Assuming the House and the Senate pass whatever health insurance bill comes out of the conference committee, Republicans and Democrats are likely to highlight the reform during next year’s campaigns. Recent polls have shown that most Americans don’t expect action by this Congress to improve the quality of their own health care or reduce its cost. Complicating matters for Democrats, key provisions of the bill won’t take effect until 2013 or 2014, giving Republicans plenty of time to exploit fears about the so-called “government takeover” of health care.

After the jump, Mariannette Miller-Meeks and Senator Chuck Grassley preview messages we’ll hear from GOP candidates across the country, while Senator Tom Harkin summarizes some “immediate benefits” of the health insurance reform.

Senator Tom Harkin’s commitment to end the abuse of the filibuster hasn’t waned just because Democrats managed to find 60 votes to pass health insurance reform. Harkin discussed the current dysfunction in the Senate with Ezra Klein:

In the past, we’ve always had one or two or three senators who would try to block something. The most famous was Jesse Helms. He could tie people up in a conniption. But the thing is, when he went too far, his leader, Bob Dole, wouldn’t put up with it. Neither would Trent Lott. And later on, even Bill Frist. You allow him to do so much, and after awhile, you say, that’s enough.

Now we have more of the Jesse Helms. The Vitters and DeMint and Coburn, and maybe throw in Inhofe and a couple other newcomers, and they now run the minority. You don’t have a minority leader putting them in check, saying we have to work together. Dole would never put up with what’s going on over there. Neither would Trent Lott. We’ve had 101 objections from Republicans to proceeding. […]

You’re supposed to filibuster something that is a deep seated issue. But in September, we had an extension on unemployment insurance. We had a filibuster that lasted over three weeks. They held up everything. And in the end, the vote was 97 to one. Filibusters are no longer used to debate something, but to stop everything. […]

The idea is to give some time for extended debate but eventually allow a majority to work its will. I do believe there’s some reason to have extended debate. If a group of senators filibusters a bill, you want to take their worries seriously. Make sure you’re not missing something. My proposal will do that. It says that on the first vote, you need 60. Then you have to wait two days, and on the third day, you need 57 votes. And then you need to wait two days, and on the third day, it’s 54 votes. And then you’d wait another two days, and on the third day, it would be 51 votes.

Harkin told Klein he will start looking for co-sponsors for this measure next month. Freshman Senator Jeff Merkley presumably will be an ally, as he has advocated reform of Senate procedures. Unfortuantely, Harkin is likely to run up against stiff resistance, and not only from Republicans. The de facto supermajority requirement for conducting Senate business empowers corporate hacks like Joe Lieberman, Blanche Lincoln and Evan Bayh, who caucus with Democrats but don’t support most of the progressive agenda.

Senators approved the health care reform bill 60-39 as Vice President Joe Biden presided over the Senate’s first Christmas Eve session in at least four and a half decades. It was the expected party-line vote, with Republican Jim Bunning absent.

More updates and reaction to this vote to follow.

Yesterday Tom Harkin asked for unanimous consent to move up the final health care vote to make it easier for some members to spend Christmas with their families, but Republican David Vitter of Louisiana said no.

Speaking of health care maneuvering, Joe Lieberman’s brand has taken a hit this month. It’s no mystery why. As Nate Silver observed here and here, being at the center of the health care reform debate tends to bring senators’ approval ratings down.

Recent polls have shown Chuck Grassley still above 50 percent approval, but with far less support than he has enjoyed for most of his career. He has already been running some positive television ads, but I don’t think he’ll be able to get his numbers back up to the 70 percent range by next year’s election. Nevertheless, Grassley’s Democratic challenger will need to make a broad-based case against him, because his double-dealing on health care reform won’t be the focus of news coverage next fall.

After this morning’s health reform vote, the Senate moved on to raise the debt ceiling. Retiring Republican George Voinovich of Ohio voted yes, making up for the no vote by Democrat Evan Bayh of Indiana.

UPDATE: On Tuesday Chris Bowers previewed some of the key fights coming up as House and Senate members reconcile their bills in conference.

From a statement Richard Trumka of the AFL-CIO released today:

SECOND UPDATE: This chart at the Washington Post site shows how each senator voted, how much he or she has received in campaign contributions from the health industry, and what percent of that state’s residents lack health insurance.

Last night the U.S. Senate voted 60 to 40 to move forward with debate on the health insurance reform bill. All senators who caucus with Democrats voted for cloture, and all Republicans voted against. The breakthrough came on Saturday, when Senate Majority Leader Harry Reid secured Senator Ben Nelson’s support with extra money for Medicaid in Nebraska and new language on abortion.

At Daily Kos mcjoan published a good summary of what’s in the latest version of the bill.

Reid reportedly promised Nelson a “limited conference” on this bill, meaning that very few changes will be made to the Senate version. However, it’s far from clear that the House of Representatives will approve the Senate’s compromise. About two dozen House Democrats plan to vote against health care reform no matter what, meaning that it will only take 15-20 more no votes to prevent supporters from reaching 218 in the House.

Bart Stupak, lead sponsor of the amendment restricting abortion coverage in the House bill, has been working with Republicans against the Senate’s abortion language. Meanwhile, the leaders of the House pro-choice caucus have suggested the Senate language may be unconstitutional.

Even before Reid struck the final deal with Nelson, Representative Bruce Braley told the Des Moines Register, “I think the real test is going to be at the conference committee and if it doesn’t improve significantly, I think health care reform is very remote based on what I’m hearing in the House.”

Senator Tom Harkin has done several media appearances in recent days defending the Senate compromise. He seems especially pleased with the Medicaid deal for Nebraska:

The federal government is paying for the entire Medicaid expansion through 2017 for every state.

“In 2017, as you know, when we have to start phasing back from 100 percent, and going down to 98 percent, they are going to say, ‘Wait, there is one state that stays at 100?’ And every governor in the country is going to say, ‘Why doesn’t our state stay there?’” Harkin said. “When you look at it, I thought well, god, good, it is going to be the impetus for all the states to stay at 100 percent. So he might have done all of us a favor.”

