Democrats to use reconciliation to pass healthcare bill

[bascule]

http://www.politico.com/livepulse/0310/Harkin_Reconciliation_is_a_go.html

 

Reconciliation is a process which limits debate about a bill and prevents filibuster, and therefore favors the majority party. The Democrats intend to use it to pass the healthcare bill.

 

I most certainly hope such a bill will include a public option. With that one caveat, I would support use of reconciliation here. The Democrats attempted bipartisanship and it was an utter failure.

 

A bit of history of reconciliation:

 

http://en.wikipedia.org/wiki/Reconciliation_%28United_States_Congress%29#Historical_use

 

Congress has used the procedure to enact far-reaching omnibus budget bills, first in 1981. Since 1980, 17 of 23 reconciliation bills have been signed into law by Republican presidents (a Republican has been president for 20 of the last 29 years). Since 1980, reconciliation has been used nine times when Republicans controlled both the House and the Senate, six times when Democrats controlled both the House and the Senate, one time when the Democrats controlled the Senate and the Republicans the House, and seven times when the Republicans controlled the Senate and the Democrats controlled the House. Reconciliation has been used at least once nominally for a non-budgetary purpose (for example, see the College Cost Reduction and Access Act of 2007, when a Republican was president and the Democrats controlled Congress). The 1986 Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) contained some health care provisions.

[jryan]

They never tried bipartisanship. They spent a year changing locks on doors and trying toget a vote on healthcare in August without reading the bill even while the American people opposed it, claiming the Republicans had no health care plan when they did.

 

They have been supremely partisan for all but one day out of the last 400 days, and even that one day was "we'll let you speak for a third of the time, we will dominate the conversation, and it means nothing because we're going the reconciliation route anyway". Now they want the vote to occurr without discussing what is actually in the 2,700 page bill... just like they did back in August. The Democrast seem to suffer from light sensativity.

 

And they only had the one day show-summit because they lost their super majority.

 

Bipartisanship? No. The closest they ever came was plucking the low hanging fruit from the Republican side with political pay-offs.

Edited March 4, 2010 by jryan

[bascule]

They never tried bipartisanship. [...] Bipartisanship? No. The closest they ever came was plucking the low hanging fruit from the Republican side with political pay-offs.

 

Well, that's an awful lot of blanket statements.

 

Was there something you feel the Democrats should've tried that the Republicans would've actually been open to?

[npts2020]

It seems to me the reconciliation route is about a day late and a dollar short. Nobody I have talked to has a good idea of what any sort of reconciliation bill is going to look like but it also seems to me that, if this had been done a year ago, there would have been enough time before this coming election to see if it was working or not. As it stands now, Republicans will gain from painting it in the worst possible light because there will not be time enough to see if it works and they know Americans will not vote for a second party when the more liberal side of their own party (Democrats) screws up.

[jryan]

Well, that's an awful lot of blanket statements.

 

Was there something you feel the Democrats should've tried that the Republicans would've actually been open to?

 

That is a odd way of looking at things, Bascule. A long term bipartisan effort to craft a bill that all sides would be at least moderately happy with would have been a great start. What kind of bill would it be and what would it include? I have no idea.. but the Democrats, being the ones in power and being the ones who decide on the procedure took the idea of bipartisanship, smashed it into a million pieces and sprinkled the pieces into the congressional toilets for target practice.

 

One day of one-sided summit talks won't bridge that gap.

 

And to add to the insanity of the "we tried being bipartisan!" bull-hooey that Democrats are now claiming, the one day summit was.. oh... a week ago? And rather than building on even that miniscule effort, here we are talking about reconciliation and an end to discussion. That is absurd to the Nth degree.

 

Democrats should know that anything passed by reconciliation can be recinded by reconciliation as well.

 

It would be all too easy to get public support for rescinding it since this idiotic 2,700 page bill does nothing but tax the public for the first several years while inserting regulations into private health care that will make costs skyrocket. It won't be hard to get public support for killing such a ill-conceived bill through reconciliation when Republicans regain control of Congress -- which they will if this bill gets passed.

