Well it's passed the five committees, congrats Democrats 
But now the real work begins. Much is still up in the air as to what the final bill will entail.
Firstly the House has yet to merge its three Bills into one. Now this wouldn't have being a problem if the Blue Dogs hadn't attempted a last minute surge in the last committee and turned a remarkably similar bill into a compromise. Now Pelosi and the other Democratic leaders have to agree on several competing questions.
Public Option: this is big, in fact Health Reform hinges on it. Why? Because the Congress has decided to throw money at health insurers to maximise coverage, so there needs to be at lease some cost control element to it. Otherwise the bill just doesn't work. Obama could pass a bill without the Public Option but it would be a massive defeat and everyone knows it. Now the House is debating two possible public options.
1) The Robust Public Option: The key to RPO are the rates are linked to Medicare +5%. Also called Medicare Plus 5, it is the most liberal PO still on the table. The Progressive caucus have threatened to vote against the bill if the public option isn't Robust and Pelosi likes it too. But make no mistake, this isn't a Progressive's wet dream (that's single payer), and Robust PO has broad support and even some Blue Dogs actively support it. Why? Because it works best, it's cheaper brings down rates faster and is easier to understand. But in rural states it would not be great because of how Medicare rates are calculated (as someone with no experience of Medicare I don't know the details) so the more conservatives Dems are looking for a compromise
2) The Weak Public Option: The idea is the public option stands alone and has to negotiate rates on its own in the open market. By its very name you can see what it's about, it's weaker so it's less competitive so insurance companies can keep rates higher and make more profit. But it does add some degree of competition.
The Blue Dogs were at first very vocal against the Public Option because a large amount of campaign cash flows from the Healthcare Industry to their re-election campaigns. As a consequence we saw them propose a co-op solution to cost containment to Pelosi to consider. But that issue is practically dead. Why? Because CBO came out and said basically "Co-ops don't work" and even worse "RPO is fiscally better than WPO". For the supposedly "fiscally responsible" blue dogs to ask their constituent to pay more taxes when they didn't need to was a tall order. Indeed they are breaking ranks.
The Maths: If we assume no Republican will support the bill and the Blue dogs say no Pelosi is 14 votes short. At least two Blue Dogs said yes to RPO so we'll see.
The other key problem in the House is how to pay for it. Progressives favour a surtax on the very wealthy, for obvious reasons. But there are two other options.
1) A soda tax: and other "sin" taxes would certainly help income revenue but it's hard to calculate how much tax it could raise and is a tax which hit the middle and working class more. But if it encourages people to act more healthy it could help reduce health problems anyway (debatable). It would also be go against Obama's promise for no taxes on the Middle/ Working class.
2) A tax on Healthcare Benefits: is the Republican idea of paying for healthcare (though they'd never vote for it) and would make the bill very bipartisan in my view (and hopefully the American People) even if not a single Republican voted for it. Economically speaking it's a great idea. It would generate a lot of funds and would reduce massive inefficiency in the system. But many workers gave up pay increases for better health insurance and the house progressives have said NO! so basically that's not going to happen in the House- but Pelosi has threatened it. Labour would also baulk at the proposal and could lead to a split party and a nasty Mid-Term.
And even if they solve the "how do I pay for it" and "what's the public option" questions, there are other issues that need to be resolved. For example the Republicans voted for Kucinich's Amendment which gives states the right to create a single payer system if the states vote for it. One of the more progressive states in America (Vermont) tried this only to be told it's illegal. In other words it would allow America to do what Canada did in her quest for Single Payer. The Republicans hoped it would kill it bill but we'll see if Pelosi keeps it.
I want to turn to the Senate now and explain what's happening there. The Newly released Finance Bill will be merged with HELP Bill and the final details will be hammered out with Baucus, Reid and Dodd with several other big players like Schumer and Snowe in there. Should be messy and probably behind closed doors.
In the senate RPO is called the Rockefeller Amendment which was handily defeated in the Finance Committee. It doesn't have 60 votes but it probably has about 47-53 votes depending. Now WPO is basically in the HELP bill and written by Dodd and has the backing of Schumer. By all rights WPO should be in the finance bill too but isn't. The Conservative Democrats beholden to the Health Insurance Industry have felt massive pressure. The clearest example is Kent Conrad: who says he opposes the Public Option linked to Medicare because his state is rural (fair enough, though the issue could be addressed
) but when we turn to WPO his argument becomes much squishier and more annoying.
