Susan's Views                                 
International writer Susan Trevelyan-Syke on politics, media and economics.
                                                                                       
Health Care

Why the Public Option (or Medicare Buy-In) Was Always Dead in the Water  

Senate Majority Leader Harry Reid (D, ND) announced that he had 60 votes to prevent a filibuster on the ObamaCare health care bill and will call a Senate vote before Christmas--unless someone like Senator Joseph Lieberman (I, CT) changes his or her mind about supporting it.

Reid is optimistic that no one will defect from cloture as generous deals were cut with rebels like Senator Mary Landrieu (D, LA) who received $300 million in Medicaid funds for Louisiana in exchange for her vote and she is now a prime defender of ObamaCare.

Senator Ben Nelson (D, NV) will receive undisclosed millions in Medicaid subsidies for Nevada and he was allowed to further restrict women's access to abortions through insurance in the bill.
 
Pennsylvania, New York and Vermont were also big winners in receiving awards of undisclosed millions of Medicaid subsidies which explains their Senators' vehemence in attacking anyone who questions ObamaCare.

It appears that supporters of ObamaCare have made support for ObamaCare a "sanity" test leaving most Americans branded as "insane". 

That cannot surprise anyone given Landrieu's incoherent attack on America's majority who support the public option--as not being smart enough to know the public option is not free.

Medicaid benefits for only certain States could well become a very serious issue for the States that do not benefit. 

Accommodation to the current winners will cut into Medicaid's shaky budget.  Giving the same benefits to all States could well destabilize Medicaid or bankrupt it and the poorest of Americans depend on Medicaid.

Since most of the deals are secret, there are no accurate budget numbers yet. 

The bill mandates that, from 2014, 30 million Americans must buy health care insurance from private insurers or a limited non-profit policy managed by private insurance companies.  The latter option will only be available in States which permit it since States negotiate and award operation franchises to insurance companies for their States.

The standard argument for the admittedly-flawed bill is that 30 million uninsured will have health insurance.  No mention that they will pay for it or of the 20 million who will not be covered. 

Defenders of ObamaCare claim any problems can be tweaked later.

ObamaCare advocates (New Dems/Conservatives) and apologists (Progressives/Liberals) refuse to answer why they cannot or will not produce a good bill or pass the best parts in increments. 

They insist on an all-or-nothing NOW doomsday scenario.

Undeserving Republicans, who have contributed nothing positive to the debate, have been given a gift that will keep giving.  They expect to claim many Congressional seats and Governorships because of ObamaCare.

Whatever happens, Americans will have to pay for the bill with or without tweaking.  Americans are smart enough to understand that.

Americans are also smart enough to be angry.  They were asked to support health care reform and lured by the possibilities of a single-payer option, a public option or a Medicare buy-in with the qualifying age lowered to 55.

Many are still stunned by the exclusions and/or hope that the House will reinstate them.  That is not possible. 

They are smart enough to know there is NO REFORM in ObamaCare, but now 30 million citizens will be forced to buy insurance from private companies or be fined or go to jail.  Over 20 million are left uninsured.

Creator of the House's Stupak Amendment, Rep Bart Stupak (D, MI), has said he will NOT accept Nelson's cave in on abortions.  Planned Parenthood opposes both parts of the House and Senate versions and the Catholic Church want stronger anti-abortion legislation. 

The list of disputees grows.

Unions are unhappy, because the rich or health care industry companies will not be taxed (as in the Baucus bill); however their members will be taxed if they have the so-called "cadillac" insurance policies which include their families.

The rich and corporations avoid tax; workers and the middle class (if it still exists) pay it.

ObamaCare assures that no one with a pre-existing condition can be refused health care insurance or be dropped, but they and older Americans can be charged up to 300% of standard policies (3 to 1 or, i.e., $30,000 instead of $10,000). 

How much of an insurance gift is a 300% limit if there are no cost controls on base prices?  Prices will be set by an insurance industry committee.  

