Healthcare bill up for vote today

[Dominus Atheos]

Here's a factsheet or those who haven't kept up on what a clusterfuck this bill is.

Firedoglake

The Firedoglake health care team has been covering the debate in congress since it began last year. The health care bill will come up for a vote in the House on Sunday, and as Nancy Pelosi works to wrangle votes, we've been running a detailed whip count on where every member of Congress stands, updated throughout the day.

We've also taken a detailed look at the bill, and have come up with 18 often stated myths about this health care reform bill.

Real health care reform is the thing we've fought for from the start. It is desperately needed. But this bill falls short on many levels, and hurts many people more than it helps.

A middle class family of four making $66,370 will be forced to pay $5,243 per year for insurance. After basic necessities, this leaves them with $8,307 in discretionary income — out of which they would have to cover clothing, credit card and other debt, child care and education costs, in addition to $5,882 in annual out-of-pocket medical expenses for which families will be responsible. Many families who are already struggling to get by would be better off saving the $5,243 in insurance costs and paying their medical expenses directly, rather than being forced to by coverage they can't afford the co-pays on.

In addition, there is already a booming movement across the country to challenge the mandate. Thirty-three states already have bills moving through their houses, and the Idaho governor was the first to sign it into law yesterday. In Virginia it passed through both a Democratic House and Senate, and the governor will sign it soon. It will be on the ballot in Arizona in 2010, and is headed in that direction for many more. Republican senators like Dick Lugar are already asking their state attorney generals to challenge it. There are two GOP think tanks actively helping states in their efforts, and there is a booming messaging infrastructure that covers it beat-by-beat.

Whether Steny Hoyer believes the legality of the bill will prevail in court or not is moot, it could easily become the "gay marriage" of 2010, with one key difference: there will be no one on the other side passionately opposing it. The GOP is preparing to use it as a massive turn-out vehicle, and it not only threatens representatives in states like Florida, Colorado and Ohio where these challenges will likely be on the ballot - it threatens gubernatorial and down-ticket races as well. Artur Davis, running for governor of Alabama, is already being put on the spot about it.

While details are limited, there is apparently a "Plan B" alternative that the White House was considering, which would evidently expand existing programs - Medicaid and SCHIP. It would cover half the people at a quarter of the price, but it would not force an unbearable financial burden to those who are already struggling to get by. Because it creates no new infrastructure for the purpose of funneling money to private insurance companies, there is no need for Bart Stupak's or Ben Nelson's language dealing with abortion - which satisfies the concerns of pro-life members of Congress, as well as women who are looking at the biggest blow to women's reproductive rights in 35 years with the passage of this bill. Both programs are already covered under existing law, the Hyde amendment.

But perhaps most profoundly, the bill does not mandate that people pay 8% of their annual income to private insurance companies or face a penalty of up to 2% - which the IRS would collect. As Marcy Wheeler noted in [url=http://]an important post[/url] entitled "Health Care on the Road to NeoFeudalism," we stand on the precipice of doing something truly radical in our government, by demanding that Americans pay almost as much money to private insurance companies as they do in federal taxes:

When this passes, it will become clear that Congress is no longer the sovereign of this nation. Rather, the corporations dictating the laws will be.

I understand the temptation to offer 30 million people health care. What I don’t understand is the nonchalance with which we’re about to fundamentally shift the relationships of governance in doing so.

We started down a dangerous road with Wall Street banks in the early 90s, allowing them to flood our political system with money and write our laws so that taxpayers would subsidize their profits, assume their losses and remove themselves from the necessity of competition. By funneling so much money into the companies who created the very problems we are now attempting to address, we further empower them to hijack our legislative process and put more than just our health care system at risk. We risk our entire system of government.

Congress may be too far down the road with this bill to change course and save themselves - and us. But before Democrats cast this vote, which could endanger not only their Congressional majority but their ability to "fix" things later on, they should consider the first rule of patient safety: first, do no harm.



*Cost of premiums goes up somewhat due to subsidies and mandates of better coverage. CBO assumes that cost of individual policies goes down 7-10%, and that people will buy more generous policies.

