When Waxman CAVED, & STRIPPED "Pub Opt" of MEDICARE RATES, he KILLED "REFORM" as defined by H. Dean

[Faryn Balyncd]

Lost in the hype of Waxman's deal with the Blue Dogs is the sad reality that the "public option" that was "saved" has been gutted.


What is left is a "public option" in name only:


But it no longer offers a route for Americans to buy in to a system based upon fair MEDICARE PRICING, and it no longer can be a force which will force insurance companies to lower prices.


The now gutted "public option", rather than forcing insurance companies to be competitive, now serves to create the OPPOSITE effect: Since the deal with Blue Dogs forces the "public option" to ABANDON Medicare pricing, and instead use higher rates based on what insurance companies "can compete with" the "public option" (coupled with the mandate to purchase) now serves to SOLIDIFY THE INSURANCE CABAL, not to force insurance companies to become competitive.


MEDICARE RATES in the pricing of services was quite simply the economic heart of the issue.


The fact that until NOW (Waxman's cave-in to the Blue Dogs) the "public option" has been based on Medicare rates is what gave it the power to force the insurance/medical complex to become more efficient instead of steadily eating up an ever increasing % of our GDP.


And the fact that until now, the "public option" was based on MEDICARE RATES was the only thing that qualified it as REAL REFORM, according to the simple and valid definition given by none other than Howard Dean.


Several months ago, Dean made this simple statement:

"...health insurance reform. . . . rises and falls on whether the public is allowed to choose Medicare if they’re under 65 or not. If they are allowed to choose Medicare as an option, this bill will be real health care reform. If they’re not, we will be back fighting about it for another 20 years before somebody tries again."

- - - Howard Dean

http://wonkroom.thinkprogress.org/2009/02/24/dean-public-option/

Until Waxman caved & allowed the Blue Dogs to gut the public option on the alter of Big Insurance, the "public option" would have given every American the right to buy in to a plan BASED UPON FAIR (MEDICARE) RATES. The fact that the "public option" would not have been called "Medicare" is irrelevant because it would have allowed every American to opt in to MEDICARE PRICING: specifically, to purchase insurance with low administrative overhead at prices based on reasonable & customary Medicare fees.


All this is now gone.


Stripping the Medicare fee schedule out of the so-called "public option" is not a minor technical detail. Rather, as Rep. Lynn Woolsey points out, it rips out the public plan's economic heart.










"Public Option" R.I.P.








Shame on you, Henry Waxman! The "progressive backlash" you are now seeing, is not something to be mollified. You need to listen, to look into your heart for your own values, and you need to restore Medicare pricing.


Healthcare "reform" with a toothless, token "public option" forced to play by rules designed, not to address our problems but to protect the insurance cabal, is not worthy of the name "reform", and not worthy of the support of our party and our nation.


Restore a real Public Option now, Henry Waxman!!!










:kick:

[Teaser]

1. well, since Dean's definition isn't mine

I'm not really all that upset.

[George II]

44. Me neither - I like Dean very much, but he's not the be-all and end-all on Health Care!

[sharesunited]

2. What about fair Medicare reimbursement rates?

If you think premiums which Medicare charges insureds are fair, what do you think of the rates at which Medicare reimburses providers?

[RB TexLa]

4. No one has to accept medicare, if they don't like the reimbursement, don't sign up.

Of course many of the doctors and facilities that do accept medicare do so because they are going to defraud the plan for as much as they can get above the normal payments.

Whether it's from insurance companies or the government, doctors are going to steal as much as they possibly can.

[George II]

45. That's a positive outlook, isn't it? .....

...the obvious conclusion of yours is that all doctors are frauds? Are you a lawyer?

You simple, narrowminded one-dimensional statement about payments is insulting. Your similar statement about stealing is as bad.

I wonder how many rules of DU you violate in your 2 sentence post?

[shireen]

56. are you serious?

Doctors deserve to be paid well. Like any profession, some are greedy. But for their services, and for compensating the people they employ, they deserve a good wage.