Senator Kent Conrad (D, ND) has already threatened that the House "had better return" the Senate version of ObamaCare after their joint negotiating conference committee meets or the Senate will NOT approve the final version. 

Then what is the point of negotiating the two bills?  Oh, I forgot.  Stupak wants more restrictions on women.

Evidently, Speaker of the House Nancy Pelosi will be wasting her time conferencing especially since there are four members on the committee, beholden to the insurance industry, and they have vetoes. 

Two things that are obvious to all from the Senate debacle is that our system is a mess and we are ruled by an indescribable lot of clowns in both parties.

Why was the public option (or Medicare buy-in) always dead in the water?

A clue might be in the fact that President Barack Obama has raised more health care contributions for himself than any other member of the 111th Congress, 1989-2009 (according to Jane Hamsher's research, www.firedoglake.com). 

His grand total is $39,064,681.  His wife is a former Vice President of Community Affairs at the University of Chicago Hospitals and Clinics.  

Senator John McCain is second highest in health care contributions with a paltry $17,803,644; Senators John Kerry third and Arlen Specter fourth. 
 
The best write up on "How health lobbyists influenced reform bill (Former staffers of lawmakers from Harry Reid to Mitch McConnell push clients' agenda)" can be read on my Health Care page or at
www.chicagotribune.com/health/chi-health-lobbyists_bddec20,0,4862599.story.

Our rulers, the lobbyists and the health care providers have made out like bandits and the taxpayers will pay.

Taxpayers have no advocates in government.  We are on our own.

Unless the Tea Party and protest movements grow to include ALL Americans. 


ObamaCare:  "the plan the President wanted all along", Senator Russ Feingold (D, WI)

All the recent independent polls taken show the American public does NOT favour the current (section changes yet to be written) Senate bill since it dropped both single-payer or public option and Medicare buy-in.  The public opposes mandated insurance purchases from private insurers.  Failure to buy is punished by a fine or jail.

The bill delivers a bonanza of 30 million mandated clients to the insurance industry and contains no cost controls.

The Brian J Dorgan (D, NV) bill, which would have allowed Americans to re-import drugs bought by the Canadian government under their lower negotiated rates, was defeated 51-49 after a vigorous White House campaign to prevent it reaching 60 which would have avoided filibuster. 

It is alleged that the White House was trying to protect the deal it negotiated in private with PhRMA to maintain pharmaceutical prices in return for its not opposing the health care bill.

Congressman Michael Burgess (R, TX), who is a doctor and founder/chairman of the House Health Care Caucus, has demanded the White House turn over any written contracts or data on its deal with PhRMA. 

Democrat Henry Waxman (CA), chairman of the House Committee of Oversight and Government Reform, also demanded to see any such documents.

Republican threats of time-consuming procedural moves and filibuster forced Senator Bernard Sanders (I, VT) to withdraw his single-payer bill from having a vote. 

The Republican Senators have opposed all health care reform in a solid block assisted by Senators Joseph Lieberman (I, CT) and Ben Nelson (D, NE).  Nelson demands absolute prevention of any funding for abortions.

Respected Progressive Dr Howard Dean, former Chairman of the Democratic National Committee, called for the bill to be killed or stripped down to its good parts and sent back to the House for conference revision.  He noted that the bill was in no way health care reform.

Representatives of the White House made serious mistakes in calling Dean "insane", "irrational" and a "spoiler" among other things.  Their strategy backfired among Democrats, the public and the media.

Unhappy Progressives who had fought hard for a single-payer or public option with a Medicare buy-in and without a mandate were galvanized into fighting the current bill which they feel conceded too much to the corporate New Dems and Conservative Democrats.

Two of America's largest unions concur with Dean and told President Obama to live up to his campaign promises and send the bill back to the House "or else".

The Senate health care battle has publicly broken open the Democratic Party disputes between the Progressives and the White House over multiple issues including the economy, healthcare, jobs, the Afghanistan war surge, etc.

