An Open Letter to Harry Reid on Controlling Health Care Costs
Dear Senator Reid,
I know you're in a tough spot. It would be bad enough if you only had to get Ben Nelson, Evan Bayh, Mary Landrieu, and Blanche Lincoln on board, but anyone who has to kiss Joe Lieberman's derriere deserves a congressional medal of honor.
But Harry, you really need to take on future health-care costs. The House bill fails to do this. The public option in the House bill is open only to people without employer-provided health insurance. That will be too small a number to have bargaining clout to get good deals from drug companies and medical providers. And it will mainly attract people who have more expensive medical needs, which is why the Congressional Budget Office decided it would cost more than it would save.
You also know a public insurance option that's open to everyone would cut future health costs dramatically by imposing real competition on private for-profit insurance plans. That's why the private insurers hate the idea. Even if states were allowed to opt out of this robust public option, the big states would almost certainly opt in, giving it the scale needed to negotiate great deals from drug companies and medical providers. This would put pressure on any state that opted out because their citizens would soon discover they're paying far more.
In addition to the House's weak public option, the deals the White House and Max Baucus made with the drug companies and the AMA will force Americans to pay even more. If, on the other hand, Medicare were allowed to negotiate lower drug prices, biotech drugs weren't granted a twelve-years monopoly, and doctors had to accept Medicare reimbursements in line with legislation enacted years ago, Americans would save billions.
You know all this but you're also trying to get 60 votes in order get any bill to the floor. You have my sympathies, but unless you get these reforms into the final Senate bill you're not really helping most Americans afford future health care.
So what do you do?
First, try for the "reconciliation" process, which requires only 51 votes. Every one of the reforms I mention above would fit under the Byrd rule.
If that doesn't work, wrap these reforms together -- a public option open to everyone (allow states to opt out of this if they dare), Medicare-negotiated drug benefits, no 12-year monopoly for new drugs, and a major squeeze on Medicare reimbursements for doctors -- and have CBO score the savings. I guarantee you, the number will be large. Then you should dare anyone, Democrat or Republican, to vote against saving Americans so much money in years ahead. How is Ben Nelson going to face voters in Nebraska who would have to pay, say, 20 percent more for health care in the future if Nelson refuses to go along?
If neither of these tactics work, then take whatever bill you must to the Senate floor. But then introduce this reform package as the very first amendment to the bill. Call it the "Ted Kennedy Amendment for Helping Middle Class Families Afford Health Care," and whip the hell out of the Democrats. Get the President to help you. Surely Joe Biden will. If you can't get 51 votes out of Dems for this, publish the list of Dems who vote against it, strip them of their committee chairs or sub-chairs, and make sure the Democratic Senate Campaign Committee gives them zilch when they're up for re-election.
Nobody promised you this would be easy, Harry. But, hell, why are you there, anyway? Your responsibility isn't just to pass whatever will muster 60 votes and that the President and Dems can later call "health care reform." It's to do the right thing by the American people and bring down future health-care costs. Don't cave in to Lieberman or Nelson or the drug companies or the private insurers or the AMA or anyone else. Lead the charge.
All best.
Cross-posted from Robert Reich's Blog
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"You also know a public insurance option that's open to everyone would cut future health costs dramatically by imposing real competition on private for-profit insurance plans."
Mr. Reich thinks that even more government intervention is the way lower costs. That is not real competition. Real competition is when companies are allowed to provide goods and services with minimal or no government interference. Bad companies will be driven out and those left standing will adjust as needed to consumer demands. More government regulation means less freedom in the market. But government "competition" will eliminate otherwise good companies. With TARP (and other similar bailouts) government has been known to prop up otherwise bad companies.
What Mr. Reich, the Democrats and Republicans are doing now is legitimizing employer-based health care as the de facto standard for Americans. That has to change with individuals being in charge of purchasing their own health care. As long as employer-based healthcare remains the status quo there will never be any true reform nor will health care costs go down dramatically.