Ezra Klein has posted some amazing spin this morning about how the Senate bill is “not very close to the health-care bill most liberals want. But it is very close to the health-care bill that Barack Obama promised.” Sorry, no. Obama campaigned on a health care plan that would control costs and include a public insurance option, drug re-importation, and letting Medicare negotiate for lower drug prices. Obama campaigned against an individual mandate to purchase insurance and an excise tax on insurance benefits.

Those of you still making excuses for Obama should listen to what Senator Russ Feingold said yesterday:

“I’ve been fighting all year for a strong public option to compete with the insurance industry and bring health care spending down,” Feingold said Sunday in a statement. “Unfortunately, the lack of support from the administration made keeping the public option in the bill an uphill struggle.”

Republican Senator Olympia Snowe was about as unprincipled and two-faced during this process as White House officials were. She voted for the Senate Finance Committee’s bill in October and had suggested her main objection to Reid’s compromise was the inclusion of a public health insurance option. Yet Snowe remained opposed to the bill even after the public option was removed last week. Because of her stance, Reid cut the deal with Nelson. The supposedly pro-choice Snowe could have prevented the restrictions on abortion coverage from getting into the bill if she had signed on instead.

Speaking of Republicans, the Iowa Republican posted this rant by TEApublican: “Nebraska And Huckabee Respond To Ben ‘Benedict’ Nelson’s Christmas Senate Sellout.” If you click over, be prepared to encounter mixed metaphors and misunderstandings about what this “reform” does. Still, the rant is a good reminder of how Republicans will still scream about government takeovers even though corporate interests got everything they wanted out of the bill.

I have had it with e-mail blasts like the one I got over the weekend from J.B. Poersch of the Democratic Senatorial Campaign Committee:

Republicans tried every trick in the book to block us, but Senate Democrats scored important health care reform wins in the past two weeks. We passed the Mikulski Amendment, to make sure every woman gets crucial cancer screenings. And we defeated the Senate’s version of the Stupak Amendment – one of the biggest attacks on choice in a generation.

But these wins didn’t faze the Republicans. A lot of what they are doing to kill the Senate’s bill isn’t making the headlines – but that doesn’t make it any less insidious. We’ve pulled together facts on their latest heinous tactics in our new Obstruction Report.

The Constitution does not contain a supermajority requirement for ordinary legislation to pass the Senate, but the filibuster has evolved into a means to kill any bill unless 60 senators support it.

The current use of the filibuster is not “traditional.” This memo from December 1964 shows that no one imagined Medicare would need more than a simple majority in the Senate. There was no expectation that Lyndon Johnson’s reform efforts would fail if Medicare couldn’t command a filibuster-proof majority.

Senator Tom Harkin tried to change Senate rules on the filibuster in 1995, and the Burlington Hawk Eye reports that he may try again, “Given what he sees as the abuse of power by a couple members of his own party whom he said are threatening to join the minority party if their every demand is not met.”

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.

Members of the House Populist Caucus, chaired by Representative Bruce Braley (IA-01), held a press conference on Thursday to endorse a bill that would “assess a small fee on Wall Street day traders to pay down the national deficit and invest in America’s middle class families.”

Details about the bill are after the jump.

Yesterday the U.S. Senate unanimously confirmed Stephanie Rose and Nick Klinefeldt to be the U.S. Attorneys in Iowa’s northern and southern districts, respectively. Senator Tom Harkin recommended Rose and Klinefeldt for those positions in March, and President Barack Obama nominated them in September.

Some defense and immigration attorneys criticized Rose’s nomination because of her role in last year’s Postville prosecutions. Harkin and Senator Chuck Grassley defended Rose’s qualifications for the U.S. attorney position.

I still think the Senate Judiciary Committee should have thoroughly examined the treatment of Postville detainees before voting to confirm Rose. The Supreme Court ruled unanimously in May that “federal prosecutors have inappropriately used aggravated identity theft laws to prosecute undocumented workers.” Most of the fast-track Postville prosecutions were identity-theft cases. I sincerely hope that under Rose’s leadership, the U.S. Attorney’s office in the northern district will treat alleged illegal immigrants more fairly in the future.

Main Justice posted a short bio of Klinefeldt here and a short bio of Rose here. Those pages include links to the nominees’ full Senate Judiciary Committee questionnaires (pdf files).

I’m heading to the Iowa Democratic Party’s Jefferson-Jackson Dinner. I won’t be blogging there, but I will update this post with some highlights when I get home.

If you’d like to watch online, the IDP will be livestreaming the proceedings here, beginning at 6:30 pm central.

Senator Tom Harkin has taped a video greeting for the event, because he’s in Washington as the Senate begins to debate the health care reform bill. Democrats have all 60 votes they need to bring the bill to the floor, but several members of the caucus have not ruled out backing a Republican filibuster before the final vote. I won’t be supporting the Democratic Senatorial Campaign Committee this cycle, because I don’t want a penny going to a dishonest tool like Blanche Lincoln. She’s probably going to lose anyway.

In addition to any comments about health care reform or the JJ Dinner, please consider this an open thread for anything that’s on your mind this weekend.

For comic relief: in the middle of this afternoon’s Senate proceedings, Chuck Grassley tweeted,

Can somebody tell me why Wall st Journal no longer list Des Moines in its weather cities list. Iowa still exists

UPDATE: I hadn’t been to the JJ dinner in a few years and had a great time. Iowa House Majority Leader Kevin McCarthy and Iowa Senate Majority Leader Mike Gronstal were making fun of each other when the bucket was passed around for extra donations.

McCarthy: What’s the difference between God and a state senator? God doesn’t think he’s a state senator.

Gronstal: What’s the difference between House representatives and boy scouts? Boy scouts have adult supervision.

Speakers: Bruce Braley, Leonard Boswell, Patty Judge, Chet Culver, and Tom Harkin’s recorded video before Biden. (Dave Loebsack is out of the country.)

Huge ovation shortly after 8 pm when IDP chair Michael Kiernan came on stage to announce that the U.S. Senate defeated a filibuster of the motion to bring the health care reform bill to the floor, 60-39. Harkin promised in his video that they will get a health care reform bill bassed before the end of the year, and it will contain a public health insurance option.

Biden gave a great speech, with plenty of jokes, Irish poetry, quiet moments and a few lines that got the crowd on their feet. He apologized for being a little late; he had been on the phone with some unnamed senators whose votes he had helped sway on health care reform.

