TalkLeft

Fix Needed for State Opt-Out Provision of Public Option

Jeralyn — 2009-11-20T13:04:02-05:00

McJoan at Daily Kos explains what needs to be fixed in the Senate version of the public option in the health care bill: It's the date on which the states can opt out. First,

There's no requirement of a waiting period before states can opt out, which in this political environment means the battle is taken directly to the states, because insurers will have until 2014 to get state legislatures to pass those laws. That could lead to as much as a third of country being left out, according to CBO estimates [pdf] (h/t Jon Walker).

[More...]

Here's the current language:

(3)STATE OPT OUT.—

(A) IN GENERAL.—A State may elect to prohibit Exchanges in such State from offering a community health insurance option if such State enacts a law to provide for such prohibition.

(B) TERMINATION OF OPT OUT.—A State may repeal a law described in subparagraph (A) and provide for the offering of such an option through the Exchange.

By 2014, states will have had plenty of time to pass legislation opting out, which means the public option won't ever go into effect in them.

McJoan says:

Changing the opt-out date is an amendment waiting to happen when this bill hits the Senate floor (probably) early next week, and a barring a fix there, a priority for conferees when we finally get to that point.

Political Controversy Over Colorado U.S. Attorney Selection

Jeralyn — 2009-11-20T12:38:10-05:00

President Obama, upon the recommendation of Colorado's two U.S. Senators and others, has nominated former Denver Chief Deputy District Attorney Stephanie Villafuerte for Colorado U.S. Attorney.

Republicans are having a hissy-fit. The brouhaha is over the criminal case of former ICE agent Cory Voorhis. Voorhis was acquitted of misdemeanor charges that he improperly accessed the restricted NCIC database and passed information contained in it to Gov. Bill Ritter's then opponent for Governor, Bob Beauprez, who used it in an ad to attack Ritter as being soft on undocumented residents while District Attorney.

Voorhis' didn't deny accessing the database or passing the information on to the Beauprez campaign. His defense was that he did nothing wrong by doing so and that the charges were politically motivated. [More...]

Villafuerte, who was on a leave of absence from the DA's office and working for the Ritter campaign at the time the Beauprez ad came out, concluded from her search of publicly available databases, that the identity and immigration status of the defendant portrayed in the attack ad could only have come from the restricted NCIC database.

Without any evidence Villafuerte's account is inaccurate, and intent on making Voorhis a hero because of his allegiance to their cause (even though he did pass restricted information on to a political candidate), Republicans are now fighting to keep Villafuerte from being confirmed. Absent any evidence of wrongdoing, they are reduced to complaining she didn't answer questions about her actions to the media.

Villafuerte has now provided this detailed letter of her actions to Senators Udall and Bennett, who have tendered it to the Judiciary Committee.

My view: The complaints against Villafuerte are unfounded and the product of the radical right anti-immigration faction. Cory Voorhis is no hero. His actions may not have been criminal, but they were wrong. Federal criminal agents should not access restricted databases and pass their findings onto political campaigns.

As I wrote here, Villafuerte is qualified, principled and deserving of the job. The Republican attempt to stall her nomination should be seen for what it is, political maneuvering and a misguided attempt at payback.

Friday Morning Open Thread

Big Tent Democrat — 2009-11-20T09:54:24-05:00

Another busy day ahead.

This is an Open Thread.

Former Bush DOJ Officials Back Holder on Trial of 9/11 Suspects

Jeralyn — 2009-11-20T09:26:00-05:00

James Comey and Jack Goldsmith, high-ranking Department of Justice officials under Bush, have an op-ed in the Washington Post defending Attorney General Eric Holder's decision to prosecute Khalid Sheikh Mohammed and four other detainees in federal criminal court instead of a military commission proceeding. The conclusion is fine:

But Holder's critics do not help their case by understating the criminal justice system's capacities, overstating the military system's virtues and bumper-stickering a reasonable decision.

In reaching that correct assessment, however, there's a few statements I take issue with. They posit that Holder made the decision to keep the U.S.S. Cole detainees in a military proceeding not for the reasons he said (that the attack happened outside the U.S.) but because the case against them is weak and the chance of conviction is greater in a military commission trial. In other words, Holder forum-shopped (as, they say, Bush's DOJ did before him) and there's nothing wrong with that. I think when it's done hoping to skirt the requirement of proof beyond a reasonable doubt because you know you can't meet it, there's definitely something wrong with it.
[More...]

