Last night a group of Senate Democrats reached some kind of compromise on the health care reform bill. Senator Tom Harkin “told reporters he didn’t like the agreement but would support it to the hilt” in order to get a bill through the Senate. Reports on the nature of the compromise varied, but Talking Points Memo seems to have the most details:

If this trade-off carries the day, the opt out public option is gone. […]

As has been widely reported, one of the trade-offs will be to extend a version of the Federal Employees Health Benefits Plan to consumers in the exchanges. Insurance companies will have the option of creating nationally-based non-profit insurance plans that would offered on the exchanges in every state. However, according to the aide, if insurance companies don’t step up to the plate to offer such plans, that will trigger a national public option.

Beyond that, the group agreed–contingent upon CBO analysis–to a Medicare buy in.

That buy-in option would initially be made available to uninsured people aged 55-64 in 2011, three years before the exchanges open. For the period between 2011 and 2014, when the exchanges do open, the Medicare option will not be subsidized–people will have to pay in without federal premium assistance–and so will likely be quite expensive, the aide noted. However, after the exchanges launch, the Medicare option would be offered in the exchanges, where people could pay into it with their subsidies.

It appears as if liberals lost out on a Medicaid expansion that would have opened the program up to everybody under 150 percent of the poverty line. That ceiling will likely remain at 133 percent, as is called for in the current bill.

In addition to the new insurance options, the group has tentatively agreed to new, and strengthened, insurance regulations, which the aide could not divulge at this time.

Those unspecified insurance regulations might refer to this:

Additionally, there was consensus support for a requirement long backed by Sen. Jay Rockefeller, D-W.Va., and other liberals for insurance companies to spend at least 90 percent of their premium income providing benefits, a step that supporters argue effectively limits their spending on advertising, salaries, promotional efforts and profits.

The health care bill approved by the House would require insurers to spend 85 percent of premium income on providing benefits. Upping that to 90 percent is even better; my concern is that if enforcement is left to state insurance commissioners, evasion will be widespread.

Chris Bowers is excited about three “meaningful concessions” Senate progressives received in exchange for dropping the (already weak) public option.

I’m off the bus, however, unless further details come to light about very good provisions buried in this compromise. This bill creates millions more customers for private insurers but doesn’t give Americans enough choices, doesn’t create a government plan to keep private insurers honest, and therefore is unlikely to reduce costs or solve the various problems of our current health care delivery system.

In the good news column, last night the Senate tabled (killed) Ben Nelson’s abortion amendment modeled on the Stupak language in the House health care bill. The vote was 54-45, with seven Democrats from conservative states voting with all but two Republicans (roll call here). Harkin voted to table this amendment, like most Democrats, while Chuck Grassley was on the other side.

UPDATE: Can any Obama fans defend this kind of action from his administration?

A proposal to enable the importation of cheaper prescription drugs could endanger the U.S. medicine supply and would be difficult to implement, the Food and Drug Administration said Tuesday. […]

But the Obama administration’s declaration on the eve of the vote could derail the amendment despite the fact that Obama co-sponsored Dorgan’s drug imports bill while a member of the Senate and that White House Chief of Staff Rahm Emanuel was a vocal proponent of the House version of the bill when he served as a member of the lower chamber.

Feel the hope and change!

SECOND UDPATE: The compromise still may not be enough for Joe Lieberman. They shouldn’t have given up on using the budget reconciliation process to pass a better bill with 51 votes.

Many Iowans will be leaving work or school early today, or perhaps not going in at all, as the season’s first big winter blast rolls in. Here’s plenty of reading to keep you busy if you are stuck at home.

Global news first: The United National Climate Change Conference in Copenhagen opened yesterday. To follow news from the proceedings, I’m reading the team of Mother Jones bloggers in Copenhagen. The Open Left blog will also post regular updates from Natasha Chart and Friends of the Earth staff who are on the ground. If you prefer a mainstream media perspective, check out The Climate Pool on Facebook, which is a collaboration among major news organizations.

Also on Monday, Environmental Protection Agency Administrator Lisa Jackson signed off on two findings that will pave the way to regulate carbon dioxide emissions under the Clean Air Act. This action follows from a 2007 U.S. Supreme Court ruling in Massachusetts v. EPA. More background and details can be found on the EPA’s site. Environment Iowa explains the significance of the EPA’s action here. An expert panel surveyed by Grist disagreed on whether the EPA’s “endangerment finding” would affect the Copenhagen talks.

The most important reason I oppose the current draft bills on climate change kicking around Congress is that they would revoke the EPA’s authority to regulate carbon dioxide. Chris Bowers explains why that would be disastrous here.

Uganda is considering a horrific law that would subject homosexuals to long prison terms or even the death penalty. One Iowa is collecting signatures on a petition to Senator Chuck Grassley, asking him to speak out against this law. Grassley’s never going to be a gay rights advocate, but he should agree that criminalizing homosexuality is wrong. Grassley is involved with “The Family,” which is connected to the proposed bill in Uganda.

On the economic front, President Obama is expected to announce plans to use about $200 billion allocated for the Wall Street bailout to fund a jobs bill Congress will consider soon.. The Hill previewed some of the measures that may end up in that bill.

Some economists who met with Governor Chet Culver yesterday think Iowa has already reached the bottom of this recession. I hope they are right, but either way, policy-makers should listen to their ideas for reforming Iowa’s budget process. I’ll write a separate post on this important development soon. Here is the short take:

The state could base its spending on a multi-year average, such as the previous three years, or five years or seven years, said Jon Muller, president of Muller Consulting Inc., a public policy and business development consulting firm based in Des Moines.

“The way it’s always worked, when times are really good, we increase spending and we cut taxes,” Muller said. “And when times are bad, there’s pressure to increase taxes and decrease spending. And that all happens when the demand for government is at its highest,” Muller said.

The multi-year idea would flip, he said.

“In good times you would be squirreling money at way a little at a time. And in bad times, you could continue to increase spending to service the growing demands of a recession.”

It would require state lawmakers to not touch the reserves, even in times of plenty. But it would also reduce the need to tap into reserves just to get by during rainy days, the advisers said.

Regarding budget cuts, the Newton Independent reports here on a “plan to reorganize the Iowa Department of Human Services operations under two deputy directors, six rather than nine divisions, five rather than eight service areas, more part-time offices and the elimination of 78 currently vacant positions” (hat tip to Iowa Independent). Click this link for more details about the proposed restructuring.

On the political front, John Deeth analyzes possible changes the Democratic National Committee is considering for the presidential nomination process. Jerome Armstrong had a good idea the DNC won’t implement: ban caucuses everywhere but Iowa. No other state derives the party-building benefits of caucuses, but just about every state that uses caucuses for presidential selection has lower voter participation than would occur in a primary.

I haven’t written much on health care reform lately, because recent developments are so depressing. Our best hope was using the budget reconciliation process to pass a strong bill in the Senate with 51 votes (or 50 plus Joe Biden). Now that Senate Majority Leader Harry Reid has taken reconciliation off the table, we’re left with a variety of bad compromises to get to 60 votes in the Senate. I am not convinced the final product will be any improvement over the status quo. It will certainly be worse for millions of Americans required to buy overpriced private health insurance. If there’s a quicker way to neutralize the Democrats’ advantage with young voters, I don’t know what it is.

Speaking of health care reform, Steve Benen wrote a good piece about Grassley’s latest grandstanding on the issue.

Speaking of things that are depressing, John Lennon was shot dead 29 years ago today.  Daily Kos user noweasels remembers him and that night. Although Paul’s always been my favorite Beatle, I love a lot of John’s work too. Here’s one of his all-time best:

Share any relevant thoughts or your own favorite Lennon songs in the comments.

Developing a line of attack he has used before, Republican gubernatorial candidate Bob Vander Plaats asserted yesterday that Terry Branstad’s past support for Democratic Senator Ben Nelson of Nebraska makes Branstad partly responsible for any health care reform bill Congress passes this year.  

From the Vander Plaats campaign press release of November 23:

“Ben Nelson gave Senate Democratic Leader Harry Reid the vote he needed to get the 60 votes to steamroll Republican opposition. It means the Democrats will be able to proceed with legislation that will effectively destroy our private health care system while saddling businesses and working families with hundreds of billions of dollars in new taxes and limiting our access to care,” said Vander Plaats, who is seeking the 2010 Iowa Republican gubernatorial nomination. “Whatever happens from here on out, Terry Branstad is going to have to accept some responsibility because he was a very active supporter of Ben Nelson in his first campaign for the Senate.”

A few thoughts on this line of attack are after the jump.

I’m heading to the Iowa Democratic Party’s Jefferson-Jackson Dinner. I won’t be blogging there, but I will update this post with some highlights when I get home.

If you’d like to watch online, the IDP will be livestreaming the proceedings here, beginning at 6:30 pm central.

