Health Care Meeting: Expert Updates, Reaction And Analysis

Health Care Meeting: Expert Updates, Reaction And Analysis

The Huffington Post asked a variety of health care experts, bloggers, members of Congress and progressive activists to weigh in on Thursday's health care summit in Washington where President Obama will be joined by Democratic and Republican congressional leaders to discuss health care reform. Their thoughts will be regularly posted below.

From Merton Bernstein at 9:00 PM: Final Thoughts

The President is a master of debate and lucky to have the opponents that he has. He won on points, but one had to sit through the whole affair, which most of the American public did not. I was not heartened by the commentary on the various channels carrying the summit. It certainly mirrored the predilections of the commentators -- most notably David Gergen. So, what the public hears will not fully reflect what was said.

Given that the President won on points, that does not cure the basic mis-design of the bill -- the combination of mandate and very expensive subsidies to (it's claimed) make the resultant pack age affordable.

When the Congressional Budget Office gave a tentative cost estimate of the HELP bill, the negative reaction caused the sponsors to reduce both eligibility and the size of the subsidies. That indicates that neither element had been tested for adequacy. Whether the recent sweeteners of subsidies goes far enough requires analysis that I have yet to see.

Sen. Baucus said that everyone knows of the variation in prices charged by providers. Perhaps.

How many know that health care providers had a variety of rate schedules that reflect whether the patient has insurance and with whom and what plan of the insurer. There are 5700 or so hospitals. Hospitals have multiple rate schedules -- often as many as 100 or even 150 or more. So provider clericals have to match thousands of rate schedules with a billion and a quarter bills a year. In contrast, Medicare is organized into 15 regions and prices are made uniform by billing areas. The price schedule in each billing area reflects the costs that providers have in those areas. The simplicity of that arrangement results in far lower rates for Medicare-covered procedures than the very same privately insured procedures -- for which there are numberless variations. So clericals do not develop -- the expertise and speed and accuracy they achieve with processing Medicare bills.

The amounts involved are huge - $300 billion according to a McKinsey Magazine a June 2007 article. That article found the private insurer processing wasteful and inefficient.

Had the President started with Medicare-for-All, the cost of covering everyone would be markedly lower. Under the President's proposal, coverage had to be sacrificed because of cost. With hugely lower costs coverage for everyone would me more manageable.

Still, the Obama bill has several important improvements over current arrangements. Too bad, the opportunity was lost for doing the job better.

--Merton Bernstein, Walter D. Coles Professor Emeritus of Law, Washington University

From Ellen Shaffer at 8:32 PM: Final Thoughts

First of all, kudos to Lynn Woolsey, Barbara Lee and the Progresive and Black Caucuses for presenting just the right statement on the public option; to HuffPo for giving it (and us) space; and to the 1.2 million people who stood up in one day(!) around the country yesterday for comprehensive reform. All this certainly paved the way for final statements by Murray and Pelosi on the public option.

The upshot? Obama's time line - up to 6 weeks - to resolve all this was worrisome, if he meant to suggest this could drag on through Easter recess. But on the whole, I think it was a careful and methodical dismemberment of every Republican argument and proposal. After both sides agreed that it was imperative to do something about the health insurance crisis, and almost 5 hours of discussion, Boehner retreated back into the standard Republican tropes and misrepresentations. It left the President sounding like the soul of reason and consideration in stating that he could not settle for a Republican plan that made no progress and would at best cover 3 million of the 45 million uninsured. He outlined places where the Democrats had already compromised (no public option, allowing insurance companies to trade across state lines, within the context of a national exchange), and offered a few weeks for the Republicans to consider if they had actual compromise proposals. But he made a firm commitment to move forward if the two sides could not agree soon. It made the reconciliation process, with a 51 vote majority, seem like a desirable process, and perhaps one the country would do well to rise up and demand. It is clearly the moment for the public to continue the drumbeat.

-- Ellen Shaffer, Center For Policy Analysis

From Digby at 5:56 PM: Final Thoughts

As a good liberal political junkie I watched the summit today and saw Democrats staying within the bounds of reality in discussing the various ideas on the table and I saw the Republicans making things up. The president was in command of the facts, competently defended the Democratic position and successfully batted back many of the GOPs misrepresentations. The Republicans were effective in repeating their usual talking points and non-sequitors.

However, if I were to tune in to this summit without having a fairly good grasp of the politics in play, I'm afraid I might come away from it thinking that both sides are equally earnest in trying to fix the problems with our health care system and they both have equally good ideas. After all, they told us that all day and the picture of these people all sitting around a table politely exchanging ideas creates that appearance. But the fact is that the substantive disagreements between the two parties represent more than an abstract philosophical difference of opinion. They represent a hardcore, political impasse.

