Live Blogging the Senate Finance Markup

The Senate Finance markup is taking up Chairman Max Baucus's proposal.

The Post's Alec MacGillis gives you a cheat sheet for all the action coming out of the markup of Chairman Baucus's proposal.

DAY TWO

6:15 p.m. | Here Comes the 'R' Word
Well, after being sidetracked by lengthy debates about legislative schedules and corporate free speech, the committee finally got down to brass tacks: a good old back and forth about health care rationing.

For weeks, Republicans have gotten good mileage out of warning that Democratic health care proposals would result in the rationing of health care, culminating in their warnings about "death panels" for those who are deemed unworthy of treatment. Now, Republican senators are bandying about the R-word as they try to drum up worries (and politically useful votes) about Max Baucus' bill on its slow, slow march through markup.

Jon Kyl, the Arizona Republican, is pushing his amendment that would strike from the bill a provision empowering a federal commission to recommend Medicare payment reforms. Under Baucus' bill, if Congress rejected the savings suggested by the commission, Congress would have to come up with equivalent savings of its own. If it did not, the commission's recommendations would go into effect. The thinking is that the commission would serve the same function at the Base Realignment and Closure commission -- making the tough calls that elected officials find hard to make, since congressmen now are heavily lobbied by various health industry groups against reforms that would reduce Medicare reimbursement rates.

Kyl acknowledged the problem in the status quo but said that outsourcing Congress' power to set Medicare rates was a dereliction of duty. And while the provision explicitly forbids the commission from reducing Medicare benefits or rationing care, its recommendations would in effect be doing so by reducing payments to doctors, who might in turn stop providing seniors with care. He compared the commission to the British panel, dubbed NICE, which decides what the British health system does and doesn't pay for. BRAC was a poor model, he said, because that involves base closures, where this will involve people's lives.

"We represent these folks...and we have to be accountable to them," he said. "I'm cognizant we don’t always cover ourselves in glory. It's true we might be responsive to special interests. But the answer is, that’s our democratic republic at work. If intelligent and courageous people are elected to office, they will make decisions that reflect their constituents."

In response, Democrats left aside the easiest retort: that it was a bit rich for Republicans to be arguing against cuts in Medicare payments to doctors, after years in which Republicans have themselves been seeking to cut Medicare (and often been vilified for it).

Instead, they assured listeners that the new panel would have no ability to deny care and that Congress could easily assert its authority if it found its own Medicare savings. (Indeed, other Democratic proposals would give the new commission greater authority in setting reimbursement rates than Baucus' bill does.) And they noted that the Congressional Budget Office had praised the provision for its deficit-reducing potential.

"This is not anything resembling NICE in Britain. That's totally irrelevant to this provision," said Baucus. "This addresses the growth in provider payments and giving the commission the appropriate authority to look at provider payments."

4:28 p.m. | Committee Veers into Free Speech Discussion
As if the Senate Finance Committee does not have enough on its hands in working through more than 500 amendments to chairman Max Baucus' proposed bill, it just spent more than an hour in a debate over the First Amendment and corporate free speech.

At issue was a side battle that has been brewing for several weeks between Baucus and Humana, one of the insurers that contracts with the federal government to provide Medicare Advantage plans, HMO-style Medicare plans with added features that have been chosen by more than a fifth of seniors. Baucus' proposal, like the other Democratic health care proposals, pays for universal health care partly by slashing the subsidies that are provided to the insurers that are providing the Medicare Advantage plans -- $113 billion in cuts over 10 years, in Baucus' plan.

Fearing these cuts, Humana fought back by sending letters to the beneficiaries in its Advantage plans -- labeled as official communication about the enrollees' Medicare Advantage plans -- warning them about the subsidy cuts, saying the cuts would result in reduced Medicare services for beneficiaries, and urging them to contact their congressmen to argue against the cuts.

The letter outraged Baucus and other Democrats, and the Centers for Medicare and Medicaid Services fired off a letter to Humana telling it to cease and desist because, CMS said, the letters were in violation of the company's contract laying out its fiduciary responsibility with the government and Medicare enrollees. The CMS letter, in turn, set off Republicans and the Wall Street Journal editorial page, who saw it as blatant censorship.

Today, Republicans on the finance committee took the matter up, proposing an amendment that would prohibit limitations on lobbying by companies. Sen. Jon Kyl (R-Ariz) objected to the assertion that the Humana letter contained misleading statements about the effect of the legislation, but said that even if it did, it was protected by the First Amendment. "It wasn't lies," he said. "But you can’t take this kind of a letter and tell them to cease and desist simply because CMS differ with you and your judgment."

Sen. Pat Roberts of Kansas was more outspoken, saying that the CMS letter had sent a "cold chill" through every company in the country that received some form of government help and was now on notice that it could not agitate against the government. "Do you mean if you get involved in any federal help you can’t petition the government?" he asked the Democrats on the panel. "I'm amazed you're defending this position."

Democrats countered that Humana had every right to lobby Congress or the government, but that it was not appropriate for it to be using the lists of Medicare recipients it had obtained from its contract with the government to send those recipients letters in an attempt to salvage their subsidies. The contract had given the company the fiduciary responsibility to serve in the place of the government in administering the recipients' Medicare, not to be lobbying those recipients against the government.

"We're talking about government contractors hired by the government to stand in the place of government," said New Mexico Sen. Jeff Bingaman. "Government should not impede the ability of that contractor to run TV ads or influence Congress. But to say they should use their position they have contracted to have with these seniors on Medicare to lobby them to influence legislation seems a little bit out of the ordinary."

Sen. Debbie Stabenow said many of her Michigan constituents had gotten the letter and taken fright at the prospect of Medicare cuts -- when in fact, she said, insurers could absorb the cuts in the form of lower profits instead. Added New York senator Chuck Schumer: "This is not close to being a First Amendment case."

Baucus conceded that the CMS letter may have "overstepped" in its language. But he rejected the broader Republican claim. "I have deep respect for the First Amendment," he said. "We're talking about a special category here.... We’re talking about the communication that these plans have with their membership. These plans have personal information that no one else has."

And with that, the committee voted, on a party line, against the Republican amendment.

One more amendment down, another hour gone.

More than 500 amendments left to go.

