The most important number in health policy is 218-51/60-1-5.
218 votes in the House
51 or 60 votes in the Senate
1 President to sign and implement the bill
5 votes on the Supreme Court to support the bill amidst political and legal challenges.
All of those elements need to be lined up for a major policy change to be embedded into our social-economic-political system.
Since March 23, 2010 major individual market changes have not had that coalition. At times, there are sufficient votes in the House plus a friendly White House and a Supreme Court that would be on board with those changes while the Senate was a vote short (Summer 2017). At other times there would be a supportive signature in the White House and no working Congressional majority in Congress (3/24/2010-1/20/17 and 10/1/17 to present) where both chambers could agree on something for the White House wants to sign.
This logic constraints my thinking.
It also appears to constrain AOC’s thinking:
AOC on likelihood of M4A getting passed: “The worst-case scenario? We compromise deeply and we end up getting a public option. Is that a nightmare? I don’t think so,” she said. (H/t @eschor) https://t.co/nbI4TBkgJI
— Alexandra Jaffe (@ajjaffe) February 13, 2020
When there aren’t huge working majorities, this creates a constraint on massive change.
So I can understand the frustration of someone like TC in a comment to a recent technocratic tinkering post:
This post is exhibit A for why the ACA is a failure. Only the nerds care anymore how if we could only tweak this and incentivize that we might be able to keep all the interests happy and make it work. Not. The rest of us know it’s the kind of cluster-fuck Rube Goldberg contraption you get when you have way too much ‘compromise’ creating a bill that should have been M4A from the start
I agree that an elegant, simple, straightforward solution is referable than a solution that is complex, messy, and counter-intuitive provided that there is an equal chance of actual implementation. But I think that implementation probabilities have to be weighed.
My big question to comments like this is HOW???
How could the Obama Administration keep on board Nelson, Nelson, Baucus, Lieberman, Lincoln, Pryor, Landrieu, Bayh, Conrad, Dorgan and MacCaskill for a bill that completely up-ends the insurance of 70% of their voters?
How could Pelosi wrangle enough votes from Blue Dogs representing a lot of districts well to the right of the median voter for an even more disruptive bill when she was able to get the ACA to pass with 3 spare votes?
HOW?
How does a future Democratic administration get Medicare for All passed when the decisive vote in a reconciliation vote is either Senator Manchin or Senator Sinema?
How does Pelosi wrangle 218 votes to massively upset the status quo biases when again, her median vote is representing a district well to the right of the median voter.
How does this bill survive a Supreme Court challenge?
I have a hard time coming up with positives answers to the HOW? question in 2021 that don’t involve either pictures of multiple Senators with goats or high quality peyote.
This is a significant constraint on my thinking and it limits me to spend most of my effort within a paradigm of what is, and what is a modest displacement of the now.
By nature, I’m an incrementalist. And I have a real hard time seeing how the political stars align for Medicare for All bills to pass and survive challenges in the current political configuration.
218-51/60-1-5 rules my world.
Baud
Worst case is that nothing gets done and we lose our credibility on health care.
I don’t know why people think other people are obligated to negotiate in good faith and compromise.
debbie
@Baud:
She’ll never get BS to compromise even a little bit shallowy.
Chyron HR
If we wanted to listen to the demented assholes who worship Bernie “I was just lying about Medicare for All, you dumb schmucks!” Sanders as their god, we wouldn’t need the pie filter.
OzarkHillbilly
It rules every American’s world. We don’t have to like it but we do have to accept it.
RobertDSC-Mac Mini
So achieving universal coverage could be done by federalizing Medicaid and enrolling everyone who does not have insurance into that, then incrementally increasing the benefits package?
Since red states have refused to expand Medicaid, why not take it out of their hands and enroll everyone that way?
Belafon
@RobertDSC-Mac Mini:
It wasn’t supposed to be in their hands in the first place. It was Roberts that put it there.
Another Scott
I’m on the same team.
I think the main argument for maximalist positions here, and in other areas of politics, is that voters (and people we want to be voters) supposedly don’t get enthusiastic about incremental progress. A chicken in every pot, and all that. So candidates promise a lot, get elected, find (or already know) that anything more than incremental progress is really, really hard. Opponents argue – Mayhew didn’t get it done! Elect me and I will!!!!1 Rinse and repeat.
Maybe voters are more sophisticated these days, I dunno. Too many still ignore or tut-tut reality (what Donnie is actually doing) and are fearful of explicitly advocated changes (like making the PPACA better).