Senator Tom Harkin has taped a video greeting for the event, because he’s in Washington as the Senate begins to debate the health care reform bill. Democrats have all 60 votes they need to bring the bill to the floor, but several members of the caucus have not ruled out backing a Republican filibuster before the final vote. I won’t be supporting the Democratic Senatorial Campaign Committee this cycle, because I don’t want a penny going to a dishonest tool like Blanche Lincoln. She’s probably going to lose anyway.

In addition to any comments about health care reform or the JJ Dinner, please consider this an open thread for anything that’s on your mind this weekend.

For comic relief: in the middle of this afternoon’s Senate proceedings, Chuck Grassley tweeted,

Can somebody tell me why Wall st Journal no longer list Des Moines in its weather cities list. Iowa still exists

UPDATE: I hadn’t been to the JJ dinner in a few years and had a great time. Iowa House Majority Leader Kevin McCarthy and Iowa Senate Majority Leader Mike Gronstal were making fun of each other when the bucket was passed around for extra donations.

McCarthy: What’s the difference between God and a state senator? God doesn’t think he’s a state senator.

Gronstal: What’s the difference between House representatives and boy scouts? Boy scouts have adult supervision.

Speakers: Bruce Braley, Leonard Boswell, Patty Judge, Chet Culver, and Tom Harkin’s recorded video before Biden. (Dave Loebsack is out of the country.)

Huge ovation shortly after 8 pm when IDP chair Michael Kiernan came on stage to announce that the U.S. Senate defeated a filibuster of the motion to bring the health care reform bill to the floor, 60-39. Harkin promised in his video that they will get a health care reform bill bassed before the end of the year, and it will contain a public health insurance option.

Biden gave a great speech, with plenty of jokes, Irish poetry, quiet moments and a few lines that got the crowd on their feet. He apologized for being a little late; he had been on the phone with some unnamed senators whose votes he had helped sway on health care reform.

I had to leave right after Biden’s speech, so I missed the after-party, where U.S. Senate candidates Bob Krause, Roxanne Conlin and Tom Fiegen were set to speak. If you were there, post a comment or a diary to let us know how those speeches were.

SECOND UPDATE: After the jump I’ve posted Kiernan’s remarks and excerpts from Culver’s speech.

FINAL UPDATE: The Iowa Democratic Party posted a slideshow from the event here.  

I’m looking forward to the Iowa Democratic Party’s Jefferson-Jackson dinner this weekend. It will be live-streamed for those who can’t be there in person. The Iowa branch of Organizing for America is having a grand opening on Saturday as well, right before the JJ dinner.

Details for those and other events are after the jump. Post a comment or send me an e-mail (desmoinesdem AT yahoo.com) if you know if something I’ve left out.

Linn County Dems: Don’t forget that November 24 is the special election in Iowa House district 33.

One more “save the date”: the Culver-Judge campaign’s holiday party will be on Saturday, December 5 at the Val-Air Ballroom in West Des Moines from 7:30 pm to 11:00 pm. Tickets are just $35 for an individual, $10 for students and $50 for a family. Call 515-244-5151 or go to www.chetculver.com for more information.

Health Care for America NOW and the American Federation of State, County and Municipal Employees are running television ads this week thanking 20 Democrats in relatively tough districts who voted for the House health care reform bill last Saturday. If you live in the Des Moines viewing area, you may have seen this commercial about Congressman Leonard Boswell:

Corporate-funded conservative groups have targeted Boswell in negative ads this year because of his vote for the climate-change bill in June. Ads attacking the health care reform project (many funded by insurance industry fronts or the Chamber of Commerce) have been plentiful this summer and fall too. It makes sense for reform advocates to thank Boswell, as Iowa Republicans are gearing up to challenge him with State Senator Brad Zaun or some other well-known figure.  

In other health care reform news, Tom Harkin is among the Senate Democrats trying to keep the "Stupak amendment" language on abortion out of the Senate's version of health care reform. He's absolutely right that some people pushing amendments are trying to kill the bill rather than make it better. A lot of questions have been raised about whether defeating the bill was Representative Bart Stupak's main goal. Since 1992, Stupak has been involved with the fundamentalist Christian "Family" group and has lived in their house on C Street in Washington.  

Stupak claims that as many as 40 House Democrats would reject health care reform without his amendment, but yesterday House Whip James Clyburn said the Stupak amendment only gained 10 votes for the bill. Meanwhile, more than 40 House liberals are threatening to vote down the final bill out of conference if it contains the Stupak language.  

Final note: MyDD user Bruce Webb wrote an interesting piece about what he views as "the most important and overlooked sentence" in the House health care reform bill:  

Most of the criticism of HR3962 coming from the left revolves around the belief that the House bill has no premium and so no profit controls, that it in effect delivers millions of Americans into the hands of insurance companies who can continue to raise premiums at will while denying care by managing the risk pool in favor of those unlikely to make claims. This just is not true, not if the provision in this one sentence is properly implemented. In a stroke it guts the entire current business model of the insurance companies, based as it is on predation and selective coverage, and replaces it with a model where you can only make money by extending coverage to the widest range of customers and or delivering that coverage in a more efficient way.

 Like they say, go read the whole thing.
 

After many hours of debate, the House of Representatives approved HR 2962, the Affordable Health Care for America Act tonight by a vote of 220-215. In a nice touch, Representative John Dingell (MI-15) presided over the chamber today. He was one of the architects of the original Medicare bill.

President Barack Obama went to the Capitol this morning to urge House Democrats to pass the bill. But as you can see from the roll call, 39 Democrats voted no. All of Iowa’s Democrats voted “aye.” Only one House Republican voted for the bill (Joseph Cao, representing the heavily Democratic LA-02).

I am upset that no House Progressives were allowed to offer amendments today, but Bart Stupak (MI-01) was able to further restrict women’s access to abortion services. His amendment is a very bad deal for women. I’m with Angry Mouse: this is not okay.

The Stupak amendment passed 240-194, gaining 64 Democratic votes (roll call here). That’s almost a quarter of the House Democrats. An embarrassing number of Democrats who aren’t even in the Blue Dog caucus voted for it. As Natasha Chart tweeted tonight, the Stupak amendment is exactly the kind of thing a Democratic majority was supposed to stop from coming to the floor. The DCCC won’t get a dime from me this cycle.

Supposedly Obama told progressives this morning he will try to have the Stupak provision removed from the bill in conference. I would bet money against that happening. I expect to see bipartisan movement to include a similar clause in the Senate health care bill.

According to Jane Hamsher, the AFL-CIO may cut off contributions to Democrats who vote against health care reform. Again, I would bet money against this happening, but some Blue Dogs would have trouble funding their re-election campaigns without support from organized labor.

Speaking of Blue Dogs, I want to give special credit to Leonard Boswell (IA-03) tonight. Unlike most of his fellow Blue Dogs, he voted no on the Stupak amendment and yes on passing the bill.

Bruce Braley (IA-01) noted tonight that we hear a lot of Republican talk about medical liability, but not one word about medical safety.

Also worth noting: the future of the State Children’s Health Insurance Program is uncertain. As fairleft2 notes in this diary, the House bill moves children either to Medicaid or into private plans. It’s not clear whether this provision could pass the Senate.

Meanwhile, a new poll from Virginia suggests opposing the public health insurance option was disastrous for Democratic gubernatorial candidate Creigh Deeds.

Share your own health care reform thoughts in this thread.

UPDATE: Jacob Hacker, “godfather” of the public health insurance option, thinks the House bill is worth supporting. Whether the public option can survive a House/Senate conference committee is another question. A few days ago the Stupak amendment was considered a “poison pill” that would doom the health care reform effort, but last night House Progressives almost all voted for the bill even after the Stupak amendment passed. I think that signals the death of the “progressive block” strategy for demanding a public option in the final version of health care reform.

Representative Steve King (IA-05) enjoyed Thursday’s “House call” rally against health care reform so much that he organized another rally at the Capitol today to “kill the bill.” Unfortunately for fellow Republicans, King and several other wingnuts blew off a House Judiciary Committee hearing on Thursday. In their absence, several Republican amendments to the PATRIOT Act reauthorization bill failed to pass:

Those votes took place, a committee staffer confirmed, between noon and two — the very time when Republican lawmakers were rallying the Tea Party troops on the Capitol steps.

One measure, offered by Rep. Lamar Smith of Texas, the ranking Republican on the committee, would have extended the “lone wolf” provisions of the Act, which would allow the FBI to surveil or search foreign nationals even if it can’t be shown that the person is an agent of a foreign power. Many believe that had this been in effect before 9/11, the FBI might have caught Zacarias Moussaoui. And Republicans had said that extending the lone wolf provision this time around was crucial to protecting national security. Even some Democrats supported the measure, giving it a good chance of passage. But it failed by a single vote, 15-15. Reps. King and Gohmert were absent.

Another measure, offered by Rep. Dan Lundgren (R-CA), failed by a vote of 11 to 8. Reps. King, Gohmert, Jordan, and Poe were all missing.

