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House Leadership Seeks CBO Score for HR676; single-payer will get a floor vote

Sarah's picture

Democratic members of the House of Representatives are hearing the people. Keep the pressure on! It started with the tenacious Anthony Weiner of New York. California's Nancy Pelosi, Speaker of the House, changed her mind in July and said single payer would get an up-or-down floor vote.

Now Maryland's Steny Hoyer, House Majority Leader, says the Congressional leadership has asked the Congressional Budget Office to score House Resolution 676, entitled "To provide for comprehensive health insurance coverage for all United States residents, and for other purposes" -- aka United States National Health Insurance Act.

This bill's other short title is the Expanded and Improved Medicare for All Act -- and according to SinglePayerAction, Hoyer's told a constituent he'll address single payer and the effort to get HR 676 scored at a town hall this week:

House Majority Leader Steny Hoyer (D-Maryland) said on Friday that he will address the vote on single payer and the effort to get the CBO to score it at a town hall meeting on health care he is scheduled to attend in Waldorf, Maryland on Tuesday.

On Friday, Hoyer told a constituent, Dr. Carol Paris, that he would raise the single payer issue at his town hall meeting on Tuesday.

“Speaker of the House Nancy Pelosi has put single payer on the table,” Paris told Single Payer Action. “She has called for an up or down vote on the Weiner amendment when Congress convenes in the fall. I pointed that out to Congressman Hoyer, along with the fact that the Congressional leadership has just called to have HR 676 scored by the Congressional Budget Office.”

“So those two events – asking to have HR 676 scored, and calling for an up or down vote on the Weiner amendment – puts single payer on the table as an option in the ongoing health care debate,” Dr. Paris said.

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Sarah's picture
Submitted by Sarah on

and gives examples. One of them is the President's grandmother. He also refers to David Leonhardt's column on rationing.rationing, which carries this:

Health care, I realize, seems as if it should be different. But it isn’t. Already, we cannot afford every form of medical care that we might like. So we ration.

We spend billions of dollars on operations, tests and drugs that haven’t been proved to make people healthier. Yet we have not spent the money to install computerized medical records — and we suffer more medical errors than many other countries.

We underpay primary care doctors, relative to specialists, and they keep us stewing in waiting rooms while they try to see as many patients as possible. We don’t reimburse different specialists for time spent collaborating with one another, and many hard-to-diagnose conditions go untreated. We don’t pay nurses to counsel people on how to improve their diets or remember to take their pills, and manageable cases of diabetes and heart disease become fatal.

“Just because there isn’t some government agency specifically telling you which treatments you can have based on cost-effectiveness,” as Dr. Mark McClellan, head of Medicare in the Bush administration, says, “that doesn’t mean you aren’t getting some treatments.”

Milton Friedman’s beloved line is a good way to frame the issue: There is no such thing as a free lunch. The choice isn’t between rationing and not rationing. It’s between rationing well and rationing badly. Given that the United States devotes far more of its economy to health care than other rich countries, and gets worse results by many measures, it’s hard to argue that we are now rationing very rationally.

On Wednesday, a bipartisan panel led by four former Senate majority leaders — Howard Baker, Tom Daschle, Bob Dole and George Mitchell — will release a solid proposal for health care reform. Among other things, it would call on the federal government to do more research on which treatments actually work. An “independent health care council” would also be established, charged with helping the government avoid unnecessary health costs. The Obama administration supports a similar approach.

And connecting the dots is easy enough. Armed with better information, Medicare could pay more for effective treatments — and no longer pay quite so much for health care that doesn’t make people healthier.

The rest is worth reading, if for no other reason than the expose on the effect rising health care costs have on wages, the quality of care, and of course the outcomes.

Submitted by hipparchia on

canada spends relatively more on its old people [and less on its younger people] than we do, by a significant margin. japan has an even greater spread between old and young. germany is closer to us.

yes, medicare needs some fixes, but all of these people -- klein, yglesias, leonhardt, many others -- are just apologists [whether they realize it or not] for those who want to cut 'entitlement' spending and keep the dollars flowing to the insurance companies and hospital chains and drug manufacturers and associated fatcats.

so, while they do sometimes make a valid point here and there, it's worth casting a jaundiced eye on everything they say or write.

