“Senate Democratic leaders’ hopes of approving health care reform before adjourning for the August recess appear all but dead, with the prospect of meeting President Barack Obama’s demand for a bill on his desk by Oct. 15 looking increasingly difficult.”

Senator Dodd confirmed what everyone already knew:

Sen. Chris Dodd (D-Conn.), managing the health care bill in the Health, Education, Labor and Pensions Committee, signaled late last week that Democratic leaders do not expect a bill to clear the Senate in the next five weeks. Rather, Dodd indicated, the goal is to complete the tricky merger of the HELP and Finance Committee bills, with the floor fracas over a final bill put off until after Labor Day.

The issue, as always, is money.  Here is an interesting article from Politico, titled:  “Drug deal may be bad trip for Democrats” which further details another issue of intra-Democratic Party battles, this time over how to deal with prescription drugs.

The CNN poll question: If Obama’s health plan passed, your family would be…

20% Better Off

35% Worse Off

44% About the Same

It is even more difficult to make talking about health care interesting and witty.

The winner is George Newman writing in the Wall Street Journal in an article titled: “Parsing the Health Reform Arguments.”

If you are going to read any one thing on health care, read Newman’s piece.

If you are going to read any two things on health care, read this from Forbes by Shikha Dalmia.  All of the foregoing comments apply.

This ad is playing in 12 States, and is being aired by Patients First, and is airing in:

Alaska (Senator Begich-D)
Arkansas (Senator Lincoln-D)
Colorado (Senator Bennet-D)
Indiana (Senator Bayh-D)
Louisiana (Senator Landrieu-D)
Missouri (Senator McCaskill-D)
Montana (Senator Baucus-D)
Nebraska (Senator Nelson-D)
Nevada (Senator Reid-D)
North Dakota (Senator Conrad-D)
South Dakota (Senator Johnson-D)
Virginia (Senator Warner-D)

Pro-Life Dems

Pro-Life Dems send Speaker Pelosi a letter with a simple message: the new health care reform bill cannot provide for taxpayer funded abortions.  See the letter here.

More internal battles are ahead on health care, according to today’s Wall Street Journal:

…intraparty tensions are frustrating some Democratic leaders and activists, who believe they have an opportunity to enact a broad liberal agenda. MoveOn.org announced Friday that it is running ads criticizing Sen. Kay Hagan, a newly elected Democrat from North Carolina, for opposition to a publicly run plan as part of a health overhaul.

“Our 115,000 members in North Carolina, many of whom volunteered for or donated to her campaign last year, believe the public option is the heart of true health-care reform,” said Justin Ruben, the group’s executive director.

Some Democratic lawmakers say they are trying to keep the party from moving too far left and alienating voters. “I’ve always thought a divided government works best,” said Rep. Allen Boyd, a Democrat from Florida’s conservative panhandle. “It’s incumbent on us, now that we’re in the majority, to use that leverage however we can.”

With that in mind, it is reasonable to divine where the Progressives are on the biggest debate about the Democratic health plan: should there be a government-public plan option?

Here is an interesting piece titled “Will the Left Kill Health Care Reform?” It state, in part:

“I will not vote for any health care that does not include a public option,” Democratic Rep. Keith Ellison declared this week. “I will not do it, that’s a guaranteed no vote and I will not be dissuaded from that.”

Ellison is not alone. He’s a part of the House Progressive Caucus, whose co-chair, Rep. Lynn Woosley, has said repeatedly that a majority of the 80-member bloc would not vote for any bill that did not include a “robust” government-run plan, which typically means one modeled after Medicare. This is the formulation that is opposed most vigorously by the American Medical Association because it would drive down reimbursement rates for doctors, and by insurers who do not believe they would be able to compete with a government plan that had access to tax dollars and would benefit from the fact that government would be writing the rules of the game.

If Woosley is serious about liberal House members voting against a compromise bill, that means scaled-back legislation could die in the House even if some Republicans defect and vote for it. And on the flip side, should the House go ahead and pass a bill with a strong government-run plan, it would have a tough time getting the necessary votes in the Senate.

Now, things are usually very different at the time of the floor vote, in terms of Member’s threats about voting or not, but my sense is the Progressives are “pot committed” to a public plan.

This is really a power test for the Progressive Caucus, the Black Caucus and the Asian Pacific Caucus of Democratic Party House Members of Congress (who have said they will not vote for a health reform plan without a public plan option) vs. the American Medical Association, the U.S. Chamber of Commerce and the Association of Health Insurance Plans, and the Blue Cross Blue Shield Association (who said they will oppose a public plan option.)

Given the implications for the entire reform effort, this is the key fault line, along with who gets taxed to pay for it.

Neither of these fault lines have been put to the test in the real test: a vote by the U.S. Senate or U.S. House.

Now the left is alternatively calling for President Obama to step in and mediate, or pressuring him on the public plan option or both.

Given the trillions of dollars on the table, being too cute with some compromise will probably die an ambush death from fire from the left and right (the compromise being caught in the middle).

