The best path forward on health care reform

Even before the Bay State debacle, Democrats faced no easy path forward on health care reform. If House Democrats like Bart Stupak, Anthony Weiner and Jerrold Nadler are to be believed, there are not 218 votes in the House for passing the Senate health care bill unchanged. Nor should there be, given the weak state-based exchanges in that bill and an excise tax that will encourage employers to downgrade the coverage they provide. Accepting a promise from the White House that problems will be fixed later would be idiotic. If the president didn't keep his campaign promises to let Medicare negotiate for lower drug prices or allow re-importation of prescription drugs from Canada, why would he keep any promises made to House Democrats now?

Key labor leaders are calling on Congress to pass a separate bill through the reconciliation process (requiring only 51 votes), while "simultaneously" passing the Senate bill in the House. I don't know what they have in mind for that separate bill besides fixing some of the problems with the excise tax on expensive health insurance policies.

Ezra Klein would prefer something like what labor is advocating (House swallows Senate bill, hopes for fixes through reconciliation), but the other option he lays out here seems far superior to me:

Democrats could scrap the legislation and start over in the reconciliation process. But not to re-create the whole bill. If you go that route, you admit the whole thing seemed too opaque and complex and compromised. You also admit the limitations of the reconciliation process. So you make it real simple: Medicare buy-in between 50 and 65. Medicaid expands up to 200 percent of poverty with the federal government funding the whole of the expansion. Revenue comes from a surtax on the wealthy.

And that's it. No cost controls. No delivery-system reforms. Nothing that makes the bill long or complex or unfamiliar.

I would add a few more things to that smaller bill, like the money for primary care clinics that Senator Bernie Sanders has been fighting for.

Democrats could then offer the insurance reforms you can't pass through reconciliation as regular bills. Will the Republicans dare to vote against allowing re-importation of prescription drugs, or revoking the insurance industry's anti-trust exemption? Will they dare to vote against banning insurance companies from discriminating because of pre-existing conditions? I don't think so. We should be able to get 60 votes for all of those reforms and more. If we can't, everyone will be able to see who stood up for consumers and who voted to protect corporate interests.

The smaller bill wouldn't solve all of the status quo problems with health care delivery, but neither would the Senate bill. Politically, this course would be less risky as well.

Feel free to tell me why I'm wrong in the comments.

Tags: Congress, House, Senate, health care reform, health insurance reform (all tags)

Comments

67 Comments

Universal HC is dead

Face it it's gone. What GOP senator is going to vote for the taxes required to support the medicaid expansion or insurance subsidies. They are not. We will get some minor insurance reform instead. I don't hold any hope either for banning  pre-existing condition discrimination - how does that work without the mandate, and how does the mandate work with the subsidies? It dosn't.

 

by vecky 2010-01-20 04:34PM | 2 recs
RE: Universal HC is dead

Those provisions are in the Senate version.  The House should pass it.  Maybe they could tinker with the excise tax or Medicare expansion through reconciliation, but I'd be cautious about that.  People are sick of this debate.  They want the Congress to move on.

by the mollusk 2010-01-20 04:38PM | 1 recs
Universal HC is dead
I agree. Unless they get the votes for moving forward on reconciliation - which I don't think are there - this turkey is pretty much done. No Republican member of the Senate will vote for any tax increase. Period. Either they pass the Senate Bill as is or there will be no real Bill.
by fladem 2010-01-20 05:11PM | 0 recs
Kent Conrad now says

he is open to using the reconciliation process to pass some kind of health care bill, depending on what's in the bill. And obviously, we wouldn't get Republican votes for the surtax on the rich, but we'd only need 51 votes. Screw Ben Nelson and Joe Lieberman.

by desmoinesdem 2010-01-20 05:17PM | 0 recs
neither the House nor Senate bill

provided universal health care anyway.