As to military commissions, they write that despite "relatively loose rules of evidence, their absence of a civilian jury and their restrictions on the ability to examine classified evidence used against them," military commissions only offer the Government "a "marginal advantage." Sorry, but those aren't the only disparities and even the revised commission procedures provide a big advantage towards conviction over a federal criminal trial -- and an unfair one.

They also predict Obama will continue with indefinite detentions of the Guantanamo detainees not charged with crimes, and they seem to have no problem with it:

It is also likely that the Justice Department will decide that many other terrorists at Guantanamo Bay will not be tried in civilian or military court but, rather, will be held under a military detention rationale more suitable to the circumstances of their cases.

"More suitable?" How is continued military detention ever suitable for someone who has never been charged with a crime? Or for someone a court has determined was unfairly declared by the Bush Administration to be an enemy combatant? Are they suggesting the Government will only indefinitely hold uncharged detainees who are guilty of something terrible, but we just couldn't prove it without their inadmissible statements made under torture? I don't believe for a minute those are the only ones who will be indefinitely detained, and I don't like giving the Justice Department or the military the sole discretion to make the call. "He's guilty and dangerous, we just can't prove it, so we're not going to try" should never be a license to imprison someone forever.

There's also a statement I find particularly grating, especially coming from lawyers:

The potential procedural advantages of military commission trials are relatively unimportant with obviously guilty defendants such as Mohammed...

"Obviously guilty?" Did I miss the trial?

To sum up the authors' views: the procedural advantages of military commissions are only "potential" not real ones, and if such advantages do exist, they are "relatively unimportant," but KSM is "obviously guilty."

At least they got the ending right, so I'll reprint it again:

Holder's critics do not help their case by understating the criminal justice system's capacities, overstating the military system's virtues and bumper-stickering a reasonable decision.

Specter On Afghanistan

Big Tent Democrat — 2009-11-19T16:09:56-05:00

Just finished participating in a call with Senator Arlen Specter (D-PA) regarding Afghanistan. I imagine Senator Specter was a bit surprised by my questions from the more hawkish view on Afghanistan. Senator Specter's position is that he opposes troop increases in Afghanistan and even questions maintaining troops in Afghanistan unless the effort is "indispensable" to the conflict with al Qaida. (See Spencer Ackerman's coverage of the call) Senator Spector's primary opponent, Representative Joe Sestak supports troop increases in Afghanistan.

Senator Spector responded to my question regarding the connection with Pakistan and Afghanistan and how an effective Pakistan policy related to adequate troop levels in Afghanistan by turning the question around to me, asking how does increased troop levels in Afghanistan help us with the situation in Pakistan? A fair question, which I will try to address more comprehensively in another post. But on the issue of Pakistan, I believe Senator Specter demonstrated understanding of the issue and when I pressed for an answer on what type of initiatives he would support, he made a good point - promoting peace between India and Pakistan would be an important breakthrough that could lead to a more cooperative and responsible Pakistan. Which could lead to a more successful policy against the Taliban and al Qaida in the region. More on this discussion in a later post.

Thursday Morning Open Thread

Big Tent Democrat — 2009-11-19T12:56:01-05:00

So, in my fantasy football league, I lost Ronnie Brown for the season and have nothing good at running back. What do I do? I offered up my best player, Peyton Manning, for the best deal I could get. The result? I got Tony Romo, LaDainian Tomlinson and Roy Williams for Manning (plus two throw ins.) What do you think?

In other fantasy news, Maurice Jones-Drew's non-TD had a big effect in FFL World:

I was one of at least two dozen non-Jaguars fans who screamed at the screens when Maurice Jones-Drew took a knee at the Jets’ one-yard-line instead of easily scoring. I can assure you we weren’t lamenting that play’s impact on the betting line. But you have to give MJD credit. In his post-game interview, he actually apologized to his fantasy owners for the play, saying he was instructed not to score so the team could run down the clock, and he had to do what was right for the Jaguars. How cool is that?

Actually it is kind of sick. Grown men and women - all of us - doing this? It's nuts.

This is an Open Thread.

The Opt Out

Big Tent Democrat — 2009-11-19T11:07:26-05:00

Firedoglake is against it:

It is encouraging that Senator Reid respected the will of the American people and included a public option in the merged Senate bill. However, the addition of a state opt-out provision threatens to leave millions of Americans at the mercy of private insurance monopolies, with the federal government acting as enforcers for a product with no competition to keep prices down. [. . .] [W]hile people struggling with crippling health care costs and pre-existing conditions may have to wait until 2014 for relief, states can begin opting out immediately. That means for the next four years, health care will become a partisan football at the state level, easily gamed by the same insurance company lobbyist dollars that flooded on to Capitol Hill this year.