Industry may not be used to listening to the Progressives, but their time is now, and they sense this is a once in a generation opportunity to get what they really want.

They are not being shy about their public plan support.  The Sunday Washington Post reported on liberal groups pounding Democratic Senators, its lead was:

In the high-stakes battle over health care, a growing cadre of liberal activists is aiming its sharpest firepower against Democratic senators who they accuse of being insufficiently committed to the cause.

Here are some of the details of the attacks:

In recent days — and during this week’s congressional recess — left-leaning bloggers and grass-roots organizations such as MoveOn.org, Health Care for America Now and the Service Employees International Union have singled out Democratic  Sens. Ben Nelson (Neb.),  Mary Landrieu (La.),  Ron Wyden (Ore.),  Arlen Specter (Pa.) and  Dianne Feinstein (Calif.) for the criticism more often reserved for opposition party members.

“Will Mary Landrieu sell out Louisiana for $1.6 million?” says one Internet ad that suggests a link between contributions she has received from the medical industry and her reluctance to back the creation of a government-sponsored insurance option.

Given that President Obama, Speaker Pelosi, Chairman Waxman, Chairman Kennedy/Dodd and Chairman Baucus all want a public option — along with their Progressive base — how (exactly) is a public option going to kept out of the final House or Senate plan, unless Democratic Members who are equally opposed dig in their heels on the subject of financing and a public plan?

This is what is really unclear, where are the Democratic House rank and file on the question of public plan, or the taxes to pay for it?

Will the more conservative Democratic Members of Congress draw their own line in the sand, or will they attempt to influence the process, but be shut out, and ultimately vote against the bill, or vote for it?

Good questions, but right now the most visible pressure is coming from the Progressives.

Even though the uber-Progressive magazine The Nation said in a recent editorial “Time to End False Bipartisanship” that “for now, the calculus of political viability has taken single-payer off the table. That doesn’t mean we cease fighting to get it back on –but it probably means we need to balance our short and longterm goals,” which seems like a clear message to the Progressives not to throw the baby out with the bath water.  But the same editorial also says:

“Joe Conason put it in his invaluable New York Observer column, “If Congress fails to enact healthcare reform this year—or it enacts a sham reform designed to bail out corporate medicine while excluding the ‘public option’—then the public will rightly blame Democrats, who have no excuse for failure except their own cowardice and corruption.” Blame could well be registered in ugly midterm election results in 2010.”

And The Nation closes with a call to go for the full-boat public plan:

“Congress is, of course, usually pretty skittish about reform, but with a President with high approval ratings and an historically unpopular GOP–if this isn’t a time to pass sweeping reform with a strong public plan, then when is”

For the Democrats, the easy part — general agitation and propaganda about health care reform is over — now comes the internal fights within their own party about the taxes to pay for it and which members of their party get happiness.

It will be an interesting dance of legislation, and the July 4th recess will likely clarify how many members view the subject, but, ultimately, the choices the Democratic Party makes, and the Progressive wing makes will determine the final course and passage of this legislation.

The stakes could not be higher on both the public/government plan option and the which taxes will be levied to finance the plan.

The Baucus plan to tax health benefits could easily pay for the reform, but some unions will defect to no, even though the tax may not apply to most of their member’s plans.

Ultimately, this is a big test of the Progressive’s power, its biggest after the Cap and Trade victory in the U.S. House.

Industry may have been taken aback by the number of Democratic defections on their own bill, and that it still passed.

It is a real lesson for the world of health care, and the final disposition of the public plan option and its financing.

Until (or more likely, if and when) the 180 million Americans with their own health care either provided by their employer or bought on their own weigh into this debate, my sense is the Progressives will push all their chips in, and are pot committed on the public plan.  And their hand looks pretty strong.

There are very good reasons to be confused about what kind of health care reform Congress is debating right now.  The health reform plans keep changing.  Even in the Committees of jurisdiction, only part of each bill is being considered because the rest of the bill has not been drafted.

            And when it gets drafted, it has to be scored (its cost to the taxpayer determined) by the Congressional Budget Office, and the scores have been so high, ranging from $1.6 Trillion to $2.4 trillion in the U.S. Senate to in the range of $3 trillion in the U.S. House, that the crippling price tags are causing further changes.

            And until the Democrats decide whether to have a government health plan option or not, the delays and confusion will continue.  On one hand, three of the most influential U.S. House Democratic caucuses have demanded a public/government plan option: the Black caucus, the Progressive caucus and the Asian-Pacific caucus.

Second, the U.S. Chamber of Commerce, the American Medical Association and the Association of Health Insurance Plans have all come out four-square against a government plan.  When the leaders of the employer, doctor and insurance communities are unified in opposition to a specific legislative health care agenda item, it becomes very difficult to pass.  It remains to be seen if that is true in a Congress dominated so heavily by the Democratic Party, but my guess it that it is still true.

            Third, President Obama said at his media conference that there is “no line in the sand” on a government plan, but House Speaker Pelosi says she cannot pass health reform in the U.S. House without a government plan.

