Senator Bernie Sanders Pushes Back On Public Option

[Better Believe It]

Bernie Sanders Pushes Back On Public Option
by Ryan Grim
November 23, 2009


While conservative members of the Democratic caucus threaten to block passage of health care reform if it includes a public health insurance option, a growing chorus of liberal lawmakers are making similar threats if the bill doesn't have one.

Bernie Sanders, an independent from Vermont who caucuses with Democrats, said in a statement on Sunday that the bill must have a strong public option to win his vote.

"I strongly suspect that there are a number of senators, including myself, who would not support final passage without a strong public option," he said. Not supporting final passage, however, is different than vowing to filibuster it and prevent it from even getting to a vote on final passage, as independent Joe Lieberman of Connecticut is now doing, hoping to strip the public option.

But Sen. Sherrod Brown (D-Ohio) said on Saturday night that if the bill bends toward the conservatives, "You'll lose people on the left."

One of those could be Roland Burris (D-Ill.), who said Saturday he'd oppose any bill without a public option. "I won't vote for it," he said.

Sanders, who self-identifies as a democratic socialist, said that democracy should triumph in the Senate. "The overwhelming majority of Americans want to be able to choose between a strong public option and a private insurance plan. Without that competition, there is very little in this bill that would keep health insurance premiums from escalating rapidly," Sanders said. "This legislation cannot simply be a huge subsidy to private insurance companies that will get millions of new customers and be able to raise their rates as high as they want."


Senator Bernie Sanders

Read the full article at:

http://www.commondreams.org/headline/2009/11/23-1

[Sebastian Doyle]

1. Who the fuck unrecs Bernie Sanders??

That's just not cool at all. Don't fuck with the best Senator we have. :mad:

[Captain Hilts]

2. Beats the Hell outta me. nt

[dflprincess]

3. I imagine it's members of the pep squad

After all, it shouldn't be advertised that someone like Senator Sanders may have some doubts about the insurance bill and, if he has to, will vote against it on principle.

[spiritual_gunfighter]

4. There are plenty of people on DU

that consider Sanders and Kucinich worse than Republicans, and they have made their allegiances known.

[GreenPartyVoter]

14. Yep

[loudsue]

18. People on DU who are on the wrong site, I'm sure.

No person who has true democratic values is going to go slamming Bernie Sanders.

[pattmarty]

34. Well then they're not progressive/liberal, are they???

[Guy Whitey Corngood]

5. I would imagine insecure children. nt

[CTyankee]

6. Well, if you ask me the whole idea of "unrecommend" is for insecure children.

People keep wondering why such threads are unrecommended. It's because it is stupid and some people love the stupid...

[Skittles]

20. I agree

[IndianaGreen]

19. the corporate wing of the Democratic Party

They have been around for a long time!

[RedCloud]

25. That or freeper sleeper cells.

[Enthusiast]

28. DU has a number of

stealth Republican operatives in place. You will know them by what they write.

[Kitsune]

7. Bernie Sanders is the best.

I wish we had a hundred of him.

Two from each state. :D

[ClarkUSA]

8. Funny how so many Failers here claimed there was no public option. Now there is? nt

[Truth2Tell]

41. I don't see where Bernie says one way or the other

whether he considers the current version to be "strong" enough.

:shrug:

[FormerDittoHead]

9. Good for Sanders (as usual) but what happened to THIS?

http://tpmdc.talkingpointsmemo.com/2009/08/sixty-house-progressives-well-kill-any-health-care-bill-unless-it-has-a-public-option.php

Sixty House Democrats have warned the Obama administration--in no uncertain terms--that they'll vote against a health care bill unless it contains a public option.

If the Senate strips the bill of the PO, will it pass the HOUSE?

[Sebastian Doyle]

16. If there's no public option, it shouldn't pass at all.

Because it would be the opposite of reform.

[MrMickeysMom]

21. Ditto...

I hate that plus one thing, plus, I'm tired of making this argument.

