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White House to Reid: We hope you know what you're doing

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Things have gotten real complicated, real quick, on the public option. This roundup of contrasting quotes and statements, for instance, has a Keystone Kops quality to it.

I've spent a fair bit of the day trying to figure out what went on in Thursday's endless series of meetings, and the best you can say is that, well, reports differ. But here's the basic outline.

Within the last week, Chuck Schumer moved from talking to various senators about a national public option with a state opt-out clause to actually conducting something of a whip count on the proposal. His team found that a number of moderates didn't love the idea, and might vote to strip it on the floor, but it wasn't enough to push them toward a filibuster. At about this point, Harry Reid began sending out some feelers of his own, and the response was positive enough that he warmed to including it in the bill.

Then Max Baucus held a meeting.

Here, stories begin to diverge. Depending on who you talk to, Baucus either held a routine, informational meeting telling the Senate moderates and members of the Senate Finance Committee what's going on, as he's been doing fairly regularly, or he held a meeting in which he tried to rally Senate moderates to change Reid's mind. Or maybe there's no difference between the two. The first to really speak out after the meeting was Sen. Ben Nelson, and, as one staffer pointed out, Nelson didn't need Baucus to remind him that he was opposed to a national public option. Soon enough, Olympia Snowe was also making firm statements against the public option, and threatening a filibuster.

On Thursday night, Reid went over to the White House for a talk with the president. The conversation centered on Reid's desire to put Schumer's national opt-out plan into the base bill. White House officials were not necessarily pleased, and they made that known. Everyone agrees that they didn't embrace Reid's new strategy. Everyone agrees that the White House wants Snowe on the bill, feels the trigger offers a safer endgame, and isn't convinced by Reid's math. But whether officials expressed a clear preference for the trigger, or were just worried about the potential for 60 votes, is less clear. One staffer briefed on the conversation says "the White House basically told us, 'We hope you guys know what you're doing.'"

Photo credit: Pablo Martinez Monsivais/AP.

By Ezra Klein  |  October 23, 2009; 3:28 PM ET
Categories:  Health Reform  
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Next: The nightmare scenario on the public option

Comments

The trigger idea seems problematic, but if it isn't, someone explain why it would work out in terms of deciding what the trigger is, and how that would really play out in say 5 years.

If opt-out, which is the most sensible of all doesn't work out, then why not a national public option where states can opt-in...

Posted by: HalHorvath | October 23, 2009 3:34 PM | Report abuse

Some might wonder how an opt-in is better than that individual state public option. My thought has been that a national public option with opt-int (you're in only if you choose to be) has the advantage over individual state with regional option in the way a single national agency is harder to corrupt. In a state, it's easier to get away with corruption, so that with 37 state plans, you might see some corruption or revolving door conflicts in most of them.

Posted by: HalHorvath | October 23, 2009 3:45 PM | Report abuse

This is exactly what happens when the governing party spends months negotiating with itself in public and wasting precious weeks and political capital wooing recalcitrants whose sole goal is to come back to power. Obama's clear message to bargain away any kind of public option has only emboldened Baucus and Snowe and Nelson to harden their positions toward the most Republican-friendly version of legislation. Once again, anyone to the left of Blanche Lincoln has been told to screw off.

Somehow, though, I can't imagine Schumer taking kindly to being humiliated. There will be blood.

Posted by: scarlota | October 23, 2009 3:47 PM | Report abuse

Dammit, how many times do we have to repeat:

"Boys throw stones at frogs for sport, but the frogs die in earnest."

These senators (and Ezra, for that matter) cannot seem to remember that every year, year in, year out, 44,000 people die from undertreatment due to lack of health insurance. That means in the last six weeks of dithering on health care reform, another TWO 9/11 tragedies occurred.

We need an effective, affordable, publicly administered alternative to the disaster that now grips our nation and kills 800 people per week. NOW. NOW.

Posted by: Dollared | October 23, 2009 3:47 PM | Report abuse

Any kind of meaningful public option was killed off weeks ago. All that dancing in the end zone was premature. The best we can hope for is a useless trigger.

Posted by: scarlota | October 23, 2009 3:54 PM | Report abuse

Dollared,

you know you're right. 44,000 people do die from no treatment or "under" treatment as you call it.

But also 100,000 people die from medical errors. Should we start imprisoning doctors that commit malpractice??

What makes you think the government can do such a bangup job of it when 4 year olds are getting refunds for tax credits for buying a home in the past 6 months. As I've said before I've got a 5 year old and he's not quite mature enough to own a home. In fact he's just only now printing his name and I know when I bought my house I had a lot of paperwork to sign. The government IS NOT THE WAY.

There is a way to cover everyone fairly, at a fair price without the government being the model. Their model is riddled with corruption. Not necessarily intentional corruption but corruption nonetheless.

Posted by: visionbrkr | October 23, 2009 4:04 PM | Report abuse

oh and the other positive thing about a trigger VS a public option that NO ONE talks about is that a trigger can be institured IMMEDIATELY. A public option will take years to put together.

Posted by: visionbrkr | October 23, 2009 4:06 PM | Report abuse

Nevermind Kansas -- What's the matter with Max Baucus?

Posted by: hutchie6 | October 23, 2009 4:21 PM | Report abuse

Is Obama about to come into a collision course with the progressive base?

Posted by: maritza1 | October 23, 2009 4:30 PM | Report abuse

Visionbrkr: The three best health care systems, by customer satisfaction and outcomes, in order: 1) VA, 100% government delivery and payment; 2) Medicare/medicaid, 100% govt insurance, private delivery; 3) employer-provided healthcare, 100% private.

You seem to be a reasonable person, until your unshakeable belief that all government activity is incompetent takes over.

Then you get irrational: um, how is it that a trigger to a public option is immediate, while the public option without trigger is five years away?

Are you willing to believe that we won WWII with a government-run army?

Posted by: Dollared | October 23, 2009 4:30 PM | Report abuse

dollared,

Thanks for calling me reasonable. I think that's the nicest thing anyone has said to me on here :-)

you see I look at ALL aspects of the system while you just look at care.

I review cost. And I care about TRULY bending the cost curve. I have no problems shaking down insurers for every single penny of profit but what are we going to do the FOLLOWING YEAR when costs are still skyrocketing and we don't have them to blame???

Medicare fraud and abuse is MUCH GREATER than insurers profits. If that ever wasn't the case as I've said on here before I'd be fine with single payer. Well except for the concern I have with if we don't slow doctors payments gradually we could see a large amount of doctors leaving practice and then we have an access problem.

And there are some things the government does well and you mention one (army) (well excpet for the fact that the army budget is astronomical but there we go with that pesky cost thing again.

I'm sure there are other things they do well. Montetary policy? Oh, well no. The Fed is (to me) partly responsible for the housing bubble by making homes too affordable for those who shouldn't be able to afford them.

The Post office is good right? WHen they're not in the red.

Please help me!! FInd me something that the government does well???

I know it MUST be out there!

Posted by: visionbrkr | October 23, 2009 4:49 PM | Report abuse

"The conversation centered on Reid's desire to put Schumer's national opt-out plan into the base bill. White House officials were not necessarily pleased,..."

Good for the White House officials.

Blue state liberals (so-called) are giddy about the opt-out compromise while red state liberals are shaking in their (our) boots. It means millions of impoverished and disenfranchised are likely to get left behind, and it means that red state liberals who worked hard to help elect a Democratic President and Democratic Congress and to give them a mandate are stabbed in their (our) proverbial backs.

Maybe somebody in the White House sees what most blue state liberals refuse to see--that an opt-out compromise is likely to result in a return to the Hillary Clinton/Mark Penn/Terry McCullough swing state strategy since red state liberals won't have anything to do with Obama for America, ActBlue, MoveOn, or the Democratic Party again. "Fool me once,..."

Posted by: cjo30080 | October 23, 2009 4:51 PM | Report abuse

and its not the trigger to a public option that's immediate. Its the fear in insurers that's immediate and if you believe that they are responsible for the cost problem and if they're forced (through much stronger utilization reviews) to reduce cost or end their business models then that should happen fairly immiedately while even the most liberal democrat knows that it takes 4-5 years to START your own insurer if you're the government.

That's why the exchanges are so far out in the distance too. They just don't "poof" appear out of nowhere.

