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Politico reports that Pelosi doesn't have the votes for the 'strong' public option

From Mike Allen:

House Democratic sources say Speaker Nancy Pelosi determined last night that there are NOT the votes for a “robust public option,” meaning the Speaker will likely move to one of the two other, weaker public options being considered. “Votes aren’t there,” a top official said. “The progressives are always more optimistic than reality.” But the Speaker knows how to count real votes to find out the truth, and she wants to release a bill that will get at least 218 votes. Aides say the count was somewhat of a surprise, but not completely. It’s a bit of a disappointment, but could help House members in conservative districts. The Speaker plans to roll out the House bill with a big ceremony on the West Front. It was planned for Tuesday or Wednesday, and may still happen then. But last night’s tally could delay the timeline a bit.

Pelosi's office disputes the story, and says the count is ongoing. Indeed, they're doing what's called a "live whip": making every member express their preferences on every variation of the public option, in order to both get an accurate count and pressure the dissenters into falling in line with the majority.

By Ezra Klein  |  October 23, 2009; 10:16 AM ET
 
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Comments

Given the counter-stories today, the actual journalistic question to ask, given that it's BS-ico we're talking about here, is who leaked and why? I hear the annoying yap of blue dogs somewhere in the distance...

Posted by: pseudonymousinnc | October 23, 2009 10:21 AM | Report abuse

Agreed, this sounds like spin from conservative Dems. I'm surprised they got Mike Allen to break it, since Jonathan Martin is much more likely to swallow these types of stories, but maybe it adds some credibility or something.

Posted by: OSheaman | October 23, 2009 10:35 AM | Report abuse

I understand that the White House pushed back on this one on MSNBC this morning. Also, TPM is indicating that the story is dubious.

Given that this is the Politico we're talking about, and Mike Allen in particular, I'm highly dubious about this one.

Posted by: JPRS | October 23, 2009 10:37 AM | Report abuse

Ezra at this point in time two things you should always be skeptical of Mike Allen and Politico. It is a hack report by a hack reporter.

Posted by: jlDC81 | October 23, 2009 10:39 AM | Report abuse

Politico, WTF? Drudge is just as reliable!

Posted by: obrier2 | October 23, 2009 10:45 AM | Report abuse

Not having the robust option (Medicare rates) is not the end of the world for all the reasons discussed in the comments on this blog over the last few months. Either Medicare+5% or negotiated rates would be a huge win.

BTW, Kos has a list of all the lean yes, lean no and undecideds. Took less than 40 minutes to call them all....and one of the undecideds (Schraeder, OR) is a yes now.

Posted by: scott1959 | October 23, 2009 11:19 AM | Report abuse

Pelosi's robust public option is DOA. It asks too much from Docs and hospitals and therefore will die - probably in the House, but if not then definitely in the Senate. Blue Dogs and others will find some way to vote against it even if they claim to support it. Just watch.

Posted by: mbp3 | October 23, 2009 11:26 AM | Report abuse

That does indeed sound like something that Politico would say.

Posted by: HerooftheBeach | October 23, 2009 11:27 AM | Report abuse

I am against the robust public option, because I do not think it is a good idea to tie Medicare rates to the public option. The shenanigans with the SGR fix are an illustration why - physician compensation turns on pure politics. Furthermore, the populations are different, Medicare is paid for by all of us, to take of the elderly and disabled - I can readily accept taking lower rates for them for the common good. However, piggybacking the public option patients on top of them is not fair, on multiple levels. This would give too much of advantage for the public plan versus the private plans. These are folks who are choosing this option and who are paying for it themselves. I think the public option should be negotiated on its own. What seems like the best policy option, then, is to combine a separately negotiated public option with Wyden's amendment allowing people to opt-in to the exchanges. Then you have a larger potential group for the public option, and restore some its bargaining power without piggybacking on the elderly and disabled.

Posted by: umbrelladoc1 | October 23, 2009 11:35 AM | Report abuse

The bit Ezra clipped from Allen's piece above is from the middle of the story. The next paragraph says that they'll probably settle on the negotiated rates options if they can't get Medicare plus 5. But at the beginning of the piece, Allen says that because they can't get the most robust option, they'll probably settle on the trigger option. Where is he getting this from? Is there even a trigger option on the table in the House. I don't even think the Senate is seriously considering it at this point, focusing more on the opt-out/negotiated rates option proposed by Schumer. How does he make this jump, a jump he then retreats away from later in the story?

