If Barack Obama doesn’t want to be a one-term president, he has a funny way of showing it. I can’t imagine how the president could come out of the debt ceiling negotiations in a worse political position.  

The U.S. Senate rejected motions to proceed with considering four draft budgets for the 2012 fiscal year yesterday. Democratic leaders scheduled the vote primarily to get Republicans on the record supporting the budget that passed the Republican-controlled House of Representatives last month. That blueprint, also known as Paul Ryan’s budget, foresees big changes to the Medicare program and became a central issue in Tuesday’s special election in New York’s 26th Congressional district.

Senator Chuck Grassley voted for two out of the three Republican proposals on the table, including the Ryan budget, while Senator Tom Harkin voted against all three GOP budgets as well as President Barack Obama’s budget blueprint.

Details on the votes and proposals are after the jump.

Nine-term incumbent Republican Tom Latham (IA-04) and eight-term incumbent Democrat Leonard Boswell (IA-03) will face off next year in Iowa’s third Congressional district. Latham spoke about the 2012 campaign today, making his first public remarks on the subject since he confirmed he would run against Boswell. Highlights from his comments are after the jump, along with Boswell’s first preview of how he will compare his record to Latham’s.

Representatives Tom Latham (IA-04) and Steve King (IA-05) are among 50 House Republicans the Democratic Congressional Campaign Committee is targeting this week in robocalls to their new districts. King will run for re-election in Iowa’s newly-drawn fourth district in 2012; his likely Democratic opponent is Christie Vilsack. Latham will run in the new third district against Democratic incumbent Leonard Boswell. The automated phone calls highlight the April 15 vote for Paul Ryan’s budget, which would transform Medicare over time into a voucher program through which seniors could buy private health insurance. Here’s the script:

Hi, this is Claire from the Democratic Congressional Campaign Committee calling about Congressman Tom Latham’s vote to end Medicare.

Everyone agrees we must cut spending and tighten our belt, but Congressman Latham has made all the wrong choices.  He actually voted to end Medicare, rather than end taxpayer giveaways for Big Oil making record profits or tax breaks for the ultra rich!

Seniors who pay a lifetime into Medicare deserve the benefits they’ve earned. Under the Latham-Republican plan Medicare ends, benefits to seniors are less, and costs to seniors increase – in order to pay for Big Oil taxpayer giveaways and the ultra rich’s tax breaks.

America is built on shared sacrifice.  Tom Latham is choosing to place the burden on seniors.  That’s not right.

Please call Congressman Latham at (515) 232-2885 and tell him to keep his hands off our Medicare!

The robocall against King uses the same script, substituting King’s name for Latham’s and giving King’s phone number at the end: (712) 224-4692.

The DCCC clearly sees Medicare as a central issue for the 2012 campaign. The new IA-03 and especially the new IA-04 contain a higher-than-average proportion of senior citizens. I think most incumbent Republicans will be able to explain away this vote, saying changes to Medicare wouldn’t affect current beneficiaries and Democrats have also voted for cuts to the program.

The 501(c)4 organization Americans United for Change started running a television commercial against King this week, also focusing on Medicare. Mark Langgin posted the video in this diary. He notes that Public Policy Polling’s latest Iowa survey found Christie Vilsack’s favorables to be better than King’s statewide. Too bad she’ll be running against him only in the 39 counties that make up the new IA-04.

Under The Golden Dome has the story as well, but Americans United For Change has a new ad up going after some of the more conservative fiscal hawks in Congress including our very own 4th CD Rep. Steve King.

This also comes at a bad time for Congressman King as Public Policy Polling has new numbers from statewide Iowa polling – showing him having weak favorables statewide, and particularly weak favorables when compared to Christie Vilsack.

Former First Lady Christie Vilsack announced Wednesday that she will move to Ames next month and “continue to explore the possibility of representing Iowa in the US House of Representatives.” A Christie Vilsack for Iowa Facebook page and Christie Vilsack for Iowa website launched today as well. Vilsack’s statement and more news on the IA-04 race are after the jump.

Remember when Republicans were saying that Washington was going to pull the plug on grandma? Little did we know, they were on to something.

The newly released Republican budget does indeed threaten grandma – by dismantling Medicare and ending the guaranteed health care that so many seniors' lives depend on.

If House Republicans and Budget Chairman Paul Ryan get their way, they would privatize Medicare – getting rid of the government guarantee that makes the program accessible for all elderly Americans. Under this “brave” and “courageous” Republican plan, seniors would get a voucher to purchase insurance on the private market. This may sound like a reasonable plan until you consider that privatizing Medicare would cost seniors significantly more, almost doubling their out-of-pocket costs to more than $12,000 a year and leaving many unable to afford health care at all.

The Senate version of a bill designed to create jobs, support state budgets and extend various tax credits and benefit programs failed to overcome a Republican filibuster yesterday. Tom Harkin was among 56 members of the Democratic caucus who voted for the cloture motion (which would end debate on the bill), but Ben Nelson of Nebraska and Joe Lieberman of Connecticut voted with all the Republicans present, including Chuck Grassley, to kill the bill (roll call here). Joan McCarter observed that Senate Majority Leader Harry Reid

voted yes, without changing his vote, signaling that this iteration of the bill is indeed dead.

Reid followed the vote by attempting to pass the emergency provisions of the bill, the “doc fix,” unemployment benefits extension, and FMAP as well as the homebuyer tax credit, as separate bills under unanimous consent. McConnell objected to each, so we’re stuck in further limbo.

