Last Thursday, the Republicans filibustered Finance Committee Chairman Max Baucus’s Medicare Improvements for Patients and Providers Act of 2008. Among other things, the bill would prevent a 10% cut in Medicare payments to doctors that will otherwise take effect in July. Why does this matter?
The 10.6 percent pay cut — the result of a Medicare formula set up several years ago to limit payments to physicians — originally had been scheduled to take effect at the beginning of this year, but Congress agreed in December to temporarily delay it until July 1 while lawmakers searched for ways to pay for eliminating the cut.
Doctors have repeatedly warned that if the cuts take place, many of them will refuse to accept new Medicare patients.
Congress could agree to simply extend the delay on the pay cuts, but that would mean Medicare’s 44 million beneficiaries would pay higher premiums next year to help finance the higher-than-scheduled payments to doctors this year.
The key to any medical reform in this country runs right through Max Baucus’s Finance Committee and the Senate Republican’s filibuster. The Finance Committee is one of the elite committees in the Senate. No one from the Class of ’06 has yet earned a seat on the committee. The most junior member is Ken Salazar of Colorado, who is hardly a liberal. I’ve long despaired at the makeup of the Finance Committee because it is so conservative that I assume it will never consider a truly universal system of health care. Even if we elect 10 or more new senators this fall, it’s unlikely that any of them will win a seat on Finance until at least two years later. That’s why I was so encouraged by something I saw on CSPAN last night. It turns out that Senator Baucus, who professes to watch very little television, just happened across the recent Frontline documentary on universal health care called Sick Around the World. Baucus was so impressed by the documentary that he decided to invite the creator to present the film at his Senate Finance Committee 2008 Health Reform Summit yesterday. Here’s a snippet about the film:
In Sick Around the World, FRONTLINE teams up with veteran Washington Post foreign correspondent T.R. Reid to find out how five other capitalist democracies — the United Kingdom, Japan, Germany, Taiwan and Switzerland — deliver health care, and what the United States might learn from their successes and their failures.
T.R. Reid visits the five countries in turn, and explores the strengths and weaknesses of each health care system. He finishes in Switzerland.
Reid’s last stop is Switzerland, a country which, like Taiwan, set out to reform a system that did not cover all its citizens. In 1994, a national referendum approved a law called LAMal (“the sickness”), which set up a universal health care system that, among other things, restricted insurance companies from making a profit on basic medical care. The Swiss example shows health care reform is possible, even in a highly capitalist country with powerful insurance and pharmaceutical companies.
What’s impressive here is that Max Baucus did not recoil in horror at the idea of cutting the insurance and pharmaceutical companies out of the profits from basic health care but, rather, was so enthused about the idea that he made the entire Finance Committee watch the documentary. That’s a very positive sign because nothing can get done on health care reform unless Sen. Baucus signs off on it.
Now, Barack Obama is not running on a truly universal system for the simple reason that it is not politically possible to get a truly universal system passed. Obama proposed a plan that would result in everyone that wants it having health insurance. That’s quite distinct from having health coverage. You can call them both ‘universal’ but it’s a sleight of hand. The question is, though, what if the Democrats pick up 10 or more senate seats this fall and win the White House? That will change what is politically possible because it will eliminate the Republican filibuster. If the Democrats find themselves with that large of a majority they could rework Obama’s proposal into a truly universal system like the ones portrayed in Sick Around the World. Until I saw that Baucus was enthusiastic about the documentary I considered him the biggest obstacle to single-payer health care. Now, I’m not so sure.
Very interesting.
Yet, rather than feeling hopeful, I’m embarrassed to say my main reaction is to feel nauseated by how my own health insurance problems are determined by out of touch people who, if I’m lucky, will happen to see a documentary about people like me who can’t afford insurance.
Good point, but sometimes history is made by virtue of little accidents, like an important senator picking up the remote control at just the right time.
This is where Elizabeth Edwards will begin to use the hammer that Obama is willing to give her.
I remember hope. And it’s on the faces of the people last night…
Maybe it’s looking more like a President Obama 247, McCain 157.
I love those numbers. It means Obama only needs 13 EVs to win this thing. That’s very doable.