            If you are confused about what is happening on health care reform, don’t worry, until a political decision is made and enforced by either the White House or the Democratic leadership in the U.S. House or U.S. Senate, about whether there will be a government plan option or not, the delays, confusion and stop and go will continue.

Krugman then uses that argument to state:

Which brings us back to health care. It would be a crushing blow to progressive hopes if Mr. Obama doesn’t succeed in getting some form of universal care through Congress. But even so, reform isn’t worth having if you can only get it on terms so compromised that it’s doomed to fail.

Three key progressive Democratic Party caucuses in the U.S. House drew their own line in the sand on a public plan, demanding it be in any health reform bill. And given Speaker Pelosi’s statement that she does not have the votes to pass a health care reform bill without a public plan option, before these caucuses made their statement,

Krugman’s view that “reform isn’t worth having” without a public plan may foreshadow actual events: there may be no reform plan at all.

There is a lot of talk about trillions of dollars these days. I heard this last week and verified it with my trusty HP calculator.

A million seconds ago was last week (11 days ago).

A billion seconds ago, Nixon was running for re-election in April of 1971.

A trillion seconds ago was 30,000 years before the birth of Christ.

In other words, a Trillion is really big!

Even so, a consistent theme is clear: Americans know that the system is broken and would like to see it fixed. But the more a potential fix affects them personally, the less interested they are in supporting it.

Mimicking the national interest groups, who are happy to talk about the need for health care reform and sit around a table and discuss the best way to reform health care, when the bottom lines turns to their interests, their backs stiffen and they push away from the table:

when asked if they’d be willing to pay more in taxes, either on their current health care plan or in general, respondents quickly pull back. Just 33 percent agreed with the idea of taxing health care benefits for those with “generous” plans. The Diageo/Hotline poll found just 26 percent of voters supported a tax on health care plans. And a Kaiser poll reported that only 41 percent of Americans were willing to pay more either in taxes or health care premiums to cover the uninsured.

A CNN/Opinion Research survey and a poll taken for the Republican group Resurgent Republic both asked the question on taxes this way: “Would you prefer a health care reform plan that raises taxes in order to provide health insurance to all Americans, or a plan that does not provide health insurance to all Americans but keeps taxes at current levels?”

CNN’s poll, conducted in mid-May, found the public split between the two at 47 percent. The Resurgent poll, released on Monday, showed stronger opposition to tax increases (39 percent) and more support for keeping taxes at the current levels (52 percent). Still, both suggest raising taxes to pay for health reform is not a popular position.

Is health care reform the political equivalent of a nuclear waste dump: not in my backyard?

Which brings us back to the main issue that has tied the shoelaces of many a health plan, the details.

On health care, Obama left open the door to abandoning his demand that people under any revamped system have the option of choosing coverage from a government-funded program.

“We are still early in this process,” he said. “So, you know, we have not drawn lines in the sand other than reform has to control costs and that it has to provide relief to people who don’t have health insurance or are under insured.”

Just before President Obama’s media conference in which he offers up the public plan option as not essential, the American Health Insurance Plan Association and Blue Cross Blue Shield Association sent a letter up to the U.S. Senate HELP Committee opposing the inclusion of a public plan option.

From the Washington Post:

Shortly before Obama entered the White House briefing room, two key health industry groups — the America’s Health Insurance Plans and Blue Cross and Blue Shield Association — sent a letter to the Senate Health, Education, Labor and Pensions Committee outlining their opposition to the inclusion of a public option in the legislation.

“A government plan option — in any form — is unnecessary to achieve comprehensive reform and would have devastating consequences on the health insurance coverage that employers and individuals currently have, the federal budget deficit and existing provider systems,” the groups said.

I wonder what Paul Krugman of the New York Times will say about this, since his last column rips conservative Democrats for balking at the health reform bills now before Congress.

Meanwhile, the Daily Kos is re-posting an alert to its members to call the White House to get President Obama to keep his public plan option.

But the health care reform shoes just keep dropping.  There are now a series of sustained attacks on the phrase often repeated by the President about keeping your own health plan.  Maybe not.  James C. Capretta, in the Corner, tags President Obama hard for his redefinition of his often-repeated promise “if you like your plan, you can keep it.”

What he meant, he now says, is that the government wouldn’t force people out of their health-care plan. If tens of millions of people get pushed out of their current coverage, it would be because firms chose to drop their insurance plans — never mind the fact that they would do so based on the financial incentives the government put in place.

The president’s “clarification” seems highly unlikely to be the final word on this. For starters, it doesn’t matter much to the voting public who pulls the trigger. They don’t want today’s stable, job-based coverage turned upside by “reform.” When they hear that tens of millions of people will get moved out of employer plans and into the “government option,” they will wonder if they themselves will have to switch insurance — and most don’t want to. The president’s comments today aren’t likely to put their fears to rest.

This is the equivalent of Plutonium 244 in the health care reform tea.

If the 180 million people with health insurance believe that they will be pushed into to a government health care plan — by their employers or by the conditions the government plan creates in the market — it is the death kneel for the Public/government option.

Even the NY Daily News is getting into the pound the health reform plan act.