Extending unemployment benefits should be a no-brainer when the percentage of unemployed Americans who have been out of work for more than six months is higher “than at any time since the government began keeping track in 1948.” Without the “doc fix,” medical providers’ reimbursements for Medicare patients stand to drop about 20 percent. FMAP stands for Federal Medical Assistance Percentage funding, relating to federal government reimbursements for part of each state’s Medicaid spending. The 2009 stimulus bill temporarily raised FMAP payments for states during the recession, with larger increases going to states with higher unemployment rates. Failing to extend this provision will put state budgets under further strain for the 2011 and 2012 fiscal years.

Republicans who blocked this bill claim we should not be adding to the federal deficit. A spokesman for GOP enabler Ben Nelson laid out his views here. Ezra Klein pointed out a few glaring problems with the analysis: the federal budget can’t start approaching balance with unemployment at 9 percent, polls show Americans are much more concerned about jobs than the deficit, and the current rate of economic recovery is “far, far too slow to really dent unemployment.” Meanwhile, the same senators who claim to oppose adding to the deficit also oppose rolling back tax cuts or tax loopholes for the wealthy in order to pay for extending unemployed benefits, state fiscal aid and tax credits.

I share John Aravosis’ view that it was a terrible mistake for President Barack Obama to talk tough about reducing the deficit earlier this year. As Aravosis writes,

[T]he President didn’t want to blame Bush and the GOP for the deficit, and he didn’t want to sufficiently defend the stimulus and explain to people that they had a choice between a Great Depression and a bigger deficit. […] If the public understood that the deficit was a) mostly caused by Bush, and b) not nearly as important as staving off a Depression and creating jobs, the GOP would be facing far more pressure not to launch these filibusters at all.

Perhaps no jobs bill passed this week would alter the economy enough to affect the November elections, but if we accept current unemployment levels and don’t pass additional fiscal aid to the states, the economy may still be very weak leading up to the 2012 election.

Share any relevant thoughts in this thread. From where I’m sitting, the case for Harkin’s filibuster reform proposal has never looked stronger.

It’s crunch time for health insurance reform, and Senator Tom Harkin and the three Iowa Democrats in the House “announced a major breakthrough today on the issue of Medicare payment reform in the final health care reform bill,” according to a joint press release. Excerpt:

[Representatives Dave] Loebsack, [Senator Tom] Harkin, [Leonard] Boswell and [Bruce] Braley have been outspoken advocates for changing the way Medicare pays health care providers for services, from its current fee-for-service system into a quality and value-based system.

Loebsack, Harkin, Boswell and Braley helped negotiate a compromise adding language to the health care reform bill that provides an immediate $800 million to address geographic disparities for both doctors and hospitals, as well as written guarantees from Health and Human Services Secretary Kathleen Sebelius for further action to reform Medicare reimbursement rates that do not qualify for reconciliation under the Byrd Rule. The Senate bill previously only provided a Medicare reimbursement fix for doctors.

The House reconciliation package maintained automatic implementation of a value index as part of the reimbursement structures for doctors, beginning in 2015.  This language was secured in the Senate bill with the help of Harkin and is based on Braley’s Medicare Payment Improvement Act, introduced in June 2009. Under the fixes secured in the Senate bill and the House reconciliation package, Iowa doctors will see five percent increases in current Medicare reimbursement rates in both 2010 and 2011.

I posted the whole press release, containing more details, after the jump. This deal appears to have secured the vote of Peter DeFazio (OR-04) as well. Yesterday he threatened to vote no because of language on the Medicare payments disparity.

President Barack Obama gave House Democrats a pep-talk today, and his speech (which wasn’t pre-written) got rave reviews from many Democrats. If only the Senate bill were as good as Obama made it sound. (UPDATE: I posted the White House transcript of Obama’s speech after the jump.)

House Democratic leaders have decided to ditch the “deem and pass” method for passing health insurance reform with a single vote, even though the legislative procedure isn’t as rare or controversial as Republicans would have you believe. Instead, the House will hold an hour of flood debate tomorrow on “the rule to allow reconcilation to get to the floor,” then House members will vote on the rule, then they will debate the Senate health insurance reform bill and vote on it. I assume this means that House Speaker Nancy Pelosi is confident she has the 216 votes she needs.

Bart Stupak is now claiming only about half a dozen Democrats are willing to vote against the bill unless it contains major new restrictions on private insurance coverage of abortion. Stupak was supposed to hold a press conference this morning, but he cancelled it, so maybe that means he didn’t get the deal he was hoping for from Pelosi. David Dayen speculates on who is still in the Stupak bloc. David Waldman warns about the prospect that Stupak will use a “motion to recommit” to try to get his anti-abortion language into the reconciliation fix package.

Outside the Capitol, tea party protesters shouted racist insults and held signs threatening gun violence if health care reform passes. Congressional Republicans should disavow this reprehensible behavior, but of course they won’t.

On Sunday, the House of Representatives will vote on the Senate’s health insurance reform bill and some “fixes” to that bill. The procedural details have not been fully worked out (David Waldman takes you through the weeds here and here), but it’s clear that the vote will be very close. House Speaker Nancy Pelosi needs to find 216 votes to pass the bill.

Various whip counts are floating around the internet. Take your pick from David Dayen’s version at FireDogLake, the Chris Bowers tally at Open Left, or the latest from The Hill staff. Several Democrats who voted against the House health care reform bill in November have announced plans to vote for this version. However, others who voted for the House bill remain undecided or have said they will vote no.