Are they trying to just beat the public option down until people don't know what it means anymore? They did that with SINGLE PAYER, for crying out loud.

[Truth2Tell]

43. What? You thought they really meant that?

Well, one of them did.

[timeforpeace]

10. Yeah right. His initials ain't BS for nothing.

[Name removed]

11. Deleted message

Message removed by moderator. Click here to review the message board rules.

[sudopod]

17. Obviously

[kenfrequed]

38. Feh

I am glad you post so much content in your total ad hominem attack on Senator Sanders. I recommend doing something to educate yourself or going back to post on the Blue Dog dating site instead.

[polichick]

46. What's your specific gripe re this Senator? nt

[zulchzulu]

12. Even without a Public Option, clearly many new reforms would be in place

I'm for Single Payer and HC w/PO if possible. But to vote against ANY reform due to no Public Option only kicks any reasonable healthcare reform down the road YEARS FROM NOW.

What does voting against any new healthcare reform do?

It will add YEARS to insurance companies being able to drop coverage due to preexisting conditions. It will add YEARS to any legislation to control costs.

It would be a tough vote, but look at the full picture. Voting against ANY new reform now will guarantee that nothing happens again well past 2012 or 2016.

[Bette Noir]

24. There is nothing in the bill to control costs, except competition from the public option.

In my opinion, without free access to the public option to all Americans, it won't be enough to control costs.

There are other things in the bill that are good-- eliminating rescission, eliminating pre-existing condition exclusions, eliminating annual and lifetime caps on benefits-- but they are meaningless without controls on costs. Mr. Nixon would have put price controls in effect, in these circumstances, but the current corporate-controlled political climate would make that impossible. Even attempts within the last few weeks to bring the insurance companies under the same kind of oversight practiced over casinos have failed.

It seems that the priority, for a large enough minority of Senators to prevent passage of reform, is to make sure the insurance companies continue to collect at least as high a proportion of the gdp as they do now.

If there is no public option, there cannot be a mandate to buy insurance. That's obvious to me, but not to the lawmakers who are receiving large amounts of cash from the industry.

[BREMPRO]

37. this is a fallacy - just a the line used to help sell the public option

its not actually true that there is "nothing in the bill to control costs, except competition from the public option"

There are provisions for comparative effectiveness research to reduce unnecessary tests and find best practices, resources allocated to reduce medicare waste fraud and abuse, funds for wellness and preventative care that should over time lower costs, and the fact that 30-40 million more Americans will have health insurance and not just go to the expensive emergency room for treatment should also reign in costs. I'm all for the public option, even a limited one that can be expanded over time, but there is more value to this bill than just the PO.

[kenfrequed]

42. So...

-Money for research about comparative effectiveness of tests

-Reducing Medicare fraud and abuse

-Money for preventative care

-Health insurance for more.


Nothing among these statements addresses actual concrete cost reduction. Studies and tests are only effective if policy comes out of it. And Insurance companies are under no impetus to pass on savings to patients as Private insurance will just eat any savings as profit.

The real way to 'reduce medicare fraud and abuse' would be to undo Part D. There is nothing like that in the current Senate bill. Moreover the administrative costs of medicare, as a portion of money spent, is already far, far more efficient than ANY private insurance plan.

Money allotted for Preventative care will just be a giveaway to insurance companies who will feel less pressure to cover the yearly physical, which ends up being something they actually have to pay out for with most of the body of their payers who ordinarily cost them nothing. The corrupt Texas style clinics where the doctors own all the equipment and refuse to do phone consults with their patients will push additional tests and evaluations into a yearly physical and charge it up to the insurance or the federal government.

If more health insurance means mandated insurance you can ram it. Mandated insurance usually results in higher premiums, deductables, and in the case of health insurance it will result in higher copayments.


I see no 'miracle of the free market' solutions here. Nothing is practical and nothing has any sense of what health care and health insurance is about. Every one of these solutions will do little if anything to affect the overall cost for the insured and will accomplish little to benefit the uninsured.


