Anytime you want to buy time and discredit an issue you throw it to the states.

If the Senate leadership were 1/3 as good as Dean's party leadership, this party would be hummin'!

Let's see, 50 laboratories of democracy working on a heretofore intractable problem, or one rushed diktat from a President who burns through money faster than a drunken sailor with hookers on each arm?

That's a toughie. Stick to your guns AND maintain your independence Senator Wyden!

Now wait a minute.

Torture works, especially when one secretly assents to its use while lying about it to the public.

That old bs about Pelosi? Give me a break. I don't believe Pelosi ever assented to anything close to what the CIA was conducting. Do you actually believe for one second that the CIA copped to waterboarding?

Boats is fighting to preserve torture. Does anyone really think it's over just because we elected a new Prez?

"This is a … curious argument for CIA Director Leon Panetta to make in a court filing arguing that the CIA shouldn’t have to describe the contents of interrogation videotapes it destroyed. The Washington Post: The “disclosure of explicit details of specific interrogations” would provide al-Qaeda “with propaganda it could use to recruit and raise funds,” Panetta said, describing the information at issue as “ready-made ammunition.” He also submitted a classified statement to the court that he said explains why detainees could use the contents to evade questions in the future, even though Obama has promised that the United States will not use the harsh interrogation techniques again.

The propaganda-fuel argument is at least straightforward. But — and I freely concede that this is speculative, occurring in the absence of information due to the statement’s classified nature — how can al-Qaeda detainees learn how to evade questioning from descriptions of techniques that the Obama administration has forsworn? This is the sort of move that suggests that remnants of the so-called “enhanced interrogation” program are going to live on, speeches in Cairo promising new beginnings notwithstanding. Another thing to watch closely as the administration’s interrogations and detentions review proceeds."

Boats is fighting to preserve torture. Does anyone really think it's over just because we elected a new Prez?

A lack of a sense of humor runs rampant here. One does not have to defend the continued use of waterboarding to make the case that the Speaker is an at large WAR CRIMINAL just like Bush and Cheney.

It seems to me one problem with the public option, as it is currently proposed, is that it puts each employer through the ringer and benefits the least generous.

I'm sure this argument has been made at some point but I will present it because it seems relevant to this post. Let's say there are two kinds of employers: "good" employers and "bad" employers. Good employers buy health insurance for their employees and make sacrifices to maintain their coverage. Bad employers either do not offer coverage or drop coverage as soon as the costs go up. Over time, as health costs go up for employers, bad employers give up on providing benefits early, switch to the public option, save money (public option contribution are much lower than actual insurance), and gain competitive advantage over other firms that are still shelling out for insurance. The good employers however, keep trying to stick it out. They put off hiring new employees to maintain the health benefits for their employees. Until one day, they either cannot survive their cost structure or must switch to the public option.

Below you can see the percent of firms that offer coverage by their number of employees from MEPS:

Firm EmployeesPercent Offering Coverage <10__35.1% 10-24__63.2% 25-99__81.6% 100-999__94.1% 1000+__98.4% Overall____55.8%

This gives a sense of what is to come without the more fundamental reforms as Wyden is proposing. Right now, for small firms (<10 emps), "good" employers are in the minority at 35%. What we will see over time with the public option, as it is currently conceived, is these percentages will get lower. And, every time the percentages drop, a firm drops coverage and gains a competitive advantage by having lower costs. By creating an exchange that all employers must participate in, Wyden's plan does not benefit the "bad" employers at the expense of the good.

I agree with some who have speculated that a public option is possible with Wyden's plan. In fact, his plan could accommodate a public option so that anyone could choose it (not just those who lack coverage or work at a small business). As most observers know, Wyden is trying to maintain some bipartisan support for making comprehensive change and is not (as some argue) a shill for the insurers. I hope readers will recognize that a public option is just one feature in reforming health care and Wyden's plan can accommodate that and many more.

Do others have a sense of how the public option will proceed to avoid this? This issue seems pretty plausible to me and not very positive.

I am not affiliated with Ron Wyden or his plan but I do think it is the better policy. Clearly it is not politically the most popular right now. However, since I doubt Obamas plan will grow to include the fundamental reforms Wyden offers, I hope instead that Wyden's plan can incorporate a public option and be popular.

Here's what Wyden is now saying:

“Senator Wyden’s Healthy Americans Act has for more than two and a half years contained a provision allowing states to pursue their own public option on 'Day One.'"

