Top Ten Fixes To The Senate Bill

Posted on 12/21/2009 at 5:40 pm by Bob Cesca

I’ve been thinking about the 10 things I’d like to see fixed with the Senate bill. Here they are in no particular order of importance.

1. Add a public plan or Medicare buy-in to the exchange.

2. Implement the exchanges sooner.

3. Implement the subsidies sooner.

4. Make up the deficit hit caused by the near-term implementation of the exchanges by adding a rollback of the Bush tax cuts for the wealthiest one percent. I’m not wonky enough to know whether they will perfectly offset, but since everyone in Congress is hawkish about the deficit and not so much on the wars…

5. Remove the anti-trust exemption. Not a fix so much as an add-on.

6. Add drug reimportation. The Obama administration is authoring a bill to do this. Fixes already!

7. Kill the 12 year exclusivity window for name brand prescription drugs. Just awful and wrong and deadly.

8. Close the Part-D doughnut hole more rapidly.

9. Push the medical loss ratio back to 90 percent.

10. Kill any and all Stupak/Nelson abortion language. Or, make sure to explicitly add language that restricts federal funds to pay for erectile dysfunction and, I don’t know, hair restoration procedures.

Bonus: Government-funded, government mandated atomic wedgies for Joe Lieberman. Administered daily. By me.

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  • kansasdem

    Look, the holdouts got what they wanted!We can piss and moan forever or just accept it. If you try and change it now we’re likely back to square one!Relax. Breathe. Relax!

  • http://politicalpartypooper.wordpress.com/ Political Party Pooper

    Those are all good fixes, but I would also include some sort of tort reform. Doctors and nurses are human, too. No one should be forced to file for bankruptcy over a mistake that was not intentional, and hospitals and clinics are no exception. Litigation attorneys aim for these cases, and the sky seems the limit to what they believe their clients are entitled to.If money could buy back a patient’s life, we would have no need for litigation at all.

  • eljefejeff

    eww….you really want to touch Joe LIEberman’s stained undies?

  • eljefejeff

    This has been said to death, but tort reform is such a small number when it comes to cost savings. Plus, it’s a republican demand, it’s not like adding it will gain votes. If Snowe and Collins said “put that in and I’ll vote for the public option,” that would make sense. Then we kick Nelson and LIEberman to the curb.So if that would get us all the changes on that list, I’m fine with that compromise.

  • IntoxiNation

    @Political Party Pooper:As a paramedic for going on 20 years now I really wish they would. I have to pay outrageous malpractice insurance every year.Of course big payouts from malpractice aren’t really that common. In 1995 my cousin went to the local emergency room with severe chest pains. Without putting him on a monitor or anything they started pushing blood thinners. It turned out he had a bad bleed in his stomach from an ulcer and the blood thinners caused him to bleed out faster and ultimately die. His wife ended up with less than $200,000 from the settlement. He was 47 when he died and actually in very good health.

  • http://nanotyrnns.blogspot.com/ Nanotyrannus

    These items don’t have to be fixed now, or even in conference. They can be fixed next year. And the year after. And the year after that. I’m more for passing this as it is now rather than rocking the boat any more than we already have. I know that sounds like capitulating to the whiny bastards that are going to vote no in any case, but let’s get this done already.PPP – Let’s do for docs and nurses what we did for Wall Street. Let’s bail them out. If they screw up and ruin lives, the government will pick up the tab. That might sound like I’m joking, but I’d much rather assume the liability for people that stand on their feet all day working their asses off caring for people rather than folks on Wall Street that drove the economy off the cliff and then got bonuses for it.

  • roxsteady

    They’re not going to get a public option or any of those changes without first, changing the filibuster rule. According to Paul Krugman there is no 60 vote rule in the Constitution. So, why do they keep feeding us this bullshit about 60 votes.

  • kansasdem

    PPP,What happened to State’s rights? I know that both Kansas and Nebraska have laws on the books regarding erroneous claims.Both of the GOP’s suggestions trample on Stae’s rights:#1. Stick the fed in the middle of a states legal procedings regarding malpractice.#2. Eliminate the State’s ability to regulate insurance.Sounds like the federal government taking over state’s rights to me.

  • roxsteady

    The Senate, Krugman stated is a dysfunctional body.”After all, Democrats won big last year, running on a platform that put health reform front and center. In any other advanced democracy this would have given them the mandate and the ability to make major changes. But the need for 60 votes to cut off Senate debate and end a filibuster — a requirement that appears nowhere in the Constitution, but is simply a self-imposed rule — turned what should have been a straightforward piece of legislating into a nail-biter. And it gave a handful of wavering senators extraordinary power to shape the bill.”This is a disgrace. I’d suggest that Liberals and Progressives should push hard to make this change at the start of the next session. If we could get a petition together of say 5 or 6 million people pledging not to vote in 2010 unless this rule is changed. It may not sound like much but, if 5 million people stay home the Dems will get their asses kicked. I think it’s worth a try. The Republicans reached their 98th filibuster on December 18th. Enough is enough. People need to know how awful this process is because if they knew, they’d probably be pissed.

