If I just read the Harry Reid press statement at http://www.cbsnews.com/blogs/2009/11/03/politics/politicalhotsheet/entry5513630.shtml correctly, the Senate probably won't take up health care reform until 2010 which of course means that nothing will pass due to the mid-term elections, so whatever the House does or does not do can now be officially categorized as "pissing into the wind".

I'm in-district and I called. His staffer was non-committal. I'm pretty disappointed in Schrader right now. If he's going to sabotage this effort and side with the Republicans, he's going to lose a lot of his constituency in a swing district.

I don't think there's enough momentum coming from the top. Obama was a winds of change guy and if he were blowing now like he did on the campaign trail the fence sitters would be out leading the parade.

He has to pick up the pace. He has a perfect opportunity, and frankly a test of whether progressives can have any hope for his administration. He decided to continue renditions. Yeah, with more oversight. Like telling me I'm going to have health insurance while in Gitmo. Point is, that policy is now a war crime . If he can't revoke a policy he ran against when it's patently untenable, why should we be doing the work to push Party members off the fence?

Sometimes I think the talk radio scrum is for the benefit of the Democratic Party. If the GOP weren't such parodies of idiots, none of this would have flown this long. The treatment of real progressives, too. It seems the strategy is to marginalize every one else to the point that the public is left with no other sane choice. Maybe talk radio's obsession with "socialist" comes from knowing their masters. Eh? They don't mean socialist as in good for all, they mean as in the one party State!

But then, doesn't every party dream of being the monolithic assumption made by all that perceive the political spectrum?

@ Greg D.

That's a BS statement from Reid, whining about GOP amendments. He knows very well if he doesn't pass it now, there is no future for him, or the Dems in 2010. He will be gone from Majority Leader and from the Senate. The Senate will pass a bill, as will the House, and there will be a Conference Report that will pass also. It won't be a pretty bill that everyone here will like. But there will be a bill.

On the issue of bending the cost curve: There is wide agreement among health economists that the Senate bill does more to slow the long term rate of growth of health care costs than the House bill. This is due to two provisions:

1) The financing mechanism for the Senate bill, a tax on high cost health insurance policies (basically a politically acceptable way to cap the tax exclusion for employer provided coverage) would encourage less expensive policies, more cost sharing, and less overutilization of care.

2) It empowers a commission to suggest policy changes to Medicare that will save money and requires Congress to take an up or down vote. Right now, a lot of the good work done by the Mediare Payment Advisory Commission gets ignored, hopefully this would bring more of it into law.

I don't know what specific proposals Rep. Schrader wants to see in the House bill to control costs, but there is no question that the Senate bill does more on this issue.

For the record, I personally prefer the House bill's approach to coverage (it will cover more people) and the Senate bill's financing mechanism for the cost control benefits stated above. Hopefully this is how it works out in conference! :-)

Just called and let him know that I too am hesitant about this bill because of the cost curve ... thanks for pointing out this weakness Carla!

Geoff

Just shared on Facebook!

Schrader may say he supports a public option (and he may very well genuinely support it as a matter of policy). But I would be shocked if he actually voted for it. He's on the short list of targeted districts. He's facing his first re-election during the first midterm election of a Democratic president. The NRCC has a candidate that it will fund if the race looks like a good bet. The last time District 5 was under this kind of pressure, Jim Bunn won it for the Rs in 1994.

Schrader is a smart, astute politician and a survivor. I may be wrong, but I say no way he risks his reelection to vote for a public option.

@Carla: We're all Tea Partiers now.

Well, it's a common refrain; "I support X, but not this particular legislation."

Several years ago there was an effort in Oregon at campaign finance reform. Most of the liberal groups opposed it, though they claimed to support reform. None of those groups has does diddly since then to promote campaign finance reform - but I'm sure they still "support" it.

Schrader has an opportunity to push amendment of Pelosi's bill to reduce future healthcare costs, but at some point, he will either support the final bill or not. We're not likely to see another for several years.

@carla: Yeah, uh, how about that NJ Governor's race ... boy, that NJ, pretty blue state huh? Elected a conservative governor ... strange ... 25 point shift in preference between 2008 and today. Sort of like the folks are saying something isn't it?

