There's been a lot of grumbling on the current health care legislation - and there are bound to be.  As President Obama often says, if health reform were easy, it'd already have been done.  But it's not.  Nonetheless, Congress is poised to make history by finally passing health reform this week, and it is important to understand what it means for all of us.

Last week, I wrote about the health insurance lobby's deceptive campaign to hide their real costs as a measure of the portion of the health care in America that is actually paid for through insurance companies.  But they are right about one thing: the skyrocketing cost of health care in this country isn't the fault of the private insurers alone.  In January of 2008, the Congressional Budget Office (CBO) released a report showing the various contributing factors that have ballooned our nation's health care costs.  In the report, we find this demonstrative chart:



As you can see, the biggest chunks of our health care costs are taken up by two major factors: hospital care and physician and clinical services.  Another skyrocketing costs recently have been the cost of prescription drugs, and nursing home care and administrative costs seem to be jockeying for a fourth place medal.

So today, I start a series to look into the cost measures in the current health reform legislation - not just with health insurance but with health care.  Today, we will look at three things: bargaining by insurance, community health centers, and electronic medical records.

In order to effectively bring costs under control, a comprehensive health reform package needs to address all of these areas.  There are direct ways to reduce those costs, as well as indirect ones.

INDIRECT COST CONTROL: INSURANCE COMPANY REGULATIONS

One of the most effective indirect ways to bring costs under control is forcing insurance companies to negotiate harder on behalf of their members.  Currently, they have very little incentive to do so, given they can simply pass on their costs to their members, or worse, drop them when they get too expensive.  When they are no longer able to do so, it will be incumbent upon them to negotiate better rates with hospitals and providers. Uwe E. Reinhardt, an Economics professor at Princeton, penned an article at New York Times last year to show the disparities in payment, using figures from the New Jersey Commission for Rationalizing Health Care Resources in 2007.  Let's look at one just for demonstration purposes:



Whoa! Did you see that? The same insurance company in the same state pays one hospital $1,800 for an appendectomy while paying another one almost eight times as much, $13,700?  What is the rhyme or reason behind this?  There isn't any, except that with hospital industry consolidation, hospitals don't have much competition, and with insurance company deregulation, they don't have much of an incentive to negotiate down the price.  When health reform is implemented, your insurance company will not be able to drop you or increase your rates when you get sick, refuse to accept you into a new plan because you are sick, and they will not be able to make you pay unlimited out-of-pocket expenses.  So how do they make money?  By negotiating with providers and hospitals, and bringing down the cost.  Obviously, there is no reason why they have to pay different hospitals ridiculously different amounts.

DIRECT COST MEASURES

COMPETITION WITH HOSPITALS AND PROVIDERS - COMMUNITY HEALTH CENTERS

Here's a real public option in health care.  The President's proposal invests $11 billion in Community Health Centers over five years.  The Senate bill invests a total of $8.5 billion over the next 5 years in services ($7 billion) and construction (1.5 billion), and the House bill approves $12 billion over the same period.  One might ask, then, why Sen. Sanders' office was reporting a $10 billion funding in the Senate bill and a $14 billion funding in the House bill.  According to the actual texts of the Senate bill and the House bill here is how funds are distributed: the parts the president's proposal quotes are correct - for the CHC's themselves.  The remaining amounts, $1.5 billion in the Senate bill and $2.5 billion in the House bill, are to fund the National Health Service Corps over the same 5 years (fiscal years 2011 to 2015).  Given that the Senate bill is now the underlying bill, it is safe to assume that the Senate bill's $1.5 billion additional funding for the National Health Service Corps remains intact.  That is a total of $13.5 billion related to community health centers. As Sen. Sanders said, the House bill's $14 billion funding would deliver actual health care 45 million people.  Adjusting that number to $13.5 billion, we have over 43 million people that will be able to be served by the Community Health Centers by 2015.

Why am I making to read through all these numbers?  Because the Senate bill is expected to lower the number of uninsured to 23 million - and with the President's proposal and higher subsidies in reconciliation - likely even lower.  So, as you can see, for the first time in American history, Community Health Centers will be able to serve almost twice as many people as will be uninsured.

What does that have to do with competition?  Right now, Community Health Centers are not well concentrated everywhere in the country.  These, remember, are the baselines - CHC's are able to leverage federal dollars on a one-to-five ratio with private dollars.  This means for the first time, we are going to be able to put community health centers in real competition with private providers and hospitals.  What will big hospitals and large Medical businesses (not family practitioners, who already charge reasonable rates) do when there's a CHC right around the corner?

Of course, Community Health Centers are meant to be primary health care providers.  This is direct competition to for-profit primary care providers, but even more importantly, the vast amount of people that will be able to get services from CHCs in this expansion will mean vastly improved health, early diagnoses of both actual diseases and risk factors, and treatments in early stages.  What does that add up to in a lifetime?  A lot less in hospital bills for individuals and a lot less in hospital related expenses for our economy.

ELECTRONIC MEDICAL RECORDS

Last year's Recovery Act had a $19 billion investment in Health IT.  The Senate health bill pushes for electronic medical records and directs the Secretary of HHS to give EMR companies priority when contracting - this means in terms of Medicare and Medicaid administration, Medicare and Medicaid contracts, etc.  A Harvard study published in Health Affairs magazine in 2005 points to big potential savings in our health care system with electronic medical records.  Here's what the study finds - it's absolutely stunning, at near universal adoption of electronic medical records adoption, per year:

• $147 billion in chronic disease prevention and management and reduced acute care
• $77.4 billion in efficiency
• $40 billion in health costs for a modest increase in patients who follow physician lifestyle recommendations (from the current 10 percent to 20 percent)
• $28.5 billion in near-term disease management for Asthma, Congestive Heart Failure (CHF), Chronic Obstructive Pulmonary Disease (COPD), and Diabetes
• $4.5 billion in adverse drug events ($1 billion in inpatient, $3.5 billion in ambulatory settings)

Add it all up and it's a total of - are you ready for this - $297.4 billion in savings, almost $300 billion in reduced costs and savings each year. And the savings are real - health plans that have switched to electronic prescription records report millions of dollars in savings just by being able to more easily find generic alternatives to expensive brand name medication.  This is serious downward pressure on the health care cost curve in this country.

This gives us an idea on savings and cost measures in just three areas that we need to go after.  I hope this article has been helpful to you to understand these various cost measures.  In the coming days there will be at least two more in this series focused on: (1) nursing home vs home health care and the cost savings therein, primary care (which I alluded to today) savings paired with prescription (generic) drug savings, and (2) excise tax and administrative costs.  Please stay tuned.

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Well, other than the fact that their lips are moving, that is. America's Health Insurance Plans (AHIP), the health industry lobby group released a new ad - that they are spending at least $1 million running - playing the victim in the current health care debate. It comes with a nice pie chart, too! Sure enough, they back it up on their blog (I found out that this is their blog by calling them and being directed to it from their Communications department):

About 4 percent of what we spend in health care in this country goes to our administrative costs and profits.

Now, of course, this is a piece of propaganda - meaning there is an element of truth to it, but it's used to obscure the whole reality. What the insurance companies are doing is cleverly measuring their profits and administrative costs against total national health care spending, and not just the portion of health care spending that is actually done by health insurance companies. Almost half of health care spending in this country are done by the public sector, and by 2011, public spending on health care will be more than half of total health expenditures. What's more, private insurers don't even do all of the private health care spending.  So I will go about actually figuring out what that 4% amounts to when you strip out all the mumbo jumbo and focus on just the expenses made by health insurers.

The Center for Medicare and Medicaid Studies (CMS), the agency that keeps track of health expenditure numbers, released numbers showing US total health expenditures having topped $2.3 trillion in 2008, and $1.2 trillion of it was private health expenditures. So lets do a little quick math:

Health insurance company profits and administrative costs accounted for 4 percent of total national health expenditures, or according to CMS, $92 billion. And that number is actually 7.7% of private health expenditures, not 4%. But wait, that's not all. Is all the private health expenditures done by private health insurance? Of course not. There's your cost sharing when you have insurance, some expenditure for people without insurance or procedure that isn't covered by insurance by private individuals, and expenditure by charitable and philanthropic sources.

It turns out that of the $1.2 Trillion in national private health expenditures, only about $780 billion, or less than 64%, was attributable to private health insurance spending in 2008. This tracks closely with Kaiser Family Foundation's calculations for the previous year. So the profits and administrative costs that AHIP admits to for the health insurance companies, $92 Billion, are actually it's 12% of actual health insurance company spending.. That's three times as much as the AHIP would like you think.