 

I've never seen the Democratic party this intent on suicide, but so be it.

[Phi for All]

None of the plans I've seen is worthy of what needs to be accomplished. The Republican plan jryan mentioned is inadequate because it didn't address pre-existing conditions or tort reform, two issues I feel very strongly about. None of the other plans seem to handle these issues either, and I can't put any trust in a bill with 2700 pages that has limited debate and amendment. This whole thing stinks as I watch the path towards healthcare being narrowed down to two steel rails, and I'm tired of being railroaded by those who want to snake their way between me and my tax dollars.

[jryan]

It seems to me the reconciliation route is about a day late and a dollar short. Nobody I have talked to has a good idea of what any sort of reconciliation bill is going to look like but it also seems to me that, if this had been done a year ago, there would have been enough time before this coming election to see if it was working or not. As it stands now, Republicans will gain from painting it in the worst possible light because there will not be time enough to see if it works and they know Americans will not vote for a second party when the more liberal side of their own party (Democrats) screws up.

 

Nobody could ever know what a reconciliation bill looks like. By design it hurries measures through congress with no debate... which may be ok with a 100 page bill that can bee read in a sitting.... but this is 2,700 friggin' pages.

 

It's not surprising though. In August we saw Democrats swearing up and down that reading the then 2,000 page beast was not really important, what was really important was voting on it before the August recess.

 

Also, here is the kind of measures that I would like to see in a health care reform bill. As an actual bill there would be more than one page, but this plan targets the actual problem and is far more efficient in doing so:

 

The Small Bill (pdf)

 

 

None of the plans I've seen is worthy of what needs to be accomplished. The Republican plan jryan mentioned is inadequate because it didn't address pre-existing conditions or tort reform, two issues I feel very strongly about. None of the other plans seem to handle these issues either, and I can't put any trust in a bill with 2700 pages that has limited debate and amendment. This whole thing stinks as I watch the path towards healthcare being narrowed down to two steel rails, and I'm tired of being railroaded by those who want to snake their way between me and my tax dollars.

 

 

See the reform proposal I linked to. I mentioned the Republican bill only as evidence of the bill actually existing as a good faith starting point for compromise. The Democrats spent the last year pretending it didn't exist and lying about the lack of a Republican bill. I didn't say I supported that bill as written.

 

"The Small Bill" is the kind of legislation that I would support, and it has a solution for pre-existing conditions that is at least a good starting point.

Edited March 4, 2010 by jryan
Consecutive posts merged.

[bascule]

A long term bipartisan effort to craft a bill that all sides would be at least moderately happy with would have been a great start. What kind of bill would it be and what would it include? I have no idea..

 

Given the Republicans track record on the matter, it wouldn't have been much of anything, or if it was, it'd be little more than a handout to the insurance companies and the pharmaceuticals.

 

but the Democrats, being the ones in power and being the ones who decide on the procedure took the idea of bipartisanship, smashed it into a million pieces and sprinkled the pieces into the congressional toilets for target practice.

 

At least the Democrats attempted bipartisanship, and the Republicans spat in their faces. It went a little something like this:

 

Republicans: "Democrats are meeting behind closed doors! These meetings should be open to the public!"

Obama: "Okay, we're going to have public televised meetings"

Republicans: "Noooo they're putting it on TV to make us look bad!"

 

How do you reasonably work with something like that. The Republicans complain about what the Democrats do. The Democrats try to offer concessions. The Republicans complain about the concessions.

[jryan]

Given the Republicans track record on the matter, it wouldn't have been much of anything, or if it was, it'd be little more than a handout to the insurance companies and the pharmaceuticals.

 

So you would support rescinding the Medicare prescription drug program, then?

 

Also, I already linked to two Republican health care bills, neither of which included pay outs to pharmaceutical companies.

 

At least the Democrats attempted bipartisanship, and the Republicans spat in their faces. It went a little something like this:

 

(4 Months of closed door meetings by Democrats on Health care reform)

 

Republicans: "Democrats are meeting behind closed doors! These meetings should be open to the public!"