[Faryn Balyncd]

5. Those are the rates I'm talking about, & I am speaking as a physician:

I have made, and make, my living as a provider. But the fact is that current medical pricing is irrational, unfair, not conducive to optimal health, and damaging to our overall economy. (In many cases, it is predatory.... and a disgrace to free enterprise.)


We cannot afford to continue on the path of ever increasing medical costs.


The only way premiums can be reasonable is for ultimate costs at the provider level be reasonable.

[sharesunited]

9. Why are you so confident that Medicare reimbursement is fair and not below market price control?

I think we ought to be continually fighting to ensure that Medicare reimbursement rates really are fair.

But if they are just being arbitrarily set on the pretext of controlling costs, that will surely cause providers to opt out of the system.

Also, why would below market reimbursement rates through the public option be unwelcome by for-profit insurers? Wouldn't it make their private policies more desirable because they would be more widely accepted by providers?

[Faryn Balyncd]

14. Medicare rates aren't perfect. But here's an example of why they're better than insur. cabal rates:

This is an example of the arbitrary, irrational pricing that exists in our current system:



A friend has an outpatient thallium stress test. The patient was insured, with a high deductible policy, having been denied other insurance.


The test utilizes a treadmill for perhaps 15 minutes, a scanning machine, and requires an infusion of contrast.


The $1100 Medicare reimbursement (for the technical part of the proceedure alone) is adequate that many entrepreneurs would be anxious for the business. (One could pay a return on capital of 3x the return on the S&P, pay off the equipment in under 12 months, pay the tech's $150/hour, and repair-people $500/hour, house your scanner in the most expensive real estate, and still make a profit 3 times what any primary care physician makes.)


Excluding some HMO's which negotiate prices close to the Medicare rate, prices approved by insurance companies for this proceedure in this geographic area arbitrarily range from $1755 to $6375. "List prices" charged by 6 hospitals in this area range from $2341 to $7100, though in each of the 6 hospitals surveyed, the hospital would accepted the insurance insurance negotiated rate as full payment (with the patient paying the deductible).


This friend's insurance approved a price of $6375 for the proceedure, applied it all to the deductible, resulting in the patient being billed $6375. Meanwhile, other facilities were happily making profits charging other insurance companies as low as $1755.


For the most part, insurance companies have been happy to pass along a great deal of egregious charges, and simply raise premiums.


All of these prices are regarded as proprietary information, and not readily shared with the patient. (You might imagine how difficult it was to obtain this data.) This makes informed decisions about purchasing insurance very difficult. (Just try calling a hospital and asking them for a price lists A, B, C, D that shows what you will be charged should you choose to purchase insurance from Company A, B, C, or D. They won't give it to you. They will ask you what you have, keep you in the dark, and then give you an arbitrary bill. If you don't have insurance, they may offer you 20% off, even though they might give 60% off to some of their 3rd party payers.)


My point is that in the above example, the Medicare price was more than fair to the provider. To the extent that Medicare payments call for being changed, it would probably make sense to pay higher rates for low tech primary care, and less for high tech imaging.


Secondly, the insurance companies have not even been an adequate check on egregious pricing, simply taking the lazy way out and passing on the egregious charges in higher premiums. Medicare has been the greatest single influence on RESTRAINING excessive fees even as it provides cae to millions that would otherwise not have afforded it.

[sharesunited]

15. Wow, I had this completely backwards. I thought providers overcharged

so that a fractional reimbursement would get them something resembling fair compensation.

A public option adhering to the Medicare reimbursement schedule would therefore (1) improve pricing transparency and (2) discourage overcharging, making it more difficult to (3) pass on the cost of unconscionable profits taken by unscrupulous providers in the higher premiums charged by the insurers who enable them.

Thanks for the lightbulb moment!

[mmonk]

20. Yep.

[Laelth]

41. Thanks for that example.

What you describe is truly evil.

:dem:

-Laelth

[Amos Moses]

42. thank you

That was a very informative post. :thumbsup:

[Lasher]

50. Thank you for the insight.

Might email this around to my GOP friends who love efficiencies of the private sector.

