As far as I can tell, the Senate bill has been neutered down to the following changes:
1.) No more recission
2.) No more denial because of pre-existing conditions.
That pretty much is about all I can think of… The bill does nothing to curb costs, allows insurance companies to place caps on payments, bans drug re-importation, does nothing to foster competition.
Basically, unless I am missing something, this is basically the gift of 30 million or more customers at the cost of, well, very little. Maybe Dean is right.
Do any of you in the know know exactly what is included in the current incarnation of the bill? There has to be more positive aspects than just what I have stated.
j.e.b.
3.) Subsidies
4.) Individual Mandate
5.) Exchange
CJ
Did they keep in that provision that allowed people to stay on their parents’ insurance until they’re 27, or did my poor college mind dream that up?
Chuck Butcher
A gift to insurance companies mandated by congress…
We should all jump on our chairs and cheer.
Fuck them and I’ll go bankrupt rather than send a fucking dime to HealthInc – it won’t be the first time.
scudbucket
What is the benefit of no recission/no pre-existing denials if the can arbitrarily cap the lifetime payment? How low can they go?
YankeeApologist
I haven’t really heard anything positive at all, John.
I think the basic formula is that if you already have it, it’s about the same, and if you don’t have it and can’t afford it, it’s about the same.
Max
Maybe I’m stupid, but doesn’t this bill still need to go into conference to be reconciled with the House bill and then we only need 50+Biden to pass it coming out of conference?
Seems dumb to let this blow up now.
Spiffy McBang
I think the caps are allowed, but there are minimums as opposed to the companies being allowed to cap it wherever they want.
That may have been a misread on my part, though, no guarantees. Confirmation (or otherwise) would be nice.
Chad S
I’ll wait to see what they vote on before characterizing it either way. Ezra seems to be behind the bill sans the buy-in/trigger and makes the point that the Dems can do that in a couple months with reconciliation in the budget.
MattR
So no denial for pre-existing conditions, but are there any restraints on what premiums they can charge those customers? The former without the latter is a pretty hollow change.
GP
What a HUGE let down
kwAwk
It gives Obama a great campaign speech accomplishment.
Lev
Plus the Medicaid expansion to 133% of poverty and the “Members of Congress” plan as a private option.
I never thought I’d see the day when people who call themselves progressives would put spite of insurance companies over helping people afford insurance. They only care about their power instead of helping people. Fuck them.
scudbucket
@kwAwk: Exactly. But at a pretty steep price: this bill seems like it was crafted by the insurance lobby.
General Winfield Stuck
No, i don’t know, and neither does anyone else. They are still amending it and Harry Reid really hasn’t said whats in it while it is being scored by the CBO.
And I won’t even get into the fact that of a conference and being changed some more there.
The Senate could pass Aunt Harriet’s Chocolate Cake Recipe, which might be the only thing Joe schmo will vote for, and when Reid appoints the conferees, we will know where things are headed.
If he appoint a Nelson, Conrad and their ilk, then it’s doom for HCR, because the House just won’t go along with their corporate whoring and no gov. involvement.
But if Reid appoints people like Harkin and Rockefeller, the game will still be on, I think
==-+
@Max:
What emerges from the conference committee is subject to a filibuster.
cyntax
It gives Lieberman the opportunity to pay back the DFHs.
dmsilev
@Max: Unfortunately, the conference report is subject to a cloture vote, so Revolting Joe still would have a meaningful voice.
-dms
beltane
There are even wiggle room with regards to recissions and pre-existing conditions. This bill was allegedly written by a Wellpoint VP and is worse than the status quo in some states. I don’t see how a high-deductible plan that only pays 60% of subsequent “reasonable & customary” is of any use to anyone. Does it really matter if people are forced to declare bankruptcy for $50,000 as opposed to $100,000?
I’ve really been trying to keep an open mind, but I have to agree with Howard Dean on this one.
General Winfield Stuck
@Max:
It’s no use Max. Libs don’t want to hear that sort of thing. Spoils the poutrage orgy. Can’t have that now can we.
smiley
@Max: You’re exactly right. We still don’t know what the final product will be. I really disagree with those like Kos, Hamsher and Dean who say that this bill should be killed. We’ve go to start somewhere. It may not be perfect but killing the bill now could mean another 20 years before anyone tries again. Incrementalism is needed on this subject.
Added: Some people seem to think that whatever comes out of this process is it, forever. Laws can be amended, changed and improved over time.
lamh31
Go ahead, kill it, who cares bout the 30 million, to quote my mean azz ole Repub uncle ” I got mine, you need to go get urz”.
If the GOP is smart (and I have serious doubts) they should just keep quiet and enjoy the early Christmas present they are receiving right now, cause from the outside looking in, the Dems looks mighty disorganized right about now. And here I thought it was the GOP who didn’t have it’s act together.
Formica
The current incarnation of the bill does nothing about recission. The text of the bill reads:
Those reasons – fraud or intentional misrepresentation – are the reasons cited every time someone has their coverage dropped. It’s not like they’re saying “LOL you got sick” now; they always represent it as fraud (for example, failing to report that you had acne when you were a teenager now that you have breast cancer).
This bill is a multi-trillion dollar giveaway to the health insurance industry. If there was real recission protection and pre-existing folks were not being shoved into an essentially useless ultra-high premium subgroup, I might be willing to swallow the loss of the public option and Medicare expansion. But as it stands right now, this bill does nothing to address:
1. Recission (LOL you got sick)
2. Costs (we pay twice as much as the rest of the industrialized world)
3. Competition (a public option might at least help keep costs down; anti-trust exemption stays in place)
4. Pre-existing conditions (being shoved into an impossibly expensive policy is not reform)
My hatred for Joe Lieberman grows by the minute. I hope he dies of pancreatic cancer and is denied coverage for the painkillers.
thefncrow
@Max: You’re confusing conference and reconciliation.
If the houses both pass different forms of the same health care bill, you’ll go to a conference committee and work out a unified text that then has to be passed by both chambers. The conference report is filibusterable, so it still needs 60 votes.
Reconciliation is a Senate process for budget bills which does not allow for filibusters, thus allowing you to pass the bill with a bare majority. If the Senate passes a bill via reconcilliation, and the House passes a different form, you still go to conference, and the conference report is filibusterable.
SpotWeld
When did you start using “HCR” ?
Browsing a few google searches, it seems that only the politcal blogs and twitter feeds seems to contract it like that.. especially the conservitive ones.
(A subliminal repsonce to thier desire to grope it with other icky things, like HRC?)
asdf
Those wags at Fark.com have gotten wind of your exploits with GOP.AM and are having quite a bit of fun with it.
Here’s the link
http://gop.am/Habs
Oh, thanks everyone. That was some funny stuff.
batgirl
@scudbucket:
Seems? The Baucus bill out of Finance that we had to wait for was written by the insurance lobby.
TWP
You can remove “recission” from your list, via twitter:
@HunterDK You think rescission is banned? Wrong. Most common rescission method, claiming prior applicant “fraud”, is explicitly exempted.
blahblahblah
Kill it.
They’re essentially delegating the sovereign right to tax to a cartel. It’s feudalism. This country is absolutely fucked.
GP
Harry Reid wears pink pantys, You weak pussy
chrismealy
Follow the money: it takes $90 billion from rich(er) people and gives it to poor(er) people to buy insurance. Not bad.
Zifnab
I predict some time in the next four years, we’re going to see the whole system go belly up when the insurance companies either skyrocket their premiums to the point where the subsidies are a joke or the government starts bleeding cash from every orifice trying to feed the beast.
Aetna is anticipating dumping 650k people next year. What, exactly, is an insurance mandate supposed to do to fix that?
http://www.huffingtonpost.com/2009/12/04/aetna-forcing-600000-plus_n_380130.html
The rules against rescission are nice, but they could easily have gone into their own bill. Something that would have been written up and passed inside a week. Not this 2047 page monstrosity of nothing.
Without the public option, exactly where is anyone supposed to go for actual affordable coverage? The exchanges better turn a capitalist miracle, because I don’t see any advantage over the status quo.
dbblg
The best plain-English source is probably http://healthreform.kff.org/.
They’re pretty good at updating it, but, obv., we don’t know what will be in Reid’s manager’s amendment yet.
Re: the question upthread: the House bill allows people to stay on their parents’ insurance until 27 (provision effective Jan. 2010) and the Senate bill allows people to stay on until 26 (provision effective six months after the bill’s passage).
donovong
I am not going to pretend to know all the particulars, but I have read enough of sources that I trust to believe that the nitty-gritty details in the bill – particularly the ones that do not cause all the sturm und drung – do a great deal to potentially lower costs and provide care to more people. I would refer you to the writings of Jonathan Cohn, Ezra Klein for the details. They know their shtuff.
jibeaux
Nate Silver cheered me up somewhat. I think the takeaway from the wonkiness is that we’re talking about vastly expanded coverage at subsidized rates. But who knows. I’m reserving judgment just yet.
Kryptik
I’m going to quote myself from a post earlier here, since it’s relevant:
southpaw
John,
From the previous post, it appears that you buy Ezra’s argument that Lieberman’s threat to scuttle the bill unless it’s made more inefficient (and more beneficial to insurers) is inexcusably casual about the cost in human life that the failure of the bill would impose. I don’t see how you can hold that position and simultaneously suggest scuttling the bill on the grounds that it’s been made too inefficient or overly beneficial to insurers. Wouldn’t it be better to save those lives inefficiently than not at all?
General Winfield Stuck
@dmsilev:
This is true, cloture is required for the CR. But the bill can be primed for reconciliation in conference, split up with a PO separate, so as when it returns, some lib senator could pull the reconci. trigger for a PO to pass with 50 votes and the VP.
And pass the other reforms by regular order after cloture, or not pass them. Lots of scenario’s and cards to play, provided Reid picks the right senate conferees with the right instructions. Harry has some personal stake in not failing the base, if he wants to get reelected, and all signs point to that he does.
Max
@thefncrow: Can those that oppose it just say “hey, fillibuster, tag you’re it”
or
do they actually have to man the podium 24/7?
How the fuck did we end up in Iraq if it is this complicated to get shit done?
Tsulagi
No telling exactly as there isn’t a finished product. It’s not Xmas yet and the Rs still want even more presents.
But not to worry, CHESSCOM reports they’ve fallen for the trap. A long-range flash forward in Dimension #5 confirms people seeing insurance cards.
mo
I couldn’t agree more with this – it’s really disheartening to me.
The subsidies and Medicaid expansion and health insurance exchanges are really big deals. Many people have no access to affordable insurance and are suffering dramatically for it. To me, helping them is a way more important goal than “sticking it to” the insurance companies.
The mandates are not simply a gift to the insurance companies – they are central to making sure the insurance exchanges and individual markets function and truly do offer affordable health insurance. Otherwise, the healthy will be more likely to stay out and will drive up costs for everyone. This problem of adverse selection was why McCain’s reform proposal was so dangerous – you can’t dismantle our employee-based system without having a well-developed system that prevents excessive risk-sorting.
If the exchanges end up working – and they seem relatively promising (although weakened in some regards) – they could be a major step toward getting us to a better overall system.
geg6
Well, since there effectively is no Senate bill at all at this point, I don’t think it says we have anything. Because they still aren’t done with the sausage making. Anyone seen any commitments to vote for cloture from Holy Joe yet? No? Well, then he’s not done gutting this thing. All we will have here in the end is a mandate. No subsidies. No cost controls. No end of recission. No lifetime limits. And forget about pre-existing conditions. None of it will be in there in the end because the insurance companies don’t want those either. And so, neither does Holy Joe.
I read a quote from ol’ Holy Joe earlier today (and can’t remember where so I can’t link, but I think it was TPM) talking about what fun he was having being the center of attention. Think he’s tired of it yet? No, I didn’t think so.
Kryptik
@Formica:
Well, that’s wholly depressing.
The recission loophole, not your wishes for Lieberman.
valdivia
@donovong:
this.
Brien Jackson
@MattR:
Yes. There’s community rating in the bill.
Ruemara
It seems to be based on The Mittsters healthcare bill with mandates, easy to find loopholes to still deny coverage, poorly funded subsidies and the one best thing, the Franken amendment which requires 90% of premiums to be spent on actually providing health services. I’m in DougJ’s camp, Liebermanize this turdball and reconcile it with 50+1 amendments. Also, if you want to really do something, Bernie Sanders Single Payer Amendment, Bill 2837 is up for vote tonight. Have you harassed your congresscritter today?
Chuck Butcher
Jayzooos on a crutch, if you lay mandates on people to buy from the sharks with no alternative anything else in the thing is fucking meaningless. If the Democratic Senate Caucus can’t do any better with its bill why think the conference bill will improve? Explain to me why forcing people to buy products is excused by the little bit of other shit in this bill and why you’d throw that on people and call it a fucking improvement.
scudbucket
@southpaw:
The only beneficial thing I see with regards to saving lives is the Medicaid expansion – which could be done independently.
Sentient Puddle
Maybe for the sake of clarity, we need to start referring to reconciliation as “budget reconciliation” (which it is). Going to conference does reconcile the bills, but yeah, that ends up causing all too many people to think that budget reconciliation rules apply to the conference bill…
Brachiator
@kwAwk:
Actually, it doesn’t. The Village and the Beltway crowd foolishly believe that voters can be mollified by the lame assertion that “we did the best that we could.”
People voted for Obama in the belief that he would bring solutions to their problems. His performance so far has been mixed, but people are dreaming if they think that health care reform as it stands now is some kind of victory for anyone.
Jamey
Well, Republicans get to rub shit in Democrats’ faces from now till Kingdom Come. So there’s that …
mcc
The HCR bill does this (link goes to CBO analysis for the Finance bill, which is essentially what will be passing):
This is what the Democrats will have to show for themselves when this is all over– a majority of those who otherwise would lack insurance will receive it, and a framework will be in place for hacking at those numbers further. Non-bloggers will most most likely consider this significant.
MattR
@Zifnab: I hate to say this, but we need to “go Galt” and drop our health insurance en masse. I have not run the numbers, but I would guess that the average family could save enough pretty quickly to cover one decent sized emergency (and they would be recissioned (?) if they had a major emergency).
Corey
@Max:
The conference report can be filibustered.
Sentient Puddle
Other thought: a trigger may just be a fancy word for “not going to happen,” but it seems to me that we may get more from Snowe than Lieberman. Is there any reason why we’re not working with her instead?
dr. bloor
@Zifnab:
This. This whole thing has turned into an exercise in which Big Insurance is guaranteed a few more chances to stuff cash into its pocketses before the whole thing implodes.
Elie
@Max:
Its only complicated to get something done that is beneficial for a lot of little people. Yep its pretty easy to go to war and to cut taxes…the only thing that W ever did
Kryptik
@Brachiator:
Nate even did some poll analysis, to point out that a significant chunk of opposition to the ‘Senate Bill’ as it stood up to that point was from the left. In other words, people who didn’t want the bill, because they felt it didn’t do enough.
The problem is that we get so little major coverage of criticism from that side, while we consistently get updates on the latest from the Death Panels Anonymous side.
BR
There’s an important political reason we need this bill to pass: if it doesn’t, there won’t be another chance to reform health care for another decade. Remember what happened to Clinton.
We need to eat the shit sandwich.
THEN: we spring the trap. After the president signs the bill, senate progressives need to attach a public option amendment to the next budget. It can’t be filibustered, and is simple enough that it won’t require extensive analysis or debate.
That’s our best hope now.
kindness
Health Care creep. I see all the supporters of the current defanged bill continue to say the Senate bill should be passed because:
1) these opportunities only come around once a generation
2) It will stop pre-existing conditions exclusion and getting seriously ill coverage termination.
3) it’ll save 10’s or 100’s of thousands of people.
What I haven’t seen is this:
1) there’s nothing in the Senate bill to stop them from raising premiums to a point where no one (especially a pre-existing condition or cancer patient) can no longer afford to pay. Considering the Insurance Industries past, you and I both know they’d be doing it quicker than Liebermann going down for the low blow.
2) The mandating of coverage. if you do nothing to control the price of a policy, and force people to buy a policy you are guaranteed to get fucked. Guaranteed.