Guess what? The 12% number tracks well with a CBO report last year that put administrative costs and profits at - you guessed it - 12% industry-wide. You might say, then is the 15-20% maximum profits and administrative costs (depending on the market - large group markets have an 85% Medical Loss ratio requirement, small group and individual markets 80%, with the ability of states to set lower requirements) in the health reform bill meaningless in terms of helping with costs and premiums? Not at all. For one thing, this 12% is of total revenue of insurance companies, whereas the health reform proposal restricts 15% of premium revenue. There's a small difference. But that's not really why the 80-85% Medical Loss Ratio (again, depending on the market) is important. Ezra Klein wrote about it last June:

Nor is it easy to measure administrative costs among private insurers. For one thing, which private insurers? When the Congressional Budget Office examined this issue, it found that administrative costs -- including advertising and profits -- accounted for 12 percent of the average insurer's dollar. But that hid substantial variation among insurers. Among employer-based plans, the largest firms had the lowest costs. Plans covering companies with at least 1,000 employees had a mere 7 percent in administrative costs. Those covering companies with fewer than 25 employees spent 26 percent of premiums on administration. And the individual market was a mess: 30 percent.

The big problem in health insurance isn't in the large group market. If you work for a big company (save Walmart, probably), they likely already provide you with pretty good insurance. But the biggest problem is with small group and individual markets, and as you can see, for those plans, administrative costs and profits shoot through the roof. No wonder insurers like it when people move to the individual market now, and it's also no wonder that insurers don't like the reforms in the private market as well as setting up exchanges that would give people buying in the individual market the same kind of leverage that the largest employers have. That 26 and 30 percent figures above drop to 20 percent right away when the MLR requirements go into effect.

Now of course, surely, health insurance companies aren't the only problem in our health insurance system. The hospital industry, the pharmaceutical industry are all just as big - or perhaps bigger - culprits in our broken system as are health insurance companies. As is our antiquated medical records system. There are steps for all of these in health reform - and I will cover them in detail next week. But for now, here's my question: who negotiates rates with medical providers and drug companies? Currently, they have no incentive to negotiate lower prices in the small group and individual markets, since the consumers have little choice when the insurance company simply passes on those other costs. Health reform will force insurance companies to negotiate as hard on behalf of those plans as they do for their bigger customers - the large group plans.

At any rate, in conclusion, AHIP is trying propagandize with their ad, as they usually do. That is nothing we didn't know, but here's proof. If you want to give them call and an earful, feel free.

America’s Health Insurance Plans
601 Pennsylvania Avenue, NW
South Building
Suite 500
Washington, DC 20004

Switchboard: 202.778.3200
Fax: 202.331.7487

Email: ahip@ahip.org

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Today Adam Green, founder of the Progressive Change Campaign Committee went on MSNBC's The Ed Show and just brought change!  To math!  You see, Adam Green and his PCCC has been going around viciously attacking good, progressive Democrats like Dick Durbin.

Adam and his group have been pushing Senators to go on record about whether they support a public health insurance option in a reconciliation bill.  It's important to make the distinction between plain old support for a public option, and the support for it in reconciliation, which works under different rules in the Senate and can only make narrow changes to law.  So you need a vote count of how many Senators think it should be included under reconciliation, not just how many think it's good policy.

The PCCC has been keeping track of those commitments (which stems from a letter signed by far fewer Senators actually asking for it to be included in reconciliation).  As of earlier today, they had 41 commitments, a little more than half of which are actual signatures on the letter and a bit less than half are on-the-record commitments to vote for the public option if it is included in reconciliation.

Obviously, time is of the essence in the current health reform process, and as you can see, 41 is not 51, the number of votes that would be needed even if the public option could be put under reconciliation.  So what is Adam Green to do?  Of course, change the math in the middle of the counting!  He went on MSNBC and rattled off a bunch of names of Senators who fit into three categories:

1. On the record supporting the public option (but not specifically under reconciliation)
2. Have said they are for it (once again, in general, not necessarily specifically under reconciliation) but they are concerned it would affect the chances of overall reform - the viability question.
3. Would never ever ever vote against the public option under reconciliation if it came down to their vote on the final final bill.  Never ever ever.  Adam Green promises.

And most senators he named fit more than one category.

• Kay Hagan - 2
• Claire McKaskill - 1
• Tom Harkin - 2
• Jay Rockefeller - 2, 3
• Herb Kole - 2, 3
• Mark Begich - 1 (obviously, otherwise Adam would have counted him on his current list on Whip Congress), 3
• Max Baucus - 1, 2, 3
• Mark Warner - 1, 3
• Jim Webb - 1, 3
• Robert Byrd - 3 (Ted Kennedy's best friend)

See? If you take the 41 Senators who are on the record saying what we want them to say, and 10 more who we think would say what we want them to say if they were voting, that makes 51!!! New math!!! When you can't come up with the numbers on the question fair and square, go in and say "these other people would do it, too, because I think and I promise they will!"

Let's take category 3 first.  The ones who wouldn't vote against the final final bill never ever ever if it comes down to their vote would only even work if their vote were the make-or-break vote. Then there can't be 7 Senators in that category when you are working with the bare minimum (51). And of course, Adam Green is purely speculating on whether they would vote against it under reconciliation procedure (and there is a good change they will to uphold what they think the rules say, not what the policy says), without any on-the-record evidence.

The Senators who are concerned on the viability concern, they do not have any indication that the public option in reconciliation is any more viable today than it was yesterday.  In fact, the "viability" number in this case may well be 60 and not 50, given the constraints of the reconciliation procedure.

Lastly, it's just plain ignorant (or worse, intellectually dishonest) to claim that anyone on the record supporting a public option under normal procedure thinks it fits under the rules of reconciliation.  That is simply not the case.  Claiming it to be the case is dishonest and wrong.

And this is the type of garbage he is using to "update" Whip Congress (watch the change in language - "commitments" to "likely").  With friends like these... never mind.

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Last night, I wrote about David Waldman name-calling me because he seemed to have lost the debate on how the current reconciliation proposal could be used under current rules to amend the current underlying Senate health care bill.  David Waldman is now quoting stories from CQ and Politico about how he's right.  Of course, none of the stories say he's right.  Here's what I have to say about the Politico story:

But according to reporting by POLITICO’s David Rogers... That is that reconciliation must amend law but this could be done without the Senate bill being enacted first.

How do things become law? I was looking at this document called the Constitution, and it says that the only way for something to become federal law is for the President to sign it into law (or let it become law without his signature and waiting for 10 days while Congress is in session). Did David call anyone in Politico and ask how they suppose something can be "law" without having been signed into law?

For example, if the big bill itself amends some Social Security statute, reconciliation could be written to do the same --with changes sought by the House.

Ah yes. If a reconciliation bill could be written as if it had nothing to do with the underlying bill and was amending things already into law, then of course it could be passed without the underlying bill. Can you say, 'Duh?' But that is not the case here. Here, the reconciliation bill will actually amend parts of the Senate bill - parts that create new law and don't yet exist in federal code. That's the point, David. This reconciliation bill isn't just amending statutes that currently exist (and the Senate bill also amending the same statutes). If it amends, for example, the levels of subsidies in the exchanges, you can't exactly do that without creating the exchange first (and the exchanges themselves cannot be created under a reconciliation bill).

Of course, David points to a Roll Call story that says exactly what I just deduced in the above paragraph:

However, it appears that if Democrats choose to pursue reconciliation before the Senate bill is enacted, they likely would have to narrow the scope of the reconciliation bill.

Once again, monumental "Duh" moment. The point remains that a reconciliation bill must make changes to existing US code (law). You can write a reconciliation bill to change any currently existing US code as long as the changes fit into the rules of reconciliation. But it cannot amend a law that does not yet exist - which is what David had patently said it could. And if you get that narrow, you won't actually be able to fix everything that needs fixing - especially the subsidy levels (once again, you can't change the subsidies in an exchange if the exchange does not exist in law yet) and the creation of a national exchange.  The fact, therefore, remains that the current reconciliation measure, as a whole, cannot move before the underlying bill.

It should be noted that David is also pointing to stories like the ones in Roll Call and Politico, which are inexplicably reporting that the House still wants to hold off passage of the underlying Senate bill until the Senate actually passes the reconciliation package - i.e. until the reconciliation process is complete. As I noted last night, that is, of course, absurdly incorrect. By the end of last month, the House had already agreed to move forward with the Senate bill first. That kind of blatant misreporting should make us question the rest of the content of the story as well.

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I know what your first question is.  Who the hell is David Waldman?  David Waldman, also known as "Kagro X," covers Congressional affairs for the popular Democratic blog Daily Kos, and is at least seen by members of that community as somewhat of a voice of authority on Congressional matters.