Carla repeats here several times: The head of the CBO says the cost curve argument here is BS.

That may be your personal interpretation but the CBO Director doesn't say (starting on Page 7) 'bending the curve' is BS - he just states there are several cost trends to consider and different ways to determine/measure them. That it's difficult for the CBO to project costs of the various healthcare proposals and the resulting effect on the federal budget deficit 10 to 20 years out with any degree of accuracy/precision. And thus the CBO is really only prepared to address whether healthcare proposals 'lower' or 'raise' the federal budget deficit and budgetary healthcare commitment curves. That doesn't illegitimize concerns about the long-term costs of the healthcare proposals and their impact on the federal budget - nor is it a green light go-ahead license to 'just do it' throwing all caution to the wind.

The latter is how we got started down a path to a Medicare program that in 1990 cost $110B - 10x the original 1966 projection of $12B. And Medicare now costs more than $400B annually. Seniors are now paying more out-of-pocket (in real, inflation-adjusted dollars) for healthcare expenses than they did PRIOR to Medicare.

@Carla -- of course it had nothing to do with the President, it's the long string of failed leftist policies in NJ that folks are reacting to. It's too bad that instead of making a decision on Afghanistan, the President chose to devote SO MUCH of his time to NJ and that Corzine "douche" as you say (talk about going all in!) -- makes me wonder about the President's judgment a little.

As far as VA goes, that was supposed to be a "realigned" state following 2008 but, we saw a clean sweep of all state wide offices by conservatives.

AND, the most important thing. Those "Moderates" that conservatives were supposed to have "chased away" broke 2 to 1 in favor of conservatives.

Yeah, we'll take NJ and VA.

TABOR sucks. It sucked when they tried it here too. I believe the formula they use is flawed.

Thx 4 chatting.

Keep up the good work.

Geoff

OK...I'm a VIGOROUS supporter of health care reform and of the public option, but I have to strongly disagree here. I'm very happy with Schrader's position.

Oregon providers, especially in purple areas are getting screwed by Medicare. I say out in the purple (and red) areas of the state because of the payer mix that they have. As Kari and others have explained, because Oregon is efficient with its Medicare dollars, providers get crappy reimbursement rates. In contrast, in Florida and Massachusetts where they are incredibly wasteful and inefficient, their provider reimbursements are sometimes 2x higher than in efficient (Oregon) states. It's a system of perverse incentives.

Back to the purple areas. In places outside of Portland, the payer mix (Medicare/Medicaid/Private/Uninsured) tends to be more uninsured/medicare/medicaid than in Portland where the mix is weighted with more private payers. Because of reimbursement rates, private payers end up subsidizing Medicare/Medicaid patients.

As a result, providers are hurting in red/purple Oregon...and more and more are not accepting Medicare patients. I think OPB did a "Think Out Loud" show on this recently. Even more are simply choosing to not practice in rural areas anymore. It's one of the reasons why this state has had to fund a rural provider credit and subsidy.

So, I'm glad that Kurt is speaking truth to power about how crappy a deal the "Medicare +5%" PO is for Oregon. It's the wrong option for Oregon.

If we want real health care reform, we should start by not shooting ourselves in the foot. We need a public option (that is accessible to everyone in the system, thank you Wyden). I'll admit: I don't know that a "negotiated rates" PO is better; but not fixing Medicare reimbursements and creating a PO based on bad fundamentals is a BAD pill to swallow for Oregon.

Now, if only Kurt can explain this to the rest of the delegation...

I have talked to Schrader staff twice in the last day or so, and I called about what was important to me, not what was important to Carla.

I think Kari is right, about the blue car with the leather interior (are all loyal Dems supposed to agree on leather interior and not ask questions?) and about this "If we're hoping to build a universal health care system that survives the next recession, it's gotta hold costs down - for federal, state, and local public budgets, as well as for employer and family budgets.".

Now Carla, if Kurt said "I support exactly what Carla says I should support because nothing else matters" and constituents wanted to know things like where he stands on the Cong. Stupak crusade to limit abortion coverage, or why effective dates are in 2013, do you think constituents would be happy? Or wouldn't that matter as long as you are happy---and who is the Congressman for the district where you live?