And a third, brought by Rep. Tom Rooney (R-FL), which would have bolstered the ability of local law enforcement to use a device that records phone numbers from a particular phone, failed by 12 to 10, with King, Gohmert, Jordan, Poe, and Franks all absent. (A subsequent amendment that did essentially the same thing later passed, it’s worth noting.)

Several other members of both parties missed some of these votes as well, but there’s no evidence they were Tea Partying.

I guess King likes preaching to the converted more than doing his job.

UPDATE: In fairness to King, he is apparently missing his son’s wedding today in order to be in Washington for the health care debate.

The Quad-City Times reports today that Roxanne Conlin is “in the midst of putting together a [U.S. Senate] campaign” and will file papers with the Federal Election Commission next week. She seems to have hired at least one campaign staffer already; the newspaper quotes Mark Daley as Conlin’s spokesman.

I expect Conlin to raise large sums of money quickly once she has formed a campaign committee, but she has a ways to go to become competitive with Senator Chuck Grassley. He had $4.4 million cash on hand at the end of the third quarter, and there will be plenty more where that came from. During this election cycle alone, Grassley has raised more than $1.6 million in individual contributions and $1.9 million from political action committees. Health care and insurance interests have generously supported him:

Iowa Sen. Chuck Grassley (R) has raised $154,350 in campaign donations in the 3rd quarter of 2009 from health care interests, including $43,590 from health insurance interests, according to research conducted by the campaign finance watchdog Public Campaign Action Fund. Grassley serves as the ranking Republican on the Senate Finance Committee, which voted out a health care reform bill earlier this year.

Over his career, Grassley has raised at least $3.3 million from the health care and insurance industries during his time in Washington, according to the Center for Responsive Politics.

“Sen. Grassley was showered with health industry contributions while the Finance Committee was meeting to discuss health care legislation,” said David Donnelly, national programs director for Public Campaign Action Fund. “Insurance PACs and executives wanted Grassley to oppose health care reform, and that’s what they got.”

Last week Cityview’s Civic Skinny expressed doubts that Conlin can raise $10 million without taking any money from lobbyists or PACs. $10 million might be a tall order, but Conlin has plenty of major donor contacts around the country, not to mention potential support from small donors who got fed up with Grassley this summer. Conlin probably won’t be able to match Grassley dollar for dollar, but she certainly will raise enough to stage a credible statewide campaign.

Conservative activists gathered in Washington yesterday to protest Democratic-backed health care reform proposals. As usual, right-wingers are completely wrong about the substance of the bills, crying “socialism” when the real problem is not enough government-backed competition for private insurers. Former House Majority Leader Dick Armey, a key figure in the “tea party” movement, claims to believe that “The largest empirical problem we have in health care today is too many people are too overinsured.”

Anyway, when ill-informed right-wingers are causing a spectacle inside the beltway, you can count on finding Representative Steve King (IA-05) nearby. Hey, it’s been almost three weeks since national media last paid attention to his unfounded allegations.

So King gets on MSNBC yesterday and falsely claims that the House Democrats’ bill would cancel every private insurance contract in America. You can watch the clip on the Iowa Democratic Party’s site.

Not only do the Democratic bills not void private insurance contracts, they prevent Americans covered by private insurance from choosing a public health insurance option.

Politifact should add this gem to their fact-checking page on King. I noticed that Representative Michele Bachmann (MN-06) is way ahead of him in terms of the number of “false” and “pants on fire” claims subjected to Politifact’s Truth-o-meter, but it shouldn’t take long for King to catch up.

By the way, I recommend watching the video of Mike Stark’s brief interview with King outside the Capitol, recorded a few days ago. King doesn’t know how many uninsured people live in his district (approximately 83,000), and he doesn’t know how many bankruptcies in his district are related to medical costs (about 700 last year), but he does know that “my people want freedom” from health care reform.

Senate HELP Committee Chairman Tom Harkin told reporters yesterday that he does not expect Senator Joe Lieberman to join a Republican filibuster to block the health care reform bill. He also hinted that Lieberman has a lot to lose by sinking this bill.

Good news, part 1: Senate Majority Leader Harry Reid announced yesterday that the health care bill he’ll bring up on the Senate floor will have a public health insurance option. That means opponents of the public option will have to try to strip out the measure with amendments on the Senate floor. They don’t have 60 votes to do that.

Good news, part 2: at yesterday’s press conference, Reid “definitively stated that a trigger bill wouldn’t get a [Congressional Budget Office] score – effectively taking it off the table as a legislative option.” The insurance industry and its allies in Congress, including Republican Senator Olympia Snowe, have pushed the “trigger” idea because it would virtually guarantee that the public option would never go into effect.

Bad news, part 1: Reid’s compromise would allow states to opt out of the public health insurance option, and limits participation in the public plan in many other ways too.

Bad news, part 2: At crunch time, President Barack Obama did nothing to help progressives fighting to strengthen the health care bill. On the contrary, he urged Reid to drop the public option in favor of a “trigger.”

More thoughts on that betrayal are after the jump.

The House of Representatives will soon bring a health care reform bill up for a floor vote. All three relevant committees have approved bills containing a public health insurance option. In August, Jacob Hacker explained one of the key differences between those bills (pdf file):

The versions of the House bill approved by the House Ways and Means Committee and  House Education and Labor Committee contain a Medicare tie-in that has two crucial  characteristics:

    1.  Providers participating in Medicare would automatically be considered participating  providers in the new public plan, although they would have the right to opt out.

    2.  Initial payments to providers would be set at Medicare rates plus 5 percent. After  three years, the Secretary of Health and Human Services could adjust rates. But  during the crucial start-up period, the public plan would be able to piggyback on  Medicare’s payment methodology. 17    

     These are good provisions. They would be even better if they included an explicit  protection of providers’ rights to join the public plan. Private plans (at least those that  participate in the exchange) should be prohibited from setting as a condition of participation  in their networks that providers not join the public plan.

     By contrast, the House Energy and Commerce Committee approved the House bill  with amendments that preserve only the first of these two elements. 18 Providers participating  in Medicare would be presumed to participate in the new public plan (but, again, allowed to  opt out). 19 However, rather than setting the rates the public plan would pay providers on the  basis of Medicare rates, the Secretary of Health and Human Services would have to  “negotiate” rates directly with providers. 20 These rates in the aggregate would have to be  between Medicare rates and private rates, but no other details are given. 21 This is a not-so-good provision that could drive up individual premiums and federal costs, burdening  Americans as health care consumers and taxpayers alike. It threatens the viability of the  public plan because it may require the government to pay providers higher rates than they would otherwise accept if the rates were set.

Click here to download Hacker’s full report, which includes analysis of the Senate HELP Committee’s bill.

When the House Energy and Commerce Committee passed a watered-down bill to placate Blue Dog Democrats, most people assumed that this compromise would be the health care reform bill sent to the House floor. However, House Progressives have been rounding up votes for the stronger public option provisions, and yesterday Progressive Caucus co-chair Raul Grijalva claimed to have 210 votes supporting or leaning toward supporting the stronger bill. Speaker Nancy Pelosi won’t bring that bill to the floor unless she is sure she has the 218 votes needed to pass, however. As many as 19 House Democrats have not decided whether they would support the “Medicare plus 5 percent” public option.

Chris Bowers published a pdf file listing 36 House Democrats who are either undecided, “lean yes” or “lean no” on the stronger public option. Representative Leonard Boswell (IA-03) is on that list. It’s not clear whether he is undecided or leaning one way or the other. I have sought clarification from his office and will update this post when I hear back.

You know the drill. Boswell needs to hear from as many constituents as possible. The “Medicare plus 5 percent” version of the public option is better policy, and if the House approves it, our negotiating position in the Senate will be stronger. I would call Boswell’s office rather than e-mail, because phone calls are harder for staffers to ignore. Office contact information:

Washington DC Office

Phone: (202) 225-3806

Fax: (202) 225-5608

Iowa District Office

Phone: (515) 282-1909

Fax: (515) 282-1785

Toll Free Phone: (888) 432-1984

In related news, Boswell joined Representatives Bruce Braley (IA-01) and Dave Loebsack (IA-02) today in announcing final legislative language to change “the way Medicare pays healthcare providers for services, from its current fee-for-service system into a quality and value-based system.” After the jump I’ve posted a joint press release explaining how this deal will affect Medicare reimbursement rates.

UPDATE: Supposedly there are at least 218 votes in the House for the “robust” public option. The deal on Medicare reimbursement rates helped secure some extra votes for the public option. Also, the House bill will strip the insurance industry of its anti-trust exemption.

CORRECTION: Apparently we don’t have 218 votes for the stronger public option after all.

For uninsured homo sapiens, not so much.

Meteor Blades brought to my attention a surreal editorial from the Colorado Springs Gazette about a silverback lowland gorilla who needed medical care.

Senator Chuck Grassley complained this week that he is not being included in negotiations to merge the health care reform bills passed by the Senate Finance Committee and Committee on Health, Education, Labor and Pensions.

Finance Chairman Max Baucus, a Montana Democrat, “assured us that Republicans would be at the table through the process of negotiating a single bill,” Grassley said. “And obviously that’s kind of ruled out now by the fact that I am not a part of a bipartisan agreement.”

Look, the HELP Committee adopted about 160 Republican-proposed amendments to the health care bill during the markup process, yet not a single Republican voted to send that bill out of committee. Then Baucus bent over backwards to include Grassley in negotiations all summer, but he joined all the Finance Committee Republicans except for Olympia Snowe in voting against the health care bill. Why should Grassley have a say in how the HELP and Finance bills are combined?

Now Steve Benen catches Grassley “going around the bend” in his criticism of health care reform:

This week, Grassley appears to have completely lost it, offering at least tacit support for radical “Tenther” theories that insist that health care reform may be unconstitutional.

    “I’m not a lawyer, but let me tell you, I’ve listened to some lawyers speak on this. And you know, it’s a relatively new issue. I don’t think we’ve ever had this issue before of having to buy something. And a lot of constitutional lawyers, saying it is unconstitutional or at least in violation of the 10th Amendment. Now maybe states can do this, but can the federal government? So, I have my doubts.”

This was specifically responding to a question about individual mandates — a measure he’s already endorsed as a good idea that he supports.

Obvious inconsistencies notwithstanding, the notion that health care reform is “in violation of the 10th Amendment” is demonstrably ridiculous. The idea that “a lot of constitutional lawyers” see health care reform as unconstitutional is absurd.

For more details on Grassley’s previous public support for an individual mandate to purchase health insurance, read this post by Benen or this one by Jason Hancock.

Grassley’s misleading and inconsistent comments about health care reform have greatly harmed his reputation with Iowa Democrats and independents this year. It will be interesting to see whether he can repair the damage before next November. I don’t see him getting nearly as large a crossover vote as he has in his previous elections.

The Senate Finance Committee approved its health care reform bill on a 14-9 vote yesterday, with all Democrats and Republican Olympia Snowe of Maine voting in favor. Ranking Republican Chuck Grassley, a key member of the committee’s “gang of six” negotiators this summer, joined the rest of the Republicans in voting against the bill. Speaking to the Des Moines Register Grassley “said he has no regrets about working with majority Democrats on the committee, only to oppose the bill. Given more time, he might have struck a deal, he said.”

This guy is the perfect picture of a bad-faith negotiator. From the Register:

Grassley said he objects most to provisions in the bill that would require Americans to obtain health insurance. But Grassley also said the bill does too little to block federal money being spent to provide abortions and provide coverage for illegal immigrants.

“Those aren’t the only things, but I think they are the most controversial or the most difficult to deal with,” Grassley told The Des Moines Register.

As Jason Hancock reported for the Iowa Independent last week, Grassley publicly supported the idea of an individual mandate to purchase health insurance this summer. I agree that requiring individuals to purchase insurance is problematic if there is no broad-based public health insurance option (because then the government is just subsidizing private insurers), but of course Grassley opposed the public option too.

In addition, the “gang of six” made changes in the bill before markup to address groundless Republican claims about illegal immigrants. According to PolitiFact, the “Baucus plan explicitly states that no federal funds – whether through tax credits or cost-sharing credits – could be used to pay for abortions (again, except for rape, incest, or the life of the mother).”

Trying to cut deals with Grassley is a waste of time. For more on that point, check out the skipper’s recent diary.

Speaking of Grassley, Cityview’s Civic Skinny thinks he should be worried about a potential race against attorney Roxanne Conlin. When a reporter asked Secretary of Agriculture Tom Vilsack whether his wife, Christie Vilsack, might run against Grassley, he replied, “You should ask her about that.” (UPDATE: Dave Price did ask her and wonders whether she is the mystery candidate.)

As for the health care bill, the Finance Committee and HELP Committee versions have to be merged before a floor vote. It’s imperative that a public option be included in the version sent to the floor, and HELP Committee representative Chris Dodd says he will fight for that. On the other hand, Snowe and a few Democrats, like Blanche Lincoln of Arkansas, might vote against the bill on the floor if it contains a public option. Chris Bowers wrote more at Open Left about the merging process in the House and Senate.

Breastfed babies can be long and lean, short and fat, or anywhere in between. But I never heard of an insurance company citing a breastfeeding infant’s “obesity” as a pre-existing condition before reading this story from the Denver Post:

By the numbers, [four-month-old] Alex [Lange] is in the 99th percentile for height and weight for babies his age. Insurers don’t take babies above the 95th percentile, no matter how healthy they are otherwise. […]

Bernie and Kelli Lange tried to get insurance for their growing family with Rocky Mountain Health Plans when their current insurer raised their rates 40 percent after Alex was born. They filled out the paperwork and awaited approval, figuring their family is young and healthy. But the broker who was helping them find new insurance called Thursday with news that shocked them.

” ‘Your baby is too fat,’ she told me,” Bernie said.

Up until then, the Langes had been happy with Alex’s healthy appetite and prodigious weight gain. His pediatrician had never mentioned any weight concerns about the baby they call their “happy little chunky monkey.” […]

“I’m not going to withhold food to get him down below that number of 95,” Kelli Lange said. “I’m not going to have him screaming because he’s hungry.”

Good call, Mrs. Lange. There is “no evidence to support ‘dieting’ or substituting other foods or liquids for human milk to reduce weight gain.”

It’s outrageous for an insurance company to use Alex’s weight at four months of age as an excuse to deny coverage. Not that exclusions for other “pre-existing conditions” (such as a benign heart murmur that a child would grow out of without treatment) are any more defensible.

Also, the Lange family wouldn’t have been shopping around for new coverage if their previous carrier hadn’t raised their rates by 40 percent after Alex was born. I remember our insurance premiums went up quite a bit after our second child was born, but I don’t think it was by that much. Then again, they went up 10 percent last year even without any new babies or health problems in our family.

Share any relevant thoughts in this thread.

Senate Democrats have not given up on passing health care reform through normal procedures requiring at least 60 votes to overcome a Republican filibuster. The problem is, several conservative Senate Democrats are on record opposing a public health insurance option. Meanwhile, a bill with no public option will have trouble passing the House of Representatives, where the overwhelming majority of the Democratic caucus supports a robust public option tied to Medicare rates.

The obvious political solution is to include some watered-down public option in the bill, giving cover to Progressive Democrats who insist on a public option while placating House Blue Dogs and Senate conservatives who want to protect private insurers’ market share.

The “triggered” public option favored by many industry allies didn’t fly, because most Democrats understand that the trigger would never be pulled. This past week, a new possible compromise emerged:

It was pulled out of an alternative idea, put forth by Sen. Tom Carper (D-Del.) and, prior to him, former Senate Majority Leader Tom Daschle, to give states the power to determine whether they want to implement a public insurance option.

But instead of starting with no national public option and giving state governments the right to develop their own, the newest compromise approaches the issue from the opposite direction: beginning with a national public option and giving state governments the right not to have one.

I consider this idea’s pros and cons after the jump.  

All of the health care reform bills under consideration in Congress would prohibit insurance companies from refusing to cover people because of prior health problems. “Guaranteed issue” is the wonky name for this ban on discrimination because of pre-existing conditions. Unfortunately, various economists and health care experts told David Hilzenrath of the Washington Post that “simply banning medical discrimination would not necessarily remove it from the equation […].”

If insurers are prohibited from openly rejecting people with preexisting conditions, they could try to cherry-pick through more subtle means. For example, offering free health club memberships tends to attract people who can use the equipment, says Paul Precht, director of policy at the Medicare Rights Center.

Being uncooperative on insurance claims can chase away the chronically ill. For people who have few medical bills, it is less of a factor, said Karen Pollitz, research professor at the Georgetown University Health Policy Institute.

And to avoid patients with costly, complicated medical conditions, health plans could include in their networks relatively few doctors who specialize in treating those conditions, said Mark V. Pauly, professor of health-care management at the University of Pennsylvania’s Wharton School. […]

America’s Health Insurance Plans, a lobbying group for health insurers, has endorsed the idea of guaranteeing individuals access to coverage regardless of their medical history — if that guarantee is part of a larger plan to help the uninsured pay for coverage and bring everyone into the insurance market.

At a more nuts-and-bolts level, AHIP has been trying to shape the legislation in ways that could help insurers attract the healthy and avoid the sick, though it has given other reasons for advancing those positions. In a recent letter to Baucus, AHIP President Karen Ignagni said benefit packages “should give consumers flexible options to meet diverse needs.”

If the final health care reform bill has no public health insurance option, many chronically ill Americans are likely to be left outside the system as insurers find new ways of denying coverage or dropping policy-holders.