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You have to be kidding? Let the private marketplace correct itself??? First, the private market has been given decades to do this and has failed miserably. Premiums keep going up and up? Second, the private market is in business to make lots of money ---off of you and me. So here is what I suggest to you: stay with private insurers without a public option; I'll go for a competitive marketplace with a public option. In ten years, we'll see who has been "screwed" more. A deal?
This is such a reasoned, rational approach that it baffles me that the American people are not clamoring for their representatives & Senators to take it to heart.
Thank you, Mr. Reich! Keep voicing your opinion & I'm going to send this link to my Senators right now.
EXACTLY right, Mr. Reich. Thank you for breaking it down for us.
You really need to be the replacement for Tim Geithner or Larry Summers. Ah, but then there would be someone in Obama's cabinet that looks out for normal American citizens and not fat cat bankers and the super rich and we can't have that, can we.
Thank you Mr. Reich. This is the best written piece on health care that I've read. It says it all.
Now Senator Reid it is up to you to do it. I know it won't be easy but you CAN do it for all of us middle class Americans that cannot afford health care now. Soon many more will be added to the rolls.
Senator Reid, If you accomplish REAL health care reform, you will go down in history as the person that provided and saved health care for America and thereby really saving America in the long term imo.
Please be strong for us. We need you so much. Also, I believe your poll numbers will soar when you step out in the spotlight with a STRONG plan for health care.
I wish everyone were reading and posting comments about this important and intelligent article.
Thanks Robert !
Hopefully Harry Reid and several Senators will read it.
Yes, yes, yes. The voice of reason, Mr. Reich. Is anyone in the Congress or White House listening??
And while we are at a plan which actually works, how about this super simple zinger: US Government insurance plans (Medicare, Medicaid, etc), pay the exact rates for pharmaceuticals as WalMart. Period. Will save tens of billions a year!!
Amazing nobody is proposing this. Simple and fair.
Don't hold your breath waiting for the politicians in Washington to go to bat for you against the greedy drug companies. You stand a better chance of dealing with high drug prices by improving your eating habits, not smoking, getting some exercise every day and minimizing your need to buy prescription drugs to begin with. If you are young and healthy, give some thought to moving to another country that offers a better health care system and lower drug prices. It's a lot harder, if not impossible, to change countries when you are sixty, out of work and in poor health.
very nice, Mr. Reich. The Greedy Old Party wants to pretend that the exclusiviity of the patent system and "competition among the oligarchs" will bring dowm costs in our for maximum profit system. Our too too timid Democrats are afraid--despite double digit increases in drugs and insurance premiums in a year with "zero"inflation-- to say what is: that the private sector provision of health care doesn't work for more and more Americans and their families. Instead, the Democrats work a $300 billion "docfix", look for ways to pay hospitals more, and allow the gouging of all by insurance comapnies and big PhRMA. True, the timidcrats try to legislate away their unwillingness to curb costs by a willingness to incrrease subsidies for the least wealthy, including those with family incomes 30 percent above the median household income. But the subsidies still end up with the greedy, and care won't improve or costs fall. Soon fifty percent of Americans will be paying less in taxes than they receive in benefits from the government, while a scant one percent of Americans and their corporate lobbyists drive a historically unprececedented consolidation of wealth into their hands from bank bailouts, housing bailouts, energy concessions, and now health care incentives for the greediest among us. Will Reid step up for a noble failure? I doubt it.
"If you can't get 51 votes out of Dems for this, publish the list of Dems who vote against it, strip them of their committee chairs or sub-chairs, and make sure the Democratic Senate Campaign Committee gives them zilch when they're up for re-electio
Declare war on the Moderates Mr Reid ... DARE the voters who are moderate in California not to RETALIATE and do every thing they can to vote Boxer out of office to punish the progressives who you followed.
DARE the Democrat middle not to create a repeat of the LAST time the Liberal wing of the party declared war on the middle.
A broken down cowboy becoming president and the Republicans winning TWELVE of 17 Democratic seats to gain the Senate for the first time in a generation ... a Majority of 52-48 ... intriguing how that result would mirror the same numbers in 2010.