Much, as always, depends on how the media chooses to frame this summit, but I'm afraid that many people are nonetheless likely to be left with the impression that problems passing this bill are the result of Democrats refusing to put all these neat Republican ideas into the mix --- and if they can just agree to do that, we can all hold hands and sing kumbaaya. This is, of course, nonsense. Republicans do not want to pass any health care reform that will be signed by President Obama and even if he agreed to implement their ideas in whole cloth and call it day, they still wouldn't vote for it. In fact, even if a Republican president were in charge, conservatives of both parties don't want health care reform except to the extent it reduces the current inadequate safety net and loosens existing regulations. They basically say that the answer to this problem is to eliminate physician liability, allow people to buy insurance across state lines, require Americans to get healthier and make them shop around for cheaper services in order to bring down costs. There's really not much more to it than that. (Senator John Barasso, a medical doctor, even said that patients who have only catastrophic insurance are the best patients because they have to consider whether or not they can afford tests when they get sick.)

The fact remains that Republicans and certain conservative Democrats are bad faith players in this process. They have no serious plan to fix the health care system but this summit's optics may have led people to erroneously believe they do. And rather than helping speed the momentum to pass the plan through reconciliation by sharpening the differences, I am afraid that this meeting may have slowed it down. And that may, unfortunately, lead inexorably to "Plan B."

We'll have to wait to see what the mainstream media highlights to know if the unctuous disingenuousness of the Republicans will be obvious for all to see. Let's hope so.

From Darcy Burner at 4:57 PM: Pelosi Goes For The Public Option

It's saying something about how well the grassroots demands have gone that both Senator Patty Murray and Speaker Nancy Pelosi are explicitly championing the public option.

It's not dead yet.

-- Darcy Burner, Progressive Caucus Policy Foundation

From Merton Bernstein at 4:39 PM: Conrad's Assertion On Saving Great Sums

Senator Kent Conrad asserted that coordination of care for Medicare patients with chronic conditions would save great sums. Studies show that people who reach Medicare eligibility age without having had health insurance arrive sicker and more expansive to treat than those who had had coverage.

--Merton Bernstein, Walter D. Coles Professor Emeritus of Law, Washington University

From Amy Allina at 4:24 PM: Too Many Falsehoods, Too Few Facts

I understand why the President didn't want to spend the small amount of time they have left refuting all the misstatements that Boehner made. But unfortunately, the result is that the falsehoods were stated and the facts weren't.

And it's also unfortunate that none of the prochoice members of Congress at the summit has found time to point out how damaging the abortion restrictions in the bill will be for the health of women and our families.

--Amy Allina, Program Director at the National Women's Health Network and a coordinator of Raising Women's Voices for the Health Care We Need

From Amy Allina at 4:09 PM: The Senate Bill And Abortion

The Senate bill clearly maintains Congress's long-standing prohibition on the use of federal funds to pay for abortion, except in cases of rape or incest or threat to the mother's life. It also would put in place cumbersome regulations that make it very unlikely that women who buy health insurance with their own money will be able to get a policy that covers abortion. The abortion restrictions in the Senate bill would require people who want a policy that covers abortion to make two, separate payments of private money each month -- this is all private money, so the requirement serves no purpose except to make it difficult for insures, employers and consumers to have policies that cover the comprehensive reproductive health services that are a basic part of women's health needs.

--Amy Allina, Program Director at the National Women's Health Network and a coordinator of Raising Women's Voices for the Health Care We Need

From Ellen Shaffer at 4:08 PM: Uninsured Don't Need Better Shoppers, They Need Insurance, And Malpractice Reform In California Didn't Work

Republican argues that high deductible plans with health savings accounts makes people better shoppers for health care. President points out that these plans work best, if at all, for healthy people with high disposable income, and that members of Congress earn $176,000 a year.

Waxman: California already has implemented medical malpractice reforms. It hasn't reduced health care costs for Californians, who now face 39% increases in the individual market.

-- Ellen Shaffer, Center For Policy Analysis

From Darcy Burner at 4:00 PM: On The Medical Malpractice Red Herring

First: medical malpractice costs represent a miniscule portion of health care costs.

Second: the best way to reduce medical malpractice costs is to reduce medical malpractice.

The Republicans including John McCain seem to be obsessed with the idea that they should "fix" medical malpractice by limiting what people who are victims of medical malpractice can recover in damages. Under their proposals, non-economic damages would be capped at $250,000. That means that the life of a child - who doesn't have income, and therefore doesn't have economic value under their calculations - would be worth a maximum of $250,000. The life of a stay-at-home parent? $250,000.