Documentation:

1. March 11, Letter from Doug Elmendorf to Harry Reid (PDF)
2. The AHIP Plan in Context, Igor Volsky;Max Baucus WellPoint/Liz Fowler Plan" rel="bookmark" href="http://emptywheel.firedoglake.com/2009/ ... lers-plan/"> The Max Baucus WellPoint/Liz Fowler Plan, Marcy Wheeler
3. CBO Score, 11-30-2009
4. “Affordable” Health Care, Marcy Wheeler
5. Gruber Doesn't Reveal That 21% of Massachusetts Residents Can't Afford Health Care, Marcy Wheeler; Massachusetts Survey (PDF)
6. Health Care on the Road to Neo-Feudalism, Marcy Wheeler
7. CMS: Excise Tax on Insurance Will Make Your Insurane Coverage Worse and Cause Almost No Reduction in NHE, Jon Walker
8. Employer Health Costs Do Not Drive Wage Trends, Lawrence Mishel
9. CBO Estimates Show Public Plan With Higher Savings Rate, Congress Daily; Drug Importation Amendment Likely This Week, Politico; Medicare Part D IAF; A Monopoloy on Biologics Will Drain Health Care Resources, Lancet Student
10. MaxTax Is a Plan to Use Our Taxes to Reward Wal-Mart for Keeping Its Workers in Poverty, Marcy Wheeler
11. Estimated Financial Effects of the “Patient Protection and Affordable Care Act of 2009,” as Proposed by the Senate Majority Leader on November 18, 2009, CMS (PDF)
12. ibid
13. ibid
14. ibid
15. Health insurance companies hang onto their antitrust exemption, Protect Consumer Justice.org
16. What passage of health care reform would mean for the average American, DC Examiner
17. How to get a State Single Payer Opt-Out as Part of Reconciliation, Jon Walker
18. Medical bills prompt more than 60 percent of U.S. bankruptcies, CNN.com; The Patient Protection and Affordable Care Act Section‐by‐Section Analysis (PDF)

If anyone has any other questions on whether or not this bill needs to be defeated, I have several dozen other articles saved that I'd be happy to infodump upon request.

[Knife]

To say it is no where near what many wanted is an understatement; however, at this point I think it will represent a change in political momentum. If this passes, and the Dems keep a majority, it forms a foundation to keep adding to, until we can get some semblance of sanity to health care.

[SirNitram]

I have no interest in arguing the 'Perfect' in place of the 'Start we've needed since Roosevelt'. I will simply place the facts of the CBO on the Reconciliation bill before the board.

Link

1. CUTS THE DEFICIT Cuts the deficit by $130 billion in the first ten years (2010 – 2019). Cuts the deficit by $1.2 trillion in the second ten years. 2. REINS IN WASTEFUL MEDICARE COSTS AND EXTENDS THE SOLVENCY OF MEDICARE; CLOSES THE PRESCRIPTION DRUG DONUT HOLE Reduces annual growth in Medicare expenditures by 1.4 percentage points per year—while improving benefits and lowering costs for seniors. Extends Medicare’s solvency by at least 9 years. 3. EXPANDS AND IMPROVES HEALTH COVERAGE FOR MIDDLE CLASS FAMILIES Expands health insurance coverage to 32 million Americans Helps guarantee that 95 percent of Americans will be covered. 4. IS FULLY PAID FOR Is fully paid for – costs $940 billion over a decade. (Americans spend nearly $2.5 trillion each year on health care now and nearly two-thirds of the bill’s cost is paid for by reducing health care costs).

Lower deficits, closes the donut hole, extends medicare solvency, removes waste, expands medical care, and is paid for.

And did I mention it also completely reforms the Student Loan program, removing it from the banks(Who were given federal subsidies, passed on any failed loans to the tax payers, AND pocketed large amounts of money from higher fees, interest, and so forth.

Clearly, I believe this should be done. Single Payer for states to make is in here. An amendment for Medicare Universal Buy-In is in here. Huffpost paints things it's own way, seeking the perfect.(My own contempt towards Huffpost should be released for full disclosure: They promote Anti-Vaccine propaganda, and Autism falsehoods. I cannot take their editorializing seriously. And that is most of what was posted here.)