Today Peter DeFazio (OR-04) threatened to vote no on the bill because of changes in language on correcting geographical disparities in Medicare spending. DeFazio explained, “We spent months working this out. If we don’t get it in this bill, we will never get it.” The Huffington Post reported that other House Democrats share DeFazio’s concerns.

Because all three Iowa Democrats in the House strongly supported the changes to Medicare reimbursement rates that were included in the House bill, I contacted their offices today to find out whether they, like DeFazio, consider this issue a deal-breaker. I have not yet heard back from staffers for Representative Leonard Boswell (IA-03) or Dave Loebsack (IA-02), but a spokeswoman for Bruce Braley (IA-01) sent me this response:

Congressman Braley has spent hours in meetings with Speaker Pelosi and House Leadership this week, discussing the need to correct geographic disparities in Medicare reimbursement and how those corrections can be accomplished in this final bill.  Congressman Braley is still very much undecided on how he will vote on the reconciliation package and this is one of many factors that will play a role in his final decision.

I’ve never seen Braley on any list of wavering Democrats on the health insurance reform bill. If he and DeFazio do end up voting no, it will be much harder for Pelosi to find 216 votes. On the other hand, a compromise could be reached before Sunday:

At her press briefing Friday morning, House Speaker Nancy Pelosi (D-Calif.) was asked about Rep. Peter Defazio’s objections to the removal of the Medicare disparity fix from the final bill. “We’re working on that language,” said Pelosi. “I feel comfortable about where we are heading.” She said she supports the language that was in the House bill and is working toward restoring it as much as possible.

“We have reached agreement before,” she said of the dicey political issue.

I will update this post if and when I hear back from Loebsack’s and Boswell’s offices.

UPDATE: Loebsack’s spokeswoman confirmed that he will vote for the bill. Boswell seems like a firm yes as well, judging from an e-mail blast he sent yesterday, which I have posted after the jump.

SATURDAY UPDATE: Braley confirmed that he will vote for the bill because of the deal on Medicare reimbursement payments I discussed in more detail here.

Iowa Senators Tom Harkin and Chuck Grassley voted no on Tuesday as the Senate rejected an amendment to “establish a Bipartisan Task Force for Responsible Fiscal Action, to assure the long-term fiscal stability and economic security of the Federal Government of the United States, and to expand future prosperity and growth for all Americans.”

President Barack Obama supported creating that commission, which is the brainchild of Senate Budget Committee Chairman Kent Conrad. The goal is to find some way to get big Social Security and Medicare cuts through Congress. Don’t get me started on why a Democratic president and a bunch of Democratic senators are so keen on cutting the most successful programs Democrats have ever enacted.

Anyway, Conrad’s idea was for the commission to work out a comprehensive deficit reduction strategy, which Congress would be not be empowered to amend before voting on it. Two decades ago, a similar procedure was developed for recommending military base closings to Congress.

Conrad’s amendment, offered to a bill that raises the U.S. debt ceiling, failed on a bipartisan 53-46 vote. 36 Democrats, 16 Republicans and Joe Lieberman voted for creating the deficit reduction commission, while 22 Democrats, 23 Republicans and Bernie Sanders voted no (roll call here). Bloomberg News reported,

Conrad’s idea was attacked from the left and right, with groups such as the Washington-based anti-tax Americans for Tax Reform saying it would mean higher taxes while the AFL-CIO and NAACP said it would lead to cuts in federal benefits.

It was also opposed by lawmakers who lead congressional committees with authority over tax and spending programs. Among them are Senate Finance Committee Chairman Max Baucus of Montana, Appropriations Chairman Daniel Inouye of Hawaii, Commerce Committee Chairman Jay Rockefeller of West Virginia and Tom Harkin of Iowa, head of the health-care panel.

Senate Republican Conference Chair Lamar Alexander told Politico that Obama needs to “produce a Democratic majority in favor of” this idea if he wants more Republicans to vote for it.

During tonight’s State of the Union address, Obama is expected to announce plans to create his own deficit reduction commission. Bloomberg noted yesterday that “Such a panel’s recommendations ordinarily could be ignored by lawmakers, although Conrad, North Dakota Democrat, is trying to negotiate an agreement to guarantee a vote.”

Too bad the wrong North Dakota Democrat is retiring from the Senate.

Any relevant comments are welcome in this thread.

Following up on my review of news from the first half of last year, I’ve posted links to Bleeding Heartland’s coverage of Iowa politics from July through December 2009 after the jump.

Hot topics on this blog during the second half of the year included the governor’s race, the special election in Iowa House district 90, candidates announcing plans to run for the state legislature next year, the growing number of Republicans ready to challenge Representative Leonard Boswell, state budget constraints, and a scandal involving the tax credit for film-making.

Following up on the diary I posted this morning, this post compiles links to Bleeding Heartland’s coverage of national politics from July through December 2009. Health care reform was again the number one topic. I wish there had been a happy ending.

Oh no! Representative Leonard Boswell must be quaking in his boots now that the National Republican Campaign Committee is running this robocall against him in Iowa’s third district:

“Leonard Boswell spent 2009 helping liberal Speaker Nancy Pelosi push a massive government takeover of health care, a cap-and-trade energy bill that will increase costs for Iowa workers, and a massive $787 billion pork-laden spending bill that he called a stimulus but that has not helped the Iowa economy. Tell him your New Year’s resolution is to watch his votes in 2010 to make sure he is voting for Iowa families, not the liberal agenda of the Democrat party leaders in Washington.”

