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Despite claiming the current plan to pass health care reform with the House acting first on the Senate bill would not get enough votes in the House, Stupak sounded rather upbeat about the possibility of passing health care reform with what sounds like a reconciliation-only strategy. If this becomes the preferred strategy for passing something called health care reform, it would represent a significant change in direction.
I was just talking with some of the leadership folks here earlier this morning at the Energy and Commerce committee and we don’t necessarily have to vote on the Senate bill. As Anthony [Weiner] said. I don’t think they have ten votes for the Senate bill. But during the reconciliation process this is where the president can put his proposal or a single-payer, whatever the president is going to put forward and that we can make that part of reconciliation that would be the vehicle we would use…
I’ve outlined several different strategies to achieve health care reform using reconciliation (here, here, here). Most of the strategies for expanding coverage using a reconciliation bill would rely heavily upon expanding existing public health programs like Medicaid, Medicare, and SCHIP. It is interesting that Stupak brings this up because dealing with Stupak’s concerns about abortion coverage on the new exchanges has been one of the biggest stumbling blocks to passage of health care reform legislation. Since the current public programs are all covered by the Hyde language, which Stupak supports, he, in theory, should have no abortion-related issues with simply expanding public programs.
Stupak’s statement might be one of the first signs that Democrats are concluding they simply can’t get the votes for the Senate health care bill, but can’t walk away from health care reform empty handed. A new, clean, and easy to explain reconciliation-only bill is one potential political solution.
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But that isn’t what they want.
See E. J. Dionne’s recent piece in Truthdig: Can’t we all just get along? No. I don’t think they want reconciliation. They want what we don’t want: mandate, no public option.
Expect a lot of time to be wasted on the current strategy, followed (at the very end, just before the deadline) by face-saving moves.
What about Dionne’s other piece two days later? The Big Lie About Reconciliation
Dionne is a WaPo staffer, deeply enmeshed in the MSM. Not sure he has anything original to offer here.
Even if we take him as the voice of sanity, he says only that Republicans don’t want to pass health insurance reform, which we know is untrue. We know that the corporatist Dems are as much or more of a problem than the GOP. The GOP has been irrelevant since well before Baucus started his stupid gang-of-six meetings.
Oh, and P.S. The Senate bill completely sucks and should be killed. Didn’t we say that? About three months ago? Kill the Senate bill.
If public health insurance programs like Medicare & Medicaid are immune from the Stupak abortion demagoguery [spellcheck is off], just add back the robust public option and give it the same protections against anti-abortion meddling as Medicare & Medicaid.
…where the president can put his proposal *or a single-payer*, whatever the president is going to put forward…
whuh?
bart really needs to get out more.
Sure — my point was that Dionne’s logic could be used just as effectively ‘tween us and the Obama administration — Obama wants the Senate bill, we don’t, and so no, we don’t agree. All of this “pretty please we want reconciliation” is going to get us nowhere.
AND THE KILLIN’ GOEZ ON AND ON AND…
Citizen Jon Walker and the Firepup Freedom Fighters:
First of all Citizen Walker, I want to thank you for the incredible work you have done on the substance as well as the politics of this entire sorry episode. You have shown amazin’ patience with some of us old and slow folks out here whose only understandin’ of our healthcare system is in the delivery of the care. I am reluctant to get too optimistic about your analysis because it seems that reconcilliation hangin’ the structure of the public option on the expansion of existing public healthcare mechanisms has been here all along and the politics of it is so simple and transparent that I can’t believe that Rahm would’ve fucked up so royally as to put Obama in such a political corner dictated by a very hard rule of restricted choice. Something can’t be right about this because no one on the left has been willin’ to get out in front here and last night Sherrod Brown looked positively beaten.
What are the political implications here, Brother Jon…it seems to me that the November elections and the possibility of gettin a stronger congress look awfully good if what you have presented is anywhere close to what’s gunna happen.
Thanks again Citizen, you get another star on yer Norske Medal of Citizenship.
KEEP THE FAITH AND PASS THE AMMUNITION, AND WHAT ABOUT THOSE STUDENTS IN THE STREETS OF CALIFORNIA??!!!
On the last HCR thread, you made a comment that if there were any chance of the doing what has been suggested here and simply passing the *House* bill, that you would have seen evidence of it somewhere in the MSM.
Well, this fall all you saw in the MSM regarding passage was “60 votes”; discussions here about using 50+1 to get what we wanted and was popular, were crazy talk and unserious…Now it would appear that reconciliation was available all along, just like the votes for Dawn Johnson.
Oh Norske the student I can assure you have not been forgotten.
Depends on which “they” you are talking about.
Well, just a few hours after your LAST post and here’s new hope to have . . . interesting.
Did Stupak REALLY mean *single payer* when he said it, and does HIS version of single payer mean what MY version does? And why did he drop a NO NO WORD that RahmNation has made verboten to say for so long?
This new post Jon, fits in neatly with what I was dreaming of last week . .
The longer this drags out with NO resolution or passage of ANYthing, the further left it drives the Senate, Obama/WH and The House!!!
Because there IS an election coming!!!! *G*
And to do NOTHING by November is pure Dem Death across the board, and to pass the Senate bill as is is upre death for Dem’s across the board!
Interesting as all hell, again.
I’m (and so is this issue) up and down like a yo yo on a string!
I’m goin pickin tonite with a semi band rehearsal mixed in, you Pups take care of FDL and have fun for me, y’heah??? *G*
Uh, I believe Stupak’s strategy is called, “dump this bill and start with something new.”
Obama has already rejected that idea.
Oooh, Rachel’s got teh GOODS on STupak.
