This sounds fairly ominous to me ~ ~ Sooz

Senate Democrats on Tuesday night took a major step toward reaching a compromise on a health reform plan, agreeing to ask congressional scorekeepers to give them cost estimates on a possible compromise on a public option in the Senate bill.

The broad outlines of the deal had been discussed for days and would include creating a new national health plan administered by the federal government that would offer insurance policies offered by private companies.

In addition, Democrats have discussed allowing older Americans to "buy in" to Medicare, as a way to expand coverage.

With a deadline imminent, Democratic senators scrambled Tuesday to break a months-long impasse over the public option, but stubborn political obstacles emerged as details of the possible compromise took shape.

A group of five liberal and five moderate Democrats emerged from a late evening meeting with a plan to send the ideas to the Congressional Budget Office. They had hoped to deliver the framework for a deal to Senate Majority Leader Harry Reid (D-Nev.) by Wednesday.

As quickly as the outline of an agreement seemed to emerge Monday, parts of it had fallen away by Tuesday afternoon - the casualty of opposition raised by moderates. At the same time, progressive senators, including Sen. Russ Feingold (D-Wis.), were still resisting pressure to give up entirely on the public option, according to an official briefed on the meetings.

By Tuesday evening, the group was no longer considering opening Medicaid to people with incomes 150 percent above the poverty line. It faded as a realistic option amid concerns among moderates and many governors that it would put too much of a burden on state governments, which pick up a portion of the coverage costs.

Sen. Olympia Snowe (R-Maine), who is still being wooed by Democrats, expressed strong skepticism toward another key element, the expansion of Medicare to people between 55 and 64. She said she was concerned the bill would rely too much on government to fill gaps in insurance coverage that the private sector should handle.

An added difficulty was the Senate's rejection Tuesday of an amendment by Sen. Ben Nelson (D-Neb.) to strengthen restrictions on federal funding for abortion coverage. He has said he would filibuster the bill if it didn't provide adequate restrictions but on Tuesday would only say that the defeat of his amendment "makes it harder to be supportive."

"I had no Plan B, and I'm not looking for a Plan B," Nelson said.

Nelson said he would look at any compromises on the abortion language that were presented to him but he does not plan to work on one himself. Nelson continued to participate Tuesday night in the public option talks.

Senators were haggling Tuesday evening over details, according to the official briefed on the meeting. The moderates were resisting a proposal to include a public option trigger in the federally administered national health insurance program. There was also pressure not to expand a proposal from Sen. Maria Cantwell (D-Wash.) that would allow states to negotiate with private industry to provide group coverage for low-income people. The bill limits states to negotiating for people who earn up to twice the federal poverty line.

Sen. Chuck Schumer (D-N.Y.) said the talks were progressing. But if the talks do result in a deal, the framework would very likely break the stalemate over the public option.

"If the 10 people in the room come to an agreement, it doesn't guarantee everybody, but it's a pretty broad reach in the caucus," Schumer said.

Snowe was highly skeptical of a proposal to expand Medicare and Medicaid - signaling Tuesday that her support for an emerging public option compromise will be difficult to secure.

Democrats have been hopeful they could attract Snowe's vote for a final health reform deal and gain a little breathing room in trying to reach 60 votes. But Snowe said the latest proposals on the table would take the legislation in the wrong direction, adding more government involvement at a time when voters want less.

"My deep concern is about the breadth and scale of this legislation, taking it in a more expansionistic approach for government's role rather than the reverse," Snowe told reporters. "You can design incentives in this legislation to maximize the power of the marketplace in making sure the industry performs."

West Virginia Sen. John Rockefeller, one of the leading Democrats calling for a public option, said there is "not a lot" of discussion anymore on expanding Medicaid to people at 150 percent of the poverty level, instead of the 133 percent of poverty level included in the Senate bill.

Germany has the world's oldest universal health care system, with origins dating back to Otto von Bismarck's Health Insurance Act of 1883.^{[54][/sup] As mandatory health insurance, it originally applied only to low-income workers and certain government employees, but has gradually expanded to cover the great majority of the population.[55][/sup] The system is decentralized with private practice physicians providing ambulatory care, and independent, mostly non-profit hospitals providing the majority of inpatient care. Approximately 92% of the population is covered by a 'Statutory Health Insurance' plan, which provides a standardized level of coverage through any one of approximately 1100 public or private sickness funds. Standard insurance is funded by a combination of employee contributions, employer contributions and government subsidies on a scale determined by income level. Higher income workers sometimes choose to pay a tax and opt out of the standard plan, in favor of 'private' insurance. The latter's premiums are not linked to income level but instead to health status.[56][/sup]}

Historically, the level of provider reimbursement for specific services is determined through negotiations between regional physician's associations and sickness funds. Since 1976 the government has convened an annual commission, composed of representatives of business, labor, physicians, hospitals, and insurance and pharmaceutical industries.^{[57][/sup] The commission takes into account government policies and makes recommendations to regional associations with respect to overall expenditure targets. In 1986 expenditure caps were implemented and were tied to the age of the local population as well as the overall wage increases. Although reimbursement of providers is on a fee-for-service basis the amount to be reimbursed for each service is determined retrospectively to ensure that spending targets are not exceeded. Capitated care, such as that provided by U.S. health maintenance organizations, has been considered as a cost containment mechanism but would require consent of regional medical associations, and has not materialized.[58][/sup] Copayments were introduced in the 1980s in an attempt to prevent overutilization and control costs. The average length of hospital stay in Germany has decreased in recent years from 14 days to 9 days, still considerably longer than average stays in the U.S. (5 to 6 days).[59][/sup][60][/sup] The difference is partly driven by the fact that hospital reimbursement is chiefly a function of the number of hospital days as opposed to procedures or the patient's diagnosis. Drug costs have increased substantially, rising nearly 60% from 1991 through 2005. Despite attempts to contain costs, overall health care expenditures rose to 10.7% of GDP in 2005, comparable to other western European nations, but substantially less than that spent in the U.S. (nearly 16% of GDP).[61][/sup]}

