Call me overly optimistic, but lowering the medicare age, opening up the same options as federal workers have, stricter regulations, and a trigger should these fail seems to be a pretty good deal. I’m sure you all will take the opportunity to explain to me why I am full of it, but I’m actually kind of pleasantly surprised. Hell, the medicare thing alone I thought would never happen.
Open Thread
This post is in: Open Threads
TR
Yeah, I’m having the same reaction. “Medicare for All” was what progressives were originally pushing, but it went off the table pretty quickly. And now that’s the compromise?
Uh, OK. If you insist, Ben Nelson.
El Cid
I agree that what I have heard discussed in the past day sounds much better than what I thought we would be hearing. How that relates to what we get, I don’t know, but it’s at least a sign that some number of influential Democrats are able to think at least a few months in advance to perceive what would happen from the electorate if nothing but a pro-insurance industry bill gets through (as opposed to ‘mostly’).
joe from Lowell
Any public option has always been described, in the progressive community, as a way-station towards universally-accessible public health care. Once a public option was in place, the thinking went, the better service and lower costs it can provide would inevitably lead to its expansion.
Medicare buy-in is going to work the same way. It’s only a matter of time before it becomes available to younger and younger people.
joe from Lowell
It’s not just the compromise; it’s a massive sell-out, which is not change we can believe in, demonstrating that Obama is just like Bush.
I’d go so far as to call it a slap in the face.
This message brought to you by the National Coalition of Naderites and PUMAS Working to Destroy Obama.
NCNPUMAWDO: Because some feet need shooting.
robertdsc
At this point, I don’t care. Just pass a fucking bill and get it over with.
Just don’t chicken out and send the Senate bill to the President without a conference report as has been rumored. Fuck that shit.
geg6
Oh, well, John. Just check out the previous thread for all the people who are taking their toys and going home come November 2010. Because, as I posted there, the pony they and I had hoped for turns out to be a broken down nag. Because, well, that’ll show them! And as we all flood the Canadian border trying to get out as the Teabagger Party takes over, we’ll all be so grateful for their ideological purity.
El Cid
@joe from Lowell: I agree with Digby: We dirty hippies need to go nuts opposing Medicare buy-in so that the Lieberites and hippie haters don’t dare notice we like it, because then they’ll replace it with tobacco subsidies for toddlers.
Hunter Gathers
Since this seems like a good idea, I suggest that libs throw a hissy fit over it anyway. If we say we like it too much, it will give the ConservaDems a reason to oppose it.
dr. bloor
I don’t like it, but I’m not in charge. Ironically, I don’t think the system was quite broken enough to affect real change this time around. Once enough employers start going bust due to health insurance costs, and once those lucky folks who continue to get employer-sponsored insurance start getting nothing but plans with big co-pays and four- or five-digit annual deductibles, they’ll be back at the table again.
TR
Speaking of which, this is a nice rebuttal to the purer-than-thou.
ploeg
The sticking point is that, if you want Medicare, you will have to pay for it, particularly in the 2011 to 2014 time frame, where you would have to pay for it without subsidy. And it isn’t going to be cheap.
That said, when you pay for Medicare coverage, you’re going to get Medicare coverage, not denials and excuses.
buckyblue
Start high and then ‘compromise’ to what you really want. It almost sounds like they knew what they were doing. Nah, I’ll believe it when I see it. We will have to provide some faux outrage to appease the righties, however.
Victory
http://mobile.politico.com/blog.cfm?blogid=42719&bloggerid=4
We lose.
Napoleon
I will withhold comment until more details are made available and I see some people like Ezra and the like weigh in after more details come out and they have a chance to ponder the bill.
Having said that, if it is decent I say if it passes the Senate send it right to the House for passage without amendment. no conference committee, no f-ing around with it any more, just pass it as is.
Victory
http://mobile.politico.com/blog.cfm?blogid=42719&bloggerid=4
We lose.
chopper
for me, the ‘federal worker’ option was the first, most basic step forward. but not what i’d want to see as the end.
as a federal worker with a pretty sweet plan, i would really like everyone else to have at the bare minimum access to similar deals, without denial of coverage for pre-existing conditions etc.
i’d still like a single-payer-type system. my insurance is nice but its still complicated as hell, and the claim paperwork i get is befuddling.
stevie314159
No pony. No ice cream. No way.
4tehlulz
This is a better deal than I thought we’d get, and this hasn’t even gone to House-Senate conference yet, which I suspect will make it better.
Obviously, this means I should vote Republican because it didn’t have the public option*.
*To be defined later.
matoko_chan
I’m with you Cole.
If healthcare reform passes IN ANY FORM that is a wooden stake in the heart of the conservatism.
Remember, they phrased it as Obama’s “waterloo” (we can break him!)
Savor this WSJ article.
Chad S
I wasn’t a big fan of this agreement until reading the details: if the insurance companies don’t create national non-profit(ie cheap) insurance plans that will be offered in the state/national health exchanges and they aren’t effective in providing cheap health insurance, there’s a public plan trigger fairly quickly. Heads the consumers win, tails the insurance companies lose.
Comrade Jake
What will be interesting is to watch members of the GOP, who have painted themselves as the defenders of Medicare over the past couple of months, now tell everyone how that program should not be expanded. I look forward to the Michael Steele version of the verbal gymnastics for retards.
Kenneth Fair
This is a terrible compromise! We should rally against it! Don’t throw us in that awful briar patch!
smiley
@ploeg: People over 65 pay for Medicare Part B now. They pay a monthly premium of about $100 per month. Only Part A is “free” to them.
