Monday, August 03, 2009

Health Care: Prospects Better for a Public Option

Prospects for a public option are brightening. (Maybe everyone has been watching what's been going on in the Senate Finance Committee too closely, and ignoring what's been going on elsewhere on Capitol Hill) From Politico:

Senate Finance Committee Chairman Max Baucus (D-Mont.) runs the health care negotiations like the patriarch of a sprawling clan, urging his members to keep their feuds within the family.

But internal clashes about the government insurance option have begun to spill into the open — as Sen. John Rockefeller (D-W.Va.) has gone public with his case against consumer-owned health care cooperatives, which are viewed as a compromise between progressives who want a public competitor to private insurers and Republicans who don’t want a new government plan.

“I will be darned if I support or allow to move forward — to the extent that I can make a noise about it — something which sounds user-friendly,” Rockefeller said in an interview. “What I have to worry about is, are co-ops going to be effective taking on these gigantic insurance companies? And from everything I know from people who represent them, the answer is a flat ‘no.’”

With four of five congressional committees having endorsed health care bills with a public plan, the focus now turns to the Finance Committee, where debate on the issue has been heated and mostly private up until now.

It’s the only committee proposing a private-sector insurance cooperative, rather than a government-run plan, as a mechanism to hold private insurers accountable. But the passage Friday of a House Energy and Commerce Committee bill with a strong public plan puts another squeeze on the odd man out, the Finance Committee.

“They may be right,” said Sen. Kent Conrad (D-N.D.), who proposed the co-op model because he believes the public plan cannot clear the Senate. “I have seen no evidence that changes the vote count in the Senate.”

As Congress attempts to overhaul health care, the public plan debate has been among the most volatile, noisy and expensive.

Early last week, progressives thought their top priority looked dim. President Barack Obama told Time magazine that a co-op could meet his definition of a public plan. Senate Majority Leader Harry Reid (D-Nev.) said his main responsibility was getting legislation that could pick up 60 votes and thwart a filibuster, which the public plan is unlikely to do. And liberal House Democrats revolted over a deal with conservative Democrats to weaken the new government insurance plan.

By Friday, though, public plan advocates were suddenly feeling pretty good. They didn’t get exactly what they wanted in the Energy and Commerce Committee bill — their first preference was a government-run plan tied to Medicare rates rather than negotiated rates — but they had strengthened their hand against the Finance Committee.

“There will be a backstop,” said a Democratic Senate official, who spoke on the condition of anonymity to discuss strategy. “It ensured that whatever happens in the Senate Finance Committee, there will be something of a firewall in the conference. The House will be an equal partner in the conference, and they will be united in presenting a pretty viable, strong public option and one of the two committees marking up in the Senate will have done the same.”

Rep. Eliot Engel (D-N.Y.) called the inclusion of the public plan “a line in the sand.”

“We’re trying to provide health care to 47 million uninsured people,” Engel said. “I believe the way to help them is to have a robust public option with plans tied to Medicare.”

The Finance Committee leans moderate to conservative. There are only a handful of Democrats who might go to the mat for the public option, including Rockefeller, Sens. Chuck Schumer of New York, Debbie Stabenow of Michigan, John Kerry of Massachusetts and Robert Menendez of New Jersey.

It’s too early to tell whether the liberal committee members would vote against a bill with a co-op option. They will look at the whole package for affordability measures and make a judgment, aides said. But since Baucus is negotiating with three Republicans, he could lose a few Democrats and still push a bill through his committee.

Monday, July 27, 2009

Health Care Reform: No Public Option?

After all that has gone on, there might not be a public option?

Extraordinary that this is not a bigger deal. The loss of a public option is a radical overhaul of, well, what was supposed to be the radical overhaul...

Tonight's Associated Press story:

WASHINGTON — After weeks of secretive talks, a bipartisan group in the Senate edged closer Monday to a health care compromise that omits two key Democratic priorities but incorporates provisions to slow the explosive rise in medical costs, officials said.