12:08 p.m. | A Question of Language
If anyone was planning on holding a drinking game party later this week to mark the Senate Finance Committee's vote on its long-awaited health reform bill, they might want to put the good stuff back into the cabinet for a while.

The committee has been bogged down for more than an hour this morning discussing just one of the 500-plus proposed amendments on the bill: whether or not to require the bill be converted into legislative language, with a full Congressional Budget Office analysis, before the committee votes on the bill. This would delay a committee vote -- and the bill's move to the Senate floor -- by as much as two weeks. The Democrats on the committee beat back the amendment just now on a party line vote -- but not before Chairman Max Baucus had to assure as a concession that the committee would wait for a more preliminary CBO analysis of the amended bill, which will in all likelihood delay a vote until next week.

At issue was whether to wait until the bill was written in bona fide legislative language. It is the committee's tradition to write its legislation in more accessible "conceptual" language and only later have it converted into the impenetrable jargon of actual legislation.

But Republicans on the committee argued that such an important, far-reaching bill should be put in legislative language before a vote, so that Americans would know exactly what was being voted on and so that the CBO would know exactly how to analyze the bill's cost.

Leading the charge in making this case was Olympia Snowe, the Maine Republican who is showing every sign of being the only Republican to back the bill. Here, though, she sided with other members of her party in arguing that the committee needed to take whatever time was necessary to guarantee transparency and get a reliable cost estimate.

"I truly do not understand the skepticism about this request, the reluctance and the reticence. This is about doing our job," she said. "If it takes two more weeks, it takes two more weeks. We're talking about trillions of dollars in the final analysis. What is the rush? Is theres something happening in two weeks?"

Also speaking on behalf of a delay was Chuck Grassley, the senior Republican on the committee, whose support Baucus had been hoping to win for the bill, but who has come out strongly against it, including warning to voters back home in Iowa that health reform might involve "pulling the plug on Grandma."

If the committee did not wait for the full legislative language, he said, it would "insult the intelligence of the American people."

Democrats on the committee saw the move as a blatant stalling tactic designed to push health reform even deeper into the fall. Kent Conrad, a North Dakota Democrat, argued that waiting for legislative language would do nothing for transparency because the language is so dense and inscrutable. Once the bill was in legislative language, he said, the committee could make sure that any discrepancies with the conceptual language were addressed and adjusted in the CBO score.

To make his point, he read a passage from one of the other health care bills, which are already in legislative language. It was a stream of legalistic gibberish. "There are five percent of Americans who would understand this," he said.

Mike Crapo, an Idaho Republican, helped Conrad's cause by making a point about what he had read aloud in a way that showed Crapo had misunderstood what the passage involved. "It just makes my point perfectly," Conrad said. "Even the members can't recognize this."

10:38 a.m. | Lincoln on Board
Blanche Lincoln is one of the handful of conservative Democrats whose support for health care reform legislation has been up in the air. President Obama and congressional leaders need her vote to block a Republican filibuster, and in recent weeks she has been sounding markedly ambivalent about the Democratic proposals already submitted.

But judging by her remarks this morning, the Arkansas Democrat is on board with Max Baucus' bill in the Finance Committee. She hailed the bill for being deficit-neutral, saying she could not support any bill that was not. She praised it for its main features, such as making it easier for small businesses to buy health insurance for their workers. "I firmly believe health care reform is a key component to facing our challenges," she said.

Lincoln noted that the bill could yet change to the point where it would become harder for her to back -- and in fact, several of the changes made to it in the past two days have raised the price tag by expanding subsidies to make insurance more affordable and reducing the revenue gained from a new tax on high-cost insurance plans. "I hope at the end of the process the product is a fiscally responsible product," she said.

Interestingly, the bill does not include one feature that was objectionable to other conservative Democrats (but which might have been palatable to Lincoln): a mandate that employers must provide insurance to their workers. A few months ago, Wal-Mart, which dominates Arkansas politics, declared that it could support an employer mandate. Skeptics noted that this was less altruistic than it seemed -- Wal-Mart now offers coverage to a majority of its workers and so might be less hurt by a mandate than many of the smaller mom-and-pop stores that it competes with in many towns around the country. But Wal-Mart's stance did make it easier for Lincoln and her fellow Arkansas Democrat, Sen. Mark Pryor, to back a mandate in the Senate.

As it turned out, though, the mandate was not in the Baucus bill, which instead has a so-called "free rider" provision that requires employers who don't offer coverage to help pay the cost of the public subsidies for health coverage for employees that qualify for help. That provision is more acceptable to many employers than a straight mandate, though critics say it would have the effect of discouraging companies that don't provide insurance from hiring low-income people who would qualify for subsidies. Indeed, the provision could hit Wal-Mart harder than a mandate would.

DAY ONE
6:25 p.m. | The Mayo Model
Just before the Finance Committee broke for dinner, Maria Cantwell, the Democrat from Washington state, got in a strong plug for her proposal to overhaul Medicare so that it pays doctors and hospitals according to a "value index" based on how cost-efficiently they deliver care.

The proposal sounds anodyne but it is in fact at the heart of a roiling debate over regional disparities in Medicare spending. Cantwell has been at the forefront in advocating for hospitals, many of them in the Upper Midwest and Pacific Northwest, that have been shown to spend much less per Medicare patient than hospitals elsewhere, particularly in the Northeast, Los Angeles, Florida and Texas. These hospitals -- the most famous of which is the Mayo Clinic -- argue that the current Medicare payment system rewards doctors and hospitals that perform unnecessary tests and procedures and that Medicare would save money if adopted a "value index" that rewarded lower-spending hospitals like theirs and punished others.

But some health care experts as well as lawmakers and hospital officials in higher-spending states argue that much of the difference in spending has to do with demographics, noting that most of the "high-value" hospitals are in low-poverty and racially homogeneous areas. They also note that the model centers are less low-cost than they are made out to be because they charge very high rates to private insurers even as they scrape by on relatively low Medicare payments. Cutting payments to hospitals with poor cost-efficiency ratings, they say, could just lead them to stop treating poor patients.

Baucus's bill right now includes many provisions that could move the system in the direction of cost-efficient model, but Cantwell argued that the bill needs to get there faster, with a value index that would immediately force hospitals to change the way they do things.

