Why those sneaky progressives, playing a little chess after all.

[grantcart]

So Senator Saunders, Rockfeller, Feingold, Durbin, Kerry, Levin, Franken and Sherrod Brown all for it. Kennedy's family says he would have supported it.


In the House the Progressive Caucus the Black Caucus among many others saying they won't vote for a bill without the Public Option are strangely quiet.


So what could be in the bill that push every Republican against it. I mean Senator Snowe - it no longer has the public option why are you still against it?



IMHO there are the tools to make Orin Hatch's apocalyptic predictions true, even without the public option.


Hint 1) http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=389x7264604


Hint 2) Tommy Douglas



After finishing the entire managers ammendment report I'll give my guess why all of these progressives are voting for this bill with Cheshire grins on their faces.

[saracat]

1. Let us hope so but I don't really believe it.False hope at this point, IMHO.

[grantcart]

6. so you have read either the bill or the manager's ammendment?

[saracat]

11. Read the proposed Bill

[grantcart]

16. Have your read the manager's ammendment?

[saracat]

17. Got a Link? I'll read it.

[grantcart]

20. sorry should have included it in the OP

http://democrats.senate.gov/reform/managers-amendment.pdf

[saracat]

24. Thank you. I skimmed it and mostly it is a rehash of things already in existence that haven't been

enforced and won't be by this bill either.We already have a patrient's Bill of rights that isn't enforced at all. The opt out is horrendous and this is still offereing us nothing for our mandate and leaves us much worse off. Sorry.I will read it in further depth when I have more time but I don't see anything wonderful in this bill yet.

[cliffordu]

30. Reading that stuff makes my ass hurt.

[billyoc]

37. You're Doing It Wrong.

:rofl:

[cliffordu]

38. I wondered about that....

:rofl:


Yo!! Billyoc!!! howearya??? Ain't seen you around these parts in a while....

[billyoc]

41. I'm good, looking to get this HCR bill fixed/killed soon.

I forget which side I'm on at this point. :crazy:

[cliffordu]

44. Fock, me too....For an hour I think it's great....then I completely

switch over to the 'fuckthisbillican'tstandwhatthefucktheyaredoing"

:silly: :argh:

[Hutzpa]

31. so far so good

‘‘(4) LIMITATION ON DETERMINATION OF PRE18
MIUM RATES OR ELIGIBILITY FOR HEALTH INSUR19
ANCE.—A premium rate may not be increased,
20 health insurance coverage may not be denied, and a
21 discount, rebate, or reward offered for participation
22 in a wellness program may not be reduced or with23
held under any health benefit plan issued pursuant
24 to or in accordance with the Patient Protection and

[Phoebe Loosinhouse]

2. The medical loss ration is 80/85 in the Manager's Amendment. nt

[grantcart]

8. close but no cigar your statement is not 100% correct

[phleshdef]

3. Yea, when I read some of these regulations, I almost think they created a backdoor to nationalizing.

...the health insurance companies, or at least damn near.

[havocmom]

7. Hope so

otherwise, we are serfs to Wall Street via Big Insurance. And DEMS fall from power and remain so for ANOTHER generation or so.

[HughMoran]

4. Interesting

I know many of us are wondering what is going on. Very rarely is the bulk of DUs most progressive posters apoplectic about a particular political action by Democrats while nearly all progressive Dems are mum or supportive of such measure. I guess it's a wait and see - I'll look for your follow-on post.

[DJ13]

5. Frankly I dont care about the politics of this bill

I care about whether this bill serves the original purpose of trying to reform the system.

Does it make health care (and insurance) affordable enough so it will help those who have already decided they cant afford to buy insurance in the current system?

Will it cost the average american too much in the midst of a serious recession?

If the answers are no or even maybe.....it will be a success sometime in the future after we tweak it.......its a failure.

And for those concerned about the politics of this, if its a failure so is this party in future elections.

[grantcart]

10. The bill will

1) save lives

2) reduce costs

3) create the potential for us to move to single payer.

[DJ13]

19. 4) cost millions of americans money they dont have in this economy

Which gets back to the political cost to this party in future elections.

Seriously, you people behind this havent thought this through, and millions of people arent going to look at the Democratic Party as their savior when they're paying premiums they cant afford.

[cliffordu]

32. I think you have been snowed about this

Still lots of room for subsidies and tax credits for the folks it'll hit too hard.

They aren't stupid, they have to get elected again.

[DJ13]

33. They aren't stupid, they have to get elected again.

Ask the Dem Congress in 94 about that.