These officials said participants were on track to exclude a requirement many congressional Democrats seek for businesses to offer coverage to their workers. Nor would there be a provision for a government insurance option, despite President Barack Obama's support for such a plan.

The three Democrats and three Republicans from the Senate Finance Committee were considering a tax of as much as 35 percent on very high-cost insurance policies, part of an attempt to rein in rapid escalation of costs. Also likely to be included in any deal was creation of a commission charged with slowing the growth of Medicare through recommendations that would take effect automatically unless overturned by Congress.

"We're going to get agreement here," Sen. Max Baucus, D-Mont., the Finance Committee chairman, said Monday. "The group of six really wants to get to 'yes.'"

Obama has outlined two broad goals for legislation he is struggling to win from Congress: expansion of health insurance coverage to millions who lack it, and reining in increases in costs.

Like bills drafted by Democrats, the proposal under discussion by the six Finance Committee members would bar insurance companies from denying coverage to any applicant. Nor could insurers charge higher premiums on the basis of pre-existing medical conditions.

But it jettisons other core Democratic provisions in a reach for bipartisanship on an issue that has so far produced little.

The effort received a boost during the day from the U.S. Chamber of Commerce, normally a close ally of Republicans. In a letter to committee leaders, the business group called for the panel to "act promptly, preferably before" the Senate's scheduled vacation at the end of next week. In doing so, the business organization dealt a blow to the Senate Republican Leader Mitch McConnell of Kentucky and other GOP lawmakers who have called repeatedly for Democrats to slow down.

In yet another boost for the drive to enact legislation, PhRMA, which represents drug companies, has purchased more than $500,000 worth of television ads to air during the week in nine states.

Obama's top domestic priority has suffered numerous setbacks in recent weeks, and Republicans have stepped up their criticism. A Senate vote has been postponed until September. Administration and Democratic leaders hope to show significant progress before lawmakers begin their monthlong recess in hopes of regaining momentum.

In the House, the leadership sought to allay concerns among the rank and file. Speaker Nancy Pelosi, D-Calif., said, "We're on schedule to do it now or do it whenever," when asked whether the House would complete its bill before lawmakers leave at the end of the week for their summer break.

In the Senate, officials stressed that no agreement has been reached on a bipartisan measure, and said there is no guarantee of one. They also warned that numerous key issues remain to be settled, including several options to pay for the legislation. They spoke on condition of anonymity, saying they were not authorized to discuss matters under private negotiations.

They said any legislation that emerges from the talks is expected to provide for a nonprofit cooperative to sell insurance in competition with private industry, rather than giving the federal government a role in the marketplace.

Obama and numerous Democrats in Congress have called for a government option to provide competition to private companies and hold down costs. White House spokesman Robert Gibbs said during the day, "I don't believe that the president has come down (on) one versus the other in terms of denoting co-ops equal to or above public option."

One of the senators involved in the talks, Olympia Snowe, R-Maine, confirmed that co-ops are the preferred approach. "It's safe to say that'll probably remain in the final document," she said.

Officials also said a bipartisan compromise would not subject companies to a penalty if they declined to offer coverage to their workers. Instead, these businesses would be required to reimburse the government for part or all of any federal subsidies designed to help lower-income employees obtain insurance on their own.

"We don't want to undermine (employer coverage) or create a perverse incentive where employers potentially drop coverage because their employees can get subsidies," Snowe said.

Democratic-drafted legislation in the House includes both a penalty and a requirement for companies to share in the cost of covering employees.

The senators involved in the negotiations are all members of the Senate Finance Committee, and include Baucus and Chuck Grassley, R-Iowa, the senior Republican. Others participating are Democratic Sens. Kent Conrad of North Dakota and Jeff Bingaman of New Mexico, and Republicans Snowe and Mike Enzi of Wyoming.

They have met for hours in recent weeks in Baucus' office, joined by aides and outside advisers such as actuaries summoned to explain arcane details of insurance. Douglas Elmendorf, head of the Congressional Budget Office, has also attended.

Baucus has been under intense pressure from the White House and Senate Democrats in recent weeks to convene the committee to vote out legislation. He has so far declined to do so, opting to give the bipartisan negotiations as much time as needed to succeed.