There are a bunch of stupid things in our insurance/health care systems. It never would have been designed that way from the start. But it is what it is, and any change in the near term is going to be adjustments to it and not throwing it out.
But, electing people who understand how broken it is and how much it needs to be changed increases the chance that they will try to make it better.
Thanks.
Cheers,
Scott.
David Anderson
I get suspicious of maximal demands in order to move the Overton window approaches as opponents or plausible convertible supporters might hear a maximal demand and end the conversation versus moving their preferred positions.
Baud
@David Anderson:
Agree. If I offer Jeff Bezos $10 for that fancy new Beverly Hills mansion he just bought, that doesn’t mean I’m going to get it for a steal because I forced him to negotiate from a position of strength.
Jerry
Hey David, what was it that you said a year or so ago about powerful moneyed interests getting in the way of us having nice things?
PenAndKey
@OzarkHillbilly: Oh, I’m beyond “not liking it”. If I had a CRS score high enough to move my family to Canada I’d have already left. Since I doubt that will ever happen, I’ve had to take solace in guiding my kids into making the smart choice and getting into a college outside of the country and staying there once they graduate. I have absolutely no confidence that this problem will be fixed before I die from poorly managed hypertension and cholesterol issues that I had to pretend didn’t exist for years because I couldn’t afford treatment, and because my insurance through work was so bad I couldn’t afford to get checked.
This might just be about vote numbers, but the status quo is quite literally killing us. I see the value in the technocratic discussions on health care but given that I am good friends with people in other countries that don’t have these issues all I can usually do is leave the wonk debates to you all and check out of the discussion. Most of my solution proposals would likely end up putting me on a watchlist or two.
David Anderson
@Jerry: Hookers and blow matter
rp
When I was in law school we had to do a negotiation exercise and were broken into teams. Everyone on my team said “let’s ask for $50 billion (or whatever) and the other side will have to meet us the middle!” I looked at them like they were insane. And some of these people were much better students and some of the smartest people I’ve ever met.
Hortense
The other key moment in this history is the extreme backlash when a lot of the Democrats that Speaker Pelosi had persuaded to get on board lost their seats in the next election.
They did the right thing and their constituents – many of whom eventually came to love their new health care rights – voted them out of office.
Which is why AOC and other idealists really irritate me. She is in a very safe seat and can afford to propose unrealistic solutions that will never see the light of day.
lashonharangue
@David Anderson: I would have much preferred if Democrats had switched to policy proposals that incrementally addressed health care costs after ACA, rather than arguing about M4A.
For example, aggressive antitrust enforcement; federalized drug development for all high cost low incident diseases; expended scope of practice for NPs.
Not only would they be good on their own terms, but it would have helped shift the conversation to about why our costs are so high compared to other countries. Both incremental and helps change the terms of the debate.
OzarkHillbilly
So am I, and most of my solutions boil down to “Kill the rich.” but that ain’t happening so I have to accept it whether I like it or not.
Chyron HR
I’m just amazed that for four goddamn years these lunatics have been screaming that anything less than Medicare for All is literal MURDER, and now that there’s a risk of Bernie actually becoming president, suddenly it’s just a campaign promise! You’re not supposed to take it literally! But don’t stop sending us those $27 checks, kids!
Goku (aka Amerikan Baka)
@OzarkHillbilly:
Never say never. Who knows what will happen within the next 10-20 years?
Steeplejack
@Chyron HR:
That’s it in a nutshell. I hope Baud sees this. It distills the conversation downstairs. (Immediately preceding thread for special-needs reader J R in WV.)
OzarkHillbilly
@Goku (aka Amerikan Baka): A man can dream, can’t he?
r€nato
Every time I am reminded of the colossal clusterfuck that is the US healthcare exploitation system, I am deeply grateful that I have citizenship in an EU nation that has one of the healthiest populations and one of the longest lifespans of its people in the world and an exceptional socialized medicine system. I will live there one day in the medium-term future and never have to worry about Republicunts stealing my Medicare nor losing everything to a bout with a serious disease like cancer.
