This is unbelievable. What I understand of Wyden's Free Choice plan, it is the only option out there that is actually founded (at least in part) on free market principles and consumer choice. Why would anyone in their right mind ever want that? (please note sarcasm). Geez.....

I have a question, though. I have sent an email to Sen. Wyden's office for an answer, but haven't heard back (I am probably on their black list - just kidding). Does Sen. Wyden's Free Choice Act allow insurance companies to sell insurance across state lines, or does every insurance company still have to get licensed by every state insurance regulation agency?

I apologize for any unkind things I said about Senator Wyden during the early stages of this Bill. He, and Merkley, and DeFazio, are doing Oregon proud. If good things don't happen, it won't be the fault of OUR state's delegation (except Walden).

The finance committee should just pass whatever cowflop of a bill Baucus allows, and then let the full Senate try to fix it in a forum where Baucus doesn't have such a ridiculous degree of power over the process. Polls show that pluralities or outright majorities support the public option in Montana, North Dakota and Arkansas (which is also true in every state but one that doesn't already have two Republican Senators, and in many that do). Baucus and his enablers are not just screwing America, they're spitting on their own constituents.

Thanks Kari, like sausage making, watching the initiation of law is a very unpleasant business.

Wyden's speech begins at 78 minutes and it is awesome. He really takes the democrats to task (I suppose the Republicans as well). This whole thing makes no sense to me. Who could be against Wyden's bill. Even I, a Republican, think it is a good idear. God forbid we give consumers the power in the health care market, we wouldn't want that.

Just unbelievable.......

What I've read elsewhere is that the CBO had not analyzed the impact of the amendment on employer sponsored insurance - business is concerned that lots of healthier people would leave the corporate self-insured plans for the exchange. But the reality is that none of us know the full story about what happened.

Hopefully Wyden will be able to come back with some version of what he's working on for the floor. From my perspective, the bill would be improved just by allowing larger businesses to pick the exchange as their health insurance plan earlier rather than later. (Initially, the exchange will be limited to individuals and businesses with 100 or fewer employees.) I suspect more and more will want to take advantage of that option, and that will provide much greater choice for employees.

Wyden should vote to kill the Baucus abomination in committee. We'll be better off with nothing than with this phony "reform."

I'm used to Senators acting as little dictators but this Baucus guy is a real dick. I first learned about this stuff when the former Governor of Massachusetts was nominated as ambassador to Mexico and Jesse Helms blocked it from coming to a vote. Imagine someone from one state vetoing the nation's business. Jesse even said something like, "He may be visiting Mexico as a tourist but he's not going as ambassador."

 But at least he didn't have to play dirty like Baucus to accomplish it.

  Baucus...what a dick. Let's hope he needs our help really bad someday.

The truth is that the incompetence of Wyden and his people in this very episode is striking, if Walker's presentation is to be believed. And that is Kari's goal in leveraging it here, isn't it? Just how bumbling are they that they didn't come prepared and able to produce documentation from CBO on the spot demonstrating the amendment he was introducing had been scored. It's being generous to say that's pathetic. It's episodes like this that expose and really give the lie to so much of what Wyden and the rest of the Democrats who claim to be on the side of the people in this reform debate. (By the way Kari, why don't you print the text of the two amendments here so we can argue whether the substance of what he proposed actually matters one wit towards giving people real choice? Some of us who have followed this closely have constantly been rebuffed as we tried to get the text of what was been proposed.)

Does anybody really believe that if we through irresistible grassroots pressure manage to get a strong public option in a final reform bill that it wouldn't also include the opportunity for anybody to buy into it? That is part of the definition of strong public option. At this point the stakes have been raised such that this means nothing less than letting anybody have the true choice of buying into Medicare or it's equivalent. And to Ross Day, that's truly the free market at work baby, not the lie of a free market that you indicate you support.

Wyden and Kari want us to be outraged at this supposed affront by Baucus. He can prove once and for all he is the champion he claims to be now by throwing down in no uncertain terms with the strong public option side, rendering his whole false-choice charade moot. He can round up Senators to come out with an amendment that says anybody can buy into Medicare and take to the road and the talk shows to get the people behind it. It's come to that and we are waiting Senator Wyden.