"We should not walk, we should not skip, we should run toward this model," she said.

5:40 p.m. | Keep It if You Want It?
John Ensign, the Nevada Republican, has been distracted by an adultery scandal the past few months, but he's been paying enough attention to the health care debate to zero in on one inconsistency in the Democrats' reform arguments. For months, President Obama and congressional Democrats have been emphasizing that their proposals will not force Americans to change their health care coverage if they do not want to.

But as Ensign just noted, the proposal in Max Baucus's legislation to impose an excise tax on the most costly of health insurance plans does not really match up with the "keep it if you want to" promise. Ensign asked Thomas Barthold, the chief of staff for the Joint Tax Committee, whether insurers wouldn't just pass on the excise tax on the costliest plans to employees in the form of higher premiums. Barthold gave the answer that the plan's supporters have been giving in response to this question -- that the expectation is that to avoid the excise tax, insurers and employers would stop offering the costliest, or that if the tax is passed on in the form of premiums, employees would instead choose less expensive plans.

That, the hope is, would accomplish reformers' other big goal, of slowing the growth in long-term health care spending, if employees become more conscious of what their health plans do and do not cover. But it would also mean that many employees would have to lose coverage they liked, either because their employers no longer offered it or because the workers' share of the premiums became unaffordable.

"It's important to be honest with Americans about what the excise tax will do," Ensign said.

Baucus retorted that as it now stands, plenty of Americans are losing employer coverage they like because their companies, under pressure from rising costs, are either dropping coverage or switching to other plans. "The fact is," he said, "you can't keep what you like today."

4:49 p.m. | Markup Heats Up
Things got a bit heated just now in the hearing room, generated from an unlikely source: the by-the-numbers, just-the-facts-ma'am director of the Congressional Budget Office, Doug Elmendorf. Asked by Olympia Snowe how many people the CBO was estimating would pay a penalty instead of buy health insurance, Elmendorf said he did not have the estimate handy, and went on to say that his office had been overwhelmed with work in the past few days. Faced with 500 proposed amendments to score, he said, his staff had not been able to analyze all of the modifications that Baucus had already made to the bill in recent days.

This did not sit to well with Baucus, who in increasingly testy tones made clear that the CBO better analyze the modified bill as it now stands as soon as it can, even if it means moving more quickly through the proposed amendments and dispatching of the ones that seem less pressing. "We urge you with all speed" to produce a final cost estimate of the revised bill, Baucus said. "I can't overemphasize this enough."

This rubbed the earnest Elmendorf the wrong way. He noted that his office had responded to countless requests from Baucus and other senators in the past 48 hours. "We've turned around a vast amount of material for you, but there are limits," he said. He added, as if comparing the work of the CBO to driving a car or flying a plane, that there are "maximum limits of safe speed" that the CBO can work at before it imperils the quality of its analyses. "We're not sitting around chewing things over."

Baucus was unimpressed, noting again that the CBO had done "very little analysis" on his own modifications to the bill.

Some of Baucus's critics might see irony in the exchange -- after all, it was Baucus who many Democrats in the House and Senate believe was being too punctilious in drafting the very bill whose CBO analyses Baucus was now finding late and lacking.

3:36 p.m. | Rockefeller Horse Trading with Kindness
It's not easy to divine true sentiments amid senatorial niceties, but it does appear from watching Jay Rockefeller speak just now that the rift that opened up between him and other more liberal Democrats on the one hand and Finance Committee Chairman Max Baucus on the other has closed a bit.

Rockefeller, of West Virginia, has been open in voicing his displeasure with the direction that Baucus took all summer -- gathering the Gang of Six in a room to try to has out a bipartisan compromise that would not include several liberal planks, notably the public option, which Rockefeller strongly backs. But now that the bipartisan effort has stalled, and it has become clear that Baucus's bill will need Democrats' votes to get out of committee, Rockefeller and his allies are, for now, in a slightly stronger position to bend the bill in their direction.

So his words for Baucus just now were kind even by senatorial standards. He compared the legislative process that Baucus has been leading to D-Day, and said that "Chairman Baucus is our General Eisenhower." He thanked him for his "enormous commitment." He mentioned the "incredible meeting" that Democrats on the Finance Committee had held last night to prepare for the mark-up, which he said was dominated by a "new spirit" on health care and a "good, good feeling that we're moving forward."

And he listed the features he would hope to have added to the bill in exchange for such high praise. They include his wish that children now in the Children's Health Insurance Program be allowed to stay in that instead of what the proposals contemplate, moving them into either conventional Medicaid or the "exchange" where uninsured families will be able to buy subsidized coverage. He urged that the subsidies on the exchange be increased to make coverage more affordable.

And he made one more pitch for the public option, which he said he wished had been called something different -- maybe "the family health insurance plan" -- because "the word public is not a good word these days.

11:55 a.m. | The Wyden Plan
No one ever accused Ron Wyden of lacking persistence. Even as the Finance Committee is marking up a bill that is premised on leaving the current employer-based insurance system in place (for now), the Oregon Democrat was making another plug for his far more aggressive reform plan.

For several years, Wyden has, with Utah Republican Bob Bennett, been pushing a plan that would essentially dismantle the employer-based insurance system and replace it with one in which people would get tax deductions to purchase their own coverage. The thinking is that this would introduce far more competition and personal choice to health insurance and would be fairer than the current system, where people who get employer-based coverage benefit from the tax exempt nature of employer based benefits while people who buy insurance on their own must do so with after-tax dollars. The primary objection to the proposal is that it is just too dramatic a change for a country where health reformers feel the need to constantly reassure people with insurance that they can "keep what they have."

The Baucus bill has actually moved slightly closer to the Wyden vision by expanding accessibility to a new "exchange" where small businesses and people without employer-based coverage would buy insurance. The bill opens up access to the exchange to employers with as many as 100 workers, and envisions further expansions in coming years, which could over time lead to a shift away from employer-based plans and into the exchange. But Wyden said this is not going far enough to provide true choice to the 200 million Americans who now have employer-based coverage.

"It does not hold insurance companies accountable and it denies choice of insurers to 200 million Americans," he said. "It stipulates that you can keep what you have but if you don't like what you have...you're stuck."

He said he realized that the odds of his plan had always been long: "I know I'm taking on what amounts to the status quo lobby," he said.

