Something huge happened today. The kind of thing that changes the nature of the economy, and Americans’ relationship with their government, and with the corporations that seem to rule so much of our world.
Today is the day that a significant part of the Affordable Care Act took effect. Today is the day that companies that sell and provide health insurance have to start spending 80% to 85% of their income from insurance premiums actually delivering the services for which they charge their customers. Overhead like office space and supplies, marketing expenses, salaries, and yes, profits have to come out of the remaining 15-20%. The rule is called the the medical loss ratio, and in an important decision recently by the Department of Health and Human Services, the insurance companies cannot count the sales commissions that they give out to the people who sell you your insurance plan against the medical loss ratio.
The MLR can ONLY be allowed expenses, which must be actual costs of coverable medical expenses. This is huge. This means no more nonsense like refusing your mother’s cancer treatment because she forgot about that prescription skin cream she had for acne when she was fifteen when she was filling out the application. Hell, the insurance companies are going to be scrambling to pay for coverable things because any part of that 80-85% they don’t spend on allowables will have to be refunded to the policy holders.
Simply put, this is the end of the beginning of the long track to single payer health care.
So, can private health insurance companies manage to make a profit when they actually have to spend premium receipts taking care of their customers’ health needs as promised? Not a chance-and they know it. Indeed, we are already seeing the parent companies who own these insurance operations fleeing into other types of investments. They know what we should all know – we are now on an inescapable path to a single-payer system for most Americans and thank goodness for it.
Let us realize the arc of the moral universe is long but it bends toward justice — Martin Luther King
That person doesn’t know how business works.
I am a fervent soonergrunt fan and want to see him soar with the eagles so I need to say…
While it is true that the MLR rules are huge and will propel change it is not true that the MLR will reduce denial of care problems in commercial health insurance. In fact, in the short term, it may make the problem worse.
I agree with the overall thrust of the post and, I say…
Lone live sonnergrunt
As much as I would like to see a single payor system, I think you are vastly overreaching in your argument. There are many models for the delivery of healthcare around the world that have competing non-profit insurance entities competing in a functional and efficient market delivering quality care at half the cost of our system without going full NHS.
Make no mistake, requiring a reasonable Medical Loas Ratio is a HUGE step for our country. It just doesn’t lead inevitably to single payor.
The for-profits like Cigna are going to have a problem with it. The putative non-profits like BCBS of NC will do just fine. Their executive compensation is merely bloated, not obscene, they have so much market share in the states their in that they can rein in marketing costs if they need to–especially once the for-profits exit the market. Most of them are already at or below that ratio.
MLR is huge, but is not the death knell for health insurers. That can only be done by the Supreme Court. (If they strike down the mandate while leaving the community rating mandate intact.)
My mantra is “Medicare for All.” People can enroll in Meidcare at any age— or they can buy commerical insurance. Choice!
Traditional Medicare would crush all the private market like a bug and the VSP’s know it.
This Is FDL bait if I’ve ever seen it.
KILL THE BILL forevar!!!!
Cool. Thanks for letting us know.
Good post. We hear a lot about the ACA, but not enough about the impact it will have. Thanks.
@Wag: You’re pre-supposing that American health insurance companies could ever be as efficient as those elsewhere. Still believe in American exceptionalism?
Our health insurance companies are a total joke – just look at Medicare Advantage – and they will not adjust.
@taylormattd: So even if FDL isn’t mentioned at all every post here is now considered hippie punching?
I can understand why it’s such a popular hobby.
My opinion has always been very similar — the ACA is designed to slowly transition us back to (at a minimum) non-profit healthcare insurance as for-profit providers find that they can’t make the massive profits they used to and start looking for new avenues of business. With a few more pieces of legislation, it would be very easy to take us over to a single-payer system.
But, of course, we can’t possibly slowly transition our system to a non-profit or single-payer one — we’re exceptional! We can do what no other country has ever done and revamp the entire system with a single bill, and if we didn’t, then any transitional bill is FAIL!
Ahem. Just trying to get in ahead of the trolls.
IIRC health insurance companies in the Netherlands and Switzerland have to run their basic government-mandated insurance packages off a 95% MLR. I can’t see American health insurance companies do that. I mean won’t someone think of the
leeching CEOsjob creators?
I am clueless on this, is this a herd thing? ie does it mean that the insurance companies collect X in premiums per year and have to spend 85% of that on medical expenses and if not the balance they have to send pro rata to each premium payer? Or in my case I (or my boss in my case) pays $12,000 a year on my health insurance and for the past say ten years has paid nothing out in claims (cause I refuse to go to an American bloodsucking doctor) do they have to repay my boss his premiums? Help an idiot out here.
