We Demand, Maybe

On his PlumLine Thursday, Greg Sargent wrote hopefully:

In a letter delivered to the White House moments ago, the two leaders of the bloc of House progressives bluntly told President Obama that they will not support any health care plan without a public option in it — and demanded a meeting to inform him face to face.

The letter was signed by Lynn Woolsey (D.-CA.) and Raul Grijalva (D.-AZ.), leaders of the House's Progressive Caucus. It termed any bill without "a public option built on the Medicare provider system and with reimbursement based on Medicare rates-not negotiated rates" as "unacceptable"- and noted it must be available immediately "and not contingent on any trigger."

The denunciation of the "trigger" concept is welcome news, and significant- up to a point. The progressives stop short of pledging to vote against any bill which does not include the relevant provision, instead calling such proposed legislation "unacceptable."

From thefreedictionary.com:

unacceptable - not adequate to give satisfaction; "the coach told his players that defeat was unacceptable"

To continue the analogy because (sarcasm alert) sports analogies are, oh, so unpretentious:

Coach Smith (what could be more typically American than Smith?) of the Chicago Bears tells his players that defeat in the upcoming game is "unacceptable." They lose, anyway. Does Coach Smith resign; appeal the outcome of the game; launch an assassination plot against the lead official? The third option is no more unlikely than the first two. "Unacceptable" has become acceptable.

More significant is Sargent's fear that

Should Obama jettison the public option, progressives will come under tremendous pressure to back the plan anyway. White House advisers will likely insist that liberals mustn’t deny the president a historic victory and enable a defeat that could cripple the first African-American presidency.

Could Sargent have been referring to this? Glenn Thrush of Politico wrote Thursday

The Congressional Black Caucus -- alarmed by reports that President Obama may plan to ditch the public option and reduce the scale of health care reform -- is pre-emptively warning the president to express his "unwavering support" for the progressive provisions in his speech next week.

The letter read in full:

Dear President Obama:
We eagerly anticipate your address before Congress next week regarding the urgent need to reform America’s ailing health care system. As the Members of Congress who represent the men, women and children who are disproportionately under- and uninsured, and whose health and wellness have suffered because of the numerous gaps in our nation’s health care system, we are deeply concerned about the current discussions surrounding health care reform and the possibility that current components of the bill – such as a robust public option and myriad health disparity elimination provisions – may be stricken in order to lower its cost to about $500 billion. We sincerely hope that you stress unwavering support for the following in your remarks:
1. An unwillingness to reduce the current costs of the health care reform bill. Despite misinformation about health care reform, such drastic cuts are unnecessary. Many of the nation’s health and health care experts concur that a meaningful, upfront investment is necessary to adequately mend the nation’s broken health care system. The TriComm bill (H.R. 3200), as you know, is budget neutral; in its current state, it is reflective of health legislation that is not only medically and socially appropriate, but fiscally sound. Reducing the overall cost of a budget neutral bill is therefore unnecessary and not a strategy that we do or can support.
2. A strong public health option that will allow the nation’s more than 46 million uninsured Americans – more than half of whom are people of color – to finally have access to affordable, meaningful health care coverage no later than 2013. As you know and we have firmly noted throughout the health care reform debate, a robust public option not only will play a pivotal role in our collective efforts to eliminate uninsurance – a public health challenge that detrimentally affects millions of hardworking, innocent Americans – but also in our efforts to ensure that every American citizen, regardless of race, ethnicity, geography or gender, has affordable access to meaningful, reliable health care treatments and services when needed. Thus, we firmly believe that the extraordinary benefits of a robust public option to the health and strength of this nation should, and do, outweigh the immediate, upfront costs associated with creating it.
3. A strong and demonstrative commitment from the White House to, in the days and weeks to come, use health care reform to achieve health equity. This will include not only ensuring the passage of existing health disparity elimination provisions – such as those around data collection, workforce diversity and community health workers – but also supporting stronger provisions, such as those included in Titles I, II, III and IV of the Health Equity and Accountability Act of 2009 (H.R. 3090). These measures are necessary to address the root causes of the health inequities that disproportionately and detrimentally affect racial and ethnic minorities, women, rural Americans and Americans within the U.S. Territories. These provisions are integral to efforts to ensure that as health care reform proceeds, we succeed in closing the gaps in health care that are independent of an insurance coverage, but that millions of Americans fall through and suffer from every day.
4. Inclusion of provisions that will ensure equity and parity for the American men, women and children in the U.S. Territories. The nearly 5 million Americans who live in the U.S. Territories should benefit from health care reform in a manner that is equitable to those Americans who live within the 50 states and in the District of Columbia. This is especially pertinent, given that so many of the nation’s worst health and health care trends are in the U.S. Territories. Therefore we urge you to, reiterate your commitment to ensure that these American citizens receive equal treatment under the health care reform bill..
5. Strong consideration of a trigger that will allow for the savings from prevention and other provisions in H.R. 3200 to replace the current pay-fors that have been identified. This strategy will not only allow the realization of true cost savings of prevention, health disparity elimination and other provisions, but it also will provide an avenue through which the savings generated can replace current pay-fors and/or be used to add important services and programs not currently offered because the costs are deemed too high.