We don't need GOP votes for Medicaid expansion, because that can be included in a bill passed through reconciliation with 51 votes.

by desmoinesdem 2010-01-20 05:11PM | 0 recs
RE: neither the House nor Senate bill

WTF... 94 or 96% get covered under either of the bills.

Medicaid expansion under reconcilliation lasts for only 5 years. If the GOP is in charge then they will not renew it, they hate medicaid and the working poor. And it still has to be paid for. Ofcourse even for 5 years I would support it, but it's not reform.

by vecky 2010-01-20 05:17PM | 0 recs
RE: Universal HC is dead

How pathetic...  They wasted all that capital and are going to end up with nothing but thin gruel.  This is the weakest, most pathetic 59 seat Sente majority in history!

by LordMike 2010-01-20 05:11PM | 2 recs
the mandate has to go

No room for that in this scenario. But the Senate bill never should have included a mandate without a public option anyway, and even the public option in the House version was too weak. We don't get our public option, insurance companies shouldn't get 30 million guaranteed customers.

by desmoinesdem 2010-01-20 05:15PM | 0 recs
RE: the mandate has to go

16 million I think, becasue about 14-15 million ended up on medicare. Personally from a policy perspective I didn't see the mandate as a big deal. Given the < 8% of income exemption it would only have hit the rich or wealthy, folk who should have (and do have) insurance anyway. Also over 160 million americans currently have private insurance (including public servants), so adding another 10% to those rolls was not a big deal to affect insurance companies one way or the other.

But I agree the politics & optics was bad.

by vecky 2010-01-20 05:45PM | 1 recs
RE: The best path forward on health care reform

Will the Republicans dare to vote against allowing re-importation of prescription drugs, or revoking the insurance industry's anti-trust exemption? Will they dare to vote against banning insurance companies from discriminating because of pre-existing conditions?

Uh, this is the same group that held up funding the War in Afghanistan so that it could slow down the Healthcare debate.  They would vote against a resolution saying that today is Wednesday if they could somehow link it to Marxism.

 

by the mollusk 2010-01-20 04:36PM | 1 recs
RE: The best path forward on health care reform

I would also like to point out that about half of republicans and half of democrats voted against allowing drug importation. It was a turely bipartisan moment!

by vecky 2010-01-20 04:51PM | 0 recs
but many Dems who voted no

like Jay Rockefeller, said they only voted no because they didn't want the Dorgan amendment to blow up the whole health care reform compromise. Presented as a stand-alone bill, this easily passes.

by desmoinesdem 2010-01-20 05:12PM | 0 recs
RE: but many Dems who voted no

In that case I demand it comes up for a vote again and it passes. Whatever "compromise" was reached is now dead.

by vecky 2010-01-20 05:23PM | 0 recs
Mitch McConnell

is already on record supporting revoking the industry's anti-trust exemption, as are some other Republicans.

by desmoinesdem 2010-01-20 05:13PM | 1 recs
RE: Mitch McConnell

Well, Olympia Snowe was on record saying that she'd vote for cloture if they dropped the public option.  Charles Grassley was on record saying that he preferred state-level co-ops to the Public Option.  Not a single pro-life Republican voted for the bill despite the fact that it is probably the most pro-life piece of legislation ever brought up for a vote and is supported by the Catholic Council of Archbishops.  When will we learn?

by the mollusk 2010-01-20 05:29PM | 1 recs
RE: Mitch McConnell
Not soon, I think. The problem is that too many in the leadership forgot why they're Democrats in the first place - we favor the rights of people over the 'rights' of corporations, we believe that a society works best when more people can work hard and enjoy its benefits instead of most of the benefits flowing to a few, we don't think it's anybody else's business *what* kind of sex you have as long as there are no children involved, and so on. They remember it for a little bit, but the corporatists and consultocracy starts whining and since that's all they have to do during the day it drowns out the rest of us.
by beerwulf 2010-01-21 12:38PM | 1 recs
Not with leadership like this...

