There is no question that Senator Max Baucus (D-MT) intends to sell out progressives on health care. His containment operation has been successful so far, but there is leakage. So-called “listening” sessions in Montana turned sour has people asked his staff questions the regular media doesn’t touch – what about single payer? What about all that insurance money? The sessions got coverage in the media, but not the usual kind that Max likes.

The latest angle the insurance industry is pulling is called the “trigger“, where the insurance industry would have to fail to meet certain targets before a public option would kick in. Baucus and other Democrats in Congress would give the industry years to meet the goals, in effect killing the public option.

And that would be the goal.

I rarely say this – write to Senator Baucus’s office, tell him that you want a real and viable public option. Just kidding! Max knows exactly what we want. The game plan is to dodge and sidestep like …

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Max can neither sing nor dance, nor does he leave many people wondering what he is about. He is sneaking around looking for a way to appease the insurance industry. For once his cards are on the table, for once he will not be able to fool people into thinking he’s doing their business.

George W. Bush, according to Mark Crispen Miller, lapsed into his famous verbal gaffes – food on the family, etc. – when he was trying to feign something he did not feel, like compassion. Baucus has a similar trait, I think – he stutters when he is being disingenuous. Public speaking is really hard for him because he seldom gets to say what he really believes.

But I did notice that when he kicked the single payer advocates our of his hearing room and had them arrested, his words were sharp and his meaning clear.

Jeff at Speedkill wrote a post in response to mine below which I liked – his traffic is way down right now, so I’m going to reprint the whole thing – his succinct comments and my no-so-succinct response.

Jeff: You can almost hear this blog dying, can’t you?

Anyway, I was thinking about this post by Mark, which is post 93 in his long running anti-hope series.

Progressives like to claim the public is supportive of their agenda based on single issue polling. It seems to me that once public opinion collides with an opposition campaign, things look different. Public opinion is also contradictory. People like more services and they like lower taxes. They can’t have both. California is trying it and it’s not working. Opinion polls show that if you pay income taxes, you think you’re paying too much. So despite the fact that polls also show people will trade taxes for services, they don’t think they’re getting a good deal. That’s ripe territory for conservatives. And if we’re talking about single-payer, it’s hard to see how anything gets past “the government is taking away your health care for some brand new thing that sucks for various reasons.” Even if the various reasons themselves suck, losing your health care is scary.

That’s all obvious, isn’t it?

So single-payer organizing is pointless right now. If we get a public plan, that changes. Are we going to get a public plan? Beats me.

Mark:

You are one of the better writers and thinkers in the Montana blog world, along with maybe Crisp and Budge. I hope you hang in there – you just don’t write enough to keep up traffic.

I keep getting this single payer stuff – as if I did not understand practical politics and the power of propaganda campaigns and the public relations industry. I have said repeatedly that if we are going to have single payer, it is going to be in Canadian fashion, where the barriers were first broken down in Saskatchewan by a dynamic leader, Tommy Douglas, and where it then spread due to its unquestionable success. Perhaps the PR industry and health insurance companies in Canada were not as powerful then as they are now in this country – I don’t know. But I see our best laboratory as being post-Arnold California.

You did not address the central theme of my post – the emergence of the Democratic Party as a mere containment vehicle for opposition movements. Take 2000 – there is absolutely nothing – nothing! wrong with mounting a third party campaign. I don’t give a rat’s ass how effective or smart you think it is. But the Democrats have demonized Nader now, and very wisely so – it’s a message to anyone else who wants to try it – prepare to be ostracized.

That is now the role of the Democratic Party – to geld third party movements, to contain all popular movements and minimize their impact. The practical politicians tell us that we must keep our expectations low, and Democrats like Matt and Jay are perfectly happy with that concept. It’s a distressing situation. Screw your hope comment – let’s talk reality.

The bottom line is that we do not live in a functioning democracy. The Russian people were able to change aspiration to reality. Maybe they aren’t happy with the outcome now, but the point is that they wanted change and got it. Whose system is more democratic?

Regarding polling and health insurance, it seems contradictory that people are both happy with their current coverage and want single payer. Most people aren’t sick, and have not been exposed to how shitty their coverage is. Those that have want something better. Enough information about the 47 million has spread around that people also understand that while they might be OK, many others aren’t. It seems to fit.

And pollsters aren’t stupid – they know how to ferret out information in a sly manner. That’s the object of much polling – to get information that the person being questioned does not know he is after. So they hide their objectives, riddle the survey with protrait and contrait questions – the professionals, anyway. The bottom line: Most people favor a single payer system even if it would cost them more in taxes.