2th&nayle
Just a personal note. I took my Mother, who is 77 and on Medicare, to the oncologist yesterday. All her screens came back negative. She doesn’t have to go back to the docs for another 6 months! WooHoo! Thank goodness for Medicare!
Brian J
As I said last night, it’s not exactly great that certain part of the population might be shut out from a public option, but if a smaller part of the public gets access to Medicare, the already existing public option, it makes for what appears to be a fair trade off. I suspect a big part of the battle with a public option will be convincing people it’s not responsible, along with the Clintons and ACORN, for all things go wrong in their lives. With Medicare, we’ve essentially already won that battle. The focus can then be on other things, like better cost control measures.
On a related note, everyone should read this piece by Atul Gawande in the latest New Yorker. His point seem to be that (a) the fact that the health care bill tries a lot isn’t a bug but instead a feature, since there’s no easy answer and (b) what is happening now is very similar to what happened with agriculture back in the early 1990s. Like health care is today, it was plagued with inefficiencies and low quality and was eating up an ever increasing share of money in this country. I simply didn’t realize any of this about farming before I read this article. (Hint to media types everywhere: this is what real journalism looks like.)
2th&nayle
Hey! Got a edit function for the first time in ages! Double WooHoo!
seabe
Well, before the details, I can’t say for sure, John. At this present time I am leaning towards agreeing with you, but like Kevin Drum, I wasn’t a big supporter of the PO in the first place. What mattered to me was providing coverage for everyone, and having a national price setting mechanism where all insurance companies pay the same damned thing for the same procedure; this could be done with private insurance totally, single payer, or a mix.
In my opinion, allowing people to buy-in to Medicare gets us closer to single payer than a public option does, especially if it’s available right away. Just keep extending it every 5 years or something to the next 10 year list; in 5 years, extend it to 45 year olds.
AM
I think it’s time that Obama starts to find his inner-Dubya and start exploring the use of signing statements and other nefarious manuvers.
ek hornbeck
It is a complete fail.
It’s not Medicare in any recognizable sense.
The trigger will never be pulled.
The fundamental flaw is it provides NO competition for private insurance.
A maximum sellout.
dr. bloor
@2th&nayle:
No Death Panel for mom! Huzzah!
Shoe
it’s flawed because it doesnt do any cost control
and what we need is cost control
stacie
I guarantee the congress that its approval numbers will jump by ten points if it passes any HCR package at all and the Washington press corps can once again turn its laser-like focus to trivialities and horse races.
Morbo
NPR committed some actual journalism this morning and fact checked some of Mitch McConnell’s accusations re: Medicare. Needless to say, he’s full of shit (saving $100 billion from cutting Medicare Advantage AKA $2 trillion insurance giveaway would not be the same as cutting Medicare benefits). Also needless to say, NPR’s ombudsman has been contacted to address reporting this factual counterpoint to Republican talking points.
matoko_chan
no ed…..
don’t look at it that way…
it is one more incremental step on the path to political extinction for the GOP.
They are as dead as the dinosaurs, it is just that the tiny little dinosaur-brains in their hips don’t know it yet.
slightly_peeved
I don’t think they planned it this way (that’s a bit too “11-dimensional chess” for my liking), but good on the Democrats for playing some political judo with the Republicans. Get Republicans talking about how awesome Medicare is, and then announce the compromise to be… people getting buy-in to Medicare. Get the Republicans to accuse Democrats of wanting something different from average Americans, then offer Americans the same health plan as federal employees.
Plus, the people who’ll benefit first (55-65 year old people) are a group who the Republicans need to keep voting for them.
Wait… er… I mean…. this is a horrible compromise! Kill the bill! Killl the biiiiilllllll!
Keith G
@dr. bloor: You have a point. Once more suburbanites get screwed by insurance corps., they will plan a march on Washington.
Napoleon
@matoko_chan:
There is a corollary to that which amazingly most of my life Dems seem not to have gotten (although if anyone does it appears that the Obama WH does) and that is anything the Dems do the right will automatically scream the exact opposite, and if you are smart you take a position (sort of Huckleberry Finn style) that it is completely insane to oppose. If health care passes the right will spend the next few years talking about nothing but how good our current system is. If they do that there is a really serious chance the average voter will see them as being more out of touch with reality then they already do. If it doesn’t pass the issue will die for the next decade and instead the Republicans may talk about issues they may be able to get more traction with.
(by the way in part this is the reason I think it will be a win for the WH to prosecute torture because the right will knee jerk take the opposite position and defend torture)
Brian J
@seabe:
I was a supporter of the public option if for no other reason than I think the problems we are facing are so severe that a multi-step approach, where we try a lot, expand what works and cancel what doesn’t, and keep trying to make things better. There are other reasons, but for you, like me, it sounds like the public option was appealing but never a deal breaker. Is that right, or do you feel differently?
ericvsthem
Pollitically, a lot will depend on the CBO score. Regarding the medicare buy-in for people between the ages of 55 and 64, I’ll be interested to see if they ask the CBO to score the option with more age brackets, just to get an idea of how much more affordable it would be if more (ie. younger) folks were able to buy in…
matoko_chan
I think the medicare bit is 11-d.
Feint with a public option, then stab under the sheildguard of terminal electoral stupidity by expanding an existing public plan that the conservatives are already locked into defending.
Genius.
DBrown
Correct me if I am wrong but does not Medicare cover the oldest and hence, most expensive people already? So unless the age to start is lowred to 18 – 30 year olds, all this bill does is add almost the highest cost people (50+ – 66) to the most costly people (66+.) Which begs the question, at what age will this coverage start? Medical care costs rise fast for people over 60 and isn’t great for 55+. I don’t see how this doesn’t make big insurance companies jump for joy as the profits roll in and the older costly people are dumped into Medicare. Tapayer gets the risks/costs, the insurance companies get the risk-free profits. Great.
chopper
@2th&nayle:
sweet!
