Can Progressives and Conservatives Agree on Health Care Reform?

That is the big question everyone is wondering about these days. Most of the traditional media is drooling over the idea of a train wreck, hyping the disagreements and hoping for failure. But the disagreements are also quite real and quite significant. Conservative Democrats don't want a public option, progressives are insisting on it. Conservatives don't want to spend too much, progressives want to be sure insurance is actually affordable to the middle class. Conservatives don't want businesses to pay anything for their workers' health care, progressives don't want businesses to get a free ride, especially if their workers are being forced to buy insurance. Conservatives want workers taxed on their health plan if it's a good one, progressives would rather have the super rich pay more in taxes instead of the middle class worker with a decent insurance package.

These are tough issues to work out, but I am confident that the White House and the legislative leaders will figure out a way. When legislation is this important to pass - substantively and politically - leaders figure out a path to getting it done. I have seen it happen many different times over the years - seemingly impossible to solve policy differences worked out with patience, muscle, and creativity.

Take the public option. In what is either a sign we will pass health reform, or sign of the apocalypse (or maybe both for certain fundamentalist Christians), conservative Blue Dog Mike Ross and I, one of the original hard core public option advocates, actually agree on something related to the public option. Ross is now suggesting that "instead of creating an entirely new government bureaucracy to administer a public option, Medicare should be offered as a choice." I have fought like crazy for a new public health insurance option to be created for people under 65 years old, but I actually think that this idea is a very reasonable compromise: don't create a new entity, just open up the perfectly good public option we have - Medicare - to anyone who wants to buy into it. That would actually strengthen Medicare because younger, healthier people would be joining the risk pool. And it would satisfy progressives by giving some real competition to the private insurance industry.

Or take affordability. For the fiscally conservative Democrats, they can take reassurances on that issue from the latest CBO report which says that both of the two House bills comes close to (one slightly above, and one slightly below) the $900 billion amount targeted by fiscal conservatives, but they also cover more people, are far more affordable and are deficit neutral.

Here's the bottom line on middle class affordability: the compromise the Blue Dogs forced on the House Energy and Commerce bill made the cost for middle class families $551 a year more, while the Senate Finance bill was a staggering $3,900 a year more for middle class families than the Senate HELP Committee bill. And yet the CBO now says that the better House version of the bill (which is closer to the Senate HELP Committee) is just as fiscally responsible as the "centrist" alternatives that cost the middle class families so much more. When you look at the actual numbers and policy implications of the bills, it's easy to come to terms. In this case, the House bill allows both fiscal conservatives and those of us who want more affordability for the middle class to win.

When conservatives and progressive Democrats in the Senate and House sit down to look at these bills, compromise ideas like Ross' idea of letting everyone buy into Medicare will emerge, and when the merits of the bills are analyzed, I believe that people will come to understand that the political and policy logic of going with the better alternatives in all these areas. This is too important - to the country, to the President, to the Democratic Party - for this not to get resolved.

And if Mike Ross and a lefty like Mike Lux can find a common ground, then anything is possible.

Comments

[amt77]

Wow! This Blue Dog proposing the Medicare Part E concept that so many others have been trying to get across blows my mind! Thom Hartmann has spoken about Medicare Part E (E is for Everyone) on his radio show forEVER! Oh well, whatever it takes, it takes. The simplicity of this plan over getting a whole new program up and running holds a multitudes of benefits, including NOT giving Republicans the opportunity to bitch about more government department­s... but more importantly would be the simplicity for the user. The burden of the complexities and all the paperwork of the current insurance systems for people who are already ill and trying to get well has long been one of my main complaints with our current system. That and the constant fear you might be dropped if you fail to dot an "i" or cross a "t".

[SewaneeLeftist]

Good article, Mr. Lux. Buying in to Medicare sounds the best idea short of single payer. That is, if I understand the distinctions correctly. In this jargon-loaded and euphemism-packed debate, I'm never sure I do.

It certainly sounds the easiest program to administer. Cutting out the middleman, you just use the same process for adding people now... and blow it up exponentially. Could provide some much-needed employment for office workers.

Only the vulture and vampire industry suffers in that case, and most people outside the insurance cartel or other big-business types would not feel all that sympathetic to their plight. To mix metaphors, they've had a good long time at the trough. If they haven't prepared for a more humane future without their obscene profits, as the cigarette companies and even the government of Saudi Arabia have done -- too bad for them.

Chalk up another win for the invisible hand of capitalism, in that case.

[treetracker]

Mike Lux -

Where have you and Mike Ross been? - maybe you should read HuffPo's comments, not just write for it. We've been saying for months that a Medicare buy in is the only way to go, if we can't have single payer!

[ncmom54]

I'm a 3rd generation Yellow Dog democrat..­. my grandmother would come out of her grave & haunt me the rest of my days if I voted for a Republican.
but right now I'd vote for this Republican before I'd vote for another spineless dem that 'negotiates' away the will of the people.
Excerpted from: http://www.pnhp.org/news/2009/august/former_jasper_county.php
Former Jasper County Republican Chairman on Single Payer
"I am a Republican, former chairman of the Republican Party in Jasper County, Ga., and chair of that county commission.
Universal Medicare will both control costs and achieve universal access to high quality care. Congressmen would get the same insurance as you and I. You better believe your coverage would be just as good as or better than what you are getting now.
The problem is not technical; it is political.
It is high time we put the country ahead of ourselves and establish a single-payer system." http://www.pnhp.org

Bi-Partisanship happened on Election Day!
The For-Profit Health Industry that has caused Bankruptcy, unemployment & homelessness is no respecter of party affiliation!

[WilliePilgrim]

In a word; "NO". At least not as long as they insist on framing the argument as a right versus left, or GOP versus Democrat, or progressive versus conservative conflict. The actual political landscape as expressed in the full range of how people and their experiences have led them to perfectly legitimate and defensible perspectives is not one side versus another. Our two party system and the domination of the press by the media has distorted our common perception of how things can be. The secular paleo-conservatives have been ejected from the GOP, and fiscal conservatives have been marginalized by the democrats, with both parties now the party of big spending in order to insure that all power over the people goes through the legislature. There is clearly an alternative but until people recognize it and reject the artificially constrained debate as presented by the profit driven media, it will forever be presented as a highly competitive sporting event or war where instead of competition bringing us something improved we end up with battered and broken laws and protections funded by a taxation system that sees us as sheep to be sheared instead of contributors to the nations strength.

[Izomagritte369]

Fanned. Great, truth speaking post. Until we quit being distracted by the diversions set up by the big money and their media lackeys, we will never unite for our own welfare. We will keep acting in opposition to our own best interests.

[lapdogs]

Agree. There is no way in the world that Democrats and Republicans could agree on anything in today's Congressional Climate.

One side could say it is sunny and warm and the other would automatically say is is snowing and cold.

The only way Dems and Repubs would ever agree on anything is if two NEW parties were created to get things done in a bipartisan way.

Then and only then would both the Dems and Repubs say as "One Party" that the two new were lying.

[UpFromLiberalism]

Can Progressives and Conservatives Agree on Health Care Reform?

as long as the conservatives completely cave on their principles

and take more money and freedom from US citizens.

[Izomagritte369]

B.S. Democracy and (vulture) capitalism are not the same thing. In fact you cannot (and we do not currently) have democracy when special interest, big money runs the gov't. What we have is called Plutocracy - 1% of the populace uses it's enormous (stolen) wealth to control the legislature and the lives of the other 99% of the populace.

You need to quit swallowing party talking points manufactured by the uber wealthy few to keep us divided and start acting in own (and the people's) best interests.

Unless, of course, those same special interests are paying you to post this divisive crap

[treetracker]

Fanned --- You've got it, we are a plutocracy. Been saying that for months now.

The soon people wake up and get it, the sooner we can take the necessary steps to break them. It will only get worse, if we do not stop them soon.

[Tena]

It's going to be quite the accomplishment if even the left and the left agree on this. Part of the left is very busy tearing down the president we worked ourselves to death electing.

