“Pelosi wants to back the so-called fiscally responsible Blue Dogs into a corner by giving them a bill that the CBO scores well and includes a robust public option as well as bills with a trigger or a weak public option that score worse, so that to reject it, they would have to actually accept a larger price tag.”

I attended the whole Senate hearing last week where Snowe stated we have had “decades of inaction” and “when history calls history calls” It was a pleasure watching Senator (divert or delay all investigations into false pre war intelligence) Roberts and the rest of the Republicans as Snowe said “aye” Their chins hit the table and I thought a few of them might have strokes.

They kept repeating the close to 800 billion number over 10 years and then kept repeating that close to half of the cost would be off set by Medicare savings. I know there is a great deal of fraud and abuse in the system but is that where they project all of those savings coming from?

When Conrad brought up that medicare recipients in rural areas receive less than medicare (maybe medicaid recipients also not sure) recipients in more urban areas…I was surprised.

After the hearing I went out of the room to hear the press ask questions. They did not ask any questions I wish I had piped up.

GOP reaction to vote (I ended up behind Senator Grassly with my “I am one of the 40 million uninsured”

Code pink folks there. I have witnessed our press not ask questions when given the opportunity. It is shocking when they do not.

Would have asked “When Senator Snowe mentioned the “decades of inaction” in regard to health care “do any of you feel responsible for those ‘decades of inaction”/

http://www.c-span.org/Watch/Media/2009/10/13/HP/A/24253/Senate+Finance+Cmte+Vote+on+Health+Care+Legislation.aspx

If you watch that clip above you will notice that when Cornyn asked the press “does anyone in the press corp have any questions” Not one of them had a question. So pathetic, so irresponsible. Then one of the peasants (we are peasants to them) said “I have a question” Cameras shut down.

Clear example of how our corporate media works. I

I think she’s trying to hold Reid’s feet to the fire too. If the House passes a bill with a medicare +5 public option, even if it’s the Baucus bill that passes the Senate, the final bill will have a public option. 4 of the 5 bills on the table have some form of public option. It is almost impossible that a bill is going to pass without a public option. Only if Harry Reid makes it happen. Not lets it happen, makes it happen. I have listened to my Senator Sherrod Brown of Ohio say over and over, most recently on TRMS on Monday, that the health care bill will have a public option. He is on the HELP Committee and he has never wavered in his confidence about the public option. I trust Sen Brown.

thank you for mentioning Co Chairs Grijalva and Woolsey’s major contribution to this effort.

while everyone is applauding wildly for Rep Grayson, these two have held firm and whipped the sh* out of their caucus – the Speaker wouldn’t have a MediCare + 5 to shoot for if these two hadn’t insisted on it

although there are miles to go before we sleep, these two have toiled all but anonymously and consistently told Leadership what’s up – and have done so without any of the usual wiggle room - IOW, it’s looking like the CPC has found it’s voice and power as a bloc – c’mon, a pipedream during the Supplemental fight – a major shift that could portend so much in the battles ahead

Thanks for that first person account.

The truth is that Medicare does pay less in rural areas, but expenses are less too, and there is no place in the country where you couldn’t run a profitable hospital or clinic with Medicare+5% rates.

Negotiated rates is bad because of the logistical challenge of negotiating with thousands of health care providers and, because it is a political organization, the government is not good at driving hard bargains in negotiations. There are other reasons negotiated rates are bad but I don’t want to bore anybody.

This is true. We would have no shot at real health care reform if it weren’t for the efforts of the CPC.

ditto

didn’t hurt to have a certain Free Range blogger as a D.I. either :D

Thanks to Madame Secretary; You might inform the dogs that each one of them will certainly be a loser in an upcoming election if they don’t back the Medicare E program? They already know this probably, but it will cause them to rethink their fealty toward insurers and perhaps represent their people?
The destruction of the GOP is near folks. It only takes the democrats to do one little thing and it’s all over. They will be marginalized forever if they vote to kill people. Soon you can have a gop and a KKK party, and there won’t be any real need for compromise as we fix what has been neglected in this country for 65 years. It’s people.

At least we have someone at our backs. Why don’t you let us know who to call Madame? We will take care of pressure.

Thanks. Didn’t know that.

I hope the Maine No on 1 folks are also asking folks to call their senators on health reform.

actually scratched out a diary comparing their statements on the Supplemental to those on the MediCare + 5 – significant and obvious differences

still tweakin’ it

Look forward to it.

Yay Congressional Progressive Caucus!

If anyone deserves credit for getting a strong PO through the House (besides our Jane Hamsher, of course, without whose whip effort we would not even have a PO on the radar), it is Grijalva and Woolsey–the Co-Chairs of the Progressive Caucus.

As for Nancy…she’s still got to prove herself after taking impeachment off the table.

Hooray Grijalva and Woolsey! More of this whipping in the future, please.

Soon you can have a gop and a KKK party

Isn’t that the GOP of today?

The way the House leadership is playing this is encouraging. We might end up being grateful that Obama removed Rahm from Congress. He can still attempt to piss in the pool but it’s harder to reach from the West Wing.

