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Obama about to go nuclear on their behinds?


By Misty - Posted on 19 August 2009

Now remember kids, I'm a Democrat and I know how to talk good. It's "new-clear" not "nook-ya-lur," got it?

The video that has everyone rejoicing . . . See Video

The "nuclear option" over healthcare would be a very bad precedent for the Democrats in the Senate to set.

It would backfire on the White House and Congress politically and be very detrimental to Obama's long term effectiveness at governing.

If we can pass health care reform we should pass the BEST reform we can design. If it works it will survive on its own because the people will guard it like Social Security. If it's a piece of Republican infected crap, people won't see the point of it and it will blow away and be forgot.

"If it's a piece of Republican infected crap, people won't see the point of it and it will blow away and be forgot."

Not entirely accurate.    The Medicare Advantage program was a Republican innovation and is wildly popular with Seniors.   Yes, it's a little more expensive, but it delivers a much more comprehensive package than bare-bones Medicare.

Of course, the Left hates it, calling it a "giveaway" to insurance companies, etc., etc., and would abolish the option if they could get away with it.

IMO, the best reform would include a combo of public/private options such as the MA program that would offer the most bang for the buck.

A nationwide MA program would also break the pernicious link between employment and health coverage, be completely "portable" from one location to another in the country and most importantly would belong to each individual, not an employer.

Yes, these are Republican ideas, but not necessarily bad ones.

Some of the greatest achievements in our nation have come through public/private collaboration---the Trans-Continental rail system, the Interstate Highway System, the Rural Electrification project and the Space Program for example.

Maybe its time to stop demonizing the insurance industry and find ways for public/private cooperation to build a truly national health system.

http://www.seattlepi.com/opinion/367835_solarofocus22.html

IMO, the best reform would include a combo of public/private options such as the MA program that would offer the most bang for the buck.

A nationwide MA program would also break the pernicious link between employment and health coverage, be completely "portable" from one location to another in the country and most importantly would belong to each individual, not an employer.

Yes, these are Republican ideas, but not necessarily bad ones.

I agree with you Night!  Never thought the day would come.  

I've heard horror stories (cost related) about the MA plan from friends and family in Boston, but every plan will undoubtedly have its flaws.  So, the MA plan would be a good place to start.  

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Lewis Black says:  "A Republican will stand up in Congress and say, "I've got a really bad idea." And a Democrat will immediately jump to his feet and declare, "And I can make it sh*ttier.""

Source: AARP

Critics, including Obama, say the plans (Medicare Advantage) offer lower premiums because insurance companies are subsidized by taxpayers at a rate 14% higher per patient than regular Medicare. Lawmakers initially set a higher reimbursement rate to draw private insurers into the program. The non-partisan Congressional Budget Office says eliminating the disparity would save $150 billion over 10 years.

At a recent virtual town hall meeting intended to quell seniors' concerns, Obama said the cuts would not affect care. He said the Medicare Advantage program amounted to "giveaways that boost insurance company profits but don't make you any healthier."

"We're overpaying plans that were basically promising greater competition," said David Certner, legislative policy director for AARP, which supports cutting the added payment to Medicare Advantage. "It's not sustainable."

Another Democrat canard.

If you knew the Medicare law, you'd know that Congress mandated that MA plans rebate excess payments back to their policyholders in the form of lower premiums, co-pays, deductibles or increased benefits.

So carving out "savings" from these plans really means reducing coverage for millions of Seniors and increasing their out-of-pocket costs.

Implementing such cuts will be borne on the backs of 10 million Senior citizens in MA plans.

 

 

Night, I'm very interested in getting to the truth here.  Could you please post some sources to back up what you are saying, as Misty has done?

Nightwinger is correct about overpayments as can be seen here but my understanding is that it is separate from the bidding process itself:

 Plans that offer Medicare benefits for less than the amount of their payment from the government are required to give enrollees additional benefits or, in an option that became available recently, rebates on their Part B or Part D premiums.3 Those additional benefits and rebates of premiums are a major incentive for beneficiaries to enroll in Medicare Advantage plans and are particularly attractive to people without Medicaid or employer-sponsored supplemental health insurance.