@arguingwithsignposts: That’s a quote for the Forbes article on the MLR – they know a little bit about business
GOD, I wish.
PJMedia’s review after HCR passed was that everyone knew this was just a Trojan Horse for a public health insurance option was in turn was just a Trojan Horse for single payer which was a Trojan Horse for an American NHS, or something like that… To which I say, one can only hope.
God forbid this country someday actually have a health care system that’s actually cheap and doesn’t leave people behind.
Medicare Advantage was specifically written to be a cash cow for the private insurers. It was not a reform in any way, shape, or form, unless you actually thought the Republicans were telling the truth when they pushed it through.
Universal healthcare via national health insurance could be much more easily implemented here than trying to set up a British-style NHS model.
I think it’s a herd thing, but your boss will probably still benefit because no for-profit insurer is using 85% of their income for health coverage.
J. Michael Neal
@Litlebritdifrnt: No. They are talking in aggregate, not each individual policy holder. If, in aggregate they do not meet the spending requirement, they send back a check for the difference split among everyone they collected premiums from. It means that they overcharged you for the *risk* that you would rack up large medical bills; the amount of the actual bills you racked up is irrelevant to the question of risk.
and J. Michael – thanks, makes it more clear now.
Yes, but our current system is rife with for-profit leaches. The single payer model is the most efficient model
Actually, what this means is insurance companies, rather than returning premiums or reducing overhead costs to comply with mandatory loss ratios, will start taking kickbacks from doctors for overpaying them. At a ratio of 75% they’ll hand out extra to unscrupulous doctors, improving their loss ratio, and taking back half of the extra in a kickback. Doctors and insurers win, while the insured get screwed.
It’s not as though there’s sufficient regulatory oversight in place to stop this from happening. It’s inevitable.
Mark, Medicare Advantage might be an example of successful regulation. We don’t know yet.
What the ACA did was restructure the regs to (graduall) eliminate the subsidy that was going to the private plans (13%).
So they have to compete on an equal footing w/ the public plan.
They screamed bloody murder that it would put them out of business, but, you know, they do that. That seems to be the model. Threaten people that they’re going to DIE unless we meet their demands.
Anyway, we’ll see if they can actually compete with the public plan, which was supposedly the whole point of letting them in.
The ACA re-regulated Medicare Advantage.
That’s where the 500 billion over ten years came from.
[email protected]MikeJ: I’m sorry, is it now verboten to point out, in the context of a post about the Affordable Care Act, that a large swath of allegedly “progressive” bloggers literally allied themselves with wingnuts and started a campaign to “kill the bill”?
While private insurance amounts to an unnecessary middleman that bloats costs they bloat costs at the same rate year after year. They simply cannot be driving cost increases (what their premiums do is largely reflect the cost increases passed on to them from doctors and hospitals). What drives costs, however, is the supply constraint of doctors in this country that serves to allow them, and healthcare provider such as hospitals (often times doctors and providers are effectively the same) to gouge consumers and, in the process, bankrupt this country.
There are two paths that we can go forward to get medical costs under control – set rates or eliminate the supply constraint that allows doctors and hospitals to charge outrageous sums in a crooked market. Creating a functioning market for doctors in the US we’ll likely take a long, long time fwiw. I actually don’t have a preference between the two but here is how setting costs (already) works in MD:
As I wrote here during the ACA debate demonizing health insurance companies is probably apt and makes for good theatre but it has no chance to adequately address costs. Set rates or eliminate the supply constraint – there isn’t another answer.
And before anyone shouts “but single payer works” – single payer only works because it tells doctors exactly wtf they can charge (ie it sets costs).
@Ailuridae: Agreed. It’s easy to blame an insurance company. It’s hard to know if the hospital padded their bill on your angiogram. So most people just take the easy route and blame their insurer.
When, when, will they resort to holding their breath? I dream of the day.
My doctor says he dreams of single payer so he won’t have to spend so much time dealing with 1000 different sets of rules, he said often he spends more time doing that than seeing the patient.
Alliriude, I think they’re going to expand licensing at the state level, because they don’t have any choice.
Not more physicians.
Expand what allied professions are licensced to do.
CA is moving in that direction.
I think it was inevitable. They had to do something, and states are in the better position to legislate licensing.