BDeevDad
Cole,
looks like your Senator is taking the lead on this and had one of the best quotes
seabe
@Brian J:
Meh, I just didn’t see the public option as being something that would keep costs down. And because it was available to such a limited amount of people, I saw it as something that actually had the possibility to increase health care costs, or do little to nothing about them. If it was available to everyone on day one, had a national price setting mechanism instead of negotiated rates, it would be something I’d fight tooth and nail for, and without it, almost tell Dems to join Republicans in filibustering.
I still don’t know why the left decided that the insurance companies are the enemy here. Yes they’re not very nice people, but they’re not evil, either. Their profit margins are not very high; they’re doing what they see fit to profit, even if just barely.
The real enemy to prices is pharmaceuticals and price setting. No national/regional price setter? Prices will continue to rise in procedures, public option or not. No government setting prices on drugs/importing the cheapest ones possible, and/or no changes to protecting intellectual property? Drug prices will continue to be sky-high.
So while a public option is something I “support,” I just didn’t care that much about it. However, without these things that we’re getting which John listed, I would say filibuster. Health insurance reform isn’t worth it. I want whatever is the fastest way possible to single payer/single negotiator. The PO seemed like the golden ticket to that, but that’s because I didn’t think people would be open to opening up Medicare to lower ages. Now I think opening up Medicare to people of lower ages is the fastest way possible to single payer, and it’s politically viable. Good. Less government bureaucracy, actual lower costs, etc.
My only worry? All of the cheaper and younger people are cherry picked by the insurance companies while Medicare continues to destroy the federal debt. The expansions need to happen rapidly, or…well, I don’t know.
batgirl
@Victory: Oh, they’ll be getting government funding in the subsidies that the government will pay for low-income people to buy insurance except now it will go straight into their pockets without competition.
As for the public option — none of the bills had a real, workable public option. They were all tiny. That said, at least having a PO in the bill was a start to get in there later to improve it. nd hope the American people and Congress
As easy as it seems to blame Obama and the Democrats, I blame us, the American people — stupid, easily misled, easily distracted — who keep sending these assholes back to Congress, who refuse to look at difficult issues like grownups, who should be in the streets on strike demanding that Congress lose their health benefits until all Americans have them. I also blame the system — a system where “money is speech” and therefore corporate America can by their senators, often on the very cheap and a system where senators representing only 11% of the population can control the legislative process and screw it up for the rest of us.
Seanly
How will a trigger work? If healthcare rise only exceeds inflation by a factor of 3 or 10 or 100 that won’t trigger a change?
I don’t want to sound like a concern troll, but I have deep deep fears that the new unspecified compromise is just going to result in all of us non-Beltway folks continuing to get screwed by insurance companies.
I still haven’t heard anything about what exactly is going to lower insurance premiums. So far it’s a lot of underpants gnomes strategy – 1) pass HCR bill, 2) something magical happens, 3) insurance premiums decrease.
ericvsthem
@DBrown: ..that’s why I’m hoping they get CBO scores for a variety of age brackets: 55-64, 45-64, 35-64, etc.
Politically, I doubt that Senate leadership can get lower age brackets into this bill and still get conservadems like Bayh, Carper, and Nelson to vote for it. But it seems inevitable that, over time, the age hurdle will be lowered due to a combination of consumer demand and cost containment.
Two things that have me worried: first, does Reid really have the votes to pass this bill, and two, how pissed off are people going to be about mandates (if they are still in the bill) and being required to buy health insurance (or pay a fine) that they cannot afford?
Ailuridae
@ericvsthem:
I would like to see it scored all the way down to 18 and then have age 55 be a “zero point”. Use some increment (1% for year for example) as a pricing point and open it to everyone. At age 55 you pay for 100% of your Medicare if you choose that as your insurance. If you are 35, as I am, you pay for 120% of your Medicare (actually your percentage of the actuarial class) and it declines as you approach 55. That would be a huge shot in the arm financially for Medicare, would allow the self-employed like me to have actual health security (I would go on Medicare tomorrow if allowed and I have next to no use for health care in a given year) – its a win all around.
EconWatcher
@DBrown:
DBrown seems to make a great point: Did the insurance company lobbyists just find a way to unload their higher risk customers (55+ in age) onto the Medicare system, and keep the younger, healthier people–and with some kind of mandate for them to buy insurance? I don’t know enough to be able to say this is true, but it’s a great question to ask.
Brian J
@seabe:
You make some good points.
Victory
I’ve always thought of the HCR and the Public Option being similar to the SS reform of 2005 and Private Accounts. Each are the mainstay of reforming an issue pushed by the base of each party.
Now, can you imagine the unmitigated nuclear explosion from the republican voters if that had failed while republicans held 60 seats? I know I can.
Somehow I don’t think we will see anything like that, or even close to that, from democrat voters.
Jade Jordan
I have a friend that works for an insurance company. They absolutely hate it and sent several emails yesterday (along with several AHIP emails), If they hate it – it’s good for America.
I agree that this is the gateway drug to Medicare for all. Once we breach the 65 year old barrier once, it will make it easier to longer it again and again.
Some 62 year olds would retire if they had health insurance. This will open up jobs.
People are complaining about the price of the buy-in for Medicare when that price has not been set.
Fingers are crossed that this passes.
Lisa K.
@Shoe:
“it’s flawed because it doesnt do any cost control
and what we need is cost control”
Here is the hard truth about that, IMO. We have two choices to make in healthcare: Continue to provide it at the most intense level possible to the greatest numbers of people possible, or do not.