But less than a month ago, in a report entitled "Harmonizing the Obama, Baucus and Wyden/Bennett Health Reform Proposals: Technical Feasibility", John Sheils of the Lewin Group (you know them, the people Wyden and FactCheck pointed to to falsely label the AFSCME ad misleading" said on page 8:

The HAA does not include a public plan at the national level, but does permit local area Medicaid-only health plans to participate in the exchange. In many areas of the country, public plans have formed around public hospitals and clinics at the local level that compete for enrollment under state Medicaid managed care programs. These entities would be permitted to continue as one of the health coverage options offered through the exchange. In addition, the HAA provides a federal fallback plan in any state or region that does not have at least two private plans offering coverage.

In brief, Wyden only allows states to keep public plans that have been created for low-income people, and only to create public plans that would be open to anyone regardless of income if the private insurance industry does not offer at least two private options ("the trigger"). Not what Wyden claimed. Nor does it "track" what the Oregon Health Fund Board recommended or that is in HB2009. The OHFB did not include any tie to a pre-existing low-income plan (that would continue a low-income limitation) or a trigger.

Now let's go to the text. We'll note Wyden didn't cite the actual text of his bill to back his case. However, we can first note there is no direct measure of a public plan anywhere in his bill. The mention of what states can do is found in Title VI, Sections 632 and Sections 641

In both the original 2007 110th Congress version SB. 334, and the new 2009 111 Congress version SB. 391, the picture is not quite what Josh and Ron have now lied:

In both, Section 641 says, in summary, that if state has not managed to set up a "Health Help Agency"(HHA - an entity that collects our money under Ron's mandate we must buy from private insurance companies and turns it over to them) in which 2 "Healthy Americans Private Insurance" (HAPI) plans are available, the HHS Secretary will insure the individual shall be given the opportunity to enroll in a fallback HAPI (private) plan. This is part of the trigger, so to speak, and it doesn't even automatically give the state the right to create a public plan.

In both Section 632, and specifically paragraph (b)(1), mentions state waivers to the Wyden's general formulation that people be forced to buy private (HAPI) plans. A state could apply for a waiver if a state approves a plan to provide health care coverage to it's residents that is at least as comprehensive as the coverage required under a HAPI plan. The catch? This waiver is not automatic, but it subject to criteria established at the discretion of the Secretary of HHS. That is, the HHS is not required to grant a waiver nor are any guidelines the Secretary must follow specified in the bill so it's all a matter of politics whether a state could possibly offer a public plan.

Interestingly, in the 2007 version ("Day One") Wyden spefically required that the state must create it's plan only if the legislature of such State enacts legislation, or the State through a publicly approved ballot measure approves a plan, which could have barred administrative means for creating such as the OHFB could have proposed under it's mandate. Ron changed this language In the 2009 version to simply allow eligibility for a waiver (but still not mandatory grant of a waiver) the State approves a plan

Ron and Josh are trying their best to spin their position on technicalities, and they are even lying about that.

At the bottom line, anybody who has had contact with Wyden's office knows he consistently stated his plan was based on private insurance and the option of a state to create a public plan was all but non-existent: By Section 641, the Feds would step in and offer a fallback private (HAPI) plan and there would be little basis for the Secretary to approve a waiver for a state to create a public plan. That was always what advocates of a single payer or a genuine public plan were told, and Ron and Josh are being dishonest revisionists here.

One political tip for single-payer advocates like myself who would also support the right public plan:

When you are talking to legislators' offices or following the news, be aware there is a game also going on wherein the terminology "public plan" is also being spun.

Some are calling the idea to allow people to buy into a version of the Federal Employees Health Benefit Plan a "public plan". As Dennis Kucinich pointed out yesterday, this is just using that label to hide a scheme whereby the government just collects your money and uses it to buy private insurance for you. The FEHBP is a managed competition system in which government employees are offered a menu of private insurance options.

A true "public plan" is one that looks like the Medicare system. It is publicly owned and administered by a public agency that is responsive to us through our public processes, not the private interests who offer private insurance as through the FEHBP. Moreover, a "public plan" would use private industry for high volume, low-overhead cost, administrative services including claims processing as the CMS does for Medicare, but not for "claims adjusting" where you have to argue with a private insurance company for your benefits as FEHBP recipients do.

Of course, a true "public plan" we are only talking about the insurance system by which your doctors, of your choosing, get paid. Doctors, hospitals, and all providers remain private businesses, just like with Medicare. (Have to add that because a lot of dishonest opponents try to deceive people into thinking "public plan"/"single payer" advocates are arguing for a system in which the doctors are government employees, which is a complete lie.)

