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Posted Tuesday, August 18, 2009 11:12 PM

Fineman: The Democrats' New Strategy on Health Reform

Howard Fineman
I think I understand the Democrats' latest strategy for passing a health-care reform plan. At least I think I do after talking to some plugged-in party types on Capitol Hill. For want of a better term, I'm calling their strategy "50-218," which stands for the minimum number of votes President Obama and his party are aiming for in the Senate and House, respectively, to pass a piece of legislation they can plausibly call "reform."

Here is the first point: forget bipartisanship, meaning forget Republican votes. Yes, I know that the Senate Finance Committee's "Gang of Six" is still negotiating, but Republicans on and off the committee are making it increasingly clear that they are fundamentally uninterested in a deal of any kind. And Democratic Hill leaders are concluding the same thing. Indeed, they've been deeply skeptical all along of the wisdom of the White House's insistence on trying to craft a bipartisan pact. "If there's one thing I would fault Obama on, that would be it," said one Hill Democrat, who declined to be named because he was discussing private talks.

The second strategic consideration is this. The votes simply do not exist in the Senate to enact a new entitlement program, which is what Senate Democratic leaders have concluded a "public option" health care plan for non-elderly, non-poor Americans would be. That is especially true since two of the Senate's strongest Democratic supporters of the idea, Ted Kennedy of Massachusetts and Robert Byrd of West Virginia, are too ill and incapacitated to come to the chamber to vote. Assuming that Republicans would threaten a filibuster of any new entitlement program -- a safe assumption -- the Democrats would need 60 votes to pass it. But even with every ambulatory Democrat voting for it, they'd still max out at 58. "We can't get there," said a Democratic senator, who spoke only on the promise of confidentiality. In fact, the Dems could fall several votes short if it came to a vote.

Here's the third strategic consideration: it's highly unlikely that the House of Representatives will pass a bill without a "public option," at least the first time around. Depending on the count you believe -- and the protest letters you read -- anywhere from 56 to 100 of the House's 256 Democrats are threatening a "no" vote. All it would take to kill a bill without a public option is 40 Democratic "no" votes.

How do the party leadership and the president square this circle? They can't entirely, but they can go a long way toward doing so by using the so-called "reconciliation" procedure in the Senate, a budget-related mechanism that would allow the Democrats to pass much, though not all, of Obama's shifting wish list with a mere 50-vote simple majority. With that as the operative target, Senate leaders could move considerably leftward, while allowing butt-covering Senate Blue Dogs to shout "no" in the crowded theater.

The leadership couldn't get the "public option," but they could sweeten the pot with generously-defined expansions of Medicaid and other programs, and by other mandates and rules that would allow the president to claim that he had achieved his main and most cherished historical role in the health care debate: as the man who brought the nation "universal" coverage. Then, so the theory goes, enough liberal House Democrats will climb back on board to save the day. In other words, work around the conservative Blue Dogs in the Senate by settling for the minimum 50 votes; accept their support in the House while trying to win back just enough liberals to pass a final bill by the 218 votes.

There's only one potential problem with this plan, and it could be a huge one. His name is Alan Frumin. He is the Senate parliamentarian. His job is officially non-partisan and his reputation for probity and independence is impeccable. It will be up to him to decide whether much of what Senate leaders want to do in a simple-majority "reconciliation" vote is valid under Senate rules. Simply put, everything in the bill is supposed to relate to balancing the budget. It's a definition that can be stretched -- and that Senate leaders will need to stretch to win reluctant House liberals.

Remember Frumin: he could decide whether 50-218 is a winning formula, or just another losing lottery ticket.
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Member Comments

Posted By: hsr0601 (August 22, 2009 at 7:12 AM)

Equation !

$1.042trillion (cost of reform) + $245bn (cost to reflect annual pay raise of docs) = $1.287bn (actual cost of reform).

$583bn (the revenue package) + $80bn (doughnut hole) + $155bn (savings from hospitals) + $167bn (ending subsidies for insurers) + $277bn (ending medical fraud, a minimum of 3%) = $1.257trillion + the reduced tax on the wealthiest = why not ? (except for magic pill, an outcome-based payment reform & IT effects and so forth)

In relation with medical fraud, please visit http://www.npr.org/templates/story/story.php?storyId=111967435, you will be stunned !  Thankfully, in May 2009, the Obama administration announced a new task force made up of officials from the Department of Justice and the Department of Health and Human Services to work on health care fraud.

Thank You !

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Posted By: thehappyamerican (August 20, 2009 at 8:25 AM)

The DNC is in AUTO DESTRUCT and thinking only of the next 5 months, and only in POLITICAL terms. When the majoriy of us get ill ,it will be AFTER these next 5 months. When health care will be experiencing The Government Touch in many creepy ways.