Does the current bill bend the curve of health care costs? Or will the inflation rate on health care costs if all good Democrats let Speaker Pelosi tell them exactly what to vote for or against be as big a problem as it is now?

Dr. Bates (St. Senator from Ashland) says it is a real problem to find out what to charge for a procedure because every time he has asked the answer is "depends on whose insurance it is". But a health care reform bill supported by Pelosi which doesn't fix that problem is OK because Congressmembers should just follow orders?

Suppose all Democrats vote for what apparently Carla wants them to vote for:

" a public option (with negotiated rates) if it goes to the floor."

I thought the last fight was because Kurt was more comfortable with negotiated rates than Medicare + 5, now Carla wants an oath of loyalty to negotiated rates because of course people outside of Capitol Hill always know more than the people we elected to represent us in Congress. Part of this problem is working out whether states like Oregon and Iowa get reimbursed as well as NY and Florida. Or doesn't that matter?

So far I have not seen anything to cause me not to support Kurt next year for re-election. But then, I believe elected officials have the right to make their own decisions on the details of a complicated bill.

If a health care reform bill passes "with negotiated rates" without any concern for costs, with an effective date of 2013, and with a lot of details that have unintended consequences (Wyden is worried at how few people will qualify for public option, for instance) is that better than negotiating a bill which has fewer unintended consequences but doesn't have the magic bullets some activists believe in?

I believe answering those questions is more important than "you must call this Congressman and tell him to tow the party line".

Karla, how would you like it if someone misspelled your name like that? The PRESSURE SCHRADER crusade did that with Medicare+ 5 but we should forget that because all good Democrats allow themselves to be bullied by people so little concerned with details that they can't check the spelling of a Congressman's name?

For every left-wing howler that Schrader loses by sitting on the fence, or not following Pelosi in lock-step...he will pick up a moderate Republican. I live in this district and have no problem supporting Kurt for making good choices THAT REFLECT THE VALUES OF HIS DISTRICT. He and I may not agree on everything, but I think we can find enough common ground to make some progress in areas of mutual interest.

You have inspired me to call his staff and remind them of this fact. Since we already have an excellent working relationship, and that since Obama's election was due (apparently) to people who can't be counted on to show up every single time, Kurt needs to know that moderate Republicans are willing to give him a shot. Opposition to this turd of a health care plan is something I'd like to see from Schrader...and I'll put my money where my mouth is.

Very interesting, Carla----either I see the bill and Schrader's role from your point of view or I "don't support the public option"?

Very few things in life are thata bipolar!

Is JTT wrong as well? Posted by: JTT | Nov 4, 2009 4:39:46 PM OK...I'm a VIGOROUS supporter of health care reform and of the public option, but I have to strongly disagree here. I'm very happy with Schrader's position.

Which is why this is such an interesting NY Times article:

http://www.nytimes.com/2009/11/05/health/policy/05health.html?hpw

@ LT

Your and Kari's arguments are irrelevant right now. Because it's fish or cut bait time. The bill is posted, it's going to be voted on at 6 PM EDT on Sat. And it will get an up or down vote. If it goes down, health care is dead. If Schrader wants to amend it, he needs to press for changes in the Conference report. But pulling this last minute obstructionism thing is simply sabotage, and nothing short of it. If Schrader wants to pass health care, and if he wants to keep his seat, he needs to get on the train, because it is leaving the station on Sat. evening.

Carla...I respect your passion. But it's a poor substitute for effectivness. This "my way or the highway" stuff will keep you marginalized, and while you may find a certain nobility in rejecting compromise...well, you seem to be what Lenin referred to as a "useful idiot". His words - not mine. I really don't know you at all. But I know that you are a shill for these ideas, and when it all comes to pass (a turn of phrase, not the actual bill) you will be left out in the cold. Many of us on the right can't stomach those on our own side that stand in the way of getting stuff done and being effective. You and they are two sides of the same coin, and you won't let facts or logic, or even a reasonable alternative come between you and your one-string banjo. Best of luck. You will need it. I hope you have a job skill that will give you access to health care...because I'm pretty sure you won't be getting it for just using up oxygen in the blogosphere. It's not an entitlement.