Thus we see the designed to fail mechanism in its full splendor. Baucus, who was re-elected in 2008, can not be more disliked and therefore could not be damaged by dismissing Wyden's amendment. Wyden saves face by being ruled out of order. Well, at least he tried. Sigh.

Now for the real test. Will Wyden vote against "reform" without the strong public option (itself a failed concept) or will he go along with Baucus in the end.

Bread and circus. The bread is increasingly moldy. And the circus animals are flea bitten and long in the tooth.

Brian Collins - business is concerned that lots of healthier people would leave the corporate self-insured plans for the exchange.

Kurt Chapman - Brian I agree. that is the same worries that the various unions of the AFL-CIO have. The question remains - WHY?????

If reform passes, pre-ex clauses go out the window as do lifetime caps. Individual plan ratings also are gone so the concern of adverse selection (the younger, healthier employees selecting from the Exchange) would not adversely impact the plans. Is it all about the Corporate/Union feudal belief in control?

Kari - good piece of material. Some of us do not have cable etc. So we depend upon the web, the papers, etc.

Yes, Jack you have correctly identified that it is not the health of people but of the insurance industry that is of concern. Alan Grayson is correct.

Don't get sick.

If you do then die quickly. Preserve profits at all costs. People are disposable. Remember that empty phrase We The People.

The health of the Republic is what is at stake here after thirty plus years of Neo Liberalism. Turn off the bubble machine. Trillions for the too big to fail banking industry. Another trillion to fight the Talliban who are funded by drug sales. Divide and conquer.

Unsustainable.

Time for Baccus to go, not just from chairship but the office of a federal senator. He is not helping the people of this country.

Sad to see the Dems madly go marching back to 1994, doing everything possible to snatch stinging defeats from the jaws of what could have been an historic realignment and return to another long period of Democratic dominance.

Excellent post, Kari. Thanks.

And, Kari: why the tone of truculence? What the hell is up with you these days? Yer so cranky!!! Of course this is serious inside baseball, as you say. So why the cranky "move along assholes if you don't like it"???

This is the right stuff you gave us!

I think you are still stinging from the relentless spate of attacks on you as the guy who builds every single website for most every single politico around... maybe just ultimately being a cheap shill for them.

Let it roll off you. Seriously.

They are just being nidgets. They need to go build their own blog and see how difficult it is to have anything to say if you have no real relationships and do not much of anything.

I have long believed that Ron Wyden has more sense than the "run someone against him in the primary" crowd gave him credit for. This incident only confirms my belief that Baucus had "gone over to the dark side" and lowers my respect for Conrad. Even if every object to Wyden's amendment is true, blindsiding him after midnight is just plain stupid. Why would he ever trust the people who blindsided him again if they told him it was raining outside, much less anything more serious?

With regard to this, "I hope Ron is pissed off enough with Baucus that he will join in stripping him of the chair the next chance it can happen. Baucus has really worked hard to antagonize just about everyone. How did he get into politics anyway?"

In 1984, at the Democratic National Convention, I met some very nice people from Montana. They were very excited that they might just have the possibility of re-electing Max and thought very highly of him.

I have thought about them all summer and wonder how many of those folks still support him.

(Once more into the breach...) Posted by: Kurt Chapman | Oct 7, 2009 9:33:42 AM

Brian Collins - business is concerned that lots of healthier people would leave the corporate self-insured plans for the exchange. Kurt Chapman - Brian I agree. that is the same worries that the various unions of the AFL-CIO have. The question remains - WHY????? If reform passes, pre-ex clauses go out the window as do lifetime caps. Individual plan ratings also are gone so the concern of adverse selection (the younger, healthier employees selecting from the Exchange) would not adversely impact the plans. Is it all about the Corporate/Union feudal belief in control?

See, here's where details matter.

In our collectively bargained plan, everyone pays the same premium, irrespective of age.