From the CBO report Misty referenced here:  http://www.cbo.gov/ftpdocs/79xx/doc7994/04-11-MedicareAdvantage.pdf

If they choose to lower the payments to be more in line with FFS services, that would necessarily decrease the amount private insurace providers would receive and also decrease "overpayments."  However, I think it's also important to take into consideration the points the GAO brings up here regarding the MA plan and how it is being paid for: 

Critics question the cost of the current MA program and suggest that if the policy objective is to subsidize the health care costs of individuals with low incomes, it would be more efficient to directly target subsidies to a well-defined low-income population instead of subsidizing the cost of all MA beneficiaries. Further, they are concerned that the additional payments to MA plans are funded in part by the approximately 80 percent of beneficiaries in the FFS program who do not receive enhanced benefits.

http://www.gao.gov/new.items/d08522t.pdf

(Sorry I don't know how to change the font sizes when I cut and paste.)

Basically it looks like a two-tiered system, with the "choice" MA tier getting "more" in terms of dollars (not necessarily quality, mind you) out of the system than those on the FFS program.  Is that the objective?  Should the two be on more equal footing or not?  And as a result of the MA portion expanding more than anticipated, the costs are increasing faster than anticipated.   It looks to me like a reasonable area in which to consider cuts given the budget circumstances.    If I were using MA I probably wouldn't like it, but I can understand why they'd look there.  That's a lot of money with no real evidence of better quality. 

An important issue not often mentioned is that,  in return for a (capped) payment, the private MA plan also assumes the total risk for taking care of an individual---including those with pre-existing health conditions.

So, potentially expensive catastrophic events are the responsibility of the private carrier and can not be billed to Medicare.

I don't know if comparative figures are available, but it would seem removing such costs from reimbursement by Medicare may actually be saving the government money.

Then too, what constitutes "quality?"  

MA plans frequently offer expanded immunization benefits, inpatient hospital-day coverage, yearly physicals, stop-smoking programs, obesity reduction clinics, a 24-hour nursing staffed hotline, cholesterol screenings and various healthy lifestyle programs, to name a few.    Things usually not provided by Traditional Medicare.

I will admit there are drawbacks and it's not for everyone.    For instance, if you have a chronic condition that requires frequent office visits for monitoring, you will incur a co-pay for each visit, and that can add up.

Another downside is, since private carriers fall under state laws and regulations, there is no national uniformity in either coverages or premiums.

Personally, I feel lucky to have a Blue Cross MA plan that I like and don't want the government messing with it.

I am a great admirer of the President's views on many issues---but this is not one of them.

Night, I can agree with your idea of public option supplemented with private insurance.  To be honest, my ideal scenario would be government insurance for basic coverage, supplemented by private insurance for those who want it, and can afford it.
Am I missing something? I really don't see Republicans in negotiations pushing a MA-type program. I don't see them vocally discussing any real ideas related to what Nigtwinger shared. Is this occurring in negotiations? Are they willing to vote yes on reform if such a system was replicated on a national level? I guess maybe they are low key on it because they really don't want to compromise at all. Today is the first I've heard of this MA program. I've heard good and bad, but Pres. Obama seems to want all ideas out there. Bring it on if they truly want to talk and hash out ideas, as long as they are willing to vote yes.

Kelly - the GOP is pushing certain elements that will probably be included in any "reform" legislation.

Their primary goals:

  • PORTABILITY - Your health plan stays with you, even if you change jobs or move to a different state.
  • OPEN MARKETS - Allowing individuals to choose health plans across state lines.    Someone in Oregon could obtain a policy from a plan in Florida, for example.  As an analogy, suppose you lived in Michigan and were told you couldn't buy a car made in Alabama.   That would'nt make sense.   But it applies to health plans.

While Republicans can be seen as obstructionist to reforms, they do have some good ideas too.   Preserving and/or expanding freedom of choice is a bedrock Republican principle. 

That's how MA plans were established as part of the Medicare "reform" legislation under President Bush.   Critics on the Left claim it was an attempt to "privatize" Medicare, but I think most Republicans saw it as a choice available to beneficiaries.  No one is forced to join it.