Over the last few months I’ve attended public policy-related focus groups discussing issues related to the current election cycle. Generally the people who participate in these groups are middle-of-the-road voters with left or right leanings. Many of them – even the more conservative ones – recognize that the US healthcare exploitation system is colossally fucked up. But too many of them won’t vote for Sanders or Warren because they are “socialists”. Apparently these misguided souls are simply wishing for a kinder, gentler form of healthcare exploitation
The answers are simple, according to me, but getting there is exceptionally difficult in the current paradigm. Either eliminate the health insurance middleman or adopt the Swiss model. Employers currently pay a significant amount of money to provide health insurance to their employees; levy a payroll tax that amounts to a significant portion of that amount to pay for a public option or a socialized system or M4A and mandate that some of the remaining amount be kicked back to employees. Phase in a similar tax on employers that do not provide health insurance or provide shitty, inadequate plans. Have the government negotiate drug prices and in some cases such as insulin, the government manufactures the drug itself and gives it away at cost or free.
Uncle Cosmo
@Baud: In my late 20s I saw for sale a large Baltimore row house in easy walking distance of JHU’s Homewood campus. The building had been subdivided into 3 apartments & when I realized I could live in the largest & pay the mortgage from the rent on the other two, I decided to put in an offer.
One of my former friends, a college classmate who’d gone into
slumlordingreal estate, advised me out of his accumulated whizzdumb not to offer full price: Lowball him & he’ll meet you halfway. So I did – and never heard a single word back. Had I proposed full price, I would now in all likelihood be several hundred thousand dollars to the good. (NB former friend…)Eunicecycle
@Hortense: My congressman lost his election over it. He was a freshman Democrat that won a seat held by a 18 term Republican who retired.
Bruce K
“Should have been M4A from the start?” How would the US have achieved M4A in the 2009-2016 period except at gunpoint, which is the province of Republicans, not Democrats?
r€nato
@Uncle Cosmo: that’s very unfortunate. Sometimes a deal is so good you just take it as is before the other party changes their mind or gets a better offer. Your former friend actually kind of sucks at negotiating.
Xavier
Even if you’re not an incrementalist, slow change is prudent. Instead of ripping things out by the roots, slowly train growth in a new direction. But you also need a long term plan.
p.a.
I understand the political climate and constraints. What I don’t understand is the argument from those ostensibly on the side of ‘adequate coverage for all’ side of the political spectrum making ‘it’s unaffordable’ arguments when every Western country has better coverage. Lack of imagination? Frauds?
p.a.
@Xavier: And long term political dominance.
PenAndKey
One of the largest barriers to people in this country working for small businesses or starting their own business is lack of anything approaching affordable care outside of working for a large corporation. I would argue that this is by design, because just like union busting and the proliferation of non-compete contracts it’s just one more chain around employees to prevent them from leaving bad conditions and low pay.
kindness
Anyone who says the ACA is a failure is an idiot. Sure, it needs to be improved. But it is way better than what we had before it which was nothing.
Mnemosyne
@Belafon:
This. PPACA was designed to get everyone into either Medicaid or heavily subsidized insurance, and Roberts ripped the heart out of it by deciding it shouldn’t be mandatory for the states to expand Medicaid.
If he hadn’t done that, we would be MUCH further down the road towards universal coverage right now.
The problem was not with PPACA as written. The problem is that the Republicans deliberately sabotaged it. But that’s all Obama’s fault because he, like, didn’t want it bad enough or something. ?
lee
I work for a mid-sized company that is a subsidiary of a multinational foreign company. I’m in IT and I tend to work with HR a lot on various projects.
If we suddenly had a public option I’m pretty sure that the policy would become ‘sign up for the public option, we will just offer supplemental’. Heath insurance costs are brutal for companies our size.
There are talks of trying to put all of the subsidiaries onto one gigantic policy. The problem is we are spread across the Americas.
Mnemosyne
Also, fixing this going forward is going to be MUCH harder because Trump has packed the courts with his idealogues. Thanks again, Jill Stein voters! So happy that you’re going to be screaming at us sensible people for years to come because your vote was too special to sully with Hillary Clinton’s name.
Kent
Shorter AOC:
OK, we were lying about M4A.
But we are still REALLY telling the truth about Free College for All, Universal Student Loan Forgiveness, Universal Free Childcare, Expanding Social Security, Universal Rent Control, and all our other stuff…….H O N E S T!!!!!
Jinchi
I’m sorry, but this type of thinking is what hobbled the Obama administration throughout his presidency and resulted in half-measures, constant threat of government shutdowns, dabbling with the idea of Simpson-Bowles reforms and the austerity-lite of sequestration funding.