3) When citizens start seeing that their Health insurance premium is tripling, they will blame Democrats & vote them out of office. Once that happens, even this shitty plan will be scrapped by Majority Republicans and Progressives are left with nothing.
Between no bill and Democrats in the minority, I’ll take no bill and work like hell to elect better Democrats, but don’t ask me to support something I know will come back to kill me.
mr. whipple
Think of this: there are currently ~45 million uninsured, and these bills will do a hell of a lot to get most of them insured.
And as Ezra has said, an alarming number of the uninsured end up dying for no good reason except that they aren’t insured.
Shygetz
@southpaw: Of course not. In any world of limited resources, there must be a cap on the value of a human life. Otherwise, we would all mandate the latest and greatest in car safety technology and lower the speed limits to 15 mph. After all, that would save lives, right?
Additionally, your question assumes the Lieberman bill would result in a net gain. I think it can be reasonable argued that the Lieberman bill will make useful insurance harder to obtain–after all, we are mandated to buy at any cost, but are the insurance companies mandated to sell at a reasonable rate? So what’s to prevent insurance cartels from jacking up their rates, driving people currently on the edge of affordability off the rolls while still jacking up the insurance cartels’ profits?
Kryptik
@Sentient Puddle:
Because she’s pulled the same moving of the goalposts as Lieberman, albeit not quite so infuriatingly predictable.
thefncrow
@Max: Forcing a “real” filibuster, ie a Mr. Smith Goes To Washington filibuster, isn’t really an option.
There’s technically some bit in the Senate rules about coming to a vote by attrition(the Mr. Smith filibuster), but it hasn’t been used in probably 50-100 years and there’s not really any clear indicators in the Senate rules about how you could actually do it. Barring that, there are only 2 ways to a vote on the underlying matter:
1) Unanimous Consent from the body to proceed
2) The passage of a Cloture resolution
So long as the Republicans keep 1 guy in the chamber to object to unanimous consent, the rest of them can go home and sleep, safe in the knowledge that the matter cannot be brought to a vote.
Debate is considered the default state of the Senate, and continues until it is closed, by either cloture or unanimous consent. Without unanimous consent or cloture, you cannot proceed to a vote, period.
The Republicans can successfully filibuster by sending 1 man to the chamber to object whenever UC is asked for. That man doesn’t have to give floor speeches, debate, talk, or do anything but object to unanimous consent motions.
jl
I’m with General Stuck. No telling what will happen. I do not see how things can get much better, since the WH wants to keep Lieberman pleased for things other than health care, the climate change bill probably being the most important.
If a chocolate cake recipe is plugged in during conference, and the no-fat recipe option is voted down by the corporate Democrats. then we are in trouble.
For me, the final test of whether the thing is worth passing is whether it gets to universal care quick. If that is the case, then we gamble that most people will want to keep their coverage, and health care reform will quickly become another third rail of politics: voters will press for reform rather than junking a very imperfect system. The MA plan was pretty stinky, but it is supported by 79% of MA voters and 75% of MA doctors. If we can do as well as that stinky plan, then there is hope for the long run. If not then the GOP and the corrupt corporate Dems will shoot it down as soon as it is feasible and we will just be further down the spiral to a total health care mess.
As for the effects on the election, I think health care reform may be overblown because there is the issue of jobs that have higher priority for a mass of voters. But the WH and Democratic plans there are tepid and uncertain there too.
As I said in a previous post, I do not care much about whether Obama grants me my personal political wish list in his first year in office. I do care that he works on an effective plan to keep the barbarians at bay during the midterms and next presidential election. On that score, I give him a Not Passing, so far.
mr. whipple
That is not true, at least for people who receive subsidies, whose premiums are capped as a percentage of income.
GReynoldsCT00
@asdf:
The gift that keeps on giving, I’m surprised they haven’t pulled the site down yet.
Seanly
@mcc:
Well, it’s great that 94% of us will have insurance. We just won’t be able to afford anything except our insurance premiums.
I haven’t heard of anything that will make insurance companies compete and lower rates. Maybe forcing them to use 90% of the premiums on providing care might help. Maybe…
When we have the revolution, it will be the insurance company executives up against the wall first.
Shygetz
@MattR: Can’t do it, unless we form a collective and group insure. The problem is, the temporal and numerical distribution of medical emergencies is far from homogeneous. So, while the average might be one major crisis per family after 10 years, you would have many families with three crises within a couple of years, and they’d be SOL. Insurance works on risk-pooling, so the numbers average out and you can make these kinds of risk assessments.
Elie
@MattR:
Nice idea — as long as you dont have anyone with a chronic condition, are not in the midst of treatment for something or have had a history of something that is currently under control… Also, that you dont plan a pregnancy or have any accidents…
I casually know one of the checkers at our local food store. She is standing up there checking groceries with a hat over her bald head from the chemotherapy she has just finished. She has to work to make her copays and deductibles as her benefits are pretty weak. Still, better than nothing where she would have to spin down to be Medicaid eligible to get any coverage, and that wouldnt be first dollar.
It all sounds doable, these noble acts of scrapping the whole thing or having everyone drop their coverage — unless you are ready for the details of how everyone actually has to live with that.
BTW — I know that you did not mean anything bad and don’t kick you in the pants, so to speak, for your idea to get some leverage politically
MattR
@Kryptik: I thin we have a better chance of talking to Jim Bunning and pointing out that the Canadian people voted Tommy Douglas as the Greatest Canadian for his role in creating their health care system and doesn’t Bunning want to take one last big shot before he retires to be that guy in the United States. Crazy I know, but is it really more unlikely than any of the other options.
J. Michael Neal
@Formica:
The provisions that I have seen are actually very useful. What it does is tightens up the rules for claiming fraud or intentional misrepresentation. Frankly, you have to have those exceptions permitting recission, or you will get a lot of fraud and intentional misrepresentation. Where the bill makes a difference is in establishing a threshold for materiality. Granted, the full bill isn’t available yet, but the language I have seen means that an insurance company would have to show that the missing information would have really made a difference in their decision to offer coverage. Trivial omissions on an application would no longer be sufficient justification. That’s a huge change.
That is further compounded in a world of community rating and a requirement not to reject pre-existing conditions. That raises the bar for what an insurance company could claim was material. If they wouldn’t have been allowed to refuse you a policy if they had had the missing information, then they can’t claim that it justifies recission.
If you break each of the pieces of the reform of on its own, you can find a lot more ways in which they are useless than if you take them together as a whole package.
Shygetz
@thefncrow: It’s not to object to unanimous consent, it’s to force a roll call. Even then, they would have to keep one guy there continually forcing a roll call…on national TV. I think it might be worth it. After all, when Gingrich shut down the government over the budget, it didn’t turn out well for him. Granted, this won’t close the Post Office, but it will close the Senate for all intents and purposes.
Kryptik
@mr. whipple:
The problem is, I’m not seeing exactly where it actually helps people to get insurance. There’s the mandate, but without assistance or cheap options, that’s essentially holding a gun to your head. There’s the medicaid expansion, but that feels like a small pittance at best. There’s no real help for those who actually have insurance and still get fucked up the ass, there’s no actual means to reign in the insurance companies who have promised to jack up premiums and costs regardless, and will most assuredly do so even higher once things kick in, there’s no fallback plan for anyone really…
It’s like giving someone a piece of stale bread after promising them a sub for lunch.
mr. whipple
@Lev:
That’s the way I see it. Sad.
Quiddity
What kind of deadline is this?
There are reports that the White House is pushing to have the Senate pass a health care bill by Christmas. From the NYTimes:
With one week before his Christmas vacation is scheduled to begin, President Obama is calling the entire Senate Democratic caucus to the White House on Tuesday.
The president is seeking to push – or prod? – Democrats to coalesce around a bill and pass it before Christmas Eve. The meeting marks the first time during the tumultuous health care debate that Mr. Obama has invited the Democrats to the White House.
The meeting, confirmed by administration officials and Senate aides, is designed to increase the momentum around the legislation. But it still remains an open question how involved Mr. Obama intends to get in the debate.
When he went to Capitol Hill a week ago to meet with the Democratic caucus, he did more listening than talking. That may not be the case on Tuesday, officials said, with Mr. Obama poised to begin pushing in hopes of getting his signature domestic priority accomplished before the holidays.
Why does that matter to anyone? It’s not the final bill and if you want to point to something, the House already passed a bill weeks ago.
I think that the White House is pressing for passage in the Senate by Christmas in order to put the squeeze on Harry Reid, so that he is forced to take the Lieberman route and not try to work something else out (perhaps with Snowe).
OT: Block quotes auto-close on newline? Same with italics tag? That’s not the way HTML is supposed to work.
Nicholas Beaudrot
There are some other insurance market reforms that are good. The restrictions on what insurers can use to vary premiums. A stricter definition of covered services. Mandatory first-dollar coverage for certain services.
The bill, on the whole, redistributes wealth downwards because of the subsidies.
There’s still a giant expansion of Medicaid. Today, it basically only helps welfare recipients, pregnant mothers, and people in nursing homes who are poor. Getting real insurance to everyone up to 133% of FPL is a big deal.
The reforms that start to bust up fee-for-service are also very good.
The end of Medicare Advantage is good.
Believe me, I’m not happy about it. There’s just not enough that will discipline private insurers. But it’s a step forward, not a step backwards.
Tonal Crow
@thefncrow:
Even if not, the rules can be changed by a majority vote, per Art.I s.5 cl.2:
Kryptik
@MattR:
But waiting times! Queues! People dying in Emergency rooms! Waiting 6 months for cancer treatment!
Guhh…..all this crap, I’m going to honestly need insurance soon for my blood pressure.
dww44
Thanks, Max, at # 35 (would someone kindly tell me how to do that linky thing back to the comment one would like to link to?)
Exactly what I said today in a comment at a DKOS diary on the health care reform debacle, except that you said it a lot more succintly and pithily. We never won anything while Bush was President. Was it because of the Blue Dog Democrats who voted with Repubs , like the MCA and the Patriot Act. As much as I abhor everything Republicans stand for, they do get legislation passed ( or not passed as is apparently the case when Dems are in power).
dr. bloor
@mr. whipple:
The question is, what kind of insurance will these people be getting, and by extension, just how many lives will it save? As currently crafted, the bill does little to prevent Aetna from writing the words “INSURANCE POLICY” on toilet paper and charging (modestly subsidized) customers eleventy skabillion dollars for it.
trollhattan
At least Lieberman’s reputation as a giant dick is forever assured. That thought will help pass the time while in the line at the E.R.
In other news, Oral Roberts—he daid.
http://www.nytimes.com/2009/12/16/us/16roberts.html?hp
MattR
@Elie: No offense taken. It was an emotional reaction on my end. I am well aware of the reality that prevents it. I have Polycystic Kidney Disease so I definitely get my money’s worth from the sytem. And I am pretty screwed if I ever leave the system (voluntarily or not) the way things stand today.
Cat
@Formica:
This is why the bill should be killed.
You forget to include a doctor or the Dr office loses some or all of your medical records and you lose your insurance. How are you actually better of?
Da Bomb
@Max: Yep.
I have said it, the General, and a few others too. This isn’t the final bill, it has to be merged with the House bill.
JD Rhoades
This. I think I need to stop reading blogs for a while.
southpaw
I’ll associate myself with Julian Sanchez’s comments on this: http://www.juliansanchez.com/2009/12/15/checking-in-on-the-healthcare-debate/
We’ve been waltzed around the dance floor to a place where the insurers get massive amounts of money and nothing much controls costs. Like it or not though, we’d already reached that point in the dance before Joe Lieberman cut in.
AngusTheGodOfMeat
That is from DKos. We have said the same thing here more than once recently.
The actual bill that goes to conference is basically a placeholder that creates the need for the conference.
Whatever the president sees after conference and a vote on the final bill, will come from that conference, and not from the Senate bill itself.
Therefore … if this is true, and I believe it is, why do we keep having this same conversation over and over?
mr. whipple
Nate Silver had a good post in this today: Why Progressives Are Batsh*t Crazy to Oppose the Senate Bill
http://www.fivethirtyeight.com/2009/12/why-progressives-are-batshit-crazy-to.html
MattR
@Kryptik:
Sadly, I take some comfort in the fact that I have dual citizenship and can always escape to my mother’s homeland if I absolutely have to (although there is no damn way I am moving to Winnipeg. Vancouver or Toronto are much more likely)
jwb
@Max: Because the fucking Dems didn’t want to stop it or were too scared of being called traitors. If the Dems had wanted to stop Iraq, they had the votes to do so.
Elie
@dww44:
Just click on that little curved light blue arrow next to the time to reference the post you want…
going to war is always easier than trying to create detailed social policy from the ground up…the offense is always harder to start and maintain than defense…dealing with the details that make enemies and affect constituencies is always a challenge. Things are always peachy when you are dealing in generalities..
J. Michael Neal
One thing to consider when objecting that there are no caps on premiums is community rating. That limits the insurance companies’ ability to raise the rates of a selected group of people. That makes it more problematic to just raise rates willy-nilly.
Again, it’s far, far, far from perfect, but to say that there are no restrictions on their ability to raise rates is incorrect. You need to look at the implications of all of the provisions, not just what they say explicitly.
Et Tu Brutus?
The Emperor’s New Clothes
b-psycho
Maybe I’m just in the wrong circles on this, but I don’t recall much pushback from “progressives” against the individual mandate in response to this whole There Must Never Ever Ever Be A Non-Profit Alternative crap…
Really. All they had to do was say “No option? Then fuck you, no mandate”. As offensive as the concept of “buy this or else” is, they can’t even manage to keep in so much as the tiniest safety valve. Frankly I wonder why any of you ever bother to vote, all you do is get fucked regardless of who you support.
jwb
@mo: While agree with your analysis here, I have to say that I think mandates will be a big political loser until people get used to them—and I think that will take awhile.
J. Michael Neal
@Cat:
I’m better off because your analysis is wrong. Under the proposals I’ve seen, neither of the things you mention would allow an insurance company to rescind your policy. The first does not constitute fraud or intentional misrepresentation, and the second isn’t material.
Elie
@AngusTheGodOfMeat:
Because — shut up thats why!
(meant as a joke)
thefncrow
@dww44: It’s pretty simple to explain.
On any vote, you can expect probably 75-85% of Democratic Senators to vote with their party, and roughly 15-25% of them to vote against the party.
On the other hand, you can count on between 98-100% of the Republicans to vote with their party, and 0-2% of them to vote against the party.
Just look at the 2006 session where the Democratic Party held a majority in both houses and Bush still got his legislation. How did that happen? Well, they needed 50 votes in the Senate, and they really never started with less than 48. Even 2 Democratic defections was enough to put their garbage over the top, and you could usually count on 5-6 defections.
AngusTheGodOfMeat
@Elie:
Moo-hoo!
Kennedy
If this is a once in a generation opportunity, than who is to say that it won’t be another generation before someone gets around to fixing this piece of shit?
@Max: Because Republicans toe the party line and know how to ram shit through Congress, while Democrats prefer to be giant WATBs, stab each other in the back, and pander to the least amongst them, and bear the full brunt of the political risk for what ultimately becomes a shitty bill.
I’m kind of concerned about 2010. If you think it’s hard to get anything done now, imagine what it’ll be like if we lose a handful of seats in each house. Reid can’t even get his shit together with 60 Dems.
J. Michael Neal
@b-psycho:
That’s because reform doesn’t work at all without a mandate. It’s not a giveaway to the insurance companies. Sure, they love it, but that doesn’t mean that it’s a bad idea. Without a mandate, you get adverse selection problems that would make the rest of the reforms unworkable.
cyntax
@AngusTheGodOfMeat:
Proabably because the lack of a PO in the Senate bill greatly increases the chance that the PO will get cut from the House bill.
thefncrow
@AngusTheGodOfMeat: Because whatever comes out of conference has to go back to both houses for a vote, and in the Senate, that means defeating any potential filibusters.
If you can’t get the public option through the first time, what makes you think you’re going to have any better luck the second time through?