Is your child's life worth more than that? Your spouse's? Your own?

There are known ways to reduce medical malpractice, including things as simple as the use of checklists. A tiny fraction of doctors account for the overwhelming majority of malpractice cases; those doctors shouldn't be practicing medicine.

The best way to reduce medical malpractice costs is to reduce medical malpractice - not to further punish people who are already victims.

-- Darcy Burner, Progressive Caucus Policy Foundation

From Ellen Shaffer at 3:45 PM: Boehner Hits Every Republican Talking Point

Boehner hits every Republican talking point, including those already refuted:

Boehner claims that paying for the program would bankrupt the country, despite long discussion about bipartisan faith in the CBO, which says the opposite - extending coverage would reduce the deficit. Boehner claims the House bill stops the use of federal funds for abortion. while the Senate bill allows new federal funding for abortion; this is clearly and unequivocally incorrect. Others will comment on this. Paraphrasing Lois Uttley of MergerWatch:
There is no federal funding for abortions now, and none in the Senate bill. To the contrary, there will be new restrictions on women paying privately for insurance through the Exchanges. The Nelson (Senate) language is almost as bad as Stupak (House), and will result in some states banning abortion coverage in their health exchanges. In the states that do allow it, the 2-check provision could discourage insurance companies from offering abortion coverage, since it will be an administrative burden. There is no issue here about use of federal funds, and it should not be used as a political football!
-- Ellen Shaffer, Center For Policy Analysis

From Ellen Shaffer at 3:28 PM: Obama-Grassley Exchange on Medicare Advantage

Good explanation by the President of the diversion of Medicare funds to private insurance companies through Medicare Advantage, while charging non-MA beneficiaries an extra $90 a year. Grassley returned to the point that some doctors are refusing to take Medicare patients/payments. President correctly points out that's a different issue.

-- Ellen Shaffer, Center For Policy Analysis

From Ellen Shaffer at 2:50 PM: Where Is The Left?

Maybe this is a wonk's view of politics - but on another level - where is the left in this discussion? Why is there not a credible defense of the role of a strong central public authority to negotiate prices with health care providers, just for example?

The Bush Admin. acted like Democrats did not exist. Here we are a year after an historic election, watching the Republicans get full venting rights to their generally ineffective schemes (some of which therefore seem legitimate). It's comforting to think this may chill out some of the more frightening extremist tendencies of the right. But we called out 1 million messages yesterday for health reform (attached to some related number of bodies). Can we do better than this? As Roger said, at least demand a commitment to keep working on the issue and a structure for doing so?

I am not so impressed with claims that this is all about the influence of big money from the health care industry, tho that plays a role. I think we (also) haven't won the political battles (haven't won over the public or decision-makers); possibly, and interestingly, there is still public support for the public option (thanks to many on this list). This is still a far cry from the health reform we really need (uhoh back in wonk territory). And it does open up the discussion of how this Admin has chosen to proceed and to position itself.

-- Ellen Shaffer, Center For Policy Analysis

From Joan McCarter at 2:45 PM: The National Exchange

In a back-and-forth with Marsha Blackburn, President Obama made a strong case for the national exchange as the best means of increasing the buying pool, but his proposal accepts the Senate bill's state-based, multiple exchanges. This is a key sticking point for House Dems, and a key element for making reform work. Hopefully Obama's endorsement of the national exchange here is an indication that we'll see more of an effort to get the House provision for the national exchange adopted.

-- Joan McCarter, DailyKos

From Ellen Shaffer at 2:43 PM: Yes, Everyone In! Also Need Gov. Action And Structures

Rockefeller quotes Wendell Potter on the insurance industry. "The health insurance industry is the shark swimming just beneath the water....Rapacious...unknown to Americans, except for individuals who are affected...The individual mandate isn't about 'big government' per se - we need to get everyone in one pool, everyone here says that." Talks about how states that have tried to expand coverage without cost controls have gone bust. Then goes on to say he liked the public option but it looks like that's not going to happen. Why not? What else then? Regulation, even at the national level, even through the FTC, is not a substitute for a structural alternative.

-- Ellen Shaffer, Center For Policy Analysis

Here's a copy of the document Lee and Rep. Lynn Woolsey (D-Calif.) tried to deliver to the event. Woolsey tells HuffPost that she couldn't get in, but gave it to Hoyer, who used it in his remarks, which Hoyer confirmed.

From Jay Bhattacharya at 1:42 PM: How The Plan Affects Premiums For Those Already Covered

Would Pres. Obama's plan raise health care premiums for people already with insurance? Here's a good and neutral description of the non-partisan Congressional Budget Office (CBO)'s take on what the effect the Senate health care bill would have on premiums . The Senate bill is a close cousin to the Pres. Obama's plan, so this CBO score is good approximation to what effect the Obama plan would have. (Please remember to come back here after your through reading!).