The real solution would be universal single payer or medicare for all. A compromise would be a strong and sturdy Public Option. Giving up on both of those and setting the starting point at modest reform amounts to rearraging the deck chairs on the Titanic. As a starting point it is worse than useless as any legitimate bills reforming the system such as doing away with pre-existing exclusion will be compromised with the lawyers for the insurance companies writing the other sides proposals (or in the case of scum like Baucuus-our sides).

I really recommend doing research on health care because this reform, particularly the four glowing proposals you cited, will not result in actual reform.

[BREMPRO]

47. SO...the CBO report means nothing to you?

the CBO DID DO extensive economic research on health care- this non-partisan budget office has estimated a savings of 130 Billion over 10 years and 650 billion over 20 with the current minimal public option and competitive exchanges. But insurance is not the core of the savings. You want more specifics? The CBO has the house bill scoring online so i'll use that as a rough guide given the Senate bill has similar provisions and will eventually be combined in conference.

savings estimated (only over 1 billion savings listed here):

Skilled nursing facility payment: 6 billion
1103 productivity improvements 24 billion
1131 productivity improvements 11 billion
1146 payments for imaging services 1.3 billion
1151 reducing potentially preventable hospital readmissions 2 billion
1155 home health changes 16 billion
1158 revision of medicare payment to address geographical inequities 8.7 billion
1161 phase in of payment based on fee for service costs and quality bonus payments 154 billion
1162 coding intensity adjustment 15.5 billion
1181 elimination of coverage gap on part D 42 billion
1187 accurate dispensing in long term care facilities 5.7 billion
1188 free generic fill 3 billion
1301 accountable care organization pilot program 2.6 billion
1704 reduction in medicare DSH 10 billion
1743 Drug rebate provisions 24.6 billion
1907 medicaid innovation 8.2 billion
tricare interaction 4.7 billion
medicare advantage interactions 67 billion
2577 licensure pathway for biosimilar biological products 6.2 billion
2581 community living assistance service and supports 101.6 billion


There are expenses too: more for primary care and preventative care. I can't tell you exactly what some of these provisions are, but my point is much of the savings are from provisions that have nothing to do with the public option or insurance. The mono-focus here and in the media on insurance and the demonizing of the insurance industry ignores the savings the are not directly related to insurance.

We currently don't have a health care system, just a hodge podge of competing unregulated profit oriented interests. These efforts put in place a foundation for an actual system that can be improved, regulated and refined over time. The status quo is NOT acceptable. Failure would result in a lost chance at legislation for perhaps a decade or two, in which time we would have millions more deaths from lack of insurance, more uninsured, and a business and citizens unable to afford premiums. This bill limits that outlay to 10% of income. There are estimates that the status quo in 10 years could reach 50% of income. The REAL problem is "fee for service" delivery and no thoughtful controls over expensive and inhumane end of life care. This is where the cost reduction focus should be and not so much on insurance.

http://www.cbo.gov/ftpdocs/107xx/doc10741/hr3962Revised.pdf

[kenfrequed]

48. This is irritating

So rather than logically defending your previous statements you respond with a dizzying flurry of savings from a bill that actually does contain the public option. It is almost that you prefer to dismiss an argument rather than to actually debate.

I stand by my initial position without a public option and terse and stern regulation any "savings" produced will be swallowed by a for profit industry.

[BREMPRO]

50. you're not listening- my point was the savings from a public option are minimal

that the majority of the savings come from other cost cutting provisions and results, listed in both of my posts. Yes- the bill referenced contains The public option- BUT it will only be available initially to a small portion of the population- most will keep there current insurance (roughly estimated at 80%), others will have options through the competitive exchange including a government run public option. I support a public option, but to consider it absolutely central for the bill to produce savings ( your original argument) is just simply not true. The argument you are hearing for it being central from Dean and others are rhetorical tactics to get it passed. The hope is that once a public option is law, it can be expanded and refined over time to be a larger portion of insurance coverage. YES, the public option would save some money- but again- the way these bills are written they are a fraction of the savings.