If you can get a public option passed without an opt out, then let's do it. But if we can not, then I believe an opt out that requires enactment of a state law through regular procedure is acceptable. My view remains that the only real reform in this bill (as I have stated, there are other good features in the proposal - specifically the expansion of Medicaid coverage, but they are not meaningful reform imo) is the public option. Indeed, if given a choice I would rather have an opt out Medicare +5 public option available to more persons with an opt out than a level playing field national public option without an opt out. Neither seems politically possible at this time, even through reconciliation. More . . .

Firedoglake writes:

If Harry Reid truly cares about fighting for the good of the country over the good of Wellpoint, he will immediately dispense with the opt-out and move to reconciliation and allow a majority in the Senate to deliver to Americans what they want and desperately need.

I think this assumes a non-opt out public option can be passed through reconciliation. I do not believe that is true. A whip count is in order on this issue.

Assuming, for the moment, I am correct about the non-opt out public option not having 50 votes for reconciliation, the question becomes, as always, is it better to have this proposal or to not have it? I still fall on the side of favoring the proposal. To me the question is does this proposal create a program that can be built upon to improve health care in our country. In my view, it does - specifically, it creates a public option untethered by profit motives and tethered by the desire for cost control that does not impinge on the coverage of its beneficiaries.

Many Village Wonks hold the view that excise taxes on health insurance and the exchanges will function as cost control mechanisms. I disagree. Indeed, there is no evidence to support their views. Conversely, there is a mountain of evidence that demonstrates that government run health insurance has more effectively held down health care costs than private insurance.

It is for this reason that it is my view that the public option is the only meaningful reform that has been proposed to date. The opt out provision does not challenge that view.

Finally, with regard to the concern expressed by FireDogLake about insurance company lobbying at the state level, this seems to me to be better seen as a call for state level activism, as opposed to a lament about our broken political system. It appears to presuppose that the only political battles worth fighting are at the national level. I believe that lamenting the need for local activism is wrongheaded. The challenge should be welcomed and accepted state by state.

The public option is worth fighting for - state by state.

Speaking for me only

About the Long Term Care Benefits in the Health Care Bill

Jeralyn — 2009-11-19T09:09:00-05:00

(Warning: This post is going to be controversial and expresses my views only.)

Both the House and Senate bills would create a voluntary federal program to provide long-term care insurance that pays small cash benefits to people with severe cognitive or physical disabilities. Like the elderly.

I don't think most people understand what long term care insurance covers. It covers nursing homes, assisted living facilities, and for the cognitively or physically disabled, some home health care costs in lieu of going to a facility. This isn't medical coverage but coverage that assists those who can't feed, clothe, toilet or bathe themselves. You aren't eligible until you can't do at least two of the above. The payments cover a fraction of the actual cost of the services. In other words, you have to be basically physically or mentally dysfunctional to qualify for what is a paltry amount of benefits. [More...]

I have spent enough time in assisted living facilities and nursing homes (both of my parents died in them, one in a rehab unit and the other after three years in a nursing home preceded by three years in assisted living) to know I have no intention of going to either. When the time comes that I can't feed, dress, bathe and toilet myself, I'm checking out. I canceled my long term care policy years ago, I'm just not going.

There is something seriously wrong with a system that shuttles the old and demented to a nursing home where they will die at an average cost of $10,000 a month. Most long term care policies pay between $75 and $200 a day (the rest of the expense is not covered by Medicare or private insurance.)

What do you do there besides wait to die while suffering indignities like being diapered and wheeled from the dining room to your room and back, to eat among strangers you can't communicate with even if you wanted to? The odds are one or both of you will not make sense due to dementia.

Even if physical therapy could help you, Medicare gets it seriously wrong. They will pay for therapy until you have reached "a peak" where they acknowledge you've gotten as far as you can. So if your head falls into your chest when you sit in your wheelchair, and they finally get you to where your head stays semi-up, they say that's as far as you will go, and Medicare cuts off your therapy. (You then are eligible for restorative therapy which consists of a nursing home staffer coming in your room to offer to wheel you around the facility once a day.)

Even if you offer to pay for continued therapy with your own money, they won't continue the therapy. They say they don't have the staff available -- their therapists are needed for those who haven't yet reached "their peak."

