Thursday, September 24, 2009

DeLay of de land in Congress

Tom DeLay may be a mean, corrupt extremist thug whose chief mission while in power was to sell sell legislation to lobbyists. But that doesn't mean he doesn't know the legislative process:
"The Democrats will do exactly what we always did, rewrite the bill over and over until they give all the members what they need to get to 218 votes. The Senate will do the same thing." It will, he predicts, be a straight party-line vote, and "maybe a few Republicans voting for it, but not many."
Right on cue, the Times today reports that Senator Bill Nelson, Democrat of Florida, is getting hammered by seniors up in arms about planned cuts in subsidies to Medicare Advantage providers, and is in turn holding out to have those cuts eliminated or scaled back. The Times' Robert Pear notes the likely effect if Nelson succeeds:
Approval of the amendment could invite other Democrats to ask for similar deals that might make the bill more palatable to their constituents, but more costly as well.
So we'll see what happens to all those lovely cost-saving measures in the Baucus bill that led the CBO to score it better than deficit-neutral.

The Times article also highlights the many channels of corporate influence. Nelson has received substantial contributions from the insurance industry, health professionals and pharmaceuticals -- a total of over $1.6 million, putting him at about #14 among Democratic senators. But he's being pressured also by seniors in Medicare Advantage programs (remember, he represents Florida), put up to it by their insurers (e.g., Humana), who are scaring them with letters that the Obama administrations calls "misleading and confusing." Ah, democracy...

As a footnote, one under-reported element of the health care debate is the performance and value (or lack thereof) offered by Medicare Advantage programs. The subsidies paid to Advantage providers have been targeted and denounced. Some programs have been flagged for misleading representations of benefits. Obama has implied that Advantage programs provide nothing of substance that seniors can't get from traditional, fee-for-service Medicare. At the same time, the programs should at least have the potential to implement many of the cost-saving measures touted by the Administration - global payment systems, preventive and wellness care, teams of doctors that communicate with each other. I'm going to see what I can scare up on the topic.

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