If you haven't already, i would suggest you read "The Cost Conundrum". The article chronicles two similar communities in Texas that have similar demographics- yet one spends nearly twice as much on health care as the other. Why? I used to be a single payer advocate, but this well researched non-partisan article opened my eyes to the real problem with our health care system: "fee for service" incentives. More health care, it turns out, is not better health care. Our incentive system encourages doctors and hospitals to spend more on tests and surgeries to make budget. Part of the reason they need to do that is to pay for uncompensated care-and the reason an MRI is randomly priced at $1500 when it should cost $300- back to one of my original points- with 30-40 million more insured, the hospitals will no longer need to pay for as much uncompensated care. That COST is passed on to us in the form of higher cost for services and higher insurance rates. We are already paying for the uninsured. These bills (with or without a public option) not only save lives, but they should lower premiums.

http://www.newyorker.com/online/blogs/newsdesk/2009/06/atul-gawande-the-cost-conundrum-redux.html

[kenfrequed]

51. Great!

We will save the Insurance industry a wheelbarrow full of money!

You still have not explained how we will control their games.

You still have not addressed a single counter point I raised to your original post.

The competative exchange or cross state insurance purchasing game is pure capitalist-cheerleader soundbite. There is nothing garaunteeing that the insurance you purchase from a carrier in Rhode Island is going to help you find any coverage for your office visits in Frostbite Falls Minnesota. You will be out of network and out of luck in all likelihood.

The arguments I am hearing are not from Dean. I work for a goddamn HMO/clinic network (which is a hell of a lot more benevolent than the hell that is private insurance).

Nothing in the bill seems to direct or compel insurance companies to pay for the "uncompensated services" which as you truthfully point out is the cause for some clinics raising the rates on insurance compensated services.

You are throwing around some of the lingo here but you are no closer to an actual solution. Fixing the clinic end is part of the solution but unless you have a public form of insurance that covers patients adequately and compensates services properly, or you can somehow create laws forcing the insurance companies into straight jackets you will not have a viable reform.

[BREMPRO]

52. really.

First: PLEASE read the article.

Second: It's easy to simply demonize the insurance industry, but this is not the core problem with health care costs. I'm sure your "goddamn HMO/Clinic network" is more benevolent that private insurance- but they are also a business and need to cover costs and pay your salary. Your point of view is therefore not entirely objective. If we save the insurance industry money, WE save money.

Third: Your "straitjacket" idea is in the works and a good idea. There are amendments currently proposed that would require insurance co's to spend at least 80% on actual health care. There are Dem's like Barney Frank trying to address this concern. I would suggest you contact your senators and rep. to support these proposals.

Forth: you are misinformed about the exchanges- they are intrastate exchanges NOT interstate as you suggest. The across state line proposal was a Republican one that was rejected by the Dems and are not in these bills. I agree with you that that is not a solution as it would lead to a race to the bottom of regulation as the credit card Co's did. The idea of the exchanges is to create competition within states- currently in many states (like the one I live in)there is NO competition. The exchanges are a step toward giving us options and therefore cost competition.

Fifth: regarding "uncompensated care" I don't know how else I can explain it so you understand the concept. It is not only moral to get 30-40 million more insured but it will save all of us money so YOU and I and YOUR hospital doesn't have to pay for overcharges and emergency room services as a result of so many uninsured citizens. With more insured, the millions of currently uninsured will not have to use expensive emergency room services and will get more early screening and preventative and wellness care.

Sixth: You complain about me not addressing your counter points (which i'm trying to do), but i don't see you addressing my points either.

Seventh: PLEASE READ the article before responding again.

[kenfrequed]

53. OK I suppose I could type in caps a bit mroe as well but...

1- The article has absolutely nothing to do with health insurance. Squat. Diddly. nil. Granted, as I had admitted, costs are a part of the problem but only solving the cost of care problem does nothing but enrich the insurance companies that Will eat all savings and post them as profits. I don't know how I can say that any simpler.

