Ladies and Gentlemen, We Have a Bill

by Tim Foley

categories: Enemies of Reform, For Profit Insurance, National Health Exchange, Obama and Congress, Public Plan

Published June 09, 2009 @ 04:00PM PT

Technically speaking, the dropping of one bill isn't a huge change in affairs.  After all, as I previously wrote here, here, here, here, here and here, there have been dozens of health care bills introduced in either the House or the Senate already this year.  Many of them are slated to go to the dustbin of history -- or at least recycled as campaign plans for the 2010 and 2012 elections. What's different about the big doings in Congress today is that these are moves that are being taken with full leadership support and involving many of the brand names in progressive politics.  Although that's no guarantee for success, there's no question we've entered the next phase of our national debate.

Suffice to say, it only gets rougher from here.

With that said, here's a breakdown of the four big things happened in Congress today:

1.)  The Senate Health, Education, Labor and Pensions Committee unveiled a full draft of its bill.

Weighing in at 615 pages, this is the foundation for the weeks of work that will follow, including hearings, mark-up, committee votes and eventually being sent to the Senate floor, where it will intersect with a parallel bill coming out of Senate Finance.  We don't know when we'll see Ted Kennedy, but we do know that Sen. Chris Dodd (pictured) has been the Riker to Kennedy's Picard to date, and has been the man in front as this bill has been released.

I'm not going to get into the weeds just yet because it appears to closely track to the principles document released earlier by Sen.  Kennedy.  Also, let's face it, I can't read 615 pages that fast, even if the font is pretty big.  But one thing that struck me about the press release was how strongly the committee, speaking through Sen. Mikulski, is focused on improving the quality of care.  "A national health care quality strategy will provide solutions to the biggest problems - medical errors, preventable hospital readmissions and failure to manage chronic disease - that severely impact people, their lives, their checkbooks and national health care costs. Emphasizing quality improves lives, saves lives and helps pay for reform by saving money."  (italics mine)  Given the obsessive-compulsive need for those in opposition to reform to warn that messing with health care reform will inevitably lead to degrading the quality of our current 37th-in-the-world system, this is an important argument for reform - and one we don't hear enough.

2.)  The House Tri-Committee releases its principles for reform.

They're referring to the combined leadership of the Ways & Means, Energy & Commerce, and Education & Labor Committees as "The Tri-Committee."  Today, similar to the draft of principles circulated by Kennedy and the HELP committee about two weeks ago, the Tri-Committee began circulating its own public set of principles.

There's not a lot surprising in here.  Indeed, the surprise for some, like Bob Laszewski, is that "Those who thought the House would come up with an unrealistically liberal proposal need to think again."  The devil is in the details, but these principles fit nicely into the contours of what's being worked on in the Senate.  Most news accounts immediately leaped to the public health insurance option, which sounds a lot more like the Schumer "compromise" version than the more robust, Medicare-based public plan in the HELP bill:  "The public health insurance option is self-sustaining and competes on 'level field' with private insurers in the Exchange" - self-sustaining doubtlessly meaning supported by premiums and the same subsidies that are available to private insurance plans participating in the Exchange.  Oh, and about that Exchange, the House may be positioning itself as the compromise between what's likely to come out of Senate Finance (one national Exchange for everybody) and Senate HELP (state-based exchanges, set up with federal dollars and guidelines but customizable by the states).  The House principles document recommends a National Exchange, but "permits States the option of developing a State or regional exchange in lieu of the national Exchange."  Similarly, the House is looking at 400% of the Federal poverty line as the cutoff for subsidies, rather than the 500% sought by Senate HELP, although the House draft does a much better job explaining the context for that benchmark:  "(NOTE: The average cost of family coverage today is 14% of a family's income at 400% of poverty.)" (italics in the original).

There are plenty more hints on workforce development, prevention, insurance regulation, employer pay or play, and fixing the delivery system to deliver better quality, but of course the big news is that there isn't news.  At first glance, it suggests the leadership of the House and Senate efforts continue to move in tandem.

3.)  House Republicans say health care reform will steal all the covers, hide your keys, and leave the toilet seat up

Starting with Rep. John Boehner, a parade of Republican representatives took the House floor to denounce progress on giving every American quality, affordable health care.

And honestly, I can't be buggered to write more than that.  It was nice of the House Republicans to demonstrate months ago that they could all vote against a bill and it would still pass - saves me a lot of time.  Suffice to say, we got to hear an awful lot about Canada (which would make sense if either the House or Senate leadership were proposing something based on Canada), scary stories, how trying to solve the crushing burden of health care costs constitutes a war on the middle class, and a lot of other claptrap syllogisms you've already heard a gazillion times.  I suggest you grab yourself a Frank Luntz Bingo card and craft your own speech.  Just remember - House rule is 5 minutes or less.

4.)  House Blue Dogs ponder, "What the hell did we just do?"

The way it's supposed to work is that House Democrats and leadership support something, the Blue Dogs - a coalition of fiscally conservative Democrats - send out a release saying, "No way, Jose," the media frets about internecine brawling over the deficit, everyone gets to go on TV, and the folks back home cheer their members of Congress for weakening whatever social program was discussed in the name of fiscal conservatism.

This time around, there's been some backlash to the Blue Dogs declaring that they only wanted a public health insurance option with a "trigger" - delaying its implementation for years to see if we can trust private insurance to clean up the mess they helped create.  That could be because prominent Blue Dogs like the popular Rep. Patrick Murphy - the first Iraq War veteran in Congress -- immediately distanced themselves from the Blue Dog stance.  That could also be, because, you know, 20 out of the 51 Blue Dogs had publicly signed a pledge saying they supported giving people a choice between public and private plans.

Now, we're seeing quite a bit of equivocating on what exactly the Blue Dog principles meant to avoid the "Liar, Liar, Pants on Fire" charge.  Ryan Grim of Huffington Post quotes on Blue Dog staffer as saying, "The sense in the room when these principles were drafted was that the coalition was shooting a bit past where they want to end up."  Oh, I see, so that statement of principles was a negotiating tactic?  Another aide chimes in, "The principles laid out last week are just the beginning of negotiations, the aide said, and an attempt to hold the industry accountable for its pledge to trim $2 trillion from health care spending."  Oh, I see, you're trying to pull a fast one on the health care stakeholders.  Well, I gotta say, your original intentions were so well-hid, they were practically opaque.

But that's Congress for you.  Bits of progress amidst the sound and fury.

(Photo credit:  SEIU International on Flickr.)