Tonal Crow
@b-psycho:
Because it’s better to get fucked by Joe Lieberman than to get fucked by the horde of Uruk-hai called the “GOP”?
mcc
@AngusTheGodOfMeat: If [thing A] cannot get 60 votes to pass the Senate as a bill, then it is unlikely [thing A] can get 60 votes to pass the Senate as a conference report. The conference committee will most likely take this into account. The House can try to play chicken with the Senate and refuse to pass a bill unless certain demands were met, but this seems unlikely given (1) the House bill was a nail-biter as it was and only passed the first time by granting the Blue Dogs the biggest restriction on private abortion since roe v wade, and (2) no serious moves appear to be yet coming from the House to do this.
cat48
A health insurance exchange that may make it more affordable. It is based on the govt employee health exchange which has a great amount of choices. My ins. is from them and I like it. Wyden thinks the exchange will be a cost saver. He has been screaming for this since the beginning. I think they have one in his state which he says helps control costs.
Keith G
I Think I know the underlying problem:
Lets assume that a really stinking, awful bill passes. How many of the people victimized by the “system” would be ready and willing to take to the streets?
Short answer: Not fucking enough.
And well, if ya aren’t willing to fight for it, you are likely to come up empty. FDR was mentioned in an earlier thread. Well, FDR’s successes were in part fueled by the fear of European-style social unrest (see Bonus March).
We get the government and the policies we earn, and right now the vaunted American people have not earned shit. Ezra’s point is not academic. People will die and more people will have their lives disrupted by the results of what our Congress is doing.
Will we get off the sofa and make a bunch of fucking noise or will we continue to surf the net looking for those nude pictures of Tiger?
The corporations and their politicians know the answer, which is why we are getting these results.
jwb
@dr. bloor: If nothing happens with health care costs, you’ll see the corporations starting to drop coverage within the next five years—I’d wager sooner rather than later. The cost is becoming too large and the rise in rates too unpredictable.
mr. whipple
There are numerous mechanisms to help people get insurance that currently don’t have it.
For instance, say you are a poor schmuck that works at Mickey-D’s and make 17k a year. You are uninsured because your employed doesn’t offer coverage, and you can’t afford coverage on your own because buying an individual policy is gawdawful expensive and/or because you have some prexisting condition.
Such a person will be able to go to the exchange, where there are a variety of available plans and choose one. The house and senate plans all differed, BUT in general such a person would be able to get almost ALL of the premium paid by the gvt, with the most being paid out of pocket capped at 4% of income.
Now, it isn’t free. A person making $17,000 might find coming up with $700/year a lot of money. But on the flip side, they’d never be able to come up with $6,000 or not get insurance at all if they have a pre-existing condition.
AngusTheGodOfMeat
@thefncrow:
It’s all about posturing, so that congressmen can say things like, “I voted for it, before I voted against it.”
The votes after conference will not line up with the votes before conference. Deals will be made and votes lined up on the basis of different agreements.
None of this happens until a Senate bill passes. Once that happens, all bets are off as to what the final bill will look like. Moaning over individual provisions now is a waste of time. Of course, that won’t stop the blog from flogging this until the very last fucking day.
TooManyJens
@GP:
Misogyny *always* helps.
Olly McPherson
@Keith G:
Really? This sounds like some “Street Fighting Man” bullshit to me.
Don
Ezra claims there’s still lots of good things in the bill and I don’t think there’s anyone who I trust over him about HRC at this point.
Put me down in the “if it’s better than nothing it’s worth passing now” camp, and indications seem to be that it is.
AB
No public option or similar + individual mandate makes it illegal to be poor in America.
jwb
@BR: Good news: if nothing passes, it’s almost certain it will have to be addressed again in the next five years because the system is likely to go belly up.
Bad news: if nothing passes, it’s very likely that it will be a Republican congress and perhaps president who will put the system in place. And if that’s the case they’ll try to gut medicare and social security in the process of “fixing” the health system.
JoyceH
As crappy as it is, I say pass the bill. There are two alternatives here – to pass it, or to blow it up and start all over again. Actually, the second alternative is to just blow it up, and nothing happens.
You all know that. We’re not going to get a better bill. It’s this as a first step, or NOTHING. Nothing with a Congress too gun-shy to touch health care again for at least another generation.
So pass this one. Without a public option or Medicare buy-in. The good stuff goes into effect. The insurance companies act like the soulless wieners they are and start jacking up rates. At which point it will become political suicide to NOT pass either a public option or Medicare buy-in or some other mechanism to bring down prices and free customers from the clutches of the insurance companies.
mcc
As I distinctly remember, before the public option started to look in doubt “progressives” were widely in favor of the mandate. Voices against the mandate were lonely, and derided for not being “progressive” enough.
Brachiator
@Kryptik:
Pressure from the left to make the bill better would have been far more effective than leftist opposition because the bill wasn’t perfect. But even here, the average citizen doesn’t care about left or right.
Obama’s own speeches rightfully noted that health care reform could benefit both business and the majority of ordinary people. The Senate bill, and GOP opposition to health care reform, seems to only benefit the insurance industry.
I agree with you here. This nonsense was little more than a tiresome distraction (much like the Sarah Palin book tour).
mr. whipple — Think of this: there are currently ~45 million uninsured, and these bills will do a hell of a lot to get most of them insured.
I really don’t see this as necessarily happening if the Senate bill’s proposals are adopted.
I hate to cast doubts upon St Ezra because so much of his writing on this issue has been good, but I simply don’t believe him on this point. What, exactly, is an “alarming number?”
TooManyJens
@Kryptik:
That’s because this is a center-right nation. Also.
Dork
If health care prices really do skyrocket (as I’m fairly confident they will), I truly believe we’ll see a non-trivial amount of people emigrating to Canada, and maybe Mexico. When HC costs become 30% of one’s income (and I dont think we’re that far off), shit will be unbearable, and people will move.
J. Michael Neal
@Keith G:
FDR’s successes were also fueled by majority vote in the Senate. Most of the New Deal passed with less than 60 votes. If they had had to get through what current proposals do, they would have been substantially watered down.
Elie
@JoyceH:
This and many other similar approaches I agree with…
tomvox1
Wonks vs. Activists via the redoubtable Steve Benen.
I think this bill now sucks but I gotta go with the number crunchers and not the purity testers on this one. Also, not passing the thing would cripple this presidency.
MattR
@Dork: We are actually already putting stress on the Mexican health care system with the number of Americans who have “retired” there recently.
b-psycho
@J. Michael Neal:
Requiring people to purchase from companies that are widely seen as screwjob merchants isn’t a giveaway?
They love it precisely because it’s a bad idea. Right now the management at these companies are planning out how to jack up their soon-to-be-subsidized rates. You have to buy it anyway, fuck do they care?
cat48
A public option could be added to the exchange later if the plans the exchange offers dont reduce costs. I think they should pass it as a down payment on hlth ins for all because I doubt any pres. in the future would be dumb enough to take this on again for another 20 yrs or so. O blew all of his political capital on this so future pres. will avoid it all costs I would imagine. Poor O has been at 48% for days now on Gallup & will probably drop lower regardless of whether this passes or not. It was a lethal blow for him which is bad because the opposition will become even stronger now–Dems and Repugs.
valdivia
What Ezra just said.
Chuck Butcher
So you’re going to “help” people get insurance by mandating that they buy it from ….
Shove your help up your ass. You give me no alternatives and tell me you’re helping me? No, you’re not, you’re forcing me to help corporations with my money and taxpayer money, the same rapists who drove this into a national fiasco.
Cat
You know what makes me mad about this whole thing? The insurance company’s actuaries could tell us how much it would take per person to give everyone under 65 medical insurance.
I would like to see how much that number would be so we could see how much each person between the ages of 18 and 65 has to pay into the system.
Why is nobody waving this number around either to scare us or to convince us. The absence of this number makes me angry and suspicious.
Max
For those of you that want to “Kill the Bill” does it worry you in the least that you agree with the teabaggers and GOP?
Not being snarky.
valdivia
Weird, post got eaten up.
Anyway, Ezra with a must read post.
mai naem
The recission is written in such a way that I’m not sure it matters. The pre existing condition bit is not paired with rates so you end up cherry picking again. The exchanges from what I remember is going to end up being last resort for the very sick. Additionally, the 90 percent bit, I thought, is not in the final bill. Most importantly there is a min. amount of total cost sharing which is something like 70 percent of total medical costs. I’ve seen enough medical bills of my parents to know that $50K ain’t all that hard to spend during an acute illness with days spent in the hospital. That means that you can be responsible for $15K very easily. The lifetime caps are still there. Fuck Joe. Fuck Rahm. Fuck Reid. Most of all, Fuck Obama.
Linus
The two main threads of thought I see here are:
1) millions of people who aren’t covered will now be covered, so don’t forget that
vs.
2) there is nothing to keep down costs, so the insurance companies will keep charging ever higher premiums (esp. if they can’t deny you coverage)
So my question for all, particularly those supporting this bill still: Regarding those millions who are supposed to get covered, what happens if the $900 billion over 10 years that is supposed to subsidize and thus enable coverage is not enough, because the insurance companies keep charging more, and nothing in the plan prevents that?
thefncrow
@mcc: Because with a solid non-profit insurance option that keeps the insurance companies in check, a mandate is a good thing. It means that everyone is contributing in some form to insuring their fellow man.
If their customers start leaving in droves, that should lead the insurance companies to increase patient care and reduce premiums wherever possible. If they don’t and the insurers get greedy, the customers will flow to the public system, and eventually you’ll end up with most of the public in the public non-profit system, a la Canada.
Without a solid non-profit insurance option like the public option, though, the mandate just locks consumers into the private system, without any serious mechanism to force the insurance companies to keep their premiums reasonable. The best you can do is by regulating the insurance companies, but insurers are really good at finding loopholes, playing the rules, and maximizing profits inside the barest constraints of the regulations, assuming that the government is even seriously holding them to those regulations.
A mandate is a good idea so long as there’s serious non-profit entities in the market to keep prices competitive. The Senate bill’s mandate, however, is coming without such a mechanism to control cost, and should be opposed.
Zifnab
@AB:
Not illegal per say. It just creates a “poor tax”, where you’re fined by the government for refusing to participate in this farce of a health care system.
Elie
@b-psycho:
Not trying to be stupid, but even with the public option, werent people going to be forced to buy insurance? If people were not forced to have it, and it was truly voluntary, why would people buy it at any price? The mandate is essential.
PO in or out, people were going to have to buy the insurance at some level.
The assumption as well is that there won’t be regulation of pricing — that the insurance companies will just name their own rates. Yes, they can jack up the rates — but only so far and over time and scrutiny, be forced downward.
Dork
Ah, young padawan. Much to learn, there is. Just because it doesn’t constitute fraud doesn’t mean they wont say it’s fraud. Then what are you going to do, go to court and hire a lawyer for $2K/month against Big Insurance lawyers who can drag out the case for a year, emptying your pockets all for a $3K hospital bill?
cyntax
@Max:
Not sure if I agree with the “kill the bill” sentiment, but if you aren’t being snarky, then your question pretty much answers itself.
The teabaggers opposed the bill from the start for reasons like wanting to keep the government out of the Medicare, fear of death panels, and the idea that corporate bureaucrats are more benevolent than government ones. Once Howard Dean starts saying this shoulsn’t be done, we’ve passed into a territory where there are a number of substantive reasons to “kill the bill” from a progressive/liberal/whatever standpoint.
Keith G
@Olly McPherson: So…ah….the Rev King was engaged in street fighting bullshit? If that’s what you want to call it sign me up.
Cat
@J. Michael Neal:
Because the bill going to stop Insurance companies from claiming you committed fraud by doing these things? The bill is going to make them take your word someone else failed to include all the documentation? The bill is going to stop them denying your claims or dragging out the appeals process so long you die or give up, like they currently are doing?
Color me skeptical.
Xenos
The basic problem with the for-profit medical insurance remains, in spite of how good or bad the final law might be.
Given the actions of the industry, it is time to take the fight to them. The next step is to drive them out, state by state, for violating the public trust. Go right after their corporate charters, and seek to deny them the right to do business. Any state could pass a law making the operation of a for-profit medical insurance company a crime. If Ralph Nader were not such a fool that is the social movement he should have been driving for the last decade.
J. Michael Neal
@thefncrow:
No. The mandate is absolutely essential, and none of this works without it. The adverse selection problems are crippling. I agree, the mandate without further options is far from ideal, but without it, you gut community rating. Without community rating, the pre-existing conditions provisions are meaningless.
Saying that we should oppose the mandate is the exact same thing as saying that we should oppose the whole bill. All of the reasons for not opposing the whole bill still apply.
Olly McPherson
@Keith G:
Lead the charge!
Tsulagi
@Chuck Butcher:
You don’t understand, Chuck. Mandates+No Cost Containment= THE BEST HEALTHCARE IN THE WORLD MOST EVER.
valdivia
Yglesias, also making some smart points.
Max
@cyntax: “Kill the bill” libs seem like circular logic to me, and frankly, if I’m at the point where I want the same result as the teabaggers, then it would seem time to rethink my position.
I saw the following by @DaveWeigel on Twitter that portrays my thoughts on Dean…
But hey, I live in the middle, and I’m an O-bot.
qwerty42
From Nate Silver, via Yglesias. Yes, the bill is worth it. Sux, but still worth it.
thefncrow
@Max: The teabaggers and the GOP think the sky is blue, that if you hold an apple in your hand and let go that it will fall to the earth, and that food, drink, and sleep are essential parts of a normal daily routine lest you die.
I’m assuming you agree, so does it bother you that you agree with them?
This specific bill, the Senate bill, should die. I think health care reform should be done, and I think this Congress should be taking it up, but this bill has been watered down to the point that it’s a poison pill. We should kill it, or at least pare it down to the bare essentials like “No recission, no pre-existing conditions, no annual caps, and the establishment of the exchanges”. Then, we should prepare for a bill to go through reconciliation with a strong public option to go on the exchanges and/or the medicare buy-in, plus anything else we can push through in reconciliation.
Violet
It’s going to be cheaper for poor people not to buy health insurance and then pay whatever fine they have to pay when they get caught than to buy it. Unless they get sick, of course. But even if they do get sick, no guarantees they won’t be dropped.
I have no idea if this bill is good, but I hope it’s a step in the right direction. Apparently Social Security sucked initially. It’s taken time to make it something reasonable.
mai naem
The tax on the so-called cadillac plans still stays. And just in case you think it only affects a few people. It ends up affect one in three plans. I am sure these people are going to be thrilled to pay an extra couple of hundred bucks a month in this tax. As far as recission, they only have to claim fraud. Who do you think wins here? The sickie who’s desperate or the corp. with lawyers who are waiting it out for you to die?
Martin
Ok, since people are getting lost in details:
Expanding coverage:
– Eliminate or strongly curtail pre-existing denials and rescission.
– Employer and individual mandates with exchanges to help individuals and some small businesses (exchanges will help some with competition, which is the argument for dumping the PO from some)
– Subsidies based on income
– A somewhat replacement for, and a provision to prepare for a full replacement of the SGR which was designed to increase Medicare reimbursements to keep track with inflation, but wasn’t well designed to begin with. The goal here is to make Medicare payments more fair (higher in some places, lower in others) and therefore increase the number of physicians participating.
– A series of trials designed to pay physicians for the effects of care rather than the nature of care, based on the results of research below. For example, if doctors get together and find a cheaper procedure to affect the same outcome in patients, Medicare will split the difference with the the physicians. That is, doctors will get paid more, while Medicare will save what they would have over the previous procedure. This will all be based on the standard survivability studies that the industry uses now for care, but the government will subsidize these studies to encourage and expand their use. Basically, the fed is trying to create a win-win on innovation.
Lowering costs:
– Reduced prescription drug costs – some of which will be used to close the doughnut hole.
– Cap on administrative costs for insurers
– Provide funding for research dedicated to measuring cost/benefits of various policy changes and medical procedures. Think of the recommendation to stop covering mammograms under a certain age, or drug/surgery options. There’s going to be some give/take here.
– Either create fines for hospitals with high readmission rates or reduce Medicare payments due to that. Basically, penalize hospitals that fuck up care.
– More money/coverage for preventative care
– Bundling payments under Medicare for certain kinds of care – so hospitals can’t do procedure and then dump the patient to a nursing home so they get the better part of the reimbursement. If the nursing home is just covering for getting rid of a patient too early, the hospital will lose part of their payment due to that decision.
– Continuing the efforts from the Stimulus Bill ($20B or so) to overhaul the hospital records system and Medicare reimbursement system.