  • ceu

    Rox – Senate rules. 60 votes needed to overcome a filibuster. There are a large number of Senate rules that aren’t in the Constitution.The insurance companies are taking in much more in malpractice insurance premiums than they are paying out in judgements & settlements. Large awards are very rare. CA & TX both used tort reform as a way to bring down insurance costs, and premiums are still outrageous & 25 % of Texans have no health insurance at all. Seems like what is needed is a government enforced cap on what companies can charge medical professionals.Really – the whole tort reform meme is sounding very much like the cut taxes solution to the national debt. Been there, done that, didn’t work.

  • http://politicalpartypooper.wordpress.com/ Political Party Pooper

    Kansasdem,you cannot possibly be citing states rights at a time like this, can you? Not when we are about to pass a Federal health reform bill.:D

  • ceu

    Think hard about doing away with the 60 vote cloture rule. Democrats will not be in the majority forever & when we really need it, it won’t be there. What if the GOP gets 51 Senators in 2014 & they decide to repeal this Health Reform Act. Without that filibuster, they could do it – and do not doubt for a moment that they will if it’s at all possible.

  • http://politicalpartypooper.wordpress.com/ Political Party Pooper

    roxsteady,I’d say we should pass lobbying and campaign finance reform with real teeth before worrying about changing senate procedure.This bill wasn’t about one senator, no matter how much we’d all like to blame Lieberman.

  • roxsteady

    Ceu! If it’s not in the Constitution then, why are they holding themselves to this? The Senate can change that rule. Period. It won’t take a Constitutional amendment since, it’s not in there. I’m not willing to just accept this. The question is, are you?For instance, over the summer when many people ran out of their unemployment the Dems tried to get the extensions but, Republicans filibustered and tried to add an amendment regarding ACORN. Well the Dems were finally able to pass it after 30 days 90-0. Because of this hold up many people including some of my friends didn’t get their extensions until after Thanksgiving. I suspect that many of those 200,000 people arent’ aware that this took so long because of Republicans. They probably blame the Dems. They need to know this and it needs to change.

  • IntoxiNation

    @ceu – I had a better/scarier analogy earlier. The filibuster is gone. It’s 2017 and President Palin is winking away from the oval office. Suddenly there is a seat open on the Supreme Court. President Palin decides to nominate the best person she knows for the job – Rush Limbaugh. Of course no Republican say no to Rush, and with no filibuster, well he gets confirmed.The filibuster is an awesome tool to give the minority power and it is actually needed, but when the majority just caves in on every threat of a filibuster and doesn’t actually force on to happen – well you get the 111th Senate.

  • kansasdem

    PPP,I certainly am! Are you suggesting that 100 Senators should be able to decide what a human life is worth? Or an arm or a leg? Or mobility?When it comes to regulating insurance consider how well Medi-gap plans have done for decades. They’re regulated by the states, whereas Medicare Advantage is managed by some BS fed formula cooked up by a GOP potus and congress.

  • roxsteady

    I don’t care if the Republicans get to use the 50 vote rule someday. If the Dems had it and could get a lot of the progressive changes we want and the Republicans wouldn’t smell the majority in the near future. Think about it!

  • Hielo

    A certain kind of tort reform needs to be a pert of the fix.It is not as much about the cost savings as it is about good lawyers vs. assholes.Lower the contingent fee to a reasonable sliding scale. Make the losers pay the court costs. This will blow out the dickheads that file nuisance lawsuits.Medical people should not have to put up with this threat unless they really screw up.

  • roxsteady

    It’s not even mathematically correct. 51 percent of anything is the majority and if the Senate continues the minority party to block legislation that is favored by the majority of Americans like the public option, then the system needs to be changed. Both Tom Harkin and Bernie Sanders were on Ed Shultz tonight and one of them said that they had 55 Senators who are for the public option. 55! So why are 4 or 5 Senators who I didn’t vote for allowed to fuck up this bill? Because no one is pressuring them to stop this shit!

  • http://politicalpartypooper.wordpress.com/ Political Party Pooper

    Kansasdem,money doesn’t replace a life or a limb. It doesn’t matter what the jury decides, and you know that. Why don’t admit the real reason why Dems won’t touch tort reform? Come on.Could it be the trial lawyers’ lobby?Why don’t we just say that we don’t want Senators deciding how much lawyers can get paid for someone else’s injury, and be done with it?

  • roxsteady

    By the way, tort reform isn’t the big problem that Repblicans make it out to be. It’s 0.47% of healthcares costs. I’ve never seen the urgency. I’m not saying they aren’t problems with it but, it’s not even 1% of the costs. And have you noticed how many doctors the Republicans have in their party? There are several. It’s sounds somewhat self serving.

  • Rollah

    And what happens to Bob’s list (or his underlying support for passing some version of reform) if only a few or even none of these items get fixed? A couple sound as though Nelson or LIEbertool would threaten another filibuster if even attempted (#s 1 and 10)… Also, wouldn’t #6 mean Obama reneges on Rahm’s secret pharma deal?

  • roxsteady

    Actually, they’re already working to fix the pharma deal. And David Axelrod pointed that out yesterday. I also read about this on firedog.

