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The Status Quo Wins in Health-Care Reform

PH2009092902113.jpg

The Senate Finance Committee finished its markup last night. Pretty much, anyway. It adopted a couple of important amendments, including one from Olympia Snowe cutting the penalties for the individual mandate to less than $800 per person. But the drama came late in the evening. About one in the morning, Wyden's Free Choice Act came before the committee. But it never came up for a vote.

Instead, Max Baucus effectively ruled it out of order. The reason? It didn't have a full CBO score. This came as a surprise to Wyden and his team, who'd gotten the amendment scored by the CBO, and had been in endless negotiations with Baucus, the White House, employers, and labor over the past week. If the score was in fact partial, as Baucus and Conrad claimed, you'd think someone might have mentioned it. No one did.

But suddenly, in the wee hours of Friday morning, the chairs of the Finance and Budget Committees were explaining that the amendment lacked a valid score. ANde an amendment without a valid score is "out of order." Wyden was left with little choice but to withdraw the amendment. It was not deliberative democracy at its finest. But it served its purpose: it killed the amendment.

To understand the Free Choice Act, you need to understand that the exchanges are currently closed to businesses over 100 employees. In many states, they'll be closed to businesses over 50 employees (the Finance Committee's bill lets states choose their threshold, either 50 or 100). And in all states, they're closed to individuals who are offered "affordable" coverage by their employer. If I don't like the insurance The Washington Post is offering, or I feel I can get a better deal on the exchange, I am simply not allowed to go use the new network and take my pick from the many plans offered.

To understand how this will play out, consider these two graphs. One was made by my friend Matt Ficke, and it breaks out the percentage of workers employed by firms of different sizes. As you'll note, everyone working in the last four columns -- that is to say, a solid majority of the population -- is barred from the exchange.

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To put this more starkly, here's a graph showing the workers who might be eligible for the exchange, if all states go up to businesses of 100 people and all eligible business buy their workers in, and the workers who will not be eligible at all.

choice_for_some!.png

If the Free Choice Act had passed, politicians could have made a very simple argument to the insured: When this bill becomes law, you will have insurance choices just like those enjoyed by a member of Congress or a government employee. You will have a variety of insurers competing for your business and the opportunity to keep the same insurance even as you change jobs, or fall unemployed, or open your own business. You don't have to take advantage of this if you don't want to. You can stick with what your employer offers. But if you do want the choice, you can have it. It's here for you. That's what reform means, for everyone: choices, competition and continuity.

But it turns out not to mean that. The proposal was doomed by the joint opposition of businesses and labor. Businesses didn't like it because they lose control over their employees' health benefits. Labor groups didn't like it because they lose control over their members' health benefits. That's not an entirely selfish concern: It is easier to bargain on behalf of your workers or members if they have no other options, and thus are guaranteed customers for the insurer. But it is a short-sighted concern. It means the protection and preservation of a system where employers offer us one or two health-care choices, which may or may not be of high quality, and which will almost certainly dissolve if we leave or lose that job. It also means a system in which insurers compete less, and costs are further hidden from consumers, and businesses continue to bargain on their own.

This was, in other words, a battle over the sufficiency of the status quo. And the Senate Finance Committee, hearing complaints from those who preside over a health-care system that works so poorly, sided with the status quo.

Photo credit: AP Photo/Susan Walsh.

By Ezra Klein  |  October 2, 2009; 12:41 PM ET
Categories:  Health Reform  
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Comments

What happens as employers change size? I worked for a startup biotech (employee #5) and it was under the threshold for the first three years, but is now over 50 employees. Would I be forced to change my health insurance plan (and maybe doctor) because I'd be kicked off the exchange? Is there a grandfather clause? Way to penalize employees of successful business that manage to grow.

Posted by: _SP_ | October 2, 2009 12:54 PM | Report abuse

So can Wyden offer it in the melded bill? On the floor? Does this portend nothing serious on reform? With the reduced penalties and paucity of choices, this doesn't look like much at all, considering the hoopla. This is very disappointing. I can't believe this will be good for the Dems ion Congress. What a bunch of craven, lame egotists.

Posted by: Mimikatz | October 2, 2009 1:04 PM | Report abuse

There is (or shouldn't be) no argument over what SFC wants: the status quo.