Odds are it won’t – we are ridiculously expensive right now, spending twice what Canadians do per capita. Overhead runs 10% in a good not-for-profit plan, as high as 50% in some for-profit plans. Emergency room care is incredibly inefficient. I doubt it could cost more than we spend now.

And anyway, watch out. When the Democrat leadership embraces a concept, the odds are that they, like pollsters are really after something else. Beware Baucus. He’s not even a good actor or an appealing persona – I don’t know how he fools so many people other than that they want to be fooled.

Sorry to take up so much space. I have my own blog. And I love writing – I am one of those who thinks with his fingers.

Republicans have proposed their own health care package. I doubt that the Democrats can muster forty votes to stop it.

Democrats are putting together their own health care package, but Republicans (and some usual-suspect Democrats) will easily defeat anything they do. Baucus has made it clear he wants sixty votes for his package, another way of saying in advance that he is willing to give away the store.

So the outlook at this time is bleak – Republicans hold all the cards, Democrats have no leaders. Republcans will insist on certain provisions for passage of a bill, such as no public option, or a horribly weak one, and perhaps no negotiating allowed on policy prices when government subsidizes insurance companies. The Democrats will give them what they want, supposedly just to get a bill passed, but in reality because this is what they want too.

I think it is important to focus on two aspects of the Baucus plan – one, his plan to tax benefits, and two, his intent to use the IRS to force people to buy private policies. In that, many of us can find common cause in opposing him. There aren’t enough progressives in the Democratic Party to stop him, but maybe we could do the odd bedfellow thing.

“Die another day” appears to be our only hope.

The health care debate has been crystallizing in my mind this past week – I’ve been suspicous of Senator Max Baucus. He’s holding the football and the regular Lucy’s are lining up. But what does he want? How does he intend to get it?

This morning I was visited by a ghost of Democrats past. It was eerie – he spoke with a drawl and had some charm and charisma and a thing for cigars. His name: Triangulation.

In the 1990’s, Bill Clinton enlisted the support of Democrats to advance various right wing causes, among them the deadly Iraq sanction regime, welfare “reform”, increased incarceration of blacks, the attack on Serbia, and privatization of Social Security. Democrats presumed that his rhetorical support for their causes meant he could be trusted to follow through. They didn’t apply force on him – odd thing about liberals – they do not threaten office holders. They merely trust them to carry out their will. Bill Clinton took them down his road.

As Mel Brooks reminds us, it’s good to be king, and Democrats like being in power. Once in power, they are like sheep lined up at the sheering wagon. With health care reform, it is Max Baucus holding the clippers.

The game is afoot. (I am one tall, handsome and balding mixed metaphor this morning.) First, Baucus took “single payer” off the table. Democrats were OK with that. Don’t let the “perfect spoil the good”, they were told.

Second, he’s making coverage mandatory. There’s some justification for that, though it seems heavy-handed. But the key to mandatory coverage, from the Baucus standpoint, is the so-called “public option”. With a true option, we will have a choice between private and public coverage. I was traveling down this path until I realized that Baucus does not intend us to have a real choice.

The “choice” will belong to his campaign contributors – the health insurance companies. They will get to “choose” who they cover. They will be allowed to cherry pick – healthy people will be required to purchase private coverage. Government will pay the premium for poorer people, but as with Medicare D (another Baucus product), there will be no price negotiation allowed.

The “public option” is really an “insurance company option” on who to cover. Anyone deemed unprofitable will be turned over to government. Since it will be by definition a high-risk pool, it will be expensive coverage. Those of us who are not poor and who do not qualify as healthy enough for private coverage will be forced to pay exorbitant premiums.

Who will manage the high-risk pools? Again, it will be private insurance companies. However, they will not be at risk. They will merely be paid a management fee, and will have a guaranteed profit.

We have such a plan in Montana, as I wrote about before. It’s called the “Montana Comprehensive Health Association“. It’s a high-risk pool, very expensive with high co-pays and deductibles, and a private insurer, Blue Cross Blue Shield of Montana, is paid to manage at no risk to itself. There are 77,000 uninsured Montanans. MCHA covers perhaps three thousand of them. If Baucus were in charge, all 77,000 would be required to purchase MCHA coverage.