In the US, there are two main types of private insurance coverage: insurance you get through your employer and insurance you buy on your own. The vast majority of people (about 180 million people) who have private insurance get that insurance through their employer. The CBO says that the Senate bill would have no effect on the premiums paid for plans that are provided by employers. So to a first approximation, the right answer is that Pres. Obama's plan would do nothing to lower costs, which contradicts what both the Republicans and Democrats are saying in this forum.

The remainder of the population (about 25 million people) who have private insurance buy it on the private market apart from their employer. According to the CBO, the Senate health care bill would increase health insurance premiums about 13% in the part of the market that does not run through employers over what would happen if no law were passed at all. Much of that increase would happen because the Senate bill would require insurers to provide more generous insurance than is typical in that part of the market. The increase would be higher still except that the Senate bill would mandate that people without insurance--who are typically healthier than the rest of the population--buy insurance too, which offsets some of the increase.

In that sense, the Republicans are right to point out that Pres. Obama's plan would raise health care expenditures, and Pres. Obama is right to point out that in exchange for these higher costs, people would have more generous coverage. The Senate bill also gives subsidies to people who cannot afford to pay their health insurance premiums, so out of pocket payments for premiums would not go up for a large portion of those 25 million people. But the greater these subsidies are, the more taxes will have to be raised or Medicare cut to pay for them. There's really no such thing as a free lunch.

-- Jay Bhattacharya, a Stanford Health Policy Professor and health economist

From Lori Lodes at 1:36 PM: Women Get Short End Of Stick Under Current System

As Congresswoman Slaughter noted during the Summit and Ryan Grim pointed out back in September, it is perfectly legal for insurance companies to deny coverage to victims of domestic violence in eight states and the District of Columbia. LEGAL. Senator Murray attempted to end this practice in 2006 and what happened? It didn't make it out of committee because ten Republicans voted to kill it.

Another reason women get denied coverage? C-Sections. In Colorado, UnitedHealth considers a C-Section a pre-existing condition. There is an exception however: if she decides to be sterilized. Really, there are no words.

Check out SEIU's blog for more coverage about the insurance industry's discrimination against women.

--Lori Lodes, spokeswoman for SEIU

From Digby at 1:30 PM: Slaughter Moves Beyond Soundbites

In all the talk today about "philosophical differences" Slaughter was one of the only participants who really got beyond the soundbites and illustrated how the liberal philosophy works in action. It's always good to tell personal anecdotes to illustrate an issue, but it would be useful if more Democrats could tell this kind of anecdote as well --- instances of government stepping in to fix systemic institutional problems. More of this please.

From Amy Allina at 1:19 PM: Slaughter and Pre-Existing Conditions

I agree that Slaughter's comments were important for focusing attention on some of the most popular elements of health reform -- a ban on excluding people with pre-existing conditions and prohibitions on discriminatory insurance practices like charging women more. I would have liked to see her make one additional point -- that the House bill extended these protections to more people than the Senate bill (details explained here) and that Congress should pass reform which protects everyone from those abuses.

--Amy Allina, Program Director at the National Women's Health Network and a coordinator of Raising Women's Voices for the Health Care We Need

From Susan Wood at 1:06 PM: Louise Slaughters Comments On Women's Health

Rep. Louise Slaughter (D-NY) identified some of the critical issues in women's health, pointing out gender rating which has been found across the country to lead to increased premiums for women purchasing individual plans and the use of pre-existing conditions (domestic violence!!) to deny coverage to women She also retold the history of the legislation that requires the National Institutes of Health to ensure that women and minorities are included in clinical research studies funded by the NIH. She connected this to health care reform by correctly asserting that it took legislation to get that change, and that it will take legislation to regulate insurance companies in order to eliminate exclusion of coverage for pre-existing conditions and to abolish gender rating. Making that connection, calling for action and drawing attention to some of the outrages in access to coverage - very important and very well done!

-- Susan Wood, Jacobs Institute of Women's Health, George Washington University School of Public Health and Health Services

From Debbie LeVeen at 12:40 PM: Need For Minimum Benefits Standard

I think Obama is doing an excellent job of continually focusing the discussion on the underlying issues in this case: whether there should be a minimum baseline of benefits.

And I think if we pursued this in terms of specifics it could be a very effective focus:what benefits should people be able to count on? How much should they be expected to spend out of pocket? Should "young healthy people" be allowed to buy less? Is it right to expect the sick to pay more? Is that what we Americans want?