DARE the moderate Demcratic voter and send them a message "VOTE HOW YOU ARE TOLD BEYATCHES OR GET THE HELL OUT OF OUR PARTY!!!!"
And of course ... the moderate middle WILL get the hell out of the party.
And we will have a repeat of the 1980s.
I have a couple questions for this post. Firat, what is the 12 year monopoly? Is it the patent protection on new drugs? If so, this will have bigger implications. It costs about $1B to complete full clinical trials. Do you think pharms will take the risk if this is gone? This will create problems world-wide.
What Republican issues would you include? You want bipartisanship, you need to include at least one. That is my biggest issue with Democrats. It's either their way or nothing at all. Liberals would rather whip their delegates to get what they want. Funny how Cao is a hero for standing up to GOP, even though he was looking out for his contingency. That's what Blue Dog Democrats are doing. But their contingencies must be too stupid to realize a good thing, huh?
I hate people that don't know the true meaning of reconciliation and use it for their own puposes. The true definition is to submit legislation changing existing law in order to bring spending, revenues, or the debt-limit into conformity with the budget resolution. (Look it up in Wiki). Please explain how reconciliation will accomplish this? The Senate is still awaiting the CBO to complete is "scoring" on their bill.
"That is my biggest issue with Democrats. It's either their way or nothing at all. "
That's truly fascinating, because--in the real world--it's exclusively the Republicans in Congress who, for almost the entire the past decade, have been unwilling to the last man to work across party lines. (And even Olympia Snowe--their last moderate woman--hasn't been all that co-operati
"I hate people that don't know the true meaning of reconciliation and use it for their own puposes."
Were that true, then you'd hate the Republicans, for whom reconcilliation was a favored and often-used legislative tactic when they were last in the majority in the Senate--in the real world.
Well Done!
Reconciliation is not a declaration of war on the Repubilicans.
It is a declaration of war on the moderates in the Democratic Party.
It is stating "We do not care about your concerns, we do not care about your vote. Thanks for putting us in the majority now get lost."
Of course from what I understand, the authors advice will not be followed.
Because before the first chairmanship is pulled, there will be a motion for a no-confidence vote.
Harry Reid will no longer be Sen Pro-Temp, because the Blue Dogs will nominate Evan Bayh in his place and with the Republican backing ... he will win.
And THEN the war inside the party will turn into a full-fledged bloodbath as the PROGRESSIVES find THEMSELVES stripped of all their leadership positions
The DINOs represent a tiny sliver of the electortae; their states are small and the majority of Americans support a robust public option. So don't b.s. us with talk of a being obstinate.
The bills, both House and Senate, are stuffed with Republican (and Blue Dog DINOs) issues. Where have you been for the last 3 months?
The Republicans put their ideas in, the Dems accept them and then the Repubs and DINOs STILL vote NO. Makes perfect sense to me to strip their ideas from a bill they voted against.
Why should they get what they want but not have to go on record with a Yes vote to push it through? So they can say they voted against reform; that is the ONLY reason. They don't lose the anti-reform votes of Medicare seniors, and the low info voters that believe the poor and middle class are actually represented by Republican family values platforms. Pharma and big business continue to line their pockets. They have it both ways: they get what they want and can still vote no.
It is the Republican party that refuses to work toward bipartisanship, and it has been that way since Reagan.
Thankyou for another insightful posting, Professor Reich-
I would add one tactical suggestion- every time a republican claims to worry about what health care will add to the deficit, progressive legislators should BEGIN their response by referring to the three trillion dollar war to find Saddam Hussein's WMD, all financed with borrowed money, and only then refer to nonpartisan CBO scoring of health reform. Repetition is the only way to convince many voters, including many crucial swing voters (many still tell pollsters that Saddam Hussein contributed to 911).
It aint pretty but its the only reality we have.
I don't understand that if reconciliation is a possibility and only 51 votes are necessary, why isn't this being pursued? What is the Byrd amendment. Why go for 60 votes if only 51 are necessary?
“ We the Corporations of the United States, in Order to form a more perfect marketplace, establish Profits, insure workforce instability, provide for the common defence of corporate handouts, promote the general Welfare of the Wealthy, and secure the Blessings of Greed to ourselves and our subsidiaries, do ordain and establish this Constitution for the United States of Corporations.