Game playing and grandstanding in the Senate has soured voters on health care reform and lowered public respect for it to a new low--hard to believe it could have gone lower. 

People across the spectrum believe the system is broken and this Administration is not doing enough to fix it.

The public sees only corporations prospering and gaming the system.  Individuals are suffering without help.

The majority of Americans polled now say they want the current Senate bill killed and, since it is identified in the public mind as ObamaCare, Obama's ratings are suffering badly. 

Three other factors affecting Obama's plummeting ratings are the economy, budget deficit and no jobs--the very issues Obama promised to improve in his Presidential campaign.  

Progressives want solutions that help citizens and do not only benefit large corporations--the crux of their argument against the health care bill and Obama's policies.

It was interesting to see the amount of pressure put on all Senate Democrats to support the bill despite admissions that it is flawed by former President Clinton, the Democratic Leadership Council wing, New Dems, Conservative Dems and the White House spokespersons.

They urge passing it flaws and all as it is our last chance to get health care reform; the flaws can be tweaked later.

Even one of the major stumbling blockers Senator Mary Landrieu (D, LA), who opposed health care reform and received $300 million for her state from the White House to support the new bill, defended the bill by attacking the public. 

She claims that high poll ratings for the public option is simply that "They don't understand they have to pay for it.  They think is free."

In other words, the public is stupid and venal.

She could not explain why insurance and pharmaceutical stocks are skyrocketing since the ObamaCare modifications were leaked to the public since she claims the two industries are still battling against health care reform with a war chest of $600 million.

They are not still battling.  Both industries have exactly what they want with Obamacare--30 million new mandated clients and no cost controls.  Future billions of dollars for $600 million is a really good deal.   

Senate Majority Leader Harry Reid (D, NV) plans on having a vote Christmas Eve on the bill, but lacks 60 Senators at this point to prevent a filibuster.  Lieberman and Nelson are still "no" voters and no Republican will support it.

White House Chief of Staff Rahm Emanuel boasts that all Liberals are on board as they would not dare risk this last chance at health care reform.

If Reid does get the votes to pass the Senate bill, ObamaCare will be sent to the House of Representatives for Speaker of the House Nancy Pelosi (D, CA) to meld it into the House bill early next year.  

The House bill is thought to be better by Dean, the unions and Progressives.  

At this point, Pelosi is the only person who can get an acceptable health care bill passed.  

She has also put the President on notice that he will have to "convince" her to support his requests for money to pay for the Afghanistan war surge. 

All Democrats are relying on Pelosi to get their programs through and Progressives/Liberals hope she will exact a price on their behalf. 

Fortunately, her political skills are growing and may match those of the sorely-needed late Speaker and President Lyndon Baines Johnson. 

The honeymoon is over for President Obama.


Lieberman, 'de facto' President of the USA

Living in London, I have clearly missed a critical national election or several extraordinary interim appointments of individuals empowered to act as President of the USA in his absence. 

Many reliable sources have verified that the White House (muscleman Rahm Emanuel) has ordered the Democratic Senate Majority Leader Harry Reid (NV) to give Independent Senator Joseph Lieberman (CT) whatever he wants in the health care bill to get it passed. 

Giving Lieberman what he wants means removing any link to Medicare, a public option or, in fact, any health care bill which does not significantly increase the profits of the insurance industry which he represents.

This shameless senator and his wife openly tout their lobbying and contributions from the CT insurance industry.

Evidently, the Senate ethics rules do not apply to this Senator who gives "corruption" a new meaning. 

The Connecticutt Democratic Party purged Lieberman for not representing their state and party.  He ran as an Independent and was elected. 

Over 80% of 'polled' national Democrats want Lieberman removed from the Democratic Caucus and disciplined for his wrecking tactics.

The President has refused.  In fact, he appears to have appointed Lieberman the 'de facto' President of the USA.