For years, Republicans have trotted out versions of this script against Boswell: blah blah blah Nancy Pelosi blah blah blah liberal agenda blah blah blah Democrat Party. It hasn’t resonated before, so why would it work now?

Specifically, I don’t think they will get far running against the stimulus package. Even in a weak economy, Boswell will be able to point to dozens of programs from the stimulus bill that benefited Iowa families. He has brought money to the district through several other bills passed this year as well. The Republican alternative, passing no stimulus and freezing federal spending, would have made the recession far worse.

The health care bill doesn’t even contain a weak public insurance option, let alone a “government takeover.” I don’t dispute that there will be plenty for the Republicans to attack in that bill, but Boswell will be able to point to items that benefit Iowans, such as new Medicare reimbursement rates to benefit low-volume hospitals (including Grinnell Regional Medical Center and Skiff Medical Center in Newton).

Boswell fought for concessions in the climate change bill that weakened the bill from my perspective but will be touted by his campaign as protecting sectors of the Iowa economy. Anyway, many people’s utility bills are lower this winter because the recession has brought down natural gas prices.

It’s fine with me if the NRCC wants to drain its coffers by funding robocalls like this around the country. I doubt they will scare Boswell into retirement or succeed in branding him as a Washington liberal.

Bleeding Heartland user American007 noted not long ago that Time Magazine often gives its “Person of the Year” award to people attempting to deal with a weak economy. So it was this year, when Time’s editors laughably chose Federal Reserve Chairman Ben Bernanke:

The story of the year was a weak economy that could have been much, much weaker. Thank the man who runs the Federal Reserve, our mild-mannered economic overlord

I wish I were joking, but here’s more from Time:

The overriding story of 2009 was the economy – the lousiness of it, and the fact that it wasn’t far lousier. It was a year of escalating layoffs, bankruptcies and foreclosures, the “new frugality” and the “new normal.” It was also a year of green shoots, a rebounding Dow and a fragile sense that the worst is over. Even the big political stories of 2009 – the struggles of the Democrats; the tea-party takeover of the Republicans; the stimulus; the deficit; GM and Chrysler; the backlash over bailouts and bonuses; the furious debates over health care, energy and financial regulation; the constant drumbeat of jobs, jobs, jobs – were, at heart, stories about the economy. And it’s Bernanke’s economy.

In 2009, Bernanke hurled unprecedented amounts of money into the banking system in unprecedented ways, while starting to lay the groundwork for the Fed’s eventual return to normality. He helped oversee the financial stress tests that finally calmed the markets, while launching a groundbreaking public relations campaign to demystify the Fed. Now that Obama has decided to keep him in his job, he has become a lightning rod in an intense national debate over the Fed as it approaches its second century.

But the main reason Ben Shalom Bernanke is TIME’s Person of the Year for 2009 is that he is the most important player guiding the world’s most important economy. His creative leadership helped ensure that 2009 was a period of weak recovery rather than catastrophic depression, and he still wields unrivaled power over our money, our jobs, our savings and our national future. The decisions he has made, and those he has yet to make, will shape the path of our prosperity, the direction of our politics and our relationship to the world.

Reality check: Bernanke has no plan to deal with unemployment, even though the “Federal Reserve Act dictates that one of the founding directives of the Federal Reserve is to ‘promote effectively the goals of maximum employment.’”

But Bernanke is wild about cuts to Social Security and Medicare. Hooray for our “mild-mannered economic overlord”!

The Senate Banking Committee votes on Bernanke’s renomination tomorrow, and he is expected to pass. However, three senators have said they will put a hold on his renomination when it reaches the floor.

I agree that the current recession could have deepened without the federal stimulus bill, especially if we had imposed the federal spending freeze Republicans wanted. But the stimulus should have been larger and better targeted toward job creation. Bernanke doesn’t favor any additional federal stimulus to create jobs. He shouldn’t even get another term at the Fed, let alone “Person of the Year.”

UPDATE: Proposed excise tax on insurance looking like a very bad idea too.

One key goal of “health insurance reform” was to prohibit insurance companies from limiting how many dollars they would spend on a patient’s care during a year. This makes sense if you want to eliminate medical bankruptcies, which are unknown in most of the developed world.

But the merged Senate health care bill gives insurance companies an out.

Last night a group of Senate Democrats reached some kind of compromise on the health care reform bill. Senator Tom Harkin “told reporters he didn’t like the agreement but would support it to the hilt” in order to get a bill through the Senate. Reports on the nature of the compromise varied, but Talking Points Memo seems to have the most details:

If this trade-off carries the day, the opt out public option is gone. […]

As has been widely reported, one of the trade-offs will be to extend a version of the Federal Employees Health Benefits Plan to consumers in the exchanges. Insurance companies will have the option of creating nationally-based non-profit insurance plans that would offered on the exchanges in every state. However, according to the aide, if insurance companies don’t step up to the plate to offer such plans, that will trigger a national public option.

Beyond that, the group agreed–contingent upon CBO analysis–to a Medicare buy in.

That buy-in option would initially be made available to uninsured people aged 55-64 in 2011, three years before the exchanges open. For the period between 2011 and 2014, when the exchanges do open, the Medicare option will not be subsidized–people will have to pay in without federal premium assistance–and so will likely be quite expensive, the aide noted. However, after the exchanges launch, the Medicare option would be offered in the exchanges, where people could pay into it with their subsidies.