And he made clear that he would be prepared to vote for the Baucus bill even if it fell short of his vision, as many other dissatisfied Democrats would. "This bill for a lot of my colleagues is not our first choice," he said.

11:30 a.m. | All Politics is Local
The home-state pressures facing the senators on the Finance Committee are not hard to discern so far. First, there was Olympia Snowe speaking up for the fairness of the Medicaid burden being imposed on states like Maine that have been much more generous than other states when it comes to Medicaid.

Then there was Chuck Schumer, the New York Democrat who in addition to making another plug for the public option, zeroed in on two issues of real concern to his constituents: the affordability of the insurance they will be required to buy and the proposed tax on high-cost plans. Because health care costs are higher in New York, middle and working-class residents will have a harder time affording insurance with the subsidies that they'll be getting under the plan. And the high health care costs in New York also mean that people who do have coverage are more likely than elsewhere to fall above the $22,000 threshold for a family plan at which plans will be subject to an excise tax that will result in yet higher premiums. Schumer said he would be proposing an amendment to address one subset of constituents in particular -- firefighters and others whose coverage plans are costly because of their line of work. But look for him to be trying to protect other union members and middle-class residents more broadly from the excise tax, which is the main new revenue source for Baucus's bill.

Up next came Bill Nelson, the Florida Democrat who, after some hemming and hawing, focused in on the issue most important to his many elderly constituents -- proposed cuts in Medicare, and specifically in the subsidies to insurers who offer Medicare Advantage plans. If those subsidies are cut, some insurers will in all likelihood stop offering the plans, which are HMO-style enhanced forms of Medicare chosen by about a fifth of Medicare recipients. Nelson argued that the cuts should not hurt people in Medicare Advantage plans now, that they should be grand-fathered into their current plans -- a step that would greatly reduce the savings gained from reducing the Medicare Advantage subsidies. "These citizens have come to rely on [Medicare Advantage]. To suddenly whack it away from them is unconscionable," he said.

10:53 a.m. | Winning Over Snowe
If Max Baucus failed to get his pal Chuck Grassley on board, it became clear just how likely it is that the bill will get support from one Republican: Maine's Olympia Snowe. Her statement on the legislation was full of understated praise for its main features -- features that Baucus had hoped would win over Grassley, but in the end seem to have netted only the moderate New Englander.

Snowe praised the bill for being "fully paid for" using revenues from within the health care system, not outside it. She praised the "robust competition" that would be offered on the new "exchange" where insurers would offer plans for small businesses and people without employer-based coverage. And she praised it for taking "incremental" steps toward reducing overall health care spending over the long term.

And her criticisms of the bill, such as they were, also put her closer to many Democrats than to her fellow Republicans. She said she was still worried about the affordability of health insurance for middle-class families who would now be required to purchase it, saying that proposed subsidies would need to be expanded further.

Snowe gave positive reviews of Baucus for loosening access to the exchange to include businesses with as many as 100 employees. But she said she was still concerned about potential regional unfairness in the bill's approach to expanding Medicaid. The bill opens Medicaid eligibility nationwide to people with incomes up to 133 percent of the poverty level, which is a far more generous threshold than many states now have. The bill would have the federal government paying a far greater share of Medicaid costs for these new enrollees than it now does for Medicaid in most states. This will lead to an obvious state-by-state imbalance: states that already have generous Medicaid eligibility rules -- which includes Maine and much of the Northeast, as well as California -- will be paying a much bigger share of Medicaid costs than states that have been less generous. "I'm concerned about the unforseen impact" on state-by-state fairness, Snowe said.

Given how crucial Snowe is to the bill's passage, her leverage in getting this and her other concerns addressed is strong. And indeed, after she finished her statement, Baucus said that he took her concerns about affordability to heart and recognized that more might need to be done in that area.

10:38 a.m. | Courting Grassley
One of the leading subplots of the health reform battle has been Senate Finance Committee Chairman Max Baucus's courting of his longtime ally across the aisle, Chuck Grassley. With the White House's encouragement, Baucus spent months trying to get Grassley on board with his legislation, to give a bipartisan stamp. But even after extending the process beyond the August recess, and including many of Grassley's planks, the Iowan was unmoved.

As the Finance Committee's markup got underway this morning, Grassley tried to explain his opposition to the legislation that has emerged. His overriding concern, he said, was that there was a lack of guarantee that any bipartisan bill that he agreed to would survive a Democratic-led Congrss. "No one wanted to be used in a process that was going to have the rug pulled out from under it at some point down the road," he said.

But having decided to oppose the bill for this political dynamic, Grassley was left with relatively little to oppose in the bill's substance, underscoring the length to which Baucus had gone to try to win him over. He acknowledged that the bill did not include a government-run insurance option, but raised the specter that might yet lie in the future and lead the U.S. in the direction of Europe, where "countries have inevitably turned to government imposed rationing to control costs." He praised Baucus for crafting a bill that was full paid for, unlike the other congressional proposals -- "it ought to be recognized how fiscally responsible this approach is." But he then attacked the revenue sources that pay for the bill, such as higher fees on medical device makers. He acknowledged the need for people to take responsibility for insuring themselves so as not to impose their health care costs on others, but then criticized the bill's means of encouraging that responsibility, an individual insurance mandate, as an "intrusion into personal lives."

The line that most likely got the biggest roar among House Democrats, though, was Grassley's assertion that the full House had yet to vote on the bill because of the "public backlash" against it. In fact, the House decided to hold off on a vote before the August recess in large part because it wanted to see what the Senate Finance Committee would do -- and that committee waited until after the recess precisely to give more time to try to get Grassley on board. And it was during the House's August wait on Baucus and Grassley that the backlash got underway.

By Post Editor | September 23, 2009; 7:34 AM ET
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Comments

what sen. baucus and his gang of six gave us is nothing more than another 2003 medicare modernization act - mo money for the health care industry with what looks like a nice, juicy carrot for those of us who pay the bill. like wiley coyote, we have been over this cliff before.

Posted by: sbvpav | September 22, 2009 11:01 AM | Report abuse

Max Baucus' bill should be SCRAPPED!. Use the HEP bill if you must! Take medicare , give it to All Americans and use supplemental insurance form the insurance industry to cover what M'Care does not cover.That would make one and all happy! and it would cost less too.