  The DNC won't look like heros then. They won't look 'caring!" And they'll be trying to get more of that creepy Government Touch in YOUR health care! The health care of your spouse or children.

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Posted By: hsr0601 (August 20, 2009 at 3:10 AM)

No More Health Catrina !

Let's set up the Equation !

1.  All across the spectrum share the urgent need for the reform as the course today is financially unsustainable. By the way, how do we pay for it ?

    Let's make it affordable while improving quality.

2.  Of all choices on the table, savings via efficiency is the best, and Removing Wastes alone is Enough to Meet the Goal.

   As one instance, please visit http://www.npr.org/templates/story/story.php?storyId=111967435, you will be stunned !

   No one knows just how much medical fraud there is, and estimates range from from $600 to $6000 billion over the next decade lost to it.

   And, in May 2009, the Obama administration announced a new task force made up of officials from the Department of Justice and the Department of Health

   and Human Services to work on health care fraud.

3.  Enough Room For Savings !

Many reformers recognized roughly 30 percent of all health-care spending in the U.S. -some $700 billion a year- might be wasted on medical abuse, unnecessary procedures, unnecessary visits to the doctor, overpriced pharmaceuticals, bloated insurance companies, and the most inefficient paper billing systems imaginable, and payment reform could solve this problem.

Provided the American people pay around twice the amount of the efficient systems, the result is still well below them, the ratio of waste might be estimated to far more than 50% in the U.S.  

Let's be conservative regarding the ratio.  Even If as little as 10% of savings apply to the combined Medicare and Medicaid cost of $923.5bn per year, as of July, the savings of  $923.5bn over the next decade are possible.

And when these savings add to the already allocated $583 billion, the savings of wastes involving so called "doughnut hole" , the unnecessary subsidies for insurers, medical abuse, exorbitant costs by the tragic ER visits etc, the concern over revenue might be a thing of the past.

As a matter of fact, with the promising redesign in the pipeline, some patient-focused clinics in 10 regions have already achieved 16% of savings in Medicare while their quality scores are well above average.

Please be 'sure' to visit http://www.nytimes.com/2009/08/13/opinion/13gawande.html?hp  for credible evidences !

Thankfully, the provisions in the reform include more expansive, systematic policies such as 'a patient's outcome-based payment system' than they have. I for one firmly believe this American innovation, 'a patient's outcome-based payment system' , is capable of turning profit-oriented practices into patient-focused system / value.

Dr. Armadio at Mayo clinic says, "If we got rid of that stuff (waste), we save a third of all that we spend and that is 2.5 trillion dollars on health care. A third of that and that is 700 billion dollars a year. That covers a lot of uninsured people."

Please visit http://www.kare11.com/news/news_article.aspx?storyid=820455&catid=391 for detailed infos

-- Americans' Best Friends  Are The Envy Of The Planet ! --

-- Except For The Underinsured, The Uninsured Alone outnumber The Entire Population In Canada --

4. Some say, if the reform package is affordable and improve quality, then the inflation/bankruptcy-oriented market can not last, thereby competition should begin with our unfair, unsustainable market value, or let's make another insurer-friendly scheme, even though  the inflation/bankruptcy-oriented market share the need for change.

5. CONCLUSION = THE WILL OF REFORM, NOT COST.

The runaway premium similar to the peak fuel price last  year and left so many folks in despair insists on staying the course with the attitude 'unchanged', clearly this trend could bankrupt individual, business, and government. Now the government subsequently is tasked with these two main assignments, first, to address premium inflation, second, to expand coverage to all in urgent need.

In order to cover all and not to add to the deficit, the public option can not set the same rates of private market, rather, it needs to have BALANCING function to keep it in check in terms of INFLATION, too. Unfortunately, this 'unavoidable' direction is aggressively being accused by the runaway premium, citing government 'take-over' .

Under the circumstances the energy bill to determine human future and the other major issues are presently piled up, who wants to waste time making enemies ?, which also does not benefit the forthcoming election.

with the heartbreaking tears in mind (Nearly 11 Million Cancer Patients Without Health Insurance), private market also needs changes and should join together to complete this reform , as promised, otherwise, the runaway premium only has itself to blame while new firms are filling the void with competitive deals.

And It can be said that fair competition starts with a fair, sustainable market value.

However, Job-based coverage (indirect payment) and a limitation code over transfer, mandate code, and ample capital, reduced ER costs, IT base to streamline the administrative processes and trim the costs might be favorable to the private market. Over time, supposedly, the public plan will concentrate more on basic, primary cares, and the private insurers will provide their clients with differentiated services.

Let me repeat;   No More Health Catrina, No More Bankruptcy Of Middle Class !

-- Americans' Best Friends  Are The Envy Of The Planet ! --

-- Except For The Underinsured, The Uninsured Alone outnumber The Entire Population In Canada --

Thank You !

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