Video: Decision time for a public option

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    >> run of the democrats spoken out against the public option is senator mary landrieu from louisiana and with us also is jonathan capehart. i'm confused about the word of the use option and public option. i'm confused by the use of the words reform in the context of health care . how is it a public option if no one in this country could opt to use it, isn't that a lie? and how is it reform if all we're doing is expanding coverage, but not allowing 90% of americans to actually choose their health care and bring the democracy of free markets to a moply monopoly business with antitrust exemption?

    >> there is the dilemma. the focus has been misplaced on whether this is a public option or not. in my view, the focus should be on increasing competition, lowering costs, improving quality for all americans . whether you're on the medicare system, the medicaid system, or you're in the private insurance market. for some reason, this debate has gotten very side-tracked. i heard what you said about the president and i want to restate. the president's focus, as i think it should be, has been on reducing costs, particularly for average americans , for small businesses and i'd like to hear him say more about that and that is why we're having a hearing this morning for how this proposal can drive down costs for small businesses . and you all know this because you cover the business sector. 60% of uninsured americans , 60% of the uninsured work for small business . small business rates are going up. they are losing coverage. so this is one of the issues that i think needs more attention.

    >> i couldn't agree more. the insanity, senator, there is an exchange proposal there that would bring choice to everybody. you were one of the original sponsors of wyden/bennett going back a few months now. walk for us how that exchange that everybody participating in it would help small businesses in america.

    >> well, the finance bill took a step in the right direction, but we've got to take a couple of more steps for this exchange to really work. the finance bill allows for state-run exchanges and regional exchanges . for some reason, it doesn't allow a national exchange and that is really what small businesses need. let's take the federal employees insurance program. 8 million people are in this exchange. i'm one of them. we have lots of choices, reasonably affordable and that is what we'd like our small businesses to have. it's not only a health care issue or moral issue but economic imperative to break this recession and start creating jobs. so that's what our focus has been on and we're going to stay focused on real reform , market reform , and driving down costs.

    >> senator, why is this such a grand effort? i don't understand whether it's you or senator wyden. i mean, lists of politicians have come through the show the past few months have said a version of what you're saying or a version of what has been written in anybody who believes in democracy and freedom in this country, yet the legislation does not reflect it. why is that?

    >> that's a very interesting point. actually, the finance bill coming out of the senate is the closest to providing market reform and choice. now, all of the bills have some, you know, insurance reform in them which is important. we've got to reform the insurance industry . i'm not for a government-run national public option, but i am for choice and more competition which, if it's done correctly, it would be a more transparent market, more honest market, more robust market and that, in itself, would drive down costs. so we're still working on this compromise but, again, i think the finance bill is a step in the right direction but we're going to hear from small business owners this morning and give them a voice in this debate. we have 27 million of them. they work hard and take the risk and, yet, can't afford insurance.

    >> to steal something from the financial regulation conversation, the small businesses owners are the end-users for health care reform . let's help them be able to start businesses to hire our children and our friends and our parents to do business in this country. last question for you. antitrust exemption is the final piece here. if you're going to have choices, you can't have monopolies. where do we stand on that for health insurers that goes back to 1945 ?

    >> i think either eliminate it or chip away at it because that is a real barrier. i generally support a good reform honest insurance system. i'm not a barber of insurance. i think there have been some abuses. let's curb them. i think we need reform and let's do it, but we can't just have government-run everything. we've got to create markets that work and we can do that. so if we need to cut back on their monopolies, yes. we need to reform them, yes, but not eliminate.

    >> senator, i agree with you.

    >> thank you very much.

    >> thank you for shining more light on this. again, whether it's the banks or health insurance , you have to understand you are dealing, senator, i'm getting to contessa in a second so i'll see you later . you have to understand there are two priorities here. one, the consumer, governor spitzer and rob johnson and others have said transparent market and lots of choices where whoever is selling things has to post it publicly, whether it's a bank or credit derivative or insurer with a health insurance policy and the government who sets the rules whether things have to be sold in public or not. if the government is taking bribe money from those who make money by not having to compete in public, we no longer have a democracy, we have a corporate communist, fascist state, whatever you want to call it. this is not a left/right issue. this is a right/wrong issue. you are either favor of incomes or markets in this country or in favor of exploiting americans for the benefit of the few. that is a simple question and whether it is financial regulation or this health reform , it will be very transparent to everybody in this country where our government stands based on whether they do allow choice and do bring the democracy of markets to markets right now that are controlled by special interests and outdated government rules. senator landrieu, i'm excited she is involved in this and the momentum does seem to be building. so that is encouraging. contessa has the balance of the

updated 10/20/2009 11:58:17 AM ET 2009-10-20T15:58:17
ANALYSIS

In the special interest war over health care, the White House and congressional Democrats have the nation's drug makers and hospitals generally on their side; the insurance industry, not so much.

