Over at TNR, special correspondent Thomas B. Edsall raises
provocative questions about the coalition of wealthy and poor that
elected Obama.  Will they stand together?  Below, excerpts from his
post, and my comments:

“The health care debate has exposed the
ideological tension in Barack Obama’s political coalition between
moderates and liberals. But it has also offered hints of how another,
less obvious divide built into the Democratic majority could wreak
havoc on the administration during the years to come.

“In 2008, the Democratic Party blossomed into a successful alliance
of the upscale and the downscale–wealthy and needy marching hand in
hand, sharing animosity to George W. Bush and the war in Iraq. The
extent to which Democrats are relying on the far extremes of the income
spectrum is striking. Democrats have generally performed well among
low-income voters in the past, but now, the phenomenon has become more
pronounced. Voters from households making less than $30,000 backed
Obama by 31 points last November. That margin was 13 points higher than
Jimmy Carter’s advantage over Gerald Ford with poor voters in 1976–and
21 points better than Walter Mondale’s advantage among the same
demographic in 1984.

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We knew that the Senate Finance Committee would reject the public sector option. Now they have done just that.

This is not news. Nor is this a “fatal blow” for progressives.

Will the public option survive a vote on the Senate floor?  Probably not—though it could happen. But this still does not mean that the public option is dead.

We know that the bill that emerges from the House will contain a MedicareE (for Everyone) alternative. The House bill and the Senate bill will then go to conference. This is the moment that matters. As a respected HealthBeat reader who knows Washington well recently told me, “Everything else is foreplay.” Much of what we are reading now is posturing–by some politicians ( Charles Schumer deserves an Emmy), by some pundits and by unnamed sources who want reporters to think that they know more than they actually know.

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Earlier this year when President Obama told the graduates of Notre Dame that the country needed to find “common ground” on abortion, it’s likely he envisioned national reconciliation on an issue that has fiercely divided the country for decades. But when it comes to health care reform, Democrats are hoping to find  “common ground” through balky legislation that would extend the reach of the current ban on federal funding for abortion to include all plans that participate in health insurance exchanges.

These provisions, contained in the Senate Finance bill and also in the Capps Amendment passed by the House Energy and Commerce Committee, are designed to be “abortion neutral,” meaning that they don’t restrict or expand abortion rights beyond the status quo. The status quo is as follows: Although Roe vs. Wade ensures access to safe, legal, abortion; since 1976, the Hyde Amendment has banned federal funding for abortion except in the case of rape, incest or threat to the life of the mother. This ban currently applies to Medicaid beneficiaries and also to federal employees and military personnel.

Obama has already said that abortion will not be included in any minimum benefits package mandated by the government. The Senate Finance and House Energy committee reform plans reiterate this provision; but they do allow insurers who choose to offer abortion as a covered service to participate in the exchanges. They just can’t use any federal funds to help pay for these services.

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Today, the LA Times reports:

“Healthcare overhaul legislation moving through the Senate Finance Committee would put crucial rule-making authority in the hands of a private association of state insurance commissioners that consumer advocates fear is too closely tied to the industry.

The National Assn. of Insurance Commissioners currently writes model laws and regulations that individual states are free to accept or discard. Under the bill by Sen. Max Baucus  (D-Mont.), it would craft a model rule governing ‘health insurance rating, issuance and marketing requirements’ that would become ‘the new federal minimum standard without any further congressional action.’ States would be permitted to deviate from the standards only by appealing to the Department of Health and Human Services.

In effect, the bill would allow the group to write many of the new rules on issuing and marketing insurance to millions of uninsured Americans who would be required to purchase policies.

‘The NAIC is clearly an organization that is dominated by the insurance industry,’ said California Lt. Gov. John Garamendi, a former state insurance commissioner.

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If nonprofit hospitals spend far less money on providing charity
care for the poor and uninsured than the value of their federal, state
and local tax exemptions, do they deserve those exemptions? What about
if they turn away indigent patients or hound them with aggressive
collection practices?