Posted by: mjohnston5209 | September 22, 2009 11:11 AM | Report abuse

Why would anyone in the democratic caucus wast a second trying to make Chuck Grassley happy?
He's proven himself to be a two-faced liar, who has ZERO intention of voting for anything proposed by ANY democrat.
He actually spewed those awful death panel lies over the August recess.
He's an instrument of republican greed, plain and simple, and he needs to be marginalized, not feted.

Posted by: jeffc6578 | September 22, 2009 11:18 AM | Report abuse

grasley is irelevant. His objections are that it is a health reform package. He and the gop have made it perfectly clear that they will object to anything that resembles actual reform, so who cares? Let he and the gop object while Democrats write a bill that will work, and in doing so the gop drifts further away into obscurity. Where they belong after what they have done to America and the tiny faction of fanatics and loonies they represent these days.

Posted by: John1263 | September 22, 2009 11:21 AM | Report abuse

John1263,
Why are the Democrats so opposed to the bill by Baucus? Is it because it is actually a pretty reasonable bill? It sure beats H.R. 3200.

The following in the Baucus will need to be changed because a state cannot be forced to go against its conscience:

Rules Regarding Coverage of and Tax Credits for Specified Services
Current Law
No provision.
Chairman’s Mark
The Secretary would ensure that in each state exchange, at least one plan provides coverage of
abortions beyond those for which Federal funds appropriated for the Department of Health and
Human Services are permitted. The Secretary would also ensure that in each state exchange, at
least one plan does not provide coverage of abortions beyond those for which Federal funds
appropriated for the Department of Health and Human Services are permitted.

p.27

Posted by: kwoods2 | September 22, 2009 11:33 AM | Report abuse

Democrats are not vehemently opposed to the Baucus bill. however, many or most think it has flaws, and are thus working to amend it. However, the lack of a soecific government option is a big problem. The private sector has had more than 60 years to step up. They have every incentive to not do the right thing, until they are pushed to the wall with the threat of losing customers to a less expensive more effecient plan. IE the government option. Health insurance is not like buying cheescake. It is not a luxury or an optional purchase. The very fact that there is an inperative to buy has made market forces unresponsive to normal price point preasure. Until there is that very real preasure, and until everyone is in the overall pool, we will continue to have the very same problems.

And yes - some form of tort reofrm and malpractice insurance pooling is a must to bring down costs. However, the idea of caps is anathema to keeping thesystem functional. Perhaps a mechanism to recover costs from frivilous suits...

Posted by: John1263 | September 22, 2009 11:40 AM | Report abuse

The Democrats should just do the bill they think will work for the american people and take resonsibility for it. By changing the bill to try to get the GOP to buy into it. That is not going to work. they say slow down listen to me,bypartisonship is the only way. It is plain by now that they are not going to go along with any healthbill that comes forward. If they had one they had eight years to do it and did nothing.

Posted by: chasgreen11 | September 22, 2009 11:44 AM | Report abuse

Snowe is worried the middle class won't be able to pay under the new plan?? We're in big trouble! If the middle class can't afford it, and the government is subsidizing the poor ---the only people who can afford it is the rich? What kind of bill is this?D! This sounds scary to me. The middle class wil have to pay more taxes, and in addition, won't be able to afford healthcare insurance either?

Posted by: ohioan | September 22, 2009 11:47 AM | Report abuse

"Why are the Democrats so opposed to the bill by Baucus?"
1. It mandates coverage to 94% of Americans but does absolutely nothing to make it affordable to anyone other than the very poor. That is worst than no bill at all for the middle class.

2. We have yet to hear a definition of a Cadillac Plan. I spoke with Baucus's aid last week in the Hart Bldg. and he made it clear that have yet to tackle that concern. I pointed out that there ar many corporations with older workers such as in the oil and gas and chemical business here in Houston who's plans cost more simply b/c of the age and health of their workers who would penalized b/c of the cost of their premiums even though their benefits are no more generous than say BMC Software with a much younger workforce. The same premium differentiation exists b/w New York Corporations and Georgia Co. simply b/c of their location and the different cost of healthcare.

3. Unless premiums come down at least 25% the Baucus plan will only be a windfall for the healthcare companies. Since the righties oppose a pubic option what is their sollution. Texas has the most draconian med mal statute in the country. Since its inception in 2004 healthcare premiums have still gone up 10% annually. So what is your answer if you oppose a public option?

Posted by: leichtman | September 22, 2009 12:03 PM | Report abuse

So after Baucus did everything possible to write a bill that Grassley couldn't oppose on the merits, then Grassley says that he cannot support a bill because there is no guarantee that the public option won't be in some final bill? That is an impossible concession to grant. Grassley is a piece of work.

Posted by: zackool | September 22, 2009 12:12 PM | Report abuse

When is the focus of the public, political, and health care community discussion of this issue going to get around to disscussing what will be done to actually reduce the cost of health care? How will the productivity and efficiency be increased and the unnecessary costs be eliminated? Where are the WalMarts and Home Depots of the business? Where are the health care equilavents of Intel/AMD competition of microprocessor development, and the Dell/Hewlett-Packard of computers?

Until there is serious competition within all aspects of the business, at a degree that will threaten the profits and even the survival of expensive providers, there will be no significant reduction of growth of health care costs.

The opposition to the public insurance plan is based on the fact that it will threaten all of the elements of the business, from insurance providers to those delivering health care. Without that threat there is no real incentive for them to cut costs.

Posted by: BobNH | September 22, 2009 12:17 PM | Report abuse

The senate's job is to kill any health insurance reform.

The illusion is that they are working independently - and in different directions - for reform. The reality is that they are working in concert to kill any chance of reform in order to protect their corporate masters and the income stream they receive from them.

Posted by: natterly71 | September 22, 2009 12:22 PM | Report abuse

"And yes - some form of tort reofrm and malpractice insurance pooling is a must to bring down costs. However, the idea of caps is anathema to keeping our system functional. Perhaps a mechanism to recover costs from frivilous suits... "

apparently you ignored my post where I have shown that mal practice reform has done zero to reduce healthcare costs here in Texas with our draconian caps.