I had to leave right after Biden’s speech, so I missed the after-party, where U.S. Senate candidates Bob Krause, Roxanne Conlin and Tom Fiegen were set to speak. If you were there, post a comment or a diary to let us know how those speeches were.

SECOND UPDATE: After the jump I’ve posted Kiernan’s remarks and excerpts from Culver’s speech.

FINAL UPDATE: The Iowa Democratic Party posted a slideshow from the event here.  

Politicians in both parties have complained that proposed federal climate change bills are “unfair” to Midwestern states, which rely largely on coal to generate electricity. Utility companies and corporate groups have tried to reinvent themselves as defenders of the public interest against those who would unjustly “punish” consumers living in coal-dependent states.

Physicians for Social Responsibility released a report this week on “Coal’s Assault on Human Health.” This report should be required reading for all members of Congress, especially Senator Tom Harkin and other Democrats who have demanded more subsidies for coal-burning utilities in the climate-change bill. From the executive summary (pdf file):

Coal pollutants affect all major body organ systems and contribute to four of the five leading causes of mortality in the U.S.: heart disease, cancer, stroke and chronic lower respiratory diseases. […] Each step of the coal lifecycle–mining, transportation, washing, combustion, and disposing of post-combustion wastes–impacts human health. Coal combustion in particular contributes to diseases affecting large portions of the U.S. population, including asthma, lung cancer, heart disease, and stroke, compounding the major public health challenges of our time. It interferes with lung development, increases the risk of heart attacks, and compromises intellectual capacity.

In yesterday’s Des Moines Register, Lee Rood highlighted some of the extra burdens Iowans bear because of coal-fired power plants. Follow me after the jump for more.

Few problems require federal action more urgently than global warming. I admire the members of Congress who have been trying to address this issue. House Energy and Commerce Committee Chairman Henry Waxman tried to get the best deal he could. Senator John Kerry has tried to keep things moving in the upper chamber. Senator Lindsey Graham is getting tons of grief from fellow Republicans because he admits that climate change is a problem.

I want to support these people and their efforts to get a bill on the president’s desk. Unfortunately, the time has come to accept that Congress is too influenced by corporate interests to deal with climate change in any serious way. Pretending to fight global warming won’t solve the problem and may even be counter-productive.

This depressing post continues after the jump.

The Des Moines Register released more results from its latest Iowa poll by Selzer and Co., and Senator Chuck Grassley’s approval rating was 57 percent, the same as in the Register’s September poll. Only 32 percent of respondents said they disapproved of Grassley’s work.

Grassley’s 57 percent approval figure remains well short of the 75 percent he began the year with. […]

Political independents and Democrats have been responsible for much of Grassley’s slide since January. He made up little ground with them this fall. […]

More than half of Republicans say he did an excellent or good job on health care, while only about a quarter of Democrats and 39 percent of independents rate his work positively.

In a head to head matchup against Roxanne Conlin, Grassley led 57 percent to 30 percent. Last month’s Research 2000 poll of Iowans found Grassley leading Conlin by a much narrower margin, 51 percent to 39 percent. I’d like to see more polling of this race, but given Selzer’s track record in Iowa, I’m going to assume that the Register poll is close to the mark.

Since the media won’t be as focused on health care reform in the autumn of 2010, Democrats will need to build a case against Grassley that goes beyond his double-dealing on that issue. Even if Democrats run a near-perfect campaign against Grassley, he is very likely to be re-elected unless he makes some unforced errors.

On the other hand, it’s worth remembering that Grassley’s never been re-elected with less than 66 percent of the vote before. Holding him below 60 percent, or better yet below 55 percent, would greatly help down-ticket Democratic candidates next November.

Incidentally, Selzer’s poll for the Register found Senator Tom Harkin’s approve/disapprove numbers at 54/33, which is fairly strong but down from the 70 percent approval rating Harkin had in the Register’s January poll.  

Health Care for America NOW and the American Federation of State, County and Municipal Employees are running television ads this week thanking 20 Democrats in relatively tough districts who voted for the House health care reform bill last Saturday. If you live in the Des Moines viewing area, you may have seen this commercial about Congressman Leonard Boswell:

Corporate-funded conservative groups have targeted Boswell in negative ads this year because of his vote for the climate-change bill in June. Ads attacking the health care reform project (many funded by insurance industry fronts or the Chamber of Commerce) have been plentiful this summer and fall too. It makes sense for reform advocates to thank Boswell, as Iowa Republicans are gearing up to challenge him with State Senator Brad Zaun or some other well-known figure.  

In other health care reform news, Tom Harkin is among the Senate Democrats trying to keep the "Stupak amendment" language on abortion out of the Senate's version of health care reform. He's absolutely right that some people pushing amendments are trying to kill the bill rather than make it better. A lot of questions have been raised about whether defeating the bill was Representative Bart Stupak's main goal. Since 1992, Stupak has been involved with the fundamentalist Christian "Family" group and has lived in their house on C Street in Washington.  

Stupak claims that as many as 40 House Democrats would reject health care reform without his amendment, but yesterday House Whip James Clyburn said the Stupak amendment only gained 10 votes for the bill. Meanwhile, more than 40 House liberals are threatening to vote down the final bill out of conference if it contains the Stupak language.  

Final note: MyDD user Bruce Webb wrote an interesting piece about what he views as "the most important and overlooked sentence" in the House health care reform bill:  

Most of the criticism of HR3962 coming from the left revolves around the belief that the House bill has no premium and so no profit controls, that it in effect delivers millions of Americans into the hands of insurance companies who can continue to raise premiums at will while denying care by managing the risk pool in favor of those unlikely to make claims. This just is not true, not if the provision in this one sentence is properly implemented. In a stroke it guts the entire current business model of the insurance companies, based as it is on predation and selective coverage, and replaces it with a model where you can only make money by extending coverage to the widest range of customers and or delivering that coverage in a more efficient way.

 Like they say, go read the whole thing.
 