On January 25, David Waldman and I had a little debate about the process of health reform moving forward.  By then it was pretty clear that the House was going to have to pass the Senate bill, as is, and both the House and the Senate would have to agree on a separate package of targeted changes to the Senate bill to fix parts of it that House Democrats found objectionable.  This would be done through a process called budget reconciliation, which would allow the Senate to pass it by majority vote, rather than the 60-vote threshold the Republicans are forcing on nearly everything.  The only question then was who was going to move first: the House with the Senate bill or the Senate with the reconciliation package.

David contended that it was perfectly fine for Congress to pass a reconciliation "fix" to a the Senate bill before the Senate bill actually becomes law.  It struck me as a rather bizarre argument, and I countered that the House must pass the Senate bill first, and that Congress can't amend parts of the federal code that do not yet exist.  David said it could, so long as the President signed the Senate bill first and the reconciliation measure second, making them law in that order.  Needless to say, David did not change my mind.  Besides the logical incongruity of the process David described, I was also concerned about its real world implications - what if this were possible and a future Congress did this, and a future President decided to sign the 'fix' measure and veto the underlying bill.  It would set up a legal limbo.

Anyway, back then, we parted on amicable terms, and we agreed to disagree.  At least that was my impression.

Fastforward to recent news.  It has now been agreed that the House will, in fact, move first and pass the Senate bill, sending it to the President.  Immediately afterwards, the House will begin consideration of the reconciliation measure; once passed, sending it to the Senate for final passage.  That news came from Majority Leader Steny Hoyer on February 28.

Fast forward, once again, to today.  Today, news broke that the Senate parliamentarian has advised that current reconciliation instructions require that the reconciliation bill amend existing law - that is, to the extent it amends new law in the Senate bill, the Senate bill must be law first.  David Waldman first poo-pooed the report because it came from GOP Senate aids who said that the parliamentarian had advised them so verbally.  Of course, he never amended his post after Democratic aides and Budget Committee Chair Sen. Kent Conrad confirmed the report, or even acknowledged the confirmation.

In his post, he pointed out that reconciliation law and Congressional Research Service point to the idea that reconciliation can indeed be applied to bills or pending legislation (presumably something that isn't law yet).  What he left out was the fact that even according to that, the House cannot pass a reconciliation bill amending the Senate bill - because the Senate bill has not yet been passed in the House!  How does a body change a bill with a separate bill (not through the amendment process) without passing the underlying bill first? The House is, of course, Constitutionally mandated to originate revenue related bills, which the reconciliation fix will be.

But I digress.  When the news of the opinion of the Senate parliamentarian broke, I openly questioned (as I do at this very moment) Waldman's "expert" status, saying also that I found it curious that as someone proud of covering Congress, he did not seem to actually read the current reconciliation instructions.  I went after David's interpretation of former Parliamentarian Bob Dove's comments.  The comment is below:

Dove says the Dems' planned use of reconciliation is highly unusual. "I've never seen a two-bill strategy" where reconciliation is used to fix another piece of legislation, he says. "It's permissible, I've just never seen it."

It's important to investigate this part - since David seems to think that it means that Mr. Dove was saying that reconciliation bill could pass before the the underlying Senate bill. Obviously, in my judgment, that's a little bit of a logical leap. The more straightforward explanation is that the former parliamentarian is intrigued at the process, and that he is referring to the idea of a the immediacy with which the "fix" will follow through after the Senate bill. But if you aren't clear on that and the idea that the House can't fix something the House hasn't passed, look at the date of the article in which Mr. Dove's comments appear. March 3, 2010. Which is after February 28, when it had already been decided that the House would go first, as I noted above. I don't think it makes any logical sense for the former parliamentarian to be talking about a hypothetical that has already been decided against for current legislation.

This is when I found out that David Waldman hates me.  He got angry, calling me a "turbo-douche" and accusing me of  engaging in a "pissing match," simply because I said, and I turned out to be correct about, according to the opinion of the current Senate parliamentarian, the common sense idea that you can't change a bill outside of the normal amendment process without passing the bill first.

I have to admit, it was mildly amusing.  David Waldman is a front-page blogger at Daily Kos, and runs the associated Congress Matters.  I am a tiny little blogfish.  But he is either so insecure in his position or so thin-skinned that he had to name-call me.  Kind of funny, if you think about it.

Please note that in the external links to Daily Kos, comments (and diaries) from 'deaniac83' are authored by me.

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This will be a quick response to Adam Green's hubbabaloo at the PCCC tattooing 'BETRAYAL?' on Dick Durbin's forehead because Dick Durbin, the majority whip of the US Senate has said that liberals might be asked to vote 'no' on all amendments to the health care 'fix' package that they are hoping to pass through majority vote, using a rule called reconciliation.

Why? Because we need to get this done soon, and the only way to do so is for the Senate to agree to the reconciliation bill that the House sends over (after passing the Senate-passed health care bill) to the Senate without amendment. Here, I'll let the Senator explain, despite Roll Call's patently ridiculous headline:

Majority Whip Dick Durbin (D-Ill.) acknowledged Wednesday that liberals may be asked to oppose any amendment, including one creating a public option, to ensure a smooth ride for the bill. “We have to tell people, ‘You just have to swallow hard’ and say that putting an amendment on this is either going to stop it or slow it down, and we just can’t let it happen,” Durbin, who supports a public option, told reporters. “We have to move this forward. We know the Republicans are likely to offer a lot of amendments, and some of them may be appealing to Democrats, but we have to urge them to stick with the bill.”

Republicans are planning to derail the process by offering an unlimited amount of amendments. And any amendment that the House's version of reconciliation will set up another round of back and forth between the House and the Senate. This will delay health reform - and may kill the entire reconciliation process - and then all of us will be stuck with the Senate bill. If the House reconciliation bill does not include a public option - and all indications are that it will not - then adding it in the Senate will simply reduce the chances of a reconciliation fix passing at all. That means all amendments to that House reconciliation bill offered in the Senate need to be killed. Conservative ones and liberal ones. For the sake of finality to the process.

That, really, is all Dick Durbin is saying. The Huffington Post reports, hot off the press:

Sen. Dick Durbin, the Democrat in charge of rounding up votes for the health care reconciliation bill, said on Thursday that he will whip support for whatever package comes through the House. With 50 Democratic votes, Vice President Joe Biden could then break the tie and send the bill directly to the White House. If any amendments are adopted, it slows the process down by requiring the House to vote once again.

Not convinced? Here it is again:

Durbin was asked by HuffPost if he would whip a reconciliation package from the House that included a public option...

Durbin, in response to the question, said at first that it was hypothetical, but then answered, "I think there will come a time when we reach agreement on what the reconciliation package includes, with the understanding that any changes in the House or Senate could slow down or stop the process."

So whatever comes from the House, that's what you will whip?

"That's basically it," he said.

Once again - all Durbin is saying, in his position as the Senate majority whip, is that the Senate will need to pass the House's version of reconciliation, as is, without any amendments, and send it to the President for his signature, otherwise, the entire process stands a chance of going into a loop of amendments by both houses, and eventually ending up nowhere. This process has to end somewhere. And this is it. It ends here with Speaker Pelosi in charge of what the reconciliation package will look like, not Dick Durbin.

You know what's funny, though? Adam Green even responded to what Durbin said.

"Dick Durbin just offered Nancy Pelosi a rubber stamp, something that will never happen again -- especially in a 50-vote reconciliation environment," said Adam Green, when told of Durbin's remark.

So Adam Green thinks Drubin is offering the Speaker a rubber stamp, but does he take his anti-Durbin petition down and go after the House instead? Nope. Last I checked, it's still there. What the hell is going on here?

Dick Durbin has done more for the progressive movement and liberal causes that Adam Green ever can imagine doing - especially by PCCC's constant bashing and bludgeoning of good, solid Democrats. Dick Durbin has done better than to deserve this from a self-crowned "progressive" champion:



ENOUGH!

Update II: Got an email from Ryan Grim saying the Huffpo article didn't mean to imply that Adam Green thought it was a "positive sign" that Durbin is turning final reconciliation bill form to Pelosi. Ok... his quote still speaks for itself I guess.

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The GOP is running around whining about Eric Massa (until recently, Glenn Beck's darling) and tying him to Pelosi.  They want the House Ethics Committee to re-open their investigation into Ex-Congressman Massa's behavior (an investigation that died with the resignation of Ex-Rep. Massa).  Their big point of attack is really Speaker Pelosi.  They want to tar and feather her with Massa.  I'm sure that to that extent, they are going to be touting around a Politico report, titled "Nancy Pelosi aide knew of Eric Massa Concerns in October."  ZOMG!! Didja hear?  Nancy Pelosi knew!