[irishmick79]

By no means is this a perfect bill, but it's a major step forward for American health care. Hell, just getting a set of unified standards for administration and billing procedures slapped onto these insurance companies would be a major accomplishment in its own right. This bill does that and bans denials based on pre-existing conditions, creates mechanisms to provide coverage to high risk individuals, and encourages a lot of consumer advocacy. Yeah, it sucks that there's no public option and by and large the insurance companies are still in business, but this bill is a big step towards tightening the leash and brings the most change to the health sector since medicare and medicaid were passed.

Could it be better? Sure. It could also be a lot worse, though.

[Lonestar]

A middle class family of four making $66,370 will be forced to pay $5,243 per year for insurance.

I'm guess with me making more than this and no dependents I'm going to end up paying more than this. Or is this only for people who do not have insurance?

[SirNitram]

A middle class family of four making $66,370 will be forced to pay $5,243 per year for insurance.

I'm guess with me making more than this and no dependents I'm going to end up paying more than this. Or is this only for people who do not have insurance?

I suspect this is the 'upper bound' of an insurance premium. There will no doubt continue to be cheaper ones. Of course, you may decide to say 'Fuckit' and pay a mere 2% in additional taxes. And that's perfectly OK.

[irishmick79]

A middle class family of four making $66,370 will be forced to pay $5,243 per year for insurance.

I'm guess with me making more than this and no dependents I'm going to end up paying more than this. Or is this only for people who do not have insurance?

I suspect this is the 'upper bound' of an insurance premium. There will no doubt continue to be cheaper ones. Of course, you may decide to say 'Fuckit' and pay a mere 2% in additional taxes. And that's perfectly OK.

I'd be curious to see where they pulled that number out from too.

if you go over to the Kaiser Family Foundation's Subsidy Calculator and plug in a family of four with the same income and a policy holder age of 40, the out of pocket cost for the family would be something like $6,284. Even if you opt not to pay, the tax penalty at most would be 2.5%, which would be $1,659.25 at the income level described.

[Dominus Atheos]

Lower deficits... is paid for

Not exactly:

An important component of the longer-term analysis is that, beginning in 2019, the reconciliation proposal would change the annual indexing provisions so that the premium subsidies offered through the exchanges would grow more slowly; over time, the
spending on exchange subsidies would therefore fall back toward the level under H.R. 3590 by itself. Another key component of the longer-term analysis is that, beginning in 2020, the reconciliation proposal would index the thresholds for the high-premium excise tax to the rate of general inflation rather than to inflation plus one percentage point.

...

... Of course, the tax does not kick in for 8 years, so it is some future Congress’s and future President’s problem. Nothing says fiscal responsibility more than dumping a huge political mess on your successors.

There is simply no way to believe, given its ill convinced design, that this will not be heavily modified or scrapped in the future. Democrats might be proud of their “math-magical” CBO score showing huge deficit reductions in the next twenty years, but I don’t think anyone should boast about illusions that will never come true. This second decade projections are based on the false assumption that a poorly thought-out, huge, new tax will remain completely unchanged for the next two decades. The changes might be needed for process reasons, but Democrats should not proudly brag like they will actually happen.

This is the equivalent of a president saying they have a twelve-year plan to end the budget deficit. He can just propose a bill now that says taxes will remain the same for the whole eight years of his presidency, followed by everyone’s taxes jumping to an 92% tax rate the year after the president leaves office.

Single Payer for states to make is in here

Not exactly

The current Senate health care bill has a provision (Section 1332. Waiver for State Innovation (PDF)) that will allow states to opt out of the current reform structure if they can provide the same level of care for the same amount or cheaper with a different plan. Given how poorly designed the Senate bill is, that shouldn’t be hard on a policy level. In theory, this could allow for state-based single payer plans, and reconciliation could deal with two major problems with the provision.

Delayed Until 2017

The first problem is the date of implementation. States can’t apply for the waiver until 2017, which is completely ridiculous. There is no reason for the delay, and it would make state innovation very difficult to implement. It would first require states to go through all the work of setting up the new system of exchanges for 2014, only to turn around and try to replace it with another new system three years later.