Iowans Nick Klinefeldt and Stephanie Rose were among three U.S. attorney nominees the Senate Judiciary Committee approved today by unanimous consent, the Main Justice blog reported. Their nominations still need to be confirmed by the full Senate, but that is likely to be a formality. In March, Senator Tom Harkin recommended Klinefeldt for the U.S. attorney position in Iowa’s southern district and Rose for the position in Iowa’s northern district. President Barack Obama nominated the two last month.

Main Justice posted a short bio of Klinefeldt here and a short bio of Rose here. Those pages include links to the nominees’ full Senate Judiciary Committee questionnaires (pdf files).

A Bleeding Heartland reader who watched today’s committee meeting tells me that Judiciary Committee Chairman Pat Leahy asked if there were any objections to the nominations, and none were raised. Senator Chuck Grassley told his colleagues that he “had interviewed both Iowa nominees –he praised Harkin’s selections and both nominees–he asked that a statement he prepared be made part of the record but did not read the statement.”

I expected the Senate Judiciary Committee to question Rose about her role in last year’s prosecutions of hundreds of undocumented workers from Postville. Harkin has defended her on the grounds that officials senior to Rose made the key policy decisions. Even so, Rose should have been asked about the cases and how they might have been handled differently. As things stand, I agree with critics who say promoting Rose without asking serious questions “would constitute a stamp of approval on the Postville debacle.”

Professor Erik Camayd-Freixas, a Spanish-language court interpreter, has spoken and written at length about injustice he observed in the aftermath of the Postville raid:

Professor Camayd-Freixas wrote that the immigrant defendants whose words he translated, most of them villagers from Guatemala, did not fully understand the criminal charges they were facing or the rights most of them had waived.

In the essay and an interview, Professor Camayd-Freixas said he was taken aback by the rapid pace of the proceedings and the pressure prosecutors brought to bear on the defendants and their lawyers by pressing criminal charges instead of deporting the workers immediately for immigration violations.

He said defense lawyers had little time or privacy to meet with their court-assigned clients in the first hectic days after the raid. Most of the Guatemalans could not read or write, he said. Most did not understand that they were in criminal court.

Click here to watch a video interview of Camayd-Freixas or download his 14-page essay about his experience with the Postville detainees. Rose may have the skills to be a good U.S. attorney, but it bothers me that the Senate Judiciary Committee has just indicated that they have no concerns or objections about last year’s events in Iowa. That’s a bad message to send to U.S. attorneys everywhere.

Senate HELP Committee Chairman Tom Harkin told reporters yesterday that he does not expect Senator Joe Lieberman to join a Republican filibuster to block the health care reform bill. He also hinted that Lieberman has a lot to lose by sinking this bill.

Good news, part 1: Senate Majority Leader Harry Reid announced yesterday that the health care bill he’ll bring up on the Senate floor will have a public health insurance option. That means opponents of the public option will have to try to strip out the measure with amendments on the Senate floor. They don’t have 60 votes to do that.

Good news, part 2: at yesterday’s press conference, Reid “definitively stated that a trigger bill wouldn’t get a [Congressional Budget Office] score – effectively taking it off the table as a legislative option.” The insurance industry and its allies in Congress, including Republican Senator Olympia Snowe, have pushed the “trigger” idea because it would virtually guarantee that the public option would never go into effect.

Bad news, part 1: Reid’s compromise would allow states to opt out of the public health insurance option, and limits participation in the public plan in many other ways too.

Bad news, part 2: At crunch time, President Barack Obama did nothing to help progressives fighting to strengthen the health care bill. On the contrary, he urged Reid to drop the public option in favor of a “trigger.”

More thoughts on that betrayal are after the jump.

Soon after becoming the new chairman of the Senate Committee on Health, Education, Labor and Pensions, Tom Harkin expressed hope that the Senate would approve a food safety bill this year. However, he was less optimistic about that timetable when speaking with a group of Iowans who came to Washington last week to lobby for passage of the bill.

Senate Democrats have not given up on passing health care reform through normal procedures requiring at least 60 votes to overcome a Republican filibuster. The problem is, several conservative Senate Democrats are on record opposing a public health insurance option. Meanwhile, a bill with no public option will have trouble passing the House of Representatives, where the overwhelming majority of the Democratic caucus supports a robust public option tied to Medicare rates.

The obvious political solution is to include some watered-down public option in the bill, giving cover to Progressive Democrats who insist on a public option while placating House Blue Dogs and Senate conservatives who want to protect private insurers’ market share.

The “triggered” public option favored by many industry allies didn’t fly, because most Democrats understand that the trigger would never be pulled. This past week, a new possible compromise emerged:

It was pulled out of an alternative idea, put forth by Sen. Tom Carper (D-Del.) and, prior to him, former Senate Majority Leader Tom Daschle, to give states the power to determine whether they want to implement a public insurance option.

But instead of starting with no national public option and giving state governments the right to develop their own, the newest compromise approaches the issue from the opposite direction: beginning with a national public option and giving state governments the right not to have one.

I consider this idea’s pros and cons after the jump.  

As expected, the Senate Finance Committee rejected two amendments yesterday that would have added a public health insurance option to the health care reform bill Chairman Max Baucus drafted with a big assist from industry lobbyists. Five Democrats voted with all the committee Republicans against Senator Jay Rockefeller’s amendment, which would have created a national public option tied to Medicare rates. Three Democrats also joined Republicans to vote down Senator Chuck Schumer’s much weaker “national level playing field” public option. CA Berkeley WV liveblogged yesterday’s hearing for Congress Matters.

Senator Chuck Grassley sang the same old song about the “government run plan” forcing private insurance companies out of business. He got a little tripped up when Senator Chuck Schumer asked him for his views on Medicare, though.

“I think that Medicare is part of the social fabric of America just like Social Security is,” Mr. Grassley said. “To say that I support it is not to say that it’s the best system that it could be.”

“But it is a government-run plan,” Mr. Schumer shot back.

Mr. Grassley, a veteran Senate debater, insisted that Medicare did not pose a threat to the private insurance industry. “It’s not easy to undo a Medicare plan without also hurting a lot of private initiatives that are coupled with it,” he said.

Chairman Baucus scored highest on the chutzpah meter, praising the public option even as he refused to support it. Grassley also held out false hope that maybe someday some other bill will accomplish that goal.