A simpler, less ambitious bill emerged as an alternative only hours after the loss of the party's crucial 60th Senate seat forced the Democrats to slow their all-out drive to pass Obama's signature legislation and reconsider all options.

No decisions have been made, lawmakers said, but they laid out a new approach that could still include these provisions: limiting the ability of insurance companies to deny coverage to people with medical problems, allowing young adults to stay on their parents' policies, helping small businesses and low-income people pay premiums and changing Medicare to encourage payment for quality care instead of sheer volume of services.

Obama urged lawmakers not to try to jam a bill through, but scale the proposal down to what he called "those elements of the package that people agree on."

http://news.yahoo.com/s/ap/20100120/ap_on_bi_ge/us_health_care_overhaul

How can we go wrong, with such strong "leadership" like that?

by LordMike 2010-01-20 05:24PM | 0 recs
RE: Not with leadership like this...

They really don't want anyone to vote next fall do they?

by the mollusk 2010-01-20 05:33PM | 0 recs
RE: Not with leadership like this...

I'm a little confused because I don't see how the "simpler, less ambitious" plan is remarkably different from the old one:

no denial of coverage to people with medical problems : Check

allowing young adults to stay on their parents' policies: Check

helping small businesses and low-income people pay premiums: Check

changing Medicare to encourage payment for quality care: Check

How is this any different from what we have now (medicaid expansion exempted)?

 

by vecky 2010-01-20 05:49PM | 0 recs
RE: Not with leadership like this...

Because this is not what would emerge from the bill.  The longer this goes on, the messier it gets.  The messier it gets, the more people suspect foul play.  The more people suspect foul play, the more the Democrats just look like a slightly less pre-pubescent version of the Republicans.

So, the calculus is really waiting another two months to get something else that no one wants and has an uncertain fate in the House.  I'm as unhappy as anyone about the process and the bill that has emerged, but this is what we got this time.  And it's not bad.  If the House Progressives want something more liberal, it'll have to go through reconciliation anyhow.  So why not pass this now and then continue the work on the back-burner while bringing financial regulation and job to the forefront.  That's what people want the Dems to be talking about.  Some kind of reconciliation package could be put together and voted on by late spring. 

If a financial regulation bill goes though and some incentives for hiring, that will be an extremely successful session.  The Democrats would be in a great position for the fall.  If we're still talking about health care reform with nothing to show for it two months from now.  We're screwed.

 

by the mollusk 2010-01-20 05:59PM | 0 recs
RE: Not with leadership like this...

If this bill gets shoved through by reconciliation, voters will be even angrier than they are now. And if we are still screwing around with this come November, voters will be pissed. It makes sense to try and pass a bill that includes provisions mentioned above. If it cant pass in a much scaled down form, than the Party can still point and say " we come up with a very reasonable smaller far less costly proposal and the GOP still wouldnt play ball" Move forward and work towards addressing the economy, and it cant be another multibillion dollar plan thast voters see as giveaways....

by BuckeyeBlogger 2010-01-20 06:29PM | 0 recs
the voters would be angry

if we passed something with a simple majority...good to know.

 

 

by ND22 2010-01-20 08:00PM | 0 recs
I don't get this

This is what Grivalja (sp?) was saying yesterday.  Something to the effect of "make the Senate take responsibility for the failure".  So, you pass a bill you like in the House, the Senate votes it down and then....?  We lose.  The point isn't to make the Senate look foolish (that's a pretty low bar).  The point is to pass meaningful Healthcare Reform.  The Republicans know full well that if nothing passes this year, they win.  There's almost no downside for them to not play along.  People want something to be accomplished.

Think about it this way.  The boss tells you and your coworker to have a report written by next Tuesday.  Your coworker does shoddy work, knocks off early, and isn't cooperating.  Tuesday rolls around and the boss calls you into her office.  At that moment, would you rather be a) holding a less-than-perfect piece of work , or b) nothing but a tirade.