The other big problem with the date is that 2017 would be right after Obama left office (assuming that he served two terms). Since it is very rare for one party to hold the presidency for three straight terms, it will likely be a Republican in the White House in 2017. Assume their HHS secretary would not be open to granting the waiver for a state-based single payer system, it would likely not be until 2020 or 2024 that this provision could be used for creating state single payer, and that assumes a supportive Democratic president is elected. This is completely unacceptable.

Getting Around ERISA

The other major impediment is the scope of the waiver, which I interpret to mean it can’t be used for a waiver of ERISA. From the Senate bill (with Secretary defined as Secretary of HHS and Treasury):

(c) Scope of Waiver-

(1)IN GENERAL- The Secretary shall determine the scope of a waiver of a requirement described in subsection (a)(2) granted to a State under subsection (a)(1).

(2)LIMITATION- The Secretary may not waive under this section any Federal law or requirement that is not within the authority of the Secretary.

ERISA falls under the jurisdiction of the Departments of Labor and Treasury. I don’t think this provision could be used waive ERISA without further action by Congress, at least I think it would become a potential legal mess if that were tried.

ERISA prevents states from telling employers or labor unions what kind of insurance they must offer. Not having an ERISA waiver would make adopting a true state-based single payer system incredibly difficult, if not impossible, and make implementing a very cost effective, Hawaii-style, strict employer mandate system impossible in other states.

An amendment for Medicare Universal Buy-In is in here.

Not exactly

House Speaker Nancy Pelosi was firm today: A public option will not be included in the reconciliation package. After reminding reporters that she has been for single payer health care since "before most of [them] were born", she explained there would be no public option in the reconciliation bill.

Huffpost...I cannot take their editorializing seriously. And that is most of what was posted here.

Not exactly. Not at all actually, none of the footnotes link there.

[Dominus Atheos]

I'm guess with me making more than this and no dependents I'm going to end up paying more than this. Or is this only for people who do not have insurance?

I suspect this is the 'upper bound' of an insurance premium. There will no doubt continue to be cheaper ones. Of course, you may decide to say 'Fuckit' and pay a mere 2% in additional taxes. And that's perfectly OK.

I'd be curious to see where they pulled that number out from too.

Hooray for checking the links!

Here’s a version of one family’s total household costs under the plan: a middle class family with two cars and some child care costs. Note, in this scenario, I’m assuming the middle class family will pay 7.9% of its income for health insurance premium, significantly less than the 9.8% the plan assumes that family could pay to get the subsidies available. This, then, shows what a family would be required to pay (or incur a penalty) under the 8% opt-out rule.

301% of Poverty Level: $66,370

Federal Taxes (estimate from this page, includes FICA): $8,628 (13% of income)

State Taxes (using MI rates on $30,000 of income): $1,305 (2% of income)

Food (using “low-cost USDA plan” for family of four): $7,712 (12% of income)

Home (assume a straight 30% of income): $19,275 (30% of income)

Child care (average cost for just one pre-school child in MI): $6,216

Health insurance premium: $5,243 (7.9% of income, max amount before opt-out w/o penalty allowed)

Transportation (assume 2 cars, 12,000 miles each, @IRS deductible cost of $.55/mile): $13,200*

Heat, electricity, water: $1,500

Phone, cable, internet: $1,200

Total: $64,276 (97% of income)

Remainder (for health care out-of-pocket, debt, clothing, etc.): $2,091

[Dominus Atheos]

A middle class family of four making $66,370 will be forced to pay $5,243 per year for insurance.

I'm guess with me making more than this and no dependents I'm going to end up paying more than this. Or is this only for people who do not have insurance?

Apparently if you make over 300% of the poverty line you're required to pay up to 8% of your income towards health insurance before you qualify for any subsidies. I can't find a link right now since Google (and Bing) refuses to search for "8%".

[Dominus Atheos]

This bill does that and bans denials based on pre-existing conditions, creates mechanisms to provide coverage to high risk individuals, and encourages a lot of consumer advocacy.

Could you please bother the read the OP before posting? It's not difficult.