Now, it may be argued that the final post-conference bill may contain some change, but not fundamental root-and-branch change.

My opinion is that Baucus, Conrad and others have really done is make clear that their won't be 60 votes on breaking a filibuster on a final Senate bill, and they won't vote yes on the conference report if we get that far.

The hope for a non-reconciliation (normal) bill is gone, if it goes beyond what President Baucus wants.

Just tell yourself that a hot tasty meal of feces is want you want, and you'll feel satisfied when it's served and eaten. A clothes pin for your nose will be offered along with the chop sticks in a paper wrapper. Just add some superhot pepper sauce and you may not notice.

Posted by: JimPortlandOR | October 2, 2009 1:09 PM | Report abuse

How disappointing.

Is there any hope for it getting passed on the floor?

Posted by: Isa8686 | October 2, 2009 1:11 PM | Report abuse

I an earlier article I read that the Baucus plan will let all employers into the exchanges starting in 2017, does that mean we'll eventually have "Free Choice" with this bill?

Posted by: Mollie2 | October 2, 2009 1:16 PM | Report abuse

SP--

Under the House bill, you can't be kicked off the Exchange.

The House bill is very clear-- if you qualify for the Exchange-- even temporarily-- you can go into the Exchange.

And even if your circumstances change, so that you would no longer qualify for the Exchange --you can stay in the Exchange.

Over the last two years, one out of three Americans was without insurance at some point during the two years.

If the House bill had been in effect during those two years, that means 1/3 of all Americans could have gone into the Exchange.

Ezra is concerned that, if he keeps his job at WaPo (which I'm sure he will) he won't have a chance to go to the Exchange
and see if he can get a better deal there.

Nor will I (assuming I keep my job.)

But when it comes to healthcare Ezra and I are already among the luckiest people
in America. We have generous employer-based insurance.

On average, large companies (like the company Ezra works for) pay 75% of their employees premiums. Even medium-sized companies pay an average of 75% of premiums for employees earning over $75,000.

I'm guessing that Ezra earns enough that he won't qualify for a subsidy from the govt'

So if he goes to the exchange, he would have to pay the full cost of his insurance himself. Could he find a better deal than he has at the Post (assuming the Post pays 50% to 75% of his premium?) No.

Certainly he couldnt' find something more affordable. Could he find something with better benefits? Quite possibly-- but since he would have to pay 100% of the cost, it would be pretty expensive. REally doesn't make sense.

Finally, why doesn't the government want everyone in America to go shopping in the Exchange at the same time?

Because it woudl be chaos. We need to take care of the people who most need help first--and that's not the folks lucky enough to have an employer paying (on average) 75% of their premium.


Posted by: mahar1 | October 2, 2009 1:19 PM | Report abuse

Why the infatuation with Wyden's plan? It never, ever stood any chance of going anywhere, and Wyden somehow hoodwinked a whole pack of reporters into thinking it was relevant. His pitch was predicated in large part on talking up all the co-sponsors of the bill -- like, say, Debbie Stabenow. Debbie Stabenow is going to vote to get rid of the tax exclusion? Really? And yet, still, there are stories out there with headlines like "Wyden's upbeat about his 'free-choice' plan's chances" (Oregonian, 9/26/09). Well, maybe now that reality has intruded, it's finally time to jump off of the Ron Wyden PR express.

Posted by: dpy1 | October 2, 2009 1:20 PM | Report abuse

If Baucus ruled the Free Choice Act out of order on false pretense, shouldn't Wyden be able to appeal in some way? At the time, could he not have said, "Excuse me--what?"

Posted by: Bertilak | October 2, 2009 1:22 PM | Report abuse

I'm really starting to dislike that guy.

Posted by: adamiani | October 2, 2009 1:23 PM | Report abuse

On effect of NOT having Wyden's amendment is that employees (and collective units) can encourage their employers to drop employer-provided insurance coverage, thereby freeing the employees to select a plan from the exchange.

In some ways, this effect might be helpful: it tends to drive employers out of the post-WW II middleman-insurer role, encouraging instead direct participation by individuals.

Posted by: rmgregory | October 2, 2009 1:29 PM | Report abuse

mahar1, you obviously do not understand Wyden's ammendment. If Ezra didn't want WaPo insurance, WaPo would have to give him a voucher for the amount they currently pay (so that 75% amount you mention). He could then take that voucher and go into the exchange.