 

(No movement on the part of the democrats to open up debate on the bill for 8 months... instead they tried two more times to ramrod the bill through congress, trying to bribe Republicans and Democrats alike... leading to such a disillusionment by the national public that Ted Kennedy's seat goes to a conservative Republican... ending the democrats super majority)

 

Obama: "Okay, we're going to have public televised meetings"

 

(Hold ONE SINGLE MEETING joint meeting in the entire year.. fail to get 100% support for the absurd 2,700 page monstrocity... wait 7 days, call for reconciliation)

 

Republicans: "Nice knowing ya, democrats!"

 

How do you reasonably work with something like that. The Republicans complain about what the Democrats do. The Democrats try to offer concessions. The Republicans complain about the concessions.

 

I corrected that for you. Your account of the last year was rather myopic.

[Phi for All]

How do you reasonably work with something like that. The Republicans complain about what the Democrats do. The Democrats try to offer concessions. The Republicans complain about the concessions.

Personally, I think both parties are catering to big insurance and big pharma. If the Reps were truly interested in fiscal frugality and integrity, they would allow the federal government to negotiate with the pharmaceuticals with regards to Medicare drugs. If the Dems were truly interested in providing a workable healthcare system, they would not accept a bill without a public option to provide competition for administratively expensive insurance companies. The Big Bill is full of garbage and the Small Bill doesn't truly address what this country is worthy of: a healthcare system that takes care of its citizens like the valuable human beings they are, and puts prevention, utility and efficiency ahead of profit.

[bascule]

So you would support rescinding the Medicare prescription drug program, then?

 

At the very least, it should be modified so Medicare can negotiate bulk discounts with the pharmaceuticals.

 

Also, I already linked to two Republican health care bills, neither of which included pay outs to pharmaceutical companies.

 

I corrected that for you. Your account of the last year was rather myopic.

 

Well, let's put it in context, shall we?

 

Who made a better effort at bipartisanship: the Democrats now, or the Republicans in 2003?

[jryan]

The small bill values the opinion of the individual citizen, allowing them to pick the health care coverage that fits them best.. this benefits that majority of the citizens of the country.

 

But the bill also provides assistance to citizens that, for health reasons, have seen their options greatly diminished or vanish, and restores a level of choice to them as well.

 

It further increases the choice and opportunity of individuals that are self employed, giving them the same opportunity as those working for businesses.

 

I can only imagine the uproar if Congress decided to put further limitations on American's choice. Hell, we have a whole grassroots movement revolving around the governments limitations on intoxicant choice.

[bascule]

Who made a better effort at bipartisanship: the Democrats now, or the Republicans in 2003?

 

You going to answer this there jryan?

[Mr Skeptic]

On the other hand, I don't think the Republicans are even pretending to be bipartisan, so it is different whether the R's or D's are in fact being bipartisan.

[jryan]

You going to answer this there jryan?

 

 

 

Sure.

 

Let's start with the composition of The 108th Congress: 48D-51R-1I in the Senate and 205D-229R-1I in the House.

 

The Voting on the bill was as follows:

 

House (passed 216 - 215)

Democrats - Aye - 9, No - 195, NV/P- 1

Republican - Aye 207, No - 19, NV/P - 2

Independant - Aye - 0, No - 1, NV/P - 0

 

Senate (passed 54 - 44)

Democrats - Yea - 11, Nay - 35, NV/P - 2

Republican - Yea - 42, Nay - 9, NV/P - 0

Independant - Yea - 1, Nay - 0, NV/P - 0

 

 

That's pretty close, and pretty partisan (not as partisan)... let's look at that wiki article of yours to see if we can find the similarities between the current reform bill and the Medicare bill....

 

First line in the wiki article:

 

"The bill was debated and negotiated for nearly six years in Congress ....."

 

Hmmmm... Nearly 6 years they debated that bill in congress even though they had the House and Senate majorities all 6 years and the presidency for 3.

 

I think we're done here. You lose.

 

Now it's time for you to answer my question:

 

So you would support rescinding the Medicare prescription drug program, then?

 

So what's your answer?

Edited March 4, 2010 by jryan

[bascule]

Sure.