My best friend works in hospital admin and he said that Medicare plus 5 would still be tough for providers to swallow because hospitals wouldn't get the plus 5, only doctors, and the doc fix the Dems were pushing probably isn't going to happen, which means Medicare payments could be dropping 21%. He - and he is public option supporter - said that providers would probably be A-OK with a negotiated rates PO. He says it give providers confidence that they could get above Medicare rates (and disarms of them of the "the public option doesn't pay us enough" argument, which is actually true re: Medicare reimbursement) but would also force them to clean up waste (don't want to be seen negotiating for more money from taxpayers because you're inefficient) and move to a more "performance based" payment system.

Personally, I'm fine with negotiated rates. And I also think the opt-out could be a particularly devious politically strategy, forcing red state governors/legislatures to make an unpopular choice - ie, rejecting the public option. And I doubt many states would make that choice.

Posted by: shamey73 | October 23, 2009 11:37 AM | Report abuse

HOWEVER...I think Nancy should push for the strongest possible option - ie, Medicare plus 5. These bills are going to go to conference after this and, at best, the Senate version will include the Schumer proposal. You need to have a bargaining chip in those negotitations and the more progressive body - ie, the House - wouldn't want to go in with a public option that is virtually the same as the one the Senate has approved. The reality is that we'll probably end up with the negotiated rate option but if Nancy goes in with a stronger option, she can trade that a way for something else - ie, stronger subsidies or a tax on earners over $500k, etc.

Posted by: shamey73 | October 23, 2009 11:44 AM | Report abuse

scott1959: I read this blog every day. Nobody has ever explained how negotiated-rates could work. The PO will be a dumping ground for sick people, providers will demand outrageous fees, and the risk adjustment will fail. The only reason Medicare+5% might work is that it has such low overhead costs and can pay reasonable rates to providers.

If Obama believes in negotiated rates, why is he pushing for Snowe's trigger? It's not that he couldn't get the votes. I suspect he knows it won't work and he'd prefer to have something--anything--with a bipartisan patina.

Posted by: bmull | October 23, 2009 11:55 AM | Report abuse

bmull...if there are the insurance reforms suggested (no pre-ex, no underwriting, no recision, community rating, etc) I do not think the PO would be a dumping ground for the sick. My spouse is currently uninsurable but if we could get a policy I would be happy going with Aetna, etc. The only way the PO becomes a dumping ground is if the insurance reforms are not in place. Then we would have a mess but there is no evidence the insurance reforms will not make it.

Risk adjustment would not fail. It is being done today between plans, using prescription drug data as a proxy for health status (it is highly correlated). So I would not just make the assumption that risk adjustment would fail. It is not unproven.

Lastly, I don't think we know that Obama is pushing for a trigger.

I think shamey73 comments on the politics and realities of Medicare+5 and negotiated rates makes a lot of sense.

Posted by: scott1959 | October 23, 2009 12:18 PM | Report abuse

scott1959: If you're in the 1-2 million who are uninsurable, you will benefit from any of the plans. But we disagree as to the effectiveness of "strict regulation." If you believe in the effectiveness of regulation you don't really need any kind of public option at all.

But I can tell you from working for a Medicare Advantage program (which as you know is no pre-ex) that we went to great lengths to attract healthy seniors and then documented every teensy little problem so we could collect the maximum risk adjustment. On the other hand if you have sicker than average patients, you don't have money to hire coding consultants to help you get your full risk adjustment, and it can become a vicious cycle.

shamey73: Pelosi agreed to pay Med+5 to hospitals too. The offer is very generous: I could run a hospital or clinic anywhere in the country on Med+5 rates. The analogy is to buying a car based on dealer invoice (Med+5) versus the sticker price (negotiated rates). Only dummies start with the sticker price and bargain down.

Posted by: bmull | October 23, 2009 4:03 PM | Report abuse

scott,

I wondered what your angle was and i guess I've got it now and I appreciate your honesty with it and wish others on here were as honest as you. you've got a serious stake in the game and I can understand that.

My question for you is:


Would you be as mad at liberals as you would be republican's if NO REFORM happened (and pre-ex was still in effect) because Liberals stuck to the idea of no reform without a public option as some have said.

Posted by: visionbrkr | October 23, 2009 5:00 PM | Report abuse

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