You then have to wait until you've lost the gain from your therapy to the point where your head is back on your chest, usually about three months, before they agree to start all over again. And then, the cycle repeats. They finally get you to the same point as before, but when you reach the peak, you're done.

Same for walking. You can get therapy to get you out of a wheelchair and walking down the hall, but once they have you walking for a few minutes, and that's likely as far as you are going to be able to walk on your own, instead of continuing the therapy so your legs don't atrophy, they have to stop the therapy. A few months later, when you're back to where you started and no longer able to even stand up when getting from the bed to the wheelchair, they'll start in again -- until you're walking for five minutes, held up by a harnass, and then, you've reached your peak and the therapy stops. In other words, you lose all the benefits of the therapy and they wait months, then repeat from scratch. The off-months are miserable for the patient, and a total waste.

Long term care benefits are a rip-off. I'd rather see the money go to counseling for end of life decisions, and laws that allow the physically and cognitively disabled who had the foresight to sign an end of life directive while still cognitively able to do so, make the choice to end their life when it comes to that -- rather than forcing them to use their life-time accumulation of assets (again, at $120k year up) to live without dignity, without quality of life, sedated into oblivion by anti-psychotic drugs so they won't make a fuss and be disruptive among other patients and strangers (whether at the nursing home or at home with part-time home health care workers) until they die.

Memo to Congress: Keep your lousy $75 a day benefit. I don't want to pay for it and have no intention of using it. Instead, expand Medicare benefits to cover the full cost of assisted living facilities and nursing homes for those who need and are willing to go, and allow the rest of us to opt out through a dignified death -- meaning we are allowed to obtain prescriptions for drugs in sufficient quantities that will allow us to implement our decision to opt-out -- without fear of criminal prosecution should we fail.

The money the Government saves from the opt-outs should be enough to allow it to change those crazy policies that cut off therpay coverage when a patient is functioning at their maximum level. The whole point should be to keep patients at their maximum level of functioning, and that can only be done with continued therapy.

This isn't the fault of the nursing homes or assisted living facilities. It's the fault of the Government, for enacting its crazy hodge-podge of regulations and limits related to providing physical and occupational therapies.

I don't see how $75 a day is going to get qualified health care workers to anyone's house to do what's needed. It's a drop in the bucket. A frank discussion with our elders about what they prefer should they find themselves in that circumstance is what's needed, and in order for that to be a meaningful discussion, there must be meaningful choices available.

Senate Bill Contains "Facelift Tax"

Jeralyn — 2009-11-18T23:58:09-05:00

The Wall St. Journal reports the new Senate health care bill imposes a 5% tax on receipients of elective plastic surgery.

The tax would fall on the individuals who undergo the procedures. If they don’t pay it when they’re billed for their surgery, then it falls to the provider who performed the procedure.

Who gets the most plastic surgery? It's not the young.

Then there's the tax on "Cadillac health plans" defined as health care plans with premiums over $8,500 a year. The insurer pays it, but to recoup it, won't they just reduce benefits the plan provides? Anthem already sent out a letter that when renewed, my plan will no longer cover 100% of prescriptions. I bet this tax on Cadillac plans results in the plans becoming Chevys. [More...]

Then there's the increase in medicare payroll tax for individuals earning more than $200k a year. The House proposal taxed income over $500k. I don't think we should have both a tax on cadillac plans and a medicare payroll tax increase for those earning $200k.

One way or another, I think all these taxes are going to be passed on by the companies to the consumer. Not only the wealthy will be affected. I think those between ages 50 and 60 will be disproportionately and adversely affected. We're already paying sky-high premiums and we have years to go before Medicare kicks in. Maybe we should lower Medicare eligibility to age 60. I think that would be fair.

Here's the New Senate Health Care Bill

Jeralyn — 2009-11-18T22:36:04-05:00

Here's the text of the new Senate Health Care Reform Bill. The Washington Post reports here. Via Huffington Post:

Reid's bill includes a national, government-run insurance plan that would be available to consumers within the health insurance exchanges that the reform effort establishes. States could opt out of the plan.

On abortion: [More...]

The Senate bill does not go as far as the House bill does in restricting access to abortion. The House bill would block a woman's ability to purchase health insurance that covers abortion even with her own money in many instances. The Senate package, several senators said, makes crystal clear that no federal funds could be used to pay for abortion. But at least one plan within the exchange would have to offer abortion coverage -- and one plan would not.

