Capuano Stab in the Back

Histronics (6.00 / 6)

Have you personally read every flipping page of the Senate Healthcare Reform Bill?  Is it possible that there's something in it that isn't good for Massachusetts?  I trust Cap before I'd trust Obama, Pelosi and Reid.  Someone has to be looking out for us.  He may be angling for a fix.  

"The world was made for people who aren't cursed with self-awareness." ~Annie Savoy, Bull Durham

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by: Justice4All @ Thu Mar 11, 2010 at 20:45:36 PM CST

If Obama hadn't stabbed us in the back (5.80 / 5)

then Capuano might not have a reason to even consider the need to vote no on this bill.

"Capital is only the fruit of labor, and could never have existed if labor had not first existed. Labor is the superior of capital, and deserves much the higher consideration."
-President Lincoln

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by: liveandletlive @ Thu Mar 11, 2010 at 21:21:34 PM CST

Mike Capuano is a stand up guy (6.00 / 3)

Capuano would be the last person I would say that would ever stab anyone in the back.....I am sure his concerns about the health bill are serious enough for him to buck his very good friend Nancy Pelosi...I have known Mike Cauano to be a truly honest and principled liberal your attack on him is unfounded!

I have heard that certain language would not be good for Massachusetts and would actually imperil hundreds of millions of dollars in federal medicaid money coming to Massachusetts - that to me is a good reason to be concerned.

BTW - This sentance was also way over the top: "he will share part of the blame every time someone dies because he or she lacks health insurance."

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by: WARD3DEM @ Thu Mar 11, 2010 at 22:06:59 PM CST

Might Have Something To Do With The Anti-Progressive State Clause (5.67 / 3)

"But Obama has asked Reid to strike a provision that would send $1.1 billion in extra Medicaid funding to Massachusetts and Vermont -- states that have already expanded Medicaid coverage but would otherwise not be reimbursed at the same level as states that would boost their Medicaid populations for the first time under the bill's mandate.

"What I told Harry Reid is that Vermont does the right thing, and I don't want Vermont to be penalized for doing the right thing," Sen. Patrick Leahy (D-Vt.) said in a statement.

Through a spokeswoman, Sen. John Kerry (D-Mass.) said he, too, was working with the president "to make sure Massachusetts's past investment to expand health coverage to low-income individuals is recognized in health reform."

Read more: http://www.post-gazette.com/pg...

Apparently the 1.1 billion is needed by Goldman Sachs for next week's bonuses.

- Manny

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by: MannyGoldstein @ Thu Mar 11, 2010 at 22:07:43 PM CST

Come on, read his letter (6.00 / 3)

I don't see how you can read Capuano's letter and conclude that it is "a strong suggestion that mighty Mike will vote against HCR."  I think that's taking too much from the TPM headline and not from the content of his letter.  He has problems with the bill and deep concerns of the Senate's willingness to help fix things.  

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by: DoubleMan @ Thu Mar 11, 2010 at 22:10:28 PM CST

This Title Is A Terrible Lie (6.00 / 4)

Capuano is a great Rep, and he'd make a fantastic Senator.

It is fair and reasonable for Cap to say he has qualms with the Senate bill, and to say he has concerns with any Senate promises to "fix" problems.  The Senate is what has kept America from living up to its promises of protecting the rights of all people in the Declaration of Independence (see Strom Thurmond, filibuster).  

Sentences like these:

I have little to add other than that Capuano is greatly in error if he thinks that the vote for Scott Brown provides reason for Democrats to cave.  
Capuano provides a list of excuses for what would basically be repudiating a generation of efforts by Democrats to get health insurance for all.

If Mike Capuano succeeds in leading the GOP efforts to kill health care reform he will share part of the blame every time someone dies because he or she lacks health insurance.

have no basis in facts nor history.

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by: joeltpatterson @ Thu Mar 11, 2010 at 22:49:00 PM CST

who says its caving? (6.00 / 2)

Mike Capuano has done many things in his life, but I can't think of an example where he "caved."

The problem here is trust. There's no reason why the House should trust the Senate to do the reconciliation fix, if the House passed it first. The odds would be stacked against them that way, even if they were well intentioned at the outset -- there's simply no incentive for them to do so when both chambers have signed the bill and all it needs is a Presidential signature, especially when the reconciliation process seems to be a messy one.