Submitted by lambert on

... which is good in the abstract, feeds into the board of "experts" (I forget the name, help me out) in HR3200, which, of course, is appointed. Therefore, the compostion of the board will be crucial.

Does anyone imagine that Obama won't appoint insurance company "experts" on that board? With profit as one of their (no doubt unstated) criteria? Or that Obama won't appoint "entitlement reform" advocates?

Meanwhile, whenever I hear "bi-partisan board" I look round to see which direction the Big Wienie is coming from.

On the bright side, we've got Bob Dole on board, so at least old white guys like me can be confident Viagra's gonna be covered...

Sarah's picture
Submitted by Sarah on

a purely corporate money footing (think about the dangerous drugs recalled in just the last ten years) and if we could finally kick some of those myths about diets and the like to the curb to stay, I'd be all for finding out "which treatments work."

Our local news last night ran a "feature" on a "study" that "found that the bigger your waistline the smaller your brain."

I don't know, sometimes it's not worth moving the cat out of the way to chew through the restraints ....

BDBlue's picture
Submitted by BDBlue on

I'm betting we get a "score" that takes in all of its costs, without considering any of the private savings. Then we'll get another round of the world's stupidest debate where everyone announces single payer is "just too expensive" while ignoring that, while it will cost the government more that it will have to raise in taxes, it will cost the country less (even though it will have to pay those taxes).

I would love to be proven wrong, however.

Submitted by hipparchia on

it wouldn't surprise me if steny asked for scoring [which will look bad] instead of a full analysis [which would look much better].

i'd like to be proven wrong too.

selise's picture
Submitted by selise on

if the cbo scoring looks only at fed budget numbers (as the cbo has been doing this year -- but did not in 1993 iirc), instead of total national health expenditures, hr 676 will be look very very bad. and that will be used to reject it from discussion.

danger! will robinson!!!

it is really really important to keep talking about total national health expenditures which include costs to fed budget, state and local budgets, employer budgets and household budgets.

Jeff W's picture
Submitted by Jeff W on

I followed the link and immediately jumped to the 4th comment (for some reason—maybe because it was short, pithy, with bolding). Wow, dynamite question!, I thought. Then, I happened to look at the name of commenter (something I never do, really): you! Ha!

(The name heading falls into both the description and compliment categories, I think. I pay attention to administrivia.)

[Addition on reading more: Great responses throughout from you and hipparchia. You stole the show!

I kind of didn't like her "…I do not believe the American public has been educated enough about how such a system would work in the U.S." I'm not sure it's true—most people would understand "Medicare-for-All"—and, even if it were, that's not a precondition to action. Who was "educated" about a public option before it became the health care insurance reform solution du jour?]

Submitted by hipparchia on

"…I do not believe the American public has been educated enough about how such a system would work in the U.S."

yes, that came across as awfully snotty. made me want to ask her just how much effort she herself had put into educating ohioans about 'how such a system would work'.

Sarah's picture
Submitted by Sarah on

from Kaiser.

also found this:
To say the least, the liberal base is really not going to like this. I watched Howard Dean address Netroots Nation on the subject of health care reform last night (yes, I am enough of a policy wonk to be able to tolerate listening to Howard Dean; to be fair, when he is discussing policy, and not just focusing his attention on his myopic belief that Republicans are stupid and venal, Dean actually can be somewhat interesting to listen to), and he made it clear that as far as he was concerned–and the liberal base listening to his speech concurred in this–cooperatives are non-starters, because cooperatives were tried before, but were swallowed up and destroyed by private insurance companies. It may be that the Obama Administration and Congress will settle on cooperatives as a way to attract moderate Republican support–there remains the concern that cooperatives might eventually be taken over by government in the same way that Fannie Mae and Freddie Mac were, so conservatives and libertarians probably won’t like this plan (I know that I have my severe reservations about it)–but if cooperatives are put in place of a government option, liberals will consider it a betrayal. And rightly so.