Posted by: truth5 | October 2, 2009 1:43 PM | Report abuse

Why is the death of Wyden's Free Choice Act in FiCom a surprise? The whole process has been about siding overwhelmingly with the status quo.

One would hope Wyden wasn't surprised by this. If he was, perhaps it will open his eyes more on the people he's dealing with.

John

Posted by: toshiaki | October 2, 2009 1:51 PM | Report abuse

I just want to disagree with this statement:
"labor groups didn't like it because they lose control over their members' health benefits." Labor groups didn't like it because union health plans constitute an enormous amount of compensation that was won back when labor had a lot more strength, and there's no guarantee now that the bosses would pass on health care savings to their workers, decreasing net compensation.

http://realignmentproject.wordpress.com/2009/09/07/the-problem-with-ending-employer-based-health-care/

Posted by: StevenAttewell | October 2, 2009 1:55 PM | Report abuse

As an actuary, I could see employers just as easily -- if not more easily -- gaming the system under Sen. Wyden's Free Choice Act than employees. If the tax treatment of employer-provided health benefits and purchasing health insurance on the Exchange is equal, and there is no firewall, what's there to prevent an employer from encouraging its healthier employees to remain on their plans while encouraging their sicker employees to purchase health insurance on the Exchange? In other words, what is there to prevent small employer McConnell, Kyl Associates from promising Henry Healthy a raise if he stays on his employer's plan and promising Sally Sick a raise if she purchases health insurance on the Exchange? And what would happen to the price of plans on the Exchange if mostly sick people enrolled in the plans? Years from now it could be implicitly understood that new hires will have shorter probation periods if they choose the plan more favorable to their employer.

It just seems to me if you don't have a firewall, you have choose which system -- the employer-based system or the Exchange -- you want to subsidize through the tax laws. You can't equally subsidize both systems if you don't have a firewall.

That said, I like Sen. Wyden. I just think he's not thinking about some unintended consequences here.

Posted by: BradGabel2002 | October 2, 2009 2:28 PM | Report abuse

dpy1,

Debbie Stabenow has consistently co-sponsored Sen. Wyden's Healthy Americans Act, which gets rid of the employer exclusion. So maybe Sen. Wyden thought getting Sen. Stabenow wasn't such a big stretch.

Posted by: BradGabel2002 | October 2, 2009 2:31 PM | Report abuse

Ezra,
Your infatuation with Wyden's plan is based on false premises. Competition in health insurance will not have the intended effects that you hope it will. Nowhere on earth has there been a universal healthcare system erected on the basis of competition between basic mandatory plans. You are simply buying into the assumption by all too many economists and/or wannabee economists that competition always produces a better outcome. As applied to basic health insurance it appears that it doesn't work.

Posted by: michaelterra | October 2, 2009 2:57 PM | Report abuse

BradGabel,

You asked, "[W]hat is there to prevent small employer McConnell, Kyl Associates from promising Henry Healthy a raise if he stays on his employer's plan and promising Sally Sick a raise if she purchases health insurance on the Exchange?"

Presumably the HIPAA nondiscrimination rules would remain in effect to prohibit this type of employer activity, as they do today, and the federal agencies charged with enforcing HIPAA would prevent this type of behavior.

Posted by: Policywonk14 | October 2, 2009 3:23 PM | Report abuse

ezra,


come on now ADMIT THE TRUTH. I can't find the tape anywhere yet but its out there and I watched it live (blurry eyed and yawning but live). It was Bingham and then Kerry that were against this. Senator Ensign with all his warts was impressed by this (and i'm dumbfounded by this he hadn't heard of it at all). I'm thinking Baucus was covering for his democrat buddies and forced it to be tabled. They voted on other things that weren't scored yet through the markup.

If the truth ever was let out that Republicans were in favor of this act and Democrats were against it we'd all be in "Bizarro World".

Wyden said at the outset that big business is against it because they don't understand it. It won't supplant the employer model but strengthen it with choices. Kerry would hear none of it and brought up a large employer (campaign contributer???) in his home state of Mass. that recommended that he vote against it and he made that be known.

I'm sorry but he should have some serious explaining to do.