In May, the Senate Finance Committee
chairman Max Baucus, and ranking Republican Charles Grassley seemed to
agree that nonprofit hospitals have to start acting more like
nonprofits or they could risk losing their benefits. The committee
introduced a bipartisan proposal that would have required nonprofit
hospitals to provide a minimum amount of charity care, limit how much
they charge the uninsured, and to scale back aggressive collection
processes or face an excise tax or even an end to their tax-exempt
status.

But when the Senate committee released its watered-down
version of health care reform earlier this month, these stringent new
standards emerged equally weakened. Gone was the requirement that
hospitals provide a minimum of uncompensated care. Gone was the threat
of an excise tax, and gone was the threat that hospitals could lose
their tax-exempt status if they didn’t comply.

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Over the past few weeks, I’ve been involved in an Online Debate for NOW on PBS.  The subject: “Should Wealthy Americans Be Taxes to Pay For Health Care Reform?”

During the three rounds of debate, my opponent,  Phil Kerpen, Director of Policy at Americans for Prosperity, brought up some interesting issues about just how much the very wealthy pay in taxes.  It turns out that they pay so much because they earn so much more than everyone else. .

Did you know that, since 1975, the wealthiest 1 percent have enjoyed a  232 percent hike in their income? Over the same span, the bottom 90 percent watched their income creep up by just 10 percent.

NOW has just published the debate online here: http://www.pbs.org/now/shows/health-care-reform/ic-health-reform-wealthy.html

To read the second and third rounds of the debate, click on “Rebuttals” and “Follow-Ups, right under our pictures.  Viewers are voting on who won the debate; to see how I’m doing, click on Who Won the Debate? at the bottom of the page.

Thanks to reader Brad F for sending a link to this post from “The Incidental Economist” on what cuts to Medicare Advantage (MA) would mean to seniors. 

In the post, Boston University health economist Austin Frakt summarizes an article that he co-authored for the International Journal of Heatht Care Finance and Economics

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Medicare has ordered private insurers to stop sending letters to their Medicare Advantage customers, telling them that proposed health reform legislation could hurt them and jeopardize their benefits.  Now those who oppose reform are complaining that the government is violating insurers’ right to free speech.  I would argue that Medicare is telling insurers’ that they can’t cry “fire” in a crowded theatre—particularly when there is no fire. Medicare is quite right to describe the letters as “confusing and misleading.”  Here is an example of a letter Humana has been sending out:

“Leading health reform proposals being considered in Washington, D.C., this summer include billions in Medicare Advantage funding cuts, as well as spending reductions to original Medicare and Medicaid. While these programs need to be made more efficient, if the proposed funding cut levels become law, millions of seniors and disabled individuals could lose many of the important bbenefits and services that make Medicare Advantage health plans valuable.”

The letter is a classic example of fear-mongering. First, it is very vague: What “proposed funding cut levels”? Which “important benefits and services?”  What “spending reductions to original Medicare?  By virtue of being so vague, it will make every  letter-reader feel that he or she is about to become the victim of Draconian cuts.

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I know that many HealthBeat readers don’t have time to peruse all of the comments.

So I thought I would post two comments on “The Attack on the Dartmouth Research” that caught my eye:
 

“One of the most interesting aspects of the Dartmouth data is the comparison of centers located and working in the same city or area.

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Today, many in the media are making a special effort to report on what the Baucus bill does right.  I also am delighted to see provisions in the bill which follow suggestions in the House bill.

But I’m dismayed when I see a reform suggested by House Democrats—or by the White House – rendered toothless in the Senate Finance Bill. Here’s just one example:

Today, in Ezra Klein’s Washington Post column New American Foundation Health Care Policy Director Len Nichols praises a plank in the Baucus bill that would create an Independent Medicare Commission   charged with making sure that Medicare cuts costs in ways that are consistent with maintaining quality. The Commission would be appointed by the President and confirmed by the Senate. 

Sounds good—and very much like something that White House Budget Director Peter Orszag suggested, in July, in a letter to Congressional leaders. At the time, he outlined the administration’s support for “an Independent Medicare Advisory Commission (IMAC)–

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