--Debbie LeVeen, PhD Professor Emerita, San Francisco State University

From Joan McCarter at 12:35 PM: More Risk Pools

As of the end of 2008, 35 states had high risk pools, but covering fewer than 210,000 people. In some of these states there are long waiting lists for these programs, but the biggest barrier is cost. Because those enrolled are among the most expensive people to cover, these pools can't spread their costs among high- and low-cost individuals. The premiums for these pools are high (see KFF) and out of reach for many.

-- Joan McCarter, DailyKos

From Darcy Burner at 12:31 PM: Risk Pools

Putting everyone with a pre-existing condition into a separate risk pool that's self-supporting, as the Republicans propose, would make insurance for those folks utterly unaffordable. Or, as it's been succinctly put, the Repiblican plan is, "Don't get sick."

-- Darcy Burner, Progressive Caucus Policy Foundation

From Jay Bhattacharya at 12:30 PM: Insurance Pools

In listening to this interesting conversation, it seems to me that there's a basic confusion among many of the participants about the nature and purpose of insurance. Suppose there are two people, each 40 years old, who are identical in terms of the health risks they face. Over the course of the next year, one will develop cancer while the other will remain perfectly healthy, though neither know this when they are making decisions about what health insurance to sign up for at the beginning of the year. Because these two 40 year olds look alike at the beginning of the year, the insurance company has to charge them the same insurance premium. In essence, by buying insurance, each 40 year is betting that he will get cancer. If he loses the bet and does not get cancer, then the premiums he paid at the beginning of the year will be more than his actual health care expenditures. For the person who does get cancer, he will have "won" the bet and his premiums will be less than his health expenditures. From the perspective of the end of the year, there was a transfer from one man to another, but from the perspective of the beginning of the year, there was not transfer. Private markets, to the extent that they can measure the risk of disease at the beginning of the year accurately, are very good at creating risk pools of this sort.

A second sort of pooling involves, for example, two people one 25 years old and the other 60 years old, both healthy at the beginning of the year. Knowing nothing else, I can say with confidence that the young woman is likely to spend less on health care over the course of the year than the older woman. An insurance pool that encompasses these two women would induce a transfer of money from the younger woman to the older woman. Private insurance markets, in the absence of some sort of distortion, will not create pools of this sort.

One key difference between the Democrats and Republicans, it seems to me, is the desire to create pools of the second sort. The main social benefit of the second sort of pool is that it makes health care more affordable for the 60 year old woman. The main social cost of the second sort of poole is that the 25 year old has to pay for it.

-- Jay Bhattacharya, a Stanford Health Policy Professor and health economist

From Howard Dean at 12:20: The Good And Bad Of The Senate Bill

At this point, the Senate bill is simply an extension of the existing system to a lot more Americans. In that sense it is a missed opportunity, but it is worth voting for for two reasons. First, we simply can not permit the Far Right to push us around any more. Second, there are some pieces of real reform in the bill -- mainly the exchanges -- which we will need if we ever get a genuine reform bill. And the bill does cover a significant number of additional uninsured people.

But there are some things in this bill that are pretty poisonous, for example the provisions that allow states to prevent plans from being offered on the exchange if they cover abortion. The mandate, which Vermont experience shows is not necessary, simply forces people to become customers of one of the most heartless industries in America. There will be votes lost because of this, and because of the general pro insurance company tone of the bill. In the end, a lot more people will have access to coverage, it is paid for, and it is a step forward, albeit a pretty small one considering all the work that has gone into it.

--Governor Howard Dean, M.D., Founder and Strategic Adviser for Democracy for America

From Debbie LeVeen at 12:17 PM: Obama Responds To Republicans' Contradictory Statements

I think Obama is doing an excellent job of continually focusing the discussion on the underlying issues in this case, whether there should be a minimum baseline of benefits.

And I think if we pursued this in terms of specifics it could be a very effective focus:what benefits should people be able to count on? how much should they be expected to spend out of pocket? should "young healthy people" be allowed to buy less? is it right to expect the sick to pay more? is that what we Americans want?

--Debbie LeVeen, PhD Professor Emerita, San Francisco State University

From Joan McCarter at 12:11 PM: "Philosophical" Disagreements

The President has been charitable thus far in claiming that there are "philosophical" differences between the parties. From out here, it looks more like a visceral hatred for government on the part of Republicans rather than a real intellectual argument. That's a divide that can't be bridged. Because the Republicans continue to just lie, whether it's about process (see reconciliation) or the CBO reports on the existing plan. It brings to mind Barney Frank's confrontation over the summer with a teabagger: at some point it's like arguing with a dining room table.