"Weak Public Option is like the British system because it's government run, we need a private sector solution like the French (paraphrased)."
And I'm not making that up.
Conrad is the Author of the Co-ops, which CBO says won't work, and he's pushing hard for them and won't compromise. There are two other compromises on the table; one which appears to have the support of the white house but is a massive cop-out and one which has split the progressives:
1) After Olympia Snowe's stellar performance today at Committee the Snowe Trigger has seen new light. Problem is it's designed to never kick in. In effect what it says is if the private sector fails to make it affordable, on a state by state basis the public option can come into effect. But if the Federal Government keep giving subsidiaries to the populace the PO would never come into effect. But if Snowe votes for it the bill would become "Bipartisan" And Obama really wants that whiff of Bipartisanship a lot. The games afoot.
2) The Opt-out: this has split the progressives but if it is the WPO-Opt-out it would possibly make it two weak to function effectively. However RPO-Opt-out? Now that's an interesting idea which is well worth looking at. Proposed by Schumer it would say "every state has access to the Public Option, but if the legislatures wish it they can opt-out. It combines States Rights and a strong argument that PO is not a "government takeover".
The question over what's more important to the Dems has not being addressed: a good bill or a bipartisan bill?
The Senate's also having the same argument as the House about how to pay for it and again the issue is the best political option: surtax on the wealthy Vs. the best economical option: taxing healthcare benefits. Also on the table though are things like at what bracket do people get what help paying insurance. Then there's the Individual Mandate and how high the penalties are and the Employer Mandate and who are exempt.
But there are a few other problems. For a starters who gets the option to go on the exchange and who gets to have the option to go on the Public Option. Only the Wyden Amendment would allow everyone to go on the Public Option and break the Employer based Healthcare which makes business in America uncompetitive. If the PO is too narrow in who can go on it expect massive disappointment from the left.
The current hope is to get 60 votes for closure but the Conservative Democrats are playing Hardball. Nelson (NE), Landreui, Lincoln and Conrad in particular could throw a spanner in the works. The hope is they'll vote for closure on a WPO which the House would compromise down to. But Snowe's Trigger is a big problem.
But now the real work begins. Much is still up in the air as to what the final bill will entail.Firstly the House has yet to merge its three Bills into one. Now this wouldn't have being a problem if the Blue Dogs hadn't attempted a last minute surge in the last committee and turned a remarkably similar bill into a compromise. Now Pelosi and the other Democratic leaders have to agree on several competing questions.
Public Option: this is big, in fact Health Reform hinges on it. Why? Because the Congress has decided to throw money at health insurers to maximise coverage, so there needs to be at lease some cost control element to it. Otherwise the bill just doesn't work. Obama could pass a bill without the Public Option but it would be a massive defeat and everyone knows it. Now the House is debating two possible public options.
1) The Robust Public Option: The key to RPO are the rates are linked to Medicare +5%. Also called Medicare Plus 5, it is the most liberal PO still on the table. The Progressive caucus have threatened to vote against the bill if the public option isn't Robust and Pelosi likes it too. But make no mistake, this isn't a Progressive's wet dream (that's single payer), and Robust PO has broad support and even some Blue Dogs actively support it. Why? Because it works best, it's cheaper brings down rates faster and is easier to understand. But in rural states it would not be great because of how Medicare rates are calculated (as someone with no experience of Medicare I don't know the details) so the more conservatives Dems are looking for a compromise
2) The Weak Public Option: The idea is the public option stands alone and has to negotiate rates on its own in the open market. By its very name you can see what it's about, it's weaker so it's less competitive so insurance companies can keep rates higher and make more profit. But it does add some degree of competition.
The Blue Dogs were at first very vocal against the Public Option because a large amount of campaign cash flows from the Healthcare Industry to their re-election campaigns. As a consequence we saw them propose a co-op solution to cost containment to Pelosi to consider. But that issue is practically dead. Why? Because CBO came out and said basically "Co-ops don't work" and even worse "RPO is fiscally better than WPO". For the supposedly "fiscally responsible" blue dogs to ask their constituent to pay more taxes when they didn't need to was a tall order. Indeed they are breaking ranks.
The Maths: If we assume no Republican will support the bill and the Blue dogs say no Pelosi is 14 votes short. At least two Blue Dogs said yes to RPO so we'll see.