If the weak PO comes out with age-differentiated pricing, then the possibility exists that young healthy people will go to the PO, while older people will actually have premiums increased, for lower coverage, if they go there.

But then the collectively bargained plan only has older, sicker people in it. Guess what happens to their premiums?

Then the younger people in the PO get older; their premiums go up based on age, and they can't afford the plan anymore, nor can they afford the fines for not paying the insurance company's price.

I don't call that successful reform.

"If the weak PO comes out with age-differentiated pricing, then the possibility exists that young healthy people will go to the PO, while older people will actually have premiums increased, for lower coverage, if they go there. . . . I don't call that successful reform."

So why haven't the labor unions come out against the HELP or House bills? From what I am hearing, labor is urging that the Senate adopt the HELP version for its final bill. If the Public Option is currently "weak," why is labor urging passage of these fake reform bills instead of asking its members to call the entire delegation to demand they vote down the House and Senate versions and start over with a robust public option?

I suspect the answer is closer to Kurt's explanation than many of us would want to believe. Labor fears a future where their members can get a better deal without them, and corporations fear a future where employees are not locked into their cubicles. For labor, that's a very short-sighted concern when you look at the health benefit losses that have been piling up at bargaining tables across the country. Once it is no longer trapped negotiating for successively weaker health benefits, it can focus more of its efforts on higher wages, better retirements, and humane working conditions.

dude, where is my labor? | Oct 7, 2009 2:01:20 PM Labor fears a future where their members can get a better deal without them, and corporations fear a future where employees are not locked into their cubicles.

Another ill-informed opinion from the anti-labor crowd. "Starting over" is one of the Republican talking points. Voting down the Baucus bill does make sense. That's where Wyden should be putting his efforts.

AFl-CIO is on record as being for a strong public option. Which is more than a lot of so-called "progressives".

"Another ill-informed opinion from the anti-labor crowd. "Starting over" is one of the Republican talking points. Voting down the Baucus bill does make sense. That's where Wyden should be putting his efforts."

Wrong. I am a pro-labor, lifelong Democrat who has voted with labor on every ballot measure in this state for seven consecutive elections. I question all of our leaders from NARAL to DeFazio to labor to Wyden. Questioning and challenging our progressive leaders doesn't make me anti-. It makes me a Democrat.

dude, where is my labor I question all of our leaders from NARAL to DeFazio to labor to Wyden. Questioning and challenging our progressive leaders doesn't make me anti-. It makes me a Democrat.

When you pose "questions" ("So why haven't the labor unions come out against the HELP or House bills"), and then provide your own "answers" ("Labor fears a future where their members can get a better deal without them"), that just being closed-minded.

As I've posted before, Labor has been in the forefront of strong defense for the PO. What we don't want is a weak PO, a poor excuse for "insurance reform" and weakened collective bargaining rights added in as well.

I wrote "I suspect." Feel free to set the record straight.

But if you are truly for a strong public option, can you write with a straight face that any of the House bills or the Senate HELP bill has a strong public option? If yes, please explain how they are strong. If not, please explain why labor is supporting their passage.

I think a lot of us (including inside Labor) are less than happy about how this has been handled. What we want, what we will accept and what we will oppose are three different things.

Personally, I'd have Medicare-for-all. I didn't see Wyden pushing that, either. So, we're down to what we can accept. Weakening collective bargaining laws is not part of that. Neither is a "personal mandate" without strict cost controls and subsidies for those who can't afford the premium.

True, Wyden didn't push Medicare-for-all, but he's got a lot of company on that one (Reid, Pelosi, Schumer, Merkley, to name a few). While you are either brave or foolish to admit your feelings about how those inside labor feel about your leadership's handling of the legislation, your leaders are not nearly so brave and candid. They have used millions in resources on advertising and organizing, and for what? These private insurance protection bills? More power to you, though. If I were in a union, I would vote for you.

Cheers.