Several Senate Democrats, including Tom Harkin, insisted yesterday that they will get some kind of public option into the bill that reaches the Senate floor. After the jump you’ll find lots of links on the battles to come.

I agree that the public option is not dead yet, but for it to survive, President Barack Obama and Senate Majority leader Harry Reid will need to do a lot more than they’ve done so far to lean on the Senate conservadems.  

A full six months after Senator Tom Harkin recommended Stephanie Rose and Nick Klinefeldt for the U.S. attorney positions in Iowa’s northern and southern districts, President Barack Obama sent Rose’s and Klinefeldt’s names to the Senate for confirmation. Radio Iowa posted the September 25 press release from the White House.

I don’t know when the Senate Judiciary Committee will take up these nominations. Some advocates have objected to Rose’s nomination because of civil liberties and due process violations in the wake of last year’s immigration raid in Postville. Senators should thoroughly explore Rose’s role in the Postville prosecutions during her confirmation hearing. Harkin’s office has defended Rose’s record and her work with the detainees from Postville.

In his latest e-mail blast to constituents, Senator Tom Harkin touches on his priorities as the new chairman of the Senate Committee on Health, Education, Labor and Pensions. One point he mentioned hasn’t been on my radar screen this year:

The full agenda of the Committee will focus on reforming federal student loan programs so that we can stop subsidizing private banks and instead focus on loans that the federal government can make more cheaply.  We can save $87 billion over 10 years in that effort, and use that money to increase Pell grants for low- and middle- income college bound students, and to fund other important education initiatives.  

I had forgotten about President Barack Obama’s effort to reform the student loan system:

His plan is to do away with a system in which the Federal Government subsidizes banks and other private finance companies like Sallie Mae to lend money to students. The Administration essentially wants to cut such companies out of the game and run the system itself. Democrats claim the move will save $87 billion over 10 years, which can be used for a laundry list of education priorities, including increasing the maximum amount of Pell Grants, expanding Perkins Loans and investing in community colleges and other programs. […]

Educational institutions currently have two ways to offer federal loans to students. In the Federal Family Education Loan (FFEL, pronounced “fell”) program, the government pays subsidies to banks and lenders to dole out money to borrowers and reimburses companies up to 97% of the cost of any loan that is not paid back. The second way is the direct-loan program, created in 1993 as an alternate option, in which the government cuts out the middle man, lends money directly and gets all the profits. If the Student Aid and Fiscal Responsibility Act (SAFRA) passes both houses of Congress, the approximately 4,500 colleges and universities that are currently signed up for FFEL will have to abandon the program and start using the direct-loan option by July 1, 2010.

Directing federal money toward programs that help needy students, such as Pell Grants, makes a lot more sense than subsidizing private banks to make student loans.

Finding 60 votes in the Senate for this proposal will be challenging, however. This is one banking bailout Republicans will fight hard to protect, and according to Time magazine, at least one Democrat (Ben Nelson of Nebraska) opposes the plan too. If this bill passes, it will probably be through the budget reconciliation process, which requires only 51 votes in the Senate.

Health care reform is sure to take up a lot of Harkin’s time this fall, but I’m glad the HELP chairman will also focus on other bills that could change many lives for the better. Even if the health care project falls apart in the Senate, Harkin could accomplish a lot this year if he gets the student loan bill through and brokers a good compromise on the Employee Free Choice Act.

I see only one downside to Harkin becoming the HELP chairman, and that’s Senator Blanche Lincoln of Arkansas taking over the Agriculture Committee. Jill Richardson has been on this case at La Vida Locavore. I recommend reading her posts on industry lobbyists who used to work for Lincoln, Lincoln’s strong support for corporate ag interests such as Arkansas-based Tyson Foods, and Lincoln’s positions on trade, the climate change bill, and the Clean Water Act.

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.

This weekend is packed with good events for Iowa progressives. If you love books, make your way to the Planned Parenthood Book Sale in the 4-H building at the State Fairgrounds in Des Moines. Admission is free; the sale is open from 9-9 Friday and Saturday and from 9-6 Sunday and Monday. The sale offers great deals on books, DVDs, prints, comics, and music, especially on Sunday, when everything is half-price, and on Monday, when everything left is 25 cents.

Proceeds support Planned Parenthood’s education programs, which you can learn more about here.

Incidentally, Planned Parenthood of Greater Iowa recently merged with Planned Parenthood of Nebraska/Council Bluffs to form a new affiliate called Planned Parenthood of the Heartland.

The Iowa Renewable Energy Association‘s annual Energy and Sustainability Expo takes place in Norway Saturday and Sunday. There’s so much to learn at the I-RENEW expos.

On Sunday, Senator Al Franken (cartographer extraordinaire) will headline Senator Tom Harkin’s 32nd Annual Steak Fry. The event will be at the Warren County Fairgrounds from 1 pm to 4 pm. Click here for more info and to buy tickets.

Follow me after the jump for details on many other events coming up soon.

I mentioned on Labor Day that I haven’t heard much lately about Senator Tom Harkin’s efforts to reach a compromise on the Employee Free Choice Act. The EFCA is one of the top legislative priorities for organized labor and needs 60 votes in the Senate to overcome a Republican filibuster. Several Democrats who supported the bill in 2007, knowing that President Bush would veto it, either oppose the bill or have dodged the question this year.

Harkin has been the lead Senate negotiator on EFCA and is replacing the late Senator Ted Kennedy as chairman of the Committee on Health, Education, Labor and Pensions. Speaking to the American Rights at Work group yesterday, Harkin said he had 60 votes lined up behind a compromise this summer:

“As of July, I can tell you this openly and I know the press is all here but we had worked out a pretty good agreement. […]”

Harkin said prominent labor leaders were on board with the deal, including AFL-CIO President John Sweeney and Andy Stern, president of the Service Employees International Union.

“That’s when we needed 60 votes and that’s when I called to get Sen. Kennedy down because we needed him for three days. That’s when Dr. [Lawrence] Horowitz told me that he couldn’t make it,” Harkin said.

The Hill’s Kevin Bogardus reported that Harkin refused to specify the terms of the compromise deal:

“I will not say because it was closely held, it never leaked out and it still hasn’t,” Harkin said. “I took it off the front-burner and put it on the back-burner so it is still on warm, OK?”

