Heath Shuler: no “Medicare-like” public option.
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That’s Heath Shuler’s autograph on a Tennessee Vols cap letter some Blue Dog Coalition members sent last week to Nancy Pelosi and Steny Hoyer outlining what they saw as the chief problems with the House’s proposal for health care reform.
As is so often the case, the Blue Dogs seem to be taking great pains to show how serious they are about policy discussions. Their complaints about the reform proposal range from its failure to include adequate delivery system reform, to questions about rural health care, to concerns about small business. But the main thrust of the letter should be of concern to those who support a public option.
As usual, the Blue Dogs are going on about deficit neutrality. They’ve obviously got a point – there’s no way we can keep spending beyond our means – but as usual, they seem to be missing the forest for the trees. The fact is that health care is already costing us. There’s the human cost of people without insurance – and also those with insurance – going without care. There are also the costs incurred because the high cost of health insurance is hurting our competitiveness and ultimately costing Americans jobs.
But even beyond the problems that I can identify with this deficit hawkiness, people who know about this stuff are pointing out that it’s self-contradictory. For example, Igor Volsky at Think Progress makes the point that Congress has already committed to paying for health care reform (note, too, that the latest from the CBO estimates that the cost of a public option will be less than the Obama administration asked for). But it gets even weirder. As Volsky says,
the letter contains an inherent contradiction: the Blue Dogs want to find more savings within the system — they’re asking for Delivery System Reforms and “maximizing the value of our health care dollar†— but they’re also asking the bill to spend more on rural health and physician reimbursement. And they are reluctant to support any legislation that moves us towards that goal, causes providers to lose revenue, or regulates the system to improve efficiency.
Consider their objection to a “Medicare-like†public option that reimburses providers 5 to 10 percent above Medicare rates. According to MedPAC, Medicare rates are adequate and consistent with the efficient delivery of services. In fact, over-payments by private insurers to health-care providers drives up overall costs. . . Moreover, if the public plan pays bloated market rates, it will fail to offer lower premiums within the Exchange, and would cause the government to spend more money on subsidies.
And so there you have it. The Blue Dogs want to save money, unless you have to spend money to save money, in which case they’re against it. They also apparently want to spend money to save money, but not if it doesn’t benefit their constituency. And not, apparently, if corporations have to save money so that we can spend money on ordinary people. Got it?
What concerns me most about this letter is that we’ve seen this sort of thing before. Heath Shuler once voted against S-CHIP because the bill expanding the program would also eliminate certain Medicare services. When those services were restored in the next version of the bill that came his way, he voted in favor, though it’s unclear if his principled stance had any effect on the outcome. Shuler voted against the stimulus because it didn’t satisfy his policy priorities, though again it’s unclear whether the deal-breaker for him was that the wealthy got tax cuts or that the states would manage to avoid slashing services.
And so now we’re on health care. And my question is, if Shuler votes against health care reform, which policy priority will he cite as the problem? Will he say that the bill doesn’t do enough for rural health? Will he say the bill costs too much while ignoring the savings both in fiscal and human terms? Or will he – as I’m sure he did with the budget and the climate-change bill – overlook the specifics and endorse a major and necessary change on principle?
Only time will tell. But when you call Heath Shuler’s office and ask him to support a public option, let his staff know that you’re assuming that he opposes a public option because he opposes a public option, and that he opposes health care reform because he opposes health care reform. Why not call now, in fact? The number: 202-225-6401.
15 Comments
July 13th, 2009 at 9:04 pm
The concept of a just or fair price is devoid of any scientific meaning; it is a disguise for wishes, a striving for a state of affairs different from reality. -Mises
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July 13th, 2009 at 9:07 pm
Whoops that comment was directed at the Affordable Housing post.
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July 13th, 2009 at 11:06 pm
I think Heath will come around to the reality that the BDs are out paced on the issue. A robust public option is happening before their eyes and I’m sure he is paying attention. I for one, think that Heath is smart enough to figure this out. He has recently made me proud on several votes. I get the feeling he’s going to come through for his district and his nation.
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July 13th, 2009 at 11:24 pm
Well, maybe. And I certainly hope so. And as I note in the post, his vote on the House’s climate change bill shows what he can do when he looks at the big picture. At the same time, though, Waxman-Markey conceded as much as it could without being entirely useless.
Similarly, my guess is that the Blue Dogs aren’t going to fall on their swords to defeat a public option, but some of them will do everything they can short of that to make health care reform all but meaningless.
Ultimately the language in this letter about the public option (a Medicare-like plan that pays below-market rates) could be a straw man from either direction. If the wind blows so as to make the public option popular in a Blue Dog’s district, a congresswoman can cover herself by saying, “well, now the public option will pay 10-20% more than Medicare. That’s close enough to market pricing for me.”
On the other hand, if a Blue Dog is finding a public option unpopular, he can say, “I told the leadership that a Medicare-like program wasn’t going to do it for me,” and ignore the fact that absolutely nobody is proposing that the public plan pay Medicare rates.
