According to senior lawmakers and aides familiar with the legislation, it will not dictate what the plan can pay hospitals, doctors and other providers, a goal that many liberal Democrats had hoped for as a means to control costs.
"People are coming to realize it's going to be very tough to get to that point,'' acknowledged House Education and Labor Committee chairman George Miller (D-Calif.), a close ally of House Speaker Nancy Pelosi (D-Calif.)
Instead, much as commercial insurers do now, the federal government under the House plan would have to negotiate rates with providers, a concession that Pelosi and her lieutenants are making to conservative Democrats wary of the "public option."
It seems like a relatively minor concession to me, but one that will make the bill more expensive. The bigger problem is that this -- like the Senate version -- would seem to provide very little competition. It won't be available to the majority of Americans under either bill, so the "option" part is pretty much BS. When all is said and done, we'll have expanded coverage and ended the problem of "pre-existing conditions," but we'll have done very little to change what we laughably call a "healthcare system." You want choice, you want competition? Well, you're outta luck. Now shut up and eat your modified status quo.
Still, you can't fix something that doesn't exist. If the version of the public option that we get is far from perfect, we can go back and visit it again later. As always, it's not the best idea that makes it out of the sausage factory. Comprised and brokered to death, it's the ghost of the good idea, laden down with the chains of some real crap. The good news is that the House delivered a public option and we can fix it. The bad news is that the House delivered a public option and we'll have to fix.
And there's still the Senate, bearing it's own chains in the form of the unfortunate Joe Lieberman and his threat to join a Republican filibuster. I suggest you take your favorite curse word and replace it with "Lieberman." Because, without even this weak public "option," any healthcare reform bill is going to be one Liebermanned up piece of Lieberman.
While the House is probably going to get all the news today, it's still the Senate we should have our eyes on. While a Senate public option isn't strictly necessary, it makes a public option in the final bill more likely by universes of magnitude. There's still the conference committee, where the House and Senate bills will be merged, but -- quite frankly -- if the Senate bill doesn't contain a public option, I don't hold out a lot of hope that wiser heads will prevail in the conference committee.
It hasn't been talked about for a while, but the Senate could still go with budget reconciliation rules. These limit debate and rule out a filibuster. Harry Reid perked up a few optimists when he said it was a possibility, but his office was quick to burst that bubble.
Greg Sargent, Plum Line:
Senator Harry Reid set off a bit of a stir by saying this yesterday about the possibility of doing health care through the Dem-only reconciliation process: “Sure, it’s always an option.”
But Reid spokesman Jim Manley says his boss was only repeating what he’s said for months, and adds that it’s not seriously being considered. “It’s always been an option, but the only thing we are focused on right now is trying to get 60 votes for the strongest bill possible,” he emails me.
I guess we have different definitions of "the strongest bill possible." I'd go with something that, if signed into law, actually stood a chance in hell of actually doing something. In Washington, the work it takes to pass a bill often overshadows the need for the bill. In this case, "the strongest bill possible" means the bill that will get a cloture vote -- it doesn't have a damned thing to do with effectiveness.
Others have brought up reconciliation as well.
Evan Bayh (D-IN) said on CBS’s Washington Unplugged said that if fifty senators were dead set on getting a real public option they could always do that by using reconciliation. Reconciliation measures can’t be filibustered, so a bill brought up through reconciliation would only need a simple majority to pass (50 votes plus the VP).
Evan Bayh said, “If the people [who] want the public option in its fullest form are just adamant about that they can always just get that with fifty votes.”
Don't get too excited about Evan Bayh, though. He may just be daring leadership to try it. He's being coy on a public option and the best you could say is that he seems agnostic about it.
On the other hand, Sen. Chuck Schumer explained the reluctance to go to reconciliation -- it's kind of a headache. "I think the broad preference is not to do reconciliation, and if we can stay unified on the major procedural votes and get 60 on those we won't need reconciliation," he says. "Reconciliation is always a last resort because it's complicated.... so the preference has always been to go forward without it, and again, if we can stay unified on the procedural votes, we'll accomplish that. "
Lieberman's announcement sort of throws a monkeywrench into that unification on procedural votes, so that reasoning may be out the window. Lieberman's Liebermanhead move may have forced reconciliation back into the conversation. Is this optimism on my part? I don't do optimism. It's realism. I'm just recognizing that the best possible outcome is a possible outcome.
Because, if the public option isn't in the final bill that goes to the president's desk, I'm taking it as a loss. We'll have gone through months of a Lieberman-storm of stupidity and lies and wound up with a bill that's only substantial effect will be to make pre-existing conditions illegal, while requiring everyone to buy health insurance. Everything else that's wrong with the American healthcare system will go unaddressed and we won't even have a mechanism to tweak to improve it when it becomes clear that the bill we passed accomplished Jack-Lieberman.
If it comes to a choice between reconciliation or crap, I choose reconciliation. If we don't get something approximating a public option, then we'll be just as Liebermanned after the bill is signed as we are now.
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