[cliffordu]

35. What caused the meltdown in 94??

[ChimpersMcSmirkers]

34. Thank you for this dose of sanity.

[Cronus Protagonist]

51. lol

1. Doubtful.
2. To whom? The insurance industry, sure.
3. Total bullshit.

[Oregone]

9. Tommy Douglas would shit on this bill

Are progressives voting for this bill, or the continued existence of the Democratic Party? Its a complicated question that we don't really know the answer to.

[grantcart]

14. This bill is consistent with Douglas' SHA and HIDS and the 5 pillars of CHA

[Oregone]

23. LOL. Sure. Canada will be chomping at the bit to follow the US example now too!

Theyll have to forget about it being publically ran though

[grantcart]

26. But Canada didn't start with what they have today

Now you can have an intelligent discussion about how National Health Plans evolve or you can make scatalogical references to where Tommy Douglas defecated.


The choice is yours.

[Oregone]

27. Haha...and this is on the pathway to single-payer. Right-o! Just like Canada!

Bizzaro world is a fun place to visit, but I wouldn't want to live there.

[Zodiak]

12. I think this logic is a stretch too far

If all you do is look to leaders positions and take those same positions, then you are not doing any thinking yourself. It is deciding issues only by argument by authority, which is a logical fallacy.

There is this thing in the Democratic party calling "whipping"....getting votes in bloc and staying on message.

How do we know if these Democrats are behind this truly of their own volition, or they have been convinced this is the best political outcome by their advisors and must bite the bullet? Some have done a complete 180 turn for their own positions just a week ago...to me that is evidence of being "whipped", not sly like a fox.

The answer is, we don't know what is in ANY pol's head.

Which is why we do not use argument by authority in the absence of any real proof.

The MLR will be 80%,85%,or 90%, and the cost plus argument has not been countered effectively. Plenty of Democrats have been spinning this bill rather than being honest about pros and cons. Then there is the sunset provision argument, also a wild card.

The ONLY prudent thing to do for a grassroots progressive is to weigh the evidence and decide for yourself. Looking to leaders is too trusting for me, and logically fallacious...even if it makes one look and feel "loyal".

[grantcart]

15. The cost plus argurment is contained in the manager's ammendment

I have the page before me now.

[Zodiak]

42. Please link it

Because I do not have it before me

[Zodiak]

45. Forget it....found a summary from "The Hill

http://thehill.com/homenews/senate/73057-final-senate-health-bill-released-by-reid-in-drive-for-60


Here is a good thing I saw

"Reid retained one proposal that emerged from negotiations between liberal and centrist Democrats: the creation of multi-state, nonprofit health insurance plans that would be negotiated by the federal Office of Personnel Management, which manages the Federal Employees Health Benefits Program, as an alternative to the traditional insurance plans that would be offered under the bill."

Of course, the CBO does say the idea may not be effective:

"The proposal would call on OPM to contract for two national or multi-state health insurance plans—one of which would have to be nonprofit—that would be offered through the insurance exchanges. Whether insurers would be interested in offering such plans is unclear, and establishing a nationwide plan comprising only nonprofit insurers might be particularly difficult. Even if such plans were arranged, the insurers offering them would probably have participated in the insurance exchanges anyway, so the inclusion of this provision did not have a significant effect on the estimates of federal costs or enrollment in the exchanges."

http://www.cbo.gov/ftpdocs/108xx/doc10868/12-19-Reid_Letter_Managers.pdf



But the MLR issue is still raging

From Franken, a couple of weeks ago

"There was a time, in the early 1990s, when health insurance companies devoted more than 95 cents out of every premium dollar to paying doctors and hospitals for taking care of their members. No more. Since President Bill Clinton's health reform plan died 15 years ago, the health insurance industry has come to be dominated by a handful of insurance companies that answer to Wall Street investors, and they have changed that basic math. Today, insurers only pay about 81 cents of each premium dollar on actual medical care. The rest is consumed by rising profits, grotesque executive salaries, huge administrative expenses, the cost of weeding out people with pre-existing conditions and claims review designed to wear out patients with denials and disapprovals of the care they need the most.

This equation is known as the medical loss ratio (MLR), an aptly named figure that is widely seen by investors as the most important gauge of an insurance company's current and future profitability. In a private health insurance industry that collected $817 billion this year, a 14 percentage point difference in the MLR represents $112 billion a year! Over 10 years, that would be more than enough to pay for health reform. "

http://thehill.com/homenews/senate/73057-final-senate-health-bill-released-by-reid-in-drive-for-60

This would allow companies to pretty much continue like they are MLR percentage-wise.

Now when you say the cost-plus argument was foiled.....was it foiled by this part of the original article I cited:

"A group of freshman Democratic senators, many of them also centrists, won the inclusion of more aggressive cost-containment measures based on those already in the bill. Under the manager’s amendment, cost-containment pilot projects would ramp up more quickly and the Department of Health and Human Services would have greater authority to expand those programs without additional legislation."