Now the bill's supporters are making a play to lock in the American Medical Association, the organization that says it represents 250,000 doctors and medical students in every state and congressional district. The principal enticement, a $247 billion measure making its way to the Senate floor, aims to wipe out a scheduled 21 percent rate cut for doctors treating Medicare patients and replace it with a permanent, predictable system for future fee increases.

The AMA, firmly in favor of higher pay for doctors, began airing ads last week saying the increase would "protect seniors' access to quality care." In case lawmakers need any inducement to act, a late 2008 study by the Medicare Payment Advisory Commission, which advises Congress, found that nearly 30 percent of Medicare patients looking for a new primary care doctor had trouble finding one.

Yet the AMA won't yet pledge support for the major health care bill that is the chief objective of the White House and congressional Democrats, despite a request that several officials say was made at a meeting last week with Senate Majority Leader Harry Reid, D-Nev.

Asked several times at a news conference Tuesday whether the AMA would support the measure, Dr. J. James Rohack, the organization's president, equivocated. "We haven't seen a final bill. Once we get something, we will be able to answer that question," he said.

Nor does the AMA seem eager to soft-pedal another of its own top priorities, legislation to restrict medical malpractice payments.

"We continue to press for significant medical liability reform because we know that is a very important contributor to unnecessary health care costs," Rohack said Tuesday in an interview in which he declined repeatedly to say whether the organization had been asked to back off.

Video: Big labor joins the health care fight Higher payments to doctors and curbs on medical malpractice awards "in my mind are separate issues. I can't speak for how other people are putting this whole thing together," he added.

Evidently not in the minds of Democrats. Several officials say that request, too, was conveyed to the AMA and other doctor groups in last week's session with Reid. Not coincidentally, any limitations in medical malpractice awards are anathema to trial lawyers, whom Democrats count as among their most reliable and generous campaign supporters.

The dance is one of many in the long-running health care debate, the issue that has consumed Congress, the administration and a vast constellation of outside groups for months.

Take the Senate Finance Committee, which last week approved a middle-of-the-road measure that may eventually prove a template for a compromise on an issue that has defied solution for decades. Sen. Olympia Snowe of Maine drew headlines when she became the first Republican to support White House-backed health care legislation.

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But according to some of the bill's supporters, a vote that occurred with little fanfare several evenings earlier was crucial to the legislation's survival.

It pitted the drug makers and the White House on one side and most of the committee's Democrats on the other.

At issue was a plan by Sen. Bill Nelson, D-Fla., to sweeten drug benefits for certain Medicare beneficiaries — normally something all lawmakers can favor. In this case, Nelson proposed raising fees on drug companies by $106 billion over a decade to cover the costs. "Did PhRMA come to the table in the agreement with the White House with enough? A number of us feel that is not the case," he said of the industry.

Video: Health reform opposition loses wind But his approach happened to run afoul of a deal the industry made months ago with the White House and Sen. Max Baucus, D-Mont., the committee's chairman. Drug makers would cover $80 billion of the cost of the legislation over a decade, and the White House and Baucus would help shield them from attempts by other lawmakers to impose additional fees or taxes.

Left undisclosed for weeks was a critical codicil — that the industry would bankroll an expensive advertising campaign to promote the bill's passage, at a cost of $100 million or more.

Passage of Nelson's proposal "may well undermine our ability to pass comprehensive health care reform in this Congress and I think that would be a great tragedy," Sen. Tom Carper, D-Del., said shortly before the vote.

Baucus, too, spoke against Nelson's recommendation, although he added, "we have to find some other time and some other way to fill the doughnut hole," a reference to a gap in coverage under the Medicare prescription drug program.

Of Nelson, Baucus said, "I frankly wish the senator had decided not to push" for a vote.

Not only Baucus, but also the White House had urged Nelson to drop his amendment, according to Senate sources who spoke on condition of anonymity. On the vote, the chairman, Carper and Sen. Bob Menendez, D-N.J., joined all committee Republicans in opposing the plan, and it failed on a vote of 13-10.

The drug deal was secure, and so, too, the bill.

Special interest politics was also at play for the nation's hospitals. They, too, have a side deal with the White House and Baucus, and they also received a measure of protection in the bill that cleared the committee.

At the last minute, the chairman decided to shield them from any future cuts to be recommended by an independent commission charged with recommending savings in Medicare.

The insurance industry?

Reid made an unusual appearance at a Senate committee hearing recently to support repeal of 60-year-old antitrust laws that benefit insurance companies.

Copyright 2009 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

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