So it’s time to sink the ship. There are conservatives out there who are opposed to any kind of health care reform. It is time to enlist their services. For once, those deceptive TV ads will be welcome. For my small part, I’ve written letters to the editor to newspapers in Missoula, Great Falls, Billings and Bozeman. In them I emphasize that Baucus wants to use the IRS to force people to buy private health insurance policies. That ought to rile up some libertarian and conservative feathers. (Last metaphor – I promise.)

The objective is to drown the Baucus plan in the bath tub. (Aye!) There’s tons of good energy out there right now for reform, but triangulation has reared its ugly head again. It’s time to triangulate on triangulation, progressives and conservatives alike taking aim.

Ready, aim, fire.

P.S. Strong Mike Dennison piece in today’s Gazette, perhaps all the Lee newspapers.

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Senator Baucus wants to have a hearing and wants to exclude the most prominent public point of view, and at the same time reminds them that he can’t hear all points of view unless he has his hearing from which he has excluded the most prominent public point of view. He cares so deeply – you can see the lines of concern on his forehead.

Other politicians are better at this sort of thing – acting, it is called. Max is so bad at it that it’s a wonder he has managed to fool so many Montana Democrats for so long. It says far more about them than him.

Senator Max Baucus is saying that he favors a “public option” in his health insurance proposal, but is not specific as to what that might be. I suspect that this is where he and the insurance industry are going to nail us – the devil will be in their details.

In Montana we already have a public option. We just don’t call it that. It’s called the “Montana Comprehensive Health Association“. There are something like 77,000 Montanans without health insurance, and MCHA picks up maybe three to four thousand of them. The reason it covers so few is that it is a horribly expensive high-deductible plan. But it is a “public option”.

Here’s the rules for qualifying for MCHA:

1)You have been rejected or offered a restrictive rider by two insurers within the last six months or have one of the listed specified illnesses (see this link – there’s a bunch); and
2) You are not eligible for any other health insurance coverage, or,
3) You have comparable coverage but are paying or have received a notice of a premium rate that is more than 150% of the average premium rate used to calculate MCHA premium rates.

In other words, you can go there only after the private insurance people have decided you are too high a risk for them.

Baucus and the insurance industry need to come clean on what they mean by “public option”, and soon. This could be a trap door, with Baucus holding the lever.

Footnote: Blue Cross Blue Shield administers MCHA, but has no risk – they merely collect a fee for use of their network. This is their idea of a “public service”.

Bill Moyers had an interesting show (see here for transcript) last Friday on single payer health insurance – a troubling insight came from guests Dr. David Himmelstein, on the faculty at Harvard Medical School, and Dr. Steffi Woolhandler, founder of the advocacy group Physicians for a National Health Program.

It has to do with the so-called “public option” that I and others have been advocating as the “good vs. perfect” solution to our health care problems. I like it because I believe that if people are given an option to buy in to Medicare or VA, that it will slowly crumble the foundations of the private insurance system that is the heart of our problem.

Speaking of the downside of a public option, the doctors spoke of a program called “Medicare Advantage”, which is supposed to offer superior private insurance care to seniors:

Himmelstein …we’re worried that the public plan actually becomes a dumping ground for the unprofitable patients. As it’s happening in Medicare. … the private insurers have all kinds of tricks to avoid sick patients, who are the expensive patients. So, you put your signup office on the second floor of a walkup building. And people who can’t navigate stairs are the expensive people.

Wolfe …Get rid of the heart failure patients.

Himmelstein Or you have your signup dinners in a rural area at night, where only relatively healthy people are able to drive and stay up that late. So, there’s a whole science to how you sign up selectively healthier patients. And the insurance industry spends millions and millions of dollars on that. And would continue to as they’ve done under Medicare. Selectively recruiting healthier patients, who are the profitable ones, leaving the losses to the public plan.

Insurance industry shill Senator Max Baucus and his sub-shills are saying that there is a public option on the table, but are not specific as to what it is. Since the Democratic wing of the Republican Party has already abandoned single payer, we will be stuck with either no public option at all, or one that is structured in such a way as to allow private insurance companies to continue to operate as they do now: Cherry-picking healthy clients, dumping everyone else on government.

Himmelstein and Wolfe maintain that we can only succeed if we do what Canada did in 1970 – kick the insurance companies out of business. If anyone suggested in Canada that they go back to their pre-1970 system, there would be a bloody revolt.

PS: By the way, Medicare Advantage is 1) subsidized, 2) costs 15% more than regular Medicare, and 3) with the program, insurance people are up to their old tricks, skimming the Medicare population for the healthy ones and avoiding the rest. It could be a foreshadowing of the Baucus public option.

Prison seems too kind.