your meds, we would welcome what you have to say!

[slownewsday-05]

So that would be "yes".

[troutfishyman]

by Mortarman_29 October 27, 2009 5:46 PM EDT
My current employer pays for my healthcare coverage. I do not currently use the military retiree system. Rob is the one who said he uses the retireee system.

My current employer provides me a much better coverage!



Fair enough. But you have the luxury of TAKING the military insurance, which gives you peace of mind. Something most of us do not have. And that is the part you do not get. You are lacking that empathy gene.

[Mortarman_29]

No, I have empathy. Please remember that my employer (the U.S. government) offered that benefit to me for my services. If it had not offered it to me, I might not have decided to work for the U.S. government.

It is liek the G.I. Bill. Do I think every person deserves college paid for? Nope? Everyone should pay for college.

Some work, get money and then pay for it with that money. Others work, and their employer pays for their college (or a portion thereof). The GI Bill is there as a benefit for my work, my service. I deserve it because I earned it as a part of my pay packet. I was offered that in order to get me to sign on the dotted line and to do the job they wanted me to.

It is no different than any employer. But, do I think other Americans who did not serve deserve my benefits? Of course not. Just as I dont deserve the benefits that you get from your job. You earned them thru your hard work.

[slownewsday-05]

No, Mort, you don't have empathy. Nor morals.

[Mortarman_29]

Most of our nation's great problems, including our economic problems, have as their root decaying moral values. Whether we have the stomach to own up to it or not, we have become an immoral people left with little more than the pretense of morality. You say, "That's a pretty heavy charge. You'd better be prepared to back it up with evidence!" I'll try with a few questions for you to answer.

Do you believe that it is moral and just for one person to be forcibly used to serve the purposes of another? And, if that person does not peaceably submit to being so used, do you believe that there should be the initiation of some kind of force against him? Neither question is complex and can be answered by either a yes or no. For me the answer is no to both questions but I bet that your average college professor, politician or minister would not give a simple yes or no response. They would be evasive and probably say that it all depends.

In thinking about questions of morality, my initial premise is that I am my private property and you are your private property. That's simple. What's complex is what percentage of me belongs to someone else. If we accept the idea of self-ownership, then certain acts are readily revealed as moral or immoral. Acts such as rape and murder are immoral because they violate one's private property rights. Theft of the physical things that we own, such as cars, jewelry and money, also violates our ownership rights.

The reason why your college professor, politician or minister cannot give a simple yes or no answer to the question of whether one person should be used to serve the purposes of another is because they are sly enough to know that either answer would be troublesome for their agenda. A yes answer would put them firmly in the position of supporting some of mankind's most horrible injustices such as slavery. After all, what is slavery but the forcible use of one person to serve the purposes of another? A no answer would put them on the spot as well because that would mean they would have to come out against taking the earnings of one American to give to another in the forms of farm and business handouts, Medicare, Medicaid, food stamps and thousands of similar programs that account for more than two-thirds of the federal budget. There is neither moral justification nor constitutional authority for what amounts to legalized theft. This is not an argument against paying taxes. We all have a moral obligation to pay our share of the constitutionally mandated and enumerated functions of the federal government.

Unfortunately, there is no way out of our immoral quagmire. The reason is that now that the U.S. Congress has established the principle that one American has a right to live at the expense of another American, it no longer pays to be moral. People who choose to be moral and refuse congressional handouts will find themselves losers. They'll be paying higher and higher taxes to support increasing numbers of those paying lower and lower taxes. As it stands now, close to 50 percent of income earners have no federal income tax liability and as such, what do they care about rising income taxes? In other words, once legalized theft begins, it becomes too costly to remain moral and self-sufficient. You might as well join in the looting, including the current looting in the name of stimulating the economy.

I am all too afraid that a historian, a hundred years from now, will footnote America as a historical curiosity where people once enjoyed private property rights and limited government but it all returned to mankind's normal state of affairs -- arbitrary abuse and control by the powerful elite.

[troutfishyman]

jefleshman


What you describe is single payer, and I agree. It is the only plan that makes sense.

[Mortarman_29]

It makes no sense, if you want liberty, the lowest possible prices and the best quality.

[jefleshman]

That is what we have it is called TRI Care, and it works pretty well. Compared to Champus 100000000000000 times better!

[troutfishyman]

by Mortarman_29 October 27, 2009 5:43 PM EDT
How much does my policy cost? That is what they woudl owe me.

Take it to my current employer. If my employer, for argument's sake, pays $10,000 a year for my policy and I pay $4,000. Then, if my employer wanted to get out of providing coverage, he should give me the $10,000 in addition to my current pay.




But you said you were covered by military service. Why would you pay for this?!?

[Mortarman_29]

My current employer pays for my healthcare coverage. I do not currently use the military retiree system. Rob is the one who said he uses the retireee system.

My current employer provides me a much better coverage!

[troutfishyman]

by Mortarman_29 October 27, 2009 5:37 PM EDT
Well, I didnt say eliminate all regulations. I also didnt say that the government shouldnt provide benfits to its employees. So, please get that right.

But, if the government wants to not offer government coverage to its employees, and instead just pay me the difference and let me get my own health coverage, I have no problem with that!!



No, I agree with you. Get govt out!

How much is your monthly premium right now? Well, the govt will just send you a check for that amount, and you can go shopping like all the rest of us. Deal?

[Mortarman_29]

How much does my policy cost? That is what they woudl owe me.

Take it to my current employer. If my employer, for argument's sake, pays $10,000 a year for my policy and I pay $4,000. Then, if my employer wanted to get out of providing coverage, he should give me the $10,000 in addition to my current pay.