Posted by: visionbrkr | October 23, 2009 4:52 PM | Report abuse

"what makes you think the government can do such a bang up job of it?"

France.
Japan.
The United Kingdom.
Canada.
Norway.
Sweden.
Israel.
Taiwan.
Australia.
New Zealand.

Need I go on?

We're freaking barbarians here, savages clinging to old free-market supersitions. Frankly, it's embarrassing.

Posted by: adamiani | October 23, 2009 4:55 PM | Report abuse

Landrieu was on the warpath against the public option on NPR this morning, no doubt emboldened by the President throwing his entire base under the bus.

Later she was all smiles after meeting privately with Reid--apparently got what she wanted. Her idea seems to be to re-brand a national exchange as "the public option" and allow states to "opt out" of it and use a state based exchanges instead. There will be some kind of "trigger" too--but it was all very vague. What's clear: if anything like this passes it will be a disaster.

Posted by: bmull | October 23, 2009 5:11 PM | Report abuse

adamiani,

No i said OUR GOVERNMENT. Not anyone else's.

Fraud and abuse is RAMPANT in our little version of healthcare (medicare). I'd be interested to see the "fraud and abuse" statistics in those other countries you mention. I'd expect its not nearly as bad there as it is here. I'm just not ready to turn over the entire system to the likes of these people:

http://www.chron.com/disp/story.mpl/headline/metro/6678607.html


or these people:

http://www.cbsnews.com/stories/2009/10/07/national/main5368454.shtml


or these people:

http://www.miamiherald.com/news/top-stories/story/1245087.html


NEED I GO ON???

Posted by: visionbrkr | October 23, 2009 5:14 PM | Report abuse

*No i said OUR GOVERNMENT. Not anyone else's. *

I really do not think, "Americans are a bunch of losers who are so much worse than the rest of the developed world" is a particularly compelling argument.

*what makes you think the government can do such a bang up job of it?*

Because Americans are well-educated, clever, and good at developing working policies. Most unlike the sort of people who become insurance salesmen, because they have few other talents or opportunities in life.

Posted by: constans | October 23, 2009 6:04 PM | Report abuse

Pretty amazing.

Baucus was for the PO, except that it didn't have the votes. When it is closing in on the votes, he moves swiftly to try to kill it.

The White House "wants" the PO, but moves to kill it off / water down and even watered down version of it to keep Snowe in the deal where we know she'll simply be used in the *exact* similar fashion during Conference:

"We can put that in becaus Snowe won't support it and we won't get a colture vote on the final bill."

"We can't take that out because Snowe won't vote for it if it's gone."

Just a giant circle jerk by the White House, Baucus, Snow and the Conversative Democrats in Congress.

We've already seen the actions of the White House today firm up the fence sitters in the House where more were moving over to the Medicare + 5% (and adjustments for Rural Areas) every day. Progress there halted, and progress in the Senate rolled back.

I'm quite impressed by the President that I voted for and his chief advisors that I didn't. Strange Mission Accomplished.

John

Posted by: toshiaki | October 23, 2009 6:55 PM | Report abuse

visionbrkr, visionbrkr - where does the corruption of our government come from? It comes from business.

From non-regulated, non-accountable, non-responsible business. Something outside of the political process that the people participate in.

How do we the people fight back against the lobbyists and the corruption? Not by eliminating government.

Posted by: rosshunter | October 23, 2009 8:23 PM | Report abuse

my good friend constans,


I really do not think, "Americans are a bunch of losers who are so much worse than the rest of the developed world" is a particularly compelling argument.

I love your use of statistics to show that fraud in programs in other countries isn't nearly as bad as the US based Medicare and Medicaid system. Oh WAIT, you GAVE NONE.

maybe you should watch 60 minutes this weekend and learn how bad the problem is. $90 BILLION dollars per year. Over 10 years if they got rid of every penny of fraud we could pay for the reform plan with that and that alone. heck even tax some to get the subsidies up. Or better yet actually address the spiraling cost because subsidies alone are like putting a band-aid on a gunshot wound, a waste of time. But you keep making your witty jokes on my job. It shows how childish you are.
-----------------------------------

Because Americans are well-educated, clever, and good at developing working policies. Most unlike the sort of people who become insurance salesmen, because they have few other talents or opportunities in life.