Personally I’m hoping it will be a huge majority — Poblano has the average at 305-233 or so right now — at least big enough that the Republicans can’t derail it by stealing a single state.
what happened to my health care thread?
Anyhoo…
I think Obama could hold McCain to under 100 electoral votes in the end.
The only unwinnable states in my view?
Idaho, Wyoming, Nebraska, Oklahoma, Utah, Alabama.
To that I’d add, most likely, Tennessee, Kentucky, and West Virginia.
All other states are winnable for Obama.
sorry. it was hijacked. Gone buh, bye.
numbers and wonky issues aren’t as complex.
TPM
With over four months to go, economy souring, Kentucky looks winnable
Oh, is THAT what this was??
OK, since you insist, the margin of Obama’s victory IMO will be indicative of the gains the Democrats will make in the House and Senate. I think any health care proposals that get made will be dependent on those gains. Right now I think he’s going on a strategy of “underpromise and overdeliver.” (Again, IMO) If he has a solid, veto-proof majority to work with, or if the remaining Republicans in the Senate look at the ’08 results and figure out that their future might just depend on working with the Democratic majority instead of trying to obstruct as much as possible, the health care target might start swinging toward universal health care of some kind. Maybe something like “Medicare for all.”
I think you’re right, and believe the Democrats will end up with single-payer coming out of the convention.
I like Taiwan’s system, which was based on our Medicare system, but they added electronic records and billing to the single payer system. It would be an easy transition too.
…has its problems, like I’ve heard it loses money, and there are ways for doctors to game the system and get a lot of government paybacks, but in the almost 7 years I’ve lived here it’s never failed or faltered, and if it isn’t truly single-payer (I don’t know what it is, employers pay a monthly premium but it’s not very high) it sure operates like one when you’re using it. You go to a hospital and pay a basic rate (I think the most I’ve paid was about US$15) and that’s it. There can be other charges for some kinds of pharmaceuticals (very cheap) or vaccinations, but that’s about it.
My wife and I had a baby last year and we got lots of checkups with the doctor, mris (or is it sonograms? I’m not too sharp on this stuff, one test was in color and all the others were bw) every time she visited (which was at least once a month) and an amniocentesis test that was government-funded because she was over a certain age. My sister had a baby in America last year and what she paid for a single image (probably an mri) cost her more than I think the entire pregnancy cost us, including a private hospital room for 3 days and a c-section.
And this is high-tech care here, on top of which the doctors are also educated in English so even a foreigner like myself can walk in off the street and get by without knowing any Chinese.
…and Taiwan isn’t even officially a country. I couldn’t even afford to have a kid at the wages I was making (from 2 jobs, 7 days/week) in the US. That’s the real shame here…good for Baucus, I hope something comes from this, and that we get a real blowout/realignment in November. It’d be nice to one day be able to live the American dream on actual American soil.
Now, Barack Obama is not running on a truly universal system for the simple reason that it is not politically possible to get a truly universal system passed. Obama proposed a plan that would result in everyone that wants it having health insurance.
HR 676, Medicare for All, is far superior to what Obama is proposing. With 90 copsonsors it has a very realistic chance of passing.
The day after tomorrow there will be demonstrations across the nation, including Philadelphia, Harrisburg, and Pittsburg.
However much you like Obama, HR 676 is far superior to what he is proposing.
Just saying.
yes, it is far better but it doesn’t have any chance of passing. Not in this congress.
it has 90 cosponsors, we only need 128 more supporters and we can pass the H of R. We already have a few supporters in the Senate, only need 51 to pass. This is eminently doable.
Would that it were so. IMO the likelihood is far greater that Republicans would make a big stink about it and threaten to filibuster, which would mean in actuality it would need 60 votes to pass — or more likely 67, because I’ll bet you ten shares of HCA that Bush will veto any such bill that comes across his desk, so they would have to override the veto.
I would think that this is one of the first pieces of legislation that should be introduced into the 111th Congress, however.
with what? There is a very real possibility of a filibuster proof majority. There is also a very real possibility of the fear of God being put into the surviving Republicans. Somehow I don’t see everyone voting the Grover Norquist party line anymore.