One last tip. Watch out for this spin:

(1) limiting medical liability, which drives many unnecessary tests, procedures and high malpractice insurance rates

The amount of testing, necessary and unnecessary, a person receives is far more a function of their ability to pay and/or the willingness of their insurance to pay, not actual or even perceived liability. Testing is a revenue generator for providers.

Anybody who is uninsured or who has limited public or private insurance available to them knows how even necessary tests are not available, regardless of the actual liability that entails.

Having been in contact with Ron Wyden's office several times; I believe Josh to be disingenuous in this discussion about Wyden's plan. In fact, I've found that he and his staff have generally been non-responsive to arguments in favor of even a public option. So, I've been sorely disappointed in Senator Wyden's position regarding universal health insurance, which I feel under-serves his constituency.

We've heard this song and dance from health insurance companies in the past, with no measurable positive result in terms of access to or quality of health care. With Wyden's plan, there is no compelling reason for insurance companies to change their current business practices. And let's just forget about the "trigger" it's just another tactic to delay any change.

In the debate about health care reform and a public option, it appears that the persistence of the insurance industry is nothing more that exhausting all possibilities rather than adapting to our collective new reality.

@ Josh

So how does Wyden's plan, without any competitive public option to hold down costs, differ fundamentally from Romney-care in Mass. where Blue Cross went up 76% in premium costs since Romney-care was enacted? It looks to me like Ron Wyden is speaking with forked tongue and acting duplicitously, a collaborationist with the GOP efforts to sabotage Pres. Obama's plan, and trying to appease and mollify Oregonian supporters. I think he's forgotten who elected him.

The "public option" is another cynical deception like all the other bailouts for the rich. The Democrats have succeeded in limiting the "debate" to corporate funding of one sort or another. The "Town Hall" referred to above was a complete sham that promised a "lottery" (bad enough, since a venue could have been found that allowed for the "town") for the many single payer activists who wanted to attend, but $1000 a plate supporters and their DP shills were given tickets without being subject to a lottery.

From one who did manage to attend: "The whole 'forum' was a choreographed advertisement for the public option. The moderator must have repeated 10 times that questioners were not to make statements, that this wasn't a debate and that he would ask the question for somebody if they spoke for too long. The speakers including Dean continuously made false statements about single payer and how the public option was basically a form of single payer reform. questioners were carefully selected."

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

The "public option" is another cynical deception like all the other bailouts for the rich.

So H. Wolf, this assertion on the face of it is ambiguous and potentially nonsensical. As is this statement from an unnamed source that you must agree with because you quoted it:

The speakers including Dean continuously made false statements about single payer and and how the public option was basically a form of single payer reform.

Are you for single payer or not? Are you arguing that a public plan is actually an attempt to derail grassroots pressure for a single payer plan?

Or are you against single payer and also trying to argue against a genuine public plan (see my comment above for a definition). The tone of your comment suggest this is the case, but I think fairness demands you be called out to state your position.

And be clear about this: I am for single-payer first and foremost. I do see how a properly constructed public plan is a path to single-payer: If it's done right, the vast majority of people will choose it and that's single payer for all practical purposes. In the next Congress they can just make it official by further restricting what kind of private insurance can be offered so as to legitimately protect the expressed public interest in single payer.

Those who have worked for years, and in some cases, decades, should skin suckers like you alive for selling out for public option. What a bunch of spin and drivel. You are selling the biggest lie I have read on Blue Oregon in years.

Medicare isn't single payer. It bears no relationship to single payer. It still depends on for-profit physicians, hospitals, specialists, testing, and even managed-care. I would rather have FEHBP than Medicare because with FEHBP yo have access to virtually any doctor. Doctors are refusing Medicare patients in droves these days, or haven't you noticed.

You spun, and I almost puked. Public option has no relationship to single payer, and you know it. Your lies are an insult to single payer advocates everywhere.

Medicare isn't single payer. It bears no relationship to single payer. It still depends on for-profit physicians, hospitals, specialists, testing, and even managed-care.

Medicare Part A and B are single-payer. It's been Republicans and fraudulent Democrats who have maliciously undermined it with Medicare Part C (Medicare Advantage) and Medicare Part D in 1997 and 2006 when sociopathic Republicans held control of Congress. Two programs all single-payers advocates I know vehemently opposed precisely because those programs are overt, corrupt, cynical attempts to destroy Medicare.