And I thought Sarah Palin was our only "Being There"*.



www.chicagotribune.com/health/chi-health-lobbyists_bddec20,0,4862599.story

chicagotribune.com

How health lobbyists influenced reform bill

Former staffers of lawmakers from Harry Reid to Mitch McConnell push clients' agenda

Search our database to see who had the most influence on the health care bill

By Andrew Zajac, Tribune Newspapers, December 20, 2009

WASHINGTON

David Nexon had a big problem. An early version of national health care legislation contained a $40 billion tax aimed squarely at members of the medical device trade association he represents.

Nexon, a former adviser to the late Massachusetts Sen. Ted Kennedy, went to work. He marshaled 14 people like himself -- lobbyists who were once congressional aides, many of them from staffs of congressional leaders or committees that had a hand in crafting the health care overhaul.

When Senate Democrats unveiled their bill in mid-November, Nexon's handiwork was evident. The tax on device-makers was still large -- $20 billion -- but only half what it might have been without the efforts of Nexon and his fellow lobbyists.

Nexon's team is an illustration of how deeply the health care industry has embedded itself on Capitol Hill, using former aides of lawmakers and ex-lawmakers themselves.

An analysis of public documents by Northwestern University's Medill News Service in partnership with the Tribune Newspapers Washington Bureau and the Center for Responsive Politics found a revolving door between Capitol Hill staffers and lobbying jobs for companies with a stake in health care legislation.

At least 166 former aides from the nine congressional leadership offices and five committees involved in shaping health overhaul legislation -- along with at least 13 former lawmakers -- registered to represent at least 338 health care clients since the beginning of last year, according to the analysis.

Their health care clients spent $635 million on lobbying over the past two years, the study shows.

The total of insider lobbyists jumps to 278 when non-health-care firms that reported lobbying on health issues are added in, the analysis found.

Part of the lobbying pressure on current members of Congress and staffers comes from the powerful lure of post-congressional job possibilities.

"There's always a worry they may be thinking about their future employment opportunities when dealing with these issues, particularly with health care, because the stakes are so high and the breadth of the issues -- pharmacies, hospitals, doctors," said Emory University political scientist Alan Abramowitz.

Lobbyists' earnings can dwarf congressional salaries, which currently top out at $174,000 annually for lawmakers and $156,000 for aides, though committee staff members can earn slightly more.

In the health care showdown, insider lobbying influence has magnified the clout of corporate interests and helped steer the debate away from a public insurance option, despite many polls indicating majority support from Americans, according to Rutgers University political scientist Ross Baker.

"It imposes a kind of conservative bias on the discussion," said Baker, himself a former Senate staffer.

The lineup of insiders working for clients with health care interests includes at least 14 former aides to House Majority Leader Steny Hoyer and at least 13 former aides to Montana Democratic Sen. Max Baucus, the chairman of the Finance Committee and a key overseer of the health care overhaul.

Nexon, who is now senior executive vice president of the Advanced Medical Technology Association, is among at least a half-dozen former Kennedy aides lobbying on health care.

Nexon acknowledged the value of congressional connections, "but in the end, it's not who I know, it's what I know."

It makes sense to hire former staffers for the health care showdown because they tend to be "more generalists, dealing with a broad range of issues," something that is in demand for legislation that sprawls across at least a half-dozen federal agencies and encompasses issues ranging from tax policy to hospital reimbursement rates, according to Nexon. But specific issues also get specialized help. Earlier this year, the Christian Science Church hired a former Kennedy staffer, Carolyn Osolinik, and three of her colleagues at the Mayer Brown law firm, all veterans of Capitol Hill. The firm has been paid at least $110,000 so far to push a provision requiring insurers to consider covering Christian Science prayer treatments.

Phil Davis, a senior official of the church, said the church wanted access to decision makers. "The noise level goes sky high. It's hard to get in to talk to people," he said.