We want to assure you and your Administration that the members of the Congressional Black Caucus are committed allies and partners in the fight to reform America’s broken health care system. Together we can seize this unique moment in our nation’s history to ensure that we not only reform our nation’s health care system, but that we transform it in a manner that eliminates uninsurance with a robust public option, achieves health equity for all Americans, and makes us – as a nation – healthier and stronger.
We appreciate your attention to this letter and look forward to working with you on this critically important legislation.

With regards, Congresswoman Barbara Lee
Chair, Congressional Black Caucus

Forget for a moment the reassuring words "we want to assure you and your Administration that the members of the Congressional Black Caucus are committed allies and partners int he fight to reform America's broken health care system."

Look instead at two other aspects of the letter:

1) Emphasis. After rightly urging the President to state "an unwillingness to reduce the current costs of the health care reform bill," the CBC notes the importance of providing a public option for uninsured Americans, "more than half of whom are people of color;" of health care reform "to achieve health care equity" and provisions "to address the root causes of the health inequities that disproportionately and detrimentally affect racial and ethnic minorities, women, rural Americans, and Americans within the U.S. Territories; and of a strategy which will include "health disparity elimination and other provisions."

2) Exclusion. Where is there any indication that members of the CBC would oppose a bill without a public option which would omit a trigger (which probably would result in no public option, now or later)? Nowhere- instead they "sincerely hope" the President will "stress unwavering support" for the positions they, justifiably, advocate.

The support of the Congressional Black Caucus for a "strong public option" (and who could be against strength? and for the needs of its constituents is laudatory. But it doesn't go far enough, suggesting, as Sargent fears, that "White House advisers will likely insist that liberals mustn’t deny the president a historic victory and enable a defeat that could cripple the first African-American presidency."

Is there any reason to believe invoking this race card wouldn't work? President Obama will not stoop that low; he has Chief of Staff Rahm Emanuel to play the bad cop in the "good cop, bad cop" routine. And much of the mainstream media, which will readily, and lustfully, argue inaccurately that defeat of a minimalized health care bill is a devastating blow to the first black President.

Whittling Away At Health Care Reform

The last couple of days haven't been very kind to supporters of a strong public option health plan, including bloggers of the left, some members of Congress and, apparently, most Americans.

Wednesday evening, Politico's Mike Allen and Jim Vandehei wrote

Obama will address a joint session of Congress on health care reform in prime time on Wednesday, Sept. 9, a senior official tells POLITICO, and the president plans to give lawmakers a more specific prescription for health care legislation than he has in the past, aides said.

And although House leaders have said their members will demand the inclusion of a public insurance option, Obama has no plans to insist on it himself, the officials said....

On health care, Obama’s willingness to forgo the public option is sure to anger his party’s liberal base. But some administration officials welcome a showdown with liberal lawmakers if they argue they would rather have no health care law than an incremental one. The confrontation would allow Obama to show he is willing to stare down his own party to get things done.

“We have been saying all along that the most important part of this debate is not the public option, but rather ensuring choice and competition,” an aide said. “There are lots of different ways to get there.”

(Can anyone say Sister Souljah?)

A couple of hours earlier, firedoglake's Jane Hamsher reported

My colleague Dana Bash and I have learned from a source, each one of us, that this White House right now is very quietly in serious conversations with Republican Senator Olympia Snowe, a key moderate.