Bill R. "If Schrader wants to pass health care, and if he wants to keep his seat, he needs to get on the train, because it is leaving the station on Sat. evening."

2 questions: a) Do you live in the 5th Cong. District?

b) Who would you run against Kurt, and would you actively campaign for that person?

I've never agreed with the attitude of "vote the way we tell you to vote on this or we will forget we ever knew you".

I like the quote from Wayne Morse, "I will exercise an independence of judgement based on the evidence of each issue. I will weigh the views of my constituents and party but cast my vote free of political pressure and unmoved by the threats of loss of political support" which I can quote because it is on the wall of this room.

You may think Kurt is awful unless he votes the way you say he should vote. If you live in the 5th District you are welcome to find someone to run against him in the primary next year and we will see who wins.

I realize there are bloggers who think anyone whose views are different from theirs is odd. They have that right. But they have about as much chance of changing minds as the people who yelled in my ear decades ago because I had the "gall" to support a different point of view from theirs.

I happen to think it is possible Kurt knows more details than I do.

And I don't find this statement subversive, "That being said, he is a strong supporter of healthcare reform and continues to work with his colleagues to craft a final bill that accomplishes the two main priorities of healthcare reform: reducing costs for families, states, businesses and our overall economy while increasing access to high quality care. "

I have long said that those who say "I have concerns about this section of the bill" are better than the people who want us to agree that a bill is either "good" or "bad" and not ask for details.

Democrats used to be the party of nuance and details. If we are now to believe that loyal Democrats all say "the train is leaving the station, you had better be on board" (which many Democrats said of Mondale for President in early 1984) and not allow them to use their judgement and face the consequences if they can't explain their vote, I have better things to do than party politics.

Did anyone here read that NY Times article? Or do you know enough about the bill already and you don't want to learn any more?

@ LT

Yes, I live in Schrader's district. I'm not planning on running but if he votes with the Republicans to defeat the best chance in a generation to bring health care to nearly all Americans, then he has no business in Congress. And I will do everything as a common citizen to defeat him in the next election. Period

The time for nuance is past. The moment is now, just as when the moment came for Medicare or Social Security. The decision right now is primarily a moral one, and giving the excuse about bending the cost curve on this particular bill is so false as to be utterly dismissed. In large part because this bill, as you well know, will not be the Conference bill. So a vote against this bill is simply a vote to sabotage health care and the Dem. party and a betrayal to those who voted for him.

In summary your arguments hold no water at all, and your assumptions about the present context are utterly unreal. The comparison with the Walter Monday statement is absurd.

What's worse than Schrader sitting on the fence on the public option is his rejection of the Goldstone Report, in effect, covering up the crimes listed in that report.

The Senate probably won't take up health care reform until 2010 which of course means that nothing will pass due to the mid-term elections

The arguments that Medicare + 5% is bad for Oregon and the commensurate excuses just don't fly, IMO.

Carla, you usually post fantastically researched articles, but your response here is just poor. Have you talked with the folks at the Office of Rural Health Policy at OHSU? Have you talked with rural providers in Pendleton, La Grande, Klamath Falls, Medford, etc.? I have, and I come to the table with a little more than just my humble opinion.

Please, go talk to some rural providers doing primary care in the nether reaches of Oregon and ask them what their payer mix is and how Medicare rates are working for them. Or talk to the Oregon Office of Health Policy and Research and ask them about their annual physician workforce survey. The latest data I could find on their website was from 2006, but there's still some good stuff there. For instance, the % of physicians closed to Medicare jumped from 13% to 22% from 2004 to 2006, and a full 24% had additional restrictions on Medicare patients. In citing the main reason why physicians were closed to Medicare patients, 82% cited reimbursement rates.

Finally, can you tell me why we should get behind a bill that provides horrible incentives for the inefficient delivery of care in Florida and Massachusetts? A Medicare+5% PO would only encourage current bad behavior.

Do I hope that Schrader backs a health care reform bill with a public option? ABSOLUTELY. I just hope that it isn't a shitty PO that we had to push it through because "that's all we could get". In fact, I'd even go so far to say: I would support a Medicare+5% PO plan if the health care reform bill restructured Medicare payments to incentivize primary and preventative care, encouraged efficient states like Oregon and stopped subsidizing waste and inefficiency in heavyweight states like Florida & Massachusetts.