The largest insider lobbying cadre belongs to the Pharmaceutical Research and Manufacturers of America, or PhRMA, which employs at least 26 former congressional members and staffers, according to Medill/CRP research.

Two other drug interests, biotech firm Amgen Inc. and the Biotechnology Industry Organization trade group, with at least 24 and 16 insiders respectively, ranked second and fourth among reported hiring over the past two years of lawmakers' former staffers and members of committees considered in the analysis.

"The numbers shouldn't surprise anyone," said Ken Johnson, a PhRMA senior vice president. "Former staffers have a unique understanding of how the legislative process works. And when you are trying to advocate on behalf of smart public policies, you want smart people on your team."

But Bob Edgar, president of Common Cause, a nonpartisan, nonprofit watchdog group, had a harsher assessment, blaming "a toxic cocktail of insiders and money" for short-circuiting a government-run plan that would have competed with private insurers.

"We'll get a bill. And the president will sign it. But it'll be less than the country deserves," said Edgar, a former six-term member of the House.

Health care lobbyists increase their effectiveness by strategically targeting their campaign contributions or the donations of the interests they represent, Edgar said.

Health industry contributions to congressional candidates have more than doubled so far this decade, rising to $127 million in the 2008 election cycle from $56 million in the 2000 election, with disproportionate sums going to the party in power and to members of committees that oversee health care, according to the Center for Responsive Politics.

But lobbyist and former Kennedy staffer Andrew Rosenberg said political conditions, not big money or the predispositions of lobbyists sidelined a public option.

"You could see this coming from a long way off. The Democratic Party is now the big tent party. They have to get to 60 votes. That is the reality," Rosenberg said. "It was going to have to be something that appeals to moderates" opposed to expanding government-run health insurance.

Tribune Newspapers' Tom Hamburger and Joe Markman contributed to this report.

azajac@tribune.com

Copyright © 2009, Chicago Tribune


Leaderless:  Senate Pushes for Public Option without President Obama's Support

by Sam Stein and Ryan Grim of HuffPost

President Barack Obama is actively discouraging Senate Democrats in their effort to include a public insurance option with a state opt-out clause as part of health care reform. In its place, say multiple Democratic sources, Obama has indicated a preference for an alternative policy, favored by the insurance industry, which would see a public plan "triggered" into effect in the future by a failure of the industry to meet certain benchmarks.

The administration retreat runs counter to the letter and the spirit of Obama's presidential campaign. The man who ran on the "Audacity of Hope" has now taken a more conservative stand than Senate Majority Leader Harry Reid (D-Nev.), leaving progressives with a mix of confusion and outrage. Democratic leaders on Capitol Hill have battled conservatives in their own party in an effort to get the 60 votes needed to overcome a filibuster. Now tantalizingly close, they are calling for Obama to step up.

"The leadership understands that pushing for a public option is a somewhat risky strategy, but we may be within striking distance. A signal from the president could be enough to put us over the top," said one Senate Democratic leadership aide. Such pleading is exceedingly rare on Capitol Hill and comes only after Senate leaders exhausted every effort to encourage Obama to engage.

"Everybody knows we're close enough that these guys could be rolled. They just don't want to do it because it makes the politics harder," said a senior Democratic source, saying that Obama is worried about the political fate of Blue Dogs and conservative Senate Democrats if the bill isn't seen as bipartisan. "These last couple folks, they could get them if Obama leaned on them."

But with fundamental reform of the health care system in plain sight for the first time in half a century, the president appears to be siding with those who see the Senate and its entrenched culture as too resistant to change. Administration officials say that Obama's preference for the trigger, which is backed by Maine Republican Sen. Olympia Snowe, is founded in a fear that Reid's public option couldn't get the 60 votes needed to overcome a GOP filibuster. More specifically, aides fear that a handful of conservative Democrats will not support a bill unless it has at least one Republican member's support.

The president's retreat leaves Reid as the champion of progressive reform -- an irony that is not lost on those who have long derided the Majority Leader as too cautious.