-- Joan McCarter, DailyKos

From Ellen Schaffer at 11:57 AM: Republicans' Contradictory And Rhetorical Statements

Andrews (D) points out that current standards allow insurance companies to commit abuses and deny legitimate claims. Cantor (R) and other Rs respond that they object to the federal government regulating insurance. No substance, just reflex.

-- Ellen Shaffer, Center For Policy Analysis

From Amy Allina at 11:58 AM: Tort Reform Is Not The Solution

Rep. Camp returned to the Republican talking points -- don't cut Medicare, cut costs with tort reform. But people living in Texas and California (his examples of states that did medical malpractice reform) might be surprised to hear him claim that their health care costs have gone down. And now Sen. Schumer is coming back to Coburn's statement in support of cutting Medicare and making Jacob's point that this means restraining health care costs in the program.

--Amy Allina, Program Director at the National Women's Health Network and a coordinator of Raising Women's Voices for the Health Care We Need

From Rep. Barbara Lee at 11:48 AM: The Following Was A Statement Released From Rep. Lee:

Although we were not participants in today's Health Summit, Reps. Lynn Woolsey (D-CA), Donna M. Christen (D-VI) and I went over to the Blair House to personally deliver copies of letters from the Congressional Black Caucus and the Congressional Progressive Caucus outlining our priorities for this health summit -- particularly concerning health disparities and a public option.

-- Representative Barbara Lee, (D-Calif.)

From Jay Bhattacharya at 11:48 AM: Increase Preventative Care

If there's one area where both Pres. Obama and the Republicans seem to agree is that one key route to reducing health care costs is to increase the amount of disease prevention. It is true that there are many worthwhile preventative care interventions that ought to be applied more widely (both among children and adults). The unfortunate fact is that, according to the health economics literature, even if we expanded prevention substantially and according to the best available evidence, total health care expenditures would not decrease and in many cases would increase.

This is for two reasons. First, preventative interventions, by their very nature, needs to be applied to a broad population to be effective. Most of that population will derive little benefit from those interventions because they would never get the disease even in the absence of the interventions. Childhood vaccines are a good example of this. Of course, the extent to which is true depends on the particular intervention being considered, but the principle applies to all preventative activities. In order to prevent one person from getting sick, we need to apply the intervention to more than that one person. This fact greatly increases the costs of prevention.

Second, no matter how successful prevention is in reducing disease, no such intervention confers immortality. Everyone will eventually die of something. This obvious point has an important corollary, which is best illustrated with an example. Suppose we could find a way to prevent cancer entirely. Such an intervention would without a doubt increase the incidence of heart disease since more people would be alive to get heart attacks. This consideration is obviously most important for prevention applied to older people. In some simulation work that I have done, I have found that even if we found a way to prevent all cancers for free (and we are far from such an incredible technology), Medicare costs would fall by only a small amount.

None of this should be taken to mean that we shouldn't expand prevention. It's just that the benefits of such an expansion, which in some cases could be considerable, will not come for free.

-- Jay Bhattacharya, a Stanford Health Policy Professor and health economist

From Ellen Schaffer at 11:28 AM: Competition Among Health Plans?

Hoyer advocating competition among insurance plans. Seems misguided to me. Public option can offer an alternative to predatory insurance plans; Medicare works better than private insurance but does not hold down costs in private sector, more the reverse (at the mercy of inflation driven by private sector). VA achieves economies like single payers do - through budgets. Insurance companies are either too small to get price breaks from providers; or are big enough and pocket the savings rather than reducing premiums.

-- Ellen Schaffer, Center For Policy Analysis

From Stephanie Taylor at 11:18 AM: Democrats Need Public Option For Strength

Thanks for the clarification, Jacob, and I agree with you that the public option is both good policy and good politics. The fact is that there is a lot of lip service from Senate Democrats in favor of the public option, because they know that it's a phenomenally popular proposal. But our polls show that if they don't allow an up-or-down vote on the issue, Democratic and Independent voters will lose faith in them--and that will hurt the Democratic Party in 2010 and beyond.

-- Stephanie Taylor, Co-Founder, Progressive Change Campaign Committee

From Adam Green at 11:14 AM: The Public Option Makes Sense

Jacob Hacker asks how to respond to those who ask why the public option makes strategic sense?

A) Point out the polls that show that in state after state, the public hates the current Senate bill but loves the public option. It is in every congressional Democrat's best interest to fight for the public option very vocally, own it, and let the bill that passes Congress be defined by the public option. If voters associate health care reform with the public option, that transfers the overall bill from a political loser to a political winner, and should actually attract new votes in Congress. It's the unpopularity of the current bill that makes it a controversial vote for some skittish Democrats -- and that unpopularity is due in large part to the lack of public option.