He’s been living at K street for several years, an extremely nice living arrangement, complete with FOOD and MAID SERVICE…..
for $600 a month.
Riiiiiiiiiiiiiight. A nice room AND board ON CAPITOL HILL for $600 a month.
That means he was receiving “income” for years. That income would be whatever the difference is between $600 a month and the actual market value. (I’m thinking several thousand a MONTH).
Oh boy. That’s either a donation (as a sitting Congressman, and probably an illegal donation) or it’s income.
Anyone wanna bet on whether he reported it either????
This could get FUN!!!!!!!!!!!!
Go Rachel, bout time you went after these “Democrats.”
Here’s the link you requested last night regarding Medicare’s rejection of procedures being twice the insurance industry rate.
Link
http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/heal-claims-process/national-health-insurer-report-card/2008-nhirc.shtml
National Health Insurer Report Card for 2008 is it’s title.
The link for 2009 is
http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/heal-claims-process/national-health-insurer-report-card.shtml
NO ONE is going to approve every procedure requested by a doctor and patient. NO ONE. If they did, it would be like an unlimited budget. Even a public option or even single payer won’t do it.
You’ve been sold a bill of goods regarding this–holding out hope to you that being turned down for a procedure would be gone. They know it isn’t true, but they imply it anyway. Judge for yourself what that means.
Wow, that’s very interesting. Now that Pete Stark is Ways & Means Chairman, he should call the CBO and ask them to score his own Americare bill (a very well designed Medicare buy-in plan). Except for the “Medigap policy section (‘SEC. 2266. STANDARDS AND REQUIREMENTS FOR AMERICARE SUPPLEMENTAL POLICIES.), the entire bill is simply spending and taxing and would qualify for reconciliation. Even Sec. 2266 would fit if the civil penalties were replaced with an excise tax on substandard plans.
http://www.opencongress.org/bill/111-h193/text
I must confess, its a riddle how a bill that’s 3% the length of the Senate bill (60 pages vs. 2000) can cover 100% of the population even as it reduces National Health Expenditures (the Senate bill does neither)… and it doesn’t have a single insurance exchange! And for some reason Americare starts Jan. 1, 2011 whe the President has made it clear that real health care reform requires we wait till 2014.
http://seminal.firedoglake.com/diary/5749
This is because Physician’s Offices incorrectly put in “claims” for services not covered by Medicare.
Medicare is driven by law. The services that are covered, are covered. Those that aren’t covered, aren’t. It’s pretty black and white. If a service is covered by Medicare, then it must be paid, and if it’s not covered by Medicare, it must not be paid. (Assuming the patient is a bona-fide Medicare recipient and the Doctor a certified Medicare provider.)
Also, there are some Medicare deductibles that must be met. A physician’s office will not know whether that deductible is met or not until the claim is filed.
You appear (if I got those numbers from the same place you did) to be just comparing the percentage of claims not paid, not the claims not approved. In fact, I’m having a hard time recalling any Medicare covered procedures that require approval. Perhaps someone else can help me remember that. Unlike insurance companies, which include LOTS OF PROCEDURES that must get approval first (we call them referrals).
(Or I’m totally wrong) *g*
No, claims not approved. Not those due to paper work problems.
The study was done by the AMA.
The exact description of the category is:
Percentage of claims denied.
Description: what percentage of records submitted are denied for reasons other than a claim edit (meaning claim denied for being incorrectly submitted or other admin error).
So, no it means exactly what it says. Medicare turned down procedures at a rate of 6.85% and insurance industry was about 3.44% in 2008. The percentages changed in 2009, but the ratio was the same.
Again, IF I’m looking at the same data you are (and it does say that 6.85% number so I’m thinking it is), there are reason codes below it that explain reasons for non payment.
Everyone of the listed exclusion codes is either an error in the claim (56% of those claims) or were for services not covered by Medicare (another 40% of these denied payments). That’s 96% of the claims not paid due to error in filing or services not covered by Medicare. The “Other” is too vague to make a judgement on.
You and I apparently disagree on what is meant by “approval” so we’re likely to get nowhere anyway. Private insurances require you (the patient) to get approval BEFORE getting a procedure done. This is called a referral, and this is where lots of folks are denied approval. I still can’t recall any procedures that require a referral for Medicare, but then again I worked in a pediatrician’s office, not exactly a lot of Medicare patients (and claims) there. We had lots of Medicaid patients, but Medicare, not so much.
So, if you wish to describe non-payment due to errors or services not covered as “not being approved” then so be it. That’s not the way I think of it, because as I said, private insurance companies do require prior approval for LOTS of procedures. (Some even include the ambulance ride to a hospital as requiring a “referral” or approval. Not making that up)
Anyway, that’s my take. I could just be totally wrong and full of shit though. My memory of these things is cloudy as it’s been awhile since I worked there (I was office manager).
Well assuming that the AMA doesn’t have any history of antagonism to Medicare (ahem) and the numbers are legit, its worth considering that Medicare doesn’t have any underwriting authority to weed out sick patients nor provider networks to weed out over-treating doctors nor a pre-authorization system to keep doctor visits or procedure costs in check. In which case, maybe Medicare is doing its job in paying on legitimate claims and rejecting illegitimate ones. What’s up with you Cregan, you think tax dollars grows on trees? (I kid I kid) :o)
Would there be enough House votes for a Senate bill without mandates (and obviously also without the public option)?
As a worker in a pediatrician’s office, I would like your opinion about why you think the cost of medical services, not premiums, is going up so rapidly. Why is this happening? It would be good to hear the view of an insider and I’ve never seen it adequately explained. On the micro level.