Furthermore, without so much as a majority vote in the Senate on the public option, why should the House so easily abandon it? All along the story was that the Senate couldn't get 60 votes. Well, now all they need is 50 + Biden. Already, more than 50 have said they support a public option -- and at least 41 have signed the letter demanding there be a reconciliation vote on a public option -- so either leadership is killing it when it could pass if there's actually a vote, or there's a bunch of Senators lying their asses off. Either way, it's in each public-option supporting Representative's best interests for there to be a majority vote on it... and there's no reason why the House should carry the water of the Senate if all those Senators signing that letter are full of shit.

At the end of the day, we have a bicameral legislative branch. Congressmen and women are not bat boys and girls for the United States Senate.

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My thoughts are mine and mine alone. They should not be considered representative of any other organization, group or person - save me.

~Ryan.

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by: Ryepower12 @ Fri Mar 12, 2010 at 01:48:13 AM CST

This (6.00 / 3)

All along the story was that the Senate couldn't get 60 votes. Well, now all they need is 50 + Biden. Already, more than 50 have said they support a public option -- and at least 41 have signed the letter demanding there be a reconciliation vote on a public option...

It isn't Capuano who's caving and backstabbing - it's Obama. He's caving in to the insurance industry (yet again) and stabbing all of us in the back (yet again). With no public option, the Senate bill is a giveaway to Big Insurance. Why choose pie-in-the-sky "fix it later" hypotheticals when real, comprehensive reform is within our reach?

Shoe bomber, underwear bomber -- why aren't we waging war on clothes?

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by: kirth @ Fri Mar 12, 2010 at 05:28:39 AM CST

[ Parent ]

Capuano = Kucinich? (4.67 / 3)

Mike better get his head out of his *** very quickly.

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by: GregR @ Fri Mar 12, 2010 at 05:54:50 AM CST

Er... (6.00 / 3)

Some people might find it helpful to read the actual letter.  To me, it sounds indecisive, at least publicly so.  This may be legit, or an attempt to wring something vaguely progressive from this entire process.

In his own words:

March 11, 2010

Dear Friends,

For over a year, Congress and the President have been working to craft comprehensive health care reform. For me, throughout this process, I have focused on how to make health care available to all Americans without damaging the quality of care in Massachusetts. I do believe we achieved that goal in the bill passed by the House. I have not yet reached a final conclusion about the bill passed by the Senate last year because it would have, in the usual course of legislative business, undergone changes in conference committee before coming to the House for a vote.

As I am sure you are aware, there was no conference committee established for this bill. House Members will now likely be asked to vote on the Senate bill without changes, making it available to the President for his signature. Congress will then vote on amendments to that legislation through a process known as reconciliation. At this writing, it is not at all clear what legislative changes will be made to the final bill. Reconciliation is a complicated and dangerous process. In this instance, it requires the House ouseto adopt the Senate bill and then trust that the Senate will pass, and the President will sign the reconciled bill that "fixes" any problems in the existing Senate bill. There is great risk in this course of action. If one or both parties refuse to commit to this approach; the Senate bill could be signed by the President as the final bill. This recent New York Times article provides a good snapshot on current thinking regarding reconciliation in the Senate: http://www.nytimes.com/2010/03...
Therefore, I have been focusing on how exactly the Senate bill affects Massachusetts before I decide how much I will leave to "trusting" the reconciliation process. Trust is hard to find in Washington these days and I will have to make that decision myself.

I am also struggling with some of the larger questions related to the Senate bill, such as the lack of a public option and how we should pay for health care. Additionally, I have some concerns that are of specific importance to me as someone who represents Massachusetts.