[Faryn Balyncd]

3. This is the equivalent of dis-allowing the negotiation of drug prices in the Bush Rx Drug "benefit"

(which was followed by the largest increases in prescription drug prices in history)

[foginthemorn]

22. Well, the OBAMA WH has done the same a few weeks ago as

they promised the drug companies they would not push congress to negotiate lower rates. Yes they did. it was in the 'deal' the WH made with drug companies.

[debbierlus]

49. Say it ain't so - Obama representing corporate interests above the people

I am shocked.

:dem:

[Pirate Smile]

6. When they merge the three House bills, can't they stick it in from one of the other two?

[rhett o rick]

54. Yes, but the point is that our people are letting the blue dogs and repukes force

us into more and more compromises. I say take a stand.

NO BILL WITHOUT A STRONG PUBLIC OPTION. NO COMPROMISE.

[xchrom]

7. just don't think that what waxman did was a surprise to the white hous or

the leadership in the senate.

whether we like it or not -- these things happen with nods, winks, and full on agreements.

[RandomThoughts]

8. If they get rid of a strong public option, people are screwed.

And a little hint, actually we wont be fighting for medicare in 20 years. heh...


Can anyone guess how much national sickness would it take to completly break the insurance companies and force a fix to the system?

How much economic colapse will it take to fix wall street?

How many candies are in the jar?

whats your guess?

On the bright side, if nothing else, the news will at least get really exciting. If that article was true.

[rhett o rick]

55. Depends on your definition of "fixed". nm

[RandomThoughts]

58. I agree, there are three definitions of 'Fix' that could apply

Very good point.

I use fix instead of solve for a few reasons. First I try to avoid the use of the word solve since some people, and for understandable reasons, have a negative response on that word, the word solve had a great deal of negative added for some people. There is a flinch from just hearing that word or reading it.

So fix seemed better, plus it has the duality of context you mentioned, and also a third context of 'of ending somethings house if shown bad' which is interesting also.

[alfredo]

10. We still have the public option, but it is closer to the PO in the Senate.

http://tpmdc.talkingpointsmemo.com/2009/07/house-retains-public-option-in-compromise.php?ref=fpblg

After a week or so of canceled hearings, the Energy and Commerce Committee will continue to mark up House health care legislation this afternoon, and pass a bill by the end of the week. On substance, the exemption from penalties for small businesses that do not provide health care to workers has been raised to include small businesses with payrolls of $500,000 per year or less. Originally the bill called for the exemption to apply only to businesses with payrolls half that size.

The public option hasn't gone away, and remains in tact. Now, though, instead of being directly tied to Medicare, the rates will be negotiated by the Health and Human Services secretary--a provision which at a glance seems similar to the public option the Senate HELP Committee endorsed. States will be able to erect health care co-operatives if they choose, but that would be in addition to the public option.

The Blue Dogs managed to pull $100 billion in savings from the bill by lowering by one percent the rate at which people living between 300 and 400 percent of the poverty level will be subsidized to buy health care in insurance exchanges--they had originally tried to eliminate that bracket entirel

[bvar22]

11. It is a lttle worse than that.

The "Public Option" as specified in HR 3200 was NEVER open as a "choice" for ALL Americans.
By design, it was severely limited, and according to the Congressional Budget Office, would have an enrollment of LESS than 10 Million by 2019.

That is laughable.
ALL Americans MANDATED to BUY Health Insurance, and LESS than 10 Million in the "Public Option" after 10 years?
Thats NOT going to "force down prices" or "keep the Health Insurance Industry Honest".
SCAM from the get go.

Thank GOD for the Progressive Caucus, and FUCK Rahm and the DLC.

[eomer]

18. I believe the public option *is* open to everyone in HR 3200.

But maybe I'm reading it wrong. What provision are you reading to reach your conclusion?