Some Republicans might vote for this. Let’s see what Thursday’s demonstrations look like.
A filibuster proof majority? Before next January? I’ll believe it when I see it, with the caveat that I would be happy to see it.
You’re right about one thing, after Katrina and Iowa I think we have a lot of examples of why downsizing government is a Bad Idea. I would hope Norquist becomes one of those people who used to be relevant, and not a moment too soon.
I still haven’t read or heard any convincing arguments why the Dems shouldn’t force the GOP to do the actual filibuster, rather than simply accepting the threat of a possible one as a perfect substitute. You really think those guys would pull out real filibusters for every single piece of legislation (or even half of them) that they’ve successfully blocked so far just with the threat?
There are lots of things about Congress I don’t understand, this being one of them. Personally, I would just let them filibuster until they were tired of talking, then hold the vote. But this probably indicates why I am unfit for public office, since I don’t understand these deep complex issues.
90 cosponsors? No, sorry. There have never been 90 cosponsors, at least not for the people who are operating based on facts. I hope that the number of those people starts to increase. I do not count the deceased U.S. Representatives and people who left the U.S. House for other reasons (one roughly a year ago!). The Political Support section of the Single-Payer Support Monitor provides the facts: Voters Guide, Chart, Graphs of Progress, and Supporters by State reports.
Only need 128 more supporters in the U.S. House? No, sorry. The target for the total number needs to be 67% in the House (292) and 67% in the Senate (67). See the necessary numbers at the same Support Monitor link. Why does the support need to be strong? Because the opposition is very strong, very powerful, and very well-funded with millions of our health insurance premiums. The opposition has already spend 15-20 years or much longer controlling the minds of Americans. We were supposed to join the world by going metric in the 1970’s. It never happened, and it was and is a sad situation. Watch what happens to health care if we citizens do not get our act together.
Only need 51 supporters in the U.S. Sentat? And already have a few in the Senate? No, sorry. Again, see the Political Support section of the Single-Payer Support Monitor.
This is eminently doable? Not under the current situation. The Graphs of Progress show zero progress. Supposedly, according to single-payer national leaders in early November 2007, we were going to have 100 by the end of 2007. Another failure. We need to move to success. I DO BELIEVE THAT IT IS POSSIBLE to achieve Health Care for All with non-profit single-payer national health insurance. BUT IT REQUIRES THE CORRECT ACTIONS >>> Hundreds of thousands of EDUCATED INDIVIDUAL CONSTITUENTS COMMUNICATING MONTHLY TO THEIR U.S. REPRESENTATIVES. See elsewhere among these comments for more in the coming hours/days.
Dear Booman (and others who might help),
I have a question about the state of the public discussion of single-payer health care, at the level of ideas and principles at an economic level. First, some background comments:
——-
I agree with Keynes that “The ideas of economists and political philosophers, both when they are right and when they are wrong, are more powerful than is commonly understood. Indeed the world is ruled by little else. Practical men, who believe themselves to be quite exempt from any intellectual influence, are usually the slaves of some defunct economist.”
Often these ruling ideas have devolved into a simplistic form, like the simplistic market fundamentalism that is today a background to much of what is said about (among other things) health care.
The idea that single-payer health care systems are superior clashes with the idea that minimally regulated markets are always the best way to organize the production and delivery of goods and services. To argue for single-payer in terms of concrete facts (successes overseas, problems with the US system, etc.) doesn’t address a key problem as seen by thoughtful, principled market fundamentalists and their fellow travelers: Advocacy of “socialized medicine” seems to open the door to advocacy of socialized everything, which they know in their bones is Bad.
What principle draws a line here? How could they possibly acquiesce to single payer without abandoning their core beliefs? Without an answer to this, advocacy of single-payer is an assault on a fiercely defended intellectual fortress, and will be fought to the death.
It might be nice to avoid this, especially if it is entirely unnecessary.
——-
That said, here is the question:
Who is arguing (and where?) that health insurance markets are fundamentally different from other markets, in ways that can’t be fixed, even in principle, by greater transparency, competition, consumer information, and so on?