The other key problem in the House is how to pay for it. Progressives favour a surtax on the very wealthy, for obvious reasons. But there are two other options.
1) A soda tax: and other "sin" taxes would certainly help income revenue but it's hard to calculate how much tax it could raise and is a tax which hit the middle and working class more. But if it encourages people to act more healthy it could help reduce health problems anyway (debatable). It would also be go against Obama's promise for no taxes on the Middle/ Working class.
2) A tax on Healthcare Benefits: is the Republican idea of paying for healthcare (though they'd never vote for it) and would make the bill very bipartisan in my view (and hopefully the American People) even if not a single Republican voted for it. Economically speaking it's a great idea. It would generate a lot of funds and would reduce massive inefficiency in the system. But many workers gave up pay increases for better health insurance and the house progressives have said NO! so basically that's not going to happen in the House- but Pelosi has threatened it. Labour would also baulk at the proposal and could lead to a split party and a nasty Mid-Term.
And even if they solve the "how do I pay for it" and "what's the public option" questions, there are other issues that need to be resolved. For example the Republicans voted for Kucinich's Amendment which gives states the right to create a single payer system if the states vote for it. One of the more progressive states in America (Vermont) tried this only to be told it's illegal. In other words it would allow America to do what Canada did in her quest for Single Payer. The Republicans hoped it would kill it bill but we'll see if Pelosi keeps it.
I want to turn to the Senate now and explain what's happening there. The Newly released Finance Bill will be merged with HELP Bill and the final details will be hammered out with Baucus, Reid and Dodd with several other big players like Schumer and Snowe in there. Should be messy and probably behind closed doors.
In the senate RPO is called the Rockefeller Amendment which was handily defeated in the Finance Committee. It doesn't have 60 votes but it probably has about 47-53 votes depending. Now WPO is basically in the HELP bill and written by Dodd and has the backing of Schumer. By all rights WPO should be in the finance bill too but isn't. The Conservative Democrats beholden to the Health Insurance Industry have felt massive pressure. The clearest example is Kent Conrad: who says he opposes the Public Option linked to Medicare because his state is rural (fair enough, though the issue could be addressed
) but when we turn to WPO his argument becomes much squishier and more annoying."Weak Public Option is like the British system because it's government run, we need a private sector solution like the French (paraphrased)."
And I'm not making that up.
Conrad is the Author of the Co-ops, which CBO says won't work, and he's pushing hard for them and won't compromise. There are two other compromises on the table; one which appears to have the support of the white house but is a massive cop-out and one which has split the progressives:
1) After Olympia Snowe's stellar performance today at Committee the Snowe Trigger has seen new light. Problem is it's designed to never kick in. In effect what it says is if the private sector fails to make it affordable, on a state by state basis the public option can come into effect. But if the Federal Government keep giving subsidiaries to the populace the PO would never come into effect. But if Snowe votes for it the bill would become "Bipartisan"
And Obama really wants that whiff of Bipartisanship a lot. The games afoot.2) The Opt-out: this has split the progressives but if it is the WPO-Opt-out it would possibly make it two weak to function effectively. However RPO-Opt-out? Now that's an interesting idea which is well worth looking at. Proposed by Schumer it would say "every state has access to the Public Option, but if the legislatures wish it they can opt-out. It combines States Rights and a strong argument that PO is not a "government takeover".
The question over what's more important to the Dems has not being addressed: a good bill or a bipartisan bill?
The Senate's also having the same argument as the House about how to pay for it and again the issue is the best political option: surtax on the wealthy Vs. the best economical option: taxing healthcare benefits. Also on the table though are things like at what bracket do people get what help paying insurance. Then there's the Individual Mandate and how high the penalties are and the Employer Mandate and who are exempt.
But there are a few other problems. For a starters who gets the option to go on the exchange and who gets to have the option to go on the Public Option. Only the Wyden Amendment would allow everyone to go on the Public Option and break the Employer based Healthcare which makes business in America uncompetitive. If the PO is too narrow in who can go on it expect massive disappointment from the left.
The current hope is to get 60 votes for closure but the Conservative Democrats are playing Hardball. Nelson (NE), Landreui, Lincoln and Conrad in particular could throw a spanner in the works. The hope is they'll vote for closure on a WPO which the House would compromise down to. But Snowe's Trigger is a big problem.
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