Dear Senator,
I know you’re in a tough spot. It would be bad enough if you only had to get Ben Nelson, Evan Bayh, Mary Landrieu, and Blanche Lincoln on board, but anyone who has to kiss Joe Lieberman’s derriere deserves a congressional medal of honor.
But Harry, you really need to take on future health-care costs. The House bill fails to do this. The public option in the House bill is open only to people without employer-provided health insurance. That will be too small a number to have bargaining clout to get good deals from drug companies and medical providers. And it will mainly attract people who have more expensive medical needs, which is why the Congressional Budget Office decided it would cost more than it would save.
You also know a public insurance option that’s open to everyone would cut future health costs dramatically by imposing real competition on private for-profit insurance plans. That’s why the private insurers hate the idea. Even if states were allowed to opt out of this robust public option, the big states would almost certainly opt in, giving it the scale needed to negotiate great deals from drug companies and medical providers. This would put pressure on any state that opted out because their citizens would soon discover they’re paying far more.
In addition to the House’s weak public option, the deals the White House and Max Baucus made with the drug companies and the AMA will force Americans to pay even more. If, on the other hand, Medicare were allowed to negotiate lower drug prices, biotech drugs weren’t granted a twelve-years monopoly, and doctors had to accept Medicare reimbursements in line with legislation enacted years ago, Americans would save billions.
You know all this but you’re also trying to get 60 votes in order get any bill to the floor. You have my sympathies, but unless you get these reforms into the final Senate bill you’re not really helping most Americans afford future health care.
So what do you do?
First, try for the “reconciliation” process, which requires only 51 votes. Every one of the reforms I mention above would fit under the Byrd rule.
If that doesn’t work, wrap these reforms together — a public option open to everyone (allow states to opt out of this if they dare), Medicare-negotiated drug benefits, no 12-year monopoly for new drugs, and a major squeeze on Medicare reimbursements for doctors — and have CBO score the savings. I guarantee you, the number will be large. Then you should dare anyone, Democrat or Republican, to vote against saving Americans so much money in years ahead. How is Ben Nelson going to face voters in Nebraska who would have to pay, say, 20 percent more for health care in the future if Nelson refuses to go along?
If neither of these tactics work, then take whatever bill you must to the Senate floor. But then introduce this reform package as the very first amendment to the bill. Call it the “Ted Kennedy Amendment for Helping Middle Class Families Afford Health Care,” and whip the hell out of the Democrats. Get the President to help you. Surely Joe Biden will. If you can’t get 51 votes out of Dems for this, publish the list of Dems who vote against it, strip them of their committee chairs or sub-chairs, and make sure the Democratic Senate Campaign Committee gives them zilch when they’re up for re-election.
Nobody promised you this would be easy, Harry. But, hell, why are you there, anyway? Your responsibility isn’t just to pass whatever will muster 60 votes and that the President and Dems can later call “health care reform.” It’s to do the right thing by the American people and bring down future health-care costs. Don’t cave in to Lieberman or Nelson or the drug companies or the private insurers or the AMA or anyone else. Lead the charge.
All best.
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The solution that Mr. Reich proposes is elegant–in every sense of the word.
Thank you.
“a major squeeze on Medicare reimbursements for doctors ”
This would be the final move to kill primary care in America, a profession that is already in a shortage. Family doctors and general internalists see 20-25 patients a day already just to make enough to pay back the high costs of a medical education. Decreasing reimbursements for doctors only harms the quality of medical care, as they are forced to work longer hours and treat more patients.
Unless we overhaul the fee-for-service system entirely (as we should but won’t do) or increase payroll taxes (as George H.W. Bush did and was vilified for), Medicare will go bankrupt in a few decades.
Daniel Habtemariam
As a person on Medicare and Medicare Plan D I can tell you Harry has done nothing to help us. I realize the “cuts to Medicare” are supposed to come from unnecessary spending, i.e. $2000 wheel chairs, etc. But when did the Congress ever cut any excess spending? They will cut the amount doctors are paid, forcing doctors to cut their Medicare patient numbers even more. Forcing nursing homes to cut the number of beds they designate especially for Medicare and Medicaid patients. They say that Plan D will cover half the cost of brand medicines, which they won’t pay anything for now. I am not going on a starvation diet waiting for it to happen. Out of 5 medications I take two that are under $30 and Plan D is raising my share of the cost to 45% in 2010. They advertise $5 for a prescription? I have never only paid $5. All the other prescriptions I take are over $100 and up to $225. Plan D pays nothing for them.
Now Harry claims I will be able to get free colonscopies and physicals. Yea, if I downgrade to Medicaid and go to the mall to get them. Easy for him to say because I will always to paying for him to get the best medical care he can find. It has come to my attention that DC does not think I am entitled to equal care. Candidate Obama promised over, and over, and over that he would give us the same medical care that all government employees including Congress and the president get. You never hear about that anymore. I could afford to buy into the government plan just from the amount of money I am spending being nickled and dimed to death every month with the plan developed out of the kindness of the governments heart for me.
Until you have been in our shoes you will never understand why people give up food, cloths and move into substandard housing in order to survive the good deeds we receive from the United States government after reaching 65 years of age.