"Who knew that when it came down to crunch time, Harry Reid would be the one who stepped up to the plate and Barack Obama would shy away from the fight," emailed one progressive strategist.

On Thursday evening, after taking the temperature of his caucus, Reid told Obama at a White House meeting that he was pushing a national public option with an opt-out provision. Obama, several sources briefed on the exchange, reacted coolly.

“He certainly didn’t embrace it and he seemed to indicate a preference for continuing to work on a strategy that involved Senator Snowe and a trigger,” said on aide briefed on the meeting. Several other sources, along with independent media reports, confirmed the exchange.

Outside Congress, anger trumped confusion. On Saturday, the activist group Progressive Change Campaign Committee - which just days earlier had targeted Reid in a separate campaign - took out a new television advertisement in Maine accompanied by an "emergency petition." Titled, "Time to Fight," the spot featured a former Obama campaign volunteer pleading with the president not to abandon the public plan.

"If this once-in-a-generation opportunity to pass a public option goes down the drain after we were just a couple votes away in each house of Congress, everyone will remember exactly who was and was not willing to fight when it counted," said the group's co-founder, Adam Green, when asked why he aired the ad. "Our grassroots pressure is an attempt to get President Obama to live up to the mandate for sweeping change that was given to him in the 2008 election."

MoveOn.org rallied its base on Friday. "The President has said many, many times that a public option is the best way to keep insurance companies honest and lower skyrocketing health care costs. Senate Democrats are ready to fight for a public option--if the White House gives up now, it would be a tragic mistake," said an e-mail to the group's membership.

White House aides responded to the pressure not by embracing Reid's more aggressive stance, but by denying reports that he was discouraging the opt-out proposal.

"The report is false. The White House continues to work with the Senate on the merging of the two bills," said Dan Pfeiffer, a top White House aide whose portfolio includes health care. "We are making good progress toward enacting comprehensive health reform."

But the push-back, say sources with direct knowledge of deliberations between leadership and the administration, does not square with Obama's private indications to Senate leaders. The sources say that the president has left little doubt about his apprehension with an opt-out approach.

It is not philosophical, one White House aide explained, but is a matter of political practicality. If the votes were there to pass a robust public option through the Senate, the president would be leading the charge, the aide said. But after six months of concern that it would be filibustered, the bet among Obama's aides is that Reid is now simply being too optimistic in his whip count. The trigger proposal, said Democratic aides, has long been associated with Chief of Staff Rahm Emanuel.

"He's been so convinced by his political people from the beginning that we can't get a bill with a public option, he's internalized it. Even though it's now become obvious we can get a bill without selling out the public option, he's still on that path," said a top Democratic source. The White House, he said, continues to assure progressives it'll improve the bill in conference negotiations between the Senate and House, but advocates are unconvinced.

"If we're this close in the Senate and they're not helping us, I have a feeling they could screw us in the conference," said one.

Advocates of a public option consider a "trigger" the equivalent of no public option at all. A trigger would implement a public option only if insurance companies failed to meet certain benchmarks over time and it would only be implemented in the regions of the country where those benchmarks weren't met. The Medicare prescription drug proposal passed in 2003 includes a "trigger," but the public provision has never been activated despite soaring drug costs. The industry can help craft the trigger language and can game its stats to prevent it from becoming reality.

"The current state of our health system should be trigger enough for anyone who's paying attention," said a congressional aide in the middle of the health care battle. "The American people pulled the 'trigger' in November."

The intellectual father of the public option, Yale Professor Jacob Hacker, told HuffPost that the trigger proposal is a betrayal.

"The trigger is an inside-the-beltway sleight of hand that would protect private insurers from the real competition that a strong public health insurance option would create," he said in an e-mail. "It is unworkable in the current Senate bills, unwise as public policy, and unwanted by the substantial majority of Americans who say they want a straight-up public option."

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