– Cap insurance payments. This is certainly controversial, but it’s well known in the industry that high-cost procedures are massively overbilled due to the frequency that it puts people into bankruptcy and that insurers deny the claims, leaving care providers holding the bill. Hospitals can bill as much as 5x-10x what a procedure actually costs in order to recoup losses from other patients. This is really what the cap is designed to prevent by telling care providers that there’s a limit to how much they can suck out of any one agent. The cap isn’t arbitrary, it’ll be uniform across the industry. Care providers will likely bill right up to it, and then shift costs to other patients. Think of it as a pissy way to achieve something more resembling single-payer.
Paying for the bill:
– Eliminate the Medicare Advantage 15% surcharge
– Tax either high-cost plans or high income individuals. I think the latter will happen, but the former is at least partially designed to reduced the demand on the care system – so people with really awesome health care (like me) don’t run to the clinic every time my nose runs (I don’t). But the argument against it is that people with high impact jobs (people that do physical labor, etc.) are the ones with those plans and simply do consume more resources. I sit on my ass all day – I’m far less likely to show up at urgent care as a guy framing a house.
The main things the bill doesn’t try to do is upend the insurance industry or seriously change malpractice. It tries to do almost every other thing.
jl
@thefncrow:
“The teabaggers and the GOP think the sky is blue, that if you hold an apple in your hand and let go that it will fall to the earth, and that food, drink, and sleep are essential parts of a normal daily routine lest you die.”
I’ll need a link or reference for that, until then color me doubtful.
cyntax
@Max:
Well I don’t think that’s a very fair assessment of the job Dean did as chairman of the DNC and I don’t think it’s a fair assessment of the stuff he’s written on heathcare, but if you’ve only got 140 characters to work with, I guess that’s the results you get.
Keith G
@J. Michael Neal: Of course!
And the Democratic success was, in part, due to a desire co-opt some features of the left in order to prevent a revolution from the left.
burnspbesq
The Senate bill currently on offer reminds me of the following bad old lawyer joke.
Q: what do you call a busload of lawyers going over a cliff?
A: a start.
By that metric, the House bill is a truck bomb at a Federalist Society convention.
Let’s just get to a conference committee, and see if we can keep our truck bomb.
J. Michael Neal
@Cat:
Like everyone else in this country, insurance companies have a right to claim anything they want, and even to file a lawsuit over it. That doesn’t mean that such a claim will do them any good. It’s the same with Dork’s statement. They can hire really expensive lawyers no matter what provisions are in there.
An insurance policy is a contract. One of the most basic aspects of contract law is that a contract is subject to rescission if there is fraud or material misrepresentation. (The two are almost, but not quite, the same thing.) As a contract, there *will* be the ability to rescind if they are found to have existed at the signing of the contract. I’m not even sure that the courts would allow Congress to exempt health insurance policies from this requirement.
Arguing that a rescission provision is toothless because it follows basic contract law is stupid. What you are essentially saying is that we shouldn’t allow health insurance policies to exist at all, because they can not be made to exist in a form that we would like. It is one of the most pointless objections to the current bill that I’ve seen, and I’ve seen a number of pointless objections, though most of them come from the right.
MattR
@jl: Here ya go. http://gop.am/ORKG
jwb
@qwerty42: Except don’t let Lieberman hear that.
valdivia
@Martin:
Thank you so much for this thorough post. Exactly the kins of point by point analysis that makes BJ so great.
MattR
@J. Michael Neal: It sounds like you are saying that the recission provision of the HCR bill is no different than how things currently work. Is that correct? If not, do you know how they differ?
(and thanks for the info on community ratings and pre-existing conditions)
trollhattan
Don’t y’all understand, everything is just fine the way things are:
http://www.chcf.org/documents/insurance/EmployerBenefitsSurvey09.pdf
jl
@MattR: Thanks. Must be true then.
BTW, will there be another Balloon-Juice GOP.AM festival tonight?
Martin
@Linus:
The insurance companies aren’t the main problem. Their profit margin last year was 2.2%. Yeah, they have more administrative overhead than Medicare, but that overhead isn’t growing anywhere near the rate that costs are going up.
The problem is that the care industry is charging ever more. That’s in part to their inefficiencies but also to the fact that the care industry gets every dollar covered, and if there’s a shrinking number of people insured, then those dollars get divided up among an ever smaller number of people.
The insurers are the small part of the problem. The care providers and how costs get distributed is the massive part of the problem. People hate the insurance companies because that’s who they deal with, but they aren’t the main cause of all of this.
Shawn in ShowMe
@JoyceH
I was on board with this line of thinking when it came to the stimulus bill. Ditto for HCR.
Jibing with your point about the public option being the next step in the process, I see that House is drawing up a jobs bill . If you believed the poutrage lobby back in March the stimulus bill was the last word on the matter.
Nuance doesn’t encourage page hits.
BR
Anyone who lives in Maine needs to be on the phone daily telling Snowe and Collins to support the reform bill.
If we get them on board we don’t have to deal with Lieberman, Nelson, or both.
Jurassicpork
That was the intention all along. The last thing the HMO’s and their Congressional employees wanted was a Socialist success story. It was never about real reform. That’s why single payer was skeeved and off the table from the beginning.
Look, I know it’s Xmas and everyone’s probably maxed out and all but I could really use a little help this year.
Rhoda
Basically IMO insurance companies get millions of customers and we subsidies 30 million americans who don’t have insurance to get insurance. It’s a balky and offensive way to expand the pool of insured IMO. It’s Romenycare w/bad taxes; getting rid of the excise tax on insurance plans would be good IMO and make it pretty much what MA did.
The upside: MA residents are happy,more are insured, and they’re finally ready to deal w/cost controls now that this is all on the books and we can see the costs up front and people are getting benefits across the board.
It’s a first step. It’s a balky first step and they’re making a huge mistake pushing this out to 2014 to be set IMO. But that’s the only other issue I have against the bill.
It’s not what I wanted. But I would never vote against 30 million more people getting insurance of some kind; even if it does pretty much create an insurance windfall.
b-psycho
@Elie:
I know that, and for obvious reason I’ve never been a fan of the concept. But without some form of option, the bill just formalizes a cartel. At least with it there would’ve been an out to some degree (one that I suspected would get much larger than popularly thought, but that’s another matter).
Scrutiny from where? The politicians they have in their pockets?
I don’t get this endless search for someone that seeks and can hold political power that rates your interests over their own. Might as well be hunting unicorns.
jwb
@Martin: No, I hate the insurance companies because without a call and sitting on hold for 40 minutes I can’t find out whether any particular procedure will be covered—even if I’m in network. I’ve had three claims this year kicked back by the insurance company for services provided by my in-network doctor. And I’ve got good insurance. I can’t even imagine what it’s like for those with marginal plans.
BR
@jwb:
Exactly. That’s why we need to pass this bill.
And I really think a stealth public option attached to the next budget bill could work…
cyntax
@Martin:
That profit number is somewhat contentious:
Zifnab
@valdivia:
I have a hard time swallowing that. All these Senators have a vested interest in seeing something pass. Better to deliver a dead baby than no baby… or something. But, you know what? I’m questioning the wisdom of the “get the bill in” mentality, because it isn’t just a bucket of necessary reforms. It’s also a massive taxpayer commitment to insurance companies.
Part of the deal in this whole reform was that hospitals and pharma would take a cut, insurance companies would take a cut, and taxpayers would take a cut, and that all these cost savings and additional expenses would insure the remaining uninsured population.
But that deal isn’t being fulfilled. Rescission’s legality will just go to the courts, where the 5 conservative SCOTUS justices will happily rubber stamp whatever convoluted definition of “fraud” the insurance lawyers invent. Insurance companies aren’t taking their cut. Pharma is hiking up the rates on all their drugs early, to raise the bar on “reasonable” drug prices. All the burden is falling on the taxpayers.
It was a bad system before and these new “reforms” seem to only magnify the glaring weaknesses. This legislation doesn’t justify the pain. A bunch of little tinkering around the edges won’t address the 800 lb gorilla in the middle of the room. The industries are the problem.
Ruckus
I’m willing to wait to see what comes out of conference. I’m willing to put up with a crappy bill, which is what I’m expecting. I’m willing to wait till medicare to get coverage.
I’m willing to wait for lawmakers to pass amendments and new bills to fix the crappy bill which is the best I expect. Which I don’t expect them to be able to do. Not until the last dollar is squeezed out of everyone by the insurance companies.
@MattR:
Already done, so count me in. Though I don’t suggest it. The fun of not knowing what to expect tomorrow, will I get sick and die, or worse, will I get sick and live, keeps me on the edge of my seat. And I’m lucky, I don’t have any dependents to support.
I’m one of those 50 million. I don’t need to wait. I’m already there. All the talk of how much better it will be than now, I don’t believe it. I hope for it, but I didn’t and don’t believe it. I do believe that if we can’t, as a nation, do better than what the senate seems ready to do to us now, we have reached the end of this great experiment, because the only reason not to pass the best bill is some don’t get rich. And we’re not seeing even close to the best bill.
The senate was supposed to be a check on the willie nillie whims of the house. Maybe the rich are smarter than the rest of us. They figured out that buying 50+ senators to stand in deference to the people is the cheapest way to make money.
Please, please, someone prove me wrong.
scudbucket
@J. Michael Neal:
…a contract is subject to rescission if there is fraud or material misrepresentation.
If a provider is governed by a guarantee issue provision such that it has to cover existing conditions, how is it possible for the claimant to commit fraud with respect to an existing condition? This is just a transparent loophole by which insurance companies get legal cover for denying what is stipulated in the contract.
Martin
@Rhoda:
I don’t think most Democratic legislators would argue with you. There are two problems to contend with:
1) putting the government as the primary insurer in one step will be a clusterfuck. Everyone from the Mayo Clinic to WalMart has to change how they do business, and everyone does business in 50+ different ways due to every state law being different, not to mention every insurer. It simply has to be done in stages. A steady expansion of Medicare is the easiest path because it leverages a system everyone already has to deal with (good or bad). Most of the goal in the Senate is to fix Medicare so this is a viable option in the next bill.
2) the insurance industry employs a lot of people in various corners of our nation. At a time of high unemployment, wiping out a few million more jobs isn’t going to get anyone re-elected. Think of not killing the insurance industry over the next 2 years as a jobs program. In 2 years, let’s talk again about this, though.
SIA aka ScreamingInAtlanta
Chad @ 4:42 think you just answered my main question. Do you have a link? Thanks.
Keith G
@Olly McPherson: I will do my part as I have in past.
Your sarcasm fascinates me. What do you suggest?
It seems to me that our Founders had a reason for believing in the power of the freedoms outlined in the First Amendment.
When a Senator knows that although 60% of his state supports a public option, but that less the 5% of that group will actually act on his vote, he can easily act in a way that hurts the under insured.
Zifnab
@BR:
You don’t “stealth” anything past Congress unless it’s a corporate handout or a local boondoggle (ie, Bridge to Nowhere). And even then, they aren’t immune from being spotted and flakked out of the air.
I would love to see Reconciliation on the budget used to muscle through a bit of progressive legislation. But given the last year of legislative fail, I’m not expecting much.
Billions for Wall Street, not a penny for Main Street. That’s the way Washington wants to work.
scudbucket
@jwb:
My wife works in the medical field – she was on the phone with an insuro claims agent objecting to why a claim was denied when it is clear that the policy covers the procedure. The agent told her, after hearing some harsh words, that company policy is to deny three time before accepting the claim.
J. Michael Neal
@scudbucket:
No, it isn’t. It’s just about the most basic provision of contract law that there is; saying that rescission is allowed in the case of fraud or intentional misrepresentation is a fancy way of saying that it is a contract. In fact, you just completely undercut your point. On of the essential components of demonstrating that there was fraud in a contract is that the misrepresentation was not only intentional or recklessly negligent, but also that it was material. Far from showing that this is a loophole that insurance companies can take advantage of, you have pointed out one of the reasons why this is *not* a loophole that they can take advantage of. The claimant *can’t* commit fraud if the insurance company would have provided a policy if the misstatement had not been made. There’s no materiality.
Mark
I read Nate Silver’s analysis today, complete with a graph of what people would end up paying. It strikes me as completely unaffordable.
An individual, at 400% of FPL:
$6000 cap on out-of-pocket expenses
$4245 cap on premiums
So if you get sick, you pay $10245 on income of $43320.
That’s horrible, but you also get this:
1) Rescissions for “fraud”
2) Annual caps to be decided by the insurance companies
So let’s say you get cancer and require $100k of treatment in one year. You pay $10245 + oh, I don’t know $50k? So you pay 150% of your income for health care.
What a joke.
scudbucket
@J. Michael Neal: but you didn’t answer the question.
mr. whipple
“That’s all policy. And as I spent yesterday arguing, it has a tendency to overshadow the lives in the balance. You can choose your estimate. The Institute of Medicine’s methodology says 22,000 people died in 2006 because they didn’t have health-care coverage. A recent Harvard study found the number nearer to 45,000. Since we talk about the costs of health-care reform over a 10-year period, may as well talk about the lives saved that way, too. And we’re looking, easily, at more than a hundred thousand lives, to say nothing of the people who will be spared bankruptcy, chronic pain, unnecessary impairment, unnecessary caretaking, bereavement, loss of wages, painful surgeries, and so on.
A lot of progressives woke up this morning feeling like they lost. They didn’t. The public option and its compromised iterations were a battle that came to seem like a war. But they weren’t the war. The bill itself was. When liberals talked about the dream of universal health-care insurance 10, 20 and 30 years ago, they talked about the plight of the uninsured, not the necessity of a limited public option in competition with private insurers.”
http://voices.washingtonpost.com/ezra-klein/2009/12/is_the_senate_health-care_refo.html
Balconesfault
People should have no illusions here – a mandate without a public option will be used by Republicans as a blunt instrument to beat on the 20-somethings come next election – and may well “flip” a number of them to embracing Burkean fantasies that government can only screw them.
Well, hell. Government WILL be screwing them. It won’t even be a fantasy.
The Other Steve
Oh bullshit. Those two items alone are HUGE!
On top of #2 is also language that forbids insurance companies from basing premiums on pre-existing conditions. They can only differ premiums based on age, whether you smoke or drink, and whether or not you take a health assessment. That’s it.
So if I had diabetes and a liver transplant I could walk out and get insurance at the same rate any other 41 year old pays. I wouldn’t get the $3,000/month plan thrown at me because they don’t want to cover my conditions. The mandate that everyone has insurance is what allows this to happen… it allows us to drop the pre-existing nonsense because the insurance companies are all afraid they’re gonna get scammed.
I don’t know what it allows in terms of competition. I haven’t seen the final language. The previous bills allowed for federal oversight of insurance companies, so a company could get nationwide rather then being limited to a state. If that’s true, you will see competition. If not, then we’ll only have some limited competition at first.
In terms of cost containment… What this bill is effectively going to be doing is shifting costs. A large portion of the costs are shifted to those who are now mandated to carry insurance. Some costs in terms of subsidies are being shifted from the state level up to federal. And ideally, because of the 40 mil new customers in the pool, those of us with existing insurance will see costs shifted off our backs.
Once we have everyone with insurance, then we need to target how that care is faciliated, and that means overhauling the healthcare system. Some of that will occur naturally thorugh competition, other changes will have to be mandated. We’ll see.
This is a HUGE first step.
Mnemosyne
@beltane:
It was the Baucus bill that was allegedly written by Wellpoint. The bill currently being debated is not the Baucus bill.
WereBear
I am taking the long view, and I’m sure my circulatory system appreciates it.
We have the hard place, which is where we are now, and we have a big rock; the insurance companies, who have tremendous power over at least one legislative branch.
Now, the most sensible thing to do is create some way of disassembling the insurance companies and transferring what they do to a public utility instead.
Anything that undermines their power is both essential and why they fight so hard; because right now there is no check on their power.
At all. They kill people routinely and Wall Street gambles on how well they do it.
To put any kind of restriction on them is the beginning of defeat and they know it. So it doesn’t matter if it’s enough restrictions, or the right kind, or anything like that.
Any is enough. Any opens the door. The stupidest thing progressives can think (they can do whatever moves them) is to think that this is it, this is our one shot, and whatever happens is set in stone and we all have to live with it.