Seriously? Are you incapable of using the internet? They're posted right there on Wyden's official home page. They're helpfully labeled "Read the Free Choice Amendment." and "Read the rest of the amendments." The text that's blue and underlined is a "link". If you click on it, you'll magically get the information you want.

The beauty of the internet is how the Wyden camp can publicly make asses of themselves to thousands.

I think we are all familiar with how Wyden is trying to sell his false-choice proposal with the line to the effect: If you don't like the crappy insurance your employer offers you can choose to go to the exchange.

Up until about 2 weeks ago, his website had a summary version of his amendment but not the specific language.

Kari, I saw the alleged #C1 amendment on his website, probably the day it went up so I took a look. Funny thing about that amendment. First it is not the actual language of the amendment but the talking summary of the amendment. Second, this summary doesn't say anything close to what he's on the airwaves claiming it says. It is an employer pay-or-play provision which says employers either have to offer their employees a voucher, or have to offer two plans where the premium for one is as expensive as one of the most expensive plans in the area (state-level exchange).

It is unclear from his text whether you can actually opt out so long as the employer is paying enough for the plan. So much for real choice or controlling cost. Also at least one Democrat Senator a few days ago made it clear there is a difference between the actual text of the bill and amendments, and these summaries. (And he wasn't even going to read the actual bill before voting for it.) Since all that matters in court is the actual text --- that's what Wyden's office would not produce --- some of us recognize we should ignore Wyden's deceitful public BS and demand the facts.

Now, given that I had checked whether his own summary of his own amendment matched the spin he was putting out on the airwaves, I assumed there may be another amendment. And indeed FDL confirmed there was and is a second amendment that was not scored and that Wyden and his hucksters like you are trying to use as in your attempt to make it look like Wyden was the courageous champion of the people stomped down by the evil Baucus. (Doesn't that sound like a comic book character?) It is the actual text of that second amendment which also was not available.

The biggest problem Wyden and PR hucksters like Kari have is that they are too stupid they don't recognize some of the grassroots are far smarter and better informed than they think we are.

Sadly, no one gave AFL-CIO control (or even a veto) over what happens in this debate. Like any democratically functioning group, Labor's leaders have multiple opinions, and an obligation to meet the demands and interests of their members. Like all the others, I want a system which helps everyone who needs it, without penalizing those who don't really have a lot of money, but did have the fortune to be able to secure good insurance through collective bargaining.

I've won and lost elections for the same reason: I just say what I think.

The ugly truth here is that a Public Option, however "open", will not solve the problem of costs. Unless you regulate the prices charged by health care providers, the PO is just a shell game.

But that means taking on the AMA and the insurance companies at the same time. So there I agree with the Obama strategy: take out the insurance carriers, then implement price negotiations.

The concern that several of the senators posed about undermining the risk pool for self-insured and large employer plans ultimately raises the question of whether we don't ultimately need to move from a system of largely experience rated health care plans to a broader community rated system.

Jack, I have to say that it's too bad your ideology conflicts with what the rational argument you are trying to make.

The two truths I will not let you run away from is that a public option equivalent to letting everyone buy into Medicare is the broadest possible community rated system. The community is all of the US. And that Republicans don't want people to actually have market choice: This is allowing anyone to spend their premium dollars to buy into Medicare. (And actually clamping down on the predatory, private, inflated, rip-off of the Medicare system that Medicare Advantage actually is, and that lying trash Republicans are trying to propagandize as benefit cuts.)

So Jack I'm drawing a line and daring you to take your best shot against my position:

1) I absolutely agree with those who say we shouldn't force anyone into a government health care plan. It's because of some of the egregiously anti-liberty views of some of the most visible single-payer proponents that I don't back their advocacy at this point.

2) I wholeheartedly upport the position that we should let the market decide. Which means letting people as the consumers in the market have the widest possible choice, not artificially restricting choice to just private insurance plans.

Now, while I personally oppose a mandate, I am willing to accept a mandate on three non-negotiable conditions:

3) All private and public insurance plans must be guaranty-issue and be prohibited from excluding pre-existing conditions.

