Here’s the vote. I believe the term for this is ‘ass-clown.’
About The Author
BooMan
Martin Longman a contributing editor at the Washington Monthly. He is also the founder of Booman Tribune and Progress Pond. He has a degree in philosophy from Western Michigan University.
What’s up with Feingold?
Up for reelection. He’s been joining McCaskill and Bayh all year on these types of votes.
Maybe he thinks doctors are overpaid as it is. I do, but that doesn’t have a lot to due with medicare reimbursements.
In the last couple of years, we’ve lost all but one of our internists (5 out of 6) in our rural county because they had a high proportion of Medicare patients and weren’t fully reimbursed for their care. My physician friends say that’s a real situation and not bs.
One of the three reasons I oppose the Baucus bill is that it would pay for private insurance by cutting Medicare reimbursements.
Republicans oppose single-payer as a “government run monopoly”, but it would really be a monopsony. In a monopsony there is always the temptation to just save money by cutting the price you are willing to pay. This can lead to shortages and rationing as sellers go out of business. We have to recognize this as a problem with single-payer. Perhaps the German system of tightly regulated private insurance is better. OTOH, in Germany they have have a centuries old tradition of government regulation, while in the USA we have centuries old tradition of telling the government to STFU.
I have a question. Is it true that rural areas are being underfunded by Medicare, or is it just a case where these areas have lower costs of living and therefore should get reimbursed at the same rates as, say, New York or Los Angeles?
I’m always suspicious of rural state Senators wanting more money for their states, even though they already get way more federal dough per capita than big states. So I’m just curious what the reality of the situation is here.
It’s a shame the public option proposals are being tied to Medicare payment rates. According to the members of the ND delegation, Rep Pomeroy, Senators Conrad and Dorgan, the payment rates would be extremely deleterious to rural hospitals in ND. I take them at their word.
I recently wrote Rep Pomeroy on this issue, via his personal email, and got this reply the next day.
It would be giving ND Republicans quite a talking point if they could point to votes by our delegation that could be tied to the bankruptcy of our rural hospitals.
I myself am in favor of single payer, and if not that then as close to that as we can get. However, I do not expect my Rep and Senators to commit political suicide.
I truly believe that if this payment rate issue could be properly addressed the rural legislators would be on board, particularly since I have heard no other reason for their opposition beyond the Medicare payment issue.
The “situation” is real. I thank you for taking a sincere interest, existenz
I don’t think our cost of living is low. Everything is trucked in here. Therefore, gas, food, heating fuel, hardware, building supplies, etc. are not cheaper than urban areas and oftentimes are more expensive. We pay the same as everyone else for internet access, telephone, etc. Housing is cheaper than most (but not all) urban areas, but wages are really, really low–assuming you can get a job.
The federal government did help us build a new hospital using the CAH (Critical Access Hospital) provision. The guidelines are very strict. You have to be a long distance from a full service hospital. We are over 60 miles over winding, mountainous roads from the nearest hospital.
And I never said we shouldn’t up medicare reimbursement rates.
I said I think doctors in the United States are overpaid. That’s a different animal entirely.
Overpaid? Based on what? Have you any idea what kind of debt most doctors have when they begin to practice? Or what they pay in insurance?
is a dick. remember he was the Senate Democrat most sympathetic to the impeachment of Clinton. He gets all contrarian sometimes. But he can be counted on to make a hopeless symbolic vote every now and then.
Those who wanted him to be Majority Leader should think twice. Perhaps he only opposed the war to be an iconoclast.
Feingold sticks to his principles, and that means you aren’t going to agree with him every time. But he’s been fantastic on torture, FISA, the Patriot Act, and other civil liberties issues.
As far as this vote, I can understand where Feingold is coming from. Why should we keep raising the deficit without paying for it? This is $250 billion dollars. Either cut the funds to doctors or find cuts/taxes to offset it. I would cut the defense budget and raise taxes on the rich to pay for it. Hell, raising the estate tax to 50% on estates over $5 million would probably cover this and then some.