 

Let's start with the composition of The 108th Congress: 48D-51R-1I in the Senate and 205D-229R-1I in the House.

 

The Voting on the bill was as follows:

 

House (passed 216 - 215)

Democrats - Aye - 9, No - 195, NV/P- 1

Republican - Aye 207, No - 19, NV/P - 2

Independant - Aye - 0, No - 1, NV/P - 0

 

Senate (passed 54 - 44)

Democrats - Yea - 11, Nay - 35, NV/P - 2

Republican - Yea - 42, Nay - 9, NV/P - 0

Independant - Yea - 1, Nay - 0, NV/P - 0

 

 

That's pretty close, and pretty partisan (not as partisan)... let's look at that wiki article of yours to see if we can find the similarities between the current reform bill and the Medicare bill....

 

First line in the wiki article:

 

"The bill was debated and negotiated for nearly six years in Congress ....."

 

Hmmmm... Nearly 6 years they debated that bill in congress even though they had the House and Senate majorities all 6 years and the presidency for 3.

 

I'm sorry, how is any of that evidence of bipartisanship on the part of the Republicans? If anything, it's evidence of bipartisanship on the part of the Democrats, or maybe just the fact that some Democrats are in the pocket of Big Pharma as well. A longer period of "debate" and some Democratic votes equates to bipartisanship? Were there any concessions to Democratic concerns?

 

I think we're done here. You lose.

 

C'mon guy, don't be a Dick (Cheney).

 

So you would support rescinding the Medicare prescription drug program, then?

 

Your question was answered in #11

Edited March 4, 2010 by bascule

[jryan]

I'm sorry, how is any of that evidence of bipartisanship on the part of the Republicans? If anything, it's evidence of bipartisanship on the part of the Democrats. A longer period of "debate" equates to bipartisanship?

 

That is odd coming from someone that accepts 1 single day of negotiation as evidence of Democrats bipartisanship. The Medicare negotiations took place over 2000+ days.

 

C'mon guy, don't be a Dick (Cheney).

 

I'm not trying to be a dick, I just find your claim of Democrats bipartisanship, and evidence for it, to be absurd. Who spent more time negotiating their bills? Seriously, had the Democrats successfully ramrodded the bill through in August, or Scott Brown lost in MA they Republicans wouldn't have even gotten the 1 day.

 

Your question was answered in #11

 

Oops, missed that whole post apparently. So you don't disagree with the need for the bill, just that you would do it a different way? And how would Medicare negotiate bulk purchases of medication when they are not a drug distributor? Or are you asking that the Federal Government open their own pharmacy?

[Phi for All]

And how would Medicare negotiate bulk purchases of medication when they are not a drug distributor? Or are you asking that the Federal Government open their own pharmacy?

Medicare did just fine up until the Medicare Reform Act of 2003 took away one of their best negotiating tactics, the buying power of those on Medicare. It was a move purely to take tax dollars away from EVERYONE, not just Medicare participants, and put them in the hands of Big Pharma. Seriously, how can you possibly condone this shameful ripoff while still adhering to capitalist market integrity?

[Pangloss]

Seriously, how can you possibly condone this shameful ripoff while still adhering to capitalist market integrity?

 

Well I don't think he is, I think he's trying to point out hypocrisy in bascule's argument. But I don't think he's finding it -- bascule's been very consistent in his criticism of that bill and holding to his generally-progressive viewpoint.

 

I think jryan is also missing the point that nobody's really holding up the Democrats as a model of perfection here. He does make some good points above, at least in terms of how badly the Dems have done, but I don't think there's any lack of recognition by the public for Congress' failures.

 

In fact I think part of the reason why we're seeing reconciliation come up now is the widely-held and frequently-reported analysis over the last quarter that Democrats are going to lose a lot of seats in November. In for a penny, in for a pound.

[jryan]

Medicare did just fine up until the Medicare Reform Act of 2003 took away one of their best negotiating tactics, the buying power of those on Medicare. It was a move purely to take tax dollars away from EVERYONE, not just Medicare participants, and put them in the hands of Big Pharma. Seriously, how can you possibly condone this shameful ripoff while still adhering to capitalist market integrity?