It appears as if liberals lost out on a Medicaid expansion that would have opened the program up to everybody under 150 percent of the poverty line. That ceiling will likely remain at 133 percent, as is called for in the current bill.

In addition to the new insurance options, the group has tentatively agreed to new, and strengthened, insurance regulations, which the aide could not divulge at this time.

Those unspecified insurance regulations might refer to this:

Additionally, there was consensus support for a requirement long backed by Sen. Jay Rockefeller, D-W.Va., and other liberals for insurance companies to spend at least 90 percent of their premium income providing benefits, a step that supporters argue effectively limits their spending on advertising, salaries, promotional efforts and profits.

The health care bill approved by the House would require insurers to spend 85 percent of premium income on providing benefits. Upping that to 90 percent is even better; my concern is that if enforcement is left to state insurance commissioners, evasion will be widespread.

Chris Bowers is excited about three “meaningful concessions” Senate progressives received in exchange for dropping the (already weak) public option.

I’m off the bus, however, unless further details come to light about very good provisions buried in this compromise. This bill creates millions more customers for private insurers but doesn’t give Americans enough choices, doesn’t create a government plan to keep private insurers honest, and therefore is unlikely to reduce costs or solve the various problems of our current health care delivery system.

In the good news column, last night the Senate tabled (killed) Ben Nelson’s abortion amendment modeled on the Stupak language in the House health care bill. The vote was 54-45, with seven Democrats from conservative states voting with all but two Republicans (roll call here). Harkin voted to table this amendment, like most Democrats, while Chuck Grassley was on the other side.

UPDATE: Can any Obama fans defend this kind of action from his administration?

A proposal to enable the importation of cheaper prescription drugs could endanger the U.S. medicine supply and would be difficult to implement, the Food and Drug Administration said Tuesday. […]

But the Obama administration’s declaration on the eve of the vote could derail the amendment despite the fact that Obama co-sponsored Dorgan’s drug imports bill while a member of the Senate and that White House Chief of Staff Rahm Emanuel was a vocal proponent of the House version of the bill when he served as a member of the lower chamber.

Feel the hope and change!

SECOND UDPATE: The compromise still may not be enough for Joe Lieberman. They shouldn’t have given up on using the budget reconciliation process to pass a better bill with 51 votes.

The House of Representatives will soon bring a health care reform bill up for a floor vote. All three relevant committees have approved bills containing a public health insurance option. In August, Jacob Hacker explained one of the key differences between those bills (pdf file):

The versions of the House bill approved by the House Ways and Means Committee and  House Education and Labor Committee contain a Medicare tie-in that has two crucial  characteristics:

    1.  Providers participating in Medicare would automatically be considered participating  providers in the new public plan, although they would have the right to opt out.

    2.  Initial payments to providers would be set at Medicare rates plus 5 percent. After  three years, the Secretary of Health and Human Services could adjust rates. But  during the crucial start-up period, the public plan would be able to piggyback on  Medicare’s payment methodology. 17    

     These are good provisions. They would be even better if they included an explicit  protection of providers’ rights to join the public plan. Private plans (at least those that  participate in the exchange) should be prohibited from setting as a condition of participation  in their networks that providers not join the public plan.

     By contrast, the House Energy and Commerce Committee approved the House bill  with amendments that preserve only the first of these two elements. 18 Providers participating  in Medicare would be presumed to participate in the new public plan (but, again, allowed to  opt out). 19 However, rather than setting the rates the public plan would pay providers on the  basis of Medicare rates, the Secretary of Health and Human Services would have to  “negotiate” rates directly with providers. 20 These rates in the aggregate would have to be  between Medicare rates and private rates, but no other details are given. 21 This is a not-so-good provision that could drive up individual premiums and federal costs, burdening  Americans as health care consumers and taxpayers alike. It threatens the viability of the  public plan because it may require the government to pay providers higher rates than they would otherwise accept if the rates were set.

Click here to download Hacker’s full report, which includes analysis of the Senate HELP Committee’s bill.

When the House Energy and Commerce Committee passed a watered-down bill to placate Blue Dog Democrats, most people assumed that this compromise would be the health care reform bill sent to the House floor. However, House Progressives have been rounding up votes for the stronger public option provisions, and yesterday Progressive Caucus co-chair Raul Grijalva claimed to have 210 votes supporting or leaning toward supporting the stronger bill. Speaker Nancy Pelosi won’t bring that bill to the floor unless she is sure she has the 218 votes needed to pass, however. As many as 19 House Democrats have not decided whether they would support the “Medicare plus 5 percent” public option.

Chris Bowers published a pdf file listing 36 House Democrats who are either undecided, “lean yes” or “lean no” on the stronger public option. Representative Leonard Boswell (IA-03) is on that list. It’s not clear whether he is undecided or leaning one way or the other. I have sought clarification from his office and will update this post when I hear back.

You know the drill. Boswell needs to hear from as many constituents as possible. The “Medicare plus 5 percent” version of the public option is better policy, and if the House approves it, our negotiating position in the Senate will be stronger. I would call Boswell’s office rather than e-mail, because phone calls are harder for staffers to ignore. Office contact information:

Washington DC Office

Phone: (202) 225-3806

Fax: (202) 225-5608

Iowa District Office

Phone: (515) 282-1909

Fax: (515) 282-1785

Toll Free Phone: (888) 432-1984

In related news, Boswell joined Representatives Bruce Braley (IA-01) and Dave Loebsack (IA-02) today in announcing final legislative language to change “the way Medicare pays healthcare providers for services, from its current fee-for-service system into a quality and value-based system.” After the jump I’ve posted a joint press release explaining how this deal will affect Medicare reimbursement rates.