B) We need to make clear that there were over 50 Senate votes and 218 House votes before, and demand that those who say the votes don't exist name names. See Democracy for America's calling-out of Tom Harkin in The Iowa Independent:

As Jon Stewart rightly lampooned last night, Tom Harkin previously said, "I'd say right now we have well over 55 votes for a public option, but we need 60." Harkin also said nobody has fought harder for the public option than him.

Well, only 50 votes are needed now. Unless Tom Harkin is willing to name names, say who supported the public option before but opposes it now, and actively challenge his colleagues to re-take the same positions they had just weeks ago, than Tom Harkin is putting his relationships with DC politicians ahead of the will of the 62 percent of Iowans who want a public option. We hope Harkin decides to start fighting.

-- Adam Green, Progressive Change Campaign Committee

From Amy Allina at 11:17 AM: Is Coburn Pro-Single Payer?

Sen Coburn says that we should "go where the money is" to cut costs from health care. He thinks we should stop spending so much money in ways that don't help people with their health care needs. Something we might have heard from a single-payer advocate if there were one in the room! But of course he wasn't talking about cutting spending on high salaries for insurance executives but was actually arguing for cutting Medicare.

--Amy Allina, Program Director at the National Women's Health Network and a coordinator of Raising Women's Voices for the Health Care We Need

From Merton Bernstein at 11:13 AM: Claims About Fraud And Abuse

I have researched such claims and have found only one source - estimates of a company that offers anti-fraud services. . They appear not to be based on real life studies.

--Merton Bernstein, Walter D. Coles Professor Emeritus of Law, Washington University

From Chris Bowers at 11:08 AM: McConnell Flubs Poll Numbers

Politicians shouldn't quote polls: Mitch McConnell cites some polling. Real leadership! What's worse, he gets it wrong. Claims that polling averages show the country is opposed to the bill 55%-37%. Actually, it is very easy to find that the country is currently opposed 51.4%--41.9%. No surprise, he claimed the numbers were 8.5% better for his position than they actually are.

If McConnell can't get those very easy, very public number right, no reason to trust him on any numbers at all.

-- Chris Bowers,

From Jacob Hacker at 11:02 AM: Clarification On House And Senate

Just to clarify: I did not mean to imply that the House should act before the Senate. I am fully aware of the well-founded lack of trust over there.

But let's get off the process. I was chatting with a progressive friend (who shall go unnamed) last night, and she was convinced that bringing back the public option was a grave mistake, because it would muddy the effort to talk about what's good in a tweaked version of the Senate bill. Needless to say, I dissented. Bringing back the public option is good policy and good politics - it fires up disaffected advocates and puts the focus on the need to make insurers accountable. But curious how everyone grapples with this argument.

-- Jacob S. Hacker, Ph.D. Political Science, Yale University

From Lori Lodes at 10:58 AM: Alexander Has Major Problems With History

And even more convincing, if in fact he had not voted for using reconciliation for Bush tax cuts for the wealthy and 2005 Medicare cuts.

--Lori Lodes, spokeswoman for SEIU

From Jacob Hacker at 10:45 AM: Alexander Has Problems With History

He would also be more convincing if Republicans hadn't used reconciliation for massive tax cuts in 2001 and 2003.

-- Jacob S. Hacker, Ph.D. Political Science, Yale University

From Stephanie Taylor at 10:53 AM: House Can't Trust Senate

Jacob Hacker's path asks the House of Representatives to trust a Senate that has proven itself untrustworthy -- and that has consistently failed to deliver the real change that our health care system needs.

The Senate must move first on reconciliation and include a strong public option, to give the American people a choice and provide competition to the private insurance monopolies.

There is a huge amount of momentum behind this plan right now -- see the list of Senators who have signed on at We'll continue pushing for this path. The best way to pass a health care bill is to pass a good bill, not a bipartisan one -- and that includes a public option.

-- Stephanie Taylor, Co-Founder, Progressive Change Campaign Committee

From Digby at 10:42 AM: The Gauntlet

Lamar Alexander threw the gauntlet at the president's feet, calling reconciliation the tyranny of the majority and demanding that he disavow any attempt to use it. He would probably be more convincing if the Republicans hadn't already made it clear that their definition of bipartisanship is for the majority to adopt their favored ineffectual fixes after which the Republicans will vote against the bill anyway.

-- Digby

From Jacob Hacker at 10:40 AM: Pass, Pledge, Promise

I agree with Chris: Procedurally, there really is only one path, a path that I've been calling "Pass, Pledge, and Promise" (a variation on Senator Franken's "Pass and Pledge"): pass the Senate bill in the House, fix it with a pledged reconciliation bill, and promise to enact a public option - now or, if now is impossible, in the near future. The beauty of the "promise" part is that a public option would be a big initiative on behalf of the middle class that would actually save the federal government serious money. Amid all the attacks on the public option, it has remained remarkably popular, and for a simple reason: It sends an unmistakable message that politicians are on the side of citizens rather than insurers.