2- With regard to the industry I know percisely of what I speak. A simple example (one of hundreds really) is the process of prior authorization. Most medication benefit carriers are requiring more and more paperwork and documentation in order to approve a medication that your doctor has already decided is right for you. It is a profit management technique used to deny medications that cost a bit more by forcing the clinic to spend money getting paperwork done. Some insurances are resorting to requiring different forms for every medication to increase the time required to complete them and thwart the will of the doctor.

3- With a starting point of 80% I imagine it will be negotiated down with exceptions and tax breaks to assure that the insurance industry need not fear it. The Public option is what they really fear (well that or single payer really) anything else they can corrupt now and thoroughly demolish the next time they can get another free market cheerleader in office.

4- If market competition were the panacea (figuratively speaking) to our healthcare problem than it would have worked a long time ago. And where percisely do you expect this magical mystery free market competition to come from if not from other geographic regions? Are we going to prop it up with taxpayer bucks? Are we going to pay to subsidize the competition? Will the competition then try to avoid competing too hard while padding the difference on the public dime? For my money if your gonna be on the public dime anyhow you may as well just directly cover the public.

5- Total obfuscation alert! I am for Stronger public option or better yet universal coverage or medicare for all. That sort of solves the problems you painfully tried to assert as the centerpoint of your argument here. It also changes the definition of "Uncompensated care" which from the clinic end applies not just to patients that don't have coverage, but even more frequently applies to patients WITH insurance coverage where the insurance company dodges having to pay for something because the comma is in the wrong spot.

6 Points not addressed- I will address this again after I see your next post.

7. read it. Delay tactic. Address the issues please.

[BREMPRO]

55. addressing the core issue

if you read the whole article, the main point regarding insurance is that regarding the rise in health care costs, who pays doesn't matter as much as the form of our delivery system. That is why it has diddly to do with insurance. We are TOO focused on insurance as the problem and not the research showing that 'fee for services' models of delivery are the more significant culprits for the rise in health care costs. The example of Mayo and Cleveland clinic models of delivery, that have half the cost with better outcomes are revelations. McCallan TX is not following that model, as are most other hospitals. In part, you can't blame them since they need to cover costs for the uninsured and American-style profit seeking. We complain about the rise in rates, and sure the insurance industry are making unreasonable profits, but they are for the most part just following the trend of higher delivery costs. I agree with you that the insurance industry has not served us well and tactics such as burying clinics in paperwork to reduce their costs are deplorable. The legislation reigns in their practice of denials for pre-existing conditions, lifetime caps and rescissions, and i hope the provisions to require more of their premiums to go for health care rather than profits and overhead passes. The legislation begins to address the delivery problem with comparative effectiveness research and broad powers given to the HHS to make recommendations for reducing delivery costs, AND insures 30-40 million more Americans.

The exchanges will not come out of thin air as you suggest, but will be set up with federal grants to make sure there is intrastate competition. Your suggestion that ANY savings from reducing delivery costs will be swallowed up as profits by the insurance industry has some problems. First the competition from other options should help along with the reductions from delivery reforms. The public and congressional scrutiny now on them will not allow them to simply pocket the difference. If they do, there will be a robust public option proposed and enacted quickly without the same resistance. The senate's Opt-out provision works politically, but perhaps Snowe's trigger would be a better option as it addresses your concerns about the insurance industry running away with the profits, and holds over their head a provision that would automatically enact a strong public option if they don't reform their ways.

[quakerboy]

26. So you stand with Lieberman?

I don't agree. I say its time for a little game of chicken. Yeah, if nothing passes, some Dems are going to take a serious hit in future elections. Which ones? Will it be Bernie? Or will it be the ones in "close" states, like the ones standing against a public option?

If the liberals stand strong, this is a pissing match where they hold all the cards. The only question is if Liberals are steadfast/ruthless enough to force the issue. Its the "moderates" who will pay the price for a failure, so I say the onus is on them to compromise to get it done.