Tort refor?? Do you have ANY idea what that means? Precisely how does ending your right to collect for pain and suffering for your auto accident or death claim do Anything to reduce your healthcare costs. I will be happy to show you a study by our former Dept of Insurance Commissioner showing that neither reduces your healthcare costs.
We already have a summary judgment procedurd that ends 90% of mal practice claims. How about capping Defense Attorneys costs at lets say $400 per hour.

Again we here this garbage attacking lawyers with no evidence that it does anything but, beat up on lawyers w/o saving consumers a dime or make healthcare any more affordable.

Again if mal practice reform is the panacea for healthcare costs for the right, then precisely where is proof that it lowers healthcre costs? It certainly has not done that here in Texas, home to the infamous H.B.4 and draconian caps.

Posted by: leichtman | September 22, 2009 12:58 PM | Report abuse

I love Jordana Spiro.

Posted by: ElrodinTennessee | September 22, 2009 1:16 PM | Report abuse

Wyden bill keeps insurance company control intact; all it does is set up Bantustans for people without employer-provided plans.

Public option (or something like it) -- the only way to keep them honest. Every other solution is simply a form of welfare, and does nothing to control costs.

Posted by: BobT3 | September 22, 2009 1:20 PM | Report abuse

Nothing remotely funny about the slugs at Moveon.

Typical leftist democrat leeches.

Not a bit humerous.

Mostly contemptible.

Posted by: LarryG62 | September 22, 2009 1:36 PM | Report abuse

I have to agree with leichtman on tort reform. I really want to believe that it will reduce costs. It seems to defy common sense that it doesn't reduce costs. But the fact of the matter is that it was done in Texas already, and we're not talking about a halfway effort, either. They've virtually ended medical malpractice suits in Texas and they dramatically slashed malpractice premiums, but it has had no effect on the cost of health care there. I'd love to know why, but tort reform appears to be a simple gift concession to the GOP rather than a realistic way to control health care costs. I don't necessarily think it's a bad idea, but it evidently has no impact on cost.

Posted by: ponkey | September 22, 2009 1:41 PM | Report abuse

I agree with BobNH. Their is no incentive for any politician to champion for the average American. They are already in office (comfy), they have insurance as do their families, they are receiving campaign contributions from insurance industry/medical lobbyist, are not worried about being fired if they do not listen to the people who voted them in, so there is absolutely no incentive for Republicans or Blue Dog Democrats to take of us, we have no money to give them for campaigns, even though it is our taxpayer money that pays their salaries and our votes that put them into office. They are unconscioable human beings.

Posted by: MyTwoCents4 | September 22, 2009 1:51 PM | Report abuse

Funny stuff. But, like, where's the one on Bankers? Or, say pay caps for Hollywood execs and agents. Sorry. Forgot about Rahm Emanuel's brother. No, not Dr. Death. The Hollywood one.

Oh. Grandma Obama was a Banker and the Big Bad Ole Insurance Companies hurt her.

And the Trial Lawyers Object to Insurance Companies.

Gotcha. MoveOn discriminates.

But, oh, so tastefully.

But, funny. I agree.

But, don't stop there. Or, are you biased for Democratic special interests?

Posted by: paul75 | September 22, 2009 1:51 PM | Report abuse

even the effect on doctor's mal practice premiums here in Texas is verblown. In 2003 local Insurance carriers in a deliberate effort to push through HB4 raised medical mal practice premium 130% in a year. Since 2004 doctor's premiums have come donw 21%. That means they are still pocketing 109% increase.
I sincerely believe that insurance premiums are more of a biproduct of the huge losses carriers took in the stock market rather than in medical mal practice claims. I read a study that was done that shows that mal pratice claims constitute .05% of the cost of healthcare in this country. If mal practice claims was the cause of healthcare increases that thesis would have been proven here in Texas.
Also curious where the right's worship of the 10th Amendment has gone to. If they are so protective of state's rights and the rights of state legislatures, to dermne everything including abortion right, then why are they so hypocritical wanting national medical mal practice legislation. What is wrong with leaving that up to state legislatures. What is really ticking me off is that whenever a Republican is asked the first thing they would do to reduce healthcare premiums they point to medical mal practice reform. Again where is their proof? If their theory is correct why have Texas healthcare costs continued to rise just like the rest of the country?

Posted by: leichtman | September 22, 2009 2:00 PM | Report abuse

The problem with the Baucus bill its almost the same as HR3200. What a sham. They just changed some of the words and shifted a few paragraphs around but we're all still going to screwed and everyone will get taxed to pay for it. When has Congress ever came out with an improvement bill that didn't cause taxes to rise?

Posted by: 45upnorth | September 22, 2009 2:21 PM | Report abuse

Alec McGinnis, spewing left wing propaganda? Is this the job of a capitol hill correspondent? Did you notice she never attacked the words "left-wing" or "liberal" or "extremist" to the Moveon.org label?

Since when is this the WaPo idea of news? Wealthy limousine liberal with private health insurance, through NEA funding and White House propaganda, are what is news?

Today, Fears and Leonnig, two Washington Post reporters, had to admit they LIED about the two people who exposed ACORN. They literally made stuff up.

Now, the lunatics at the WaPo are pushing anti-business mocking of US companies by overpaid millionaires?

The Washington Post is a rag, officially.

Posted by: Cornell1984 | September 22, 2009 2:22 PM | Report abuse

Baucus need to get an backlash from his constitiuents! However, I don't know what Obama was thinking when he went out there praising Baucus bill....He must remember just because he did crossover with voters he must and always remember the BASE comes first and the BASE was here waaaayyyyy longer than the so-called blue dogs???

LET ME ASK YOU DID YOU CALL CONGRESS TODAY AND IMPLODED TO THEM THAT THE PUBLIC OPTION MUST BE IN THE BILL?

DID YOU SEND BAUCUS AN EMAIL TELLING HIM HOW MUCH YOU WISH HE WOULD HAD JUST STAYED AN REPUBLICAN....SO WE COULD COUNT THE REAL VOTES!!!

IF AMERICANS ARE SO CENTER-RIGHT HOW IS IT WE HAVE MORE ON THE LEFT IN THE HOUSE OF CONGRESS...USUALLY OUR CONGRESS REFLECTS THE MOOD OF THE AMERICAN PEOPLE

BUT FOR SOME ODD REASON THE ILLUSIONIST CONSERVATIVES STILL THINK OR WANT US TO BELIEVE WE ARE A CENTER RIGHT COUNTRY...