Except, not so.  Here's what you find when you go beyond the headline:

There is no indication that anyone in Pelosi’s office knew of allegations that Massa, a Democrat from New York, had improper physical contact with aides until February, when Majority Leader Steny Hoyer’s office was informed of the accusations and shared them with a senior Pelosi staffer.

But a Pelosi aide told POLITICO on Wednesday evening that Massa’s chief of staff, Joe Racalto, informed a member of Pelosi’s “member services” operation in October that Massa was living with several aides, had hired too many staff members and used foul language around his staff.

To repeat, there was no formal complaint filed with the Speaker's office. One aide to a freshman Congressman told another aide of the Speaker that Massa was using the F-bomb a lot.  Yes, because the Speaker has no better thing to do than to run to the Ethics Committee (or perhaps the Republicans would prefer the Capitol Police) every time someone tells an aide of her, "Congressman XYZ is saying too many swear words!!!"  You understand that members of Congress are Pelosi's colleagues, not her children.

Plus, while Republicans are moaning and whining and crying foul, they weren't so outraged while Massa was still in the House and Pelosi said she heard rumors but no formal complaints.  There was no big crusade then. Now suddenly they see a late opportunity to attack the Speaker, and it's not because they think it's legitimate.  They want to weaken her personally so that Democrats can't pass legislation.

That's all.  John Boehner can go back to oranging himself in his tanning bed now.

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I believe that it is right to demand an up or down vote on health reform.  I strongly believe that in order to get health reform passed, the House should pass the Senate bill, and the Senate should pass by majority vote by the use of the budget reconciliation process, relatively narrow, targeted changes to fix certain areas that are specific budgetary policies (amount of subsidies, putting all states on a level footing on Medicaid funding, and closing the Medicare Part D prescription coverage gap).

However, there has been what I believe to be a misunderstanding among many who claim that a public option - a health insurance option run by the federal government to compete with the private insurers on the exchanges that the current health care proposal sets up - can also be passed with a simple majority vote via the budget reconciliation process.  After all, SCHIP and COBRA were major changes to our health insurance system, and those were pushed through by reconciliation, right?

Here's how it breaks down.  Budget reconciliation has to jump through the hoops of something called the Byrd rule in the Senate.  The Byrd rule prohibits from consideration anything that does not either score against the budget or scores against the budget only as an incident of the non-budgetary parts of the provision under consideration.  This second part is where the public option is likely to be ruled out of bounds.  While the public option would have budgetary impact (positive budgetary impact that is, saving the federal government money), that impact is merely incidental to the policy of setting up a brand new federal program and setting up a part of the government to run a health insurance program.  It just does not have a very good chance of fitting into reconciliation on its face.

Well what about SCHIP and COBRA, then?  They set up brand new federal programs under reconciliation, right?  Right?  Wrong.  That is not at all how SCHIP and COBRA were structured.  Let's take them one by one.

SCHIP

SCHIP was passed as part of the Balanced Budget Act of 1997.  It derived statutory authority from a well known existing law: the Social Security Act.  Specifically, title XXI of the Social Security Act.  There's no separate law titled the "State Children's Health Insurance Program."  It is, in fact, title XXI of the current Social Security Act.  SCHIP was also not designed as a brand new federal program, or, for that matter, add new people to any federal programs.  It was designed as block grants from the federal government to the states.  In fact, the New York Times published a report during the debates about it in 1997 making that very, very clear:

The legislation does not provide a formal entitlement, with as many individuals as qualify guaranteed benefits like those of Medicare, Medicaid or Social Security. Instead, it offers a specific sum of money in the form of block grants that states can apply for or not.

It turns out states like the money, and they do apply for the grants. What we call SCHIP was a pure spending matter, as far as the budget was concerned. It didn't set up any new programs; it didn't enroll anyone new into existing programs; it simply set up a grant program and Congress defined the terms of the grant. That was it.

Also, here's another thing to note.  The Byrd rule is not self-enforcing.

The Byrd rule is not self-enforcing. A point of order must be raised at the appropriate time to enforce it. The Byrd rule can only be waived by a 3/5 (60) majority vote of the Senate.

You see, the Balanced Budget Act of 1997, which is what SCHIP was included in, passed through the Senate by unanimous consent in initial form on June 25, 1997, and the conference report with the House was passed in the Senate by an overwhelming vote of 85-15. Given its initial passage by unanimous consent, it is clear that no Senator raised an objection to the inclusion of SCHIP. Even if someone did, and the point of order had been sustained by the Chair (relying on the parliamentarian), the final vote of 85-15 smacks us of the reality that the votes to waive the Byrd rule existed, easily.  That is not the case for the public option.  You can be more than sure than Republicans and Joe Lieberman would raise objections, and 60 votes to waive the Byrd rule do not exist in the current Senate on this.

COBRA

COBRA is famous.  Because if you lose your job, you can keep your health insurance through COBRA.  But what a lot of people don't know is that COBRA stands for Consolidated Omnibus Budget Reconciliation Act of 1985.  What, reconciliation?  See I told you new benefits could be established through Budget reconciliation!  Boo-yeah!

Not so fast. COBRA, in 1985 amended ERISA from 1974. As originally passed, it was purely budgetary tax policy in that it ended a tax exemption from employers unless the plans were allowed to be carried over after employees lose their job.

As originally enacted, Title X of the Act provided that a qualifying employer will not be permitted to take a tax deduction for its health insurance costs unless its health insurance plan allows employees of the employer and the employee's immediate family members who had been covered by a health care plan to maintain their coverage if a "qualifying event" causes them to lose coverage.

Tax policy is, of course, the perfect candidate for budget reconciliation.  The way the federal government earns revenue (income or inlays) is taxes.  Yup, perfectly budgetary, perfectly narrow, fits perfectly under reconciliation.

And how did the votes on COBRA go?  In the Senate, its first version was passed by a vote of 93-6.  The Senate approved the conference report by a vote of 78-1, and subsequently, agreed to the amendments of the House by a voice vote.  Once again, from the numbers, it's clear that no one actually invoked the Byrd rule, and if a Senator did, enough votes existed to waive it even if the point of order was sustained.  That, once again, is not the case for the public option.

So what happens when such an objection is raised in the current case of the public option (if it's offered on the Senate floor under reconciliation)?  If I am right, and I think I am, and if the parliamentarian of the Senate says that the public option is out of bounds in reconciliation when a Republican or Conserva-Dem inevitably invokes the Byrd rule, one of the following will have to happen for it to pass:

It will need 60 votes to waive the Byrd rule and pass it through anyway, which we do not have.

In the second scenario, Vice President Biden, as the President of the Senate, ignores the advice of the parliamentarian and rules it allowable under reconciliation. Then a Republican would challenge that ruling, and we would need 50 votes to sustain the ruling. Now you will have an different situation altogether - 50 Democrats voting not for the public option but to essentially overrule the Senate parliamentarian. 60 votes to pass it through. That will never happen, and if it did, it will give Republicans their very first legitimate line of attack on health care: that the Democrats are playing hard and fast with the rules when the rules turn out to be problematic for them.

I am for the use of the Constitutional option where the Vice President uses his Constitutional power as the President of the Senate to strike as unconstitutional the filibuster altogether, but that is a very different matter than reconciliation (except to the extent that one can argue reconciliation will not be required for anything if the Senate were able to govern my simple majority rule), and as long as the rule remains in place, the parliamentarian ought to be able to call balls and strikes regardless of whom or what such rulings favor.

Well, what about a Medicare expansion?  Does that fit in under reconciliation?  It's certainly a better candidate than a brand new program.  But once again, its changes in incomes and outlays are a mere result of the non-budgetary provision: i.e. inclusion of additional people in the program.  So I am not too sure about that one, but I don't think it will fly, either.

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Via Probably Bad News:

Sure, it probably refers to the health care package being put together by the President and the Democrats, but what a headline, huh?

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Adam Green of the Progressive Change Campaign Committee has been quite vocal lately about the 40 Senators that are now on the record supporting a public option in reconciliation.  And to be sure, they are.  But the drive to get Senators to support the public option in reconciliation actually started as a drive to get Senators to urge Majority Leader Reid to insert the public option into a reconciliation bill that could pass by majority vote.  Adam would of course say that as long as a Senator votes for the public option in reconciliation, it makes no difference whether they are proactively asking for it to be included.