Congress gets called into the boss' office next November.  They better have something.

by the mollusk 2010-01-21 10:23AM | 0 recs
RE: Not with leadership like this...

The current bill includes mandates.....tax increases and thousands of pages of beaurocratic gibberish

by BuckeyeBlogger 2010-01-20 06:25PM | 0 recs
RE: Not with leadership like this...

Money dosn't grow on trees, if you wan to help working famalies without expanding the deficit, guess what, you've got to raise taxes a tiny tiny bit (the tax increase is a tiny tiny bit in this bill).

And ofcourse I guess we should just have a 1 page bill that says : "I herby decree everyone has health insurance. Make it so."  Rather than compalining about the length, maybe you should think about what's in it.

by vecky 2010-01-20 06:38PM | 0 recs
RE: Not with leadership like this...

And btw the mandate is part of this thing: "no denial of coverage to people with medical problems". The new "simpler, less ambitious" plan includes a mandate as well, unless Congress has some miracle plan...

by vecky 2010-01-20 06:44PM | 0 recs
RE: Not with leadership like this...
I think this should be a workable approach, since no Republicans and no jackasses like Lieberman and Nelson would be needed in reconciliation. I have been a Democrat for 45 years, and will always show up to pull the lever for them, but unless they give it a college try on this I am basically through with the Party.
by Bob H 2010-01-20 05:35PM | 0 recs
Now or Never

I'm sorry, but this is insane.  We may not like the Senate bill, but mark my words, if we follow this plan, none of it gets renewed in 5 years (the reconciliation limit) and we've got nothing.  And I don't just mean wait until we get our majority back, no, it's done.  If we don't pass something major now, mark my words, it will be 20 years before we get another shot.

Too many people just can't wait that long.  Pass the Senate bill.  Go ahead and do what we can through reconciliation, but put something in place so that if everything is allowed to expire in 5 years, there's still something there.

by bannana873 2010-01-20 05:36PM | 0 recs
Medicare Expansion
It was extremely popular with voters and many in DC overlooked or ignored how disappointed many were when it was removed from the Senate bill. If Congress uses the reconciliation process to pass expansions in both Medicaid and Medicare, they will be renewed in 5 years. Expansions of both programs would be so popular with voters, Congress would have a difficult time taking the benefits away. Enact reform measures that are simple and publicly popular through reconciliation and they will be renewed in 5 yrs, guaranteed.
by Betsy McCall 2010-01-20 08:13PM | 2 recs
I agree

I agree with what you propose, except for the reconciliation part. Voters still dont want something shoved down their throat. I think what you propose has a much better chance of getting enough support in general to pass both the house and senate. I would add one other item though, tax credits. Significant Tax credits for small businesses allowing them to purchase plans to offer their employees.

 

I also agree that their needs to be significant money to fund primary care health clinics as well a a provision to cut the number of specialist residency slots in favor of primary care slots available in hospitals. That will help improve and increase the number of those going into primary care. The other item I think would help and could fly would be grants for students to go into nursing and for med students who agree to practice primary care for 5-7 years. WE  must increase the number of primary care doctors, if we dont, when we do find a way to expand coverage the system will drown due to a nursing and primary care shortage.

by BuckeyeBlogger 2010-01-20 06:21PM | 0 recs
RE: I agree

Employee health coverage is already tax-deductible.  How can we offer tax credits on top of that?

by Steve M 2010-01-20 06:29PM | 0 recs
RE: I agree

cutting taxes can solve any problem. Any.

by vecky 2010-01-20 06:41PM | 0 recs
RE: I agree

any political problem.

by the mollusk 2010-01-21 10:24AM | 0 recs
RE: I agree

Can you read, I said tax credits for small businesses to be  able to purchase plans to offer employees.....

by BuckeyeBlogger 2010-01-20 10:12PM | 0 recs
RE: I agree

Can you read: Group-health insurance plans already are tax deductable.