The first way, healthcare costs continue to rise and outcomes continue to be poor, but we are discriminating only on ability to pay.
The second way will certainly save money, but the fact is that the *amount* of healthcare provided will in fact go down, and not all options will be available to all people rgardless of healthcare coverage.
Those are the hard choices we are facing, neither of which people like. But we simply cannot continue to talk out of both sides of our mouths. Either accept that healthcare is ungodly expensive and continue to maintain the status quo, or accept the fact that saving money means not everybody gets the same amount of care they would have under the old system.
Sly
It depends on a couple of things.
1) How expensive the buy-in is. Medicare’s small administrative overhead will probably make it cheaper than private options for people 55-65, but considering that that age group is one of the big problem demographics in terms of lack of coverage and poor health, it’s not gonna be cheap.
2) How “different” the publicly accessible FEHB package is from the one actually in use by Federal Employees. The later has some pretty generous subsidies which your average citizen likely won’t be able to take advantage of. Subsides higher than the assistance people would get in the exchange.
FEHB plans have the government covering somewhere between 60% and 80% of costs, depending on what plan you take (they are split into three categories). Most people using FEHB are in the 70-75% range. Exchange subsides will range from around 35% to 95% (for families, its lower for individuals because this country hates single people). And the way the subsidies are structured, a middleclass family of four would not get the same level of subsidies as if they were in the real FEHB. Not nearly enough.
There are a couple of other issues I have with an alternative FEHB, but I understand that this is in early consideration and a lot of them I would concede are nitpicks.
3) The problems with insurance coverage are really regional, and not national. Certain states have pretty good rates of coverage, but other states are completely FUBAR (something like a quarter of Texans, adults and children, lack health insurance, which is a fucking travesty). For a lot of states a trigger won’t actually mean much unless its set considerably lower than the current national average of 15%. Unless it’s structured to help out people in the urban areas of red states, who make up the bulk of the uninsured (and who have no genuine representation in the Senate because they vote Democratic, so their Republican Senators don’t give a shit about them) it’s really a meaningless provision.
I wouldn’t say you’re full of it, though. The bill hasn’t been fucked up to the extent that it would actually hurt people (it will actually help a whole lot of people, eventually), so I certainly think it should pass despite all this. Medicare came about almost the same way.
dr. bloor
@Victory:
No, but in my sunnier moments–you know, a minute or two a year–I like to think this reflects well on us. Large chunks of this plan blow dead armadillos, but what we’ll do is take a look at what we can build on and get back to work.
Face it. Progressives have been dragging the brain-dead, reactionary ass-end of this country into what’s good for everyone for a couple of centuries now. No reason to expect this will be any different.
kay
I have to look at it. The Medicare Advantage cuts went from 500 billion over ten years to 120 billion over ten years, and the Medicare Advantage cuts are crucial to saving Medicare, long term.
Oh, and this. Anyone who is still voting Republican because they are a “fiscal conservative” has no excuse from here on out.
Every single conservative in both the House and the Senate opposed the Medicare Advantage cuts, although they know that Medicare Advantage is a complete tax payer rip-off that will eventually destroy Medicare.
This is like the farm bill, where conservatives drafted and passed the biggest budget-busting pork-filled monster, and still their reliable voters insisted they were voting on fiscal prudence.
Get a clue. Read something. They’re not fiscal conservatives.
They had a chance to undo the mess they made they made with Medicare Advantage, and they all opposed it.
geg6
I am unwilling to comment on what, exactly, I think about this since…well, we haven’t seen it. We have hints, leaks, and speculation. So, since Reid won’t unveil this plan until the CBO scores it, I’m simply going to remain hopeful. My hope lies in the fact that what I would have originally liked to see was Medicare for all, much as Howard Dean has been pushing for eons. And Dr. Dean seemed pretty happy with this compromise as it opens the door just a crack for that to happen, eventually. I am not willing to go that far with any happiness here (though I must assume Dean has better sources than I do), but that little crack in the Medicare door, the requirement that insurance in the exchange be non-profit, and the requirement that 90% of all premiums be paid out for actual health care and not for salaries and administrative costs of insurers sound better than what we have now.
Brian J
@Jade Jordan:
My mother is one such person.
You know, this is pure speculation, but I wonder if allowing some people to buy into Medicare and thus reduce their workloads or retire altogether would help improve the employment situation.
joe from Lowell
Lol, El Cid.
Please don’t throw me in the briar patch!
drillfork
It seems this deal would actually help some folks, which is more than I expected. And if it happens that people can get affordable health insurance, I’ll be genuinely happy for the 55-64 crowd.
But, as a mostly unemployed, uninsured 45-year-old who could use bifocals, about five crowns and perhaps a prostate exam, it doesn’t do shit for me.
A bunch of us are still left in the die faster demographic…
Annie
@2th&nayle:
And, thank goodness for Moms!!! Enjoy the day.
henqiguai
@Lisa K. (#53):
Quite a binary outlook you’ve got there. Are there, in your world view, no other options ? Perhaps there’s something to be learned from the REST of the industrialized world, wherein most of those countries’ populations seem to be adequately covered at acceptable costs. They even include the option for individuals to purchase additional supplemental insurance from private providers.
Leelee for Obama
@batgirl: As someone in the 55 and older group-I’m hoping this is implemented. As someone with a younger family ti think about, expanding Medicaid and having a premium that’s affordable is a good thing, That’s how it was done years ago in NYS. I paid a small premium for our Medicaid when I was expecting my Daughter.