I don't ever expect the left to be happy, even with the left, so any kind of agreement with anyone else is kind of out of the question.

[baseline]

Yes, begin the Public Option by offering Medicare to everyone who is now receiving a check from Social Security. Such people simply sign up and their premiums are deducted each month from their checks. Thus Medicare immediately becomes available to lots of seniors between 62 and 65 years and the paperwork is minor. From here arrangements can extend gradually to anyone who wants to be on Medicare.

[MacQ]

Then it would go broke much faster than it's doing now.

[ncmom54]

not if it was a sliding scale buy in... and became the coverage available to ALL Public employees (including Congress) instead of a plan through a for-profit corp insurance company. It wouldn't take long to fortify Medicare back to life.

[yakmeat]

Medicare for all? Don't we have a bill like that already called HR 676?

[FearlessFreep]

If Mike Lux can find common ground with Mike Ross, he's no "lefty."

[krone5]

My solution to the health care issue is lower the medicare age to one, it would cover so many Americans.

[VikingQuest]

You're idea is to add more people to the roles of a program that has $38 trillion with a T in unfunded liabilities?

Seriously, regardless of what we all want, we still need to be responsible enough to not bury our children's future before they have a chance.

"Medicare and Medicaid are the single biggest drivers of the federal deficit and the federal debt by a huge margin."

- Barack Obama

[E4B32787]

"You're idea is to add more people to the roles of a program that has $38 trillion with a T in unfunded liabilities?"

Wait a sec, let's see if I can find out more? "-- which is the amount of benefits promised but not covered by taxes over the next 75 years."

So, doing a little math, a $38T divided over 75 years means a $500B shortfall/year, assuming that the situation is linear. Now, let's see how we could make up the shortfall. We spend >$500B per year on national defense, and spend 50% of world's defense expenditures, while having 25% of world's GDP. Maybe by using a little diplomacy, and not having hostilities with the rest of the world, we could acquire some allies, and reduce that spending to our percentage of world GDP.

Then, of course, given that we spend 50% more than any other industrial country for health care, we could COPY what it is that they are doing to keep their health care costs in line.

[MacQ]

THen it would go broke way before 2017, which is I think its current due date.

[Ben6768]

Please can someone tell me : is Medicare administered directly by the government or does the government pay some private hospitals or doctors to give seniors health care ?
Thank you so much, I am very interested in the debate but am not familiar with so many things of life in the U.S.
Cheers

[VikingQuest]

Medicare sets the rates that they pay for the senior's care.

The rates are low which is why many hospitals/doctors have limited the number of Medicare patients they can see. Basically, if a treatment costs $100 but the reimbursment rates are $75 for Medicare . . . the doctor makes up the other $25 on your end.

If you are seriously this far behind in the HC discussion, you should spend some time reading unbiased information.

"For years Medicare pays 14 percent less than what it actually costs for hospitals to provide the care to patients. Medicaid payments are even lower and many times are late in coming,"

http://www.medicalnewstoday.com/articles/152553.php

[KrugnacTheMagnificent]

The "cost of providing care" include all the profits to the for-profit hospital, the doctor's overinflated salaries, the Rx company profits, the trail lawyers' profits, etc.

More medicare is NOT a solution, because it simply does not address any of the concerns driving the huge levels of medical inflation we see every year.

[hollyhund]

Basic Medicare is administered by the government. Then there is Medicare Advantage that are administered by private insurers HMOs (since around 1975) and their lies the rub! This is what Obama wants to cut because they give the subscribers a few trinkets like excercise classes,hearing aids and then pockets the rest of the subsidy from the government!! I say stop MA and have the Basic plan offer these perks!

[Rogan]

I don't know why no one else wanted to answer your question clearly, but this how it works: you can use any doctor or hospital participating in Medicare, which, I think (I'm not that old yet & don't use it), is pretty much almost anywhere. They send the bills to Medicare, and Medicare re-imburses doctors and hospitals at certain set rates. Essentially, Medicare operates not un-like the insurance companies.­.. but there are complex reasons why everyone, doctors and patients, enjoys Medicare and likes dealing with Medicare, that someone else could explain better than me, if you get any other commenters, who aren't going to insist on promoting a personal opinion, over imparting a few basic facts...