Insisting that Democrats only offer up legislation that will pass the 218-60-1-5 constraints, ensures you start by conceding ground. Then the right-wing simply keeps moving the goalposts rightward. Democrats have to offer a vision for what the world would look like if they had full control. We find out where the 218-60-1-5 limit is by having the fight. Let the public see it play out in reality, make the Republicans actually strip popular measures from bills. Otherwise you wind up in a situation like 2010 and 2014 when Republicans ran on a platform of “protecting Medicare and Social Security” from the dastardly plan offered up by the Democrats.
Chyron HR
@Jinchi:
Problem: The Revolution just admitted Medcare for All was a lie all along.
Solution: Remind everyone that Obama cut social security in a parallel universe.
Mnemosyne
@Jinchi:
Fun fact: did you know that the bill passed by the House included a public option? And do you remember why the Senate bill was passed by the House with no changes instead?
David Anderson
@Jinchi: The problem with your vision is that the 51st or 60th vote or 218th vote is well to the right of the median vote in the Democratic caucus and that marginal vote has a significant amount of autonomy and agency to say “Hell NO, I’m out”
Now if the Dems have 65 seats in the Senate and 290 in the House, then the coordination problem of getting all of the marginal votes in a veto point bloc becomes real and the negoations to buy off a couple of folks gets a whole lot easier with either policy concessions or political conessions. But if you think that most worlds in the next 6 years have Dems topping out at 53 to 55 Senate seats and maybe 240 to 250 House seats, the plausibility space shrinks dramatically
Jinchi
The Simpson-Bowles “National Commission on Fiscal Responsibility and Reform” was literally created by the Obama administration to find ways to cut government spending.
It failed due to public backlash.
It’s worth remembering that fact when we’re all dabbling with the idea of a Bloomberg pitch for the presidency.
David Anderson
@Jinchi: Furthermore, asking for the moon as an opening bid with the expectation that the final bid will be a low earth orbit satellite doing useful and practical stuff assumes that the rest of the agreement coalition really is motivated to get to at least low earth orbit especially if getting to low earth orbit means the biggest employers in their district will declare war on them.
Knowing who your potential coalition is and what their plausible agreement zones may be is usually a better setting for negotiations than setting out a maximal position as the opening bid.
Baud
@Jinchi:
You realize the Commission actually failed on its own terms and never issued a valid report for lack of agreement.
Jinchi
@David Anderson: I have no problem with Democrats hashing out an acceptable plan amongst their liberal moderate and conservative wings. But the (218-50-60-1-5) constraint implies they’re trying to bargain with people who aren’t in the room. We learn where the limit is by having the fight. Let Republicans tell you where their red lines are. Don’t concede them in advance.
Jinchi
@Baud: The commission was literally framed with a Republican view. That debt was an overriding concern that would require sacrifices and pain for the American people (whenever a Democrat is in power). It’s not reassuring when Democratic leaders still list restoring the paygo rule as one of their top priorities.
gene108
From what I gather in other places on the internet is that Bernie’s M4A plan is so awesome that once everyone gets a taste they won’t want anything else.
I think that is overly optimistic view for Bernie’s supporters.
I don’t think people vote on economic issues anymore, if they ever did.
Otherwise Obama would’ve been universally loved for getting us out of the Great Recession, as well as over seeing a period in this country, when high school graduation rates reached record highs and teen pregnancy rates reached record lows.
Richard Guhl
@David Anderson: Not to mention the one+ million middle-class people who work in the health insurance industry and their counterparts filing claims on behalf of providers, people who know how to scream in their representative’s ear.
jl
I don’t think current political constraints should limit what people who understand what good systems look like should ask for. If progressives and liberals limit their asks by current political constraints, nothing will ever happen. If you always have to compromise from a small incremental ask, when powerful interests will oppose everything, the change will be so incremental, that big problems will arise in the future and we will be unprepared for them because the asks have been too incremental, and then compromised down to micro-incremental from there for passage and implementation.
The GOP, insurance industry and corporate health care chains will label every ask the same way. Recently there was an industry ad campaign that swept up every proposal from Biden and Sanders as socialism and radical nonsense that would destroy health care.
David’s ‘How’ question is fine for current legislative proposals, but I think it should not limit what people advocate for in the future. The political landscape can change over time.
Butch
@kindness: If you don’t think it’s a failure you’re not covered under one of its policies.
Mnemosyne
@Jinchi:
Did you read the actual Commission report, or did you only see the PowerPoint presentation that Simpson and Bowles did when they were pissed off that the rest of the commission members wouldn’t let them do cuts?