The upside is, if the premiums need subsidies, the money goes into Medicare and Medicaid, which need it and the Insurance Giants don’t get them.
However, I’m waiting for the scoring and the announcement before I pop any corks.
And, for the record, Kent Conrad is from ND so that’s his emphasis, but I like Jay Rockefeller’s efforts to refocus on the MUCH bigger picture. There are two jobs for Federal Congress Critters, hometown and whole nation. They need to remember that.
BC
From WaPo:
This requirement will give us something similar to Switzerland – private insurance with stringent regulations. Good on them.
PTirerbiter
@ericvsthem: I share your concern over the affordability of the mandates. I also worry about enforcement and how mandates might affect retaining all the new young Democratic voters.
However, I agree with John, it’s a step in the right direction and far preferable to the GOP’s hoped for Waterloo.
itsbenj
Um, to the people who think this is “medicare for all”, I want some of what you’re smoking. Look, opening it up for people age 55+ is great – for them. Forcing people through mandates to buy policies from openly-hostile-to-their-customers insurance companies, with no restraint in place regarding their ability to raise premiums, and loopholes around the vaunted recission and pre-existing condition ‘bans’, with inadequate subsidies in place to please the idiot Republicans and their need to spend as little as possible on American ‘health care’ is not going to be viewed by most as any kind of political victory.
The triggered public option essentially means there is none and will be none. So, the only measure left which was meant to help compete against premium prices is gone. I mean, well-to-do people like yourself won’t have a problem with this, it’s good for you. But keep in mind what a huge chunk of people out there this is poison for. As Mr. Obama was always quick to point out on the campaign trail – people don’t lack insurance because they don’t want it, they lack it because they can’t afford it. Well if this bill passes as-is, that problem is about to get worse, not better. Something has to be done to fix this bill for lower-income people, who are a greater portion of the American public than they’ve been in quite a while.
Malron
@seabe: Seabe? Seabe? Bueller? Bueller?
Excuse me, but that name and those sentiments I’ve seen somewhere before….
ChrisNBama
I’m not a pupil of Machiavelli or anything, but I can’t shake the sense that this was the end game all along.
The muted response of Lieberman’s “defection” among other democrats, particularly the liberal wing strikes me as strange. One would have thought that threats of expulsion from the caucus would have been the order of the day. But it wasn’t. Even die hard public option stalwarts like Sherrod Brown and Tom Harkin played the happy warrior role when talking about Lieberman.
So, maybe the public option was the bargaining chip all along. Maybe this lightening rod issue was used to open receptivity to expanding Medicare and providing access to the same quality of care as members of congress.
Or maybe I’m reading too many mystery novels, but this all seems like performance art to me. All a tad too neat and tidy.
PTirerbiter
@drillfork: I can sympathize. It was a pain in the ass and took 8 months, but I got about $3,500 worth of dental work done for $1300 at the Baylor School of Dentistry this year. Maybe it’s an option, good luck.
Irony Abounds
Think long term. If the old farts don’t see their Medicare taken away, some additional people get insurance that otherwise wouldn’t, and the system doesn’t come crashing down, opposition will dissipate for the next round of reform in a few years and it will get progressively easier to accomplish universal care. Lather rinse repeat. Nothing in this world is perfect – don’t make perfect the enemy of the good.
On a side note, the only real way to accomplish reduction in costs is for the entire nation to be served by Cleveland Clinic type clinics. Doctors would make a small amount less, but not have the same pressures. It would be ideal, but unfortunately getting all the doctors into a concept where they are employees rather than the big swinging dicks is near impossible.
matoko_chan
Lol, anyone that doesn’t see the medicare slippery slope is gormless indeed. Obama just feinted with the public option….medicare IS a public option…..that can now gradually be expanded in increments.
He has the “conservatives” by the short hairs….they can’t come out against medicare or they will lose the biggest chunk of their shrunken base….opening medicare to 55 and older??????
Pure genius.
11-dimensional chess Grand Master.
geg6
@itsbenj:
Well, I didn’t see anyone here say that, so it would seem you’re the one smoking funny stuff. You obviously don’t know anything at all about the history and evolution of Medicare. I would suggest you read up a little on it and see that it has never been all or nothing, but an evolutionary process that has been expanded from state programs during the early 1900s until it finally passed nationally in 1965. And that evolutionary process continues through today. So the reality is that no one ever got the whole pony all at once, but the idea expands and eventually becomes a common and universally acknowledged good.
http://www.socialsecurity.gov/history/corning.html
But sure, keep with the sour grapes. That’s always helpful.
Comrade Mary
Betty Cracker at Rump Roast has a visual summary of reactions to the plan.
Comrade Darkness
@Irony Abounds: The doctors I know would love this. What? take our extreme headaches for a small pay cut? But they serve poor, rural areas. There are so many mechanisms to help doctors. For starters, making school cheaper or more heavily reimbursed for serving underserved areas. Salary is just one part of how the system can reward doctors given that debt is such a big part of their lives.
joe from Lowell
There are people on the far-left who don’t want to reform health care.
They want to use anger over the state of our health care system to “heighten the contradictions of capitalism,” man.
These people are not our allies; they are deliberately setting out to torpedo anything that might actually improve the situation for people who lack health care coverage, because they don’t want to see the center-left Democrats become the champions of regular people’s interests any more than Bill Kristol does.
One easy way to recognize such people: they’ve spent months demanding a public option, and now oppose freaking Medicare.
TaosJohn
It’s not really Medicare. Read the fine print.
Ajay
I dont think you are wrong in saying that medicare age lowering is a big deal. In fact, its better than the so called public option. The only -ve in this is that it wont benefit all, just those who qualify based on age.