Freedom is good.   It need not be sacrificed to achieve security in a good health plan.

 

Aren't those ideas already supported by Obama?

While Republicans can be seen as obstructionist to reforms, they do have some good ideas too.   Preserving and/or expanding freedom of choice is a bedrock Republican principle. 

But they are basically saying: Even if you include every one of our great ideas, we won't vote for reform. How is that supposed to motivate the Dem's to include these ideas?

What exactly is his effectiveness when the opposition is against everything you propose and it's not flexible in the very least? Not only that, but rather than work with you is actively working against you.

My two cents:

I personally think the Sebelius thing was put out there on purpose to see just how strongly the public option was supported by the base and Dems in general. I think at the end of it all its the only option he has left and its put the Republicans in a corner. No support of even co-ops? Well, Obama tried bipartisanship and it did not work. No wonder Dean was confident these last few days. Perhaps he knew something we did not.

The "nuclear option" over healthcare would be a very bad precedent for the Democrats in the Senate to set.

Well, we know if it were the GOP in the same boat, they would not hesitate and would not care what kind of "precedent" they set. Sometimes being nice does not work. Pres. Obama has done everything in his power to make this a bi-partisan effort but when you have Grassley saying he would not vote for the bill even if it were perfect and GOP leaders saying that if any Republicans vote for a Co-Op they support a government take-over, what choice does Obama have? They are not even being subtle. I think the American people would rather the Dem's and Obama show a backbone rather than take the normal course of Congress which is to do nothing. The GOP did this to themselves and they may regret it when Pres. Obama and the Dem's can chalk this up as a victory. I could be wrong but I think if Obama can get 60 Senators to block a fillibuster/delay tactics (even if they don't vote for the bill) they can even do this in a timely manner. This would be a win for the tougher Blue Dogs: they can help the party to prevent a Fillibuster and some can still vote no so the conservative districts don't punish them

Using the "nuclear option" would be a major break in Senate decorum and tradition.  The Senate is very different than the House and the minority party always gets more of a say in that part of the legislature.

If the Democrats were to pass health care reform by a simple majority with no chance for the Republicans to filibuster, the Republicans would then make sure the Senate accomplishes nothing for the rest of Obama's term or at least until the 2010 elections.

Under the rules of the Senate, the Republicans could do several things to basically shut Congress down. They could demand that every bill and amendment be read aloud each day even the complete Congressional Record.  They could force votes on the most trivial of matters.  They could object to all unanimous consent requests.  Washington would slow to a crawl. 

 

And you think that would serve them well? Try going into the next elections with other guy basically blaming you for shutting down Congress because you didn't like how the HC bill was passed... 

If the Democrats were to pass health care reform by a simple majority with no chance for the Republicans to filibuster, the Republicans would then make sure the Senate accomplishes nothing for the rest of Obama's term or at least until the 2010 elections.

And what would be different if they go wimpy and pass nothing? The GOP will try to ensure nothing is accomplished no matter what. This changes nothing. The GOP has made that clear!

Under the rules of the Senate, the Republicans could do several things to basically shut Congress down. They could demand that every bill and amendment be read aloud each day even the complete Congressional Record.  They could force votes on the most trivial of matters.  They could object to all unanimous consent requests.  Washington would slow to a crawl.

Not being in the minority they can't. Now that would find 60 democrats and independents putting a stop to those pranks. And yup, it will further endear Republicans to the public who most except for a small few already can't stand, myself included. Republicans didn't have a problem ramrodding the Terri Schiavo mess down our throats (under Majortiy Leader Frist from TN, a doctor I might add, who sould have known BETTER), speaking of a health matter that should have been between a patient/husband and doctor.

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Golf11, NYC
Vero Possumus
http://twitter.com/Golf11

Golf, I've read in more than one place today that the Republicans could object to all unanimous consent requests and that could basically paralyze the Senate.

Under the Senate rules, one Senator can force each and every bill to be read aloud at every appearance it makes on the floor, including when they are sent to committee. 