Richard Guhl
Is the way we pay for health care in the United States an awful kludge that leaves too many people high and dry?
Clearly.
But, for me, the problem with M4A is not just the terrible political constraints of our system, but also the conundrum of making the transition from what we have right now to the world where the government foots the bills.
Specifically, the minute an M4A law is enacted, the present system enters a death spiral. Every employee in the health insurance industry and their counterparts filing claims on behalf of providers will know that their jobs have a termination date.
And how will they respond?
The best will head for the doors, seeking new employment. The rest will face an increased workload and declining morale. Hiring replacements will be a nonstarter. And the situation will only deteriorate.
The result will be a backlog of unpaid claims, which will mean an increasing squeeze on the financial condition of providers. Doctors and hospitals will scream bloody murder.
The bottom line is that complex systems are incredibly fragile. The shock of getting from here to there might be impossible to manage.
Mnemosyne
@Butch:
Even that depends strongly on where you live. People in rural areas or red states get screwed pretty easily. People in more populated areas and in states that are willing to regulate insurance companies get better and less expensive coverage.
All of this is stuff that could have been fixed via legislation if voters hadn’t put the Republicans back in power in 2010.
jl
@Mnemosyne: That is my recollection as well. Simpson and Bowles had an agenda they were pushing, it wasn’t based on anything other than their preconceived notion of how the world should work, most of the rest of the commission wouldn’t go along.
I heard an interview with Simpson shortly afterwards, and his reasoning was basically (paraphrase): The big people spent the social security money as they saw fit, and it’s gone, and the little people have to bear the cost.
Most of the commission didn’t see that as a good analysis. The commission never issued an official recommendation, and Bowles and Simpson went around pretending that it did, and unfortunately, too much of the corporate media bought it, or more cynically, went along with the con because they liked the fraud Simpson and Bowles were running.
ProfDamatu
@jl: I would largely agree with this. Certainly you need to be somewhat realistic in your opening negotiating position, lest the other party just walk away and refuse to negotiate. (Example: A couple decades ago, I listed my old car in the classifieds for $2500, wanting to get $2100 or so but willing to settle for $2k. The dude who showed up in my parents’ driveway offering $1200 and negging the car? Yeah, I told him to buzz off without making a counter-offer.) But since the expectation in a negotiation is give and take, it makes sense to ask for at least a little bit more than you think you’re going to get.
For example, the strict position being advocated in the OP might suggest that because we don’t have 218-60-1-5 for, say, eliminating the subsidy cliff, that shouldn’t even be part of our “improve the ACA” negotiations. I would suggest, on the other hand, that because this isn’t a huge budget-breaker, “eliminate the subsidy cliff” isn’t an outrageous initial position. If the opposition refuses to budge, fine; we’re no worse off than we were before, and it’s not an ask that would likely inspire a rage-quit by the opposition. But we might get a compromise to, say, raise the cliff to 600% FPL or something, which would help hundreds of thousands of people. If our opening position is 600% FPL, likely we get cut back to something considerably less than that.
Tl;dr – Yeah, asking for the moon is generally going to be a non-starter, but I agree that if you never ask for an iota more than you think you can get, very little progress will ever be made.
David Anderson
@Jinchi: The ACA was the 218-60-1-5 compromise with 99.9% Democratic or liberal votes
The bill needed to get votes from Dems in D+29 districts.
The bill needed to get votes from Dems in R+10 or more states and R+6 House districts.
jl
@ProfDamatu: I mostly agree with what you say. For foreseeable future, the ask can’t be too much, or at least you need to signal that a big ask is negotiable. So, I think AOC is correct that asking for M4A, and being happy with a robust and stable public option is a good approach.
I think there is a difference between negotiating legislative policy and selling a car: one party cannot just walk off into oblivion. Both parties are stuck with each other over the long term, and both parties can keep working on getting a strong voter consensus on their side.
If Sanders becomes president, and follows the AOC approach (i personally think he would) then a lot of die-hard progressives will feel betrayed, but that is their problem.
I think, over the long term, the ask does have to be big, very big, relative to the current debate, regardless of whether it is for M4A or improved ACA, because there are big fundamental flaws US health care finance and provision, and only big changes can fix them. There are now over two dozen other countries that do far better in many, most or all respects than the US. There are at least half a dozen approaches that can be adapted to the US. Adapting any of them requires big changes and big asks relative to the current debate. Economists understand how the big flaws in the US cause big problems, both in theory and in history and data.