Because that’s not so at all. This is the hatching of the egg.
Nothing can grow until then.
Andrew A. Gill, SLS
OK. Quick question here: Is the current bill advocating forcing everyone in the country to buy a random plan from insurance companies, or is it saying that if you can’t afford health insurance, there will be one plan which you will be provided subsidies for?
Because one of those is a shit sandwich, while the other is a rancid shit sandwich.
Comrade Scrutinizer
@Martin: Sorry, but this is bullshit. Insurance companies fix compensation rates for providers, and then providers have to jump through hoops to get paid. When they do get paid, they usually wind up writing a portion of the bill. Insurance companies usually pay later than Medicare/Medicaid, they usually dispute charges far more often than Medicare/Medicaid, and they do their damnedest to find ways to avoid paying large claims entirely (see: recission.)
The medical-loss ratio for health insurance companies is about 75% on average, with some companies having a MLR of 60%. That means that 25%-40% of premiums paid to the insurance companies go to non-medical expenses, such as marketing, admin costs, and salaries. CEO compensation paid by Aetna over a five year period was $77M, by Humana, $57M, and by Cigna, over $120M. That’s compensation paid to one person, not to mention what other top managers make.
Sorry, but I’m not weeping for a bunch of predatory assholes, and I’m not buying that the predatory assholes aren’t such assholes because health care providers are bigger assholes. That’s a lie—a very useful lie to take the heat off of the predatory assholes. And I’m not buying.
mr. whipple
The rescission and pre-existing condition aspects to me are kind of strange.
As far as I’m concerned, these issues, just as a matter of basic human decency, should have been dealt with long ago.
And if I was an insurer, my only interest in these apsects as it relates to my profit is if some other insurance company does it. If *everyone* can’t do it, I’m on a level playing field.
Keith G
@Ruckus: In this, you are absolutely right.
The Senate was envisioned a “congress of states”. The Civil War largely shut the door on the notion that we are simply a union of states. The New Deal helped to lock that door.
In a largely integrated, highly mobile society what/who then does the Senate represent? Business. The US Senate is becoming a congress of corporations. Well, some would say its already made that trip.
valdivia
How is this supposed bill different from what they have in Mass?
Mark
Martin @159
Clearly you don’t understand how insurance companies work.
Insurance Company A has premium revenues of $1B
It pays out $700M in claims
It pays its 1000 employees $97.8M in salaries
It pays six executives bonuses of $50M each
It has a “profit margin” of 2.2%
Insurance Company B has premium revenues of $1B
It pays out $950M in claims
It pays its 1000 employees $47.8M
It doesn’t pay bonuses to anybody
It has a profit margin of 2.2%
Insurance companies have whatever profit margins they want. They pay out what they feel like in claims and spend the rest on salaries.
scudbucket
@scudbucket: I’m presuming that you agree that ins. co.’s routinely deny coverage based on a determination of ‘fraud’. In fact, didn’t you admit as much upthread? If so, then I don’t know why you keep reiterating that rescission will be curtailed when apparently the language in the current bill is exactly as it was.
Comrade Scrutinizer
@Zifnab: This.
jwb
@scudbucket: Yes, I asked the claims adjuster how I’m supposed to know whether a procedure is covered. She tells me I’m supposed to look it up on some pdf they post to the web or call. But I tell her: here’s the thing: I’m in the doctor’s office. I don’t have access to the internet while consulting with the doctor, the doctor can’t wait 40 minutes for every patient to get a ruling on every procedure, you can’t pass off clearing every procedure to the billing people without causing the office to grind to a halt. Basically you are screwed, because none of these procedures was even particularly exceptional and so there was no reason to believe that they wouldn’t be covered. The only way to be sure would be to call them about everything, and I asked whether she thought I should do that. She did not seem to like that idea either, was nice enough to acknowledge the absurdity of the process, and I hope she didn’t get fired for doing so.
eemom
hey y’all — ya think Howard Dean has health insurance that takes good care of him and his family under the current system? Markos Moulitsas? Jane Hamsher?
I’ve said this before and I’ll say it again: when someone who is NOT protected under the system as it exists today utters the words “Kill the bill,” then I’ll listen.
Those who are, and have the unspeakable arrogance to say “Kill the bill” to 40 million uninsured people, can fuck the fuck OFF. They’re no better than Lieberman and the republicans.
Balconesfault
@Andrew A. Gill, SLS:
It’s the rancid shit sandwich. You’ll be required to buy an approved plan from a private insurer, or pay a tax penalty for not doing so.
It’s going to be oh so hard for Republicans to pick off hundreds of thousands of 20-something voters working contract jobs without insurance when they end up having to pay a fine on their income tax returns the following April – like the system screwing them twice. Especially since the no recissions/denials clauses will make the price of buying insurance on the open market jump up even faster.
Zifnab
@Mark: And don’t forget the BCBS “Non-profit” Insurance Companies. They don’t have any profits at all. Of course, if you’re an employee, you can make six digits no sweet, so long as you’re willing to tell some mother whose kid has leukemia that the child birth is a pre-existing condition.
Ruckus
@Martin:
But the argument against it is that people with high impact jobs (people that do physical labor, etc.) are the ones with those plans and simply do consume more resources. I sit on my ass all day – I’m far less likely to show up at urgent care as a guy framing a house.
Doesn’t workers comp take care of on the job injuries? It does in my state. (and I think we live in the same state). It does in every state that I have worked in. (not all but a number of them). So we are not talking about job risk. And I have noticed that a lot of people who do physical labor are on the lower end of the pay scale and probably have crappy or no health insurance. Just workers comp. So does having a gold plated policy actually get you better health care? Or do you just pay more up front?
J.W. Hamner
I didn’t read all of the 190+ replies, but I think Kevin Drum nailed it. Howard Dean is out of his mind if he thinks we can kill this and come back for reconciliation…. check out Kevin’s list and see if you think “sticking it to insurance companies” is worth giving up that kind of meaningful liberal reform for another decade or more… and note that after every failure with HCR the proposals have gotten more conservative, not more liberal.
Balconesfault
@valdivia:
Great point. Democrats are going to write Mitt Romney’s 2012 campaign ad for him.
Comrade Alan
The House managed to barely get this thing past and people are surprised the thing is falling apart in the Senate. Let’s face it, if anything passes, in this corporate controlled congress, the big pharmaceutical companies along with the insurance companies will be popping corks on their champagne bottles. Just as the investment bankers will when any new banking regulations are passed to prevent the next meltdown.
Martin
@jwb:
Well, like I said, that’s who you deal with. If you were dealing directly with the care provider, you’d be arguing over whether you need to pay the true cost of the procedure or the ‘you’re going to subsidize 8 other patients’ cost. You’d be equally pissed, just at someone different – and you’d have cases where the care provider would be denying care because they don’t trust you to pay. Right now they just shift that burden to the insurance companies.
People seriously overlook the shit that goes on between care providers and insurers. It’s even worse than how insurers treat policy holders.
jwb
@Balconesfault: Yup. The mandate, however necessary from a policy standpoint, is a political loser—though this would have been true with or without a public option. The mandate was always going to be used as the main political hammer in the next election. Politically, however, that action will also align the GOP against interests of insurance.
Elie
@Martin:
Absolutely. And many of the professional providers practice in plans or practices that are not part of a staff model — ie., where they get salaried and are managed by the plan entity in a capitated system. In our current system, they can control how much they order and from what entity they order — which can mean conflicts of interest in other types of ancillary services where they may be partial owners (radiology services, labs, etc)..
There are a lot of pigs on the healthcare teat and the insurance companies are just part of the entities making money. There are also thousands of consultants, etc who service these providers in various ways from practice management software to whatever…
Please everyone also remember that as we cut back on these costs, (rightfully), all those people will be impacted. There are a lot of jobs — a lot in 17% of GNP…
scudbucket
@eemom:
…when someone who is NOT protected under the system as it exists today utters the words “Kill the bill,” then I’ll listen.
I don’t have insurance. I say kill the bill.
MattR
@eemom:
While I know what you mean, I would argue that most people who have health insurance in this country are not actually protected under the system as it exists today. I will concede that they do have some level of protection that those without health insurance don’t, but nobody really knows if they are going to be covered if something goes very wrong (or if they will lose coverage for some unforeseen reason)
Balconesfault
@J.W. Hamner:
Not conservative. Bad.
If we just want to create subsidies, step back, throw most of the crap out the window … and create subsidies.
At least it will be clear then that what we’re doing is grabbing more taxpayer money to make insurance companies more money.
mcc
@AB: Aside from the little detail that public option + individual mandate doesn’t actually change that dynamic any…
Something I’ve been trying to do with each iteration of the health care bill that Congress emits is to read the actual text of the mandate provision. Every version of the bill has contained some sort of provision to limit the impact of the mandate on the poor. If you’re going to say things like “the mandate makes it illegal to be poor in America”, you should at least be aware of what those provisions are.
Here’s the text of the Senate bill as Reid introduced it; the assumption seems to be at this point that the final bill will be a lot like this only with the public option stripped. As with all other versions of the bill, you can quickly find the sections of the bill related to the mandate by searching the PDF for the word “responsibility”.
In this bill the relevant bit is on page 332, where there is a list of individuals exempt outright from the mandate. This includes anyone in a household that makes under the federal poverty line; anyone for whom an insurance premium would constitute more than 8% of their income (or after 2014, a percentage set by the HHS secretary); or anyone who applies for and receives a “hardship” waiver (there is a mechanism first described on page 140 of the bill also says that an exemption to the mandate will be granted to anyone for whom “there is no affordable qualified health plan available through the Exchange, or the individual’s employer, covering the individual”, subject to some guidelines for determining “affordable” which the HHS will cook up; it is not clear to me if this is the same as the “hardship” waiver).
The House bill that was passed has, to me, a more sane equivalent of the same policy (see page 303); on a cursory glance there’s no hard “exception” rule (other than an equivalent of the HHS-issued ‘hardship waiver’) but instead the penalty is pegged to a percentage of your modified adjusted gross income. I’ve heard it claimed that this means you aren’t subject to the mandate unless you pay income tax (as opposed to just payroll tax). I don’t think I can follow how that works, but it’s still the case that the less you make, the less penalty you pay for breaking the mandate.
In either case, the point is that the mandate is designed to not kick in unless you can afford to pay it. I’m dubious on whether that design goal is reachable (by which I mean: I think that’s bullshit). But it does seem clear the bill doesn’t exactly punish you for being “poor”. It does something weirder. It creates this weird shadow space where if you’re poor enough you get bailed out– either through the poverty exemptions or because you’re getting subsidies– and if you’re rich enough you can afford health insurance. Where you get screwed over is if you manage to fit somewhere in the middle, where you evade the exemptions and subsidy qualifications but don’t actually have enough money to afford health insurance or the mandate penalty. The case that worries me (because it’s the one that’s most likely to apply to me) is that the guidelines for determining what is “affordable” for a particular person will not take local cost of living into account.
valdivia
I ask about Mass because there have been quite a few articles, polls, reports on it and it seems the plan has a 60% popularity rating which is not shabby. Again, I don’t know how similar this would be to that, but they have a mandate no?
Mnemosyne
@AngusTheGodOfMeat:
Because we lefties aren’t happy unless we’re unhappy.
Balconesfault
@jwb:
But at least with a public option, you could be requiring people to buy into a public plan … perhaps not to you, but to me FAR more palatable than government dictating that I give money to a private corporation just to have the right to live in America.
Bwaaa haa haa! Yes, because the GOP will have any implied responsibility after they retake control of Congress to eliminate the mandate?
You’re kidding, right? This is a rachet, my friend – and the Dems will have pulled the crank that tightens the noose around the neck of lots of single younger voters.
J.W. Hamner
@Balconesfault:
Right. Every time HRC has been killed, we’ve come back with a much worse plan 10-30 years later.
However, both Medicare and Social Security passed in significantly more neutered forms than they exist today, but were continually expanded over the years.
Citizen Alan
The recission and preexisting condition provisions will do nothing, I repeat NOT A GOD-DAMNED THING!
Let me explain to all you silly people how this is going to work. You have insurance. You make a claim that the insurance company considers unacceptably large. Your insurance company discovers that you forgot to mention that great-uncle Harvey died of cancer. They rescind your contract based on fraudulent inducement.
At this point, your sole remedy is to sue the company in federal court at a cost of thousands of dollars and three to five years of litigation. And when you finally win, you will be awarded the amount the company was supposed to pay in the first place. No compensatory damages for out-of-pocket losses or mental distress. No punitive damages. No attorneys fees. No court costs. Not even fucking interest. Unless your medical bills are huge, it will be prohibitively expensive to ever challenge the companies determination that you engaged in fraud when you signed that insurance agreement.
There is no mechanism to appeal the company’s determination of fraud. No government agency to complain to. Nothing. This law gives you the “right” to challenge the legal resources of some of the world’s largest corporations and nothing else. It is a joke. Kill it.
The Grand Panjandrum
I just hope everyone hates Lieberman as much as they do now when he votes for a cap and trade bill and then helps in getting a a bill that mandates same sex partners of federal employees get the benefits of their spouses/partners. That really would make him an outrageous …. oh, wait …
Amy
Bull. The poor get health care through Medicaid. The near poor will get substantial subsidies.
Zifnab
@Mnemosyne:
And yet, our representatives always seem to make it so easy.
MattR
@The Grand Panjandrum: He’s with us on everything but the war.
Chuck Butcher
Kill the bill is supporting the teabaggers…
OK then:
Kill the bill or be a corporate shill with individual and taxpayer money.
What you’ve got is a bunch of loophole-able regs that amount to a hill of spit and mandated money for Aetna, et al. What I got was the President on my goddam TV saying, “…everybody doesn’t get what everybody wants…” as though that particular strawman has any meaning whatever. Joe Ho got what he and Aetna wanted, the rest can go suck eggs. Your fucking contract is worth exactly what the insurance company wants it to be worth. They’ll measure explosion in the face versus payout and decide. If you think you’ve already got problems because of health – go hire a lawyer and find out what problems are. One case makes the national news and they pay up, 400 others didn’t and they didn’t.
Anybody who pays attention to Corporate profit statements doesn’t know shit about tax law and should keep their stupid trap shut tightly to avoid looking like a complete and entire asshole. Corporations don’t want to make profits – idiot, and they don’t. Fuck me.
If a (D) win means that much to you, quit making shit up about it being meaningful and just say plainly you need the goddam propaganda. You’ve had the corporate power demonstrated to you and you insist that these so-called regs mean anything if that corporate power lets those pass? I had some hopes there were enough real Democrats to keep the Caucus in line, some small hopes some time ago. Now you know, you know the limits of their will and you know the limits of the shills and you still want to perpetuate the idea that something is happening? Knock yourselves out, I have no intention of calling something what it isn’t in order to satisfy propaganda.
scudbucket
@mcc:
So either the mandate provisions fail to compel folks in the middle to buy in (which is a significant number); or it penalizes people who really can’t afford insurance in the first place? Is that about what you’re saying?
Malron
@Martin: Also known as “stuff the progressives never mention because they’re too busy shitting razor blades over the public option.”
Zifnab
@Amy:
The subsidies are capped. And when the price of insurance doubles in five years, those subsidies won’t be looking nearly so substantial.
So what will Congress do? Can’t drop the mandate. Insurance companies won’t allow that. You’ll either have to spike subsidy rates to match the crazy premium inflation or tell the poor to figure shit out on their own.
I’m sure Republicans will campaign on “repealing the poor tax” and pick up all sorts of 20-something contractors and work-through-school college students getting slapped with the fees.
kay
@mcc:
Thanks so much. I’ve been looking for that.
My state mandate uses a “reasonable” standard: 8% of gross.
If the policy costs more than 8% of gross, it’s not reasonable, and you’re exempted from the mandate.
There are lots of other exemptions, 150% of fed poverty level, etc.
mcc
@scudbucket: Yes. What you said.
Annie
@Keith G:
I agree. That is part of the problem. We haven’t shouted enough…The Democrats are shitting bricks because the current discourse is that they will lose big in 2010. Republicans are dancing because they believe they have the “tea baggers” to vote in Republicans. So Joe “You lie” Lieberman feels he has stuck it to the Dems, and he actually feels good about his role. Fuck the poor. Fuck those without care, fuck costs, etc. that is Joe’s new motto.