Even if the final bill includes a limited public option, cherry-picking by private insurers could set up the public plan for failure. President Obama has endorsed the idea of making the public option available only to people who are currently uninsured, meaning it will serve a disproportionate number of chronically ill people. That will drive up costs of operating the public plan.

I don’t have an answer for this problem, beyond feeling depressed that corporate groups like AHIP have so much sway with Congress. If Americans with prior health issues are still facing discrimination after Obama signs what he claims to be sweeping “health insurance reform,” the political backlash against Democrats could be severe.

UPDATE: MyDD user Bruce Webb wasn’t impressed by Hilzenrath’s article. I’ve posted his rebuttal after the jump.

If you’re an insurance company, that is:

Late in the afternoon [on Wednesday], Sen. Chuck Grassley (Iowa), the top Republican on the committee, requested consideration of the “Grassley F-1 Modified Amendment.” Its goal: eliminate $7 billion a year in fees that the government would charge private health insurance companies, and make up the shortfall by reducing benefits to poor people and legal immigrants.

It was dangerously close to a parody: Republicans demanding that fees be reduced on a profitable industry and shifted to low-income Americans. But Grassley pressed on, unafraid. The fees on the corporations, he said, are a “bad idea” and would undoubtedly result in higher insurance premiums. “I urge my colleagues to vote for my amendment, to strike the fees,” he exhorted.

Sen. Jay Rockefeller (D-W.Va.) recognized the fat target that Grassley had just set up. “I think it’s a ‘message amendment,’ ” he said, suggesting Grassley was sending a symbolic signal to the conservative base. “It certainly takes on legal immigrants and Medicaid in a very sharp way.”

Grassley looked hurt. “You don’t really believe that this is a message amendment, do you?”

Why so cynical, Senator Rockefeller? I take Senator Grassley at his word. He would rather reduce health care coverage for poor people and immigrants (during a recession!) than force a profitable industry to pay higher fees.

I encourage Bob Krause and Tom Fiegen to add this Washington Post story to their Senate campaign websites.

In case anyone is wondering, I still have no idea who the mystery Grassley challenger might be.

UPDATE: Grassley also failed on Wednesday to get the committee to adopt “that would have required beneficiaries of Medicaid and the Children’s Health Insurance Program to show a photo ID in order to enroll.” However, the committee unanimously adopted Grassley’s amendment “that would require members of Congress to get their health insurance through a proposed federal exchange.”

The White House agreement with the pharmaceutical industry, which is reflected in the Senate Finance Committee’s health care bill, is one of the most shameful episodes of the health care reform process. Presidential candidate Barack Obama had promised to “put an end to the game-playing” in Washington, citing in one television ad the deal the pharmaceutical industry wrote into the Medicare prescription drug legislation. Yet in order to bring big Pharma on board with health care reform, the White House “stood by a behind-the-scenes deal to block any Congressional effort to extract cost savings from them beyond an agreed-upon $80 billion.”

Senator Byron Dorgan of North Dakota says no deal, according to Ryan Grim of the Huffington Post:

A Senate Democratic leader is hoping to blow up the deal reached between the White House, drug makers and Senate Finance Committee Chairman Max Baucus (D-Mont.), by introducing an amendment on the floor to allow prescription drugs to be re-imported from Canada.

It’s one of the simplest ways to reduce health care costs but was ruled out by the agreement, which limits Big Pharma’s contribution to health care reform to $80 billion over ten years.

North Dakota Sen. Byron Dorgan, a member of Democratic leadership, isn’t a party to that bargain. “Senator Dorgan intends to offer an amendment to the health reform bill and his expectation is that it will be one of the first amendments considered,” his spokesman Justin Kitsch told HuffPost in an e-mail. “Prescription drug importation is an immediate way to put downward pressure on health care costs. It has bipartisan support, and has been endorsed by groups such as the National Federation of Independent Businesses and AARP.” […]

Jim Manley, senior communications adviser to Senate Majority Leader Harry Reid (D-Nev.), said that he sees no reason the amendment won’t get a floor vote.

If an amendment on reimporting drugs from Canada gets to the Senate floor, it is hard to see how it fails to pass. Grim notes that a separate bill to allow re-importation of prescription drugs from Canada “has 30 cosponsors, several Republicans among them.” I hope the White House doesn’t start twisting arms to keep that amendment off the Senate floor.

Giving the government the ability to negotiate prescription drug prices would bring costs down even more. Obama should support that reform, since he says he won’t let the health care bill add a dime to the deficit. But apparently, not taking that step was part of the White House deal with drug companies.

Speaking of backroom deals, Alexander Bolton reports for The Hill, citing “senior Democratic aides,” that Reid will “not include legislation repealing antitrust exemptions for the health insurance industry in the healthcare package he will bring to the Senate floor.”

So far the powerful insurance industry has held back waging a full-out battle against Democratic health reform proposals because companies stand to gain tens of millions of new customers. But adding language that would open health insurance companies to prosecution by the Justice Department would provoke a strong counterattack from the industry.

Hey, why take something valuable away from the insurance industry (the ability to fix prices) just because we’re about to hand them a “bonanza” (individual mandate to buy their products)? They might run ads against us.

It is time to replace Reid as Senate majority leader. Since Senate Democrats are unlikely to take that step, I agree with Chris Bowers that Reid losing re-election next year wouldn’t be such a bad thing. Getting a more effective majority leader, like Dick Durbin of Illinois or Chuck Schumer of New York, would make up for losing Reid’s Senate seat.

As expected, the Senate Finance Committee rejected two amendments yesterday that would have added a public health insurance option to the health care reform bill Chairman Max Baucus drafted with a big assist from industry lobbyists. Five Democrats voted with all the committee Republicans against Senator Jay Rockefeller’s amendment, which would have created a national public option tied to Medicare rates. Three Democrats also joined Republicans to vote down Senator Chuck Schumer’s much weaker “national level playing field” public option. CA Berkeley WV liveblogged yesterday’s hearing for Congress Matters.

Senator Chuck Grassley sang the same old song about the “government run plan” forcing private insurance companies out of business. He got a little tripped up when Senator Chuck Schumer asked him for his views on Medicare, though.

“I think that Medicare is part of the social fabric of America just like Social Security is,” Mr. Grassley said. “To say that I support it is not to say that it’s the best system that it could be.”

“But it is a government-run plan,” Mr. Schumer shot back.

Mr. Grassley, a veteran Senate debater, insisted that Medicare did not pose a threat to the private insurance industry. “It’s not easy to undo a Medicare plan without also hurting a lot of private initiatives that are coupled with it,” he said.

Chairman Baucus scored highest on the chutzpah meter, praising the public option even as he refused to support it. Grassley also held out false hope that maybe someday some other bill will accomplish that goal.

Several Senate Democrats, including Tom Harkin, insisted yesterday that they will get some kind of public option into the bill that reaches the Senate floor. After the jump you’ll find lots of links on the battles to come.

I agree that the public option is not dead yet, but for it to survive, President Barack Obama and Senate Majority leader Harry Reid will need to do a lot more than they’ve done so far to lean on the Senate conservadems.  

Crossposted from Hillbilly Report.

It seems like the one constant that can be depended on in this country anymore in good times or bad is the fact that working folks are working harder and harder and simply are not getting ahead. Even before the Republican recession last year wages have stagnated for decades and the gap between rich and poor has only widened as our middle-class continues to shrink. New numbers show that while incomes across the board have fallen, the recession has once again hit middle and lower class working Americans the hardest.  

For months, White House officials and Senate leaders praised the “gang of six” negotiations toward a bipartisan deal on health care reform, even as other observers doubted the Republicans in that group were negotiating in good faith. At the beginning of the summer recess in August, Senator Jay Rockefeller (who was shut out of the deal-making) warned:

Changes to the bill have been frustrating, Sen. Jay Rockefeller (D-W.V.) told reporters at a press conference, particularly given that the Republicans — Mike Enzi of Wyoming, Chuck Grassley of Iowa and Olympia Snowe of Maine — are, in his opinion, just stalling for time.

“You just watch as the bill diminishes in its scope, in its coverage, in its ferocity to try to attack the problem. I don’t know where it will come out,” Rockefeller said. “My own personal view is that those three Republicans won’t be there to vote it out of committee when it comes right down to it, so that this all will have been a three-or-four-month delay game, which is exactly what the Republicans want.”

No Republicans stood with Senate Finance Committee Chairman Max Baucus last week as he finally unveiled what David Waldman described as “a plan that amounts to capitulating to every Republican demand, and then adding a heaping pile of political suicide on top of it.” The bill is in markup this week, and CA Berkeley WV has been blogging the Senate Finance Committee meetings for Congress Matters (day one, day two and day three).

Where does ranking Finance Committee member Grassley stand after Baucus bent over backwards to keep negotiating with him all summer? After the jump I’ve posted the relevant portion of a transcript from Grassley’s September 24 telephone news conference with Iowa reporters. The short version is, he’s against the bill because:

1. The individual mandate to buy health insurance amounts to “[q]uite a steep tax for people that maybe don’t pay a tax.”