Scarecrow has a fresh cross-post up on the front page: “Why the White House Probably Doesn’t Want a Public Option”

It sure would have been nice if our representatives in Congress had engaged in such long and intense scrutiny of the decisions to go into war in Iraq, and to bail out the big banks, as they are devoting to the healthcare issue.

Does anyone know much about the nuts and bolts of the House/Senate conference that will produce the final bill? I’m curious as to how things actually work in conference.

Pelosi has balls and she is doing the people a great service for which she should be rewarded. The thanks to the others in the CPC is merited as well.

Stock should be taken now as to who has impeded progress and highest on the list is Obama. His lack of support for the PO while others did all the work warrants that he should be punished come the next election. It would be a travesty to reward this miscreant by allowing him to share in the hard work of others who had to overcome his efforts to derail the PO. A challenge from Sherrod Brown or some equally deserving candidate should get the support of those on the left.

Obama is a pretentious patronizing spewer of platitudes incapable of working hard at anything. He is basically an inept wingbag and we should not have to suffer this clown any further.

This is what happens when Pelosi is to the right of her district, and Reid is to the left of his.

Jon Walker has a new cross-post up: “Mark Udall And Michael Bennet Call For Up Or Down Vote On Public Option”

A couple of non-po patches that might save a lot in the final bill, based on the existing systems in other countries:

http://www.youtube.com/watch?v=MoHF_7lZx_8

Risks are assessed using formulas to determine which plans end up with lower risk populations, which end up with higher risk populations. Those that have lower risk pools pay into a fund that compensates plans with higher risk populations.

http://findarticles.com/p/articles/mi_m0795/is_n2_v16/ai_16863015/

In plain English: “govt negotiates prices for all private and public insurance, thereby lowering administrative costs and creating an equal playing field. It shares a lot with a single payer system, but allows for more private ownership”

Neither idea is predicated on the existence of the public option, neither precludes it; both would help to contain cost.

Sooner or later, folks are going to embrace the “Medicare for Everybody” meme. Call it what you will, but it is a simple thing to understand that medicare eligibility should be extended to the uninsured. It works for my dad, I’d like it to work for me now.

Medicare part E is clever but doesn’t quite hit the high note that a progressive, nation-changing program might convey. ObamaCare alludes to the lofty potential of sweeping reform but it is not yet understood just what ObamaCare means. If there could be a more proactive name, something with cache’ that might propel promotion and acceptance in a sound bite.

Proactive Medicare? Pro-Medicare? How about something simple but provocative…

ProCare!

The truth is that Medicare does pay less in rural areas, but expenses are less too, and there is no place in the country where you couldn’t run a profitable hospital or clinic with Medicare+5% rates.

Could you elaborate as to why expenses are less in rural areas, and if you feel that doctor compensation should also be lower in those areas in light of the fact that there is such a physician drain in the rural areas?

This is what happens when Pelosi is to the right of her district, and Reid is to the left of his.

Given the demographics of her district, she must be a squarely liberal Congresswoman.

@paz3: I can elaborate on why physicians are paid less in rural areas. Medicare pays on the basis of CPTs, which are basically medical procedures. Each CPT represents a particular procedure and rates are set by CMS (Centers for Medicare (and Medicaid) Services for each CPT calculated on the basis of a fairly complicated equation, which works something like this:
(1) Each state is assigned an ‘index’ for the relative costs of: (a) Practice expense (the overhead that a physician in that state can expect to pay), (b) Malpractice expense (the costs associated with the purchase of malpractice insurance), and (c) Work expense (you can think of this as a sort of cost-of-living adjuster). Some states have particular areas carved out because of significantly different expense patterns. New York City is carved out of NY state, for example, because of the high cost of living.

(2) Each CPT is also assigned a value for work, practice, and malpractice. The biggest difference is that there are *2* values for the practice value, depending on whether the CPT procedure was performed in a doctor’s office or in a hospital. Physicians are paid less for performing a procedure in a hospital because they don’t have to cover the overhead of the hospital, whereas they have to cover the overhead of running their own office.

(3) To get the value payable to a physician for a particular CPT, you multiply the CPT-based Work value by the State-based (or more correctly, GPCI-based) Work value. To this, you add the product of the CPT-based Practice (either office or hospital, depending on where the procedure was performed) value and the GPCI-based Work value. Then, you add the product of the CPT-based Malpractice value and the GPCI-based Malpractice value.

(4) This you’re done? Not quite. There’s a multiplier that is set yearly by CMS. Changing this value changes physician reimbursement across the board. You take the final value you calculated in (3), above, and multiply it by the current multiplier. That gets you to what the physician gets paid for performing a procedure on you.

Now, back to your original question: why physicians are paid less in rural areas. In rural states, to generalize a bit, the Work, Practice, AND Malpractice figures are lower than in more urban areas, mostly having to do with the cost of labor, the cost of real estate, the cost of living, and the cost of malpractice insurance. Lower Work, Practice, and Malpractice figures lead to lower end results in the monstrous calculations I detailed above. Simple, no? Now you know why your doctor’s office has 5 office personnel per physician, when, back in the old days, the physician had a nurse who also handled the paperwork. You also know why fully 15% of all of the money spent on healthcare in the US goes towards the administration of healthcare, and not actually providing healthcare. It’s a damned shame.