IANAW (I am not a wonk) but it seems to me that this MLR provision will shift the burden of developing cost and delivery efficiencies from the government and onto private for-profit insurers. Since they are in the business of dealing with providers, they should have some sense of how innovations and better outcome-based services might allow them to stay in business. Health insurance in general, including Medicare, has been a bloated, unchecked joke of a gravy train for too long. I think this is a brilliant way to toss the whole issue into the fat lap of the free market.
@Ailuridae: Booyah! to all that. But I can still hate on insurance companies for a whole bunch of other reasons. So it’s all good.
And I say…..
Kill the Bill Today!
Kill the Bill Tomorrow!
Kill the Bill Forever!
@Mnemosyne: Actually, I remember hearing of one company who did, and they supported the ACA because from their pov it leveled the playing field. (I think it was a comment from someone who worked at the firm.)
Insurance companies are like every other private business that exists to make money. Blaming them is easy, but the problem is us, and our politics, not coming to terms with what happens when you turn over a vital service to the raw capitalists, a vital service that can’t be refused for all sorts of moral hazards. thereby blowing a hole in the swinging tire of supply and demand.
Thinking insurance companies weren’t going to do what every private enterprise does, maximize profit, in the case of life saving health care, a guarantee of customer demand for every citizen sooner of later, is the mark of a foolish society shot through with naivety, and magical thinking. But we have mad soshulists behind every tree, and you wouldn’t want them being your doctor, so on we go, to the bitter end.
I suppose the MLR ratio insurance company rules is the news peg here, but again I remain surprised by the fact that everybody seems to think that insurance companies are driving medical inflation. Get a blog post about the sustainable growth formula so I can bore you to tears with a discussion of reimbursement rates. http://healthblawg.typepad.com/healthblawg/2011/11/mpfs-2012-medicare-physician-fee-schedule-2012-is-finalized.html
Honestly, I don’t think a doctor shortage is the problem. At all. I think the for-profit hospitals that are clogging the market are a much, much bigger problem. A lot of people don’t realize that their non-profit local hospital was taken over by a for-profit chain like Tenet. All they know is that suddenly it’s way more expensive for them to be treated, so they blame the insurance company.
The doctor “shortage” could be fixed with relatively few tweaks, like loan forgiveness for doctors who agree to work in underserved areas for 5-10 years. It’s the fact that every level of our healthcare system expects to make a profit that’s killing us.
G works for a for-profit home infusion company that’s making a tidy profit, but a tidy profit isn’t enough for the executives — you need to see exponential growth year-over-year (I think the current target for his branch is 15% profit) or they start cutting staff so the executive bonuses are big enough. Who cares if patient service suffers?
but – but – PUBLIK OPSHUN.
@Wag: Pretty sure that NHS is a direct provider model (like the VA here), not a single payer model, which as you point out are sometimes not exactly pure single payer, but hybrids (i.e., competition between, public, private, non-profit) like some countries in Europe and I think Japan. But with your overall agreement with soonergrunt that this is an important step forward. I concur.
Doofus, I don’t think “everyone” here thinks insurance companies are driving health care costs.
I think Medicare For All would have been more efficient in the sense that it would have forced us to deal with reality faster, instead of screwing around with the payment mechanism.
I think most people here know that health care costs have to come down. It”s just that for-profit insurers are a painless way to cut costs, for patients and providers, anyway.
I don’t think we’re ready to address the real cost issue, as a country.
People almost had a mass nervous breakdown over the payment mechanism reform. I can’t imagine what would have happened if we had started talking about the actual health care industry.
Mass rioting? :)
As long as there’s a political bonus for hippie punching, you’ll never see single payer in this country. But your
naiveteoptimism is charming.
Dudes. Quit being such downers and celebrate a win.
And tell everyone you can all about it.
“Simply put, this is the end of the beginning of the long track to single payer health care.”
No. There was a chance to do this, since both the popular will was there, AND industrial capital supported it in order to be able to compete with German and Japanese labor (countries whose states pay the cost of HC rather than the compnay) yet Obama still managed to prevent it from happening.
The status quo had to change, and it was done in the least progressive way possible. The mandate, the deals with pharmaceuticals, the flawed long term provisions, the minor pittance fees for pre-existing condition denials, the tax on Union health care, etc.
It’s bizarre how this this some kind of victory. And sad.