But I think there is a difference.  I think there is a different signal being sent to Sen. Reid's office.  The difference is one of pressure and push.  It turns out that the letter itself has only been signed by 24 Senators, not 40.  The balance, 16 Senators, have been asked by various media sources and have said they will vote for it if it comes up.  Let me explain the difference to you this way - the difference is kind of like one between a member of Congress who sponsors or co-sponsors a bill and one who just votes for it.  The 16 who did not sign the letter are patently unwilling to create pressure on Majority Leader Reid to put the public option in reconciliation.  And for good reason.  As Ezra Klein has noted on numerous occasions, even Senators supportive of a public option do not believe that at this point, its re-emergence helps health reform pass.

So here is what is going on: Senators who are already on record supporting a public option are afraid to say that the public option cannot be passed under reconciliation.  Why?  Because in 30 second sound-bites and 24 hour news cycles, it is really hard to explain the process difference and why one thing could happen in Congress under one process but not under another.  It is really difficult to lay out the case that under reconciliation, it's quite likely that the public option, under reconciliation, will require 60 votes and not 50, in the likely scenario that the Senate parliamentarian rules that it is policy which cannot be considered within the narrow scope of reconciliation.  The only alternative scenario is the following:

Vice President Biden ignores the advice of the Senate parliamentarian and rules it allowable under reconciliation. Then a Republican would challenge that ruling, and you would need 50 votes to sustain the ruling. Now you will have an different situation altogether - 50 Democrats voting not for the public option but to overrule the Senate parliamentarian. That will never happen, since it will give Republicans their very first legitimate line of attack on health care: that the Democrats are playing hard and fast with the rules when the rules turn out to be problematic for them.  I am for the use of the Constitutional option where the Vice President uses his Constitutional power as the President of the Senate to strike as unconstitutional the filibuster altogether, but as long as the rule remains in place, the parliamentarian ought to be able to call balls and strikes regardless of whom or what such rulings favor.

See how long that took to explain?  No Senator can explain this in 30 seconds, and furthermore, expect the "public option or bust" crowd to actually give that explanation a fair hearing.  But they understand that the public option does not stand much of a chance to pass under reconciliation.  There are too many hurdles to clear, and getting reform done now is paramount.  That is why 16 Senators will go on record saying that they will vote for a public option should it come up under reconciliation, but will not ask that it be brought up under reconciliation.

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There are lots of fights on health reform.  Between the left and the right.  Within the left - the I'm-more-liberal-than-you fight.  The fight about whether the President is selling us down the river.  Tons of fights to claim the mantle of the true health reformer.  In the mean time, the focus got lost.  We were so damn busy accusing each other of siding with insurance companies, we forgot the real enemy that was siding with insurance companies.  You know, the actual insurance companies.

And in the midst of it all, they have been regrouping, rethinking, and re-inventing ways to stop health reform.  Regardless of whether or not you believe what's on the table now is real health reform, they certainly do.  And they are going to spend a million dollars running ads on TV to prove it.

Robert Zirkelbach, a spokesman for America's Health Insurance Plans, said insurance industry workers "do not deserve to be vilified for political purposes. ... For every dollar spent on health care in America, less than one penny goes toward health plan profits. The focus needs to be on the other 99 cents." AHIP plans to spend more than $1 million to run television ads on cable stations nationwide beginning in the next few days to push back on the attacks on insurers.

Aww. Poor, poor health insurance companies. Who is going to think of the poor insurance companies! First of all, let's put the lies about 1% going to profits to rest.  Last year, the top 5 health insurance companies made $12.2 billion in profits alone, up 56% from the previous year.  In a recession.  That insurance companies spend a gigantic amount in overhead, such as executive salary, paperwork, employing people to try to find ways to rescind policies, advertising, etc. that's not profit is not someone else's fault. Second, here is the real number you need to look at: the insurance company waste. The Main Street Alliance released a report in December of 2009 showing that ,erely 17 years ago, insurance companies spent nearly 95% of the premiums they received on actual Medical care. Today, according to PricewaterhouseCoopers, the average for the largest insurers is about 80%. But that's not the worst part.

Although the PricewaterhouseCoopers study gives an average for major investor owned insurance companies, other studies have found that in the individual and small group markets smaller insurers routinely have medical loss ratios that are much lower. A recent study of these markets found many as low as 60 percent.

Remember that these people - small businesses who buy insurance in the small group market and individuals who either cannot afford coverage or pay exorbitant rates in the individual market need the most help.  Large group MLR may not rise as much from the status quo, they buy in volume, and the savings realized would also be in volume.  Reform would mandate these rates to rise to 85% for large group markets and 80% for small group markets. And that alone is enough to drive them crazy. In his report about Wendell Potter, Ezra Klein noted in June of last year that

as Potter explains, he's watched an insurer's stock price fall by more than 20 percent in a single day because the first-quarter medical-loss ratio had increased from 77.9 percent to 79.4 percent.

That's not all, last Friday, Ezra also got a hold of an internal assessment of how Wellpoint stock would be affected should reform fail.

"Of course, healthcare reform is a double-edged sword for Wellpoint shares. Should reform fail, Wellpoint would be a primary beneficiary."

Insurance companies do not want reform of any kind. They want the process to die. Why, because if that happens, they would be the primary beneficiary.

What else are they afraid of?

Wellpoint's "2.2 million individual members do leave it somewhat exposed to the 80% individual [Medical Loss Ration] floor contemplated in the Senate bill and Federal oversight of rating action proposed by the President," continues the analysis. In English, that means the bill will force Wellpoint to spend at least 80 cents of every premium dollar on medical care for its customers, and it means that regulators aren't likely to let Wellpoint jack prices up by 25 percent with no warning or reason.

Should insurance companies be concerned about this? Of course they should be. This is going to cut into their bottom line - especially a company like Well Point, that does so much business screws so many people over in the individual market.  One of the basic ideas of the reform proposal on the table now is to legally mandate a minimum medical loss ratio and give people and businesses in the toughest situations (small businesses and individuals) bargaining power.  If consumers have bargaining power, the insurance companies have to compete.  They, of course, don't like it.  They don't want anything to have to do with it.  They have no better friend than the status quo.  And they are perfectly happy to have us liberals quarrel amongst ourselves if that's successful in stalling (and killing) reform.

That is why the insurance industry is adding another million.  Mind you, that's merely chump change to the $173 million that the insurance industry spent directly by August of last year, laundering money through the Chamber of Commerce and other ways.  It's probably also chump change compared to the amount they are still spending lobbying, funding fake-grassroots groups and jacking up the anger meter of Americans.

Insurance companies still think there is a chance to derail reform.  They still think there's a chance they could go on perpetuity denying coverage to people because of pre-existing conditions, or dropping people from the rolls just as soon as they get sick.  They still think that if they play their cards right, they will be able to continue to shrink their consumer base and balloon their profits.  They still believe that they can buy enough members of Congress, gin up enough faux outrage, and scare enough people to stop reform.

There is only thing that stands between them and the preservation of the status quo.  You.  Me.  Us.  We need to push back.  And yes, we can push back.  They have a $1 million a day to pour into this.  Do we have 5 minutes everyday to make some calls to our members of Congress and tell them to push reform through?  I think we do.  I think we are damn close.  I think we are going to do this.  But only if all of us do it together.  We need to all get behind the President's leadership on this and push.  This is us vs. them.  They are the insurance giants who would like to keep things as is.  We are the ones that are going to push reform past the finish line.

Let's do this! Go to House.gov and Senate.gov and contact your members. I have had indications that contacting their local office (especially if they are your rep) has a better impact than calling their DC office - or at the least, you get a better ear. Here are the numbers to the Capitol Switchboard if you must call their DC office: 1-866-338-1015, 1-866-220-0044, 1-866-311-3405. Get busy.

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Wendell Potter, the former health insurance executive and whistle blower who spoke out for health reform, today went on MSNBC's The Ed Show and urged liberals to take the current deal on health reform.  Here is the video:



A lot of people on the left has had problems with the fact that the current proposal, in effect, bring more people into the current system by providing more people with coverage but does not change the fundamental, for-profit health insurance system. Some liberals have struggled with the principled conflict that the bill provides subsidies for people to buy private coverage, thus handing more customers to the insurance companies. While that's there is true reform in the current package, starting with regulatory reform of the insurance companies. As Wendell Potter said,

If there is reform, yeah, they'll get new customers, but they'll have to live in a world that has a lot more restrictions, a lot more oversight than they've been used to.

Mr. Potter also points out correctly that in the current reality of Washington, we are not going to be able to get exactly what we want. But to pass no reform is not acceptable. Wendell Potter agrees with the President that, as Ed characterized it, there is enough good in the bill not to scrap it.