  • http://broadwaycarl.blogspot.com Broadway Carl

    IntoxiNation – Question: So if you’re saying that malpractice insurance is incredibly expensive but in reality, big payouts aren’t that common, then should it be the malpractice insurance that needs reforming?

  • roxsteady

    I think that Harkin should reintroduce this amendment. It’s ironic that he and Liberman first introduced this legislation back in the 90′s.The way it would work is that each new piece of legislation would still require 60 votes. If anyone filibustered they’d be allowed to but, in 2 days the bill would come up for a vote again but, this time, the votes required would be reduced by 3 so that now instead of 60 it’s 57. And if say Liberdick filibusterd again, in 2 days the votes required would drop by 3, this time to 54. The filibuster was not designed to block legislation, only to slow it down. People threatening to not vote for final passage of bills would be shoothing themselves in the foot each time by reducing the number of votes required for final passage by 3. I like it!

  • http://broadwaycarl.blogspot.com Broadway Carl

    The Senate can change that rule. Period. It won’t take a Constitutional amendment since, it’s not in there. Rox – guess what it takes to change the rule. 60 VOTES! Do you think they’ll get 60 when they couldn’t get 60 for health care reform without Lieberman reach-arounds and Nelson hand jobs?

  • roxsteady

    By the way, none of the changes Bob suggest will be achieved if things remain the same. If they couldn’t get 60 votes for a public option now, why do we believe they can get it in the next session? They can’t do the public option through reconciliation or, so they keep telling us. It’s now officially a bullshit excuse. Particularly after years of Reid telling us we need 60. Well we’ve go 60 and now? They either change this rule or we’re fucked.

  • Hielo

    RoxPPP actually has a point with tort reform.As a former trial lawyer, I can say with some credibility, that I knew a few “trial lawyers” that are total hairballs. Accordingly, a large number of lawsuits should never be filed. This is not to say that the medical profession should be exempt from lawsuits. Malpractice cannot be regulated by words.And, PPP, you have correctly identified the trial lawyers as a special interest group. Do you think there may be just a few in the medical and insurance industries?

  • roxsteady

    How about by a simple majority? 51.

  • roxsteady

    If 51 Senators signed onto to this, what could the other 9 do about it? The Senate makes it’s own rules. They couldn’t sue anyone. The Senate makes it’s own rules. This isn’t Roe v Wade. It’s a procedural vote. If the other 9 don’t like, that’s too bad. Seriously, what could they do about it. It’s supposed to be a majority rule. Or, maybe they could change the rule through reconciliation. They claim it can only be done if budgetary issues are involved. Well, nearly everything the Senate does is budget related. I’m just no longer willing to buy this 60 rule bullshit. I just hope enough people start to make noise about the lack of fairness and the ability this rule provides for a minority rule! I’ve fucking had it!

  • roxsteady

    I still don’t see the malpractice issue as one that has to be dealt with right away. I just don’t get it. I don’t see the urgency in it. Maybe it’s because the Republicans raised it, I automatically thought, this is a bullshit distraction from dealing with actual healthcare reform. You know, more of the same from these idiots.

  • http://nanotyrnns.blogspot.com/ Nanotyrannus

    “Could it be the trial lawyers’ lobby?”I think it needs to be pointed out that trial lawyers are no different than health insurance companies and Wall Street executives. They all make gobstopping amounts of money off of other people’s misery. Trial lawyers have as much right to create profit and wealth as health insurance/Wall Street executives, so it makes me wonder why Republicans regard them with such disdain.

  • roxsteady

    Either the majority rules or it doesn’t and if it doesn’t then why should any of us vote for a party that allows itself to be held hostage? I’ve had it! My vote too is now for sale. I want the filibuster rule killed!

  • LAH

    Perhaps the Malpractice Insurance Co’s need to be taken to task. Perhaps the Medical Community needs to direct their anger there instead of the at Trial Lawyers. I was involved in a wrongful death suit and I can promise you, I ain’t rich as a result. Far from it.A different fight for a different day.

  • Dr. Squid

    eww….you really want to touch Joe LIEberman’s stained undies?You forget – his stains don’t stink. Just ask him.

  • ceu

    oh good heavens. Read Intox’s example regarding filibustering. And if you think Rush Limbaugh being appointed to the Supreme Court is farfetched, I have 2 words: Harriet Miers!

  • Hielo

    LAHGood point. The malpractice companies are . . . insurance companies!Do not let anyone you care about have anything to do with someone that is associated with the cartels.

  • Bull Schmitt

    I don’t get this post. Bob does an effective job of talking us down to support the Senate Bill, warts and all – then he turns right around and says here are 10 things we should fix.I’d be fine with all of the suggestions mind you, but it appears obvious that #1 would lose Lieberman’s vote, and either #5 or #10 would lose you Nelson’s vote.Or are you willing to play chicken for final passage?

  • eljefejeff

    “I don’t get this post. Bob does an effective job of talking us down to support the Senate Bill, warts and all – then he turns right around and says here are 10 things we should fix.”I can’t speak for Bob, but it sounds like he’s saying the bill is worth passing as is. It would just be great if we could fix a few things but if we can’t, we still need to pass it.