Posted by: visionbrkr | October 2, 2009 3:25 PM | Report abuse

policywonk,

you really don't know how some (not all) employers operate do you? You're naive if you don't think what Brad said can and will happen. Most people laugh at HIPAA and honestly most don't have a clue as to how it works, especially the privacy part. That goes for doctors, insurers, hospitals, EVERYONE.


Posted by: visionbrkr | October 2, 2009 3:37 PM | Report abuse

Policywonk14,

It's not that easy. The employer still always has the upper hand when it comes to the employer/employee relationship. Even if ERISA law prevents discrimination, there's still a presumption on the employee's part that they'll do better if they choose the plan more favorable to their employer.

Posted by: BradGabel2002 | October 2, 2009 3:42 PM | Report abuse

Ah, the illusion of democracy!

Posted by: bmull | October 2, 2009 3:53 PM | Report abuse

policywonk,

oh and you mean THIS federal agency that as of 2006 hadn't imposed one single fine with regards to HIPAA?

http://www.washingtonpost.com/wp-dyn/content/article/2006/06/04/AR2006060400672.html

And I thought the medicare fraud and abuse department was the worst. I guess they've been topped by these folks.

Posted by: visionbrkr | October 2, 2009 3:55 PM | Report abuse

Thank you, Senators Wyden, Rockefeller and Schumer. The rest of you should be denied healthcare coverage based on your pre-existing (and apparently fatal) condition of weenie-dom.

Posted by: corbinbrooks | October 2, 2009 4:08 PM | Report abuse

Mr. Baucus’s plan will produce obscene profits for the health care industry while bleeding the life blood out of consumers, employers, and taxpayers.

To assure no more medical bankruptcies, no more uninsured people denied care, no more forced dilemmas between going without food or other necessities in order to pay for needed medications or care, (Seniors and everyone choosing public care could have it no restrictions, no insurance, no co pays, free period.), to eliminate health care burdens for employers, (Employers who select public care for their employees would not be required to pay for or have any further involvement with health care.), and save hundreds of billions of dollars annually for taxpayers, instead of adding to the national debt, we need to start over on health care reform by using what President Obama calls “government’s unfair advantages” which lower costs far below what private systems can ever attain and offer free public or private care private pay.

Posted by: BillWatson1 | October 2, 2009 4:09 PM | Report abuse

Please publish the names of the people who voted to kill this amendment and kill Freedom of Choice. They need to be voted out of office because they were bought out.

Kick the them out, recall them, get rid of them.... They can not hid behind the people who bought them out be it Business or the Unions. They are suppose to work for the American People.

Posted by: vonpfahl | October 2, 2009 4:12 PM | Report abuse

Perhaps I'm misunderstanding, but my impression was that Wyden would incentivize younger healthy employees to opt out of their employer plans and shop around for cheaper insurance so as to pocket the difference. Assuming they were sufficiently non-lazy and greedy. Older/sicker employees would be more inclined to stay with existing plans, as they are only going to loose from having to shop around. Even if unable to exclude those with pre-existing conditions, insurance companies would still be able to charge more based on age, habits, etc. End result is that businesses would be stuck with higher insurance bills, or be more biased against hiring potentially costly people. Not the case? Although it seems to be irrelevant now.

Posted by: elainelinc | October 2, 2009 4:25 PM | Report abuse

The problem with Wyden's plan is hit precisely by Brad Gabel and Elainelinc. The plan encourages employers to drop the value of the plans, thereby ditching high cost people, and encourages the young and healthy to bail as well, to buy low cost insurance and pocket the difference.

Wyden's other, more famous, plan, is also filled with unintended consequences. Its use of "actuarial value" instead of defined benefits as the yardstick for insurance plans opens the door to lots of gaming with lower benefit plans. Its use of the cost of living instead of the cost of health care for calculations in rises in value of insurance guarantees that there will be a rising gap between what insurance pays and what health care costs, born by the patient and eventually eliminating large amounts of basic health care for lower and middle income people.

Neither plan is impossible to fix. On the Wyden ammendment, there would need to be government rules to prevent, or at least strongly discourage, the well from leaving health plans to the sick, otherwise they quickly fall apart. In Wyden-Bennett, there needs to be defined benefits, not defined costs, and the idea that the people in the best position to make informed decisions about reducing health care costs are patients has to be left on the ashpile of history, where it belongs.