Described below are the most pressing concerns I have with aspects of the Senate bill that directly impact Massachusetts. As I have done throughout this process, I reached out for a wide range of opinions on the issues described below - from hospitals, community health centers and other knowledgeable sources. I am seeking their comments on the following aspects of the Senate bill and I am currently awaiting their responses. As always, I also want to hear from you. I thank you for the many thoughtful comments you have shared with me over the past year and I look forward to hearing any additional comments you'd like to share:

(1) Early Expansion States - The House bill recognized that some states took the lead on expanding coverage to more citizens by "grandfathering" in their programs so they would not be harmed by the new federal proposal. This helps Massachusetts, since we are one of the leaders on this issue. The Senate bill does not take the general grandfathering approach but it includes language that specifically protects Massachusetts. Although the Senate language is not as generous as the House language, the Commonwealth does have some protection.

I am concerned that in reaction to other state-specific Senate language such as the now infamous "Cornhusker Kickback," legitimate state-specific Senate provisions will be dropped, which would seriously damage Massachusetts. In fact, a March 10th article in Politico raises this very question and reports that the President wants the Massachusetts language out of the Senate bill. It is my understanding that without some type of grandfathering language; Massachusetts could lose in the range of $300 million per year. I am gathering more information about this aspect of the bill to determine if my concerns are valid.

(2) DSH cuts - Currently, Medicare and Medicaid provide extra payments to hospitals that serve higher-than-average shares of people without health insurance. These hospitals are called Disproportionate Share Hospitals, or DSH. In the 8th District for example, Boston Medical Center and Cambridge Health Alliance both depend on millions of dollars a year in DSH payments. The Senate bill would cut DSH payments by $42 Billion per year, as opposed to the $20 Billion cut proposed in the House. Such cuts, made before a new health care system is allowed to fully develop, would curtail the amount and quality of health care provided by DSH hospitals and their uninsured patients, thereby driving these sick and poor persons to other hospitals that will not be equipped or paid to handle the medical and social challenges they present. I am looking into this aspect of the Senate bill as well.

(3) Value Index - The Senate bill includes a proposal to adopt a so-called "value index"; the House bill does not include this proposal. It would adjust the way payments to physicians and other non-hospital providers are calculated. Supporters suggest it would encourage practices that are more frugal by rewarding "low cost areas". Massachusetts is considered a "high cost area" due to various factors, including the regional cost of living, the relative poverty of the people served, and our financial commitment to educating America's next generation of doctors. There are no limits on how much a physician's payments could be reduced by this so-called "value index" and the method has never been tested at the physician level. Due to the probability of much lower payment rates to Massachusetts doctors, this proposal seems as though it would influence (1) where doctors practice (discouraging practice in Massachusetts), (2) how they treat patients in so-called "high cost areas", and (3) how many doctors will be trained in America. Absent a thorough study of the impact of this so-called "value index", it seems to me that it could seriously harm the quality of care in Massachusetts.

(4) Super IMAC - The Senate bill contains a proposal that would shift authority to set Medicare policies and reimbursement rates from the Congress to a board appointed by the President. This proposal has been referred to as the "Super Independent Medicare Advisory Council" by many. The House bill does not contain such a proposal, although it does require formal studies on many specific initiatives to improve the quality and cost effectiveness of the American health care system. Traditionally, reimbursement rates from Medicare are based on many factors including efficiency, complexity of the medical issues, whether the provider also bears costs associated with medical education for future doctors, whether the provider engages in research that advances medicine and the cost of living in different areas. Some argue that Medicare should focus ONLY on cost containment without regard for all the other factors that affect the cost of care and that have been traditionally considered. I am concerned that if this appointed board adopts the cost-containment only approach, Massachusetts could lose BILLIONS of dollars PER YEAR. Such a loss would hurt our world-renowned medical schools, teaching hospitals, and research programs. Those losses would undermine the quality of care we provide to our own citizens and slow progress in biomedical sciences globally. To make matters worse, I am concerned that it would quickly and inevitably result in Massachusetts losing tens of thousands of jobs and would seriously undermine one of our region's economic engines. Other regions with heavy concentrations of health care would feel a similar impact, such as New York City, Philadelphia and Los Angeles. Finally, to add insult to injury, the elected representatives of the people impacted would no longer have a say in accepting, rejecting or amending any new approaches - the entire decision would be up to Presidential appointees. Moreover, I ask people who are happy to entrust these decisions to persons appointed by President Obama to remember that there will be other Presidents, with, perhaps, very different levels of commitment to medical care.

