After arguing that the House health care bill did not do enough to lower long term health care spending, Blue Dog Democrats hijacked the House Energy and Commerce Committee and promised to vote down the bill unless Chairman Henry Waxman (D-CA) heeded their concerns.

Today, the Dogs and the Dems reached a compromise:

- Reimbursement rates for public plan should be no higher than market rates: Rather than reimbursing at five percent above Medicare rates, the new public option will now directly negotiate rates with providers.

- States can offer an insurance co-op alongside public plan: Presumably this state-based cooperative would act like any other not-for-profit insurer and will lack the market clout to drive bargains and lower costs.

- Premium cap goes from 11% of income to 12%: Loosening the affordability measures is certainly one way to bring down the cost of health reform, but it does little to help families purchase coverage.

- States must pay 7% of cost of additional Medicaid enrollments: States are already worried that the plan to expand Medicaid would leave them on the hook for financing the expansion after the five year grace period (for the first five years, the federal government funds the expansion, after that, the states would gradually assume half the cost.) This will likely stoke their concerns.

- Small business exemption for payroll up to $500,000; phases out at $750,000: The original language exempt businesses with a payroll of less than $250,000 and charged a penalty on a sliding scale.

- Cost of bill must come in at under $1 trillion: Most health reform advocates believe that is nearly impossible to provide everyone with affordable health care coverage under $1 trillion.

On the whole, these tweaks are rather minor. Most observers interpreted the hoopla surrounding the negotiations as a sign of serious trouble. If the outline above is correct, then the dogs came back with their tail somewhat between their legs.

Secondly, the agreement only reinforces the notion that Blue Dogs are more interested in ideological politics than lowering long-term health care spending. After all, if they really wanted to lower costs, they would support reform that includes a robust public option and generous affordability measures so that every American is part of the health care system and has access to needed care. After all, if the public plan pays bloated market rates (as this agreement states) it will fail to offer lower premiums within the Exchange, and would cause the government to spend more money on subsidies. Unfortunately, the Blue Dogs are trying to lower the costs by making insurance less affordable and undercutting a meaningful public option.

Yesterday, during President Obama’s AARP town hall, a caller stated that she had “heard lots of rumors going around about this new plan…I have been told there is a policy there that everyone that Medicare age will be visited and told to decide how they wish to die.” This “rumor” which may have been started by infamous health care provocateur Betsy McCaughey has made its way into the standard conservative critique of the Democrats’ reforms:

- Laura Ingraham: Old people could be visited in their homes and essentially be told ” all right, sweetie, you’ve had a good life...I don’t want a government bureaucrat telling him what kind of treatment he should consider to be a good citizen. That’s frightening.

- Rep. Virginia Foxx (R-NC): [Americans will be] put to death by their government.

- Rush Limbaugh: The bureaucratic going to make the decisions. You aren’t. And it’s in the House bill. Once you reach, I don’t know what the age is, every five years, it’s in the sixties, every five years some counselor shows up.

- Sean Hannity: In other words, they would mandate that those who get government care literally could be pushed to refuse care.

Watch a compilation:

To substantiate their claims, conservatives point to SEC. 1233 of the House Tri Committee bill, a section titled “ADVANCE CARE PLANNING CONSULTATION.” But while the language allows Medicare to reimburse providers for consulting with patients about end-of-life issues, nothing in the section mandates a consultation. On page 429, the bill specifically states that seniors “may” consult with medical professionals — not government bureaucrats:

The bill aims to provide seniors with information about drafting a living will or the options surround end of life care, information Americans have been asking for. A recent report by ThirdWay found that “although 75% of Americans feel advance directives are a good idea, only 40% of Medicare patients say they have one.” Given the lack of clear information, “many patients sign documents that don’t offer clear instructions. Family members may have conflicting feelings about the care they wish to see a patient receive…For elderly patients, their end-of-life wishes regarding care are often unknown or ignored.” The new optional Medicare service seeks to reverse that trend and help patients make more informed end-of-life decisions.

Transcript: Read more

Tomorrow is the the 44th anniversary of Medicare, a government-sponsored health care program that provides health coverage to virtually all of the nation’s elderly and a large share of people with disabilities. While Medicare is not without its problems, it has dramatically improved access to health care, allowed seniors to live longer and healthier lives, contributed to the desegregation of southern hospitals, and has become one of the most popular government programs.

At the time, conservatives strongly opposed Medicare, warning that a government-run program would lead to socialism in America:

Ronald Reagan: “[I]f you don’t [stop Medicare] and I don’t do it, one of these days you and I are going to spend our sunset years telling our children and our children’s children what it once was like in America when men were free.” [1961]

George H.W. Bush: Described Medicare in 1964 as “socialized medicine.” [1964]

Barry Goldwater: “Having given our pensioners their medical care in kind, why not food baskets, why not public housing accommodations, why not vacation resorts, why not a ration of cigarettes for those who smoke and of beer for those who drink.” [1964]

Bob Dole: In 1996, while running for the Presidency, Dole openly bragged that he was one of 12 House members who voted against creating Medicare in 1965. “I was there, fighting the fight, voting against Medicare . . . because we knew it wouldn’t work in 1965.” [1965]

Despite Medicare’s success and the unrealized fears of its detractors, Republican lawmakers are still regurgitating the claim that Medicare would create a “Soviet-style model” of health care. As Rep. Roy Blunt (R-MS), chairman of the GOP Health Solutions Group, explained during a recent radio interview, “you could certainly argue that government should have never have gotten in the health care business…Government did get into the health care business in a big way in 1965 with Medicare, and later with Medicaid, and government already distorts the marketplace.”

Over the years, Republicans proposed numerous schemes to slash funding or privatize Medicare. Most notably, in 1995, under the leadership of then House Speaker Newt Gingrich (R-GA), Republicans proposed cutting 14% from projected Medicare spending over seven years and forcing millions of elderly recipients into managed health care programs or HMOs. The cuts were to ensure that Medicare is “going to wither on the vine,” Gingrich explained. Similarly, during the 2008 Presidential campaign, Sen. John McCain (R-AZ) proposed cutting $1.3 trillion from Medicare and Medicaid.

But while Republicans have sought to undermine the program, seniors have benefited from it. Since 1965, “the health of the elderly population has improved, as measured by both longevity and functional status.” In fact, according to a study from Health Affairs, life expectancy at age 65 increased from 14.3 years in 1960 to 17.8 years in 1998 and the chronically disabled elderly population declined from 24.9 percent in 1982 to 21.3 percent in 1994.”

Prior to Medicare, “about one-half of America’s seniors did not have hospital insurance,” “more than one in four elderly were estimated to go without medical care due to cost concerns,” and one in three seniors were living in poverty. Today, nearly all seniors have access to affordable health care and only about 14 percent of seniors are below the poverty line.

Moreover, a recent survey from the Commonwealth Fund, found that “elderly Medicare beneficiaries reported greater overall satisfaction with their health coverage, better access to care, and fewer problems paying medical bills than people covered by employer-sponsored plans.” In fact, Medicare is so popular that most Americans support expanding Medicare coverage to Americans aged 55 to 64. According to a recent Kaiser Family Foundation poll, “over half of Americans (53 percent) “strongly” support such a proposal and an additional 26 percent say they support it somewhat, totaling 79 percent backing.”