You said the majority could put an end to those kind of pranks, but I'm not so sure. 


I think they could as it would only require a majority to change the Senate rules -- no matter if those rules have endured for over a hundred years.

The filibuster is just one of those rules, it's not a Constitutional requirement.

That's why the thought of using the "nuclear option" (doing away with filibustering of judicial nominees) raised such consternation 1-2 years ago when Alito and Roberts were nominated. It works both ways. 

"Human beings, who are almost unique in having the ability to learn from the experience of others, are also remarkable for their apparent disinclination to do so." -- Douglas Adams

Yea, they could do that but that can be shut down too; rules work to protect the minority AND the majority. I don't think it will hurt anyone but the republicans. I mean they have the most seats up, it's just more fodder for the canon. Threats, threats...personally I don't think the Senators will do that and I'm sure the Dems have a few tricks up their sleeves. Behaving like children can only be effective for so long; I'm afraid whiners are running out of tactics.


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Golf11, NYC
Vero Possumus
http://twitter.com/Golf11

I like what Duke law professor, Erwin Chemerinsky said a few years ago when the Republicans were threatening to use the nuclear option to stop Democrats from filibustering judicial nominees: 

The second issue is whether the nuclear option should be used. The nuclear option would be undesirable. If the Senate's rules are to be changed, it should be in accord with the Senate's rules. Never in American history has the Senate changed its rules without doing so. If the Senate can change this rule without following its rules, it could do this any time. The very nature of the Senate as an institution would be altered.  

To Steven I did not support this idea back when Republicans were talking about it even though I believe my own Senator at the time, Bill Frist was the biggest proponent.

Dude, that quote sounds like double speak. "If the Senate's rules are to be changed, it should be in accord with the Senate's rules. Never in American history has the Senate changed its rules without doing so."

I don't get it. 

"Human beings, who are almost unique in having the ability to learn from the experience of others, are also remarkable for their apparent disinclination to do so." -- Douglas Adams

I think he's saying the Senate has never changed their rules by a simple majority vote.

You know, they carped about using budget reconciliation and how sneaky and underhanded that was. Then someone exposed how and the number of times they did it. Now it's nuclear option to make the hair on the necks of people like you Brandon stand on end. Frankly no one cares. The rest of us see all this for what it is.

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Golf11, NYC
Vero Possumus
http://twitter.com/Golf11

Actually Golf, I don't think the Democrats have the guts to use the "nuclear option" to get healthcare "reform" passed.  So that threat doesn't scare me at all.

It's all a game...threats I'm telling you, sabre rattling if you will. Don't forget, whatever passes has to go through reconciliation and Republicans will want a seat at that table. Moreover, Republicans will eventually find something they'd like to bring to the floor. There are many ways to thumb people into compliance. LOL.

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Golf11, NYC
Vero Possumus
http://twitter.com/Golf11

"And you think that would serve them well?"

No, but I also don't think it would serve the Democrats well to break years of Senate tradition to get their way on one bill.

Bullying through a bill would not play well with independents who are suspcious of any political party flexing too much muscle.

Republicans never bullied with Bush in office? I don't think you'd be this uneasy if it were Republicans pushing for something you believe in without Democrat support...

Republicans never cut off the filibuster with a simple majority.  

Again, the Senate is a very tradition minded body.  You don't start changing the rules just because you have 60 seats without suffering future consequences. 

Again, would you be saying this if it was Republicans doing it to pass a policy you agree with? I really find it hard to believe that you would.  Especially with your dislike of a lot of things on the left and how you wouldn't mind policy from a conservative majority Supreme Court.  I don't think you'd care if the democrats were supportive of a policy you wanted to see passed.
Yes, I would be saying this if it was Republicans doing it. While I long for the day when we have a majority conservative Supreme Court, I don't want them legislating from the bench.

Republicans never cut off the filibuster with a simple majority.

Because you can't cut off a filibuster with a simple majortiy. it requires 60 members of the senate to invoke cloture (well you need a group to sign 17 or 18 not sure to move to invoke it then you go to a vote)...why do you think Dems have been jumping up and down about the magic number of 60 +1 with the vice president. You need to study up on Senate rules if you're going to sit in here and try and "quote" them.