In May Harkin suggested that the “card check” provision might be dropped from the bill in favor of other changes to labor election procedures. He did not say anything about binding arbitration, which is also an important part of the EFCA.

If Massachusetts law is changed to allow Governor Deval Patrick to appoint a temporary replacement for Kennedy, then Harkin may be able to revive this compromise and pass the EFCA this fall. Democratic leaders in the House agreed earlier this year not to bring the EFCA up for a vote until the measure had passed the Senate. Getting the bill through the House should not be difficult, even if a substantial number of Blue Dog Democrats vote no.

Senator Ted Kennedy’s death left a vacancy as chair of the Senate Committee on Health, Education, Labor and Pensions. I had assumed that Senator Chris Dodd of Connecticut, who is looking vulnerable going into his re-election campaign, would jump at the chance to become the HELP committee chairman, but surprisingly, he prefers to remain chairman of the Senate Banking Committee. Paul Kane reports for the Washington Post,

Dodd’s decision leaves the chairmanship of the Health, Education, Labor and Pensions Committee to Sen. Tom Harkin (D-Iowa), who follows Dodd in seniority. Multiple sources in the Harkin orbit, requesting anonymity to discuss internal deliberations, said that he is certain to take over the HELP committee.

Harkin is currently chairman of the Agriculture Committee and would have to give up that position. He would likely be replaced at Agriculture by Sen. Blanche Lincoln (D-Ark.), who faces a difficult reelection bid in 2010. Other Democrats are more senior than her on the Agriculture Committee, but they hold more prestigious chairmanships already.

Leaving the chairman’s position at Agriculture means Harkin will have less influence over the drafting of the next farm bill. On the other hand, the HELP Committee deals with a range of extremely important issues.

I have contacted Senator Harkin’s office seeking confirmation of this report, and I’ll update this post when I hear back from his staff.

UPDATE: Harkin will replace Kennedy as HELP chairman. His statement is after the jump, along with a statement from Iowa Democratic Party chair Michael Kiernan.

The Bean Walker, Iowa’s copycat version of The Drudge Report, was thrilled to link to the latest approval numbers from Survey USA yesterday:

Iowa

Pres. Obama: 45 / 51

Sen. Grassley: 54 / 34

Sen. Harkin: 49 / 38

Gov. Culver: 36 / 51

This statewide poll of 600 adults was conducted on August 26 and 27 and is said to have a margin of error of 4 percent. It’s the first time any pollster has found the president below 50 percent approval in Iowa, and the first time any pollster has found the governor’s approval in the 30s. For more details about various demographic groups in this poll, you can find Culver’s chart here, charts on Harkin and Grassley here, and Obama’s chart here.

Looking at Survey USA’s trendlines for Culver since he took office, I noticed that Culver’s disapproval number is basically unchanged this summer, but his approval number has dropped significantly from 42 percent in June and 44 percent in July to 36 percent in late August.

Before anyone panics, remember that Survey USA’s approval numbers for Culver tend to run low compared to other pollsters. In early July, the poll commissioned by The Iowa Republican blog found Culver’s approve/disapprove numbers to be 53 percent/41 percent. Later the same month, Hill Research Consultants’ poll for the Iowa First Foundation found Culver’s favorability at 52 percent. (The Iowa First Foundation did not release the governor’s approval number from that poll, but you better believe they would have if the number had been in the 30s or even the low 40s.) Meanwhile, Survey USA pegged Culver’s approval at 44 percent on July 20.

Survey USA’s numbers for Obama, Harkin and Grassley are also noticeably down in the latest poll. Obama is at a record low in Iowa. Grassley’s approval of 54 percent is the lowest Survey USA has found in at least four years. I couldn’t find a similar graph for Harkin’s numbers, but it’s been a long time since I can remember seeing his approval rating below 50.

Of course, it’s possible that the recession and the health care debate have affected Iowans’ view of all political leaders. Still, I would like to see these numbers confirmed by some other pollster. Even with the best sampling techniques, approximately 1 in 20 polls is wrong just by chance (“wrong” meaning that the true state of public opinion lies outside the margin of error for that poll). Right now this poll looks like an outlier.

I also agree with Steve Singiser that if Culver were this unpopular in Iowa, Democrat Curt Hanson probably would not have won yesterday’s special election in House district 90 (a swing district). The Republicans ran at least two television ads linking Hanson to Culver (see here and here).

I’m looking forward to the next Selzer and Associates poll for the Des Moines Register, which probably will come later this month or in early October.

Share any relevant thoughts in this thread.

 (crossposted from Daily Kos) 

Yesterday, I saw our problem first hand. We are in a world of trouble, people.

Mobs are powerful and wholy beyond reason. Yet, they must be stopped, because they are extremely dangerous. There are a lot of very angry, very frightened people out there, and about 150 of them turned out on a Wednesday afternoon to harass Senator Tom Harkin, shout incoherent political slogans (the same ones that have been diaried to death here in the last week), and to let him know that they are very angry about the idea of government in general and government health care in particular. The total crowd was limited to about 210 by the fire code. 

The Iowa State Fair opened today and runs through Sunday, August 23. Senator Tom Harkin stopped by the Iowa Democratic Party’s booth in the Varied Industries Building (photos here).

Post any memories, comments or advice about the fair in this thread.

I like to park along Grand Avenue. You usually can find a spot within a few blocks of the entrance to the fairgrounds, and you don't have to walk through the midway like you do if you drive in from E. University. Also, the traffic can be very bad between the freeway and the fairgrounds all along E. University. Better to get off I-235 at E. 14th St, head south and then east on Grand.

Walking in through the Grand Avenue entrance, you're close to the DNR's building with lots of fish tanks on your left (kids love this). The Varied Industries Building is not far away on your right.

My kids like going through the animal barns, but I strongly recommend carrying young children (3 and under) in a comfortable backpack or soft carrier to keep them from stepping in manure.

If it's a hot day, kids like to cool off in the fountain area just south of the Ag Building. I buy lemonade from the honey producers in the ag building (tastes great, and they offer the best price at the fairgrounds). I never miss the Bauder's ice cream truck either.

Check the schedule ahead of time to see when there are shows you'd like to see. There's a huge variety of free entertainment at the fair. It could be a horse show or a frisbee-catching dog show or a musical act or a magician.