The problem is, and will continue to be so long as it lasts, fee for service. Either a universal adoption of the Mayo Clinic model occurs or the cost issues will not go away. MLR may help bring that about, but it would better to have a system that provides considerable incentives for it to happen asap. In the short term watch for opponents of the ACA to claim that MLR is driving insurers out of business thereby reducing competition.
Uh, two of the Big Three automakers were on the verge of bankruptcy and had to be bailed out by the government. Aerospace pretty much doesn’t exist anymore. The big retailers are happy to have their workers go on Medicaid rather than pay for their health insurance. The Chamber of Commerce, which represents most of the large companies in this country, fought reform tooth and nail and is still fighting it to this day, trying to get the Supreme Court to declare that any healthcare reform is unconstitutional.
What “industrial capital” are you picturing as the countervailing pressure to that of the healthcare industry?
Was getting ready to once again, for the eleventy thousanth time, knock down these Zombie lies that never die. You do it with a lot more style and grace than I can muster.
I just get so annoyed at the whole “Businesses were totally behind healthcare reform but Obama blocked it!” It’s so counterfactual that it’s hard to know where to begin, which I think is what people like Spectre count on. S/he can talk loftily about the “industrial capital” that supported reform without ever having to be specific which industries s/he is talking about.
Yes, you are correct that the NHS is a model similar to the VA, more strict than a single payor. For an excellent overview of various health care models from around the world, I strongly recommend T. R. Reid’s book, “The Healing of America” It is a fascinating and honest appraisal of various systems around the world, examining their histories, strengths and weaknesses.
…and yes, as I stated above, having the MLR capped at at least 85% is a huge win. There have been for profit companies with MLR’s of only 60%, spending 40% of their premiums on CEO compensation, excess administration, blocing coverage, etc. At the same time Medicare’s MLR is about 96%, meaning that 96% of money spent by Medicare goes to patient care. The difference is astounding.
The assertion that capping profits of health insurers will materially change the cost of American health care is provably false.
The hard cold fact remains that the ACA does nothing to change the underlying cost increases built into American medical care.
These cost increases result from:
 Fee-for-service operation in which individual medical devicemakers, doctors, hospitals, imaging clinics and blood labs are all encouraged to act as entrepeneurs and charge whatever the traffic will bear. ACA does nothing to rein in the endless cost increases resulting from such a system.
Let’s take a look at specific facts: the cost of a CAT scan in Germany is $350. In America, it ranges from $850 to $3500. Exact same CAT scan, exact same machine. Why the difference? Because it’s fee-for-service with American doctors and hospitals and imaging clinics making as much profit as they possibly can. ACA won’t change that.
Let’s take a look at another cost: the charge for an average doctor’s visit with a general MD. In France, that costs $40. In America, $150. The difference is due to pure greed by American doctors.
The AMA artificially restricts medical school admissions to keep American doctors’ incomes high. Doctors in America makes twice to three times what doctors in Europe make. A general MD in France makes $80,000 — a general MD in America makes $240,000. The ACA does nothing to change this.
 Bribery. The Journal of the AMA recently wrote an op-ed in which it came out and said that doctors should stop taking bribes from drug companies. Such practices are unheard-of in Europe, but standard operating procedure in America. Bribery runs rampant through every level of the American medical system — medical devicemakers bribe hospitals to use their wildly overpriced equipemnt, big pharma bribes doctors to prescibe their insanely overpriced pills, and hospitals sign lock-in agreements in return for “fee considerations” (bribes) with giant health insurers. Bribery everywhere you look. The ACA does nothing to change this.
 The American health care system is fragmented and grossly inefficient…by design. The more inefficient it is, the more money people make. Efficiency in medicine = less profits, so the U.S. medical industrial complex is one of the most inefficient industries in America. Did you know that a nurse straight out of nursing school (only a A.S. degree required) makes $55,000 starting salary in New York state? That’s unsustainable. Top engineers don’t make that much. Those kinds of outrageous outlandish salaries, like the $230,000 made by a typical general MD or the millions of dollars made by specialists like orthopedic surgeons in America, are only possible in a grossly inefficient wildly fragmented health care system. The ACA does nothing to change that.
Naturally, the kooks and cranks and flakes will scream obscenities at me because they can’t stand to hear the truth. Let’s take a look at the hard cold truth about the American medical system. We can see the future of the U.S. medical system by looking at what’s happening right now in Massachusetts, to the system on which the ACA was based.