2. Democrats supposedly were “not willing to go far enough” on enforcement to make sure illegal immigrants wouldn’t be covered.

3. Democrats supposedly “weren’t willing to go far enough to make sure that the subsidy through the tax credit was not used to finance abortions.”

4. You shouldn’t be “increasing taxes and cutting Medicare” when “we’re in depression.”

I told Iowa Republicans not to worry about Grassley voting for any health care reform bill. Senate Democrats should reject the concessions Baucus made to win GOP votes that are now off the table.

Senator Jay Rockefeller was excluded from the bipartisan group of Finance Committee members who worked on the bill Chairman Max Baucus unveiled on Wednesday, so he spent part of his summer vacation researching the fake public option favored by some “gang of six” members. He reported on his findings in an open letter to Baucus and ranking member Chuck Grassley. You should click through and read Rockefeller’s whole letter, but here are some excerpts:

“First, there has been no significant research into consumer co-ops as a model for the broad expansion of health insurance. What we do know, however, is that this model was tried in the early part of the 20th century and largely failed. As the USDA states in its response letter, ‘Government support for the cooperative approach to delivering universal health care was reduced during [World War II] and terminated afterward.’ This is a dying business model for health insurance. Moving forward with health insurance cooperatives would expose Americans, who are hoping for a better health care system, to a health care model that has already been tried and largely failed in the vast majority of the country.

“Second, there is a lack of consistent data about the total number of consumer health insurance cooperatives in existence today, and there have been no analyses of the impact of existing health insurance cooperatives on consumers.

“Third, all of the consumer health insurance cooperatives identified by the [U.S. Department of Agriculture] and [National Cooperative Business Association] operate and function just like private health insurance companies. Therefore, it is unclear how expanding consumer health insurance cooperatives would actually achieve greater affordability for consumers or bring about greater competition in the private market…

The Congressional Budget Office doesn’t expect the co-ops to affect the cost of the Baucus bill:

(The proposed co-ops had very little effect on the estimates of total enrollment in the exchanges or federal costs because, as they are described in the specifications, they seem unlikely to establish a significant market presence in many areas of the country or to noticeably affect federal subsidy payments.)

The failure of co-ops to provide competition in Iowa bears out the CBO’s expectations:

In the 1990s, Iowa adopted a law to encourage the development of health care co-ops. One was created, and it died within two years. Although the law is still on the books, the state does not have a co-op now, said Susan E. Voss, the Iowa insurance commissioner.

Wellmark Blue Cross and Blue Shield collects about 70 percent of the premiums paid in the private insurance market in Iowa and South Dakota.

It’s past time for President Obama to stop sending out White House staff and cabinet secretaries to signal that Obama might accept cooperatives as an alternative to a public health insurance option.

Here’s hoping that even in the absence of presidential leadership, Rockefeller can get strong amendments attached to the Baucus bill or make sure it never gets out of the Senate Finance Committee.

Now that we’re done with the Joe “You Lie” Wilson sideshow, I want to talk about a different kind of Republican disrespect for normal political disagreement.

Having been raised by a Republican of the now-extinct Rockefeller variety, I am often struck by how extreme the GOP has become. Chuck Grassley and Terry Branstad were on the far right in the early 1980s, but many Iowa conservatives now consider them “moderate” or even “liberal.”

Mainstream extremism in the Republican Party is depressing on many levels. It fosters ignorance, as when Iowa Republicans are led to believe that the judiciary is not supposed to interpret the constitution. It encourages politicians to put their theology ahead of civil laws.

Most troubling is when prominent conservatives use language that condones physical violence or “revolution” to resist Democratic policy proposals. I fear that people will get hurt or killed if some mentally unstable person takes these appeals too literally.

More thoughts on this subject are after the jump.

BruceMcF breaks it down for you:

So: (1) Public Choice

“No Taxation without Representation”. Every single person facing an individual mandate must be provided with the choice of a publicly administered plan. Otherwise the government is forcing the citizen to pay without the elected representatives of the citizen controlling the spending.

You want to put a trigger on the public option. Fine, except the exact same trigger applies to the individual mandate.

You want to restrict access to the public option to some smaller group? Fine, except the same restriction applies to the individual mandate.

The system is not politically legitimate if it requires payment to for-profit commercial corporations.

(2) Robust

It cannot be lumbered down with any restrictions not faced by private insurers.

State by state public options? Really? You are really prepared to restrict the corporations to firms with no commercial activity across state lines? If they are free standing state by state public options, it has to be state by state for profit corporations. Oh, not allowing [United Healthcare] into the exchanges defeats the purpose of lining private pockets at the public expense? Yeah, kind of thought so.

BruceMcF has long been one of my favorite transportation bloggers and has written great stuff on health care reform too, including Axelrod: Government by Consent of the Corporation. His home blog is Burning the Midnight Oil, but he frequently cross-posts his work at Progressive Blue, Daily Kos, My Left Wing, Docudharma, and the Hillbilly Report.

Speaking of real and fake public options, Timothy Noah explains “the sorry history” of triggers enacted by Congress, and slinkerwink has suggestions and talking points to use when contacting House Progressives about health care reform. I still think it’s worth urging Populist Caucus members as well as Progressives to insist on a real, not fake or triggered, public option in the final health care bill.

Bruce Braley (IA-01) leads the Populist Caucus, and Dave Loebsack (IA-02) and Leonard Boswell (IA-03) both belong to the caucus. All of them have advocated for the public option, but to my knowledge none has pledge to vote down any bill that lacks a public option.

For those interested in the nitty gritty of legislative wrangling, David Waldman ponders what might happen if the Senate Finance Committee members can’t agree and consequently fail to report out a health care bill.

Senator Tom Harkin told a crowd of nearly 2,000 people today that health care reform including a public health insurance option will pass before this Christmas. Speaking at his 32nd Annual Steak Fry in Indianola, Harkin joked,

“This is my kind of town-hall meeting,” […] because he didn’t see any Republicans standing up to say, “Keep your government hands off my Medicare.”

Harkin and event headliner Al Franken predicted that health care reform would pass with some Republican votes, which seems unlikely if the final version of the bill contains a public option. Republican Senator Olympia Snowe of Maine has been the focus of White House courting on health care, but she opposes a public option, apparently because it has the potential to provide lower-cost health insurance.

The Senate Committee on Health, Education, Labor and Pensions passed a bill this summer containing a public option, but according to one critic, the HELP bill’s public option is anything but robust:

the actual provisions in the HELP Committee bill call for numerous “community health insurance options,” not the single “Medicare-like” plan promised by “public option” advocates. That means the individual “options” will probably be as small and weak as the co-ops now under discussion in the Senate Finance Committee. More importantly, these “community options” will almost certainly be run by insurance companies.

The public option in the bill that cleared the House Energy and Commerce Committee, HR 3200, is also weak in several respects.

President Barack Obama met with 17 relatively conservative Democratic senators on Thursday, reinforcing many people’s fears that he was ready to discard the public option. The same day, Harkin assured the Progressive Populist blog that 51 votes can be found in the Senate for a bill with a public option.

So what about all the hubub about the Blue Dogs and/or Progressives opting out if the bill doesn’t meet their liking? Harkin said don’t put too much stock in those statements.

“Look, around here people are always jockeying for power. That’s all this is,” Harkin said.

The only chance of making this bill stronger, in my opinion, is getting a large bloc of House Democrats to draw a line in the sand. If you live in Iowa’s first, second or third Congressional districts, please contact Bruce Braley, Dave Loebsack or Leonard Boswell to urge them not to accept any bill containing a “trigger” (which is guaranteed to fail) or some other fake public health insurance option. Organizing for America has a new petition out if you prefer that method of generating an e-mail to your member of Congress.

UPDATE: Don’t miss John Deeth’s entertaining liveblog from this event, with lots of photos. Braley and Loebsack praised Boswell for standing up for a public option (unlike many Blue Dogs).

From Chase Martyn’s write-up at Iowa Independent:

Boswell and fellow Democratic U.S. Reps. Bruce Braley and Dave Loebsack also expressed optimism that a final bill would include measures to reform medicare reimbursement rates. Medicare currently pays doctors in rural states like Iowa less than what doctors in densely populated states receive for the same procedures.

President Barack Obama goes before Congress this evening to urge passage of health care reform this year. I will update this post later when the prepared text of the speech becomes available. White House officials say Obama will make the case for a public health insurance option, but it sounds as if he will still leave the door open for Congress to take a different approach. That doesn’t look like a strong negotiating position to me.

Various polling firms will survey people who watch Obama’s speech tonight. Mark Blumenthal of Pollster.com discusses the methodology of instant reaction polls and gives a few reasons for you to be skeptical of their findings.