4) Insurance companies must report full data on their pre-authorization and claims denial rates to the Federal and state governments. This is because in Wyden's no-choice plan if you have 3), costs (premiums, co-pays, etc.) or denial rates necessarily will go up as the only significant costs that insurance companies can control that go directly to the bottom line. Right now, none of the 5 bills even talk about denial rates.

5) Each and every individual has the choice in the marketplace of buying into Medicare. (This includes employers who as a recruiting perk want to pay their employees premiums and get a tax break for doing it.)

Frankly, Republicans who deny that choice 5) give the lie to their entire position. And

So Jack, which of those five principles is the deal-breaker for you as a Republican and/or an individual? There are people who are dying for lack of health care that need to know that just as they need to know the truth about Wyden.

I'm going to defer to the wonks in the crowd and ask how often this level of behavior shows up in committee? The way I see it, we've been seriously dissed here and I'd like to know why? One of our senators just got treated like yesterday's escort service.
How does Ron Wyden get treated like this? Where's the respect?

torridjoe | Oct 7, 2009 9:29:40 PM

That's what the PO in the House version does--it sets reimbursements at Medicare + 5%. That not only reduces the cost for those directly in the public plans, it puts pressure on the private choices to keep pace and competitiveness.

Right. Which is why we'd all be better off if Wyden would quit trying to "fix" the Baucus bill and simply vote No on the bloody mess.

Bill McDonald How does Ron Wyden get treated like this? Where's the respect?

To my point: if Wyden & Co. would simply vote down the Insurance company bill, they would get respect.

On the House side, in particular, this isn't just about health care reform, it's about respect (or fear, which in DC is what really counts). The Blue Dogs get listened to because everyone believes they really will vote down a proposal backed by Obama. Since everyone believes the Progressives will not, no one really listens to them. The progressives need to decide whether they want to lead, follow or just get out of the way.

The progressives need to decide whether they want to lead, follow or just get out of the way.

Exactly.

Yawn, you have no idea what my "ideology" is.

Jack, Jack, Jack. Let's be honest here. Your position that you have no objection "that any public option should be self-supporting without taxpayer subsidies" is pure ideology. Just because Obama has for political reasons also voiced a similar preference as a political tactic, doesn't make it any less ideology on your part.

You don't see Obama criticizing Medicare Part B on the basis it is not self-supporting, whatever "self-supporting" means in your ideology. Medicare Part B is entirely tax-supported because we maintain the social fabric of a representative democracy by having those who are in the working years fund the health care of their parents and their grandparents who raised them and who have passed their working years.

Now, if you want to argue that we should have an extremely progressive tax so those of Medicare age who have large financial resources should have to pay taxes into the system, or premiums if we do open up Medicare to a system people can buy into, then you might have a point that is more than ideology.

As I have said repeatedly, I have no objection to a public option. I don't even have any objection to allowing people to buy into Medicare, but I also have no idea what the premium would be on such a policy. Do you?

Jack, we all know something much more powerful in this debate than that:

1) We know Medicare could avail itself of any investment or cost-saving strategy private insurers would except refusal-to-issue, refusal-to-cover, excessive cost-increases, or arbitrary pre-authorization and claims denials.

2) We know that Medicare using the Medicare Administrative Contractors (MACs) has the far lower cost overheads than any private insurer, and despite several utterly fraudulent attempts in recent years to redefine administrative costs by the private industry.

3) We also don't need to dance around the truth here: We know allowing people to buy into Medicare will create the single biggest risk pool that will at a minimum have the most buying power of any insurance plan, and at most can make provider price setting part of a transformative public policy debate.

In summary, if our goal is to stop all of the abuses by the private insurance industry that I detailed from refusal-to-issue to arbitrary denials which they use to increase their profitability BY "controlling" costs, we know this:

Every primary fundamental market force works more in favor of controlling costs by allowing us to buy into Medicare than by forcing us to have a private health insurance system.