by vecky 2010-01-20 11:11PM | 0 recs
RE: I agree
Apparently you dont know the difference between a tax deduction and a tax credit?
by BuckeyeBlogger 2010-01-21 04:19PM | 0 recs
RE: I agree

I understand the difference, but the question is do you. A tax credit in the this case (assuming it's refundable) would be no different from a subsidy, which are already provided in the bill. Jonathan Gruber has done a lot of work on tax credits for health insurance and the conclusion is that they would help a few people and cost a bunch of money, far more than the current senate or health bills, with a  great amount of uncertainty. So unless you've got a magical funding source it's not economically feasible.

by vecky 2010-01-21 05:41PM | 0 recs
RE: I agree

I guess I need to speak more slowly.  When a small business (or a large business) purchases a plan for its employees, they ALREADY get to deduct 100% of the cost from their taxes.  You're proposing a tax credit for something that is already tax-deductible.

I'm curious, by the way, since you're normally so concerned about legislation that would increase the deficit, how you would propose to pay for this proposal.  It's worth noting that 50% of small businesses already provide health insurance (we're talking really small businesses here, fewer than 10 employees), so while providing an additional subsidy might incentivize another 10-20% of them to offer health coverage, you're basically just giving free money to the original 50% in order to achieve that goal.  Of course these numbers might look different when everyone in the individual market incorporates in order to get the tax credit.

by Steve M 2010-01-20 11:39PM | 0 recs
ugh

WE ALREADY DO THIS!

by ND22 2010-01-20 11:55PM | 0 recs
RE: ugh

Here's another idea, we could make mortgage interest tax-deductible in order to encourage home ownership.

by Steve M 2010-01-21 12:37AM | 0 recs
This

seems like a no-brainer.

I'm still leery about the whole home ownership thing. One of the right wing meme's that has been catching on is that the housing crisis is the fault of Clinton trying to push for home ownership for all, even the poor. This is of course from the crowd of "if you don't make enough money, screw you."

Buckeye's friends.

by ND22 2010-01-21 01:41AM | 0 recs
Hey guys

A tax credit is different than a tax deduction:

A tax credit is a dollar for dollar reduction of the tax burden.

A tax deduction is a dollar for dollar reduction of reported income.

by srliberalguy 2010-01-21 01:42AM | 1 recs
RE: Hey guys

Of course they're different.  But it still makes no sense to give someone both a tax deduction and a tax credit for the same expense.

by Steve M 2010-01-21 08:29AM | 0 recs
RE: Hey guys

Thank you.....if you give a tax credit instead of a deduction to small business it would have amuch larger impact on making it affordable to small businesses....I have friends who own small business who have said for years that if they could claim a credit as opposed to the deduction they could afford and would provide coverage. The deduction has limited impact to small business

by BuckeyeBlogger 2010-01-21 04:22PM | 0 recs
RE: Hey guys

I would also like to add, buckeye that tax credits for small businesses are included in the bill. Starting 2010 (this year) businesses with less than 25 employees and an avergae wage of less than 50K (i.e: over 85% of small busines employees) would receive tax credits for the cost of their premiums.

This stuff is already in the bill. It was added to the bill at Obama's request way back in July.

by vecky 2010-01-23 03:46AM | 0 recs
the Constitution doesn't say

you need 60 votes to pass bills in the Senate. You need a simple majority. If Democrats pass a bill with a simple majority, that is not "shoving" anything down anyone's throat.

by desmoinesdem 2010-01-20 06:36PM | 2 recs
The Progressive Agenda is Dead

There is no way any Republican is going to support any expansion of medicare or medicaid. They want to go in the opposite direction, like abolishing medicaid and replacing medicare with private medical accounts. My guess, the next major effort at health care reform be made by the next Republican president to do just that. The Democrats have given up on in trying to pass a bill before Brown is seated, and House Democrats will never vote for the senate bill as is. The Republicans are emboldened for they have won the jackpot with their obstructionist tactics, as they won the jackpot with the same tactics as in 1993-1994. They will continue their tactics and Democrats will continue to fail with passing their progressive agenda until they are willing to use tit for tat strategies. Democrats will not have any success with their domestic agenda until they show Republicans what goes around comes around.