And as for why the rest of the delegation is on the wrong side: I've never been satisfied with assuming that something must be ok if everyone else is doing it. Lemmings ultimately follow each other off the cliff. I'm a proud Democrat, but I'm more than happy to call BS when necessary.

Scrhader's not bad enough to primary, but unless he can generate some enthusiasm for his work in office, he may well lose in the 2010 midterm. I've personally lost tolerance for crappy Dems, and don't care if they lose. This seems to be the only way to get rid of them. We can take the seat back when we find a candidate who has the ability to maintain political power while working effectively to advance our common fundamental agenda.

For this matter, once I discussed with one of my friends, not only about the content you talked about, but also to how to improve and develop, but no results. So I am deeply moved by what you said today.

I agree with Bill Bodden. There is no upside to US enabling of Israeli thuggery. Along with this war crime denial, the US has now dropped insistence that new illegal settlement building be stopped. The Goldstone report is not factually controversial - just politically inconvenient for Israeli supremacists.

Schrader exibited either a lack of knowledge, lack of concern, or lack of moral courage in supporting Resolution 867.

Jake, I thought this topic was about health care.

Interesting email this morning from 2 groups:

DFA:

"It appears Rep. Schrader is considering standing closer to Greg Walden than he is standing for real healthcare reform that would benefit Oregon families and small businesses."

and their fundraising email which says:

"The bad news is -- even though we're winning -- we could still lose.

All it would take is one senator in the 60-member Democratic Caucus to support a Republican filibuster and healthcare reform with a public option could be stopped dead in its tracks. We're not going to sit around and hope that it doesn't happen. It's up to us to be pro-active and stop a potential turncoat senator from killing President Obama's number one domestic priority.

Today, we join MoveOn members, in pledging support for a primary challenge of any Senator in the Democratic Caucus who supports a Republican filibuster of a public option."

Onward Oregon:

"Let Rep. Schrader know that we'll be standing behind him when he chooses to cast his vote for a strong public option that covers every American. " ..........

Onward Oregon sounds to me like a smarter approach than DFA.

At one time I had heard that the Senate might vote first because one of the lessons of 1993 was that the loyal House members cast really tough votes on some bills ---only to see the Senate vote against that language but then the vote was used against them in the next election and some of them lost their seats.

I want to associate myself with this comment from Lee Coleman: "And, incidentally, Schrader is most certainly NOT a crappy Democrat; he's a fine, decent Democrat in a difficult district. "

I'm one of those folks who spent 10 years trying to get rid of Denny Smith in the 1980s. Since then, we have only had one term of Jim Bunn to remind us what it is like to have a right wing Congressman.

I recall there were people here who didn't think Darlene Hooley was "pure enough" to suit them. But by golly, once elected, she was never defeated.

Call me what you want, but I don't think excessive certitude sells in the 5th District. If the Republicans are ever smart enough to run a "solutionist" (think the Gov. elect of Virginia) campaign about solving problems rather than preaching ideology, this could be a hotly contested district. I'm talking about the rural areas of this district and some of the city and small town dweller swing voters (I mean the folks who thought in 2004 that both GW Bush and Darlene Hooley were incumbents who deserved re-election)---if those voters were were undecided...

I think Schrader should do what he thinks is best, and if enough residents of the district don't like what he does they can challenge him in the primary or general with a candidate of their choice.

And I remember that not all the civil rights laws were passed the same year. Voting Rights Law was passed in the summer of 1964. Open /Fair Housing law was not passed for another 4 years. One of the Republicans who voted for that law was a former Evangelical Layman of the Year who was offended when Martin Luther King was killed and voted for the bill in tribute to Dr. King.

Read about that bill here: http://www.hud.gov/offices/fheo/progdesc/title8.cfm

"Jake, I thought this topic was about health care. "

True, but a little context is worth considering.

Now back to health care. It looks like those of us who were skeptical about multiple committees in Congress with many members funded by health insurance corporations could be proved right in our claim this exercise in Congress is mostly a charade.