She is basically the last Republican out of those gang of six senators who have been negotiating, really the last Republican that has an open line to this White House right now.

What we're hearing that she's talking about with White House staff is sort of a scaled-back bill that would focus on insurance reforms that both sides could agree to, but would not have a full public option, instead, would have a so-called trigger. What that means in layman's terms is basically that the insurance companies would have a couple of years to make some dramatic changes.

If they do not make those changes, then a public option would be triggered. So, it would be used down the road. They would hope that this would appease liberals by saying it's not completely off the table. And the big hope is that this could bring along another moderate Republican, like maybe Susan Collins of Maine, some conservative Democrats, like Ben Nelson and Mary Landrieu in the Senate, who don't want a public option, but would sort of potentially be open to a trigger like this.

Thursday, The New York Times observed

With Congressional Republicans standing almost unanimously in opposition to the Democratic approach, the target now for Mr. Obama is primarily a handful of moderate Democrats and the one Republican who seems open to a deal, Senator Olympia J. Snowe of Maine.

“It’s so important to get a deal,” a White House official said, speaking on the condition of anonymity in order to be candid about strategy. “He will do almost anything it takes to get one.”

The Washington Post reported Wednesday that Senate leaders (presumably Democrats)

are rethinking their strategies on the issue. One option, leading Democrats said Wednesday, is to tailor a bill to the demands of Sen. Olympia J. Snowe (R-Maine), a key moderate who has displayed the most willingness to continue negotiating with Democrats.

Another option, lawmakers said, is to attempt to make any package that comes to the Senate floor more attractive to Republicans by including tighter cost controls and slowing the pace of providing coverage to the 47 million Americans who have no insurance.

This evidently mirrors (coincidence? I think not.) thinking in the White House, which, according to Ezra Klein Wednesday, falls along two lines:

The first camp could be called "universal-lite." They're focused on preserving the basic shape of the bill. They think a universal plan is necessary for a number of reasons: For one thing, the insurance market regulations don't work without universality, as you can't really ask insurers to offer standard prices if the healthy and the young don't have to enter the system. For another, it will be easier to change subsidies or improve the benefit package down the road if the initial offerings prove inadequate. New numbers are easier than new features. Creating a robust structure is the most important thing. This camp seems to be largely headed by the policy people.

The second camp is not universal at all. This camp believes the bill needs to be scaled back sharply in order to ensure passage. Covering 20 million people isn't as good as covering 40 million people, but it's a whole lot better than letting the bill fall apart and covering no one at all. It's also a success of some sort, and it gives you something to build on. What that sacrifices in terms of structure it gains in terms of political appeal. This camp is largely headed by members of the political team.

These latter two analyses omit discussion of one option: the public one. That's not surprising, given indications that President Obama, who has spoken several times to ranking Senate Finance Committee member Charles Grassley of Iowa is partial to the Senate bill.

You know Chuck Grassley, member of the Gang of Six, who has written "The simple truth is that I am and always have been opposed to the Obama Administration's plans to nationalize health care. Period."

Now all the talk is of Obama negotiating with Maine's Olympia Snowe, another Repub member of the Gang, presumably to bargain away the public option in favor of ineffectual co-operatives or the chimera of a trigger provision. In a Congress with a heavy majority of members of the President's own party, that is hardly leadership. Unless, of course, it is what Mr. Obama and Mr. Emanuel had in mind the whole time.

And While We're At It, How About That Anne Frank?

Here it was Monday, August 31, 2009 and an argument between two United States Representatives, Duncan Hunter (R.-Ca.) and Debbie Wasserman Schultz (D.-Fla.) took place on MSNBC's Hardball regarding torture. Suddenly, the exchange took a suspicious turn:

HUNTER: OK. Let me talk.

Debbie, what you should really concentrate on is the fact that the Israelis use a much more stringent method of interrogation. I look forward to you asking for the Israeli prime minister to step down, because they do it. Do you think they should stop doing it to protect the country?

(CROSSTALK)

WASSERMAN SCHULTZ: This is America. The last time I checked, this is the United States of America.

(CROSSTALK)

HUNTER: So, you‘re not going to ask the Israeli leadership to step down?

(CROSSTALK)

MATTHEWS: Mr. Hunter, that is kind of ridiculous, the comparison.

(CROSSTALK)

HUNTER: That‘s not ridiculous.