Ideally, medicare should be open to all and self sustaining based on the premiums.
kay
“The amendment does not prevent private plans from offering abortion services and it does not prohibit women from purchasing abortion coverage with their own money. The amendment specifically states that even those who receive federal subsidies can purchase a supplemental policy with private money to cover abortions.”
It’s from Stupak’s op-ed in the New York Times.
I have to say, pro-life people simply don’t get it. Stupak’s language here is insulting. I read this and had a visceral, “screw you, buddy” reaction, and I suspect I won’t be alone in that. These are fighting words. Mr. Stupak has graciously permitted adult women to purchase a legal product, “even those” who have the temerity to receive a subsidy?
He’s spends the first part of the editorial vehemently denying he’s trying to control women’s choices, but this language really gives him away.
He’s not doing The Cause any favors.
matoko_chan
Dude……medicare IS the public option.
And the beauty is the “conservatives” can’t oppose expanding coverage.
Medicare is the new slippery slope, but they can’t say that.
i haz a happy.
;)
jcricket
Sadly, the separate public option is probably dead forever. But I can see (perhaps b/c I’m an idiot?) the Medicare buy-in being extended. I mean, it’s already going to stay open forever for 55+ people within the exchanges, and it will be subsidized by 2014.
As with S-CHIP, elgibility will be expanded over time, b/c the private insurance companies won’t make their product more affordable. As Aetna’s recent memo proves, they don’t have to. Making the product less affordable still makes them more profitable, even if it kicks 650,000 people off their rolls.
Based on actions like that (which I doubt will stop) I can easily see a back-door into Medicare as an option for all (at least within the exchanges, which is as broad as the public option would ever be) as a back-stop for folks. Again, that’s no single-payer system, but if Medicare were available for everyone who can’t get affordable employer-based insurance, and subsidized, it’d be light-years better than what we have today.
I can also see companies like WalMart lobbying for a way to get at the subsidy/Medicare for their own employees (rather than pay for the subsidy themselves through their own payroll). Over time this might lead to Medicare for everyone as a health option. This is unlikely, but plausible.
Also, the 10 or so regulations (no rescission, pre-existing conditions, no lifetime caps, limiting out-of-pocket max) are a seriously good thing. Let’s hope those don’t get watered down (like how the credit card industry destroyed their regulations over time and now owns us all).
Color me simultaneously disappointed Democrats don’t know how to play hardball and present their arguments properly and impressed they didn’t just take out the public option, regulations, etc. and call it good. Passing this will keep Democrats in office/electable, if for no other reason than Republicans will be out there claiming healthcare reform means the death of everyone, and it will clearly not be seen that way outside of the crazies.
This is Social Security and Medicare all over again (go read up – neither program was universal or openly welcomed by all to begin with. Now they’re the third rail).
matoko_chan
Stupak is a closet slaver just like the rest of the Family.
Its all about the control of those uppity selfdeterministic uterii.
Very Reverend Crimson Fire of Compassion
@TaosJohn: Talk to me. Links? Show me what you’re talking about, please.
kay
@matoko_chan:
Ugh. He’s tone deaf. The whole thing comes off as if he’s reluctantly granting those yucky, messy women health care, as a class.
Way to promote your position, idiot.
It reads like Scalia. When he spits out, “abortion on DEMAND” with absolute contempt.
They don’t deserve to prevail. They’re arrogant and stupid.
eyepaddle
Has anybody seen the final shakeout on pre-existing conditions, recisions and life time benefit caps? If those got mumbled out of existence, yes I will probably throw a tantrum.
Not enough of a tantrum to oppose the rest of this bill, but a tantrum nonetheless….
Bill H
@smiley:
It’s $94, and that is a subsidized rate for having reached the age of 65 and having become eligible for Social Security. (Even though the SS age changed, they left the Medicare age at 65, but the principle remains.) The cost-based premium for Medicare will be quite a lot higher.
Ajay
@matoko_chan:
medicare IS the public option.
And the beauty is the “conservatives” can’t oppose expanding coverage.
I think thats where Dems screwed up. They should have taken this approach from day 1. Everyone would hate Republicans as they villify medicare.
Regradless, dems have done a very poor job in selling HCR. In addition, the current senate version is weak.
Tom Hilton
It is a pretty good deal.
Needless to say, Jane Hamsher hates it. Because she’s an idiot.
mvr
John, my reaction is similar to yours.
FWIW, Howard Dean seems to like the deal:
link here
AngusTheGodOfMeat
John, I have the same general reaction to the “deal” that you had.
I still believe that the real bill that the president sees will be cobbled together in conference, and that what you are seeing now is the public side of maneuvering and posturing being carried on behind closed doors, full of theatrics and bluffs and Dog knows what else.
But in any case, if this gets us closer to affordability, coverage for large numbers of uninsured, and heavy restrictions on exclusions, I’m all for it.
I’m also convinced that the feckless media have no idea what is going on, and I don’t believe a word any of them say about this subject any more.
gwangung
This is given. When they treat established science like evolution as a horse race, they are simply screaming that they have no idea what’s going on and that they don’t care to remedy that.
DCDan
Add in a 90% limit on medical loss ratio.
Two main reasons for single payer: lower prices and lower overhead.
The limit on the medical loss ratio goes a long way toward addressing the lower overhead part. Could lead to mixed incentives for insurers (lower prices to get business, but higher systematic costs so their cut expands).
Either way, it eliminates some of the most offensive practices. And, IT ELIMINATES THE INDIVIDUAL MARKET — WHICH IS A DISASTER!
All in all, I think this is worth passing. not as good as it could be, but worth passing.