In Greed we Trust
Those who insist that the socalled "free market" is the best solution to everything are ineffect arguring just that: "Trust Greed."
Sad but true. Washington was A$$ deep in snow fighting to make the USA thing happen.I wonder if he is tossing in his grave seeing the results of lobbyist licking flounder's of congressmen we have today.
If only Bob & Howard Dean with pair up, declare their intent to run as third party presidental candidates in 2012 if this congress with it's majority, & this president with a majority (yes, I know the senate is not a veto proof majority but the Repubes ruled effectively with only 51) can even get real reform on the floor for debate.
There's a ticket that would be fearless & know what they're about.
Dean and Reich: Absolutely a great ticket, but as a third party? The last time a third party (of sorts) won a national election was in 1860. So, why not have them (for starters, at least) as an insurgent ticket within the Democratic Party, starting in the 2012 Iowa caucuses and New Hampshire primary?
What debt of gratitude will the Democratic rank and file--and Americans, in general--owe President Obama if he persists in not restoring habeas corpus (which Attorney General Holder has started to do, but only on a case-by-case basis), and persists in fighting for (and not even getting) bipartisanship, for which we have no need, instead of fighting for (and actually obtaining) a strong public option, which we desperately need?
Mr. Obama's first name isn't "President" and we need to keep reminding him of that. If he doesn't move a tad to the left and become way more aggressive, why not a Dean and Reich ticket? They could beat Romney, Huckabee, or whoever in enough states to win an Electoral College majority--and that would do our country a world of good. (Strength on the bench is a good thing to have.)
I'm recommending a third party for a couple of reasons.
1) The Dem party will be too tarnished by 2012 if a real reform bill isn't passed;
2) Dean was shunned by the party after the 2008 election despite his pulling off one of the greatest upsets of modern time. There is no love lost between him & Rhamno, and many member of the "DLC" who appear to be back in control of the DNC inflicting gutless "moderate" (sell out) arguments & policies despite a real "change" election;
3) It was first time voters & independents that carried the 2008 election. As the 2009 election showed, they did not come out to support the dem candidates;
4) The Dem party needs a purging. This would be a good time. Our 2 party system has been broken for too long;
5) Should a third party garner enough support to rob the Dem's but not enough to win, the Dems will build a truce of some sort, otherwise, they know they'll go the way of the Rethugs becoming a regional party;
Bush and the Republicans attempted to cut Medicare by 5 billion a number of years ago. The Democrats cried foul and accused the Republicans of denying seniors needed health care.
The Democrats are going to pay for their Universal health care program by denying seniors a minimum of 500 billion dollars in care.
Senior citizens vote in mass in off year elections. ( like they got something better to do ).. Social Security and Medicare are called the 3rd rail for a reason. Touch it and you die.
"Senior citizens vote in mass in off year elections. ( like they got something better to do )"
Well, after 8 years of Repube greed, incompetence, budget busting borrowed war $$$$ a crash of the economy wiping out their nest eggs, many seniors I know have had to go back to work.
In all fairness, many seniors have plenty to do and lead more productive lives than many of their kids and grand kids!.
My Mom has been a "Senior" for over 20 and she leads a very busy and active life - though you are right about one thing: she and all of her friends ALWAYS find to vote.
That said, it will depend on which side can make the most noise that makes the most sense. In my Mom's retirement community (populated largely by retired Republicans) the residents overwhelming support health care reform (and public option or single payer.) They are smart enough to know that Seniors will be protected (for the obvious reason stated by Peter007) - but they also have children and grandchildren whose health care is important to them too.
Cut the %00 billion first and we'll talk. Same on immigration reform. Secure the borders THEN talk us about reform.
Let's start with prosecuting businesses who employ illegals first ...they are the ones who underpay, exploit, and undercut these people. If corporations are "persons" then perhaps it is time they actually take the consequences of "persons" and We The People force this corrupt, store-bought juicial system to send corporate CEOs go to jail.