(CROSSTALK)

WASSERMAN SCHULTZ: We‘re—we‘re talking about practices in the United States.

And the United States doesn‘t torture. No one is above the law, including Dick Cheney...

(CROSSTALK)

Two questions pop into one's mind, although apparently not into Chris Matthews' mind:

1) What does Israel (which hadn't been mentioned in the discussion) have to do with the charge that the U.S.A. tortures detainees?

2) Would Hunter have made the reference had he not been tussling with a woman named Wasserman Schultz?

Answers: 1) nothing; 2) We'll never know. But it would have been nice had Chris Matthews asked Representative Hunter what he was getting at.

His Pants Are On Fire

Repub Senators Kit Bond of Missouri, Mitch McConnell of Kentucky, and John McCain of Arizona visited Children's Mercy Hospital in Kansas City, Missouri on August 31 for a non-town hall meeting on health care. Though the appearance was by invitation only, the media was invited and they got a decent photo-op out of it.

Senate Minority Leader McConnell alleged a public option would destroy the insurance business and "then the doctors and hospitals will be working for the government.” Reportedly, he whined "nothing makes me more angry… than the suggestion that America does not already have the finest health care in the world."

Of course, the public option as contemplated by the United States Congress and/or President Obama would not be accompanied by federal government employment of doctors or management of hospitals, a practice of England's National Health Service, which has not yet destroyed that country.

If you had received nearly four million dollars from the health care industry, you, too, would be "angry" if your generous benefactors faced the possibility of being inconvenienced by reform.

But what to make of John McCain's claim in Kansas City that "the quality of health care in America is the best in the world?" He might not be aware of Japan. Or Australia. Or Greece. Or Austria. But surely Senator McCain has heard of the usual suspects- Canada, France, Germany, the United Kingdom.

The quality of health care in the United States may have improved relative to that in other nations since the World Health Organization in 2000 conducted its last analysis of care systems worldwide. Perhaps if the W.H.O. were to survey systems in those 190 countries today, and gave greater emphasis to the variables in which the U.S.A. is particularly strong, our nation would rank higher than #37, as we did nine years ago. But 36 spots higher? Not likely.

Senator John McCain says the health care system in the United States is "the best in the world." Not good. Not among the best. The best.

It is untrue. He knows it is untrue. There is a word for that. You know what it is.

Clear, Partisan, And Clearly Partisan

At talkleft.com, Big Tent Democrat, who says he has "always found Bill Bradley to be the emptiest of empty suits," has flagged the column appearing in Saturday's New York Times by the former New Jersey Senator and (2000) aspirant for the Democratic presidential nomination.

In it, Bradley recommends "a grand bipartisan compromise (which) is still possible with health care."

Mr. Bradley, meet two of President Obama's favorite Republican Senators, Charles Grassley and Mike Enzi.

These are two of the three GOP members of the "Gang of Six," cited for helpfulness by the President, which has been working- er, pretending to work- on health care reform in the Senate Finance Committee. Therefore, it's of more than passing interest that Enzi, who gave the Repub response on Saturday to the President's weekly radio address, gave a statement (video below) on the floor the day after the Senate's Health, Education, Labor, and Pensions Committee approved its bill. Enzi claimed

The partisan HELP bill allows Washington bureaucrats to ration care. The bill lays the groundwork for a government takeover of health care giving Washington bureaucrats the power to prevent patients from seeing the doctor they choose and obtaining new and innovative medical therapies.

Grassley, the Iowa Republican who is the ranking member on the committee, has sent out a fundraising letter. As The Washington Post's Ezra Klein noted (pdf) on August 31 (two days after Bradley's piece appeared), Grassley writes

I'm sure you've been following this issue closely. If the legislation sponsored by Speaker Nancy Pelosi in the House of Representatives and Chairman Ted Kennedy in the Senate is passed it would be a pathway to a government takeover of the health care svstem. lt would turn over control of your health care decisions to a federal bureaucrat ... and take it away from you and your personal physician.

It would mean government rationing in the name of cost controls....

the simple truth is that I am and always have been opposed to the Obama administration's plan to nationalize health care. Period.

Always have been opposed to the Obama administration's plan. Not then. Not now. Always. Even Bill Bradley and Barack Obama probably don't need to get knocked over the head with a two-by-four to understand that.