This does not say anything about what jurisdiction these pilot programs will have. Do they oversee the insurers directly to keep costs down?

I am not sold on how we can stop the health insurance companies from getting around the MLR by just increasing premiums and paying for more services so they can skim their 20%. And I also still think 20% is still too high when the historical rate was 5% before the 2000s and everything started falling apart. On that point, I disagree with the CBO.

[Parker CA]

13. K&R because I want to hear your follow up thoughts.

[tridim]

18. I bet Collins and Snowe end up voting aye on the final bill.

I'm not so sure about Holy Joe.

[grantcart]

22. Snowe gave a blistering attack on it today on MTP

None of it on the substance of the bill mind you but that they were "rushing this through", this after the fact that she and Grassley dragged this out for months with faux negotiations.


She got what she wnated - no public option - and still is against it.

[ShortnFiery]

21. No more chess analogies. The Insurance Cartels and Big Pharma will RULE with this trash. eom

[flamingdem]

25. k+r

[Kurt_and_Hunter]

28. Ezra Klein piece said the final bill has MLR 80% and 75%

(I don't know if that's true. Just what I read yesterday.)

I am leery of any scenario predicated on the insurance industry not recognizing the $ significance of something and doubt that Lieberman would support anything they see as a major threat.

I also see sufficient reason for elected progressives to be quiescent... they are as committed to any-bill as anyone else, IMO. When we reach a point where they lose all practical leverage they turn around and support. Seems like normal legislator behavior to me. Do what you can to shape the bill then fall in line when you can do no more.

It's not that I am disagreeing with you so much as I don't know what you're suggesting. Perhaps you could flesh out your thinking more?

[cliffordu]

29. Nice. Link to your own work...

:rofl:

Great stuff, K&R....


And I think you're right.....

[Pirate Smile]

36. If the Conference Committee uses the a high% MLR , CBO has already

said that effectively the government has taken over the industry.

The final bill can have no PO or Medicare-Buy-In but if the MLR is very high, Insurance Co's can't be huge profit makers.

Is this what you mean?

:)

Article on this issue:

Senate deal would knock health insurer profits

WASHINGTON/NEW YORK (Reuters) - A potential Senate health reform deal to force private health insurance companies to spend at least 90 cents of every dollar on medical costs would squeeze the industry's profits and shake up the way they do business.
Such a requirement may be a longshot to be enacted in Congress' final health reform legislation, but analysts say it would send shockwaves through the stocks if it became law.

The proposal, announced this week as part of a compromise between liberal and moderate Senate Democrats, would tighten rules on how insurers spend customers' premiums on doctor visits and hospital bills versus advertising, profits and salaries.

While few details emerged, the change to so-called medical loss ratio (MLR) stands to force insurers to make significant cuts to their operations.

"The bigger concern is whether private companies can even meet an 90 percent MLR and still function," said John Shepard, a senior healthcare analyst at Washington Research Group. Money not spent on care is critical not just for profits but also overhead and advertising against competitors, among other business costs.

President Barack Obama has made passing legislation to overhaul the nation's healthcare system a top priority, and Democrats have made the health insurance sector at top target for reforms.

Health insurers already would face a number of new constraints in the overall health bill, including an end to denying customers over pre-existing conditions as well as a ban on how much care patients can have covered in a lifetimes.

But the latest deal would cause a major shift. While most insurers see the bulk of their revenues from customer premiums, a few such as UnitedHealth Group Inc have other service businesses. Other health insurance companies include Aetna Inc, Cigna Corp, Humana Inc and Wellpoint Inc

"It would require a significant restructuring of how the current health industry does business," said Jason Gurda, a healthcare equities analyst at Leerink Swann.

Medical loss ratios are closely watched barometers on Wall Street. Fluctuations in the ratios may signal significant changes in profitability for a company.

When companies report quarterly results, it is not uncommon for a stock to sink if an insurer's medical loss ratio is higher than expected, meaning that medical costs ate into premiums more than projected.

A 90 percent MLR would significantly threaten profitability and curtail the insurers' ability to invest in areas such as technology to coordinate better medical care, Edward Jones analyst Steve Shubitz said.

"It's another way of basically saying there's a cap on your profitability, and no industry wants to operate under those conditions," he said.

The industry maintains that health insurers profits are far less than those seen in other healthcare sectors such as pharmaceuticals and cites disease management and other programs aimed at improving patient health as significant costs.

"While the expenses associated with these strategies are technically accounted for in administrative costs, they directly improve patient health outcomes and, ultimately, help reduce overall costs," America's Health Insurance Plans spokesman Robert Zirkelbach said earlier this week.

Analysts say private insurers currently spend roughly 80 to 85 cents on the dollar on patient care but that has fluctuated over the years.