[dflprincess]

34. It will not be open to everyone immediately.

Large employers will not have access for several years and their employees will not be able to choose the public option over whatever crap for profit insurance is being offered through their employer (remember, the bill requires you to have insurance so you will have no choice but to continue to pay the for profits). Small employers will also be phased in over the first few years. I believe the first year only employers with 10 or fewer employees will be let in, the next year 20 or less.

As Bvar22 noted - it is the Congressional Budget Office that is estimating it will only be covering 10 million people ten years from now. It took 11 months to get Medicare up and running - this mess will take years.

The bill is a gift to the insurance companies.

[eomer]

38. OK, thanks, but do you read it to say any individual can opt out of their employer's plan?

For individuals, HR 3200 says anyone who is not enrolled in any other plan is eligible to go to the exchange and on the exchange the public option would be one of the choices. So couldn't anyone opt out of the employer plan and choose the public option?

I assume that a person opting out like that would forfeit the employer's contribution so that might make it not the most economical choice, but besides that issue it is still an available option.

Do you disagree with how I read it?

[dflprincess]

39. I do. Everything I've read indicates that it will be years (at best) before

an individual could opt out of the employer's plan to take the public one. Anyone whose employer offers a plan will have to stick with that even if it is worse than the public option (which is bad enough).

[Lasher]

46. That sucks.

My retiree medical gets worse, with higher deductibles, premiums, and copayments every year. But that's OK, this is justified by perpetually longer waiting times and fewer choices when medical attention is needed.

[OHdem10]

12. Dean is the only honest one left. Let's just pass a Republican Bill

and stop fighting. The Conservatives win another round.

[dflprincess]

16. Let's not pass anything and come back to fight another day

If they pass something now, it will get slapped with a "reform" label and we'll get told to STFU because we were "given" reform. We won't get Congress to revisit the issue for years.

Better the devil we know - which will fail on its own before too long. Unless we're forced to artificially prop it up with mandated premiums. This is a lot like the 401k scam.

[Faryn Balyncd]

17. You're right. Not only that, but "reform" will get blamed for the consequences of a corporatist....

.....bill.


When people end up paying twice the present cost of insurance to either the insurance cabal or to a crippled "public option" and the federal deficits keep rising and American business unable to compete, the right wing will blame it on "reform", even those it was a corporatist pseudo-"reform".

You're right that it would be far better to pass nothing.

[foginthemorn]

23. I am beginning to think that way also.

[SammyWinstonJack]

30. Right!

:thumbsup: Prop up the health insurance racketeers before they fail? I bet that is the plan. x(


Played again. :argh:

[lumberjack_jeff]

32. What other day?

Here's how that scenario will play out;
Having failed to deliver any kind of reform, Obama wins a close election in 2012 against a surprisingly strong GOP candidate who ran on his "victory for america" by opposing icky, icky, terribad healthcare reform. Congress was not so lucky, the new GOP majority wants nothing to do with effective reform. The 2016 election sees a new Republican president who successfully ran on medical reform implemented through tax credits or some individual-responibility-stupid-medical-ira shit. He coasts through his first term with the help of a couple of minor crises. Best case scenario, if he's even a worse fuckup than GWB, we get another opportunity to try healthcare reform in 2020... but more likely 2024.

Good luck with that, I hope you're young because 20% of your fellow DU'ers will be dead by then.

Door #1 is win. Door #2 is fail.

We need to push the best possible form of reform this time 'round and work to improve it in subsequent years.

My preference is medicare rates, but if the Director of HHS is negotiating pricing, it's still pretty good. Besides, one of the gripes that DU'ers have of this plan is that providers won't be "compelled" to to take the private insurance. Setting aside the involuntary servitude option, I don't see any good alternative to establishing reimbursement that the provider will accept.

[dflprincess]

35. If HR3200 or anything similar to it is passed all it will do is give Congress

the chance to claim they've passed "reform" when all they've done is protect the for profit health insurance companies.

This bill still requires high out of pocket expenses and potentially high premiums be paid by us and will not improve access to health care.