I thought that was Droopy Dog.
this bodes ill…reid’s the guy responsible for shepherding HRC through the senate…and this is his lame ass excuse?
good luck…we’re going to need it.
he’s beyond useless as a majority leader.
Actually, assclown would be a step up for him.
I was thinking the same thing…assclown implies someone with a greater degree of strategic ability than that demonstrated by Reid.
Why did Warner vote no?
A free vote, once it was clear it was going down in flames. No one wants to vote for increased deficits if they don’t have to.
Procedurally, what happens now? Can they re-introduce it this year, perhaps as an amendment to some other bill, or is it dead until 2010?
Well, they can pass a one-year fix, as they have been doing. But, as a way to buy off the centrists, this failed miserably.
I don’t believe that this is the end of the story on this issue. There is a lot of fixes in the healthcare bills that deal with this. At least on the House side, they want to break the issue out of having to come before Congress in order to make adjustments.
I think this was a test vote to see if the industry really can sway Republicans. It also gives cover to some frightened Democrats. The Republicans proved true to form. Now Harry can work to reconcile to the two Senate healthcare bills without having to worry about getting Republican votes. It is now a matter of him having to whip his caucus to support a public option.
I don’t find it an ass-clown maneuver at all. Now we know that Republicans will not vote with the AMA. Surprise. Surprise. But now the AMA knows that too.
As a foreigner I am puzzled with the condemnation of Reid on this issue here. What’s so wrong with alienating the Medical profession from the Republicans? Now the AMA should know that their best interests lie with working with Democrats and ensuring the final health care reform includes some provision for reforming rural re-reimbursement rates. Did Reid not want to lose this vote in order to demonstrate to the AMA that they can’t rely on effective support from the GOP?
It does seem strange that Republicans would vote “no” on a bill favored by the AMA.
The original 1997 law illustrates the problem of monopsony that I mentioned above. The problem of reimbursement absent a market rate needs to be addressed before we are ready for a single-payer system. Indexing? Detailed theoretical reimbursement formulae? Collective Bargaining? Pricing by fiat from the single-payer is not the answer.
How do they do it in France? Canada? Australia? Obviously they are able to keep their doctor costs much lower than ours.
I think doctors are generally overpaid in this country, but it needs to be addressed in a more thoughtful way than this vote.
I’m not sure how they set doctor/hospital rates in Canada, but I heard once on PBS that they set drug prices at the mean of the drug’s price in twelve advanced countries of which the USA is one. If everyone did that, it would be unstable, so that is not a long-term solution.
from Wikipedia
http://en.wikipedia.org/wiki/Health_in_France#Fees_and_reimbursments
” Health care system
The entire population must pay compulsory health insurance. The insurers are non-profit agencies that annually participate in negotiations with the state regarding the overall funding of health care in France. There are three main funds, the largest of which covers 84% of the population and the other two a further 12%. A premium is deducted from all employees’ pay automatically. The 2001 Social Security Funding Act, set the rates for health insurance covering the statutory health care plan at 5.25% on earned income, capital and winnings from gambling and at 3.95% on benefits (pensions and allowances).[5]
“After paying the doctor’s or dentist’s fee, a proportion is claimed back. This is around 75 to 80%, but can be as much as 85%. The balance is effectively a co-payment paid by the patient but it can also be recovered if the patient pays a regular premium to a voluntary health insurance scheme. Nationally, about half of such copayments are payed from VHI insurance and half out of pocket. Under recent rules (the coordinated consultation procedure [in French: parcours de soins coordonné]) General practitioners (“médecin généraliste” or “docteur”) are more expected to act as “gate keepers” who refer patients to a specialist or a hospital.[citation needed] The incentive is financial in that expenses are reimbursed at lower rates for patients who go direct to a specialist (except for dentists, gynecologists and psychiatrists).
