So the congressional health fight is not only a partisan ideological fight over a sixth of the American economy, but a regional argument that cuts across everything. It's like dealing with swine flu, complicated by rabies.

It's gotten particularly complicated because the House health reform bill creates a public option with reimbursement rates based on Medicare rates, which would reinforce the regional imbalances.

Each of Oregon's three players on the issue --Wyden, on the Senate Finance Committee; Sen. Jeff Merkley, on the Senate health committee; Rep. Earl Blumenauer, on House Ways and Means --is following a different Oregon Trail to try to rebalance the state's situation.

Meanwhile, the Capitol cracks in half in the battle over whether to pass any health care bill at all.

In the bill that went through Merkley's committee, the public option reimbursement rates aren't pegged to Medicare but are to be negotiated separately by the secretary of health and human resources.

When the House bill came up, Merkley said, "I pointed out it wouldn't fly in my state, because we already had providers who wouldn't deal with Medicare patients. Then Tom Harkin (D-Iowa, now committee chairman) joined in and said Iowa was just like Oregon and it wouldn't work at all.

"I found it humorous when, 10 days later, that became the argument of the Blue Dogs in the House."

Blue is not the color of a Merkley dog.

The bill that came out of Wyden's Finance Committee doesn't include a public option --although he voted twice to insert one --but Wyden said he made some adjustments to the Medicare Advantage program to try to reduce the geographic deficit. He's concerned about any connection of a public option to current Medicare rates: "The House bill takes our state, already getting clobbered, and hits us again."

But last week, a group of House Democrats from Oregon, Washington, Minnesota, Wisconsin, Iowa and Vermont --they called themselves the Quality Care Coalition, but in Afghan terms might have been labeled the Northern Alliance --announced that the House bill would include measures to adjust Medicare payments. Studies would be carried out by the Institute of Medicine to look at geographic differences and at rewarding quality more than volume.

On the geographic imbalance, said Blumenauer, "We've made some pretty significant adjustments that I think are going to correct that."

To Blumenauer, the point is not so much the financing of a public option as to go directly to the core problem.

"What we put in the public option is minor compared to fixing Medicare," he said last week. "Four times the number of seniors are in Medicare" compared to estimates of public option enrollment.

The health care debate in Congress has gotten bogged down in questions of principle, about the role of government against private insurance in providing health care. But for a major medical overhaul to work, it will be necessary for enough members of both houses to rise above principle, and to devise a system that's not only fair to all Americans, but more important, fair to all constituencies.

At least it would help if the federal government stops thinking that living in Oregon is a pre-existing condition.

I'll get the hand of this one of these days..............:-)

My friends Maria and Gustavo.

http://www.youtube.com/watch?v=IKrBT_PHNtE

And Senator Russ Feingold of Wisconsin said that he was “frankly getting excited that we may have some momentum for something very positive,” adding that there is “a good chance” that it will “create some competition for the abuses of the insurance industry.”

http://www.nytimes.com/2009/10/26/health/policy/26talkshows.html?_r=1&th=&emc=th&pagewanted=print