Ruckus
@mcc:
Always nice to have someone do the actually work and not just piss and moan.
Thank You.
But once again we find a group to screw in this country. We never seem to be able to actually think about how to fix something, no matter how broken it is. We either have to have the biggest whatever to beat the problem to death (Iraq comes to mind, even if it wasn’t a problem), or the most complex, convoluted solution, which always has loopholes and shits upon some large but not very powerful group.
The Sheriff Is A Ni-
Kill the bill and fuck the uninsured for another generation! We’ll show, um, well, we’ll show someone the left isn’t to be messed with! We’ll really get that universal healthcare pony next time! Really!
Nach
NixonReaganBushPalin, uns!jl
My thanks to commenters for very helpful information and links and arguments.
I think hashing out what is in the Senate bill is very useful, since it is very unlikely the reconciliation will be much better. And it is good to know where the tricks are hidden. But I think it is premature to give it a death sentence.
Even though I wail and gnash my teeth at the rotten mess of a Senate bill, it occurs to me that other countries (France, Switzerland, for two examples) had to get good systems one piece at a time.
The first reform we have a chance to put into place in the US will probably be more corrupt, expensive, shameful and unfair than in many other countries. But, as I said above, if the reconciliation passes the ‘stinks no worse than MA’ test, then probably best to take it, and hope the it will be as popular as MA reform so voters will press for more reform.
I just saw news about how CMS is eliminating most doctor consultaton codes in order to save costs, or reduce mistakes, or eliminate abuse, depending on which side of CMS’s mouth you believe. Private insurers will surely follow in order to save money. The consequences for getting adequate evaluations before surgery and other procedures, relative impact on specialists and primary care, the effect on primary care availablility for Medicare recipients is as clear as mud.
And of course, such a move, if it sticks, moves our system further away from transparency. Since now having a doctor look at something requires it be reported as a visit, when actually, there is such a thing as a consultation.
The whole system, insurance through how doctors get paid, continues to slowly fall apart as we speak (or type).
Probably better to get something, as long it is not so bad the the public hates it worse than what we have now. That is a gamble I for one do not want to take, but it is one I may think is worth it if forced to choose it or nothing at all.
Max
@thefncrow: I don’t agree with those. I don’t think the bill should be killed, I was asking those that want to kill the bill if it bothers them to see who they line up with.
Notorious P.A.T.
Having not yet read any of the other posts here, I feel better about this than I did last night. People whose opinions I respect say this is a pretty good deal. I’m going to write my 2 senators and urge them to vote for it, which they probably will anyway (thank the stars above I’m not represented by an asshat like Lieberman or Nelson).
mr. whipple
If I understand correctly, the bills require insurance companies to allow parents to keep kids on their policies until they are 27.
jl
This may end up being a duplicate comment since the first vesion is in moderation due to a flagged (and false) b * n * r p * l l reference. Let’s try it again.
My thanks to commenters for very helpful information and links and arguments.
I think hashing out what is in the Senate bill is very useful, since it is very unlikely the reconciliation will be much better. And it is good to know where the tricks are hidden. But I think it is premature to give it a death sentence.
Even though I wail and gnash my teeth at the rotten mess of a Senate bill, it occurs to me that other countries (France, Switzerland, for two examples) had to get good systems one piece at a time.
The first reform we have a chance to put into place in the US will probably be more corrupt, expensive, shameful and unfair than in many other countries. But, as I said above, if the reconciliation passes the ‘stinks no worse than MA’ test, then probably best to take it, and hope the it will be as popular as MA reform so voters will press for more reform.
I just saw news about how CMS is eliminating most doctor consultaton codes in order to save costs, or reduce mistakes, or eliminate abuse, depending on which side of CMS’s mouth you believe. Private insurers will surely follow in order to save money. The consequences for getting adequate evaluations before surgery and other procedures, relative impact on s p e s h u l i s t s and primary care, the effect on primary care availablility for Medicare recipients is as clear as mud.
And of course, such a move, if it sticks, moves our system further away from transparency. Since now having a doctor look at something requires it be reported as a visit, when actually, there is such a thing as a consultation.
The whole system, insurance through how doctors get paid, continues to slowly fall apart as we speak (or type).
Probably better to get something, as long it is not so bad the the public hates it worse than what we have now. That is a gamble I for one do not want to take, but it is one I may think is worth it if forced to choose it or nothing at all.
Don SinFalta
And yet we’re told that somehow if one of them squeaks through, it’s going to provide a basis that can be made less and less conservative as time goes. How is that consistent with this history?
Existenz
I think they should pass this bill, then come back next month and pass a strong Medicare buy-in through reconciliation.
Oh, and somebody needs to smash a pie into Joe Lieberman’s face and put it on Youtube.
Elie
@scudbucket:
Are you getting regular treatment for something? Are you on regular medications necessary to manage a condition? If not, you are taking a relatively lower risk and not really taking a chance on a big out of pocket hit…
Even the most minor hospital stay for observation over night without a lot of high tech is thousands of dollars. Most testing is hundreds if not thousands of dollars..straight out of pocket…
Just sayin…do you feel that lucky?
Annie
“In an interview with the New York Times, Sen. Joe Lieberman (I-Conn.) revealed Tuesday that he decided to oppose a Medicare buy-in in part because liberals like Rep. Anthony Weiner (D-N.Y.) liked it too much.”
This says it all….
Chuck Butcher
The Haliburtinization of the country continues and BJ, of all places, stands up and fucking cheers. Shiny baubles …
General Winfield Stuck
This thread is hilarious, in a slightly dark, and maybe useful way. But that is debatable.
Much typage and bandwith to debate something passionately, something that is not known. At least the details, which is where the devil lives.
Reid’s bill, the one he sent to the CBO, is not the Baucus, or Senate Finance bill, despite wanking to the contrary. He kept it and is keeping a frieking secret. While I am sure it has provisions similar to the Baucus bill, it no doubt has other ones that resemble the Health Committee bill.
I will wait till it is revealed, with the aforementioned eleventy hundreth caveat, that whatever passes the senate, is not the one that will be finally voted on.
Kill the bill, jeebus. We need a Minority Report to learn if it will in time be guilty of something, after it finally exists.
kay
@mcc:
What it might do is create a market, and then a regulated product.
For example. If there is a set of people like you, not eligible for the subsidies, and not eligible for the Medicaid expansion, and there is a number, “affordable” at 8% of gross, there will be an insurance product that fits within those parameters. If there isn’t, you’re exempted under the “affordable” provision, and they aren’t going to be able to sell you a policy, because you don’t have to buy it.
Ogami Itto
I’m depressed. Here’s the gift that keeps on giving:
http://gop.am/vKtV
mcc
According to TPM it’s this PDF. It was posted to the front of http://democrats.senate.gov/ when Reid “unveiled” the bill on Nov. 18. Do you have any reason to believe this is incorrect?
J.W. Hamner
@Don SinFalta:
As I mentioned in that same post, Social Security and Medicare have both been significantly expanded over the years from relatively modest beginnings. In addition, every other country with socialized medicine started small and worked up to whatever they have now.
I think there is ample historical evidence that passing whatever we can now is going to lead to a much better health care system down the road.
Notorious P.A.T.
I don’t know if anyone else has posted this yet (200 posts!) but here’s Steve Benen pretty much summing up how many people here seem to feel:
http://www.washingtonmonthly.com/archives/individual/2009_12/021468.php
And here’s Nate Silver on what we have right now:
http://www.fivethirtyeight.com/2009/12/why-progressives-are-batshit-crazy-to.html
And here’s
Bondo
Don’t give into the Dean stupidity.
Medicaid up to 133% for adults. This is BIG. Right now parents are covered up to an average level of about 40-50% FPL depending on the state. Right now childless adults are not eligible at all (some states have provided coverage on both accounts but certainly not most). That is a lot of the poorest people who get good, free, insurance. Also, a lot of children who are already eligible but not enrolled in public plans (most of the uninsured children) will be more likely to enroll because their parents will also be enrolling. Between that and the subsidies, that is a lot of people getting insurance, and a lot of the remaining uninsured children that will be insured in the process.
Plus, if health reform fails this time, next time will be even harder and even less ambitious. If health reform passes this time, next time (improvements) will be easier and more ambitious. Success begets success. The idea that failure gets us somewhere better is insane (as is the concept that this bill is worse than the status quo).
jl
@Existenz: If Obama is really an n-dimensional chess player, he would get all he needs out of Lieberman on other votes and try to pressure Congress to do just that. I do not have high hopes for it, though.
Andrew A. Gill, SLS
@balconesfault
Hey! I’ll go for tax penalty! This bill is awesome!
AngusTheGodOfMeat
@Mnemosyne:
I am having Sad Cow Disease.
scudbucket
@Elie: No. It’s something I’m trying to – and will – remedy in the not too distant future (i.e., a month or two). And thanks for your concern.
Notorious P.A.T.
Kevin Drum:
http://motherjones.com/kevin-drum/2009/12/healthcares-home-stretch
Martin
@Comrade Scrutinizer:
You’re oversimplifying how things work. MLR is a very easy statistic to abuse. Take my insurer – Kaiser Permanente. They own the hospitals and doctors. They can shift all administrative expenses to the care provider side of the organization and aside from out-of-network payments, move their MLR to near 100% (which they regularly do). It doesn’t mean there’s necessarily any more or less administrative overhead, it’s just a function of where it gets reported. Given that most insurers also have local HMOs, they do the same thing. At least some insurers put all of their in-network costs in their HMO accounting, driving it near 100% and all of their out-of-network costs in their for-profit accounting where all the costs get incurred against a relatively small number of claims, driving the MLR way down. I’ve seen MLR as low as 30%. Does anyone really believe the insurer is keeping more than twice as much money as they’re paying doctors? And what of the insurers with a MLR of 110%? It’s just not as nice and tidy as anyone wishes it could be.
As for the tussle between insurers and care providers, remember that every dollar of care is paid for. Every one. If my appendectomy drives me into bankruptcy, every other appendectomy needs to cost a dollar more to make up for it because I never paid. The insurers push back against that saying ‘no, we’re not responsible for that dollar, get it somewhere else’. Everyone does that. Medicare does that. It’s all about figuring out who you can get to pay and who you can deny – at all levels.
Look, I’m not saying that insurers are wonderful – they aren’t, and most are flat-out terrible. But insurers of all stripes are generally fairly efficient (remembering that ‘efficient’ can also include dumping expensive patients). They’re less efficient than a government plan would be, no question, and some are quite a bit less efficient, but they aren’t eating 40% of premiums just for the hell of it and they aren’t going to pay whatever a doctor asks of them. Just as an experiment, see if you can find out what your insurer pays for a procedure and what the procedure would cost if you walked in off the street. In almost every case if the procedure is expensive (more than a typical annual deductible), it will cost significantly more if you walk in off the street. Should the insurer pay that higher amount? Do you think the care provider wishes the insurer would pay more and will complain when they don’t?
Again, I’m not siding with the insurers here, but they aren’t the whole problem. Not by a long shot. And I see almost NO criticism of increased cost of care outside of Pharma, excessive testing, excessive equipment purchase, and so on. I had someone check (because I know these people) and there are 17 MRI machines within 15 miles of my house. 17. At an average of $2M each, that’s $34M in equipment, most of which sits idle but nobody wants to either:
1) be inconvenienced for having to drive across town
2) lose out on a billing opportunity – MRIs bring in money and are generally overprescribed and overbilled
I know of two MRI machines within 100 yards of each other and at any given time one or both is idle. We paid an extra $2M for that arrangement, most likely through our insurers who are the only people in a position to say no to it.
Chuck Butcher
I have never proposed that any single option was make or break, what I have stated repeatedly is that mandates with no options is totally unacceptable and that is what you’ve got. You will buy your insurance from the same bunch – fucking period, end of story. That is corporate power at work and if you really think that something has been achieved by something they will let pass there are other people with other bridges for sale.
I made the mistake of thinking 56 actual Democratic Senators and the GWB legacy might mean something to the Democratic Caucus – sorry for espousing such nonsense.
Next up for the same treatment, Cap and Trade and Banking Regulation.
I don’t object to incremental progress, what I object to is going backwards and calling it progress. YOU get nothing, they get a massive gift. Try to understand that the pretty baubles mean exactly as much as they’ve ever meant or they wouldn’t be in there or Joe Ho would filibuster anyhow. What do you need to get that?
Notorious P.A.T.
Well, for one thing, Holy Joe’s political career has one foot in the grave and the other on an oil slick.
Martin
@Ruckus:
Only if its an on-the-job injury. If you’ve ever swung a hammer for a living, it breaks your body down. Eventually you’re going to pay for that damage and your insurance will need to kick in.
And yes, CA has very good workers comp laws – probably the best in the nation. Not everyone else has the same protection, however.
mr. whipple
From the Benen link provided by Notorious P.A.T.:
“As we’ve talked about recently, progressives have faced this situation before. When Medicaid passed, it did very little for low-income adults. When Medicare passed, it all but ignored people with disabilities. When Social Security passed, the benefits were negligible, and the program excluded agricultural workers, domestic workers, the self-employed, railroad employees, government employees, clergy, and those who worked for non-profits. The original Social Security bill offered no benefits for dependents or survivors, and included no cost-of-living increases.”
Keith G
@Annie: At today’s NPR news site:
December 15, 2009
J.W. Hamner
Silly me, I thought liberals supported taxes (i.e. a mandate) to help the less fortunate. The only way premiums stay down is if even the young and healthy among us agree to pay into the pool. That’s how it would work with Single Payer too.
I certainly understand the visceral hatred of people who profit by not paying for procedures when people are sick… but a well regulated private insurance market can work. We know this already. Will this bill get us there? No, but it will get us closer, and that is a significant victory.
Bob Natas
A few points:
1. The latest polling data I have seen on the Pollster website indicate that the public is more or less evenly divided on the issue, but the movement in the numbers indicate a growing resistance to this piece of legislation. I’m not exactly sure what this means, but I suspect that no matter what happens (bill is killed or barely passes), the D’s are looking at some fairly major losses in Nov. The mandate will not be popular.
2. I was fairly convinced that once Obama and company had committed to preserving the existing means of financing health care in the US, they would be required to pay some pretty hefty bribes to various bad faith private sectors actors. I’m willing to live with the bribes (and hope that others will ultimately will be as well) because I don’t see another way to get legislation like this through the Congress.
3. It is unfortunate that organizations like ACORN, who have had some success at organizing the poor (and likely uninsured) have been systematically demonized. The people who stood to gain the most from this legislation did not have much of a voice in the preparation of this legislation.
Martin
And to the kill the bill folks that feel that way primarily due to Lieberman, I leave you with this bit of wisdom:
Don’t blow up the submarine just because someone farted in it.
The bill is a good bill. It’s not great, but don’t let the perfect be the enemy of the good. Don’t give Lieberman the credit for blowing up the Democratic party. He’s not worth it. Time to turn your zen on.
Elie
The other thing — so many here are getting wrapped in details that we just don’t have and even in the final bill that eventually passes, those details would have to be further operationalized (and sometimes refined and made better), during the very extensive regulatory process to follow. A lot, a LOT of the insurance company oversight would be in that portion of this whole initiative — NOT in the bill..
Also:
Not exactly the same thing at all, but when I first started as a nurse in the neonatal icu, premature babies and those with birth asphyxiation and all sorts of other conditions had equipment and treatment modalities that just did not result in a lot of survivors. We used the primitive equipment and techniques that we had then to do the best we could. We always knew that there would be learning and improvement of the techniques, knowledge and tools (equipment). We did the best we could and we saved many but not all the babies.
Today, it is amazing how much improvement has been made on the techniques, knowledge and tools…many more are surviving and thriving in good shape with their brains and bodies intact (much less often before)
Before someone freaks out and screams at me that this is not an analogous situation — which I understand — it is similar in that you have to work with the limitations of the conditions that you have now. Our politics after years of the distortion and lack of use of our Congressional branch, are quite fragile and the expertise in getting things done through this institution is very evolving and unsure of its power. That is just who we are and where we are. We still have work to do rather than sitting back buffing our nails admiring how perfect this all was, we have a difficult road still.