The CBO says only 10 million will be covered by the public option by 2019. A lot of people are going to die waiting for the public option to be expanded to them and a lot will die because they put off seeing their doctor because they still can't afford the out of pocket cost. Meanwhile, the insurance companies will be posting more profits.

If this faux reform passes, we know we won't get another shot at it for years. We might get somewhere if it doesn't pass and Obama & corporate stooges in Congress figure out their jobs might be in jeopardy.

[lumberjack_jeff]

36. If it doesn't pass, their jobs aren't "in jeopardy", they are gone.

The factual inaccuracies aside...

Even if the repuke replacements had some inclination toward reform, they wouldn't touch it with a 10 foot pole because their predecessors will have been evicted by insurance companies, with your help.

You are doing the progressive cause no favors.

Win. Lose. Pick only one... "none of the above" or "I'm holding out for a pony" is a vote for lose.

If you win, you get to run things. If you lose, the enemy runs things.

[dflprincess]

37. We did win - apparently this is how the Democrats run things

and they're really bad at it. They seem to be doing their best to prove that when it comes to protecting the status quo there really is no difference between the parties (except the Democrats will pretend to be your friend and then pull a bait and switch while the Republicans just flat out let you know you're less than dirt to them).

Bills that don't start covering the uninsured until 2013 are worthless (and both the House bill and Kennedy's bill have these provisions). It wouldn't take 4 years to get this up and running if they weren't more interested in protecting they're campaign treasuries.

I don't want a pony - I want access to health care - not access to a for profit insurance plan. If it has to be done in increments then pass a bill the extends Medicare to everyone over the next few years but stop farting around pretending the insurance companies are our friends.

BTW what inaccuracies are you referring to? The out of pocket expenses or the CBO's estimate on how few people will be covered by this insurance plan by 2019? I'd just love to hear more about how incredibly wonderful this gift to the insurance companies will be be for all of us.

[MarjorieG]

13. Competitiveness worth making noise about. May be a few ways to do it.

I also think this is sausage, and yet to be conferenced. This was also cover for Blue Dogs.

That's me being positive for tonight.

[Vinca]

19. If there isn't a competitive public option - at the very least -

this whole exercise isn't worth the paper it's printed on. If these people were truly working for the most fiscally conservative plan, they'd be talking single payer. The current plan is meant to keep the campaign coffers filled with checks from big insurance and that's about it.

[foginthemorn]

21. Once more we are betrayed.!!

[SammyWinstonJack]

31. Sure looks that way.

x(

[pinto]

24. It's my understanding that Waxman's agreement was to allow H&HS to set reimbursement

rates, instead of directly tagging them to existing Medicare reimbursement schedules. This may not in itself be a problem. H&HS sets Medicare reimbursement rates as is.

Interestingly, it actually oversees the process which is contracted out (on the West Coast)to Palmetto GBA, a wholly owned subsidiary of Blue Cross/Blue Shield.

Palmetto GBA administers Medicare health insurance for the Centers for Medicare & Medicaid Services (CMS). We have been a Medicare contractor since the inception of the program in 1966 and provide service throughout the United States and its territories. Palmetto GBA is a wholly owned subsidiary of BlueCross BlueShield of South Carolina and is based in Columbia, South Carolina.

Palmetto GBA is a "Medicare Administrative Contractor".

http://www.palmettogba.com/PALMETTO/PALMETTO.NSF/DocsCat/Home

Medicare Administrative Contractors

New contract entities called Medicare Administrative Contractors (MACs) are replacing Medicare’s 48 current claims payment contracts known as fiscal intermediaries (FI) and carriers. In California this change means Palmetto GBA, the new MAC covering Part A and B claims (A/B MAC), will replace National Government Services (NGS), our current Part A fiscal intermediary by August 18, 2008 and National Heritage Insurance Company (NHIC), our Part B Carrier by September 2, 2008. Noridian Administrative Services (NAS) has already been serving as California’s durable medical equipment (DME) MAC since January 2006.