[Samalabear]

Well, as I recall Obama's former doctor put, doctors like it because they don't have to fight and do endless paperwork and other such garbage. Dr. Scheiner apparently has 80% Medicare and the only time he has to spend a lot of time on insurance issues is with the private insurers. Anyway, that's not my personal opinion, but what I heard in the interview between Bill Maher and Dr. Scheiner some weeks ago. I'm sure you could find out more reasons on the PNHP website.

[Ben6768]

Thank you so much to everyone for the info !

[Ben6768]

From what I see then, maybe the U.S. can consider, as a very strong public option, for the government to give money to each individual state, and then each state owns hospitals, pays doctors and nurses, etc. All middlemen are cut out. This is how it works in many European countries, and is by far the most cost-efficient way.
You would be treated then by a doctor with " State of Vermont Health Service" embroidered on his white gown.
Believe me, it works GREAT - me and my mother are well treated and very happy with this arrangement, in the country whare w live
Cheers

[GardenerNorCal]

Reagan closed our state and county hospitals.

[textynn]

The real question is can the Elite and the working people of this country agree on health care. The answer is obviously irrelevant. We know what the people want and it's not on the table. DEMOCRACY.­..NOT.

SINGLE PAYER NOW: IT'S THE ONLY PLAN WORTH FIGHTING FOR.

BAUCUS BILL IS A BJ TO THE HEALTH CARE INDUSTRY. THEY WROTE IT FOR GOD'S SAKE.

[VikingQuest]

There aren't enough votes for a watered down public option, yet people without any common sense still say single payer.

[yakmeat]

I guess the rest of the industrialized world doesn't have any common sense either. Especially since they are all paying half (or less) of what we are and getting better outcomes.

[weatherwaxx]

Progressives and GENUINE conservatives? Yes. But there aren't more than a handful of real conservatives in Congress. Those corporate puppets who call themselves Republicans and Blue Dogs only represent their biggest campaign donors, not the people in their states.

[VikingQuest]

"just open up the perfectly good public option we have - Medicare - to anyone who wants to buy into it"

That sounds so simple but what is currently the state of Medicare?

Everyone, including the President admits that Medicare is unsustainable and is out of money . . .

In May the Medicare trustees reported that the program has an "unfunded liability" of nearly $38 trillion -- which is the amount of benefits promised but not covered by taxes over the next 75 years.

This doesn't sound like an option that makes any sense . . . unless of course they fix Medicare first.

[Heartlight3]

If the people who want to use the Medicare for all option pay some sort of premium (maybe on a sliding scale) it could stretch out the viability of the program.

[VikingQuest]

How do you fix the financial viability of something by undercharging the program?

$38 Trillion with a T is the number.

Social Security is on the same path.

[E4B32787]

The thing that would fix a lot of problems is cures, as opposed to expensive maintenance regimes. The trouble here is that I don't think the current system has incentives for cures. It's the expensive maintenance regimes that drive corporate profits. That's why in this area, as well as others, I am so opposed to policy being driven by economic ideology versus a data driven approach.

We need a breakthrough on some of these: Alzheimer's, cancer, heart disease, and diabetes. That'll fix the costs.

Sorry, got to run now, and take my pill for "restless leg syndrome". ;-)

[VikingQuest]

"We need a breakthrough on some of these: Alzheimer's, cancer, heart disease, and diabetes. That'll fix the costs."

Great, do you have one?

You implying that the reason we don't have cures for these things is that people would rather make a buck from treatment is the most insane thing I have heard since Obama said doctors are cutting people's feet off to make a buck.

You want to know the ultimate profit and notability for one of these companies . . . a cure for cancer.

[baseline]

Also the added premiums paid by younger more healthy people will allow Medicare to get on a more financial footing.

[socalgal38]

Since the government is going to give the insurance companies money to help those that do not earn enough to get health care than why not give it instead to medicare. Why feed the very industry we are trying to get rid of anyway?