 

Medicare didn't have a drug benefit before the Medicare Pt D was created with the 2003 bill.

 

I used to be a social worker in the 1990s and assisted a lot of Seniors navigate Medicare, Medicaid and local benefits. The primary reason senior citizens bothered applying for Medicaid was because Medicare, at that time, didn't cover prescriptions.

 

With Medicare Pt. D Seniors had the option of buying into a prescription plan. More-over, the Medicare Advantage (previously Medicare+Choice) plans run by BC/BS, Humana, Kaiser, Aetna and so on could begin offering prescription benefits to their customers when before it was prohibited.

 

The part of the program that prohibited the Federal Government from negotiating with drug companies was specifically to keep the Federal Government from influencing the drug manufacturing business in the U.S. through spending and regulatory powers. It didn't limit Aetna, Kaiser, Walmart or any private entity from doing so, however.

 

It's a matter of opinion, but I find it incredibly open to corruption to have the government negotiate directly with pharmaceutical companies while they also have regulator and oversight power on the same companies. The thought of giant deals being done as payback, without thought to cost or quality is not a new form of corruption in the Federal government.

[bascule]

And how would Medicare negotiate bulk purchases of medication when they are not a drug distributor? Or are you asking that the Federal Government open their own pharmacy?

 

The same way Health Canada does it: buy the drugs in bulk from the pharmaceuticals and sell them to pharmacies at a discount, so long as the drugs are going to Medicare recipients.

[jryan]

The same way Health Canada does it: buy the drugs in bulk from the pharmaceuticals and sell them to pharmacies at a discount, so long as the drugs are going to Medicare recipients.

 

We don't need that program. We have CVS, Walmart, Safeway, Rite-Aid, Giant Food, Target and many other companies that already negotiate bulk rates with Pharmacies.

 

Walmart, for instance, sells most generic brands for $5 even without insurance, and most distribute common antibiotics for free.

 

Edit: Also, Bank of Canada did a study of 27 top selling drugs in Canada and compared them to the same 27 drugs in the US. Guess what they found? Canadians pay on average 56% more for those perscriptions (PDF of study here). Hardly a ringing endorsement of Canadian bulk discounting.

 

You have to love the BOC conclusion... "If we could only buy from America..."

Edited March 4, 2010 by jryan

[Mr Skeptic]

However, the generic drugs, according to the study, are only 15% of drug costs. It also mentions Canada has less competition in the generic drugs market. It says that the patented drugs are 40% cheaper in Canada, and would I imagine account for the other 85% of the costs.

[bascule]

We don't need that program. We have CVS, Walmart, Safeway, Rite-Aid, Giant Food, Target and many other companies that already negotiate bulk rates with Pharmacies.

 

Walmart, for instance, sells most generic brands for $5 even without insurance, and most distribute common antibiotics for free.

 

Edit: Also, Bank of Canada did a study of 27 top selling drugs in Canada and compared them to the same 27 drugs in the US. Guess what they found? Canadians pay on average 56% more for those perscriptions (PDF of study here). Hardly a ringing endorsement of Canadian bulk discounting.

 

You have to love the BOC conclusion... "If we could only buy from America..."

 

As someone who buys a lot of prescriptions for which there are no generic alternatives available, I'd say: no, drugs in America are heinously expensive. Preventing Medicare from negotiating bulk discounts was a huge handout to Big Pharma.

[jryan]

As someone who buys a lot of prescriptions for which there are no generic alternatives available, I'd say: no, drugs in America are heinously expensive.

 

And the majority of all medications perscribed do have a generic equivalent. So you are still talking about a fraction of the American population without health insurance, and the smaller fraction of that that have a chronic illness that require non-generic medications.

 

That remaining fraction of a fraction (actually a fraction of a fraction of a fraction) is not worth tearing down the system in order to try a drastic rework of the system.

 

Preventing Medicare from negotiating bulk discounts was a huge handout to Big Pharma.

 

Which is a gratuitous assertion on your part as medications are still negotiated and purchased in bulk by numerous large and small pharmacies in the US.