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

Ya the fellow in the 60 minutes piece is clever. Clever at robbing the government blind. Actually if you watch the story, listen to the article he doesn't have to be that clever because the government system is so idiotic. Does their system not realize that people don't need 5-10 robotic arms??? But ya let's do the public option, give them MORE to steal.


http://www.cbsnews.com/stories/2009/10/23/60minutes/main5414390.shtml?tag=contentMain;cbsCarousel


Posted by: visionbrkr | October 23, 2009 9:52 PM | Report abuse

visionbrkr, visionbrkr - where does the corruption of our government come from? It comes from business.

From non-regulated, non-accountable, non-responsible business. Something outside of the political process that the people participate in.

How do we the people fight back against the lobbyists and the corruption? Not by eliminating government.


Posted by: rosshunter | October 23, 2009 8:23 PM | Report abuse

rosshunter,

seriously? Although I wouldn't call the individual in the above piece "business" in the normal sense. Do you really expect us to believe he disappears in a public option? In a single payer? No he just FOCUSES his efforts. I can't wait to see the show but i wish the reporter would ask about the difference between him trying the same tactics with private insurance because it wouldn't work, not nearly as well if at all. Private insurance red-flags providers, investigate fraud and won't pay claims to them. The Medicare system is basically automatic. Heck you could even submit a claim and get it paid. Most of them don't even bother to submit to private insurance.

Non-regulated, non accountable business??? Are you serious?? Private insurers are the MOST regulated industry in the country. See below for a GAO report from the 90's.

http://www.gao.gov/archive/1996/he96161.pdf


And now they're even MORE regulated. Required to cover even MORE benefits under health insurance through mandates that increase the cost for all. Some are good, many are ridiculous. Please explain to me how infertility treatment is a medical condition that should be covered under insurance.

I'm not saying to eliminate government. I'm saying have government DO what it was meant to do, REGULATE, that's all. And while they're at it they may want to start with the $90 billion annual mess that's medicare. Then come talk to me about a public option. Medicare and Medicaid fraud is about 5x greater than the annual industry wide profit figures. That's like giving crooks not only the key to the safe but let's give them bags to stuff the money into too.

Posted by: visionbrkr | October 23, 2009 10:04 PM | Report abuse

visionbrkr appears to me to have a guiding analytical principle: if it's expensive, it's riddled with fraud and corruption, and this, that, or some other program that's expensive is a gasp, shudder, government program. As opposed, I suppose, to the marvelous, brilliant private sector which gave us derivatives and credit default swaps fueled by fostering growth in mortgage instruments poorly understood lay folks whose contracting gave the peddlers of the same commissions and discounts and no risks because of the peddlers of derivatives and credit default swaps securitizing and insuring those securities and peddling them to the unaware, thus ensuring no one would be held responsible. It ain't criminal, but it sure was anti-social.
What I do derive from all the chatter is that a public option consisting of offering Medicare to anyone who wants it and who will pay a premium such as Medicare folks do each month, would be immensely popular. We could then make it a life-sentence offense deliberately to fleece Medicare, and insert some ombudspeople into the process and reap some savings.
Meanwhile the Conservatives have spent trillions with a wrong and stupid war in Iraq and a poorly managed one in Afghanistan.
And part of the deficit that they wax so eloquent about was created by putting the wars into the budget, instead of running them off budget as
Cheney did (through his proxy). Speaking of corruption and waste, let's take a look at KBR and its corporate owner that Cheney used to run, and the quality of its management in Iraq.
I hope for consistency's sake that visionbrkr used to excoriate Bush et Cie in the White House.

Posted by: egburton | October 24, 2009 11:16 AM | Report abuse

egburton,

see now you're diverting into other topics when you know I'm right. Thanks for ALMOST admitting it.

For your information (and i've said this before) a major part of the mortgage problem is that the Fed is holding down interest rates so people can buy a home (even though they can't afford it) because its "politically" a good thing. Heck if home ownership is up then everyone's doing well and politicians are beloved (even if they shouldn't be, because people don't deserve a home if they can't afford it. how renting became the stigma it is nowadays is beyond me.