It is a absolute impossibility for anyone to cut off a filibuster with a simple majority vote in the U.S. Senate.

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Golf11, NYC
Vero Possumus
http://twitter.com/Golf11

It is a absolute impossibility for anyone to cut off a filibuster with a simple majority vote in the U.S. Senate.

... Unless the majority pushes a measure through using the budget reconciliation process (see my reply below). Also, the VP's vote is only used in a 50-50 tie.

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It's sad that we've reached a point where 'government service' is a dirty word... If we're the greatest country on earth, maybe we can have the greatest government.

Lewis Black

Correct, but that's not what he said. Budget Reconciliation and filibuster are two seperate and distinct maneuvers. I mentioned the VP in this instance because there are some members who may be missing (Kennedy comes to mind) so they want all Dems on the floor so the VP would probably be called to preside. The required number can vary depending on who's present and the reason for absence.

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Golf11, NYC
Vero Possumus
http://twitter.com/Golf11

As sick as Kennedy is, I think he'll be there for the vote.  Even, if they have to wheel him in, he'll vote on healthcare reform.  It is part of his legacy.  

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Lewis Black says:  "A Republican will stand up in Congress and say, "I've got a really bad idea." And a Democrat will immediately jump to his feet and declare, "And I can make it sh*ttier.""

Very true when it comes to healthcare...isn't Byrd sick and in mothballs somewhere too?

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Golf11, NYC
Vero Possumus
http://twitter.com/Golf11

Yep
I've heard that he would probably have himself wheeled for a vote on healthcare, and that he tends to vote liberal on social issues.

You are right Golf that I probably don't know the Senate rules well enough to be quoting them.

But I thought the "nuclear option" was cutting off a filibuster with a simple majority rather than the traditional 60.

http://en.wikipedia.org/wiki/Nuclear_option

Yes, the nuclear option is used to prevent a filibuster from even beginning by changing how the body acts on a particular item, essentially giving you the gun but taking away the bullets (shoot all you want but you won't hurt or stop anything). That's different from stopping a filibuster once it's started.

With 60 people affiliated with the Democrats in the Senate, there's really no need for a "nuclear option" or simply put changing the rules to ban a filibuster during the consideration of healthcare. Republicans can't sustain a filibuster unless Democrats defect and I don't see that happening.

As Magus points out, bduget reconciliation is a lot less messy.

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Golf11, NYC
Vero Possumus
http://twitter.com/Golf11

I'm sorry, that's bullpuckey, unless you think opening ANWR to drilling is a legit part of budget reconciliation.
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It's sad that we've reached a point where 'government service' is a dirty word... If we're the greatest country on earth, maybe we can have the greatest government.

Lewis Black

oops, yet another hole in our Republican talking points. I sure would like to see the Republican plan to reform healthcare. Isn't it easier to offer an alternative if you're not too supportive of what's being offered? Wonder if we talk about that in our town hall meetings.

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Golf11, NYC
Vero Possumus
http://twitter.com/Golf11

Why should they bother to offer an alternative, when they would vote against it anyway.  That would be entirely too much wasted effort. ;-)

Republicans have rammed measures through in the Senate using Reconciliation, particularly during Bush's administration.  Cuts in Medicaid in 2005, both infamous tax cuts for the rich in 2001 and 2003 were all voted in by simple majority.  http://www.ourfuture.org/makingsense/alert/2009041617/demand-majority-rule-health-care-reform

That article didn't mention it but the Medicare Advantage/Prescription D Drug plan also passed on Reconciliation.  According to Wikipedia, the modified estimated cost was kept quiet from Congress where fiscal conservatives had said they wouldn't vote for it if it succeeded a much lower amount.  http://en.wikipedia.org/wiki/Medicare_Prescription_Drug,_Improvement,_and_Modernization_Act
Well, the Republicans gave it their best shot; they stood up for their base; and held aloft the banner of free speech. After all, we won't know how this is going to turn out until after the next election cycle, and, like the hokey pokey, that's what it's all about.

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