Several Democratic officials have said he recently pledged to Majority Leader Harry Reid, D-Nev., that the committee would meet next week to vote on legislation, a timetable that implies time is growing short for the bipartisan group to wrap up its work.

Much of the cost of the proposal would come from curbing the growth in fees to insurance companies and other providers under Medicare.

But congressional aides in both parties as well as lobbyists said a proposal limiting Flexible Savings Accounts to $2,000 annually is also a strong possibility. FSAs permit the use of pretax income to pay for items such as health care and child care.

Negotiators also are considering fees on the manufacturers of medical devices and on the makers of both brand name and generic drugs coming onto the market.

To cut down on the cost of the bill, the bipartisan group may include only one year of a long-term plan to adjust reimbursement fees under Medicare.

Officials said the legislation under discussion in a series of private meetings would likely cost under $1 trillion, include an expansion of Medicaid, and provide federal subsidies for individuals and families up to 300 percent of poverty to spread health care more broadly.

Individuals would have a mandate to buy affordable insurance.


Associated Press writers Ricardo Alonso-Zaldivar and Erica Werner contributed to this report.

Friday, January 02, 2009

For those reading this, or those who do not know me, but come to my blog here for the first time, thanks for visiting. But I have a new blog where I now post on fairly regularly, here.

The last major story I broke on my new blog can be found here-- which is about what soon to be ex-Vice President Dick Cheney told the special prosecutor and FBI, in part, during the CIA leak probe.

My last two stories in The Atlantic can be found here and here, my last story for ABC News here, and my last two investigatives pieces for the Huffington Post here and here.

And this is my favorite column which I wrote last year:

Somerville, Mass, June 28, 2008–

The rules are simple enough for the kids playing in the stickball tournament this morning in Kelly Park: There are to be three people to a team. There are four innings per game. Two outs per inning. You walk on three balls. You strike out on two strikes. The second strike can be a foul ball.

Any ground ball not stopped or caught is a single. If you hit the ball over the double court line without it being caught or stopped, you have hit a double. If you smack the ball hard off the fence, you have a triple. And if you hit the ball entirely over the fence, of course, you have hit a home run. If you hit a deep foul ball over the fence, it is unclear whether it is to be counted as a foul ball or home run. In that case, the final decision is left to the whim of a grown up or the good will of the opposing team.

If you are eleven years old, and get a chance to bat, there are traditions to maintain: You must wear an oversized Red Sox jersey with the name Papelbom on the back. (That is the Sox’s closer for those not literate in such things. In an earlier time your jersey would have had the name Garciappara on it.) You dramatically roll your head from side to side to get the hair out of the eyes. Then you check the stick to make sure you are hitting at the ball from the right end. (This is very important; however, you hope that nobody sees you doing this.) Then you dig hard into the pavement with your converse high tops, lean way way back on your heels, and then smack at the ball—eyes closed allowed—with all of your eleven year old might. Whether you hit the ball or not, all is right with the world.

You hope you hit the ball of course. But if you don’t, you still get to have your face painted, hang with the older kids, have a hot dog with anything you want it on it– and then if you are really, really lucky you get to sit on your big brother’s shoulder to watch the dedication of the square to an older boy in the neighborhood.

The corner of Cragie and Summer is to be renamed in dedication for another little boy who once played stick ball in this park. There are two honor guards, one of which will fire off live rounds, interrupting the morning quiet and send singing birds scattering. A representative of the mayor will say a few words.

This is the unveiling of the new street sign dedicating Spc. Nicholas Peters Square.

Nick served a tour of duty in Iraq and came home in one piece. He survived the war but not the peace. Stationed at Ft. Hood, in Texas, someone in a bar did not like the fact that he was wearing a Red Sox jersey, and killed him...

My second favorite column/post is this profile I wrote about Todd Graves, one of the nine U.S. attorneys fired by the Bush administration:

The first sign that crimes may have been committed was when the victims no longer felt nauseous and their hair stopped falling out. Also, it wasn't cold going deep into the vein the way it was before. They needed that hurt. And when it was too long in coming, they grew anxious. Their discomfort after all was their comfort. That was the only way that they knew that the chemotherapy was working.