Speaking of polls, I was disappointed to learn from Greg Sargent that a recent White House memo omitted results from polls showing strong nationwide support for a public health insurance option. (Multiple polls earlier this summer also found majorities in favor of a public option. In fact, Republican pollster Rasmussen has found that support for health care reform drops sharply if there is no public option.

Still, expect to hear Republicans demagogue against government-run “Obamacare.” Yesterday The Iowa Republican blog hyped a new poll from the Winston Group showing that a plurality of Iowans oppose “Obama’s plan” for health care (whatever that is). I wasn’t surprised to read that the head of the Winston Group

has served as a strategic advisor to Senate and House Republican leadership for the past 10 years. He was formerly the Director of Planning for Speaker of the House Newt Gingrich, and advises center-right political parties throughout Europe. Additionally Winston was a senior fellow at the Heritage Foundation where he did statistical policy and econometric modeling. He has served in a senior staff role to four RNC Chairmen.

Gee, I’m shocked that the Winston Group would produce a poll indicating that Obama’s plan is unpopular.

The president’s support has declined quite a bit among Democrats and independents recently. The obvious way for him to turn this situation around is to get behind a real health care reform package that doesn’t give away the store to corporate interests.

Speaking of giving away the store, Senate Finance Committee Chairman Max Baucus finally made his health care plan public this week. Turns out K Street lobbyists had the draft before Baucus showed it to fellow senators or White House officials. Also, a Baucus staffer who used to work for WellPoint is the author of the document.

Ezra Klein thinks the Baucus plan isn’t as bad as you may have heard, but Chris Bowers explains why it is very, very bad. I’m keeping my fingers crossed that Chuck Todd and Andrea Mitchell are correct, and the White House is sick of dealing with Baucus. But like Bowers, I am skeptical that Obama would push for any law encountering objections from the major industry it affects. Consequently, I have no confidence in Obama to reject the Baucus approach outright.

Post any thoughts about the president’s speech or health care reform in this thread.

UPDATE: The full text of the speech as prepared is after the jump. I didn’t watch, but I did read the speech and I am very disappointed. He made a big deal about the moral case for reform, then defended the public option by saying don’t worry, hardly anyone will sign up for it. The only veto threat he made was, “I will not sign a plan that adds one dime to our deficits – either now or in the future.”

If we did health care reform right, we would save money and not add to the deficit. But on principle, I reject the idea that providing universal health care at reasonable cost is not worth doing if it adds to the deficit. Obama doesn’t mind expanding our commitment in Afghanistan, providing an open-ended bailout to Wall Street, extending most of the Bush tax cuts and any number of other things that add to the federal deficit. But for some reason, health care reform isn’t as important. Pathetic.

Corrupt Democrats will make sure that no real public option remains in the bill, which will drive up the cost, allowing Republicans to complain that Obama is breaking his promise not to add to the deficit. To keep costs down, Congress will probably reduce the subsidies available to citizens who will be forced to purchase private insurance. Huge bonanza for insurance companies, nothing to keep costs down, political suicide for the Democratic Party.

I don’t care what the instant reaction polls say; in my view this speech was a failure.

Salon.com published a feature today on 12 U.S. senators who “for reasons of questionable IQ or eccentricity, because they are vapid, stubborn or ornery, can fairly be called knuckleheads.” Here’s why Chuck Grassley made the list:

Evidence of knuckleheadedness: Oh, pretty much just the entire debate over healthcare reform. Grassley’s the primary Republican negotiator on healthcare in the Senate, and Democrats have been working hard to please him, but at this point no one besides Sen. Max Baucus, D-Mont., understands why.

Never mind that Grassley has said there’s almost no chance he’ll actually vote for the final bill, no matter how many concessions to him are included in it. He’s actually gone so far as to claim that provisions in the legislation that would provide coverage for end-of-life counseling are really setting up a “government program that determines if you’re going to pull the plug on grandma.” What he didn’t mention? He’s voted for end-of-life counseling before.

And don’t even get us started on his use of Twitter.

I’m old enough to remember when first-term U.S. Senator Grassley was known as “Tweedle Dumber,” but let’s be honest–Salon’s staff have shown here that the man is shrewd. Although he seems to have no intention of voting for health care reform, and his vote is not needed in a chamber with 60 Democrats, Grassley has made himself a major player on this issue.

Moreover, Grassley has strung along President Obama so successfully that the White House press secretary still supported the “gang of six” bipartisan health care negotiations, even after Grassley fueled unsubstantiated rumors about “pulling the plug on Grandma.” Who’s acting like a knucklehead?

Anyway, Grassley’s use of Twitter can be quite entertaining.

UPDATE: Two professional negotiators, Jerome a Paris and BenGoshi, discuss Obama’s negotiating strategy on health care reform.

Let’s say I’m trying to sell my house, and I have an interested buyer. I could tell the buyer one of two things:

1. The minimum offer I’ll consider for this house is $300,000.

2. This house is worth at least $300,000. Compared to the house down the street that went for $280,000, this house has an extra bedroom and a fully remodeled kitchen. In fact, my house has a bigger yard and more closet space than one in the neighborhood that sold for $310,000. Also, we just added more insulation in the attic and installed triple-pane windows, so you’ll spend less on utility bills than you would in a different house this size. Plus, this house is within walking distance of a good elementary school. But the bottom line is, my mortgage is expensive, and I need to sell my house this month. If you can’t pay me $300,000, I’m willing to consider another fair offer.

Which message is more likely to get me the offer I want: the one justifying my asking price, or the one making clear that I won’t settle for less?

Kid oakland has a simple request for those who supported Barack Obama’s presidential campaign:

This Labor day weekend, I would like to invite you join me in a very simple, direct project in support of comprehensive healthcare reform.

I’d like to invite you to write personal letters to the President about health care reform at his info@barackobama.com email address.

If Barack Obama inspired you should reply to him today. In particular, like msblucow, we need to root our principled requests for Obama to pass comprehensive health care reform in stories from our activism and our day to day lives, especially stories that tell the president about the urgent need for reform. The more principled, specific and rooted those stories are, the more they will break through the clutter of the health care debate. […]  

(The simplest way to write Obama is hit reply to the last email you received from BarackObama.com, that way you will be sure to use the email address they have on record for you.)

Kid oakland’s letter to Obama is here, and many more powerful letters have been posted in the comment thread at Daily Kos. Here’s a good letter from a former regional field organizer for the Obama campaign, and here’s one from a loyal supporter of Hillary Clinton during the primaries.

Please post your own thoughts or letters in the comments.

Periodically I post job listings at Bleeding Heartland, so please let me know of any progressive or environmental organizations hiring in Iowa (desmoinesdem AT yahoo.com).

Democracy for America is hiring “public option field organizers” in 12 states, including Iowa. This is a short-term position but does include health benefits. You can read more about the position and apply here.

I learned today that the I-WILL coalition (formerly known as the Sustainable Funding Coalition) has a one-year position available:

Iowa’s Water and Land Legacy campaign seeks a qualified campaign manager or consulting firm to oversee a statewide ballot campaign from November 2009-November 2010.  The coalition supports a proposed November 2010 constitutional amendment to establish Iowa’s Natural Resources and Outdoor Recreation Trust Fund.  Candidates should have extensive campaign experience-ballot campaign experience preferable, along with experience in fundraising and managing vendors.  Ideal candidate will possess significant skills in coordinating and facilitating decision-making for large, diverse coalitions; ability to relate to diverse organizations and interest groups.  Salary is commensurate with experience.

For a complete position description or to apply, e-mail resume by and cover letter by September 30 to: Iowa’s Water and Land Legacy, attn: Rosalyn Lehman, 303 Locust St, Ste 402, Des Moines, IA 50309 or rlehman@tnc.org.

Speaking of jobs, take heart, college students: the Des Moines-Ames metro area is supposedly the best in the country in terms of number of job-seekers per job available.

Not to be a wet blanket after yesterday’s great special election victory, but the latest Pew Research Center poll should set off some alarm bells at the DCCC and DSCC:

Americans are extremely displeased with Congress, and there are already some signs that this could take a toll on the Democrats in the 2010 midterm elections. Currently, 37% express a favorable opinion of Congress, while 52% hold an unfavorable view. Positive opinions of Congress have declined by 13 points since April and are now at one of their lowest points in more than two decades of Pew Research Center surveys.

At the same time, intentions to vote Democratic in the next midterm election are markedly lower than they have been over the past four years. Voters are about evenly divided when asked how they would vote if the election for Congress were being held today: 45% say they would vote for a Democratic candidate in their district, or lean Democratic, while 44% say they would vote for a Republican or lean Republican. At about this point four years ago, Democrats led in the generic congressional ballot by 52% to 40% and went on to win a majority of the popular vote and regain control of Congress the following November.