But buck up — I am happy to be seeing us going forward as wobbly as we are, than killing this and then what??? Spending the next years in recriminations and screaming matches while folks with nothing still have nothing or maybe even less?
Nope.
Chuck Butcher
@Ruckus:
Jobs like construction will eventually destroy your body, if you can’t show it was, say, falling off a wall that hurt you, that damage is your problem not WC’s. Carpal tunnel? So? What incident caused it? Not happening.
Non-union construction workers mostly will have no health insurance – the reason should be obvious – both income level and actuarial tables. No insurance company is ignorant of the fact that construction works your heart like the dickens, is dirty, is subject to all kinds of physical and environmental stresses and that small unclaimed injuries eventually add up. Bad bets.
Bob Natas
This is true in principle (for example, the way the German system works). I’m not convinced that what is being proposed is a well regulated market. I highly doubt it, actually. The question is whether or not changes can be made when the bad faith private sector actors make their intentions clear.
Notorious P.A.T.
“I’m sure Republicans will campaign on “repealing the poor tax” and pick up all sorts of 20-something contractors and work-through-school college students getting slapped with the fees.”
But college students are being forced to move back in with mom and dad in record numbers, because they are unemployed in record numbers and government aid for education is being slashed. this is not fertile ground to harvest hatred for federal help.
Balconesfault
The original Social Security bill offered no benefits for dependents or survivors, and included no cost-of-living increases.”
But it was a freaking Government Run Social Security Program.
It was not a private Social Security program that Government mandated everyone buy into.
We aren’t creating the pathway for some future public health insurance program in the future that will help control the rising cost of healthcare.
Instead, we’re deviating from the concept that taxpayer subsidized healthcare should be managed by the government – and we’re following along the Bushian Medicare Part D that just shipped more federal money to large corporations.
Who will use said money to just control Congress all the more effectively in the future.
If Dems pass a bill that’s basically a shaking down of people and taxpayers to further fill the coffers of the insurance industry … and they end up paying no penalty … why would any future Dem buck the huge pressures that come from the industry and try to do anything more progressive?
I laugh at the 8% rule, btw. What that means is that some 24 year old doing contract programming or advertising work for 45K a year is going to be told they have to be able to buy some crapola high deductable $4,000 a year program offered to them by a private insurance company – or face an additional tax burden.
Who do you think they’ll be pissed at next election – Republicans and Lieberman for stripping the public option? Or the Dems who put this shit sandwich on their plate?
General Winfield Stuck
@Martin:
By golly, I am stealing that,, and you can’t stop me.:_)
Chuck Butcher
@General Winfield Stuck:
To be sure, it’s a great line – about submarines that aren’t leaking water and radiation. With a mandate this thing is flat out poisonous, it isn’t a case of not good enough; it is toxic to the public good.
MinneapolisPipe
I don’t know if anyone’s posted this link already, but Ronald Brownstein has a good breakdown on some positive things involved with the Senate plan. I think Obama (and his budget guy Orzag) are playing a long-term game with this bill. They both recognize that the current system of corporate bloat or a significant additional financial obligation by the government will mean bad things for this country down the road. It’s worth a read. Sorry for wasting space if someone already posted this link.
http://politics.theatlantic.com/2009/11/a_milestone_in_the_health_care_journey.php
Chuck Butcher
So who was it around here that disapproved of Halliburton and Blackwater? Why was that exactly? You are to understand that this is a fart…
Balconesfault
@Chuck Butcher:
Echoes my point.
We’re not going to move towards a publicly run system by expanding the reach of private insurance companies, and by increasing public subsidies to them. That is wholly illogical.
In fact, the fastest way to getting a single payer system would be to completely eliminate any federal subsidies going to private insurance – including the tax incentives for employer provided insurance.
jcricket
@Balconesfault: I’m pretty much with you, except that the Swiss have this kind of system and figured it out, pretty much.
Basically everyone gets insurance from private companies, but those companies are all forced to be non-profit, exist under heavy restrictions, offer certain coverages, etc.
I know this doesn’t put us anywhere near far enough on those levels and I find the removal of regulations and caps and what-not even worse than the removal of the public option/Medicare stuff.
But it is possible to control private industry. We just suck at it.
mr. whipple
@MinneapolisPipe:
Thanks for that! Good read.
Annie
@Keith G:
Yes, I saw that. The good news is that they did not mobilize that many people…I will never understand why people are so willing to organize and vote against their own interests.
If some kind of reform passes, the key is to change the narrative and start talking about how the corporate interests and the Republicans — including Joe “you are an asshole” Lieberman prevented something better. The Republicans have to go from popping the cork to becoming seriously worried that they screwed the majority of Americans. If the Dems are smart, which they aren’t, they would come out swinging…
Chuck Butcher
@Annie:
If it were actually health care reform … this is about the (D)and the nigger in the White House.
Balconesfault
@jcricket:
Not just suck at it … but a structural 20% of Americans will kneejerk respond to any proposal to control private industry as being akin to the purest form of Socialism … and another 20-40% of Americans can be convinced to agree with that conclusion for at least short periods of time.
And we have close to 70% of Americans who will always kneejerk twitch in Pavlovian fashion anytime the word “Socialsm” is brought into the discussion.
This bill may end up being usable by Obama to stay in office. But it’s going to end up being used to badly hurt Dems in Congress.
At the very least, Reid should play chicken and demand that not one Republican support a filibuster, and at least 10 Republican Senators vote for the bill. Let the Insurance Companies bust their knuckles for awhile.
Balconesfault
@jcricket:
Not just suck at it … but a structural 20% of Americans will kneejerk respond to any proposal to control private industry as being akin to the purest form of Sooooooo cialism … and another 20-40% of Americans can be convinced to agree with that conclusion for at least short periods of time.
And we have close to 70% of Americans who will always kneejerk twitch in Pavlovian fashion anytime the word “Sooooooo cialsm” is brought into the discussion.
This bill may end up being usable by Obama to stay in office. But it’s going to end up being used to badly hurt Dems in Congress.
At the very least, Reid should play chicken and demand that not one Republican support a filibuster, and at least 10 Republican Senators vote for the bill. Let the Insurance Companies bust their knuckles for awhile.
Ruckus
@Martin:
I don’t think this is a good bill. Not from what I’ve seen and heard. And I do think that over time it will be, or at least can be made better. 258 comments and I recall only one talking about all the workers who would lose a job if single payer took effect today. But it won’t and nether will any bill. I believe that the earliest effective date is in 2014, which is of course over 4 years away. So hopefully we will be out of the woods economy wise. During that time there is no change except costs will rise. A lot. What will not change is people will die, people will become bankrupt, all due to lack of, well, congress. And if we wait who knows how long for another bill or if we have to wait for this bill to be corrected piece by piece, how many more die, or go bankrupt?
My take is that we have no choice but to wait. But what a shame that is. That we have a totally ineffective government, unless it’s waging war. That 300+million people are held prisoner by one or two ignorant jackasses. I hope that at least they get rich for having to be such pricks.
Chuck Butcher
@Ruckus:
This assumes a powerless Democratic Senate Caucus, not a willing particpant. I’ll say it again, that 55 or more Democrats can end the political careers of jackasses in the Senate. Can. Will? You have the evidence.
Annie
@Chuck Butcher:
Exactly. And, that is what makes me sick. I hope my health insurance covers pure disgust….
Mnemosyne
@Citizen Alan:
That’s exactly how it works now, except that you have to go to mandatory arbitration with an arbitrator chosen and paid by the health insurance company and have absolutely no recourse to federal court. The best you can do is complain to your state’s insurance board and hope they listen.
Do you know anything about what people have to deal with under the current system? Because it’s weird to be threatening people with the idea that they might get to take their rescission to federal court instead of the current system of being stuck in arbitration that decides in favor of the insurance company 90 percent of the time. At least the judge’s salary is not explicitly paid by the insurance company the way the arbitrator’s is.
Sloegin
Our current insurance system will collapse in a decade.
People will blame the insurance companies.
This legislated insurance system will collapse in a decade.
People will blame the Democrats.
No reconciliation ponies are forthcoming.
Olly McPherson
@Keith G:
I’m not being sarcastic–lead a movement and see if anyone latches on. I hope so!
I don’t plan on leading anything. I’m trying to transition into being a disinterested follower of politics, pulling my lever at election time, contributing to non-profits I like and not hoping for much beyond that.
I don’t think there will be much return-on-investment in taking to the streets. I also thought your original post was pretty nebulous, hence the “Street Fighting Man bullshit.”
Mnemosyne
@Sloegin:
No, people will scream for a bailout and blame the government for not fixing it. It’s an almost perfect tails they win/heads we lose.
Elie
@Annie:
I will never understand why people are so willing to organize and vote against their own interests.
Annie:
I am way off topic here, but I can remember ( I was a young lefty) after Martin Luther King’s assasination, discussions that the “cause” was due to his getting closer and more involved in class — empowerment of poor whites. He was starting to move into Applachia and other poor white communities. His fulcrum was the Vietnam War, which drafted a large number of poor whites (and blacks)…He was starting to talk about common interests and issues …
This is all convenient happenstance of course, but after his assasination, the Nixon/Republican “Southern Strategy” forever placed a social wedge (hence term “wedge issue”) between the aspirations of poor whites vis a vis their equally poor and downtrodden brown and black brothers.
The fear I believe is central to the right’s craziness right now is that if we get semi successful any economic or health care policy going, that this whole thing will come back and permanently shift the balance of power in this country…
THIS is what I believe from the bottom of my heart should be the strategic goal of the left/progressives…not throwing monkey poop at any forward progress…and bitching about the perfect and how blahblahblah this isnst and never will be…
Balconesfault
@Elie:
Central to the right’s craziness right now is the idea that if they monkeywrench every freaking thing until it’s so kludgy it’s bound to fail – they will regain power when the inevitable failure occurs.
And if they can not only save corporate bosses a bunch of money – but twist process into creating new cash streams for the corporate bosses that the average American perceives have the Dems fingerprints all over them – that’s just a bonus.
Ruckus
@Chuck Butcher:
Agreed. I was pointing out to Martin that his point that working behind a desk was not as dangerous as construction because it sounded like he was talking about work related insurance costs. I worked and owned a business in a fairly dangerous line of work for over 30 years and have seen the short and long term problems of hazardous work. And with OSHA, (and I’m sure other forces) the danger has been lowered, but not stopped. Lowering of costs doesn’t happen with construction as much, as most of the companies are smaller and a lot of the workers are both independent contractors and non union.
A point I haven’t seen made is countries with universal health care don’t need a workers comp program. They don’t need a veterans administration. They don’t need health care in the military except for in the field. The don’t need medicare. And most important they don’t need a federal employee insurance program. IOW, not all the over lapping costs and profit centers and the benefits work for all of us, not just the some, the privileged, the civil servants, those disabled the most noticeably during service.
/dream sequence
mclaren
Okay, people, listen up — here’s what’s going on with health care “reform.”
The American middle class is going away because the internet has let giant corporations outsource all the high-paying high-skilled jobs overseas to third world PhDs in China who’ll work for $3 per hour. Back in the 80s globalized trade let giant corporation outsource all the high-paying low-skilled jobs overseas to third world peasants, so this means that as of 2010, there are virtually no high-paying jobs left in America (except for licensed professions protected by medieval-style guilds operating monopolistic cartels — namely, doctors and lawyers).
Since the American middle class is disappearing, the insurance industry can’t vampire its customary infusions of cash of the American public anymore. People just can’t afford the health insurance premiums anymore.
What to do?
Aha! A light bulb blinks on above the insurance industry executives’ heads. Pass health care “reform” which does nothing to contain costs, imposes essentially no meaningful restrictions of the health insurance industry, lets the insurance industry dump all the chronically sick people into an exchange funded by individual states which will rapidly go broke and collapse into a boondoggle, and legally forces everyone in America to buy insurance.
It’s nothing but legalized extortion. When Vito Bent-Nose the mafia enforcer drops by your convenience store and tells you that you have to pay an outrageously exorbitant monthly fee to use Vito’s nephew Sonny Bent-Nose as your liquor wholesaler or “some very bad things will happen to you and your wife and children,” it’s illegal.
But when congress tells you that you have to pay an outrageously exorbitant monthly fee to buy health insurance or “some very bad things will happen to you and your wife and children, including getting a huge fine or going to ass-rape prison,” why, that’s now the law of the land.
Bottom line?
This health care “reform” has nothing to do with reform. It’s just the TARP bailout translated into the health care industry — in short, corporate welfare part deux.
Oh, and by the way…just wait till you see health insurance premiums zoom to the stratosphere once this “reform” gets passed and the health insurance industry finds itself with tens of millions of captive victims mandated by law to buy their shitty crappy worthless overpriced product.
Why, the health insurance CEOs are already high-fiving each other and shouting, “Bugatti Veyron, baby! Rolex Presidential! Weekly Cayman Islands vacations!”
The real reform will come after health insurance premiums skyrocket to the point where no one can afford ’em, and average middle-class families start shooting doctors and blowing up hospitals because the health care system in America has become to catastrophically broken. A word to the wise: if you think health care is expensive now, hooooo boy, just wait till you see what it costs after this ‘reform.’ And if you think a lot of Americans are locked out of medical care today, just wait 5 years. I’m guessing we’ll hit 150 million Americans without access to health care by 2015. And of course the real beauty of this plan is that it has that wonderful “blame the victim” provision…if you can’t afford health insurance and therefore don’t buy it, wow, you get fined. That’s such a fantastic Social Darwinist concept that the wingnuts are coming in their pants just contemplating it. It’s like fining people for being homeless…which, incidentally, is what the city of San Francisco has decided to do.
We could really extend this whole social policy of blaming and punishing the victim. Let’s pass “sex crime reform” modeled along the lines of “health care reform” that requires that any woman who gets raped must be gang-sodomized (to punish her for her sexual promiscuity, of course). And we can pass “violent crime reform” that legally mandates that anyone stupid and incompetent enough to get robbed must have all their possessions and their bank account legally forfeit by the state (as a punishment for their stupidity in allowing themselves to be robbed, of coruse). And then we can pass “fire reform” in which any house that starts to burn must be hosed down with kerosene by the fire department (as an object lesson in the horrible dangers caused by failing to take proper care to prevent fire, thus endangering your family).
We could do on to reform our whole society. When we see a hungry child, let’s “reform” the scandalous child malnutrtion situation in America by dragging that kid into a cell and starving him to death as punishment for insufficient self-reliance. If a woman gets beaten by her husband, let’s pass domestic violence “reform” requiring that the court sentence her to be beaten to death by a mob of men wielding baseball bats as a lesson to all women to stand up for themselves. And if you lose your life savings in a financial swindle on Wall Street, we can pass “financial reform” legislation that requires that no employer can ever hire you again in order to punish your irresponsibility and stupidity in dealing with money.
Yes indeedy, with enough “reform” along the lines of this health care ‘reform,’ we can look forward to living in caves, banging on rocks, eating dirt and grunting incoherent monosyllables.
Balconesfault
@Ruckus:
The taxpayer-financed share of health spending is near 60 percent, Steffie Woolhandler and David Himmelstein of Physicians for a National Health Program wrote in a recent paper in the journal Health Affairs. They note that federal estimates don’t include health care-related tax subsidies and public employee health benefits.
In the United States, “tax-financed costs exceed total costs in every nation except Switzerland,” Woolhandler and Himmelstein wrote. That’s hardly a hands-off approach.
Thoroughly Pizzled
@mclaren:
Jesus Christ… really?
Andrew A. Gill, SLS
@Balconesfault
Oh, fuck me.
So we’re barreling headlong into a system that’s more like the Swiss system? And some of these senators are complaining because it’s too expensive now?
Jolene
No one knows what’s in it because they’re still busy stripping things out of it — or occasionally adding things in like limits on “no limits”. But Ezra is for it…Dean is against it but who cares? The only opinions that count with the Senate and the President are those of Joe and Snowe.