Put another way, if our goal actually is to prevent those abuses by the private health insurance industry which, if unchecked, as a side effect would lead to adverse selection, a private insurance system would not be viable or sustainable if a system in which people could buy into Medicare is not viable or sustainable. And it is ideology to argue that Medicare shouldn't have taxpayer subsidy to support those who become eligible by virtue of age and who are not working to pay the kind of taxes, and as an efficient way to progressively subsidize low income people (we could get rid of Medicaid in the process.)

On that latter point, if you are opposed to tax subsidies on the basis of income, are you opposed to subsidizing the premiums of low income people as Wyden supports? Because that really is a matter of pure ideology if you opposed to income-based subsidies for private insurance premiums, or if you are opposed to tax subsidies to Medicare but not premium subsidies to private insurers.

Finally, your attempt to finesse your way out with the passive position you "don't oppose a public option" is a legitimate finesse. But the issue is not what "you don't oppose", but what you support. The two are not logically or factually the same, although a lot of people like Kari probably weren't formally tutored in logic as you should have been as a lawyer to know that. I gave you five points that comprise a complete plan. So your comment of what "you don't oppose" doesn't speak to that at all. Do you support all five points and will you start rallying people of like minds to you to put the pressure on Congress to give us those?

Kari, in my opinion, after dissing Mr. Yawn you owe the readers of this site a response to his evaluations.

Maybe if rw asks you will.

Thank you for bringing this up, Jack.

"your confidence that everyone would rush to join Medicare if given the chance. The fact that doctors are increasingly reducing the number of medicare patients they'll see or even refusing to see them altogether because of the low reimbursement rate doesn't appear to worry you."

If Congress doesn't act to put states like Oreogn on the same reimbursement rate as states like NY, but this gets into a Max Baucus vs. the rest of the Democrats debate, it won't help much of anyone.

Common sense ideas like that, like making "pre-existing condition denials" a thing of the past before the next election, of having more regulation of insurance companies and standards of what are considered best practices (centuries ago, people decided leeches were not the best medical practice, surely there can be at least some agreement on which practices work best in the 21st century, while leaving doctors some room to try another tactic if the best practice doesn't work for their particular patient), and certain other ideas which have been discussed shouldn't be too hard.

But if even outlawing denials for pre-existing conditions is "government intrusion" to some Republicans, they don't deserve any more respect than I currently have for Baucus.

Ron seems to be getting a little fortitude in his old age... that's a good thing...

Yawn, if you think Part B of Medicare is entirely tax supported, then it is hard to have an intelligent discussion with you.

...

Since you obviously make your judgments purely on ideology with no real facts or knowledge, you seem to be projecting this onto everyone else. If you actually did some research, you might discover that not everything you need to know about this subject can be found in your well-worn copy of Health Care Reform for Dummies.

Come on Jack. I don't think you'll find I said anything of the sort Medicare is totally tax-supported. The gist of what I said is that Medicare is an inter-generational social commitment. And as an inter-generational commitment, it is largely, but not entirely funded by taxpayer funds, as the 2009 annual CMS report from whence I get my information explains:

2009 ANNUAL REPORT OF
THE BOARDS OF TRUSTEES OF THE
FEDERAL HOSPITAL INSURANCE AND
FEDERAL SUPPLEMENTARY MEDICAL INSURANCE
TRUST FUNDS
http://www.cms.hhs.gov/ReportsTrustFunds/downloads/tr2009.pdf

LT has noted the obvious argument that anyone reasonable person supporting a robust public option such as buying into Medicare obviously would also support remedying the rural-urban and regional provider reimbursement disparities. As I do.

And Jack, since you say you "agree with President Obama that any public option should be selfsupporting without taxpayer subsidies". As anyone who reads the referenced report will find, right now a unconscionable amount of taxpayer support is provided to private insurance companies through Medicare Advantage (Part C) plans. May we assume you'll be very publicly announcing your enthusiastic support for Obama's effort to roll back this ruinous diversion of taxpayer dollars into corporate welfare?

Hopefully Wyden will be able to come back with some version of what he's working on for the floor. From my perspective, the bill would be improved just by allowing larger businesses to pick the exchange as their health insurance plan earlier rather than later.