We need... these kinds of restrictions. A lot of these [insurance industry] practices should have been made illegal a long time ago. But we've never been able to get even this close to getting that done... There're too many people who are counting on this passing.

Potter also said it was an encouraging sign to see 37 Senators support a public option in reconciliation, and that it gave momentum to getting such an option passed into law later on.

If it isn't included in legislation this time, I think there's really hope that we really can have a public option.

Exactly. The work of health reform does not end with the passage of the current legislation and it becoming law. Subsequently, Potter also agreed that if we don't get this bill done, health reform will likely be delayed for more than another decade yet. Let's be clear about one thing: nobody on the left is talking about giving up on a Medicare-like option that all Americans can buy into. Those who agree with my side of the debate are, however, arguing that we not hold comprehensive health reform hostage to such a demand. And Wenell Potter agrees.

Ed: So Mr. Potter, you're saying to the liberals that are having a hard time with this, 'take the deal.'

Wendell Potter: Take the deal. I understand why they don't like the deal. But we've got to have this deal or many more of us are going to be suffering and we cannot wait any longer. We've got to get something done.

This is it. This is what this is about. We cannot wait another decade and a half to start health reform. We have got to get something done, now. And as a liberal, I will remind us what is in this deal that we are getting. At the end of the day, when all is said and done, the health reform package will:

• Give 31 million additional Americans health insurance.
• Massively expand community health centers with an additional $11 billion in funding.
• Expand Medicaid and have the federal government pick up the vast majority of the tab.
• Create exchanges with both state and federal oversights in which Americans can shop for the best deals.
• Provide Americans who need it with federal financial assistance to purchase health insurance.
• Provide a basic benefits package based on the one members of Congress get.
• Strengthen Medicare and stop over-subsidizing private insurance to provide the same services as Medicare.
• Outlaw the worst insurance company practices like denying insurance based on pre-existing conditions.
• Outlaw annual and lifetime limits on health insurance plans.
• Institute other strong insurance regulations.
• Require that insurance companies spend 85% of premium dollars providing care.

All in all, I don't think this is a bad deal at all, especially as a foundation and the first big step in health reform. Let's take this deal, get this done and keep working for more and better reforms in the future.

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Rep. Bart Stupak is now threatening that a coalition of Democrats are ready to derail final health care legislation. Why? Well, Bart doesn't think the Senate-passed version of the bill (which must now go through the House) insults women enough. He doesn't want women to be able to buy abortion coverage in the insurance exchanges even with their own money. Bring it on, he says:

"I want to see healthcare pass," Stupak said Thursday on ABC's "Good Morning America." "We must have healthcare but, boy, there are some principles and beliefs that some of us are not going to pass.

"We're prepared to take the responsibility. I mean, I've been catching it ever since last fall. Let's face it, I want to see healthcare. But we're not going to bypass some principles and beliefs that we feel strongly about."

Bart Stupak, of course, was the author of the House-passed Stupak amendment, which introduced this patently ridiculous and dangerous concept that women couldn't buy abortion coverage - even if they pay for it with their own money - from the exchanges health reform legislation will set up.

But here's the part that caught my ear and my eye.  "We're prepared to take responsibility."  "We," in this context, according to Stupak himself, are 12 Democrats who voted for the original House legislation that have now told the Speaker of their willingness to hold health care hostage to their greater principle, which is evidently the degradation and humiliation of women.  The questions that come rushing to mind about what country these people think they live in notwithstanding, since the Stupak 12 are "prepared to take responsibility," here is a good first step to taking that responsibility: tell us who you are.

We know Bart Stupak is the leader of the wolf pack.  But who are the rest?  Rep. Stupak, will you name names instead of hiding these cowards behind your shadow?  Or are you a barking dog that lacks the courage - or even the ability for that matter - to bite?  What's it going to be, Mr. Stupak?  I mean, this list of Democrats who voted for the Stupak Amendment and the final passage of the House bill can only have 35 possibilities.  Here's the list, as reported by Greg Sargent.  There are 36 names on the list, but one of the members on the list, Rep. Murtha, has passed away.

To be sure, I do think that Rep. Diana DeGette, the Chair of the Pro-Choice caucus was right when she said that Stupak doesn't actually have the votes to kill health reform.  I think he's bluffing.  I also think that even if Stupak is correct about the number, Pelosi may have found 10 moderate Democratic votes that will move from the 'no' to the 'yes' column.  Some specific indications are already going that way.  So, all in all, Stupak can suck it.

But be that as it may, I want all these principled proponents of letting the government practice medicine on women to please stand up.  If Bart Stupak has the names of the other Democrats who want to impose their religious beliefs on the rest of America, we need to know their names.  They should at least have the courage of their conviction - unless they lack both. Here's Bart Stupak's number - call him and demand that he name the names of his Democratic partners in crime: (202) 225 4735.

It's time to break the secrecy and the silence.  It's time for pro-choice Americans to demand that Mr. Stupak name names and let us hold him and his cohorts accountable.   Maybe once all the huffing and puffing stops, we can get some answers from you on your relationship with the secretive religious group called The Family and your $600-a-month rent at for a room at the C-Street house, Congressman?

Update: The call for Stupak to name names still stand, but TPM might have figured out some likely candidates for the dirty dozen. Hat-tip to itskevin in comments at Daily Kos. Kevin looked up the numbers, too! Thanks!

Solomon Ortiz (D-TX) (202) 225-7742
Jerry Costello (D-IL) (202) 225-5661
James Oberstar (D-MN) (202) 225-6211
Steve Driehaus (D-OH) (202) 225-2216
Marcy Kaptur (D-OH) (202) 225-4146
Paul Kanjorski (D-PA) (202) 225-6511
Kathleen Dahlkemper (D-PA) (202) 225-5406
Joe Donnelly (D-IN) (202) 225-3915
Brad Ellsworth (D-IN) (202) 225-4636
Dan Lipinski (D-IL) (202) 225-5701
Charlie Wilson (D-OH) (202) 225-5705

Call them and ask them if they are part of Stupak's dirty dozen, since, once again, this isn't from Stupak. Stupak hasn't yet named his cohorts, so we're trying to figure it out on our own. And call Stupak and tell him to give us the names. Read him these names if you want and ask him to confirm or deny.

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I got an email from CREDO Action this morning that has me fuming. I am generally a supporter of theirs and I have signed damn nearly every petition they have ever asked me to. I had even advised my mother to switch to Credo Mobile when her contract with AT&T runs out in approximately six months. But this most recent petition they are circulating calling the President a loser is disgusting and deplorable. There are so many things wrong with this "action," I don't even know where to start. So let's start at the beginning.

If President Obama thinks that some of the senators who've claimed in the past to support the public option have changed their minds, he should start naming names and tell us who they are.

Where do you even start with this? I have explained over and over again that a senator's support for the public option as policy does not automatically imply their support for the public option in reconciliation. Reconciliation is a budgetary, narrow, restricted process and in addition to the Senators who oppose the public option on a policy ground, some senators oppose it under reconciliation on a process ground. Big ticket health care reform items - and Credo will argue that the public option for them is the biggest ticket reform item - are unlikely to move through reconciliation. Only budgetary changes to the already existing programs are good candidates for reconciliation.

But if Credo wants an example, I will give them one. The author of the robust public option in the Senate, Jay Rockefeller. Jay Rockefeller is not for pursuing the public option in reconciliation. I will give you another name. Chairman of the Senate HELP committee, author of the Americans with Disabilities Act and a lifelong champion of health care as a right for every American, Tom Harkin. Harkin believes, and Washington Post's Ezra Klein has confirmed in numerous occasions that the resurgence of the public option in reconciliation is not good news for overall comprehensive health care reform.

So, here is my question for Credo - what do you plan on doing with these people? Fund a primary challenge against Tom Harkin and Jay Rockefeller? Get your act together, Credo!

Then they go out on a limb (joining Adam Green) calling the President a loser:

Just because the White House has given up and adopted a loser mentality, it doesn't mean we have to go along with it.

A "loser mentality?" Let me tell you what a loser mentality is. A loser mentality is pursuing a path that makes health reform less likely to pass. A loser mentality is clawing your way onto a chalkboard and risk blowing up the volatile final process in getting health reform finally passed just because your favorite thing didn't make it onto the list. A loser mentality refusing to understand that if overall reform could be passed through reconciliation, painstaking negotiations in the Senate last year would have been unnecessary. A loser mentality is throwing stones at the Democratic White House when it is finally getting deeply involved in moving forward what will be the biggest expansion of social safety net since Medicare. A loser mentality is throwing monkey wrenches into the process and refusing to even admit it.