As always, you have to wonder how Our Congressman will gauge popularity. By polling? By the ratio of calls the day before the vote? By talking with constituents? And as always, the best way to convince him that it is popular is to contact his offices early and often.
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July 14th, 2009 at 1:33 pm
randall,
Today we hear that Pelosi is going to make concessions to the Blue Dogs even before a bill gets introduced. Again, the point isn’t that Heath Shuler won’t vote for health care reform. It’s that he’s on the team working to make “health care reform” mean as little as possible.
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July 15th, 2009 at 5:50 pm
Via Nate Silver, NC-11 has one of the highest percentages of uninsured among Blue Dog districts.
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July 15th, 2009 at 9:37 pm
I saw that too, Pseudo. In fact, I reckon I ought to post it.
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July 15th, 2009 at 10:58 pm
Doug,
I think the Speaker’s concessions to the Blue Dogs are just ego salves for window dressing and inter party “bipartisanship”. Hope so anyway, but that’s how I’m reading this.
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July 15th, 2009 at 11:31 pm
GUYS!!!
Wake up!
Is there not another pattern here (besides government getting continually larger) that you recognize? The Democrats will put up a “huge and outlandish, overreaching” heath care bill and as a means of compromise or “bipartisanship” the Republicans and “Blue Dogs” will offer up a watered down version of the same socialist bilge and it will get voted into law.
Unfortunately, over time we WILL have the “single payer” or “universal health care” plan you all keep screaming about just hold your horses. Even Obama admits that wont be until 2013 or so. What you all fail to realize though is that this system does not work. Oh sure “it works just fine in Canada or France” or wherever but at what price? 10 hours wait in an emergency room? Having to prove blindness in one eye to get treatment for the other? Rationed care?
Like everything else in a market, simple supply and demand can be applied to this as well. If you have “free” heath care, you artificially increase its demand. Consequently, supply must be rationed or measured as a means to balance the equation. Who suffers? (Besides the 8 year old who fell off his skateboard and wrists will never flex the same due to his 6 hour wait?) you guessed it… THE TAX PAYERS!
YAAAAAAY!!!!!!
But not to worry, we’ll just spend our way out of debt right? Like picking up a bucket full of water while your standing in it.
Look on the bright side guys…
Just think of this like a football game.
When you own the biggest team (government health care) and you’ve paid for all the best players to join your team (free medicine) AND you can make the rules because you also write laws (referees) theres no way you can fail! Unfortunately that means overtime is bankruptcy for everyone
ahhhh….
Boo!
hisssssss
P.S. if you don’t know where Shuler’s gonna stand on an issue, don’t vote for him! Stop voting for anyone without defined principles. Hell, even I would vote for a Democrat if they were consistent about what they meant, EVEN IF I DIDN’T AGREE WITH THEM! Shuler is a joke. He is a puppet and he was propped up by Howard Dean specifically because he could appeal to Republicans in this district. You know why? Because he used to be one!
oooohhh, did that hurt?
I’m sorry, just vote the bum out if you don’t like him.
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July 16th, 2009 at 9:15 pm
hr, voting is not our only tool, sorry.
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July 23rd, 2009 at 6:32 pm
I don’t think Heath will ever be for the public health option. I found out today he stays at the C Street House -along with DeMint, Sanford, and Ensign, just to name a few of the other right wing “Christians”.
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July 24th, 2009 at 11:24 am
I am an Internist at a community health center. The AMA (not a member) are CONS and THEY support public opion. We primary care docs RESENT working in a patchwork system unable to refer the working poor and indigent for needed x rays surgeries etc. We HATE all the excess paperwork and having to beg for brand name drugs for our patients. Yes Big Pharma must be reformed too. I have emailed Rep Ross of Arkansas and will also email Shuler of NC that they should support BHO on healthcare. It’s the right thing to do
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August 11th, 2009 at 8:07 pm
I am a health-care professional, who accepts Medicare, Medicaid, and many private insurance plans. I can tell you firsthand–the insurance companies are denying care already, and hospitals make you wait in the ER for hours already. The system is broken.
Why don’t some of the people on this list complain about that. Easy, because they HAVE insurance, have not gotten sick enough to care, and care more about their money than other people. My income might go down under a single-payor plan, but I am still in favor of it.
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August 12th, 2009 at 9:40 am
Dr. Bateman,
It is my understanding that the AMA does not support a public option, contrary to your post. The president’s statement yesterday that the AARP endorses his proposal is also incorrect.
Both sides of this debate, it would seem, are guilty of mischaracterizations.
MM
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August 12th, 2009 at 4:59 pm
Here’s a great column by Rod Dreher on the healthcare debate that conservatives would do well to read.
Here’s a great column by John Mackey (the owner of Whole Foods) on the healthcare debate that progressives would do well to read — that is, if you can hold your noses past the first two paragraphs
MM
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