UPDATE: Supposedly there are at least 218 votes in the House for the “robust” public option. The deal on Medicare reimbursement rates helped secure some extra votes for the public option. Also, the House bill will strip the insurance industry of its anti-trust exemption.

CORRECTION: Apparently we don’t have 218 votes for the stronger public option after all.

For months, White House officials and Senate leaders praised the “gang of six” negotiations toward a bipartisan deal on health care reform, even as other observers doubted the Republicans in that group were negotiating in good faith. At the beginning of the summer recess in August, Senator Jay Rockefeller (who was shut out of the deal-making) warned:

Changes to the bill have been frustrating, Sen. Jay Rockefeller (D-W.V.) told reporters at a press conference, particularly given that the Republicans — Mike Enzi of Wyoming, Chuck Grassley of Iowa and Olympia Snowe of Maine — are, in his opinion, just stalling for time.

“You just watch as the bill diminishes in its scope, in its coverage, in its ferocity to try to attack the problem. I don’t know where it will come out,” Rockefeller said. “My own personal view is that those three Republicans won’t be there to vote it out of committee when it comes right down to it, so that this all will have been a three-or-four-month delay game, which is exactly what the Republicans want.”

No Republicans stood with Senate Finance Committee Chairman Max Baucus last week as he finally unveiled what David Waldman described as “a plan that amounts to capitulating to every Republican demand, and then adding a heaping pile of political suicide on top of it.” The bill is in markup this week, and CA Berkeley WV has been blogging the Senate Finance Committee meetings for Congress Matters (day one, day two and day three).

Where does ranking Finance Committee member Grassley stand after Baucus bent over backwards to keep negotiating with him all summer? After the jump I’ve posted the relevant portion of a transcript from Grassley’s September 24 telephone news conference with Iowa reporters. The short version is, he’s against the bill because:

1. The individual mandate to buy health insurance amounts to “[q]uite a steep tax for people that maybe don’t pay a tax.”

2. Democrats supposedly were “not willing to go far enough” on enforcement to make sure illegal immigrants wouldn’t be covered.

3. Democrats supposedly “weren’t willing to go far enough to make sure that the subsidy through the tax credit was not used to finance abortions.”

4. You shouldn’t be “increasing taxes and cutting Medicare” when “we’re in depression.”

I told Iowa Republicans not to worry about Grassley voting for any health care reform bill. Senate Democrats should reject the concessions Baucus made to win GOP votes that are now off the table.

Senator Tom Harkin told a crowd of nearly 2,000 people today that health care reform including a public health insurance option will pass before this Christmas. Speaking at his 32nd Annual Steak Fry in Indianola, Harkin joked,

“This is my kind of town-hall meeting,” […] because he didn’t see any Republicans standing up to say, “Keep your government hands off my Medicare.”

Harkin and event headliner Al Franken predicted that health care reform would pass with some Republican votes, which seems unlikely if the final version of the bill contains a public option. Republican Senator Olympia Snowe of Maine has been the focus of White House courting on health care, but she opposes a public option, apparently because it has the potential to provide lower-cost health insurance.

The Senate Committee on Health, Education, Labor and Pensions passed a bill this summer containing a public option, but according to one critic, the HELP bill’s public option is anything but robust:

the actual provisions in the HELP Committee bill call for numerous “community health insurance options,” not the single “Medicare-like” plan promised by “public option” advocates. That means the individual “options” will probably be as small and weak as the co-ops now under discussion in the Senate Finance Committee. More importantly, these “community options” will almost certainly be run by insurance companies.

The public option in the bill that cleared the House Energy and Commerce Committee, HR 3200, is also weak in several respects.

President Barack Obama met with 17 relatively conservative Democratic senators on Thursday, reinforcing many people’s fears that he was ready to discard the public option. The same day, Harkin assured the Progressive Populist blog that 51 votes can be found in the Senate for a bill with a public option.

So what about all the hubub about the Blue Dogs and/or Progressives opting out if the bill doesn’t meet their liking? Harkin said don’t put too much stock in those statements.

“Look, around here people are always jockeying for power. That’s all this is,” Harkin said.

The only chance of making this bill stronger, in my opinion, is getting a large bloc of House Democrats to draw a line in the sand. If you live in Iowa’s first, second or third Congressional districts, please contact Bruce Braley, Dave Loebsack or Leonard Boswell to urge them not to accept any bill containing a “trigger” (which is guaranteed to fail) or some other fake public health insurance option. Organizing for America has a new petition out if you prefer that method of generating an e-mail to your member of Congress.

UPDATE: Don’t miss John Deeth’s entertaining liveblog from this event, with lots of photos. Braley and Loebsack praised Boswell for standing up for a public option (unlike many Blue Dogs).

From Chase Martyn’s write-up at Iowa Independent:

Boswell and fellow Democratic U.S. Reps. Bruce Braley and Dave Loebsack also expressed optimism that a final bill would include measures to reform medicare reimbursement rates. Medicare currently pays doctors in rural states like Iowa less than what doctors in densely populated states receive for the same procedures.