Then to be sure to stir up anger from people, they throw in this logical fallacy that has been used ad infinitum by the "public option or nothing" crowd:

Our polling shows that the public option remains overwhelmingly popular in state after state. It also shows that the version of health care reform passed by the Senate, which doesn't include a public option, is very unpopular.

I'm sure your polling does show that. It's also true. What is logical fallacy of epic proportions is to assume that if a popular provision is included in a bill that is unpopular (thanks to a year of teabagger and right wing framing), then suddenly, the bill will become popular. Bah-loh-ney. I wrote about this specifically a couple of weeks ago. There are plenty of provisions included in the legislation that are far more popular than the public option. At the risk of repeating myself:

In October, a Washington Post/ABC News poll put support for the public optionat 57%, A Reuters poll in December put it at almost 60% and most proponents agree that the support for public option is nearly 60 percent nationwide. The Kaiser Family Foundation found in its polls from February 2010:

• 91 percent support banning pre-existing conditions and annual and lifetime benefits limits
• 76 percent support reforming the way health insurance works
• 72 percent support tax credits for small businesses
• 71 percent support creating a health insurance exchange/marketplace
• 71 percent support helping close the Medicare "donut hole"
• 70 percent support expanding high risk insurance pools
• 68 percent support providing financial help for low-/middle-income people

Despite all these wildly popular provisions already being included in the current bill, the sharp divide and relative unpopularity of the overall legislation continues. Why? Two reasons. First, Americans are scared by the right, and tired of the process. They are mad at Congress being broken, and that's legitimate. Second, as Nate Silver has demonstrated, the popularity problem that health reform faces is not due to its provisions but due to the lack of awareness of its provisions (especially the good ones).

This is also unequivocal proof that mere addition of a popular provision will not make the bill more popular. However, in my judgment, passing comprehensive legislation, finally bringing the process to a close, achieving reform with the President's signature are what is likely to make it more popular. Americans often warm to social safety-net legislation after it passes.

The proposal on the table now is a great foundation for reform, and we will keep fighting to add things to it later. But let's please stop calling the President a loser and claiming that dropping a popular provision in a bill will make it more popular.

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I was a frequent blood donor. So much so that I'd get a call from the Red Cross every time there was a blood drive anywhere in my area. And I, invariably, always showed up to give blood. I have always considered it a privilege to donate blood. Then one day, I - well, one day, I had sex. And I couldn't give blood anymore. For life. Not because I have any sexually transmitted diseases; I don't. I can't donate blood anymore because I had sex.

You see, I'm gay. And gay men - well the ones who've ever had sex at any rate - are banned from the privilege of giving life, giving blood because of a policy of lifetime ban on men who have sex with men (MSM) instituted by the FDA in 1983. With everything else that makes gay Americans second class citizens, I suppose the ban on giving blood is small potatoes, but I feel very strongly about it. That is why I was delighted this morning to see Sen. Kerry lead a letter co-signed by several other Senators to the FDA asking to have this ban lifted. Sen. Kerry made the glaring discrimination clear in his letter:

prospective donors who have engaged in heterosexual sexual activity with a person known to have HIV are deferred for one year. At the same time, male donors who engaged in protected homosexual sexual activity with a monogamous partner 26 years ago are deferred for life... The ban also does not distinguish between safe and unprotected sexual activity. As a result, healthy blood donors are turned away every day due to an antiquated policy and our blood supply is not necessarily any safer for it.

I'm one of those healthy blood donors - born, incidentally, the year this policy was put into effect. The ban is not just discriminatory, however. The scientific community agrees that the ban also has no basis in sound science.

The American Red Cross, America’s Blood Centers, and AABB reported before an FDA-sponsored workshop on March 9, 2006 that the ban on men who have had sex with other men (MSM), even once, since 1977 from ever donating blood “is medically and scientifically unwarranted.” Then in 2008, the Council on Science and Public Health at the American Medical Association also advocated modifying the lifetime deferral requirement for MSM.

Let's be clear about something. There is a myriad of risky sexual activities that put one at risk for HIV. Sex between two men, both tested and clean, isn't one of those activities. Monogamous relationships between men aren't one of those activities. As Sen. Kerry says in his Bay Windows op-ed, not a single piece of scientific evidence backs up the ban. But, I suppose it's now a faith based initiative from the FDA. In the op-ed, Sen. Kerry once again cuts to the heart of the ridiculous policy:

FDA guidelines dictate that if you pay a heterosexual prostitute for sex you are deferred from donating blood, but for just one year following the incident... But a man who has had protected sex with a monogamous male partner, even one time 33 years ago, is barred for life from donating blood.

Blood donations save lives. It is not just wrong to deny us the opportunity to be part of that lifesaving process. It is cruel to those who need blood. Our nation, most of the time, runs on a shortage of blood supply. Lifesaving surgeries have to be cancelled on a routine basis because of the shortage of blood supply. Could some of those lives be made better if I were able to give blood again? If millions like me were?

I am asking you to get involved. Call FDA Commissioner Margaret Hamburg at 1-888-463-6332 and tell her to lift this ban.  I am also posting below the list of the Senators who have signed onto Sen. Kerry's letter. If your Senators are not on the list - and I frankly don't care if they're Republican or Democratic or something else - call them and ask them to sign the letter. If your Senators are on the list, call them also, and thank them for their stand.

THANK YOU to the signatories to the Kerry letter:

• John Kerry (MA)
• Kirstin Gillibrand (NY)
• Dick Durbin (IL)
• Daniel Akaka (HI)
• Sheldon Whitehouse (RI)
• Sherrod Brown (OH)
• Frank Lautenberg (NJ)
• Bob Casey (PA)
• Bernie Sanders (VT)
• Russ Feingold (WI)
• Mark Udall (CO)
• Al Franken (MN)
• Maria Cantwell (WA)
• Carl Levin (MI)
• Tom Harkin (IA)
• Mark Begich (AK)
• Rolland Burris (IL)
• Michael Bennet (CO)

And here are the numbers to the Capitol Switchboard so that you can call and ask for your Senators, and either thank them or ask them to get on board. In fact, call your Representative in the House as well, and tell them to get on board, too. The numbers: 1-866-338-1015, 1-866-220-0044, 1-866-311-3405.

Will you stand up so that I can donate blood again?

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In 2004, I went to volunteer for Howard Dean in Arizona for a weekend, and Rep. Raul Grijalva gave a great speech to rally us before we went out knocking on doors.  I have a lot of respect and personal admiration for Rep. Grijalva.  However, he is dead wrong in leaning towards voting against the President's health care proposal (which, legislatively will be put through by having the House pass the Senate-passed bill as is, and then putting together a reconciliation package).

Apparently, the president's last-minute embrace of certain additional Republican ideas is a problem with the Congressman.  Particularly, Grijalva is peeved that the President is agreeing to ensure the existence of Health Savings Account plans (HSA's) in the exchanges.

That provision "was, when we were in the minority, something that we fought tooth and nail to keep out [of legislation]," Grijalva said. "I find that ironic -- something that we had fought to keep out, and indeed were successful, gets back in as part of reconciliation.

Liberals are rightly concerned about HSA's, which are nothing more than a way to sell catastrophic coverage with really high deductibles that most people cannot afford.  It is, as the President himself once called it, house insurance, not health insurance.  Nonetheless, I'm not entirely sure what the Congressman is talking about; the fact of the matter is that while the President is proposing that there be HSA's in the exchanges, no one is forced to buy an HSA plan.  The good essential benefits requirements are still there, and only plans with those requirements met are counted when the individual mandate is in play (which one is exempt from if premiums cost more than 8% of one's income).  In other words, if one is able to afford an HSA insurance plan that is under 8% of one's income in premiums but don't meet the essential benefits requirements, one is not subject to the mandate if one chooses not to buy it.  What's more, I am not aware of a provision in the House bill that bans HSA's from being sold on the exchanges.  The Senate bill allows those under 30 who are already exempt from the mandate to buy HSA catastrophic plans.

Three other items in the President's last-minute adoptions were relatively non-controversial:

1. Reducing waste, fraud and abuse by having undercover health professionals randomly investigate providers who receive federal health care money.
2. Demonstration/pilot projects on malpractice lawsuit reforms.  It doesn't cap damages, but just sets up pilot projects to test the best ideas.
3. Improving the Medicaid reimbursement rates and regional disparities therein.

But I believe the real gripe of Rep. Grijalva is the exclusion of the public option.

And a public option that enjoys great support in the House and up to 30 senators gets left out. That's something I just don't understand.