[Enthusiast]

30. The Public Option is compromise.

Really, in all honesty, why should we live under corporate rule? A majority of the American people want a public option, a real one, not some watered down bullshit.

Why shouldn't we demand our lawmakers to follow the wishes of the American people?

[BREMPRO]

35. +1

wish more DUers understood this

[Bluenorthwest]

13. Bernie is right of course and as usual.

[yui]

15. Thank you, Senator Sanders

What it all really comes down to is this: those of us in the middle class ("the overwhelming majority of Americans") can't take much more. We're losing our jobs. We're losing our homes. We were used to bail out Wall Street, and we're about to be used to further enrich private insurance companies.

It's not that we don't want to help our fellow Americans. We want everyone to have decent health care. We don't want anyone to suffer or die because they don't have it and can't get it. BUT this is not the way to do it. Even if we can't have single payer at this time (which both Senator Sanders and Congressman Kucinich have acknowledged), we should at the very least have the opportunity "to choose between a strong public option and a private insurance plan."

We are more than willing to pay what it takes to ensure health care for all Americans. We are not willing to be mandated to further enrich those who have fleeced us and our fellow citizens for so long.

Enough is enough. We can't take much more.

[Cleita]

40. Welcome to DU and

you will need to phone, fax email and snail mail your Senators, Congress Reps, Harry Reid and the White House demanding that the public option be available to all who wish to buy into it, not the way it's set up now. Insist on no cooperatives and no triggers. It should be like Medicare and available to all who want it. Senator Sherrod Brown has stated that our activism is effective so we need to keep up the pressure.

[yui]

49. Thanks for the welcome,

and I have done exactly as you have suggested, many times.

It just seems nobody's listening!

I'll keep trying, though. I hope we all will.

[Bette Noir]

22. Bernie's the best.

I wish we had 59 more like him.

[earcandle]

23. Bernie Sanders, like Kucinich, and some others, you can trust.

[Q3JR4]

27. A REC and a KICK to the

man whom in my opinion the democrats should be listening to.

Q3JR4.

[Enthusiast]

29. Bravo Senator Sanders!

I will donate to your re-election campaign because of your stance on the STRONG PUBLIC OPTION, among other things.

[Vidar]

31. Recommended for our best senator.

[daggahead]

32. Bernie, Dennis, and most recently ... Senator Grayson ...

My heroes.

[freddie mertz]

33. That you, Senator Sanders, for standing up for the people.

We need 59 or 60 more like him.

[coyote]

36. Germany has a public/private health insurance system

Up until 2 years ago, private health insurance could cherry pick their customers. As expected, they dumped all the high risk patients into the public system. Private insurance was always cheaper that public....not to mention the care was better under private. Doctors in Germany loved private insurance patients because they paid so much more out than the public system.

However, the goverment basically said enough is enough and are forcing all private insurance companies to offer a basic level of coverage to anyone who wants it...they can no longer cherry pick their customer and reject any customer who wants private insurance.

Of course, private insurance was kicking and screaming here saying rates are going to go up. Of course their rates were kept low before because they were off-loading all the high risk patients into the public system.

[Cleita]

39. This is why in France, who also have a private/public system, basic

health care is offered to everyone from the government to spread the risk. Private insurers cannot duplicate that basic coverage but can offer coverage only for what the government doesn't cover. Otherwise you get a system that is more expensive to operate and less efficient than it should be.

[JEB]

44. Bernie Sanders always

presents a well reasoned and principled position. That's why he can ofter persuade people to his position. He's one to admire.

[polichick]

45. "democracy should triumph in the Senate" - what a concept! k&r

[nickinSTL]

54. Good for him

and for Sen.Burris.

I'm from IL, and I was not happy with how Burris came into the seat, but his stance on this makes me like him - I'd vote for him on that alone if he ran for reelection (which he isn't doing).

Durbin, who I like, I may not be comfortable voting for if he votes for a bill with no public option...or for a weak, watered down, poor excuse for a public option.

Why in hell can't we have universal single-payer health care?

damn corporatists.