Posted by: PatS2 | October 2, 2009 5:32 PM | Report abuse

Truth 5--

Why would WaPo (or any company) give a valued employee the 75% that they are now contributing to their premiums so that the employee can go to the Insurance Exchange, buy his own insurance--and no longer have a reason to stay with WaPo??

Ezra could . . let's see, get a very good advance to write an excellent book, without having to worty about paying for his own health insurance (one reason why it's hard for writers to go off on their own and write books.)

Employers now paya an average of 75% of "better-paid employees; premiums (better-paid translates to employees earning more than $75,000) because they derive a real business advantage: the employees are more likely to go elsewhere.

As Ezra indicates, it's about control.

If employers didn't get that business advantage they would not pay such a disproportionate share of health care costs.

And under health care reform, government would not ask employers to pay the equivalent of what they now pay for their own employees into the common pool.

(See how much employers have to pay into the pool if they don't provide insurance--it is significantly less than they now pay for their own employees.)

There is no country in the world where employers contribute 75% of the total cost of health insurance--and it won't happen here.

As long as employees like Ezra and I enjoy
a situation where our employers pay such a large share of our health insurance we're lucky (and tax-payers are lucky because they don't have to pick up the tab for those of us who would need subsidies.)

(I should add, I have no idea whether WaPo, like the average large company pays 75%. The newspaper publsihing biz is in trouble. Maybe they pay 50%. But it's a large chunk).

Posted by: mahar1 | October 2, 2009 8:44 PM | Report abuse

WRONG, KID

" .. But it is a short-sighted concern. It means the protection and preservation of a system where employers offer us one or two health-care choices, which may or may not be of high quality, and which will almost certainly dissolve if we leave or lose that job .. "

Kid, you convince the "old retired" to give up their security of known medical processes -- you'd be a better BSer than MESSIAH. You could be president.

Kid, you really need some common sense. To think Grandpa is going to give up existing Medicare, VA, and perhaps Aetna is to superior in schnook-ness.

As for "Mahar1" --

" .. There is no country in the world where employers contribute 75% of the total cost of health insurance--and it won't happen here .."

Yup. The USA is as lousy as the UK, France, and Germany. Not.

There's another "Mahar" writing in Ezra-style on health care. That "Mahar" claims to have writing/editing experience for Barron's.

I just Lexis/Nexis'd Barron's and Mahar -- one hit.

Same ol', same ol'. When NEJM can run push-polls -- facts die young.

----------------------

RE: General Questions and Comments: The Regressivity of Taxing Employer-Paid

Thursday, September 17, 2009 8:36 AM

From: "Guth, Lindsay"

To: XXXXX@yahoo.com

Dear Mr. XXX,

Thank you for your feedback.

Perspective articles are opinion-oriented -- not research-oriented -- so relevant affiliations are not against our policy for these articles.

Sincerely,

Lindsay Guth
Perspective Researcher
New England Journal of Medicine
P: 617-487-6539
F: 781-207-6529
lguth@nejm.org


-----Original Message-----

From: NEJM, Customer

Sent: Friday, September 04, 2009 10:56 AM

To: NEJM Editorial; NEJM, Comments

Cc: Johnson, Louisa

Subject: FW: General Questions and Comments: The Regressivity of Taxing Employer-Paid


Dear Colleague,

I am forwarding the customer comments appearing below which pertain to your area. I have responded to this customer advising that their comments have been forwarded to the appropriate area within the company.

Sincerely,
Judy Benford
Customer Service Representative
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-----Original Message-----

From: XXXX@yahoo.com
Sent: Thursday, September 03, 2009 6:53 PM
To: NEJM, Customer
Subject: General Questions and Comments: The Regressivity of Taxing Employer-Paid

To the Editors:

about this --

http://content.nejm.org/cgi/content/full/361/10/e101

The Regressivity of Taxing Employer-Paid Health Insurance

Did the NEJM feel the need *not* to identify the two authors as the founders of the MD single-payer group "Physicians for a National Health Program?"

http://www.pnhp.org/

Why? Reputable publications fully disclose their writers' major memberships.

Very, very disappointing.

This supports the claims that NEJM is very biased to one political group.

Posted by: russpoter | October 2, 2009 8:58 PM | Report abuse

Please publish the names of the people who voted to kill this amendment and kill Freedom of Choice. They need to be voted out of office because they were bought out.