Access to the “high risk pool” is limited and the pool is underfunded. It will cover few people, and will run out of money in 2011 or 2012

Only those who have been uninsured for more than six months will qualify for the high risk pool. Only 0.7% of those without insurance now will get coverage, and the CMS report estimates it will run out of funding by 2011 or 2012.

...

The bill does not empower a regulatory body to keep people from being dropped when they’re sick.

There are already many states that have laws on the books prohibiting people from being dropped when they’re sick, but without an enforcement mechanism, there is little to hold the insurance companies in check.

...

The “internal appeals process” is in the hands of the insurance companies themselves, and the “external” one is up to each state.
Ensuring that consumers have access to “internal appeals” simply means the insurance companies have to review their own decisions. And it is the responsibility of each state to provide an “external appeals process,” as there is neither funding nor a regulatory mechanism for enforcement at the federal level.

[eion]

http://www.c-span.org/Watch/C-SPAN.aspx

They're debating the bill in the House now.

This is not a great bill. It is perhaps not even a good bill, but if this bill is voted down it is the end of this push for health care reform, and we will not see another push for at least another 10 years. In order to achieve real reform we must pass this compromised bill. True progressive reform is incremental, and this is the first of many more steps.

Pass the damn thing so we can move on and do more.

[D.Turtle]

Well, now that the Stupak block has been convinced to vote for the thing its passage is ensured. Congratulations on finally achieving something.

It will be interesting to see the effects of this on the November elections.

[SirNitram]

Lower deficits... is paid for

Not exactly:

...

... Of course, the tax does not kick in for 8 years, so it is some future Congress’s and future President’s problem. Nothing says fiscal responsibility more than dumping a huge political mess on your successors.

There is simply no way to believe, given its ill convinced design, that this will not be heavily modified or scrapped in the future. Democrats might be proud of their “math-magical” CBO score showing huge deficit reductions in the next twenty years, but I don’t think anyone should boast about illusions that will never come true. This second decade projections are based on the false assumption that a poorly thought-out, huge, new tax will remain completely unchanged for the next two decades. The changes might be needed for process reasons, but Democrats should not proudly brag like they will actually happen.

This is the equivalent of a president saying they have a twelve-year plan to end the budget deficit. He can just propose a bill now that says taxes will remain the same for the whole eight years of his presidency, followed by everyone’s taxes jumping to an 92% tax rate the year after the president leaves office.

Except not quite so mind-numbingly stupid as your claims. Which are wrong. You focus entirely on one part of the Recon fix.

Payroll moves to unearned income as well in 2012: This is 2 years from not, not 8. Your math fails here.

Cadillac Tax: Hits in 2018. Here is what you thought; except that you're idiotic enough to beleive that's how all of it's paid for.

Tanning Tax: 10% on Minority Leader Bonner's orange-colouring.

The Entire Bit On Student Loan Reform which slashes spending.

Cutting waste from Medicare, which cuts spending.

That is how it's paid for. Be honest, you insipid crank. Only one portion is started in 8 years.. But you could've read the bill OR the CBO report to know that.

Single Payer for states to make is in here

Not exactly

The current Senate health care bill has a provision (Section 1332. Waiver for State Innovation (PDF)) that will allow states to opt out of the current reform structure if they can provide the same level of care for the same amount or cheaper with a different plan. Given how poorly designed the Senate bill is, that shouldn’t be hard on a policy level. In theory, this could allow for state-based single payer plans, and reconciliation could deal with two major problems with the provision.

Delayed Until 2017

The first problem is the date of implementation. States can’t apply for the waiver until 2017, which is completely ridiculous. There is no reason for the delay, and it would make state innovation very difficult to implement. It would first require states to go through all the work of setting up the new system of exchanges for 2014, only to turn around and try to replace it with another new system three years later.

'NO REASON FOR DELAY!' Except there is, and it's a good one. HEre's why: If it's immediately availiable, tomorrow, every insurance lobbyist and their GOP pals will descend on the state legislatures to get 50 waivers. One for every state.

The other big problem with the date is that 2017 would be right after Obama left office (assuming that he served two terms). Since it is very rare for one party to hold the presidency for three straight terms, it will likely be a Republican in the White House in 2017. Assume their HHS secretary would not be open to granting the waiver for a state-based single payer system, it would likely not be until 2020 or 2024 that this provision could be used for creating state single payer, and that assumes a supportive Democratic president is elected. This is completely unacceptable.

Alot of assumptions, and it all revolves around earlier.

Getting Around ERISA

The other major impediment is the scope of the waiver, which I interpret to mean it can’t be used for a waiver of ERISA. From the Senate bill (with Secretary defined as Secretary of HHS and Treasury):

(c) Scope of Waiver-

(1)IN GENERAL- The Secretary shall determine the scope of a waiver of a requirement described in subsection (a)(2) granted to a State under subsection (a)(1).

(2)LIMITATION- The Secretary may not waive under this section any Federal law or requirement that is not within the authority of the Secretary.

ERISA falls under the jurisdiction of the Departments of Labor and Treasury. I don’t think this provision could be used waive ERISA without further action by Congress, at least I think it would become a potential legal mess if that were tried.

ERISA prevents states from telling employers or labor unions what kind of insurance they must offer. Not having an ERISA waiver would make adopting a true state-based single payer system incredibly difficult, if not impossible, and make implementing a very cost effective, Hawaii-style, strict employer mandate system impossible in other states.

'I don't think.' 'We can't get the perfect immediately.' These aren't arguments.

An amendment for Medicare Universal Buy-In is in here.

Not exactly

House Speaker Nancy Pelosi was firm today: A public option will not be included in the reconciliation package. After reminding reporters that she has been for single payer health care since "before most of [them] were born", she explained there would be no public option in the reconciliation bill.

You could always read the link where I posted about the amendments to the bill. She denied a seperate vote for a seperate bill. What a tool.

Huffpost...I cannot take their editorializing seriously. And that is most of what was posted here.

Not exactly. Not at all actually, none of the footnotes link there.

Pardon me. I mistook the borders, and I over-estimated you. Hamsher and her fools at FDL? Sorry, she blew all credibility when she got on the boat with Norquist, the Tea Party, other such fools. Either she's an easily led fool manipulated by others, or she's ultimately just a glory-seeker, and being the 'progressive' to 'reach across the isle' to those who issue such proclamations as 'We Came Unarmed - This Time' was a means to that end.

She has zero credibility. Her selective quoting and refusal to examine why things happen, as I demonstrated in this, are a good reminder. Now. Put down your anger and move on. She led you along, to her dance. Grow up and realize we do what we can, not throw a fit if we can't have the perfect RIGHTNOW.

[Darksider]

Somehow I suspect the whole point of this is to get health care reform's "foot in the door" so to speak. No, this bill doesn't do real reform, or anything close to what I wished it would have been, but it will help some people, and it will begin to alter peoples perception of government health care. When the next push comes for REAL reform, we can point to the fact that this is already in effect and the nation hasn't crumbled or turned into the soviet union. That oughta take the wind out of the teabaggers sails a bit.

[The Romulan Republic]

Just Pelosi speaking and then the vote. Thank God.

[CarsonPalmer]

Ignore. Didn't mean to post.

[Darksider]

Just Pelosi speaking and then the vote. Thank God.

Don't thank him too much. You still have to listen to Pelosi.

So after all the chest-beating, none of the Repubs are going to try and filibuster this?

[TimothyC]

Filibuster is a Senate tactic, not a House one.

[Questor]

Just Pelosi speaking and then the vote. Thank God.

Don't thank him too much. You still have to listen to Pelosi.

So after all the chest-beating, none of the Repubs are going to try and filibuster this?

This is the House, filibuster is not an option.

[LMSx]

Rargablargh! Congress will never keep any cuts! Deficit cutting is impossible because future Congresses will simply repeal it! EDIT to add: maybe the 8 year tax delay was the issue? But Congress evidently has a good track record on this issue, which, given the following quotes, would have me give them the benefit of the doubt.

o nooooo
Link

Health reform legislation that has passed the House in one form and is before the Senate in another is facing a series of attacks that, taken together, suggest the legislation would do little to control health care costs and would increase budget deficits. Many of these charges are exaggerated or simply incorrect, based on the Center’s careful analysis of the legislation. In particular, a number of criticisms rest on a mistaken belief that, in recent years, Congress has repeatedly enacted provisions to achieve savings in Medicare and then generally blocked these provisions before they could take effect. Thus, critics say, no one should take seriously the provisions of the current bills that would produce Medicare savings. In fact, the Center’s analysis of major legislation affecting Medicare that Congress has enacted over the last two decades shows that Congress has permitted the vast majority of Medicare savings to take effect.