Sly
@ChrisNBama
Lieberman hasn’t exactly been a champion of HCR his entire career. He was against the 93 effort. He favored a Federal health insurance pool in 1996 or thereabouts, but was silent about it afterwards. His 2004 primary platform for HCR was to create a Federal agency to funnel more money to pharmaceutical companies, largely in order to bypass Congress.
It certainly didn’t surprise me that he bloviated about it the way he did, and I don’t talk to the man on a regular basis.
@Ajay
Of course, now the Republicans are all on record saying how they just adore Medicare, because Advantage gives them a pretty big boondoggle, and that they will fight tooth and nail to protect it. You wouldn’t have had that six months ago. An expansion of Medicare, especially with a buy-in (even if the buy-in is kinda shitty), paints them in a pretty tight corner.
Napoleon
20% of Americans think Obama ought to be impeached and 44% would prefer to have Bush back in office:
http://tpmdc.talkingpointsmemo.com/2009/12/poll-obama-in-a-close-race-withgeorge-w-bush.php
AngusTheGodOfMeat
@gwangung:
I see them in their meetings, saying, “Hmm, should we go with the methodical and informative review of the true issues in healthcare reform, or spend the day showing clips of town hall meetings and people wringing their hands over Death Panels?”
( silence )
“Okay, let’s go with the Death Panels. Okay, what do we have on the latest missing college student? Also we have a toy balloon loose in Colorado …. “
gwangung
@AngusTheGodOfMeat: You’re being quite charitable, I think…they wouldn’t spend a minute thinking about it….
maye
@Tom Hilton: then it must be good.
catclub
PTirerbiter @ 69:
“I can sympathize. It was a pain in the ass and took 8 months, but I got about $3,500 worth of dental work done for $1300 at the Baylor School of Dentistry this year. Maybe it’s an option, good luck.”
If it was pain in the ass, they’re doing it wrong.
catclub
Will private employers be able to kick their older employees into the medicare for 55+ group?
Would that be a good thing, or not?
I think it would. It lowers premiums for the rest of their
employees, and they keep the older experienced employees.
It could have saved GM its massive insurance costs
for former employees. (A mixed blessing.)
(The ability of older employees to retire, once they have reliable health insurance, has already been mentioned.)
Tsulagi
This still ain’t over. Given the Dems propensity to turn over the ball when the other team snarls at them, I’ll wait to see what actually heads toward Obama’s desk.
In the meantime, I would think big insurance carriers would like what Reid is now touting. Very good compromise for them. Those 55-64 who are employed and on company or government health plans would certainly stay on them. Along with any younger dependents who statistically would be better risks. Those in that age group who are unemployed or don’t have group insurance available to them or can’t buy insurance at any cost due to medical history will be moved to the government plan. Gets rid of those risks leaving the better ones for them.
So yeah, this compromise is full of win. Insurance companies get more cream and less of the curdled milk. Snowe gets her trigger. I’m betting that trigger would have one hell of a heavy pull if not welded. Baucus gets his mandatory coverage with penalties for those who don’t pony up. That’ll sit well with younger voters. Don’t those fuckers know they have to support the big insurance companies and pharmaceuticals profits like real Americans?
Yep, it’s all good.
I'm against it!
Since our friends (cough cough cough) on the other side of the aisle are against EVERYTHING – we just have to get creative and slip things in under the radar – like…they can have their stupid abortion amendment to the healthcare bill, as long as (per Dan Quayle) we allow pregnant women to get D and Cs, which of course are completely different.
Meanwhile here’s a video of the universal Republican debate technique. They are strong in the crazy
http://www.youtube.com/watch?v=DtMV44yoXZ0
Elie
@TR:
Great link. Thanks.
sigh
liberal
@Chad S:
I thought those in the know claimed that these triggers are never pulled.
scudbucket
That’s absolutely right. Right now it looks like mandates, but no cost containment/government competition; no real extension Medicare in the form if a buy-in; and (as far as I’ve seen) no guarantee issue. It’s a huge victory for the GOP/Insurance companies. And that’s before the final details are settled, which Dems are notoriously bad at finessing.
TJ
I’m 58, so I can say “Sweet!”, but OTOH I think screwing everybody under 55 with the individual mandate and promising them future ponies is not a recipe for success at the polls.
scudbucket
Oops, block quote fail!!
liberal
@Lisa K.:
But given that a huge fraction of health care is just a waste, that’s a good thing, IMHO.
Maude
The phrase public option was shot down by righties. Now Medicare doesn’t seen so bad to them. If the age is lowered for Medicare and the bill gets sign into law, we are on our way to Medicare for all.
It’s about the camel getting its nose under the tent.
sbjules
I have medicare–became eligible earlier this year. I am delighted that the pool will grow and believe there will eventually be medicare for all.
That wily Harry Reid.
Adrienne
I posted this in a dead thread, not realizing that it was, in fact, dead… but here is my rant of the day:
I vote for using reconciliation to get a better bill. I really don’t care if it means we have to wait an extra month or whatever to get a bill. Fuck decorum, and double fuck the “centrists” with a rusty screwdriver. And while we are at it, put in everything – the public option, Medicare buy in at 55, all of it, pass it with 50 votes + Biden, and then ping pong it (as is, without conference) over to Pelosi and the house Dems. I’m SO sick of these “showboatin cretins” having veto power over every goddamned piece of important legislation after I worked my ass off to elect Obama and get a meaningful Democratic margin in both chamber. They have managed to simultaneously make the bill less effective yet more expensive. If the fuckers want to kill the bill, let them do it out in the open; by getting 51 no votes in the Senate and 218 (219?) no votes in the House. And then we should primary their asses because clearly they don’t give two bits about the party.