Like Spinal Tap’s amp that goes up to 11, Bob Vander Plaats can ratchet up the demagoguery that little bit more than the competition. While other conservatives warn against compromising the Republican Party’s core principles, Vander Plaats says Republican moderates make voters want to throw up, like Jesus when confronted with “lukewarm” followers.

While other conservatives back a constitutional amendment to ban same-sex marriage (which would take years to adopt), Vander Plaats promises to stop gays and lesbians from getting married on his first day as governor of Iowa.

While other conservatives warn against a “government takeover” of health care, Vander Plaats isn’t just against a new public health insurance plan, he wants to protect Iowans from the tyranny of federal-run Medicare and Medicaid.  

I was encouraged earlier this year when Congressman Leonard Boswell (IA-03) signed on to Health Care for America Now’s core principles, and his spokesman assured me that Boswell was strongly committed to a public health insurance option. More recently, however, Boswell left himself wiggle room when asked about the public option, so I was eager to hear about his town-hall event in Sigourney on Thursday.

Unfortunately, I have more questions than answers after reading this Radio Iowa report. (continues after the jump)

The offices of Congressmen Bruce Braley (IA-01), Dave Loebsack (IA-02) and Leonard Boswell (IA-03) announced big news on Friday afternoon:

Boswell, Loebsack, and Braley helped negotiate a compromise adding language to the healthcare reform bill changing Medicare to a quality-based payment system in two years.  Specifically, the compromise would (1) require Medicare to conduct a two-year study on a value-based system, and (2) at the end of the two year study period, Medicare would switch to a quality-based system unless Congress specifically cast a vote to disallow that change. […]

Medicare currently operates under a fee-for-service system, basing payments to doctors and hospitals on the amount of procedures completed and the number of patients seen.  This system creates a financial incentive to order more and more procedures.  Ironically, according to many studies, this increased number of procedures does not result in better outcomes for patients.

Boswell, Loebsack, and Braley have strongly advocated a switch to a Medicare payment system based on value and quality, which determines payments based on procedures’ effect on patient health.  In June, Rep. Braley introduced the Medicare Payment Improvement Act with Rep. Ron Kind (D-WI).  Reps. Boswell and Loebsack are co-sponsors of the legislation.  The bill would have required Medicare to switch to a quality-based payment system, outlining specific details on how to measure quality and value.

If Congress adopts a health care bill containing this provision, it will be very good news for Iowa health care providers, who are reimbursed by Medicare at much lower rates than in some other parts of the country. I’ve posted the whole press release from Braley’s, Loebsack’s and Boswell’s offices after the jump.

On a related note, Iowans who support a strong public health insurance option should contact Boswell’s office. There is some confusion surrounding his position on this issue. He expressed support for a public option in June. In early July he signed a good letter from a group of Blue Dogs and New Democrats advocating for a public option. However, when confronted on camera this week, Boswell said he wasn’t against a public option and wants to see the final version of the health care bill before making a decision.

A public option could provide coverage and competition in the majority of U.S. markets that are currently dominated by one or two private health insurance providers. It also could save hundreds of billions of dollars. Supporters of the public option can Stand With Dr. Dean here. Please also consider signing up with Health Care for America Now. Senators Richard Durbin, Patrick Leahy and Chuck Schumer set up this online petition supporting a public option as well.

In other health care reform news, Senator Tom Harkin is rightly frustrated that the Congressional Budget Office scoring of the Senate Health, Education, Labor and Pensions Committee bill didn’t include any cost savings from the prevention measures Harkin fought to have included. He’s concerned that the language on prevention might not survive Senate negotiations:

“We got a lot of savings out of it. But they just don’t score it that way. And I’ve got to fight like the dickens to make sure we keep it in there,” he added. “Otherwise, people will say, ‘We’ve got some costs here. But we don’t have any savings, and since we have costs, not savings, we’ll throw that overboard.’ “

Thanks for fighting the good fight, Senator Harkin. Private sector companies that have focused on prevention have reduced costs for treating some chronic conditions.

UPDATE: Boswell’s official website explains his position on health care. He seems focused on whether the public option will be “self-sustaining and deficit neutral,” as opposed to whether it will provide competition or coverage to his constituents who are badly served by the status quo.

Funny, I don’t ever remember Boswell insisting that other government spending (like agriculture subsidies) need to be self-sustaining or deficit neutral. If universal health care isn’t worth spending public money on, what is?

Congressman Leonard Boswell still supports a health care reform bill containing a public option that would go into effect immediately, Boswell’s spokesman Mark Daley confirmed today via e-mail.

Background and details are after the jump.

Over Thanksgiving my family (all Barack Obama voters in the general) were talking about what we’d like to see him do as president. One of my biggest concerns about Obama has always been that he would compromise too much in the name of bipartisanship and not seize the opportunity to get groundbreaking legislation through Congress. I’ve also worried that he would water down good policies that threaten to significantly bring down his approval rating.

From my perspective, Bill Clinton’s presidency was not very successful for a lot of reasons. Some of them were his fault: he put the wrong people in charge of certain jobs, and he picked the wrong battles and listened too much to Wall Street advisers when it came to policy.

Some things were not Clinton’s fault: the Democrats who ran Congress in 1993 and 1994 were not always interested in working with him, and the leaders of the Republican-controlled Congress were more interested in destroying his presidency than anything else.