Tune out the corporate ag propaganda and enjoy looking at the animal babies in the Animal Learning Center, a little north of the ag building. Right next to that is a "little hands on the farm" outdoor activity that is so fun. Kids pretend to plant crops, then harvest them (riding on toy tractors) and sell them. When they leave the exhibit they get to exchange their pretend money for a real treat in the general store.

What do you love or hate about the fair?

Yesterday I posted information about some of the town-hall meetings that Iowans in Congress will hold during the next two weeks. You can also find Representative Steve King’s town-hall meeting schedule here and Representative Tom Latham’s schedule here.

If you attend any of these meetings, please take detailed notes and/or record the event if you can. Although local media will cover the story, journalists may not highlight every noteworthy comment. Senator Chuck Grassley’s infamous advice to a constituent seeking affordable health care was a sensation on YouTube and various political blogs before Iowa newspapers reported the story. I noticed that Daily Kos user clammyc used part of that clip in a video about the need for health care reform:

This diary by Daily Kos user ShadowSD contains lots of good links and talking points for you to use at town-hall meetings. Whether or not you get to ask a question, please consider posting a diary here with your impressions of the event. First-person accounts are usually a good read.

In general, I’d like to see more Bleeding Heartland readers writing diaries for this blog. Pieces with news or substantive analysis may be promoted to the front page.

Final note about this month’s town-halls: Rarely do I agree with Iowa GOP chairman Matt Strawn, but it is lame that Leonard Boswell hasn’t scheduled a health care public meeting in Polk County this month, or in any town that’s part of the Des Moines media market. If any Bleeding Heartland readers do attend Boswell’s scheduled “listening post” in Sigourney on August 13, please ask some specific questions about the kind of public health insurance option he supports. You might also want to note that rural Iowans would particularly benefit from a public option.

LATE UPDATE: I was wrong to criticize Boswell for not scheduling a health care event in the Des Moines area this month. On August 13 his office announced a town-hall on health care to be held on August 23 from 3 pm to 4 pm at the AIB College of Business Activities Center, 2280 Bell Avenue in Des Moines. RSVP by calling Congressman Boswell’s Des Moines office at 515-282-1909, or emailing boswellrsvp@mail.house.gov.  

Technically, 103 days, but who’s counting?

So far my marriage has not collapsed under the strain of sharing rights with gays and lesbians. The worst thing that’s happened to me because of marriage equality was making a faux pas when I ran into an acquaintance I hadn’t seen in a long time. She’s been living with another woman for at least 15 years, so I asked if they had gotten married. She looked surprised, then said, “Oh, we’re not…that way. I mean, I know everyone thinks we are, but we’re not.” Oops!

This thread is for anything on your mind this weekend.

I thought the American Psychological Association struck a good balance this week in adopting a resolution that rejects “reparative therapy” to change someone’s sexual orientation, but “urged therapists to consider multiple options – that could range from celibacy to switching churches – for helping clients whose sexual orientation and religious faith conflict.”

UPDATE: Congratulations to former Republican Congressman Jim Leach (IA-02), whom the Senate confirmed  by unanimous consent to head the National Endowment for the Humanities. That job is a perfect fit for Leach.

Radio Iowa’s Kay Henderson posted a detailed write-up with audio of Senator Tom Harkin’s Saturday town-hall meeting on health care reform.

President Barack Obama signed a bill today allocating an additional $2 billion to the to the Car Allowance Rebate System, more commonly known as Cash for Clunkers. The money will come from the American Reinvestment and Recovery Act (the economic stimulus bill approved in February). The Senate approved the bill by a 60-37 vote on Thursday night. Senator Tom Harkin voted yes, and Senator Chuck Grassley, who criticized the program earlier this week, voted no.

I liked Harkin’s idea to put income limits on this program, but the Senate wanted to get this measure passed before the summer recess. If the Senate had approved a different bill from what cleared the House last week, the funding would have been delayed until September.

The Senate vote went mostly along party lines, but four Democrats joined 33 Republicans in voting no, and seven Republicans joined 53 Democrats in voting yes.

I’m pleased to learn that most consumers who have taken advantage of this program have traded in a “clunker” for cars that get significantly better mileage. (Click here for lists of the most popular vehicles traded in and the most popular purchased with Cash for Clunkers vouchers.) The way Congress wrote the bill, people could have traded in SUVs and trucks for similar vehicles with only minimal improvements in fuel economy.

The Senate confirmed Sonia Sotomayor as an associate justice of the U.S. Supreme Court today by a vote of 68 to 31. As expected, Iowa’s senators split, with Tom Harkin voting yes and Chuck Grassley voting no.

Nine Republicans voted to confirm Sotomayor: Susan Collins and Olympia Snowe of Maine, Judd Gregg of New Hampshire, Richard Lugar of Indiana, Lindsey Graham of South Carolina, Lamar Alexander of Tennessee, Mel Martinez of Florida, George Voinovich of Ohio, and Kit Bond of Missouri. Bond, Gregg, Martinez and Voinovich have already announced plans to retire in 2010.

Senator Robert Menendez of New Jersey warned yesterday that the GOP will pay a political price for opposing Sotomayor.

The two independents who caucus with Democrats (Joe Lieberman of Connecticut and Bernie Sanders of Vermont) supported Sotomayor, as did all Senate Democrats who were present today (Ted Kennedy was absent). That’s a blow to Republicans, who had hoped that getting the National Rifle Association to make Sotomayor’s confirmation a scorecard issue would frighten a few gun-friendly Democrats into voting no. That would have changed the media narrative into “Democrats and Republicans divided over Sotomayor as she joins the Supreme Court.”

Although Max Baucus of Montana flirted with voting no on Sotomayor, he came around fairly quickly. I liked this comment from pro-gun Democrat Mark Warner of Virginia:

“I’m very disappointed. [NRA seems] to be going beyond their Second Amendment issues, particularly when I think the judge’s positions on those issues are still fairly open,” Warner said. “I trust in her judgment and temperament. I think the NRA at some point has gone beyond its mission, and are perhaps allowing themselves to get hijacked by those who are in the extreme.”

That hijacking occurred long ago.