Oh and for your information I was against both wars, especially Iraq (and I've said that before on here. I'm also pro-choice although I'd rather give the mother a reason to choose life but I don't presume that government has the right to tell someone what to do with their bodies.

"We could then make it a life-sentence offense deliberately to fleece Medicare, and insert some ombudspeople into the process and reap some savings"


So why haven't we done this for the last 44 years??? What were we waiting for?

Posted by: visionbrkr | October 24, 2009 12:09 PM | Report abuse

I strongly second the opinion that visionbrkr is a reasonable commentator! Whatever one may think about the merits of visionbrkr’s opinions Constans' personal insults are out of line. Blogging can be a powerful tool for organizing and disseminating information, but instead it too often degenerates into a pissing contest over who can come up with the better insult. The comments section of a blog should be about exposing people to other opposing points of view and creating opportunities to use that knowledge to more fully participate in our democratic system. To give an example of that ideal in practice see this post from just last week:

http://voices.washingtonpost.com/ezra-klein/2009/10/industry_honcho_insurers_stron.html

In the thread several commentators take issue with Ezra’s criticism that insurance company lobbyists complain about cost growth but oppose measures to constrain cost growth that affect their constituents’ bottom line. These commentators argue that the proposals to contain cost growth that Ezra supports won’t do much to constrain cost growth either. When I then asked the obvious question: what reform measures did they think will be effective in slowing down health care spending? commentators visionbrkr and wisewon immediately responded with a list of ideas they believed would be more effective than Ezra’s. This is what blogging should be like. If I don’t agree with visionbrkr and wisewon’s suggestions I should do more research and come up with my own constructive ideas, not denigrate their professions. People reading this blog should judge for themselves which suggestions seem most likely to be fair and effective and then do what they can to make sure those suggestions get implemented. I just contacted my Senators and Congressman last week. What will you do?

Posted by: nklein1553 | October 25, 2009 2:02 PM | Report abuse

Actually, I wish Ezra would do more to come up with concrete suggestions about what we can do as commentators and readers to organize for effective change. Reading this blog is fun and informative and all, but sometimes I wish I could do more to use the information I get from this blog to actually accomplish something beyond complaining to my elected representatives.

Posted by: nklein1553 | October 25, 2009 2:09 PM | Report abuse

nklein,

thank you although I don't think you'll get a lot of people who agree with you on here. I'm fine with that though. I'm not a blogger (like some on here are). I could have when the "healthcare" first started last year gone to a conservative type blogger to see what was going on and get the "feel" for how people felt but I felt it better than I saw how liberals looked at it to try to understand their point of view and I agree with it to a large extent. I don't think insurers should make egregious profits (but they don't). I'm all for a medical loss ratio nationwide at 85% to make sure that that remains the case. WHen you look at the oil and gas sectors, banking sectors you see that health insurance companies are not making profits anywhere near what those make. Banks last year made 38 billion dollars not in profit, but just in fees for overdrafts and other fees. Insurers profits were one third of that.

My biggest concern with going to a single payer system or a public option system is that the fraud and abuse that is rampant in the medicare and medicaid system could be only expanded if we go to those systems. That fraud and abuse is something that no liberal blogger takes on because they know that I'm right when i bring it up. I hope that Ezra has it in him to blog today about the 60 minutes piece last night. If he does I'm sure we won't get many liberals talking about it.

Here it is for anyone that wants to see it:

http://www.youtube.com/watch?v=QwU7xc38-cc

I'm also upset that the people in the piece bring up the fact that Medicare and Medicaid fraud is rampant but don't translate that into concern for going towards a public option or single payer. How they can't see the correlation is beyond me. I especially like the fact that AG Holder admits that it is a major problem and that the two FBI investigators realize there's not much they can do to stop it. YOu want to stop it, stop auto ajudicating claims. Actually pay some money (as insurers do) to credentialize providers. GO out and see them to make sure they are legitimate. Its not that difficult to do. But then I guess we'd cut into that great low admin cost of Medicare if we did that. That's what they should do, not necessarily what they will do.

Posted by: visionbrkr | October 26, 2009 8:51 AM | Report abuse

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