After getting burned in the 1994 elections, Clinton hired Dick Morris as a political adviser and moved to the right in order to get re-elected. He served a full two terms, but he didn’t leave a mark on this country. His greatest achievement, balancing the budget, was undone quickly by his successor. Many smaller successes on environmental and social policies were also reversed by George Bush’s administration.

Clinton approved a bunch of good presidential directives, especially on the environment, during his last 60 days in office. Doing them years earlier would not only have been good policy, it also would have prevented Ralph Nader from gaining so much traction in 2000.

Clinton left some very big problems unaddressed, like global warming and our reliance on foreign oil, because the obvious solutions to these problems would have been unpopular.

Compare Clinton’s legacy to that of Lyndon Johnson. Although Johnson made terrible mistakes in Vietnam (continuing and compounding mistakes made by John F. Kennedy), he enacted a domestic agenda that changed this country forever. Some of Johnson’s achievements were popular (Medicare), while others cost the Democrats politically in many states (the Civil Rights Act). But Johnson did not shy away from big change on civil rights because of the political cost.

I understand that no president will ever do everything I’d like to see done. I’d be satisfied if Obama enacted a groundbreaking, lasting improvement in one or two big areas, like health care or global warming. The right policies often have powerful enemies. I would rather see Obama get good laws passed to address a couple of big problems, even if doing so costs him the 2012 election.

My fear is that in Obama will end up like Bill Clinton–a two-term president who didn’t achieve anything that will continue to affect Americans’ lives four or five decades down the road.

If Obama only goes to the mat to accomplish one or two big things, what should they be? Keeping his promise to end the war in Iraq? Getting universal health care through Congress? Taking real steps to address climate change? Enacting a huge public-works program to deal with unemployment? Building high-speed rail connecting major American cities?

Would you be satisfied with progress in one or two areas, even if it meant that Obama was not re-elected in 2012?

After the jump I’ve posted a “meme” on being bold in your personal life, which is going around some of the “mommy blogs.” Some of the questions have more to do with luck or having money than with taking risks or being bold, though.

On Tuesday the House overrode George Bush’s veto of a bill that stopped planned cuts in the Medicare reimbursement rate for doctors. It’s the fourth time Congress has voted to override Bush’s vetoes. This is the bill that just barely cleared the Senate because of Ted Kennedy’s return.

This diary by noweasels has the story and links to the roll-call votes, along with a lot of comments about how this law will affect people. TomP has some background on Medicare and how it was adopted.

The House vote was 383-41. In the Iowa delegation, Bruce Braley, Dave Loebsack and Tom Latham voted yes on the override. Steve King voted no. Leonard Boswell was among the 11 representatives who missed the vote.

The Senate vote was 70-26, with Tom Harkin voting yes and Chuck Grassley voting no. Barack Obama and John McCain were among the four senators who missed the vote.

Barack Obama has released a strong statement on the Medicare bill that the U.S. Senate passed yesterday. John McCain opposed the bill but did not show up to vote against it.

Obama’s statement begins by briefly explaining why he is right and McCain is wrong:

“Today, the U.S. Senate took a major step forward in addressing the needs of seniors and military families all across this nation.  At a time when doctors are facing double digit increases in the costs of providing care, I am proud to have joined with my colleagues to stop a devastating cut in physician reimbursement that would have caused them to shut the door to many Medicare and Tricare beneficiaries.  John McCain has said that he would have opposed this bill, demonstrating yet again that he’s more than willing to put the interests of the health insurance industry over our nation’s 44 million seniors and 9 million uniformed service members,” said Senator Barack Obama.

The release then cites numbers calculated by the American Medical Association on the impact of this bill in 19 states (which just happen to be states contested in the presidential race). For each state, five numbers are given:

-the dollar amount in Medicare payments that would have been lost by December 2009 if the bill had not passed

-the average dollar amount each physician would have lost in reimbursements

-the number of employees who would have been affected

-the number of Medicare patients who would have been affected

-the number of TRICARE patients who would have been affected

For instance,

Iowa:

         Payments Lost by Dec. 2009: $110 million

         Average Physician’s Loss: $17,000

         People Affected:       27,095 employees,

468,637 Medicare patients

41,891 TRICARE patients

The format makes it quick and easy for a newspaper editor or broadcast news producer in any of these 19 states to cast this story in a favorable light for Obama and an unfavorable light for McCain.

The full text of the press release is after the jump.

Ninety-nine senators showed up today to vote on a Medicare bill, including Ted Kennedy, who recently had brain surgery and wasn’t scheduled to return to the Senate until September. (Here’s some background on the content of the bill.)

Kennedy’s vote was needed to break a Republican filibuster. Once it was clear Democrats had the 60 votes for cloture, a bunch of Republican senators flipped and voted with Democrats, so the final vote was 69-30.

John McCain was the only senator to skip this vote.

In fact, John McCain has missed more than half the Senate votes this year, including dozens after he had already locked up the GOP nomination.

By the way, the GOP stand on this Medicare bill has caused them to lose a lot of support from doctors and from the American Medical Association, which has traditionally supported Republicans.

For the past several Tuesdays, I have been posting diaries in support of John Edwards on the front page of MyDD.

This week I wrote a diary about Edwards' performance at the AARP forum in Davenport last Thursday. I thought it was a strong debate for all who participated, but I wanted to call attention to some particularly strong moments for Edwards.

The diary is long, so I put it after the jump. I welcome your feedback.

Tomorrow night there's another MSNBC debate. I don't have high hopes for the quality of the discussion, given the format and moderation of the previous debates hosted by that network.