Second, the history of health legislation in recent decades demonstrates that, despite some critics’ charges, Congress has repeatedly adopted measures to produce considerable savings in Medicare and has let them take effect. For example, Congress took such action as part of major deficit-reduction packages in 1990 and 1993 and as part of more modest deficit-reduction packages in 1997 and 2005. Virtually all of the cuts that it enacted in 1990, 1993, and 2005 went into effect. After Medicare spending slowed dramatically after 1997 — in 1999, it was for the first time lower than it had been the year before — and the budget was balanced in 1998, Congress did ameliorate some of the Medicare cuts that it had enacted in 1997. But, even in those special circumstances, it allowed four-fifths of the 1997 cuts (other than those described in the next paragraph) to take effect.

In arguing that Medicare cuts never “stick,” critics point in particular to Congress’ repeated refusal to let the reductions in physician reimbursement rates under Medicare’s so-called “sustainable growth rate” (SGR) mechanism, which it enacted in 1997, take full effect. The SGR cuts, however, represented a badly designed measure that was not intended to produce large savings (the projected SGR savings represented less than five percent of total Medicare savings in the 1997 bill), but turned into a blunt instrument that would have produced cuts far in excess of what was anticipated and would have had harsh and indefensible effects. (Moreover, even though Congress did not allow the full cuts required under the SGR formula to take effect, it has still cut the physician reimbursement rate substantially — at its current level, the reimbursement rate in 2010 will be 17 percent below the rate for 2001, adjusted for inflation.) The SGR mechanism has little in common with most of the other provisions that Congress has enacted over the years to produce savings in Medicare and that have, in fact, taken effect. This distinction is important because most of the Medicare savings provisions in the House and Senate health reform bills are similar in nature to the types of Medicare provisions that Congress has enacted in the past that have taken effect — and they differ markedly from the blunt-instrument design of the SGR cut. (For a more in-depth discussion of these issues, see “SGR and Other Medicare Cuts — What Has Worked and Why,” below.)

Actually just read that whole link it's pretty useful. These quotes were really influential for me:

“Pretty much every proposed innovation found in the health policy literature these days is encapsulated in these measures,” John Iglehart, founding editor of Health Affairs, recently wrote in the New England Journal of Medicine. (See Box 1 below.)

Similarly, Jonathan Gruber of MIT, one of the nation’s most respected health economists, recently said of the Senate bill, “It’s really hard to figure out how to bend the cost curve, but I can’t think of a thing to try that they didn’t try. They really make the best effort anyone has ever made. Everything is in here.”[2]

Maybe we should wait for the Kucinich Pony to ride in with single payer?

[Siege]

216 votes. It's passed. Now a reconciliation vote.

[LMSx]

This Boehner-Pelosi-Vote-Recommit sequence is one of the more engaging sequences of Congressional action I've seen-particularly hearing the Democratic and Republican call and response to Boehner's rhetorical questions. Too bad they gavel down any House of Commons style commentary.

[Broomstick]

Maybe the Republicans will get it through their fucking heads that the world not only doesn't revolve around the them, but things can proceed without them. So fucking learn what the word compromise means, jackasses, before the country goes any further down the shitter.

[Illuminatus Primus]

Hurrah for the Business-Ruled Society. The bill is what one would expect from the corporate-collaborationist/moderate-conciliatory wing of the Business Party (Democrats). Probably marginally better than the status quo or whatever horrors would be dreamed up by the vicious corporate-reactionary wing of the Party (the Republicans). One throws you an emaciated bone from the table though still with some goodies and benefits to go back to the masters of mankind, figuring this is the best way to keep you quiet and profits high, while the other would rather just keep you inline with poverty and prison and isn't quite as prudent or moderate.