Share any thoughts about Justice Sotomayor or the Supreme Court in this thread. I want to again express my gratitude to Justice John Paul Stevens for staying healthy all these years and to Justice David Souter for sticking it out long after he wanted to retire.

Now that Republicans have shown that they will largely oppose even a moderate, corporate-friendly judge like Sotomayor, I would like to see Obama nominate a fire-breathing liberal the next time a Supreme Court vacancy comes up.

I’m no negotiating expert, but I know that if you’re not willing to walk away from a bad deal, no one will take your demands seriously.

Americans overwhelmingly want a public health insurance option and need that option for any number of reasons. Who you are and where you live strongly affects the kind of health insurance and health care you receive. Most Americans live in communities where one or two private companies dominate the health insurance market. Rural residents often have very limited access to health care providers. People of color also are shortchanged by our current system.

Despite all these problems, Senate Finance Committee Chairman Max Baucus has done his best in recent weeks to show that The Onion was right about him eight years ago. Baucus has continued to pursue a bipartisan agreement on health care containing a fake public option.

It’s time to cut Baucus off, and a great idea floated by Iowa’s own Senator Tom Harkin offers part of the solution. (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?

The first bill Senator Al Franken co-sponsored after being sworn in yesterday was the Employee Free Choice Act. It’s a cause Paul Wellstone would have supported strongly. (Click here for background on the EFCA.)

The Hill reported yesterday,

As expected, Franken has been assigned to the Judiciary Committee, Indian Affairs Committee and Aging Committee. He will also sit on the Health, Education, Labor and Pensions Committee once the panel finishes marking up the healthcare reform legislation.

I don’t understand the logic of making Franken wait until after the health care bill markup before joining the HELP Committee, but at least he will be there when the Employee Free Choice Act is debated.

Getting to 60 votes on the EFCA will be a challenge, but Senator Tom Harkin has been working on a compromise since March. He told Bloomberg News in May that the “card check” provision may have to be dropped from the EFCA in order to get the bill through the Senate. “Card check” means that workers could form a union if a majority sign a document stating that they would like to join a union. Harkin suggested that a compromise bill might incorporate other changes to the election process and procedures for forming a labor union.

In that interview, Harkin did not mention whether binding arbitration would be a part of a workable compromise. Some people consider binding arbitration provisions to be as important a part of the EFCA as card check.

Whatever compromise Harkin crafts, I’m glad to know that Franken will be a voice for strong labor reform on the HELP Committee. I can’t wait to go hear Franken keynote Harkin’s steak fry on September 13.

UPDATE: Harkin’s communications director Kate Cyrul told Iowa Independent that Harkin is still working on this bill and expects the EFCA to pass this year.

Such as the revolving door between Congress and corporate lobbyists:

The nation’s largest insurers, hospitals and medical groups have hired more than 350 former government staff members and retired members of Congress in hopes of influencing their old bosses and colleagues, according to an analysis of lobbying disclosures and other records. […]

Nearly half of the insiders previously worked for the key committees and lawmakers, including  Sens. Max Baucus (D-Mont.) and  Charles E. Grassley (R-Iowa), debating whether to adopt a public insurance option opposed by major industry groups. At least 10 others have been members of Congress, such as former House majority leaders Richard K. Armey (R-Tex.) and Richard A. Gephardt (D-Mo.), both of whom represent a New Jersey pharmaceutical firm.

The hirings are part of a record-breaking influence campaign by the health-care industry, which is spending more than $1.4 million a day on lobbying in the current fight, according to disclosure records. And even in a city where lobbying is a part of life, the scale of the effort has drawn attention. For example, the Pharmaceutical Research and Manufacturers of America (PhRMA) doubled its spending to nearly $7 million in the first quarter of 2009, followed by Pfizer, with more than $6 million.

So corporate groups are spending $1.4 million a day on lobbying to block a real public health insurance option, which most Americans want.

That’s on top of the millions of dollars the same corporate groups have donated directly to Congressional campaigns. Iowa’s Senator Chuck Grassley has taken hundreds of thousands of dollars from the industries with the most at stake in health care reform.

Members of Congress claim lobbyists and campaign money don’t shape their opinions, but Grassley should know better. He understands that big money from pharmaceutical companies can influence the conclusions of medical researchers–why not elected officials?

Nate Silver has found strong evidence that special-interest money affects Democratic senators’ support for the public option in health care reform.

By the way, I wasn’t too cheered by Senator Chuck Schumer’s promise over the weekend that the health care bill will contain a public option. The current draft in the Senate Committee on Health, Education, Labor and Pensions excludes lots of people from choosing the public option over their current health insurance. That will limit competition for the private insurers that have near-monopolies in many markets.

Back in 2003 all the Democratic presidential candidates talked a good game on health care. Now Dick “this is a moral issue” Gephardt is lobbying for a pharmaceutical company. I’ll stand with Howard Dean and hope that John Edwards was wrong about the system being rigged because corporations have too much power in Washington.

Final note: Moveon.org is organizing health care rallies this Thursday, July 9, at senators’ offices in their home states. Sign up here to attend a rally near you.

Political activity slows down a bit during the summer, but there are still plenty of things to do if you’re not spending hours a day training for RAGBRAI. Read all about it after the jump. As always, post a comment or send me an e-mail (desmoinesdem AT yahoo.com) if you know of something I’ve left out.

If you live in the first Congressional district, consider attending one of Bruce Braley’s town-hall meetings on health care reform in Dubuque,  Oelwein, Davenport and Waterloo (click “there’s more” for details). According to a statement from his office,

Braley will discuss the draft House health care reform bill, listen to constituents’ concerns, and take questions.  Braley is a member of the House Energy and Commerce Committee, the committee in charge of authoring healthcare reform legislation.

Braley’s town hall meetings on healthcare reform are free and open to the public.

Attendees are strongly encouraged to RSVP at: http://braley.house.gov/townhall.

Speaking of health care reform, Moveon.org is looking for people to help deliver petitions this Thursday, July 9, to the Iowa offices of Senators Tom Harkin and Chuck Grassley. Click here to sign up.

UPDATE: I added information about Governor Chet Culver’s upcoming appearances in eastern Iowa to highlight I-JOBS and Rebuild Iowa projects.