When the FBI believed that they had enough to make a case, they brought the file to Todd Graves, the then-U.S. attorney in Kansas City, Missouri. Ultimately, Robert Courtney, a local pharmacist would be sentenced to thirty years in prison without parole for watering down chemotherapy prescriptions for thousands of cancer patients.

When the Bush administration ordered Graves to resign as U.S. attorney in Jan. 2006, the prosecutor wondered if it might have something to do with the Courtney case. Graves was the first of nine U.S. attorneys fired by the Bush administration for reasons that still are not entirely clear...
This can't be over the Courtney case, Graves thought.

Diluting drugs for at-risk patients had proved to be lucrative business for pharmacist Robert Courtney. At the time of his arrest, Courtney was worth $18.7 million. He owned two manses in the small exurban enclave of Kansas City known as Tremont Manor and was considering the purchase of a condominium in St. Croix...

When Todd Graves was twenty one, he discovered a lump in his groin. It turned out he had a rare form of lymphoma. And the prognosis was not very good: He was told to put his affairs in order, because it was unlikely that he would survive very long.

For a full eighteen years afterwards, he could not bring himself to touch-- even for a single moment-- the same place in his groin where the original lump was discovered out of fear that he might discover a new one.

In the end what likely saved his life was the chemotherapy.

A year of chemotherapy.

A cycle every three weeks.

At regular twenty-minute intervals for twenty six hours straight, like clockwork, the nausea and the retching and the severe pain became overwhelming. Short reprieves, then more pain.

"I would lay up in my room for twenty six hours straight."

At the time, he was attending the University of Missouri, and throughout it all, lived in a fraternity house.

"I had an open wound for a while that wouldn't heal," he recalled, "The chemotherapy didn't allow it to heal... I think some of the people in the house worried that I might just expire right there"

He met his wife during this time. He was bald and on the chemo and because he was on steroids, he was also thirty pounds overweight.

"She was a far better person then me to see past all that," Graves told me. The doctors also told him that the radical chemotherapy necessary would almost certainly make him infertile. Today he and his wife have four children, ranging in ages from four to ten.

When the street agents first came to Graves with a file on Courtney, Graves dreaded the possibility that if his personal story became known, for fear that would drown out what had been stolen by Courtney from his victims.

"I had a woman who missed the birth of a grandchild by three weeks," Ketchmark told me, "She didn't want a cure. She wanted those three weeks."

As best that can be determined, at least 4,200 cancer patients received diluted drugs. All together, those 4,200 patients in turn received at least 98,000 watered down prescriptions...

The column continues:

Somewhere today, there is another kid with cancer, like Todd Graves once was, lying flat on their back in a dorm room or a hospital room. And it will be cold going into the vein. The nausea will be followed by vomiting and when there is nothing left in their stomach the dry retching will start. If it's nitrogen mustard or methorexate, it will leave a metallic taste in their mouth. The open surgical wound will not heal because of the chemo, and even if they somehow survive, the physical and psychological wounds may never entirely heal.

They will be all alone attempting to make sense out of the senseless.

And they will wonder whether they should just give in, to succumb. What with the odds so stacked against them, is it worth that one more worth toxic violation of their person with nothing assumed and far less guaranteed?

But if you are Todd Graves, perhaps the senseless has long ago come to make perfect sense: When he looks at the four children he was never supposed to have; that he would someday stand up in court for Delia Chelston.

I hope you check out my new blog, if you are coming here for the first time! For those wanting to know more about me personally, here is my Facebook page, an interview I gave to U.S. News & World Report back in the day over a lunch where I probably drank a little too much wine, a professional biography here and a second one here, a personal essay of sorts about myself, and a collection of my articles. Two profiles of me, one by professor Jay Rosen of New York University of me, can be found here, and the other by Washington Post media reporter Howard Kurtz, which can be found here. In the meantime, thanks for visiting with me here!