In addition to the specific concerns outlined above, I am also concerned that some of these issues simply CANNOT be "fixed" through reconciliation. For example, even if everyone agreed at this point that the so-called Super IMAC should not be implemented; the reconciliation process may not allow that change because technically the provision does not impact the budgetary aspects of the bill. I am still working on clarifying this segment of my concerns.

I am sure you have heard that there is a push to have the House vote on all of this next week. I do not know if that goal is attainable, but I must presume it is real. As with all legislation, I seek to be as well informed as possible - especially on complicated matters such as these that are so critically important to our region. As always, I welcome your thoughts on this matter - on health care reform in general or on any of the issues I have outlined above. I look forward to hearing from you and I will keep you informed regarding what I learn. Please feel free to contact my office at the phone numbers listed below, or you may email me through my website at http://www.house.gov/capuano/c...

Congressman Mike Capuano
8th District, Massachusetts
Committee on Transportation and Infrastructure
Committee on Financial Services
Committee on House Administration

~~~~
Believe it or not, I have even more to say...

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by: sabutai @ Fri Mar 12, 2010 at 07:44:02 AM CST

Posturing or Kucinich (4.00 / 2)

Either Mike is really going to vote for the bill and is posturing or he really does want to become the Massachusetts version of Dennis Kucinich.

After a years of work and after countless near deaths for the chance Mike Capuano wants to be the one who can finally kill health care reform.

Why? Because he wants to make certain that tens of millions of Americans will never ever get health care without facing financial ruin? Because he has some secret as yet undisclosed plan for getting a better bill passed at some point in the next 16 years? Or because he does not care if Democrats go down in flames across the country?  

As for his expertise and consistency this seems to be the same candidate who one day criticized Martha Coakley for suggesting she would not vote for a final bill without changes in abortion language and the very next day said he agreed with her.  So Mike Capuano is either for making the difficult vote to move toward the enormous historical achievement of establishing health insurance for all Americans or he is not because it is too difficult for him personally?  

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by: Historian @ Fri Mar 12, 2010 at 07:44:32 AM CST

(4) None of the above (6.00 / 1)

Because he wants to make certain that tens of millions of Americans will never ever get health care without facing financial ruin? Because he has some secret as yet undisclosed plan for getting a better bill passed at some point in the next 16 years? Or because he does not care if Democrats go down in flames across the country?

No. Read the letter that sabutai posted. Passing the bill that Obama wants would screw MA, for one thing.

The Senate bill is corporate welfare.

Shoe bomber, underwear bomber -- why aren't we waging war on clothes?

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by: kirth @ Fri Mar 12, 2010 at 07:56:19 AM CST

[ Parent ]

agreed (6.00 / 1)

It sounds like he is struggling with a bill that is more than just imperfect. This is exactly why I voted for him. He is thoughtful, honest and not afraid to do what he thinks is right for his constituents regardless.  

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by: kaj314 @ Fri Mar 12, 2010 at 08:53:37 AM CST

[ Parent ]

zOMG! zOMG! The SKY is falling! (6.00 / 4)

Someone expresses serious reservations that a bill will hurt his state and tries to wring something better of it, and he must be hunted down and killed for it! String 'im up!

Good lord. Isn't there enough to be concerned about in this country without going off the deep end.

Does ANYbody READ anything any more? Do they teach reading comprehension?

Sigh.

Left in Lowell: cuz why read the Lowell Sun if you don't have to? ;)

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by: Lynne @ Fri Mar 12, 2010 at 10:18:59 AM CST

There comes a time when politics and policy become one. (0.00 / 0)

This is one of those times. By fence sitting, Capuano gives cover to those who would stop the bill.

The specifics of the bill are what they are. Mike's open complaining is not going to get that changed in the reconciliation process. It is a leap of faith that the Senate will do what they promise, but it is one that has to be taken, or the entire process is dead.

If Cap's hemming and hawing creates the opening whereby this bill is killed, he will become a pariah.