The case for this can be made, briefly and persuasively, but I don’t see this appearing as a visible part of the public discussion, even on the moderately wonky side of the world. Am I missing something?
I see a huge opportunity cost here. Pushing the case for a fundamental difference could melt away hard-core resistance in a small but extraordinarily influential segment of the opposition.
the fact of the matter is that health care advocates in this country have been trying to articulate solutions that have a realistic chance of passing. And in the last fourteen years with a Speaker Gingrich/Hastert, what is realistic is to use health insurance, and expand who’s covered.
To advocate for single payer in a Republican congress was a total waste of time. One result is that we have tons of health care thinkers that are now invested in their solutions and get really testy when someone criticizes them. (See Krugman’s outrage at Obama’s lack of mandate for an example).
This means that many of our natural allies are committed to insurance based solutions because that’s what they’ve been working on for years.
So we need a paradigm shift. And we’re not going to get it unless we bust the filibuster. The fact that Baucus seems open-minded is a huge upside potential sign that big wins in the senate could bing that paradigm shift.
You give a good overview of the strategic situation at the level of major interests and of groups of political thinkers and actors. What I’m looking for, though, is at the level of debates about the role of government and markets in the economic organization of society. This is not about health care policy per se, but about whether single payer systems can be advocated without (implicitly) demanding that market fundamentalists abandon their core beliefs as the price of agreeing.
I would argue that deep beliefs about the proper role of government and markets underlie many stubborn arguments, even when those beliefs are not directly attacked, argued, or stated as premises. These beliefs may be secondary to concrete interests, as seen by those in the middle of the struggle, yet still play a powerful role in how the debate unfolds.
How would a single payer advocate answer the question, “If that level of intervention is right for health care, then why not for food, energy, and everything else — isn’t this really an argument for failed socialist policies?”
I would be very useful to have a well-known answer to this, but what is it? Something like “Health insurance isn’t like other products, because….”, but the reason given can’t be that it’s vital, or expensive, or a right, etc. The same could be said of food.
The reason I find persuasive is that “…the conditions that make normal markets better — competition, free choice, better information on all sides — would, paradoxically, make health insurance almost impossible.”
“The key to any medical reform in this country runs right through Max Baucus’s Finance Committee and the Senate Republican’s filibuster.”
I was really surprised to read this statement. While the Finance Committee may be instrumental in any health care reform, it is not the key committee. The key committee is the Senate Health, Education, Labor and Pensions Committee. Which, of course, is chaired by Ted Kennedy, who in his many years on this committee, has done absolutely nothing, less than nothing even, not even participate in the debate. He’s been on this committee for decades, and has been either the senior member or chair for most of that time. And he hasn’t even come up with any kind of health plan at all.
It’s hard to come up with four areas in this country that are in worse shape than Health, Education, Labor and Pensions. And it’s a direct result of Kennedy’s long stewardship of these issues. How long are people, especially progressives, going to avoid confronting the fact that Kennedy is in power only because of his family name (and, like George W., because of his daddy’s money), and that he is utterly incompetent, if not outright corrupt, and has proven himself quite incapable of dealing with his responsibilities?
Wow. You are pretty badly misinformed.
First of all, the Finance Committee has jurisdiction over health care.
The HELP committee is responsible only for biomedical research, workplace safety, and public health.
If you remember, it was Finance Committee chair Pat Moynihan that killed HillaryCare in 1993-4.
Memory Hole:
Moynihan won.
You wrote about Barack Obama “not running on a truly universal system for the simple reason that it is not politically possible …”
OBAMA REQUIREMENT AND PROMISE
WE ARE IN DANGER OF NOT HAVING A SUPPORTIVE PRESIDENT FOR 2 REASONS
HOW TO FULFILL HIS REQUIREMENT
My Promise to You is that I have a web site that is focused on providing the facts, such as the information above. Key people in every U.S. Congressional District can either get 2,000 to 4,000 people to follow the Schedule, linked above, or kiss our jobs, our economy and our country goodbye. This is getting to be a more critical situation every month of every year. You must speak out and get this train moving NOW!
Communicate to your U.S. Representative, no matter what their political party is.