Masachusetts is in crisis mode. Costs are exploding. The state legislature is in full panic mode, contemplating premium freezes and cost freezes. As everyone know a cost freeze is unworkable in a market economy: take a look at Nixon failed and futile wage-price freeze during the early 70s, a desperately doomed and unsuccessful effort to rein in the skyrocketing inflation resulting from the Vietnam war + the space program without raising taxes to pay for ’em.
The cost of U.S. medicine continues to explode far out of control, and America as a whole is headed for the same destination the imploding Massaschusetts state health system is headed for — total collapse.
@Mnemosyne: Also, it was somehow simultaneously really easy for Obama to do more and yet at the same time every single vote was down the wire. If Industrial Capital was so in favor of the whole thing, why couldn’t they have simply talked Ben Nelson and Mary Landrieu into voting for The Thing We Totally Could Have Had? Is Obama twisting arms _against_ it in this scenario?
@arguingwithsignposts: agreed. they especially don’t know how the insurance business works. historically, most insurors don’t make their big profits from premium income, they make it from the dividends, interest and capital gains from their “required reserves” investments. this is true of all regulated types of insurance, which includes health insurance.
as a result, the new MLR rate of 85%, while annoying, will have little actual effect on overall insurance company profits. the companies will simply reduce their administrative staffs, the people who actually process/pay your claims. it won’t hurt the insurance companies, but it will certainly have a negative impact on your health care provider’s cash flow.
trust me, the CEO’s won’t suffer a loss of salary or bonuses.
Yep. Because, you see, Obama hated health insurance reform from the very beginning, which is why he made it a centerpiece of his campaign. So he basically spent all of his time trying to kill healthcare reform while going around in public claiming to want it to pass.
It all makes perfect sense as long as you start from the assumption that Obama = Bush and go from there.
You know, I looked up the word “truth” just to make sure about this, and I did not see it listed as a synonym for “opinion.”
I don’t think that the general public has any idea about the level of warfare that occurs between health care providers and the insurance industry. When I was in private practice, my overhead ran 68% of my billings, meaning that I worked for the first 250 days each year to pay overhead before I brought home any money for myself. A huge chunk of that money was to pay for our back office that spent all day every day filing claims and fighting for payment. We had 26 doctors, mostly primary care, in our group, and had 15 people processing claims.
Medicare made up about 20% of our business. We needed only 1 of those 15 employees to process medicare claims. The rest processed private insurance claims. If we want to save money in the long run, we need to stop the insanity that is medical administration costs. If everything ran as effectively medicare, we would save premeds amounts of money.
@Wag: So why is it the AMA has always opposed national health insurance?
They famously hired Reagan as their spokesperson in the early 60s to red bait against Medicare.
1) The automakers are the only groups that deal with unionized workers?
2) So what if they were in rough states? The corporate health=/=officer health.
3) Union backing.
4) He could’ve used Pharmaceutical backing, but that was co-opted by the deal he made with them not to inport.
5) He could’ve negotiated farther to the left, instead of starting at a compromise position.
6) He could’ve used the bully pulpit more effectively
7) Why were people, such as feingold, under the impression he didn’t want a public option?
8) In every developed country except ours, a combination of labor and industrial capital have overpowered finance capital. Why not here, with health costs being unsustainable and results so meager? Spoiler alert: Finance had some help.
I wonder which guy the financiers poured all their money into back in ’08. Hmmnmmmmmmmmm
So it’s just my “opinion” that general MDs in America make on average circa $230,000, while general MDs in France make on average circa $80,000, and general MDs in Germany make on average circa $100,000? No, that’s not just my opinion, it’s a documented fact. Check it.
So it’s just my “opinion” that the fee-for-service system produces wildly higher prices in America compared to single-payer systems? No, that’s a documented fact, and it’s been documented in many articles, most notably “McAllen Texas, and the High Cost of Medical Care” in The New Yorker. Check it out.
So it’s just my “opinion” that the Journal of the AMA wrote an article decrying doctors taking bribes from drug companies? No, that’s a documented fact. Here’s an article where you can find many different links to stories detailing the rampant explosion of bribery in the U.S. medical-industrial complex, from doctors taking bribes from big pharma, to hospitals taking bribes from medical devicemakers, to health insurers giving kickbacks to hospitals in order to guarantee that people in that geographical region will only get insured health care from doctors at that particular hospital, or group of hospitals.
Crook Alert!! Drug and Medical Device Companies Are Bribing Our Doctors and Exerting Undue Influence on Research
None of this is “opinion.” It’s documented fact.