For progressives, the game is over as far as a domestic progressive agenda is concerned. The next Congress will be more Republican, if not controlled by the Republicans. Obama can still play if he is willing to accept some of the GOP agenda, and may be he can pass some legislation with a coalition of Republican and Conservative Democrats. I doubt that will happen, so Obama's will end up being mainly as a foreign policy president.

by Zzyzzy 2010-01-20 06:44PM | 0 recs
If I was President,
I would ask each of the following items to be vote on individually: First Bill: Make it illegal for Insurance Companies to use pre-existing conditions to refuse coverage. Second Bill: Make it illegal for Insurance Companies to drop coverage for any reason. Third Bill: Allow anyone to buy Medicare Insurance at 5% above cost. Fourth Bill: Allow the Federal Government to negotiate Prescription Drug Prices. Fifth Bill: Allow the re-importation of Prescription Drugs. No combined bills just five simple to understand bills each to be voted upon, so we know who is with the people and who is with Pharma and the Insurance Companies.
by srliberalguy 2010-01-20 07:31PM | 0 recs
RE: If I was President,
May be what you propose would be worth a try. Although some Republicans say they will go for pre-existing conditions legislation, in the end they'll discover that such a policy will cost insurance companies profits. The second bill will never be acceptable, again that will cost insurance companies profits. Fourth bill, will never fly with Republicans - that's against their small government religion. Bill five has already been recently rejected by Congress. Finally, bill three probably would fail because it sounds too much like the public option.
by Zzyzzy 2010-01-20 08:00PM | 0 recs
Fourth bill

makes the Fifth bill irrelevant.

Personally don't support the fifth one, because I don't think it'll do anything to reduce prices, only screw with Canadians.

by ND22 2010-01-20 08:02PM | 0 recs
RE: Fourth bill

It won't really screw with them becasue Canadians can always simply just ban exports. It's more of a political vote rather than anything - show which senators are bought by Pharma and which are willing to stand up to them.

by vecky 2010-01-20 08:22PM | 0 recs
Why would it?

I wouldn't vote for it even if I had no ties to Pharma, because it's a ridiculously short sighted idea.

by ND22 2010-01-20 09:08PM | 0 recs
RE: Why would it?

Politics is full of ridiculous short sighted ideas. Some of them even get you re-elected.

by vecky 2010-01-20 09:11PM | 0 recs
RE: If I was President,

That's a fine idea, but it dosn't resolve the essential problem which lies with the first bill: pre-exisiting coverages requires a mandate, a mandate requires subsidies, subsidies require taxes and medicare payment cuts, which brings us back to a big o'll bill.

by vecky 2010-01-20 08:04PM | 1 recs
at this point...

At this point if a Medicare buy-in was allowed from age 60, and no other changes were made, I'd probably consider it a minor success. Heck, just continue moving the Medicare buy-in down 5 years every few years and in a few decades we'll have universal health coverage--which is maybe as long as it will take through any other means.

by markjay 2010-01-20 08:08PM | 1 recs
RE: at this point...
Today I called my liberal congressman Maurice Hinchey. My message was clear. "Suck it up. Vote for it."
by NYWoman 2010-01-20 08:49PM | 0 recs
If it takes 60 votes to pass anything,

who needs Evan Bayh. Let the asshole crash. He's an obstacle, not a help.

by janinsanfran 2010-01-20 09:01PM | 0 recs
Now are you all glad you supported Obama?
We are going to be giving up a hell of alot of seats with no healthcare reform in return. This was NOT the deal we had.
by Kent 2010-01-20 10:26PM | 0 recs
Deal?