On taxing the rich:

Instead of taxing the rich to pay for a significant piece of the bill, as the House does, the Senate plan would tax "Cadillac" health plans. But the value of plans that would be taxed is higher than in previous versions: $8,500 for an individual and $23,000 for a family of four. Even higher values are allowed in high-cost states and workers in high-risk jobs -- such as coal miners -- are given an exemption.

On cost and coverage:

Reid on Wednesday also presented to his colleagues a preliminary Congressional Budget Office analysis, which finds that the bill will cost $849 billion over the next decade. It would cover 94 percent of eligible Americans, including 31 million currently uninsured Americans. The bill would also lower the federal budget deficit by $127 billion over the next decade and by $650 billion during the decade after that. Kerry cautioned that the numbers were still being finalized and could change slightly.

Firedoglake has more on the public option component. The Wall St. Journal recap is here. The Senate may vote on the bill Saturday.

Update: The AP reports the bill would raise the Medicare payroll tax on those earning more than $200k a year.

Current law sets the Medicare payroll tax at 1.45 percent of income. Under the legislation, it would rise by half a percentage point on individual income over $200,000 a year and $250,000 for couples.

Obama: Gitmo Won't Be Closed by January Deadline

Jeralyn — 2009-11-18T21:52:04-05:00

President Obama made it official today. His administration will not close Guantanamo by the one year deadline in January.

Part of that is due to the inability to find countries willing to take the detainees. And while Attorney General Eric Holder was strong in his commitment today to U.S. federal criminal trials for some detainees, it's still troubling that he continues to suggest the Obama Administration may continue to hold some detainees indefinitely without charges or trial.

If the administration has evidence against these detainees, it should prosecute them in federal court. If not, it should repatriate them or relocate them to safe havens."

Wednesday Night Open Thread

Jeralyn — 2009-11-18T21:34:06-05:00

America's Next Top Model has its tv finale tonight. The winner: Colorado's Nicole Fox, an 18 year old C.U. sophomore from Louisville, Colorado.

Congrats, Nicole. (She became my favorite weeks ago.) More on her here.

This is an open thread, all topics welcome.

DOJ to Consider "Predictive Police" Tactics

Jeralyn — 2009-11-18T21:22:19-05:00

How scary is this? I got this notice from the Department of Justice today.

The Department of Justice's (DOJ) National Institute of Justice and Bureau of Justice Assistance are hosting a symposium November 18-20, 2009, to explore the potential for implementing predictive policing strategies to help make communities safer. Predictive policing integrates data analysis with law enforcement strategies and tactics. To find out how best to apply predictive policing approaches, the DOJ is supporting a number of police departments nationwide in demonstrations, or field experiments, designed to test the effectiveness of various predictive policing strategies and techniques.

[More...]

A list of those projects is available here (pdf.)

Former Los Angeles Police Chief William Bratton will be a keynote speaker. Assistant Attorney General Laurie Robinson, United States Department of Justice, Office of Justice Programs, will be in attendance and introduce Mr. Bratton.

The Government has awarded $1,150,845.00 for these programs. The symposium will be held in L.A.

Here's more:

Predictive policing "includes strategies and tactics that improve the situational awareness of law enforcement concerning individuals or locations before criminal activity occurs."

...These methods may include contemporary approaches to dynamic systems modeling and forecasting such as algorithmic methods, machine or statistical learning, or ensemble methods.

...For example, demographic trends, parolee populations, and economic factors may all affect crime rates in local areas.

...Alternatively, fusion centers or police investigative units may use predictive tools to provide leads or guide specific investigations.

Reid Discusses Reconciliation . . . With Ben Nelson, Landrieu and Lincoln

Big Tent Democrat — 2009-11-18T19:28:11-05:00

This strikes me as quite good news:

[E]arlier in the day, in a meeting about floor procedure going forward, [Senate Majority Leader] Reid let three of the key skeptics within his party know that if they join Republicans at any stage of the process to block the bill, he still retains the option of passing major parts of the bill through the filibuster proof budget reconciliation process. In response to a question from TPMDC Nelson told reporters that, at a meeting this afternoon with Sens. Mary Landrieu (D-LA) and Blanche Lincoln (D-AR), Reid "talked about process, procedure, discussion about reconciliation and a whole host of issues of that sort."

"Nobody's really jumping up and down to push for reconciliation," Nelson said, "he's not threatening that, but anybody can conclude that if you don't move something on to the floor, that is one of the possibilities."

(Emphasis supplied.) Important that people get that message. Good on Reid.

Speaking for me only

GOP Protects Credit Card Companies

Big Tent Democrat — 2009-11-18T18:52:50-05:00

Via digby: