Subject: [big campaign] New Huff Post from Creamer - What Next for Health Care Reform
From: [email-masked]
To: [email-masked], [email-masked]
Date: Wed, 23 Dec 2009 13:26:36 EST
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What Next in the Battle for Health Care  Reform? 
The expected Christmas Eve Senate vote to pass a health care reform bill  
will be a remarkable, historic event.  Given the power of the economic forces 
that have been hell-bent on  stopping health care reform dead in its 
tracks, it is extraordinary that  Democratic Majority Leader Harry Reid could 
cobble together 60 votes – every  Democrat – to pass a health care reform bill. 
That vote opens the curtain on the last act in this drama.  The House and 
Senate bills will now be  merged and a final product will – hopefully -- pass 
and be signed into law. But  like most dramas, the last act – more than any 
other – will tell us how the  story turns out.  
Seven key points: 
1). The odds are not good that a public option – or Medicare buy-in –  
will be part of the merged bill.  That is a shame.  To change  the power 
structure – and the economics -- of the health insurance industry in  America, a 
public option of some sort  is a must.  Two weeks ago we  came very close to 
getting at a “Medicare buy-in” provision for people between  55 and 65 
years old.  That deal  would have opened the door to allowing everyone to “buy in
” to Medicare – which  in my view is the absolutely best alternative for 
the future of health insurance  in America.   
That, of course, is precisely why Senator Joe Lieberman betrayed the  other 
members of the Democratic caucus and his original support for the Medicare  
buy-in.  The insurance industry  thought that – this time at least – they 
had the cards to prevent any form of  public option.  For the short term,  
they are likely to be right.  But  don’t bet against the public option being 
off the radar for long.   
In a system where everyone is required to buy health insurance, the  
pressure will grow to assure that people have a choice other than the  private 
insurance industry. I predict that before the health insurance exchanges  in 
this bill go into effect, a public option of some sort – and preferably the  
option for everyone to buy into Medicare – will be one of the choices.  
2). Even though a  public option is not likely to be part of the final 
bill, the bill will  represent an incredibly important step forward for our 
country and especially  the millions of ordinary Americans who have no health 
care coverage, or teeter  on the brink of losing their health care coverage 
every day.   
Among other things the  final bill will almost certainly: 
·       Make health care a  right for every American. 
·       Eliminate the insurance  industry’s ability to deny coverage to 
those with pre-existing  conditions. 
·       Eliminate the insurance  industry’s ability to cut people off once 
they get sick. 
·       Create a requirement  that insurance companies spend at least 80% 
to 85% of their revenue on providing  medical care – not administration, 
advertising and profits and CEO salaries.  
·       Make the health  insurance market more competitive – and reduce the 
ability of the insurance  industry to make massive, semi-monopoly profits. 
·       Put in place a whole  battery of consumer protection regulations 
that will help rein in the health  insurance industry. 
·       Eliminate almost a  half-trillion dollars of taxpayer subsidies to 
insurance companies that manage  so-called “Medicare Advantage Plans” -- 
subsidies that the government has paid  over and above the cost of providing 
these same services directly through  Medicare. 
·       Provide subsidies to  millions of Americans who cannot currently 
afford health insurance. 
·       Control health  insurance premiums. The Congressional Budget Office 
has estimated that all of  these provisions will begin to bring down health 
insurance premiums for many  Americans. 
3). The House/Senate negotiations will determine just how good the bill  is 
at achieving these goals.  It  will determine in particular how affordable 
health insurance is for tens of  millions of people, and whether companies 
have a responsibility to contribute to  provide coverage to their workers.  
4). Most crucial, the House/Senate negotiation must solve two problems  
that will determine whether huge blocks of Americans think health care reform 
is  a success or a failure.   
The first of these problems is a Senate provision that would tax  so-called 
“Cadillac health plans.”  The notion that the best way to control health 
care costs – or pay for  the bill – is to tax the insurance premiums of 
ordinary workers makes no sense  whatsoever.   
Some believe that this health care “excise tax” would somehow “bend the  
cost curve.” In fact, it would simply shift who pays for health care from  
employers to employees by encouraging companies to scale back their health  
insurance plans and leave larger gaps for individual employees to cover on 
their  own.  
The very notion of “Cadillac plans” make no sense.  The quality of these 
plans is being  measured by price – not by the coverage offered.  Washington 
Post business columnist Alan  Sloan noted last week that members of the 
Senate are currently covered under the  Federal Employees Health Benefit 
Program, where the average age of a  policyholder is 46 years old. It costs $6,971 
for individuals and $16,124 for  families in 2010. That’s well below the 
current proposed threshold of $8,500 for  individuals and $23,000 for families 
in so-called “Cadillac Plans,” which would  be subject to an “excise tax.” 