LIKE HELL WE ARE!!!

Posted by: danders5000 | September 22, 2009 2:25 PM | Report abuse

So a bunch of talented but extremely overpaid actors get a say in our nation's helathcare? Are you kidding. If insurance execs are overpaid what are studio execs, or agents, or the 'talent' themselves? please. These are fine actors but they have no reason to get involved... oh yeah, they are in the union. I think we know where the money will go.

Yeah, lets all hate executives, yeah! Each one of these folks is an 'industry executive' by the way.

Eliminate the waste, show the savings... then change the system. Seems easy to me -- put up or shut up.

I will say the 'way left', as represented by moveOn.org, and Mr. Ferrell do share one thing -- they keep making the same movie, over and over again.

Posted by: CARealist | September 22, 2009 2:27 PM | Report abuse

upnorth: curious why you are so obssesed with taxes yet make no mention of your healthcare premiums going up 10-15% annually and have likly doubled b/w 2001 and 2009. Unpaid medical bills are the singlest largest cause of personal bankruptcy in this country. The only taxes that have increased for me recently are my county and local property taxes caused by the uninsurred using their county emergency room as their personal physician.

Posted by: leichtman | September 22, 2009 2:29 PM | Report abuse

LET ME ASK YOU DID YOU CALL CONGRESS TODAY AND IMPLODED TO THEM THAT THE PUBLIC OPTION MUST BE IN THE BILL?

-------

I can only imagine what it must sound like when somebody calls you on the phone and then implodes. Obama's doing the right thing trying to make this a bipartisan effort. You can't just be the President of half of the country. Remember when Bush said he was a uniter and not a divider? This is what it looks like when that's actually true.

Posted by: ponkey | September 22, 2009 2:38 PM | Report abuse

"Baucus need to get an backlash from his constitiuents"

I was in DC last week and attempted to speak with staff of Baucus from Montana, Conrad and Snowe. I was told by their staffs they would only speak with me if I was a constituent from Maine, Montana or from N. Dakota. In other words, constituents making up less than 17% of this nation from our smallest states will be deciding healthcare for all 300 million of us. When I mentioned that healthcare is a national issue effecting over 300 million Americans NONE of their staffs cared. Perhaps if I was from the Chamber of Commerce or a tea bagger they would have listened.

Posted by: leichtman | September 22, 2009 2:42 PM | Report abuse

Baucus is obnoxious for demanding a markup on all 500+ amendments in the time it takes an egg to boil. As the CBO Director argued, there are limits.

As for Grassley, I wonder why this certified half-wit who's only achievement so far has been sucking up tax dollars for farm subsidies is on this committee. All he cares about is abortion and grain and flag burning. That's it. Plus, anyone who went about repeating Sarah Palin's lies on "death panels," and then acts like its no big deal when he's called out on it clearly has no intention of voting for healthcare reform. But why even go there? His prior record on funding for Healthcare for Veterans should be evidence enough.

Posted by: jaysit | September 22, 2009 6:25 PM | Report abuse

Hard to understand why Democrats whittle away the substance of healthcare reform to appease Grassley and save him from re-election defeat in Iowa.

Posted by: FirstMouse1 | September 23, 2009 2:28 PM | Report abuse

Health care legislation has been discussed daily for the past several weeks. I note that recently there has been no mention of any provisions to be included that would verify the nationality of a person seeking health care benefits. Just what the heck is going on!

We have about 12 million illegal immigrants in this country and although HR-3200 says that non-US citizens are not eligible for benefits under that legislation there is nothing in the bill requiring that nationality be verified. 12 million people is a significant number of those alleged to be without health care and if eligibility is not going to be enforced, would be a large burden on what I anticipate as a heavily burdened health care industry.

Posted by: Eddo1 | September 23, 2009 4:42 PM | Report abuse

We need a public option and a single payer.

Posted by: thebobbob | September 23, 2009 6:46 PM | Report abuse

"We need a public option and a single payer.

Republicans have no interest in doing anything but killing any change in the Health Care Money Machine. Doesn't anyone remember how they wanted to kill Social Security and put it all in the Stock Market? Brilliant! Never trust a Republican. They just lie!"
-------------------------------
I want to remind you that it was the democrats that said the money in social security is so abundant that it will never run out so that took the money to run other programs that they mismanaged Now it running out because it was never paid back. you say Republicans lie and I say Democats are crooks.

Posted by: rainman2 | September 23, 2009 6:55 PM | Report abuse

These Advantage programs are parasites on our nation’s Medicare program. I have been with a hospital group and a primary care physician for over 15 years during my employment through company insurance and continued this relationship under my retirement insurance from my former employer. When I turned 65 and received my Medicare card, my retirement insurance became my supplemental insurance to Medicare. I was then informed by my long term medical facility that they do not accept Medicare and if I want to continue my use of their facilities and keep my primary care physician, that I must join their “Advantage” care program but warn me that “if I currently have health coverage from an employer, joining their “Advantage plan” may affect my retirement medical insurance. While I am trying to find out if their “advantage” program adversely impacts my medical insurance supplement, or if I indeed need to give up my doctor and find another one, I basically have nowhere to go for any illness I may need treated in this interim.

Posted by: alvaroach | September 23, 2009 9:08 PM | Report abuse

I think you forgot the part where the Senate Finance committee today voted 12-11 to NOT post the bill online for 72 hours to let the public review it.
Transparency?
What are you hiding finance committee?