Twenty-nine Senators have signed a letter asking for Sen. Reid to include the public option through reconciliation, and six others have made statements that they will vote for it if Reid did happen to include it (the difference, I believe, is substantial in the sense that the last six aren't asking for it to be included, but merely saying that it has their votes should it be up for a vote - they are not demanding a vote on it).

While no one on the liberal side celebrates the demise of the public option, 35 Senators are not 51 Senators.  And as Ezra Klein has repeatedly pointed out, even Senators who support the public option privately do not believe its resurgence is good news for health reform getting passed.  We just simply cannot wait around to get the votes together for the public option under reconciliation - votes that in every likelihood will never materialize - while health reform dithers.

At the end of the day, when all is said and done, the health reform package will:

• Give 31 million additional Americans health insurance.
• Massively expand community health centers with an additional $11 billion in funding.
• Expand Medicaid and have the federal government pick up the vast majority of the tab.
• Create exchanges with both state and federal oversights in which Americans can shop for the best deals.
• Provide Americans who need it with federal financial assistance to purchase health insurance.
• Provide a basic benefits package based on the one members of Congress get.
• Strengthen Medicare and stop over-subsidizing private insurance to provide the same services as Medicare.
• Outlaw the worst insurance company practices like denying insurance based on pre-existing conditions.
• Outlaw annual and lifetime limits on health insurance plans.
• Institute other strong insurance regulations.
• Require that insurance companies spend 85% of premium dollars providing care.

Rep. Grijalva is talking about voting against all of these things.  Make no mistake: a vote against this plan is a vote for the status quo.  It is the status quo that is the real slap in the face to the American people.  The status quo kills 45,000 Americans every year due to lack of health insurance.  The status quo has 100,000 more Americans dying than need to from preventable illness.  The status quo is skyrocketing the number of medical bankruptcies.  Will this bill eliminate all of those problems completely?  No.  But it will bring us something a whole heck of a lot better than the status quo.  We cannot afford the status quo anymore.

Progressives should not be sitting on the sidelines or impeding progress on this.  Least of all, us.  We need to move this forward, and we need to move this forward now.  Congressman Grijalva needs to vote on the side of reform, of progress, of helping people, and not on the side of preserving the status quo.

Update: Returning from a meeting at the White House, Grijalva indicated that House progressives will vote for the proposal, although he didn't say anything specific about himself.  He did mention that the President has committed to fighting for a public option once this group of legislation becomes law.

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Health reform is really near the finish line. This is a critical juncture. Yesterday, the President put his bold leadership on the line and gave it one big push. Now, we need Democrats in the House and the Senate to push final reform through. I say Democrats, because the Republicans have decided that obstructing is the only path they are willing to go down. So it's on the majority party, the governing party. The Democratic party.

When the House last voted on health reform, the House progressives heroically did the right thing and voted for the bill despite its many imperfections. Conservative Blue Dog Democrats, however, weren't in a cooperative mood. 97% (all but two) of the Progressive Caucus supported the House bill, while only 57% of Blue Dogs did the same. 23 members of the Bluedog Coalition voted NO on the House bill. All the statistics and numbers here are obtained from Progressive Caucus and Blue Dog member lists and vote tallies of the House health care vote and the Stupak amendment vote. We are now hearing that Bart Stupak (who is a member of neither caucus) is threatening to walk away with 10-12 members because the abortion language in the Senate bill that the House now must pass does not disrespect women quite as much. Speaker Pelosi has always shown great leadership, and now we are hearing that 10 Democrats who voted No on the original House legislation may vote for the Senate bill and the reconciliation fix.

I don't know about you, but it's too close for comfort for me. I want to give Speaker Pelosi a hand. If the Bluedogs are going to be called Democrats, have the privileges of the majority party, hold chairmanships, and run things as part of the majority party, they must bear some responsibility and take some tough votes for the leadership. Below, I am listing three categories of Blue Dogs I believe need to hear from us (especially constituents)

1. Those who voted NO on final passage, and NO on Stupak. These members, in theory, should be the easiest switchers from NO to YES on final passage. In all likelihood, their reason for opposition was the public option. Now that that's gone, they no longer have an excuse to vote NO.
2. Those who voted NO on final passage, and YES on Stupak. If Stupak wasn't enough to get them to vote yes, the public option may have been the reason they voted against the bill. It's gone now, and they should be able and willing to accept the Nelson language on abortion.
3. Those who voted YES on final passage, and also YES on Stupak. These may be some of the wavering 10-12 above. Your message to them should emphasize that Nelson's language on abortion is still fairly restrictive, and the Hyde amendment remains in place. They need to keep their Yes votes on final passage.

So here are the Blue Dogs, in those three categories (with leadership listed on top, and the rest of the list alphabetized). If one of these members is your member of Congress, please call his or her office first, and then call as many other people as you can.

NO on final passage, NO on Stupak - 9 Blue Dogs

• Stephanie Herseth Sandlin (SD), Blue Dog Co-Chair for Administration - Phone: (202) 225-2801
• Dan Boren (OK-02) - Phone: (202) 225-2701
• Allen Boyd (FL-02) - Phone: (202) 225-5235
• Bart Gordon (TN-06) - Phone: (202) 225-4231
• Frank Kratovil (MD-01) - Phone: (202) 225-5311
• Betsy Markey (CO-04) - Phone: (202) 225-4676
• Walt Minnick (ID-01) - Phone: (202) 225-6611
• Murphy (NY-20) - Phone: (202) 225-5614
• Glenn Nye (VA-02) - Phone: (202) 225-4215

NO on final passage, YES on Stupak - 14 Blue Dogs

• Jim Matheson (UT-02), Blue Dog Co-Chair forCommunication - Phone: (202) 225-3011
• Heath Shuler (NC-11), Blue Dog Whip - Phone: (202) 225-6401
• Jason Altmire (PA-04) Phone: 202-225-2565. This genius went on Fox Noise to express his "skepticism" on health care.
• Bobb Bright (AL-02) - Phone: (202) 225-2901
• Ben Chandler (KY-06) - Phone: (202) 225-4706
• Travis Childers (MS-01) - Phone: (202) 225-4306
• Lincoln Davis (TN) - Phone: 202.225.6831
• Tim Holden (PA-17) - Phone: (202) 225-5546
• Jim Marshall (GA-08) - Phone: (202) 225-6531
• Charlie Melancon (LA-03) - Phone: (202) 225-4031
• Colin Peterson (MN-07) - Phone: (202) 225-2165
• Mike Ross (AR-04) - Phone: (202) 225-3772
• John Tanner (TN-08) - Phone: (202) 225-4714
• Gene Taylor (MS-04) - Phone: 202.225.5772

YES on final passage, YES on Stupak - 18 Blue Dogs

Remember these members have already voted Yes on the House bill, so when you call, thank them for their vote and ask them to hold firm in that position and vote Yes again. Talk about the abortion language only if they bring it up.

• Baron Hill (IN-09), Blue Dog Co-Chair for Policy - Phone: (202) 225-5315
• Joe Baca (CA-43) - Phone: (202)225-6161
• John Barrow (GA-12) - Phone: (202) 225-2823
• Marion Berry (AR-01) - Phone: (202) 225-4076
• Sanford Bishop (GA-02) - Phone: (202) 225-3631
• Dennis Cardoza (CA-18) - Phone: (202) 225-6131
• Chris Carney (PA-10) - Phone: (202) 225-3731
• Jim Cooper (TN-05) - Phone: 202-225-4311
• Jim Costa (CA-20) - Phone: 202-225-3341
• Henry Cuellar (TX-28) - Phone: 202-225-1640
• Kathy Dahlkemper (PA-03) - Phone: (202) 225-5406
• Joe Donnelly (IN-02) - Phone: (202) 225-3915
• Brad Ellsworth (IN-08) - Phone: (202) 225-4636 - by the way, Ellsworth is running for the Senate to replace Bayh. If you can create some pressure within the party, that could work well.
• Mike Michaud (ME-02) - Phone: 202-225-6306
• Earl Pomeroy (ND) - Phone: (202) 225-2611
• John Salazar (CO-03) - Phone: 202-225-4761
• Zack Space (OH-18) - Phone: (202) 225-6265
• Charles Wilson (OH-06) - Phone: (202) 225-5705

If you'd rather use one of the toll free numbers to the Capitol Switchboard and ask for one of these members, here are those numbers: 1-866-338-1015, 1-866-220-0044, 1-866-311-3405.

Please make a few of those calls. Make as many calls as you can. Get your friends and family and neighbors to call. If you have friends or family that live in the districts of the people I listed, call them and get them to call. Flood their offices. They need to hear from us. Let's get health reform done - together, all of us, on the same side - on the side of reform. Let's roll.

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