JerseyJeffersonian
Why would I think that the proposals currently on the table will be toxic? A new paradigm is stealthily being introduced, one in which the government is progressively being reduced to acting as the enabler/enforcer for the monetary aggrandizement of corporations and other private business entities. Mandates to require that the citizens transact business with private parties with the threat of the punitive power of the state being brought to bear should they fail to comply. In Mussolini’s formulation, fascism, a union of the state and the corporation, with the state being in the commanding position. But in our case, due to the overweening power of the huge, artificial people known as corporations, the power position is ceded to the corporations, and not the citizens, the advocacy for whose interests should ideally be in the hands of the state. Socialized costs, private gains. No effective means of controlling costs for the provision of basic human needs. We as citizens are being consigned to the status of mere onlookers to the intercorporate struggles over the allocations of costs, while having our taxes used to underwrite this scandalously inefficient and irrational system, and then getting ripped off through the premiums charged by corporations whose only duty and loyalty is to the maximization of profits.
The right wing has been steadily working to erode the social safety net, a set of institutions intended to limit the ravages of laissez faire capitalism, and founded on the notion that there is legitimacy in the defense of human dignity. The bank “bailout”, the privatization of military and paramilitary functions, this health care “reform” all work towards this reactionary end. The national interest is being redefined to exclude any considerations other than the unbridled empowerment of corporate entities. Neither of the main political parties seems to think that this is a problem, judging by their policies. Within this political universe, the hollowing out of the state as a viable advocate for the broader interests of the citizenry is well advanced and accelerating.
The disparity in wealth and stake-holding and the concomitant political potency between the upper percentiles and the rest of us is widening explosively. The question is, are we to be the frog who is slowly boiled, or not. Well?
Balconesfault
@JerseyJeffersonian:
Well said.
Again, that is my big problem with the bill.
With a public option, the individual mandate is more acceptable, because those subject to the mandate could at least have the option to buy into a government run plan.
Without a public option, the mandate is simply a mandate that they buy insurance from a corporation.
All of this for the progressive lure of increasing subsidies for some working class families – the subsidies, of course being yet another source of taxpayer money being pumped into those large corporations.
Anyone who believes that this will somehow work out as a pathway to a publicly financed system in the future – or even a system of non-profits running insurance – is the type of person who frequents three-card-monte tables.
NobodySpecial
You know, among my various health problems is a simple one: I have sleep apnea.
Well, I’m pretty sure I have sleep apnea. I stop breathing at night. But without a doctor’s diagnosis, I can’t get all the nice gear and meds you need to fight it. To get that diagnosis requires a sleep study that costs a few thousand dollars that I don’t have and won’t be able to get. And that doesn’t get helped under this bill, it just gets worse, because I’ll be forced to pay for a plan that undoubtedly won’t pay for said study without me coming up with that same decent chunk of cash that I couldn’t get the first time.
It doesn’t take a rocket scientist to know that there’s a lot of other people in almost exactly my condition, and the bill’s provisions don’t help them. I could opt out of the insurance if the premium’s too much or I’m too poor, sure – but how does that help me when I need to go to the doctor?
And all the time this apnea is affecting my body more and more, causing real long-term damage.
So yeah, feel free to celebrate when the Senate bill comes out of conference (Because people know that when reconcilation is done, the Senate bill always wins.) I won’t be joining you.
EDIT: And it’s real easy for a lot of commenters to claim victory – they already have insurance. I’m pretty sure Ezra Klein isn’t worried about losing his policy, and Nate Silver the same. But they can go ahead and keep lauding Senators as ‘heroes’ for taking the TREMENDOUSLY BRAVE STEP of giving Joe Lieberman everything he wants. Joe still gets his government paid health care.
Anonymoose
“Basically, unless I am missing something, this is basically the gift of 30 million or more customers at the cost of, well, very little. Maybe Dean is right.”
Well, you said it right there, 30 million more people with health care coverage. Half of those will be on the fucking government run Medicaid program, and they’re the most vulnerable of all people. 15m people get government run health care and we’re talking about killing the bill.
As for controlling costs, for fucks sake people, Medicare (single payer) costs grew at only a couple percentage points less than private insurance costs (I believe 7-8%/year against 9-10%/year recently). Insurers suck ass and it’d be awesome to have a real public option/medicare buy-in but the real problem with costs are the motherfucking inefficient delivery systems… which is a place where the Senate bill brings to mind the idea of “bold, persistent experimentation.” Moreover, the excise tax is the first step to getting the fuck out of our idiotic employment based insurance system.
It’s not a great bill. It might not even be a good bill. But it’s a really fucking good start and we’d be idiots to spurn it. Luckily, it doesn’t look like the Senate is going to pay us any mind- thank god. It’s one of the first times I can recall where I agree with the Senate over grassroots progressives.
Oh, and the next person to bitch about the individual mandate gets my fist through their monitor. The point of the individual mandate is twofold. First, to make sure younger, healthier people buy insurance and increase the risk pool thus lowering the price of insurance for older people who need health care more. Second, to make sure dumbass younguns like me and my peers get coverage so that when we’re hit by a fucking bus we’re not shifting the cost of keeping us on a ventilator onto you, the insurance premium payer. Sure, I want there to be a fucking option outside of for-profit health care plans, which there will be, and I really want a robust public option, which would be sweet but isn’t gonna happen in the short term future.
Goddamn am I mad. We’re the ones with the facts on our side. We don’t have to be fucking irrational. Yet we can’t seem to actually be bothered to learn about a bill that would help millions, be a step towards true, afforable universal coverage, and would begin the process of fixing the fee for service freakshow that is the primary driver towards our national bankruptcy.
Ruckus
Wow three late night rants within a half hour. And all of them I agree with. My pollyanna side says something is better than nothing. My realistic side says this feels like a dry fuck. With a very large….
It’s still early in the deliberation process according to that pollyanna asshole on my shoulder and things will get better in a while. I hope.
That realist butthead says that we’ve lost every battle along the way. That the bill started out at the minimum needed and has lost ground at every step. And I don’t see anything getting added back in or that being acceptable to joe asswipe if it did. So unless enough someones in the senate get on board, and I don’t see that happening, I have to agree with mclaren @286, JerseyJeffersonian @291 and nobody special @293
So who we voting for? pollyanna? or the realist?
mclaren
JerseyJeffersonian remarked:
FlipYrWhig
@Notorious P.A.T.:
Say it loud, I’m wonk and I’m proud.
Only I still want to flip around the “operative” business, because IMHO what we’re seeing is a lot of posturing, a lot of using big talk and shopworn radical-envy sloganeering to _act_ like operatives, because operatives are pure of heart and virtuous of, um, bone, or something.
Like this:
@JerseyJeffersonian:
OK, dude, let’s say, no, the frog who is slowly boiled is not to be us, for we are masters of our own fates and captains of our own souls and we need not sit by idly while malefactors of great wealth extend their hegemonic influence of bio-power. How are you going to make that happen? It’s pretty easy to talk like a sophomore who just read the first chapter of _The Wretched of the Earth_ because some cool older guy accidentally left his copy at the indie coffee place, but, you know, there’s that whole “doing” business that presents a tad of difficulty.
Mnemosyne
@FlipYrWhig:
I want that on a t-shirt.
@JerseyJeffersonian:
New paradigm? Not even close. It started when Reagan was elected and has been chugging along ever since. The fact that you’re only just noticing it now that it’s in its final stages doesn’t make it “new,” just more obvious.
Seanly
@J.W. Hamner:
Kevin makes some good points.
Especially important is community rating. The first job I worked in out of school (1990), we originally had community rating with BCBS. Then a year or so in, the insurance reps made a big deal about switching us to a rating pool composed just of the employees. I remember at the time wondering how that would save us money long term. Indeed, the next year there were a couple of heart attacks and one guy’s young daughter got brain cancer. The following year the rates went through the roof and we had to switch insurers.
Citizen Alan
@Mnemosyne:
Okay, I don’t know what kicked off this rant, but let me clarify a few things:
1. There is no universal requirement that all insurance disputes have to be arbitrated. It depends on what the insurance agreement calls for — some agreements have them, some don’t. Personally, I think arbitration clauses not expressly bargained for should be void on public policy grounds, and there are several pending bills that would do that but they don’t get any media coverage because they aren’t sexy like universal health care.
2. To my knowledge, nothing has been proposed in any pending health care bill that would eliminate an insurance company’s right to arbitrate claims or which would guarantee your right to a trial (federal or otherwise). When I referred to bringing federal claims, I was drawing on my own experience dealing with ERISA claims, another area where Democrats tried nobly to help people by regulating insurance companies only to screw the pooch every way they could.
If the insurance agreement calls for arbitration, you will still have to arbitrate the insurance company’s claim that you fraudulently induced them to insure you. If it does not, you will instead have to sue them in federal court (where it’s more expensive) and you will never be able to collect more than the original denied claim would have paid.
In short, my original point still stands: NOTHING in this bill will actually do anything to help people who have been denied coverage because of preexisting conditions because the insurance company will simply claim fraud and 99% of wrongful denial suits will simply be too expensive to ever bring, whether in court or in arbitration.
Jack
It should also be noted that the current legislation does nothing to untangle ERISA.
Fire away, lesser-evilists.
Mnemosyne
@Citizen Alan:
Good luck finding a policy that doesn’t include one these days. It’s like finding one of those mythical credit cards that don’t arbitrarily hike your rates whenever they feel like it. For all practical purposes, all health insurance policies require you to go to arbitration.
My question to you was: What makes it different than the status quo? You presented the information as though this was something brand-new and different that would be created by this bill, not an existing problem that would not be solved by the bill.
If you want to complain that the bill doesn’t fix an existing problem then say that. Don’t present a scary, scary scenario that people are already living through every day as something brand-new that’s created by the bill.
JerseyJeffersonian
Mnemosyne@297
No. In the Reagan era recension, the battle cry was merely to get the government and its regulations off of the back of the creative forces of the marketplace, and to lower taxes.
Now, although the public rap is substantially the same, the highly successful tactics of the Military Industrial Complex have been embraced by a far larger segment of the megacorporations; i.e., maintain a status as private and/or public corporation (with all of the impunity that they enjoy), but enlist the offices of the Congress and the Executive to tap directly into the public fisc. The principal tools they utilize to this end are the inducement of campaign donations, and the refined application of the revolving door between government and corporation. These tactics are employed variably, depending on the target audience in which the desired pliancy is to be induced: 1) Campaign donations and favors such as travel on corporate jets during electioneering for elected officials; and 2) The glittering promise of money beyond their wildest dreams for “helpful” bureaucrats and regulators when they ultimately earn their passage through the revolving door. This tactic has achieved its highest exponation in the defense industry, where the strident clamoring of military brass for new weapons systems, regardless of the costs, and sometimes even the very utility of these systems, is later rewarded by cushy jobs in the very corporations whose interests they forwarded. And the “old boy” network makes their employment continually useful, since they can work on their former military compatriots for future favors, holding out the prospect of big things to come for their old buddies should they be good team players. Corporate types also periodically migrate into the civilian side of the Defense Department for a while, with all of the expected back scratching and influence peddling among the military command structure that you would anticipate. This same sort of thing is increasingly going on in other areas where corporate interests would be served not only by “old school” deregulation, but also by the “new school” assisted access to tax revenues. Can you say Goldman Sachs? How about Archer Daniels Midland? Include in this group the Health/Pharma Industrial Complex. And a crisis can be a Golden Opportunity to tap the citizenry’s neck vein; bring ’em on!
A more sophisticated scam than heretofore for many of these corporations. They have begun to adopt the perspective of extractive industries such as mining; they take way more than they give, and in our deindustrializing economy, their leverage is enhanced. Welcome to the Third World. You may now kiss the ring, peasant. Show some respect to the new Boyars. If the Czar is weak, so much the better.
FlipYrWhig
@JerseyJeffersonian: Yes, right, corporations suck. Now what? In terms of actions, what next? Tell us. What comes after the blaming stage and the high-flying rhetorical puffery? It’s kinda important.
Martin
@FlipYrWhig:
I think getting Lieberman raped by a hippo and then breaking out the foam finger and declaring victory on health reform.
Substitute Lieberman/health reform with Geithner/Wall Street and repeat.
JerseyJeffersonian
FlipYrWhig @296
Pretty weak tea there, ace. What little froggie fails to understand is the dire circumstances of his situation. This deficiency leads inevitably to frog au jus.
What do you think that the Committees of Correspondence in the 18th century American colonies were about? The pooling of information and the insights that this afforded gave their inchoate discomfort and discontent needed delineation. They began to understand how they were being comprehensively held down by the exploitative, mercantilist colonial system of their time. DFHs of their day, they were, but all of this thinking and shit got some balls rolling.
I don’t know, but today’s blogs can perform much the same function, with the added advantages of wide reach and the enhanced ability to quickly develop information.
So you think that really comprehending and highlighting the implications, both individually and societally, of the decimation of the middle class is some sort of pants-pissing over-dramatization? Really? No my friend, the republic is in deep, deep trouble, and last I looked, if it’s going down, we’re going along with it. The economic model is on life support. Our governance structures are not proving themselves to be up to the task of comprehending either the present or the coming realities. The population has largely lost its sense of citizenship, having fallen for the craptastic line that we’re no longer agents in our own lives or communities, just consumers (how I hate that word).
I guess if you really don’t comprehend what time it is, the sentences you quoted do seem affected. Well, forgive me, but I think that we can do a fuck sight better than your mocking tone of disaffected ennui. There’s a lot of different ways to love your country, and to give voice to your apprehensions for its future, and for the future of the people that you care about. As to what I’m “doing”, I’m trying to live my life – as a citizen – in accordance with my principles, and gleaning wisdom from whatever quarter in which I may find it, and sharing my own perspectives, for whatever value may attach. Even though they may fall under the gaze of some patronizing, sententious boor. Dude.
FlipYrWhig
@JerseyJeffersonian: So, in other words, you’re going to keep on masturbating–oh, I’m sorry, “indulging in the delights of Onania.” And talking in a voice that’s pure Colonial Williamsburg. That’s a fun place to spend an afternoon. But buying a replica tricorn hat doesn’t actually make you a revolutionary.
Balconesfault
@FlipYrWhig:
You fight legislation that is primarily a cash cow for big insurance, that reinforces the Reagan ideal that government can’t run anything – all functions must be outsourced to for-profit businesses.
You deny Dems a blanket to cover their screw-up here.
And you deny Republicans a kudgel that they’ll use to bash Dems with repeatedly in the future as the Dem Party becomes the party of an unpopular public mandate.
Yes, the Republicans will be crowing about their success if this fails. Dems should be out there every day talking about what Republican success meant was blocking a public option. Period.
FlipYrWhig
@Balconesfault:
I appreciate your response. I just don’t think it’s such a clear political winner. I know the polls for the public option are still favorable, but I think that Republicans would just keep saying, “I stood up to my opponent’s government-run health care scheme” and “I think government shouldn’t be in the insurance business” until a big chunk of the polling support erodes. One thing that I was personally frustrated by but slowly began to understand (I think) in the debate over the public option: by treating the public option as just one possible means to an end (more competition, cost control, etc.), the Democrats made it so that Republicans actually had a harder time concentrating their fire on only one vulnerable part of the bill. In other words, I think that some of what the activist wing felt was undue evasiveness about Obama’s support for the public option has contributed to the continued _popularity_ of the public option — because the Republicans haven’t been able to go Full Metal Stupid on it by hammering it 24/7.
(I hate the way that “government-run” became a slogan that worked on the squishiest Democrats like Landrieu and Lincoln; I would love to counterprogram and have a bunch of leading Democrats talk about how government involvement can be A Good Thing. But I don’t really think enough of them believe it.)
PartyLikeIts1990
JerseyJeff is right. What we extremist we’re-fucked DFHs are trying to do is convince the rest of you, because you already share our goals and hopes and desires for this country. Once we can all agree on what exactly is being done to us, we can start talking about what to do about it. Right now we just want you to look around and see it, and stop pinning your hopes on people who are actually part of what’s being done.
PartyLikeIts1990
Look at it this way — we’re in a prison cell.
You guys: “The NICE guard gives us extra bread if we keep him happy! Let’s do what HE says and maybe we’ll get an extra blanket someday too. Otherwise they might put the BAD guard on this block — that guy gives us the hose. What, you want the hose?!?”
JerseyJeff: “Fuck both of those guards. We’re in a prison cell. You wanna help me figure out where to find a spoon so we can start digging?”