While I am offering something resembling praise to Howard Dean, I guess I should point out that I think he was right to state at Netroots Nation that Democrats should have started with advocating the implementation of a single-payer system as their starting point in the debate over health care reform. Then, perhaps, the political system and the public at large would consider the public option to be a compromise policy position. Now, instead, the public option is considered the emphatically liberal position, single-payer is off the table (save a courtesy vote afforded to liberals concerning H.R. 676, which everyone knows will not pass), and cooperatives are being pushed as the compromise policy position. For liberals, this has to be devastating, especially given the likelihood that their own tactical blunder in not pushing for a single-payer system led to this state of affairs.

My Rep., Neugebauer, is solidly in line with the odious Kent Conrad on this.

mass's picture
Submitted by mass on

Medicare for All. I think cheaper, better health care, which only HR676 promises, is the easier sell, and frankly, I think that is why it was tossed from the table.

connecticut man1's picture
Submitted by connecticut man1 on

Many of us have been saying that if they are going to vote on it... It has to be scored. If HR 676 gets scored fairly by the CBO we should be able to force a few politicians to take a really hard look at it.

This is why Weiner's amendment is the most important victory for us. Get's the scoring on the record to compare it to other answers (public option).

hobson's picture
Submitted by hobson on

Seems to me the critical element is to get people aware of the bill. Wiener has been making the rounds but the people I work with don't know anything about it even here in New York.

What also bothers me is the "up or down" that I keep hearing about. Wiener has said he doesn't have the votes to get it passed. So is it going to be, "We gave single payer a chance. It failed. It's dead."

I would like to see that comparison of 676 and 3200 stickied along with the link to write your congressman. I feel the place where betrayal is most likely is in committees that must come up with compromises when the House and Senate come up with radically different bills.

One other thing is to explain to people who have insurance whether they stand to lose what they already have if the system changes. Not everyone gets refused payment of treatments etc. all the time. I know people who feel they would be dead now if not for their work insurance. Is someone with cancer going to want to think about giving up the insurance coverage they have now for something unknown?

hobson's picture
Submitted by hobson on

Yes, that was the comparison I was thinking of. In all the discussions I listen to on the radio, no one mentions the single payer bill. Wiener said he knows he can't get 218 votes in the House. But he also said no bill now has 218 votes. He also seemed to think he could get some Republican votes for the single payer bill just to cause mischief. He didn't explain why they would do that and I didn't understand where that came from/

But what is the purpose of this vote is what I am wondering? How many votes can it get? If it goes down, and they keep calling it an up or down vote, does that mean single payer is dead? Is this vote a way of killing single payer? Could it be a way to get it back into the mix? Where is the organized support from the left for it?

Will it be a way to break the Progressive Caucus support for the public option?

Why don't we buy a drug company? or an insurance company? If we have any power in numbers, why can't each progressive buy one share of one targeted company? If you got, say 15% of the stock, gave proxies to some trusted rep (yah, I know, who) you would have a significant vote at shareholder meetings. And maybe an in to Congress critters. If we can't impress them by voting for them or staying home, let's show them we can buy them. If enough people did it, it wouldn't be such a crazy idea.

Jeff W's picture
Submitted by Jeff W on

Anthony Weiner says he doesn't have the 218 votes. Then there's something like this from Ian, whom I respect a lot:

But here’s a truth for you. According to folks I know who work in the house, there are enough votes in the House of Reps to pass single payer straight up.

He then clarified:

the votes may be there in the House, but it will not pass if the House leadership is defacto opposed, which they are. If they got behind it, however, they could pass it

Weiner's statement and Ian's explanation could both be true. Assuming that's the case, maybe some savvy legislative-type wonk might know something about fomenting a representative revolt or forcing a leadership change-of-heart.

If, as suggested from Matt Taibbi's piece, the final legislation might involve individual mandates and little else ("If things go the way it looks like they will, health care reform will simply force great numbers of new people to buy or keep insurance of a type that has already been proved not to work"), a complete catastrophe for the Democrats, maybe self-preservation in the face of impending doom might be the leverage here. (Yeah, I plead guilty of imputing rationality to our legislators but work with me here.)