I was watching the "tea party" at the U.S. Capitol on C-Span and thought what we need is a NON-partisan commission to investigate and develop a single-payer system for the more than half of the people who want it and leave the teabaggers and "freedom fighters" to the mercies of the insurance corporations.

LT wrote: Jake, I thought this topic was about health care.

There are times when one's attention should shift quickly. Fire, earthquake, tornado, and war crime denial are a few of these times.

I just called his Salem office where I was disconnected twice and then talked to a rude staff person who had no information about the bill or what was on the table as far as the various options. In particular I am interested in the Medicare +5% but the staffer kept repeating "I don't know I am in Salem and not in Washington" as if I was a complete idiot and didn't know I had called the Salem office. There really is no excuse for rudeness on the part of his staff. I hung up and called the Washington office and at least got a link to the information I was looking for although still not any information on the intentions of my Congressman.

@carla... This is the compromise bill???? WTF have you been smoking today. Like the Senate bill this was written and consulted on by DEMOCRATS only.. how in the hell does that make this a compromise bill. You and people like you are complete idiots. You would rather get something done rather than do the right thing. I doubt rewriting 1/6th of our economy can be done so swiftly without taking the cause and affect into consideration. What's the rush??? are you all really that afraid of 2010 midterms that you are willing to screw EVERYONE including yourself?

John: The previous bill had a more robust public option. This was the compromise. We saw today where the House GOP wants to go with "reform"...or did you miss it?

No Carla I din't miss it. It's called HEALTHCARE REFORM.. NOT HEALTHCARE TAKEOVER.

Oh and if a quote from a screaming Lib is worthy of political backing then this is the house of falling cards that I have entered.

Steve, what district do you live in? How many Dems vs. Rs vs. NAV/ Independents and other major parties?

Over on "What did the independent vote tell us" topic was this piece of wisdom:

Posted by: Buckman Res | Nov 5, 2009 7:47:43 PM

...bringing health care reform closer to reality?”

Health care reform?! Are you serious? The bills up for consideration now do absolutely nothing to curb the costs of medical procedures or hospital stays.

Call them the “Health Insurance Industry Stimulus Bills” for how they will line the pockets of insurers by mandating coverage.

If this is the best the Dems can do I can see why there’s populist anger in the air.

And Lee, about this:

"Rep. Schrader called me a few days ago. First thing out of my mouth was "I do hope you're going to vote for a robust public option." His reply was concern about the cost. My suggestion is that once the financing issues are settled (and I told him that the House provisions were better because they enable him to tell constituents that he voted to avoid taxing middle class and unions), we should concentrate our efforts on asking Merkley and Wyden to lobby Schrader. Those two can do far more than we can. The main thing is to show Shrader that a vote for a PO will NOT hurt him in 2010. "

All due respect but both our US Senators live in Portland, although Ron understands the rest of the state pretty well from all those years of town hall meetings in every county every year.

I heard Ron on the Ed Schultz Show the other day. He spoke of going into town hall meetings where people carried signs advocating public option and breaking the news to them how few of them might actually qualify for that. There has been some discussion of what the premiums for the public option might be--starts out federally funded, becomes a nonprofit, can never be bailed out and if that means having to raise premium rates so be it.

Without cost containment, can anyone here say for sure that they know what the differential between public option premiums and private insurance company premiums will be in 5 years? Or does that not matter because this is all about taking one for the team and voting for something one might have qualms about just so there can be a "win"?

Look into the Catostrophic Care fiasco when Rostenkowski was still a powerful congressman. It passed, people realized that the benefits would not arrive right away but the cost would, and Rostenkowski ended up being mobbed when he went home to his district. The bill ended up being repealed.

I believe unintended consequences are possible for any complex bill.

<<

"I believe unintended consequences are possible for any complex bill. "

Same for any bill that is a hodge-podge of different bills from different babbling committees. Just the way the insurance corporations wanted (and possibly planned) it to be.

I'm really very useful to follow a long-time see this as a blog here Thank you for your valuable information I'd love to take one of those for a spin. We need a lambo rental service in Pittsburgh. Any takers. Thnx for the interesting post.I found it very useful for myself.Keep writing. saç ekimi laptop

<hr/>