Doctors are refusing patients in parts of the country with lower Medicare reimbursement rates, again because the same scumballs have worked to keep those unequal reimbursement rates in place as another component of their strategy to destroy Medicare. In those states where Medicare rates are higher, Medicare patients are actually sought after --- that's why Mayo Clinic has a facility in Florida. One of the key goals of single-payer advocates and advocates of a legitimate public option is precisely to even out reimbursement rates at an adequate level.

If you think FEHBP patients have an easier time getting their insurance carrier to cover specific medical expenses than Medicare patients who live in those regions with appropriate reimbursement rates, you're a raving lunatic. FEHBP plans also have some huge coverage deficiencies, just ask FEHPB recipients.

And idiot, single-payer refers to who pays, not who provides the medical care. As in single-PAYER, not single-PROVIDER. In addition, it's been explained very carefully why a specifically structured publicly-owned plan managed by a public administrative agency does represent a path to single payer. You don't seem to have very solid cognitive abilities, so you probably weren't able to understand what you read. That realization is what has insurance companies and pathological headcases like you absolutely pissing yourself in fear and anger.

You don't have a clue what you're talking about and you clearly are so nuts you don't care. The odds are quite good we are going to get a reform package that is going to drive you crazier than you obviously already are. Fortunately, when we get that kind of progressive reform, you'll be able to get the psychological care you obviously need.

The real question is whether you're a typical Wyden supporter, or just a right wing freak. There is no as much difference these days as their used to be, now that Ron has been caught on the wrong side of the health care debate and Democrats are starting to decide they want someone else to vote for in the 2010 primary.

Vocabulary quiz for the day: What is a Republican, or a Democrat like Wyden, Landrieux, and Conrad who would compel us by law to do business with private corporate interests who they are represent without giving us the opportunity to instead support the common good by participating in a publicly-owned, publicly-administered plan?

Fascist: Those who support the merger of state and corporate power.

They Spin, You Decide asked, "Are you for single payer or not?"

I like your passion, They Spin, and the corporatists are definitely spinning, but you apparently have bought into the "public option" option, and that's what I'm arguing against. (If you had gone to my clearly marked link, you would already know what my position is.)

"Public option" is the single business party's "left wing" position. "Public option" was long ago debunked by the people at Physicians for a National Health Program (pnhp.org). Single payer is what we need. Don't buy into the propaganda.

Public Plan Option in a Market of Private Plans By David Himmelstein, M.D. and Steffie Woolhandler, M.D., M.P.H.:

The "public plan option" won't work to fix the health care system for two reasons.

1. It forgoes at least 84 percent of the administrative savings available through single payer. The public plan option would do nothing to streamline the administrative tasks (and costs) of hospitals, physicians offices, and nursing homes, which would still contend with multiple payers, and hence still need the complex cost tracking and billing apparatus that drives administrative costs. These unnecessary provider administrative costs account for the vast majority of bureaucratic waste. Hence, even if 95 percent of Americans who are currently privately insured were to join the public plan (and it had overhead costs at current Medicare levels), the savings on insurance overhead would amount to only 16 percent of the roughly $400 billion annually achievable through single payer -- not enough to make reform affordable.

2. A quarter century of experience with public/private competition in the Medicare program demonstrates that the private plans will not allow a level playing field. Despite strict regulation, private insurers have successfully cherry picked healthier seniors, and have exploited regional health spending differences to their advantage. They have progressively undermined the public plan -- which started as the single payer for seniors and has now become a funding mechanism for HMOs -- and a place to dump the unprofitably ill. A public plan option does not lead toward single payer, but toward the segregation of patients, with profitable ones in private plans and unprofitable ones in the public plan. (www.pnhp.org)

The dear leader has already sold out all single payer advocates, by the way:

http://www.whitehouse.gov/blog/The-President-Spells-Out-His-Vision-on-Health-Care-Reform/:

"Obama has endorsed an individual mandate that would expand coverage to everyone - except those who cannot afford to pay for the coverage, and those whose jobs are in small businesses that cannot afford to provide employee health benefits. That is, we'll cover everyone except most of those who are currently uninsured, nor those who will lose their health benefits as the rate of employer-sponsored coverage continues to decline, especially with a pessimistic job outlook.

"The president's letter is more than a personal communication to a couple of senators. It is a consensus statement, meant for public consumption, on the agreement between the administration and Congress on the most basic fundamentals of the reform legislation to be completed, as the president stated, in the "make-or-break window" before the August recess. Reading the full letter makes you realize how low the expectations are for the final reform product." (Dr. Don McCanne, http://two.pairlist.net/mailman/listinfo/quote-of-the-day)

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