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by: GregR @ Fri Mar 12, 2010 at 10:30:00 AM CST

[ Parent ]

STOP IT! (6.00 / 1)

That's ridiculous. We've sat and watched as conservative dems have hijacked the process and got all of their concerns addressed in this bill while progressives have been left holding the bag. Now that a progressive starts driving a hard bargain people start screaming? Are you kidding? this is the reason why we never get what we want in legislation. We don't have the stomach for hard ball.  

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by: Hayduke @ Fri Mar 12, 2010 at 10:58:38 AM CST

[ Parent ]

Congrats, then. (0.00 / 0)

You seem to want Cap to be liberal version Lieberman or Stupak. This letter does that pretty well.

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by: GregR @ Fri Mar 12, 2010 at 12:19:41 PM CST

[ Parent ]

Bull (6.00 / 2)

"Mike's open complaining is not going to get that changed in the reconciliation process."

Really? I smell bull. You declare that this must be true because, what, you have a feeling?

It might, or it might not, work, but goddamnit, when the f do we ask our legislators not to try to work in our best interest?

This bill has some serious monetary consequences for MA. I sure as shit want Mike to raise a stink about it.

Left in Lowell: cuz why read the Lowell Sun if you don't have to? ;)

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by: Lynne @ Fri Mar 12, 2010 at 11:37:26 AM CST

[ Parent ]

Umm. It's a little late in the game, dontcha' think? (0.00 / 0)

Bull yourself.

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by: GregR @ Fri Mar 12, 2010 at 12:17:54 PM CST

[ Parent ]

It's never too late. (6.00 / 1)

You seem perfectly willing top accept a shitty bill which gives MA the shaft in the name of political victory. I'm pretty happy that there's at least one progressive with enough spine to try and make a play to restore money for MA.  

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by: Hayduke @ Fri Mar 12, 2010 at 12:23:51 PM CST

[ Parent ]

Money would get restored, with, or without... (0.00 / 0)

... Capuano's games. Who are you kidding?

I don't want political victory. I want a Health Care Bill that once it is in place will evolve into a program that we can be proud of.

If you were paying attention in '93 - '94, you would know that you get ONE bite at this apple. One.

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by: GregR @ Fri Mar 12, 2010 at 12:30:11 PM CST

[ Parent ]

BS (0.00 / 0)

You can turn the Titantic faster than you can change the provisions of a law this large....and for those who fail to read the details, there will be "unintended consequences."  I would rather have Mike read the damned bill now, and fix what's wrong, then gamble on trying to fix it later...because "later" might be years from now.  

You want healthcare reform at any cost.  I want healthcare reform at a cost that most of us can afford.  

"The world was made for people who aren't cursed with self-awareness." ~Annie Savoy, Bull Durham

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by: Justice4All @ Fri Mar 12, 2010 at 20:12:21 PM CST

[ Parent ]

If they don't pass this bill... (0.00 / 0)

... I will bet $100 to the charity of your choice that healthcare reform of any meaningful kind is dead for at least a decade.

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by: GregR @ Sat Mar 13, 2010 at 18:02:47 PM CST

[ Parent ]

And a bad bill (0.00 / 0)

can live for freaking eternity.  Expediency is not the answer here.  Getting the right bill passed is vitally important.

"The world was made for people who aren't cursed with self-awareness." ~Annie Savoy, Bull Durham

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by: Justice4All @ Sun Mar 14, 2010 at 10:44:55 AM CDT

[ Parent ]

I'll see you in 2026. (0.00 / 0)

That's how long it will take to get another bite at this apple. What's on the table is far better than the status quo.

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by: GregR @ Sun Mar 14, 2010 at 14:40:55 PM CDT

[ Parent ]

Doesn't have to be that way. (0.00 / 0)

And if they were serious about insuring the uninsured, this bill would be 10 pages long instead of the ridiculous length that it is now.  

"The world was made for people who aren't cursed with self-awareness." ~Annie Savoy, Bull Durham

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by: Justice4All @ Sun Mar 14, 2010 at 19:31:33 PM CDT

[ Parent ]

Doesn't have to be that way. (0.00 / 0)

And if they were serious about insuring the uninsured, this bill would be 10 pages long instead of the ridiculous length that it is now.  

"The world was made for people who aren't cursed with self-awareness." ~Annie Savoy, Bull Durham

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by: Justice4All @ Sun Mar 14, 2010 at 19:31:33 PM CDT

[ Parent ]