Kick the them out, recall them, get rid of them.... They can not hid behind the people who bought them out be it Business or the Unions. They are suppose to work for the American People.

Posted by: vonpfahl | October 2, 2009 4:12 PM | Report abuse

See below and watch in amazement. Evening session Part 2. Start at 1:17:00 Senator Wyden tries, he really does but Kerry and Bingaman shoot him down while Senator Ensign is intrigued by it and wants to hear more. Imagine, a REPUBLICAN FOR a significant part of reform and its shot down by Democrats. Too bad not many outside here will have a clue as to this going on. Kerry even went so far as to say he went to a local to him large employer group, Raytheon (a defense contractor) and they're "dead set against it" as per Senator Kerry. So if you want choice in Senator Kerry's mind maybe you should work for Raytheon.


http://www.cspan.org/Watch/Media/2009/10/01/HP/A/23901/Senate+Finance+Cmte+Health+Care+Markup+Day+7.aspx


Ezra you should be ashamed for not putting this out to those that read you and truly writing about who is to blame for this. If this was Hatch or Grasserly shooting this down you'd be screaming from the rooftops but instead we get another primer on the Swiss system.

Posted by: visionbrkr | October 2, 2009 9:00 PM | Report abuse

why didn't baucus or conrad tell wyden that the score he got needed to be more complete beforehand?? sounds like jerkface back-stabby politics. i'm super peeved.. but thanks for what you do ezra. hope you're havin a good weekend.

Posted by: schaffermommy | October 3, 2009 2:25 AM | Report abuse

Republicans and Democrats have dragged the health care debate into the weeds. There is no proposal before Congress, public option or no public option, Wyden amendment or not, that can significantly lower premium costs while maintaining high quality health care for all,, bring real market competition to health care and provide the uninsured high quality, low cost health care. Not with the insurance companies in the business. Congress wants to keep them in the game because they give massive campaign financing to both Republicans and Democrats. There is no common sense, business reason to allow eight giant insurance companies, hundreds of small insurance companies and multi-millionaire bean counters to make a profit just by collecting premiums, deducting 30% administrative costs and denying coverage. There is one solution but no one, liberal or conservative, wants to see it.
Allow one insurance company, the low bidder in a bid process, to collect the premiums for a fixed fee under a four year contract and pay out the bills with no right to deny coverage or drop people from coverage. A private independent commission runs the health care program without government control or interference. Market based competition comes to health care because (i) payers are free to switch from doctor to doctor and hospital to hospital at the drop of a hat and (ii) the commission hires people to use market power to negotiate prices with health care providers, vendors, suppliers and drug companies just like Walmart. That is a hard nosed, fiscally responsible business-like approach. It won’t happen because both liberal and conservative voters have been conditioned, like Pavlov’s dog, to focus on attacking the other side and to pay no attention to a real solution to the health care dilemma.

Posted by: jscope | October 3, 2009 2:32 AM | Report abuse

Republicans and Democrats have dragged the health care debate into the weeds. There is no proposal before Congress, public option or no public option, Wyden amendment or not, that can significantly lower premium costs while maintaining high quality health care for all,, bring real market competition to health care and provide the uninsured high quality, low cost health care. Not with the insurance companies in the business. Congress wants to keep them in the game because they give massive campaign financing to both Republicans and Democrats. There is no common sense, business reason to allow eight giant insurance companies, hundreds of small insurance companies and multi-millionaire bean counters to make a profit just by collecting premiums, deducting 30% administrative costs and denying coverage. There is one solution but no one, liberal or conservative, wants to see it.
Allow one insurance company, the low bidder in a bid process, to collect the premiums for a fixed fee under a four year contract and pay out the bills with no right to deny coverage or drop people from coverage. A private independent commission runs the health care program without government control or interference. Market based competition comes to health care because (i) payers are free to switch from doctor to doctor and hospital to hospital at the drop of a hat and (ii) the commission hires people to use market power to negotiate prices with health care providers, vendors, suppliers and drug companies just like Walmart. That is a hard nosed, fiscally responsible business-like approach. It won’t happen because both liberal and conservative voters have been conditioned, like Pavlov’s dog, to focus on attacking the other side and to pay no attention to a real solution to the health care dilemma.