You KNOW if the Republicans were running the show, and they had a piece of legislation that could make or break the party they’d ram this shit down our throats or maybe they wouldn’t even have to because they always managed to find some chickenshit conservadems willing to go along with their fuckery. Either way, they’d get it done. If there is ONE thing I respect about the GOP it is that. When they win elections, they actually get shit passed. It might be bills I loathe, but they get it passed. We have SIXTY dems in the Senate and can’t pass any bills that clearly represent our platform. WTF?
//rant over.
Sentient Puddle
@Adrienne: Y’know, if every senator who is saying “I won’t vote for the bill unless [condition] is met” sticks to their words, reconciliation may well be the only way to pass anything.
Nelson seemed pretty wavery after the vote on his amendment though.
matoko_chan
Ajay
That would be checkers, not 11-d chess.
Medicare is the new slippery slope to single-payer and the “conservatives” cant say anything, thanks to Mistah Steele and his Bill of Rights for Seniors.
Its pure machiavelli.
matoko_chan
The teabaggers demagogued the hell out of the public option as socialism, while flogging the bluehairs into a lather over the threat of reduced medicare coverage….no way can they demogue this…..now there is abso-fuckin-lutely no way they can pivot an tell their base that……wait…..its medicare that is the stealth public option.
hahaha
joe from Lowell
This isn’t Obama playing chess. It’s probably just dumb luck.
If there’s anyone playing 11-dimensional chess, it’s Harry Reid.
Remember Obama telling him, “I hope you know what you’re doing?”
Maybe I’ve been too hard on the guy.
NR
Reasons why this bill is a big pile of fail:
– mandates that most people purchase their employers’ insurance
– no price caps on insurance premiums or pharmaceutical drugs
– even if we do get a public option, it’s a “public option” that’s structured to not kick in till 2014 and then will be open to only a small percentage of Americans; also, it’ll be more expensive than private insurance
– no subsidies to help people purchase insurance till 2014, and even then, most people will be paying about twice as much as they do now
– bill is stuffed with pork and entitlements to get members of congress onboard
– nothing in the bill will control medical costs, insurance costs, or drug costs either in the short term or long term
– most regulations on private insurers don’t kick in till 2014
– stealing money from medicare–our good public option–to fund subsidies to private insurance
– if you can’t afford insurance now, wait till you see how much you can’t afford it in 5 years
– worst of all, because of its delayed implementation, its cost to consumers and its entrenchment and enrichment of private insurance, it allows the Dems to declare they’ve “solved healthcare” while moving us further away from single-payer, the only system that makes sense
– the employer “penalty” for not providing insurance is $750/year, which means employers are financially incentivized to drop insurance
– people are taxed 40 percent on “cadillac” plans costing more than $8k/year, which incentivizes junk insurance
– the dems are going to suffer massive losses in the 2010 midterms because this is a bill that gives a big sloppy blowjob to medical and insurance lobbies at the expense of Americans’ health and financial stability
Nutella
@Brian J:
And many 55 year olds would be freed from the necessity of staying with their current jobs at big companies and would start up or join small companies. This will open up even more jobs because small companies are the ones who create most new jobs.
Something Fabulous
@2th&nayle: Congrats to you and your mom! That’s great news!
Elie
Its just interesting to me that when the liberal progressives rant about having a majority of Democrats, they expect that all the Democrats should be/must be liberal progressives and react accordingly. The Democrats are always compared negatively to how the Republicans would do anything they wante (like Democrats should adopt that cram down model).
Please remember, the Republicans have worked hard to remove any moderates from their party and are continuing to purge out any moderation – and rationality along with it. The Democrats have not undertaken such purges (obviously some of you want that – ) and therefore have a mixed group of Democrats to work to get this done — some quite conservative. Each of them represents a constituency that in some places, is quite conservative. That aint gonna change unless you change the grass roots of where they come from… a lot more work than just ranting and banging your shoes about what ought to be happening according to you.
Question: those of you who want purity ala the Republicans, would you rather have a minority of very left progressives after purging out all of those damned centrists, and a majority of the hard right folks that are now the Republican party? So, you would sweep these moderate/centrist Democrats out, to get what? A viable Republican, extreme right, majority?
This was discussed upstring and I really havent read any good answer from the purists except to bang their shoes on the table harder.
I cannot decide if the left progressives are learning impaired or just want the issue to call attention to themselves. Many of them need to read up on US civics. Others could be seen to portray the mirror image of the worst qualities of the Republicans. Why on earth would you want to implement a style (cram down) so theoretically (HA!) antithetical to what liberalism and progressivism would be about?
I am actually starting to consider that from some of the points of view, some of the extremer left progressives might actually be Republican trolls in drag
jetan
@NR:
That is exactly the way I see it.
“Thank you, Sir! May I have another?”
Cain
@Elie:
Well said, and something I’ve noticed as well. Some I agree with (eg Lieberman) It stems from the fact that people really want change from the status quo and when they see road blocks they want to remove them quite forcibly. You do want conservatives (real ones) and fiscal folks looking at it to make sure it is viable.
I blame our media. Cuz they aren’t doing enough to inform our public. Really this goddam shit should be a public service while they make money off of teh private lives of film and reality show stars.
cain
2th&nayle
@dr. bloor:
@Annie:
@Something Fabulous: @chopper:
Thanks to everyone for your kind words and thoughts! Took Mom out to do a little Christmas shopping this afternoon, she had a quickness in her step and a lilt in her voice that had been missing for a while. “New lease on life” personified! Thanks again!
matoko_chan
ummm…..joe?
you schtuuupid.
;)