But I think that the challenge goes beyond coming "to an agreement on the contents of any health reform proposal." Even more important than any of these specifics is for the President to engage fully in making reform happen and stand fully behind the Democrats in the House and Senate as they seek their own compromises. And Democrats as a whole need to recapture the notion that they stand for the middle class by pressing for simple, understandable, effective, and popular steps that will improve health security as soon as possible.

-- Jacob S. Hacker, Ph.D. Political Science, Yale University

From Charles Chamberlain at 10:40 AM: Lamar Alexander

"We don't do comprehensive well"

"Our county's too big -- too complicated"

That's Lamar Alexander talking about why Republicans can't deliver a healthcare plan and it's a classic example of why Americans no longer trust Republicans to lead. Republicans freely admit they can't handle complicated stuff. That's why Voters would rather have a healthcare bill with a public option then one with Republican votes. See the polling here

-- Charles Chamberlain, Political Director for Democracy for America

From Chris Bowers at 10:38 AM: Lamar Alexander Doesn't Cross The Aisle

Lamar Alexander says he has a good record working across the aisle. His lifetime record on crucial votes is 1.85%, out of 100.00%, according to Progressive Punch.

Alexander also invokes Democratic opposition to destroying the filibuster in 2005. However, Alexander was not part of the Gang of 14, indicating that he actually favored destroying it himself.

-- Chris Bowers,

From Chris Bowers at 10:27 AM: It Is Political Theater, But Very Good Theater

President Obama said he hopes this won't be just political theater.

Of course, the entire summit is political theater, even President Obama's line saying he hoped it wouldn't be. However, it is very good political theater. It has revived activist and news interest in health care, generating millions of contacts to Congress, and heaping piles of free media coverage. Of course it is political theater, but even as such it has helped advance an important cause.

-- Chris Bowers,

From Darcy Burner at 10:16 AM: Sunlight Foundation Has a New App

My favorite technology innovation for the summit is the Sunlight Foundation's app giving data on members of Congress as they're in the crowd - including how much money they've taken from insurance companies.

-- Darcy Burner, Progressive Caucus Policy Foundation

From Ellen Shaffer at 9:52 AM: The President's Objectve

The President walks into the summit today seeking political momentum on health care reform, an issue apparently more contentious than the economy it threatens to overwhelm. Despite compromises that have limited the reach and effectiveness of proposed reforms, and have alienated at least some progressive voters, Democrats continue to struggle for a proposal that will muster a majority of votes, and a procedure to pass it.

Progressives are finding our voices. Yesterday a "net roots" campaign generated over a million messages to Congress and the White House to pass comprehensive health reform, accompanied by waves of phone calls. Related campaigns are calling for a strong public option - a measure backed by a majority of Democrats in Congress - or a Medicare buy-in for people over age 50; and a national-level health insurance exchange. Demonstrations for Medicare for All re planned. The President's proposal offers a bridge between the House and Senate versions of reform. It:* offers more generous subsidies for premiums in the proposed new exchange, and better protection from overall out of pocket costs* changes financing to limit the tax on high-cost health plans, and includes investment income in the amount subject to the Medicare/Health Insurance payroll tax* Extends to all states the federal assistance for Medicaid, previously offered only to Nebraska.* Adds a new authority to review insurance rates. However, it leaves in place the Senate provisions restricting coverage for abortions, and is ambiguous on coverage for immigrants. The President says he supports a public option but can't pass it. Will the summit clear the path to votes, by swaying public opinion, or other lawmakers?The stakes are high for the millions forced into bankruptcy, illness and death under the present health care system. While the vote on the jobs bill suggests some Republicans will cross the aisle to pass legislation this year, the political repercussions of a doomed health reform bill are also likely to be profound. A roster of policy analysts and advocates will be commenting on the summit throughout the day.

-- Ellen Shaffer, Center For Policy Analysis

From Chris Bowers at 9:45 AM: Process Is No Longer An Issue

No matter what will be discussed today, the procedural path forward is already a certainty. The House has demanded Senate reconciliation. The White House released a legislative proposal that can be passed through budget reconciliation. Only one Democratic Senator has ruled out reconciliation, while 46 have not ruled it out.

Democrats have decided to use budget reconciliation, and appear to have both the will and the votes to do so. Process is no longer an issue. The question, at this point, is if they can come to an agreement on the contents of any health reform reform proposal.

-- Chris Bowers,

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