“As costs are borne by the patient and then reclaimed, patients have freedom of choice where to receive care.[citation needed] Around 65% of hospital beds in France are provided by public hospitals, around 15% by private non-profit organizations, and 20% by for-profit companies.[citation needed] Unfortunately recent articles suggest the the current French system is unsustainable due to the aging of the baby-boomer generation, economic downturn and ever rising costs to sustain the current levels of service.[citation needed]
“Minister of Health and Solidarity is a cabinet position in the government of France. The health portfolio oversees the healthcare public services and the health insurance part of Social Security. As ministerial departments are not fixed and depend on the Prime Minister’s choice, the Minister sometimes has other portfolios among Work, Pensions, Family, the Elderly, Handicapped people and Women’s Rights. In that case, they are assisted by junior Ministers who focus on specific parts of the portfolio. The current Minister is Roselyne Bachelot-Narquin.
[edit] Fees and reimbursments
“Health insurance
“Because the model of finance in the French health care system is based on a social insurance model, contributions to the scheme are based on income. Prior to reform of the system in 1998, contributions were 12.8% of gross earnings levied on the employer and 6.8% levied directly on the employee. The 1998 reforms extended the system so that the more wealthy with capital income (and not just those with income from employment) also had to contribute, since when the 6.8% figure has dropped to 0.75% of earned income. In its place a wider levy based on total income has been introduced, gambling taxes are now redirected towards health care and recipients of social benefits also must contribute.[6] Because the insurance is compulsory, the system can effectively be thought to be financed by taxation rather than traditional insurance (as typified by auto or home insurance, where risk levels determine premiums). …
* * *
“…All working people are required to pay a portion of their income to a health insurance fund, which mutualised the risk of illness, and which reimbursed medical expenses at varying rates. Children and spouses of insured people were eligible for benefits, as well. Each fund was free to manage its own budget and reimburse medical expenses at the rate it saw fit.
“The government has two responsibilities in this system.
“The first government responsibility is the fixing of the rate at which medical expenses should be negotiated, and it does this in two ways: The Ministry of Health directly negotiates prices of medicine with the manufacturers, based on the average price of sale observed in neighboring countries. A board of doctors and experts decides if the medicine provides a valuable enough medical benefit to be reimbursed (note that most medicine is reimbursed, including homeopathy). In parallel, the government fixes the reimbursement rate for medical services : this means that a doctor is free to charge the fee that he wishes for a consultation or an examination, but the social security system will only reimburse it at a pre-set rate. These tariffs are set annually through negotiation with doctors’ representative organisations.
“The second government responsibility is oversight of the health-insurance funds, to ensure that they are correctly managing the sums they receive, and to ensure oversight of the public hospital network.”
to this incredible ad campaign, which holds Harry’s dainty little feet to the fire in a very compelling way
http://www.actblue.com/page/harryreidad
I’m committed to term limits because Harry like all others in Congress think that if he doesn’t put his reelection first that we just couldn’t go on as a country without him!
A term-limited politician is infinitely more likely to sell his/her soul to whatever entity can provide them with their next job – take a look at states with term-limited representatives and see if the quality of legislation has increased, decreased, or stayed the same.
I’d recommend Michigan…
It’s also a too-overlooked fact that term-limits inherently favor wealth’s interests. Why? Give it some thought and the answer might come to you. The wealthiest party (though, to be fair, these days there’s not much more than a Goddamn dime’s worth of difference between what the Democrats actually do and what their opponents, Republicans, say and actually do , but never mind about that for the moment) can easily field and run new, unknown names. They can afford the publicity to make the unkown candidate “known”. On the other hand, in a party for which every penny counts, there are distinct advantages to having and keeping a good and dependable official in office rather than having to bring in a new one, untried, untested, when the former member’s term-limit has run.
In a democracy of responsible adults, the voting public sets “term limits” at the polls on election day, or, in party primaries—where this job should really be done. Only infantile publics have to (or would submit to) such a tortured resort as term limits —or fail their political responsibility to be active as early as the primary electoral processes.
But, that’s what’s involved here, an infantile and irresponsible public. Democrats, too, seem to “be fine with that”.