I'm withholding judgment until we have some hard facts ~ I think a VERY important element would be for those "nonprofits" to allow individuals/families to buy in at "group rates", which are significantly lower than "individual rates" ~ I do like the idea of opening Medicare to 55+ on a graduated premium scale ~

Sooz

Greater government involvement would potentially kick in if private insurance companies declined to participate in the nationwide plan, although details weren't available. One possibility was for the personnel office to set up a government-run plan, either national in scope or on a state-by-state basis.

"I think when people see this they'll really like what we've done," said Sen. Mark Pryor, D-Ark., who was among five moderate senators who spent several days negotiating with five liberals. Reid planned to describe the plan in greater detail after getting an analysis from the Congressional Budget Office.

The White House weighed in quickly with a statement from spokesman Reid Cherlin. "Senators are making great progress and we're pleased that they're working together to find common ground toward options that increase choice and competition," he said.

[b]Dramatic changes[/b]
The Senate is in its second week of debate on the 10-year, nearly $1 trillion legislation that would dramatically remake the U.S. health care system and extend coverage to millions of the uninsured, with a new requirement for nearly everyone to purchase insurance. New purchasing marketplaces called exchanges would make it easier for small businesses and people without government or employer coverage to shop for health insurance, and onerous insurance company practices such as denying coverage to people with pre-existing medical conditions would be banned.

The deal reached Tuesday puts even more requirements on insurers by requiring that 90 percent of premium dollars be spent on medical benefits, as opposed to administrative costs, officials said. The officials who described the details of the closed-door negotiations did so on condition of anonymity, saying they were not authorized to discuss them publicly.

Reid wants action on the health bill done by Christmas but more challenges lie ahead. On Wednesday, senators expected to debate an amendment by Sen. Byron Dorgan, D-N.D., to legalize the importation of prescription drugs from Canada and several other countries as a way of holding down consumer costs. The idea enjoys widespread support but is opposed by the pharmaceutical industry, which has worked closely with the administration on health care and has spent millions of dollars on television advertisements in support of legislation.

The Food and Drug Administration issued a letter saying it would be "logistically challenging" to assure the safety of imported drugs, raising concerns without stating outright opposition.

[b]Heated issue[/b]
Underscoring the heated emotions surrounding the government insurance plan, Reid refused to acknowledge its demise, contending that reports it was gone were "not true."

In a statement, Reid said the emerging compromise "includes a public option and will help ensure the American people win in two ways: one, insurance companies will face more competition, and two, the American people will have more choices."

It wasn't clear what he meant by a "public option" - the Medicare expansion or another element.

Either way, it's a far cry from what liberals had in mind when they envisioned the government competing directly with private insurers to offer health coverage to uninsured or self-employed Americans.

Even though the government plan would have been available to relatively few people, it took on outsize importance in the health care debate. Liberal groups clamored for it as necessary to offer consumers choice and competition, while Republicans and business groups - and critically, a bloc of moderate senators - contended it could mushroom out of control and drive private companies out of business.

In the end, dropping it was the price Reid had to pay for potential support from senators like moderate Blanche Lincoln, D-Ark., and Joe Lieberman, a Connecticut independent. Reid must have the support of all 58 Senate Democrats and two independents to achieve the necessary 60 votes to overcome Republican stalling tactics and advance legislation, giving great influence to the handful of moderates opposed to the government insurance plan.

In a statement released Wednesday, Lieberman said that he was "encouraged" by the progress on the compromise proposal. "It is my understanding that at this point there is no legislative language," he said, "so I look forward to analyzing the details of the plan" and reviewing the analysis offered by the Congressional Budget Office.

Reid already faced the prospect of losing moderate Democratic Sen. Ben Nelson, D-Neb., who said his support was in question after the failure of an amendment he offered Tuesday to insert tougher abortion restrictions into the legislation. The vote was 54-45.

The health legislation passed by the House last month includes the tougher abortion language as well as a government insurance plan; those differences would have to be resolved, assuming the Senate passes its bill.

http://www.msnbc.msn.com/id/34326187/ns ... pitol_hill

Because Dr. Cortese contends that Medicare has had such a poor track record, he has not been shy in opposing a government-run health care plan, or public option, which many liberal Democrats favor. Instead, he would urge Congress to create a national package of health insurance options modeled after the Federal Employees Health Benefits plan.

http://prescriptions.blogs.nytimes.com/2009/10/01/mayo-clinics-chief-finds-congressional-health-debate-heart-breaking/

Yes, that the same plan, but you'll notice that all of the coverage is provided through private health insurance carriers.

We need to pass health care reform ~ if this set of compromises, which I see as being necessary to capture the "moderate" Ds votes, works, then this is a solid start ~ it is far easier to revise and refine a plan in-place than it is to create it from scratch ~

I've always seen compromise as a two-way street ~ so I'm curious, gop, what compromises you think the Rs have made during this debate ~

Sooz

Liberals will live without the public option