We all have a right to our own opinions…but not to our own facts. Out here, in the real world, the facts I have described are well-documented by sources like the Journal of the American Medical Association and the New York Times.
What world do you live in, crackpot?
Here are some more facts about Massachusetts’ health care system:
Health insurance premiums continue to rise under Romneycare
Freeze sought on health insurance rates
And the smoking gun, “Office of Attorney General Martha Coakley – Examination of Health Care Cost Trends and Cost Drivers Pursuant to G.L. c. 118G, § 6½(b), REPORT FOR ANNUAL PUBLIC HEARING UNDER G.L. c. 118G, § 6½, June 22, 2011, EXECUTIVE SUMMARY”
In the 2010 Report, we examined whether the existing health care market has successfully contained health care costs, and found the answer to be an unequivocal ―no.‖ The market players – whether insurers, providers, or the businesses and consumers who pay for health insurance – had not effectively controlled costs, in part, because the prices negotiated between insurers and providers were not designed to encourage or reward provider efficiency. The resulting market dysfunction has threatened the viability of efficient providers, who have lost ground on payment rates while also losing patient volume to higher priced competitors.
Source is a Masschusetts state government pdf available here in its entirety.
Still think this is just my “opinion”…?
I live in the world where the founding fathers gave their lives so you could blow hard.
THAT’S America, buddy!
The Other Chuck
Here’s what I think is the future:
Insurers will lie. They will lie out their asses. They will lie out of every orifice. They will grab that cash with both hands and make a stash, and lie some more. They will commit fraud every single waking moment to pretend they had a MLR meeting the targets, they will juggle the books, they will do whatever it is they do every day, they will lie some more. Did I mention they will lie?
Because there is no penalty for fraud once it reaches the tens of billions. When you commit fraud on that scale, the government actually hands you _more_ money to continue committing it.
I wish you all a speedy transition/journey to universal health care. :)
@Debbie(aussie): We’ll get there. No nation ever has overnight. Except for maybe Germany, but they did invent the idea.
PS you do know it’s already happening in one state right? :)
I didt know about Vermont,good news.
@kay: As I said, I am all for the MLR changes in ACA. The ACA is a very very good bill for what it does. But the cost savings it provides is very minimal. Their are many problems contributing to inflation in the health care sector, but insurance payments are not a big driver. The two pillars of health care inflation are utilization and pricing. CMS just put up their fee schedule for 2012. It cuts reimbursement rates by 27%. But Congress will likely strike that portion down. I doubt there will be a front page post about the sustainable growth formula here, and that is a pretty substantial discussion that I think would be helpful.
@The Other Chuck: How will we be able to tell that from the present?
Mclaren above says a “general doctor” in the US earns $240000 per year.
If by general doctor he means primary care, his facts are stone cold wrong. I have been a primary care physician for 20 years and don’t know anyone making that kind of money. As far as specialist care is concerned, mclaren’s criticisms are on the money. In America we pay our physicians richly to do things (procedures) to patients, and pay poorly for management of conditions like diabetes that require thought and counseling. Until we get our administrative costs under control and change provider pay incentives away from procedures and towards health management our costs will continue to spiral out of control and we wil lag the leaders in health outcomes.
I would again suggest everyone read TR Reid’s book that I linked to above for facts about health care.
Worst metaphor on the internets. and it’s mine. None of you civilized fuckers can have it.
@Spectre: I’ll just ask you directly. Why does the fact that every vote was down to the wire not play any part whatsoever in your analysis? Ben Nelson and Mary Landrieu had to be bought off, remember? Joe Lieberman was a pain throughout. Other DEMOCRATS balked at going further than was finally done. What nefarious cabal made that happen, overpowering even the best efforts of “industrial capital”? Did “industrial capital” run ads or talk strategy to get this thing they totes wanted if not for the unholy alliance of Obama and financiers?
Obama just barely got what he did get. Given that, I’m not sure why there’s this tenacious belief that it was so easy to get more. There really weren’t the votes for the public option, regardless of how smart it is in policy terms. Why? Because conservative Dems didn’t want it and we’re willing to kill the whole thing over it. The end.
@FlipYrWhig: Stupid autocorrect. “were” not “we’re”.
Several years of contracting in health care insurance company IT departments taught me that these companies are so wasteful and inefficient because they have a huge guaranteed cash flow, and most screw-ups work in their favor.
My concern; will this new law mean the gravy train of well-paid but pointless IT project work is coming to an end?
Good post, soonergrunt. I’m developing a bit of respect.