Meanwhile, the Research 2000 polling for Daily Kos finds the Democratic lead on the generic Congressional ballot down to 6 points, with Democratic intensity “lagging badly”:

With Independents potentially sitting this next election out (as the numbers hint at), we’re in bad shape in a base election. Core Republicans are engaged and solidly home. Democratic constituencies are wavering (look at those African American numbers). The only key Democratic constituency to have moved more Democratic are young voters — from +30 Democratic to +37, but only because they are abandoning Republicans at a bigger rate than Democrats. And even those gains are threatened by the (non) geniuses in DC seriously contemplating a health care mandate without cost controls (like the public option).

At current rates, any 2010 losses would not stem from any resurgence in conservative ideology — Republicans are simply not making any significant gains anywhere — but in a loss of confidence in Democrats. There’s a way to change that dynamic — deliver on the promises made the last two election cycles. Failure to do that would make cynics out of too many idealistic political newcomers, while turning off base activists who do the hard on-the-ground work of winning elections.

But why deliver on campaign promises when President Obama can score points with the Beltway wizards by backing away from a strong public health insurance option?

I’m not saying next year’s elections will be determined solely by whether the Democrats deliver on health care reform. The condition of the economy will obviously play an important role too. But Obama has less control over the economic recovery than he has over whether he sells out the Democratic base. The correct choice is clear, especially when you consider that a stronger public health insurance option would make it easier to pass the bill through the budget reconciliation process in the Senate.

UPDATE: Hubbell told Iowa Independent he’s not interested in running against Grassley.

The Progressive Change Campaign Committee and Democracy for America have produced a new television commercial, which asks which side Chuck Grassley is on:

Click here to donate to help keep this ad on the air in Iowa and Washington, DC.

Speaking of which side Grassley’s on, Monday’s Des Moines Register reports on our senior senator’s massive campaign contributions from health industry interest groups. Thomas Beaumont’s story was based on numbers compiled by Maplight.org.

Meanwhile, Representative Bruce Braley confirmed on Friday that he is running for re-election in Iowa’s first Congressional district. I consider him highly likely to run for U.S. Senate when one of our current senators retires.

Rumors persist that a prominent Democrat will join Bob Krause and Tom Fiegen in challenging Grassley next year. Al Swearengen of The Iowa Republican blog speculates that Fred Hubbell is the mystery candidate. Hubbell currently chairs the Iowa Power Fund Board. From his official bio:

Fred S. Hubbell was a member of the Executive Board and Chairman of Insurance and Asset Management Americas for ING Group. Mr. Hubbell retired from ING Group’s Executive Board effective April 25, 2006. Mr. Hubbell was formerly Chairman, President and Chief Executive Officer of Equitable of Iowa Companies, an insurance holding company, serving in his position as Chairman from May 1993 to October 1997, and as President and Chief Executive Officer from May 1989 to October 1997.

Charlotte Hubbell, Fred Hubbell’s wife, serves on the Environmental Protection Commission.

Trish Nelson of Blog for Iowa forwarded to me a job listing from Democracy for America. They are hiring “public option field organizers” in 12 states, including Iowa. This is a short-term position but does include health benefits. You can apply here. I’ve posted the full listing after the jump.

Click here to see the list of 64 House Democrats who have promised to vote against any health care reform bill that does not include a public health insurance option. Click here to donate to Democracy for America.

Around 5:30 on Friday afternoon I received a robocall paid for by the Democratic National Committee on behalf of Organizing for America. The voice informed me about a rally for health care reform, scheduled for Saturday at 6 pm just west of the state capitol building in Des Moines. Press 1 if you plan to attend.

I didn’t press 1 and stayed on the line to see what would happen. The voice came back, telling me “The president needs you to show support” for reform.

The folks at Organizing for America have some pronoun trouble. It’s not President Obama who needs us. We need him to show support for real reform.  

House Energy and Commerce Committee Chairman Henry Waxman is ready to shine a light on the health insurance industry’s business practices, according to this piece by Bill Boyarsky at Truthdig:

Waxman has already begun by demanding that major insurance companies reveal how much they pay top executives and board members and, most important, the size of their profits from selling policies. […]

I asked Waxman whether he expected the insurance companies to reply to his letters. “Oh yes,” he said. “When we write letters, we expect to get answers.” And what was his purpose in seeking the information? At first, he was reluctant to discuss the investigation. Finally, he gave a guarded reply: that many folks perhaps take too benign a view of private insurance companies. […]

The letters from Waxman and his colleague, Bart Stupak, chairman of the House Oversight and Investigations Subcommittee, went to every major insurance company, ranging from Aetna to Wellpoint. The lawmakers want to know the pay, stock options, perks, incentives, and retirement and other financial information of executives earning more than $500,000 a year. They are curious about the cost of promotional junkets. They are seeking disclosure of premiums, revenue, claims payments and sales expenses for health insurance policies. This includes sales to employers, individuals and the government. Interestingly, while insurance companies rail against the federal government, they earn money from participating in a number of federal programs, such as Medicare.

David Mizner has more on why this is important.

Speaking of insurance industry practices, Froma Harrop of the Providence Journal wrote a powerful column last week on the “death panel” her late husband faced from their insurance company, United Healthcare, after he was diagnosed with liver cancer.

A United Healthcare subsidiary owns the Lewin Group, which has been putting out so-called “non-partisan” research to discredit the idea of a public health insurance option.

Highly recommended: the National Journal’s compilation of several dozen tributes to Ted Kennedy, as his current and former staffers and other elected officials remember him.

Ted Kennedy has died of brain cancer:

But while the White House eluded his grasp, the longtime Massachusetts senator was considered one of the most effective legislators of the past few decades. Kennedy, who became known as the “lion of the Senate,” played major roles in passage of the Civil Rights Act of 1964, the Voting Rights Act of 1965, the 1990 Americans with Disabilities Act and the 1993 Family and Medical Leave Act, and was an outspoken liberal standard-bearer during a conservative-dominated era from the 1980s to the early 2000s. […]

Said Kennedy’s biographer, Adam Clymer: “He was probably best known for the ability to work with Republicans. The Republican Party raised hundreds of millions of dollars with direct appeal to protect the country from Ted Kennedy, but there was never a piece of legislation that he ever got passed without a major Republican ally.”

There’s much more detail about his life in the New York Times and Los Angeles Times obituaries. Norman Ornstein observed, “When you survey the impact of the Kennedys on American life and politics and policy, he will end up by far being the most significant.” Some may focus on his personal flaws, but he had a lot of demons to escape from, having had four of his older siblings die violently before his 40th birthday.

I appreciated Kennedy’s commitment to improving legal protections for so many disadvantaged people. I never met him, but I’ll always remember seeing him speak at a rally for John Kerry shortly before the 2004 caucuses. The Hoover High School gymnasium was packed, and Kennedy got the crowd going with humor and passion.

It’s sad that cancer prevented Kennedy from being more involved in the Senate health care deliberations this year. He would have been a voice for many of the reforms we need.

Even if Congress approves a health care bill, it will fall short of the universal coverage Kennedy advocated for most of his career. On the other hand, Kennedy famously regretted not reaching a health care compromise with President Richard Nixon in the early 70s. (Nixon was prepared to require employers to provide health insurance, while Kennedy wanted a single-payer type system.) While that compromise wouldn’t have helped everyone, we would have a lot fewer than 47 million uninsured Americans today if it had passed.

Massachusetts law requires a special election in the event of a U.S. Senate seat vacancy. Last month Kennedy asked Governor Deval Patrick and state legislators to amend the law to allow the governor to appoint a temporary replacement (who would not be able to compete in the special election) so that Massachusetts will not be lacking a vote when important legislation comes before the Senate this fall.

Share your thoughts and memories about Ted Kennedy in this thread.

UPDATE: I’m with Senator Tom Harkin: “We must now rededicate our efforts toward passing legislation to provide robust, quality health insurance coverage for all Americans.”

SECOND UPDATE: More reaction after the jump, including a video of Vice President Joe Biden.

The Congressional Democrats fighting for a strong health care reform bill need as much help as they can get, with the insurance industry increasingly confident that they will get the bill of their dreams: a mandate for all Americans to buy health insurance, with no public option to compete with private insurers that dominate most markets.

We should all agree on how stupid it would be to let insurance companies “reap a financial windfall” from reform, when so many of our current problems stem from those companies’ high overhead costs and bad-faith business practices. If cost containment is an important goal of health care reform, we’re not going to get there by requiring people to buy overpriced private insurance.

The political fallout would be just as disastrous. Like David Waldman says,

If I’m uninsured or poorly insured, and the answer coming out of Congress is that I now have to buy crappy insurance from some private company that has no plan to actually help me pay for my health care without raking me over the coals, then I’ve gone into this fight an ardent supporter of strong reform, and come out a teabagger.

Digby warned in this excellent post that selling out the Democratic base on health care could fuel a movement comparable to the one that delivered nearly 3 million votes for Ralph Nader in 2000. Glenn Greenwald added more thoughts on the political calculations here.

The alternative to this scenario is not complicated.