Posted by: jscope | October 3, 2009 2:34 AM | Report abuse

This is sad. Baucus and Conrad are such embarrassing tools.

Seriously, Wyden's Free Choice amendment was the one good idea that everyone could agree upon, and those worthless sacks of excrement deliberately killed it.

Posted by: zosima | October 3, 2009 5:08 AM | Report abuse

zosima,


don't Kerry and Bingham deserve almost as much blame? How do they get through this unscathed?? They're the ones that made the points against it and in fact Kerry had the audacity to refer to his constituent (the defense contractor) who TOLD HIM to vote against it.

if you want good healthcare I guess you'd better work for Raytheon.

Posted by: visionbrkr | October 3, 2009 1:04 PM | Report abuse

Ezra--

You seem to have a troll on this thread who believes that rather than trying to argue a point with facts, it's best to suggest that the other person is an imposter.

Yes, Mahar1 is Maggie Mahar, who has written a book about healthcare and writes a blog. She also is a part of a panel of "experts" that writes regularly for the Washington Post's "Rx".

She was senior writer and editor at Barron's for 12 years-- writing mainly cover stories.

Why didn't you find those stories in your nexus/lexus search?

Probably becuase she was writing articles that were occasionally read into the Congressional Record you were in 3rd grade.

Barron's didn't begin to go online until sometime in the 1990s. As a result, most of her pieces are not in the blogosphere. .

Though many traces exist in the footnotes of many books where they have been cited. . .

As to the facts and the substance of what I said: U.S. employers, like other employers, cannot afford to shoulder 75% of health care costs and compete globally--and they shouldn't, not when 1/3 of those costs represent unncesssary ineffective treatments.

I will take the suggestion that I write "Ezra-style" as a compliment--though I would tend to say thar Ezra writes "Maggie-style". (I was writing about heatlhcare (among other topics) at Barron's before Ezra began blogging.
But I think the truth is that Ezra writes Ezra-style and I write Mahar-style. Very good writers have their own voices.

Posted by: mahar1 | October 3, 2009 3:39 PM | Report abuse

If you would like to take a stand for real health care reform please join our voting bloc at:
http://www.votingbloc.org/Health_Bloc.php

Posted by: letsgobuffalo | October 4, 2009 7:58 AM | Report abuse

In what media accounts are casting as a serious setback for President Barack Obama and lawmakers who back the "public option," the Senate Finance Committee Tuesday voted against including the provision in the bill. Reports also remark on GOP unity against the provision, which they compare to the Democratic split apparent in Tuesday's committee votes. Where I am a health insurance agent with www.benefitsmanager.net/SelectHealth.html . I find this frustrating somewhat. I don’t agree with the design of the “public option” where it works against a health system in place now and causes a financial burden on tax payers. But, I think we need one out there. I need the ability to get my clients a insurance policy that won’t decline them for pre-existing medical conditions. See Utah’s response to health care reform and health insurance reform. www.prweb.com/releases/utah_health_insurance/health_care_reform/prweb2614544.htm.
Perhaps the feds should look at the only second state case attempt for reform as a model. What about TORT reform? That honestly impacts doctor insurance costs as well as health insurance premiums by 13% See study in prior link.

Posted by: mikeoliphant | October 5, 2009 3:35 PM | Report abuse

Choice for some, miniature American flags for others:

Ezra, as much as I agree that Sen. Wyden's Free Choice Amendment would have been a godsend to just about every potential insuree involved, I still have major issues with the fact that practically all of the proposed health care reforms keep insurance tied into the employer-based model. As it currently stands, according to Sered and Fernandopulle in "Uninsured in America" (2005), the employer-based model is inherently biased towards the nuclear family- the husband, the wife, and the 1.86 children. Divorced or separated women are more than twice as likely to be uninsured than their married counterparts, with an 18.5% uninsured rate, which rises to 26.2% when looking at women who were never married. I can't even begin to fathom what things must be like for women in abusive relationships who simultaneously receive insurance through their husbands' work. What's more, how many women are staying in abusive relationships only for the continued insurance coverage?

It's a travesty that so few of our elected representatives have had the courage to push for an American health insurance system that's fair to everyone involved.

Posted by: adg1034 | October 6, 2009 1:23 PM | Report abuse

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