This change over to MACs, required by Section 911 of the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA), is streamlining Medicare’s number of contractors from 48 down to 23. The 23 MACs include <snip>

more info at CA Health Advocate's website:

http://www.cahealthadvocates.org/news/basics/2008/23new.html

[Faryn Balyncd]

25. This is Woolsey's take on the consequences:

The weakening of the public option incensed some liberal Members, with Congressional Progressive Caucus Co-Chairwoman Lynn Woolsey (D-Calif.) declaring she would vote against it.

“It has to be much stronger to get our support,” Woolsey said after a meeting with Speaker Nancy Pelosi (D-Calif.), who tried to sell them on the deal.

Woolsey said progressives fear that without using Medicare rates, the public option will not be able to hold down costs and force savings from private insurance companies. She said that was “great for the insurance companies” and would allow them to keep doing business as usual.

Woolsey said members of her caucus would meet at 6 p.m. to discuss their response to the deal.


http://www.rollcall.com/news/37359-1.html?type=printer_friendly

I hope your view is correct.

[lumberjack_jeff]

33. So she's saying this without having spoken to the rest of the caucus?

Presumptuous, is one way to describe this.

[WilliamPitt]

26. Shame on Waxman?

At least he tried.

Shame on the Blue Dogs.

[Faryn Balyncd]

27. no argument

Waxman's heart is in the right place.

[cadaverdog]

51. Wow. Waxman is one of the good guys and this group is ready to

throw him under the bus. I guess all those years of fighting the good fight don't amount to much around here.

Anyway, earlier this evening I spoke with a very nice lady in Waxman's Washington office, and expressed some of the same concerns that have been mentioned in this thread, and she spent a goodly amount of time with me, and basically said we need to move this forward, even in its less-than-perfect form, and as has been explained here, there will be room for "fine-tuning" as the initiative process runs its course. I don't want to go into more detail of our conversation, because I wasn't taking notes and I wouldn't want to attribute something to her that wasn't absolutely verbatim, but I did come away from our conversation feeling better about the future.

(I wasn't prepared to take notes because usually the phone conversation with these folks is nothing more than "What's your beef? Where you calling from? Thanks, I'll pass it along to him/her. Goodbye." Kudos to this nice lady for the time she gave me.)

[dionysus]

28. what is it about changing the bills in conference that you don't understand?

[Faryn Balyncd]

29. Well, I do understand that bills often get worse in conference. . . . .

(But I guess you're suggesting that I exchange my glasses for som somewhat more rose-colored.)

I hope your optimism is warranted.




(The fact that conference will be with a Senate that will likely have a far more corporatist might suggest conference might not be the best place to fix problems in the House bill, however.)

[Laelth]

40. Well said. And kudos the the Honorable Lynn Woolsey and the Progressive Caucus. k&r n/t

:dem:

-Laelth

[George II]

43. Who gets to create the definition of "REFORM"? ....

....and what's up with all the extra blank lines? You don't get paid by the number of lines in your post.

[backscatter712]

47. Don't panic - HR 3200 will be fixed.

First things first, get that bill out of the Energy & Commerce Committee, and out of the paws of Mike Ross and the rest of the Blue Dog Democrats.

With the response of the Progressive Caucus, it's a certainty that the bill will be fixed when the 3 committees's bills get merged, and when they get amended on the floor.

[redqueen]

57. Thank goodness the progressive caucus is supporting Obama's goal.

Hopefully we'll see some good ads while they're on their break, and their constituents flood them with all the support for a public option that we see in the polls.

If constituents do their jobs in Aug we might actually get a decent bill.

[debbierlus]

48. And, Obama proclaimed this deal 'progress'.

[Iwillnevergiveup]

52. TOMORROW there's a Vote on HR 676 Single Payer

See thread under "General Discussion" for details.

[rhett o rick]

53. My message to my con-critters, "Do not accept any compromise without a STRONG public option.

I would rather have nothing. We compromised and gave up single-payer, that's far enough. NO MORE COMPROMISE.

I we can't get a decent bill, let it fail.