At what point during the campaign did Obama specifically promise we wouldn't lose a lot of seats in 2010?

 

 

by ND22 2010-01-20 11:56PM | 0 recs
Reconciliation Won't Work

While the "reconciliation" option has been touted, over and over, as the way to evade the 60-vote issue in the Senate, it's also been... well, rather transparently designed to ignore the growing opposition to "reform" efforts. You can't plan for the reconciliation option and not, basically, make Scott Brown's and the GOP's point all over again: that Democrats are willing to do anything, manhandle every governmental standard, steamroll past all discussions... to get their way. Reconciliation will play horribly with the electorate, will make Republicans look sympathetic... and, as well, create all sorts of new mischief.

One key piece of mischief is the casual assertion that "fully funding Medicaid to 200% of poverty, all federally paid" isn't hugely expensive; that's one reason the House didn't go over 150% and the Senate rolled it back to 133%. Lots of progressives - who talk about the healthcare bill details, but really have only vague conceptions of the underlying issues - don't fuylly underrstand Medicaid, why it's a mess and why fixing it is an enormous, expensive headache. By itself, actually doing substantial Medicaid reform - actually federalizing it by ending the atrocious block granting program to states, unifying 50 plans into one comprehensive effort, and actually funding it enough to cover all people in poverty would amount to the most significant health reform since Johnson.

The reality is that, over the past 24 hours, the response to the new reality we're in has been almost laughably unserious. It's all "how can we basically continue the healthcare 'reform' process that just played a key role in the angry vote from Massachusetts" rather than "knowing what we now do about just how deeply voter anger can play out when we manhandle the legislative process, let's try and get a better process and more clarity about the work we're doing." Do the same things that have been done over the past year - don't explain the issues to the public, try and negotiate complex backrtoom deals, steamroll all opposition and reasonable challenegs - and you will get what was just delivered in Massachusetts, on a larger scale. The best move, as it has been all along, would be to admit that a poor process got us a bad healthcare bill, and either we abandon it and give up, or we start over on a smaller, more targeted set of reforms. That's the most realistic set of options. Or... flail about, make the same mistakes... and lose some more.

by nycweboy1 2010-01-20 11:56PM | 0 recs
in

October, I would have agreed, but now, I couldn't care less what the people want, the voters in this country are suicidal.

by ND22 2010-01-21 12:01AM | 0 recs
RE: Reconciliation Won't Work

I do agree - the bill needs to be made simplier and more "digestible". I don't know how to accomplish this though. Complex issues seem to require complex legislation.

by vecky 2010-01-21 02:08AM | 0 recs
RE: Reconciliation Won't Work

expand Medicare, for starters

 

that's much simplier and more "digestible"

 

 

by jeopardy 2010-01-21 10:43AM | 0 recs
RE: Reconciliation Won't Work

Ahhh you see stuff like that sounds simple but is it really? First it has to be "examined", medicare is expensive and will require subsidies, then it has to be paid for - raising taxes, then it has to go to the CBO, then senators from small states will cry and demand higher reimbursement rates, then the "doc fix" will come back, then payment refrom will come back, then the AARP will demand it be "solvent", the AMA will demand extra money for taking on these extra "below cost" patients.

So it may start off as simple - but like the current legislation it will quickly become more complex.

by vecky 2010-01-21 02:20PM | 0 recs
Here is a simple plan.

President Obama lead or resign so Biden can.

by srliberalguy 2010-01-21 01:45AM | 0 recs
VICTORY

I have to acknowlege the victory of the kill-billers, and hope that they choke to death on it. Perhaps there will be a bill as good as the Senate Bill in 20 or 30 years - so that our great grandchildren can kill it and experience the joy we share today. And then choke to death on it.

by QTG 2010-01-21 03:57PM | 1 recs
as usual

Barack the Magnificent holds no blame for anything that happens.

by bay of arizona 2010-01-21 04:39PM | 0 recs

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