The government-run Medicare and Medicaid insurance plans for the elderly, disabled and poor have spent about 90 cents and 87 cents on the dollar respectively, said Shepard, but "they don't have to advertise."

The U.S. House of Representatives health bill passed last month calls for an MLR ratio of 85 cents. That legislation must still be merged with whatever the Senate passes before the provision would become law.

It's not clear whether the proposal will survive as the Senate Democrats work to finish up their bill by as early as next week or, if it does, whether certain qualifications are made to limit it to certain kinds of health insurance policies.

"I think it's absolutely not baked in at this point" to insurers' stocks, Shubitz said. "That would be a very severe limitation to their profitability going forward. If that were to happen, I think the stocks would react quite negatively."

http://www.reuters.com/article/idUSTRE5BA45Y20091211

Mandated Medical Loss Ratios’ Unintended Consequence
Posted by Alan on December 15, 2009

The health care reform package currently being negotiated in the Senate contemplates requiring health insurance companies to spend at least 90 percent of premiums on medical claims. But the Congressional Budget Office is warning lawmakers mandating such a high Medical Loss Ratio would be overreaching – unless their goal is to takeover those health insurance carriers. Which, as Megan McArdle notes on The Atlantic’s site, means the 90 percent mandated medical loss ratio would turn “the operations of the nation’s health insurers the financial statements of the United States government.”

Lawmakers could ignore the CBO memo, but are unlikely to do so. The credibility of the CBO is simply too high. This means the chances of a 90 percent medical loss ratio (“MLR”) requirement making it into the final health care reform bill has dropped from “well, maybe” to “not a chance” – or lower.

The CBO memorandum reasons that requiring carriers to meet a 90 percent medical loss ratio could drive carriers out of business, reduce plan offerings and take other actions limiting choice in the marketplace. The key to determining the impact of MLR requirements is to look at the percentage of health insurance carriers impacted by the requirement. “A policy that affected a majority of issuers would be likely to substantially reduce flexibility in terms of the types, prices and number of private sellers of health insurance,” the CBO memo states.

The CBO won’t say precisely when a required medical loss ratio crosses the line and becomes a government takeover of the industry. But it did give a hint, saying an MLR requirement “at 80 percent or lower for the individual and small-group markets or at 85 percent or lower for the large-group market would not cause CBO to consider transactions in those markets as part of the federal budget.”

http://alankatz.wordpress.com/2009/12/15/mandated-medical-loss-ratios-unintended-consequence/

[mzmolly]

47. Interesting. Dean noted the Netherlands as an example of

how we might use the industry "like utility companies" to control costs. He noted the Netherlands specifically as an example.

http://content.healthaffairs.org/cgi/content/abstract/27/3/771?ijkey=DsTX9syExLZLc&keytype=ref&siteid=healthaff

[Blue State Blues]

39. And the insurance companies' stock prices hit a 52 year high because?

They know what's in the bill. They wrote it.

I wish this were chess, no one dies in a chess game.

[WeDidIt]

40. Insurance company stock prices hit a 52 WEEK high

And they did so because insurance company PROFITS hit a 52 YEAR high.

End of the day, the insurance company stock prices have absolutely nothing to do with HCR, and won't until the final bill is produced.

I predict the bottom to drop out on insurance comapny stock prices in January.

[Phoebe Loosinhouse]

43. Loose lips sink ships! nt

[janx]

49. Absolutely! n/t

[burning rain]

46. Because progressives realize moderate pap is the best that's gonna get through the Senate.

Well, unless Grampa Reid and the Senate leadership toughenup and threaten to exercise the "nuclear option," as Republicans did under Bush--facing far less frequent filibustering from Democrats, I might add. Otherwise, progressives may as well put the best face on it and call a baloney sandwich a Philly cheesesteak.

[MessiahRp]

48. "So what could be in the bill that push every Republican against it?" Nothing, It's a Dem Bill.

And that's the point. Republicans privately are probably very giddy their buddies in the insurance industry are getting to directly tap into the taxpayer pipeline and gorge themselves on our money. Publicly though they want to appear to oppose anything Obama or Democrats do because frankly there's no risk to have to take. When this health care plan fails miserably, and it will, they get to be the heroes and ride back into power on the 'I told you so'. If by some incredible miracle it succeeds, it won't hurt them too much because they at least maintained their base and worked to grow it by creating dissent against this President's policies. There is no risk for Republicans to oppose the bill.

And frankly this bill is so god awful they're going to come out looking like winners anyway.

Rp

[Wardoc]

50. Exactly. They would oppose it if it declared apple pie enjoyable. That the OP extrapolates that...

...to be indicitive of a quality bill is just sad.

[Cronus Protagonist]

52. Ding Ding Ding

You got it bro!