Cat In Seattle
Part 2
Under Mississippi law there is no fiduciary relationship or duty between the insurance company and the policyholder (pertaining to property insurance), only a contractual relationship exists:
Gorman v. Southeastern Fidelity Insurance Co., 621 F. Supp. 33, aff. 775 F. 2d 655.
The relationship of confidence and trust which exists between the insurance company and the policyholder is not a fiduciary one, and the insurance company has the right to protect its own interest along with that of the policyholder:
State Farm Mut. Auto Insurance Co., v. Floyd, 366 S.E. 2d 93, 235 Va. 136 Va, 1988.
The policyholder sued an independent adjuster for a breach of fiduciary duty. The court held that the adjuster had a fiduciary duty to the insurance company-not to the policyholder.
Thompson v. Cannon 224 CA Ap3 1413 274 Car 608, 1990. .
Under California law, no fiduciary duty exists between the insurance company and the policyholder even though the relationship requires duty of good faith and fair dealing. The insurance company is required to exhibit characteristics of humanity and decency which are similar to what is required of fiduciary, but the insurance company is not a fiduciary required to put the policyholder's interests before its own:
Hassard, Bonnington, Roger & Huber v. Home Insurance Co., 740 F. Supp. 789.
Part 1:
The Dems are talking about so cutting off these so called Medicare + programs, which charge seniors additional money to put them into HMO, adding an unnecessary layer of bean counters between the patient & doctor.
Seniors (and disabled) who clung to their standard Medicare, refusing to be bullied by Bush Co, have higher satisfaction with Medicare as they don't need a referral to see a specialist, do not get turned down for drug therapy that there isn't a generic for, don't have to wait for approval for a procedure, from some for profit Medicare + or Advantage Plus plan that adds NOTHING but a profit motive, a transfer of funds from the doctor for the patient going to these fortune 500 companies:
1. UnitedHealth Group - 25
2. WellPoint - 33
3. Aetna - 85
4. Humana - 98
5. Cigna - 141
6. Health Net - 179
7. Coventry Health Care - 266
Their fiduciary duty is to their shareholders, not the policy holders:
The policyholder had claimed a breach of fiduciary duty by the insurance company. The court found that the relationship between the insurance company and the policyholder is not fiduciary in nature:
Crossley v. Allstate Insurance Co., 400 N.W. 2d 625 Mich., 1986.
Under Mississippi law there is no fiduciary relationship or duty between the insurance company and the policyholder (pertaining to property insurance), only a contractual relationship exists:
Gorman v. Southeastern Fidelity Insurance Co., 621 F. Supp. 33, aff. 775 F. 2d
Part 3
A Fiduciary relationship does not exist between the insurance company & policyholder:
Overbey v. Illinois Farmers Insurance Co., 121 Ill. Dec. 769, 525 N.E. 2d 1076, 170 Ill. App. 3d 594, Ill App. 2 Dist., 1988.
The court found that there is no fiduciary relationship between the insurance company & the policyholder in regard to representing new coverages available under the automobile policy:
Robacki v. Allstate Insurance Co., 468 N.E. 2d 1251 Ill. App. 1 Dist., 1984.
The insurance agent owes a fiduciary duty to the insurance company, & acts not for the policyholder, but for the insurance company:
Weinisch v. Sawyer & Allstate Insurance Co., 587 A. 2d 615 NJ, 1991.
There is no fiduciary relationship existing between a policyholder and insurance company or insurance agent:
Life Insurance Co. of Virginia v. Conley, 351 S.E. 2d 498, 181 G.A. App. 152, certiorari denied.
That policyholder relied upon the insurance agent & had great confidence in that agent was insufficient to imply existence of a duty to advise. The agent & insurance company did not contract to assume duties of advisor or consultant, did not hold themselves out as specialists or highly skilled insurance experts, did not receive additional compensation for consultation or advise, were not in a special relationship with the policyholder, therefore had no duty to advise the policyholder of availability or advisability of insurance coverage:
Nelson v. Davidson 456 N.W. 2d 343 155 Wis. 2d 674 Wis., 1990.
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