 And  while it is a good plan – it isn’t a “Cadillac.”  It is about the 
same as the  run-of-the-mill plan currently offered by many employers to 
their employees.  Maybe a fancy Chevy. 
But what if the Senate – average age of 63 – had to buy coverage like  
many other groups of 100?  Then the  same coverage would cost about $14,000 for 
individuals, and $32,000 for families  – and would be taxed as a “Cadillac 
Plan.”  The Chevy miraculously becomes a “Cadillac” just because the 
people  covered get older.  You could  actually argue that the “excise tax” is 
an “older-sicker-workforce” tax.  
Truly “bending the cost curve” requires eliminating the massive waste of  
insurance company profits, marketing costs and the millions paid to CEO’s 
and  other executives; cutting the cost of pharmaceuticals so that Americans 
don’t  continue to pay much more than everyone else in the world for the same 
products  – and changing the health care delivery system so that it pays to 
keep people  well, not for every procedure or patient visit.  
No, the last thing we need to do is to raise the cost of health care for  
many average Americans by taxing their benefits.  And from a purely political 
point of  view, if this health bill taxes the benefits of a large number of 
ordinary  Americans, the Republicans will make that the signal issue that 
they pound home  in swing Democratic districts next fall.  
5). The second critical problem to be solved centers around women’s  
reproductive rights.  No one expects  the final health bill to reinstate public 
financing for abortion.  But it cannot do anything to strip women  of their 
hard-fought right to pay for abortion through private health plans. The  
current House version of the bill is actually more restrictive than the Senate  
version.  But the final version must  been carefully drawn so that it does 
not curtail a woman’s right to obtain  insurance that covers reproductive 
health.  
It is one thing if we don’t get everything we might want out of the  health 
reform bill – if, as Senator Tom Harkin says – it’s a starter house that  
can be expanded.  It would be quite  another of large groups of everyday 
Americans actually lose ground – either  through having their benefits taxed, 
or because their reproductive rights are  compromised.  
6). In the weeks ahead the Republicans, the insurance industry and  Chamber 
of Commerce will make a last-ditch effort to kill reform.  They will launch 
a fusillade of  advertisements and mobilize their Tea Party allies to 
frighten swing Members –  especially in the House.  Progressives have to brace to 
defend Democratic members from these  attacks, or there is still a very 
real possibility that the effort to pass  health care reform will be stopped 
just feet from the finish  line. 
Just remember the last scene in the classic film Fatal Attraction where the 
Glenn Close  character lies unconscious – and apparently drowned in the 
bathtub – but  suddenly springs from the water and almost does in Michael 
Douglas and Ann  Archer.  It ain’t over ‘til it’s  over. 
7). I think it would have helped President Obama’s standing with his  
political base – and swing voters – had he more forcefully advocated for a  
public option throughout the last months.  But I don’t agree with those who 
think the shape of this bill would have  been materially different.  He could  
have chosen to pass a narrower bill – that might have included a public 
option,  but no insurance regulation or exchanges – through the process of budget 
 reconciliation.  That would have  allowed him to pass a bill in the Senate 
with 51 votes.  But to pass comprehensive reform through  the regular 
Senate order – given the archaic 60-vote filibuster rule – his more  vigorous 
advocacy for the public option would have made little difference.   
It was Joe Lieberman that ultimately called that shot, standing firmly  for 
the private insurance industry -- standing against the majority of  
Americans, Democratic Caucus and the President -- and betraying his fellow  
Democrats. That, by the way, is why the rules of the Senate that empowered  
Lieberman must be changed. 
And those who are critical of the President need to remember two other  
things.  First, it appears that he  will actually pass health insurance reform –
 a monumental achievement that has  eluded Presidents for more than half a 
century.  It’s easy to criticize.  It’s not so easy to actually get things  
done. 
Second, he  didn’t have to take on this big challenge – or any of the 
other fundamental  issues on his legislative agenda.  Barack Obama believes in 
making fundamental change and though some  Progressives may question his 
strategy or tactics at any given time, it is hard  to imagine success for the 
progressive cause that does not also require that  Barack Obama be successful 
as well.  
Robert Creamer is a long-time  political organizer and strategist, and 
author of the recent book: “Stand Up  Straight: How Progressives Can Win,” 
available on _amazon.com_ 
(http://www.amazon.com/Listen-Your-Mother-Straight-Progressives/dp/0979585295/ref=pd_bbs_sr_1?ie=UTF8&s=books&qid=1206567141&sr=8-1
) . 

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