Posted by: concernedjaneco | September 23, 2009 10:53 PM | Report abuse

I do not trust the Democrats or the Republicans since they failed to do their jobs which would have avoided our financial crisis. Plus how many of our elected officials have not paid taxes or received better loans from Countrywide then you or I could have gotten. Charlie Rangel keeps racking up tax issues and he is on the committee that governs tax law. Acorn's founder embezzeled one million dollars even though it was repaid with help. They have been in the news since the primaries if not before being accused of voter registration fraud. There have been calls for an investigation yet nothing was done until recently due to the recent videos even though Acorn has received millions of our tax payer dollars. Amazingly a prompt investigation was started due to info that Humana sent to seniors about the healthcare bill. We need healthcare reform to reduce costs however I do not want the government involved other than governing to help reduce costs by passing laws to stop drug company advertising and loopholes that keep less expensive generics to be made, trade laws that keep other countries from taking advantage of our drug research, tort reform, get the FDA some help to get the backlog of generics approved and on the market, allow health insurance to be sold across state lines to increase competition, allow plans to be sold with or without all the state mandates that increase premiums 20% to 50% depending on the state, start the process of saving the billions of fraud and waste in Medicaid and Medicare, create transparency rules and improvements in insurance company plans. There are billions of dollars spent on healthcare for illegal immigrants and the $425,000 babies born each year. Hospitals and doctors are passing on the cost to those who can pay and those who have insurance for the low Medicaid and Medicare reimbursements, malpractice insurance, the uninsured and illegal immigrants. Those who are concerned about the illegal immigrants being covered should look at the proposed legislation that will give them amnesty so why would they need to exclude illegals in the previous bills? Finally, the government is inefficient. Look at what happened with Katrina, Medicare will be broke in 8 years, Social Security is also going broke, the post office is 7 billion in the hole. I don't trust government to take over healhcare. My comments could cause some of our elected officials to call me a part of the mob or a evil monger or worse. I think this language is irresponsible from anyone much less our elected government representatives. I want the very best for everyone in this country and I truly believe that problems we have today are caused by our government not doing their jobs, power, and greed; and special interest groups. Healthcare is important but becomes less significant if you can't pay for the basic necessities such as food, clothing, and shelter. My heart goes out to everyone who is homeless or unemployed.

Posted by: ProudAmericanForever | September 24, 2009 2:16 AM | Report abuse

Everyone who is interested in the truth about the insurance companies lobby and its ability to control the health care legislation the Congress is working on should watch the hearings of the House Oversight and Government Reform Committee on the impact of private health insurance companies on patients' medical care:

1. Go to www.c-span.org.
2. Under "Health Policy", click on "C-SPAN's Health Care Hub."
3. Under "Video on Demand," scroll down to and click on "House Oversight Hearing on Private Health Insurance Companies (September 17, 2009)."

Of particular interest are the statements of Reps. Patrick Kennedy and Chairman Dennis Kucinich at the very end of the recording.

Posted by: BTMPost | September 24, 2009 4:15 AM | Report abuse

"For several years, Wyden has, with Utah Republican Bob Bennett, been pushing a plan that would essentially dismantle the employer-based insurance system and replace it with one in which people would get tax deductions to purchase their own coverage."

A back-room deal with the powerful insurance lobby is the reason the sensible Wyden-Bennett proposal got no support from Baucus and Obama.

Posted by: BTMPost | September 24, 2009 4:25 AM | Report abuse

Please take this health care survey for my AP Government class. Here is the link.

http://www.surveymonkey.com/s.aspx?sm=C0cJjk_2fBoRkfZUp1UrGRSQ_3d_3d

Thank You

Posted by: brn4music | September 26, 2009 9:24 PM | Report abuse

Congress is crafting a politically horse-traded health care plan that has winners and losers based on which lobbyists have the attention of the people putting the plan together, all of them wrangling for benefits for one group at the expense of another group. Under any of the existing proposals, there is no way to find enough money to be fair, give the middle class high quality health care they can afford, keep the insurance companies happy, not cut benefits for the elderly, avoid rationing, stop the soaring cost of premiums and health care and bring market forces to bear on health care providers, suppliers and vendors. Why? Because both Democrats and Republicans refused to put single payer on the table. And once you understand the details, you'll realize that the “public option” is a toothless option. Obama compromised the chance for ever getting support for a true single payer system by making it an option from the outset. Congress will never let a so called public option replace the insurance companies while Congress receives massive campaign financing from these companies and while Congress has an exclusive Blue Chip health care plan which depends on these companies staying in the game. Part single payer for a few and part high cost insurance company run health care for the rest won't produce the real benefits of single payer. The primary discussion on mainstream and cable television, whether the liberal or conservative talk shows, from Hannity on the right to the Ed Show on the left, has been spent on heated arguments about public option versus no public option. They ignore the elephant in the room — the fact that a single payer system doesn’t have to be government run. Again, single payer does not have to be government run! The most influential talk show hosts and journalists have avoided telling the public about the way single payer solves most of the problems that the plans currently before Congress can’t solve. Liberals are the most responsible for this failure since they claimed to be the champions of single payer. They blew the chance for single payer by their arrogant insistence on a government run system come hell or high water instead of focusing on the benefits of single payer. We were entitled to a fair discussion by Congress and by the influential political talk shows of the benefits of single payer and the option of having it run by an independent private commission if a government run approach created gridlock between those on the right and the left. Only a few blogs on the Internet have given the full story about single payer. My blog explains how to have single payer without it being government run. http://jscopeg1234mailcom-jscope.blogspot.com/

Posted by: jscope | September 27, 2009 1:20 AM | Report abuse

Reform is necessary, but not just on healthcare. Every bill impacting the individual American must also apply, on the same level, to Congress and other Federal employees. The first reform should be Congress themselves. After decades of both action and inaction they are solely responsible for the situation this country is in. Before opening the door wider for more waste and corruption they need to do the job they were elected for, represent us and clean up there own house. First we need term limits then, monetary election reform, pac usage, immigration laws brought up to date (NOT amnesty)and the existing laws on immigration enforced, no more roads to nowhere etc. The lobbyists are not a branch of government! Congress works for and is paid by us. They tell us to write our Congressional members. HA! I have done that consistently over the past year and a half after seeing my country slip further down the drain. In return I have received nothing but form letters, and my questions NEVER answered, just 'thank you, your opinions are important to me'. Well, their opinions are also important to me and an explanation of why they think I am wrong. The money saved by them changing how they do business and eliminating waste would more than pay for healthcare for the ones who want it but don't have it, until and affordable and reasonable plan can be devised. There is not enough room or time on this blog for me to express the disgust I feel for where we and our wonderful country are being taken.
Comments from foreign friends on our political activities leave me with no logical explanation to their questions.
I hope my only contribution to this country's future isn't the voting booth.

Posted by: no1more2big3gov4 | September 29, 2009 9:13 AM | Report abuse