The minor tinkering can’t go on forever, otherwise the US will go bankrupt over healthcare, or we will continue to have declining or stagnant life expectancy, and ever declining population health. I think that is just an inconvenient fact of life.
Butch
@Mnemosyne: I’m in a rural area and the insured spouse is over 55, so we are totally screwed and have discovered the hard way that the 10 so-called essential health services aren’t necessarily covered because the insurance companies have gamed the system so totally. I’m past retirement age and still working because it’s the only way we can afford the outrageous premium on spouse’s absolutely worthless Bronze policy.
PenAndKey
It’s a hard change and I sympathize with the doctors and claims adjusters, but our system right now is “bloody murder”. The only difference is it’s the patients doing the dying, not the hospitals profit margins.
David ??Merry Christmas?? Koch
I love how AOC and the Bernouts are now wagging their finger, saying, “we never really meant M4A”.
HA!
ProfDamatu
@jl: Yeah, mostly agreed. I was not suggesting that negotiating improvements to the ACA was identical to buying/selling a car; apologies for my crappy writing that led you to take that away from my analogy. That analogy was ONLY intended as an example of what asking too much in your opening position will get you. The actual point of that paragraph was that asking for the moon may be counterproductive, but it makes sense to ask for at least a little more than you think you’re going to get. I should have left out the analogy, considering that it only hid my actual point. :-)
Having said that, I’d say that although the negotiating parties here are stuck with each other, that doesn’t mean that one side can’t essentially walk away from negotiating – I mean, that’s pretty much what the Republicans have done regarding health care (and so much else too); simply refusing to consider any proposal brought forward by the Democrats. Which of course is why we have to get to David’s numbers in the House, Senate, Presidency, and USSC, while hammering out policy among the Democratic caucus.
I agree that eventually fundamental reform to our health system will have to be undertaken; the way things are can’t just go on indefinitely. The ACA acted as something of a pressure valve, but the Republican sabotage unfortunately hamstrung its ability to really start moving the needle towards more fundamental change (because it hasn’t been allowed to work as well as it could have, so there’s less support for major change; too many people think the ACA was a major change that has basically failed). I mean, the plans offered on the Marketplace today are worse in just about every respect than they were 4 years ago, at least in my area, and that trend is only going to continue because of the way the law works, the fact that it was prevented from affecting the health market the way it was intended to (holding down costs, etc.), and the fact that amending it has been impossible.
I hope that at least hearing the big asks will, if nothing else, get people to the point where they no longer sound scary.
Procopius
Really glad to see a post that recognizes that Obama did not have “a majority in both houses” in the sense that he had the super-majority in the Senate that he needed. I find a lot to criticize in what the Obama administration did, but no president before him ever faced such a united opposition.
UncleEbeneezer
Right?!! I guess I just imagined the 4 years of being trashed as a Centrist, Sellout, Insurance Co Hack etc., and all those snake emojis…@David ??Merry Christmas?? Koch:
Richard Guhl
@PenAndKey: It wouldn’t be just the profit margins. If the insurance companies’ workforces get hollowed out, it would mean payments would be fitful, if at all. And then you get mass layoffs, followed by closures of hospitals, and a general collapse of the health care system.
The analogy is what happened to the financial system in 2008 after the collapse of Lehman Brothers.
Jane Menear
I have had a chronic condition most of my life, and I can tell you from experience that our so called health care system fails more frequently than most people would believe. When my father developed Alzheimer’s, my mother said that they treated him so poorly because he was so old. No, I told her, they treated him exactly as they treat everyone; she just had very limited experience with how things worked. And I would venture a guess that that is a problem with many of you healthy people. Though I’m also pretty sure that you think you are responsible for your own good health and besides when you broke your leg playing soccer…blah, blah, blah.
Ok, yes, I am bitter. But insurance employees are so special? Aren’t you from the Pittsburgh area, Anderson? Do you remember the steel industry? Do you remember all those major corporations that USED to have their international headquarters there? Did the destruction of the work force there stop those industries from hollowing out the entire region because the share holders wanted more—employees be damned? Pittsburgh be damned? The country be damned?
Our health care system is too expensive with way too much profit for way too many that contribute way too little to the outcomes for the actual patients, outcomes which are some of the worst in the world but we, the people, just have to put up with it because…John Roberts? This is insane! The ACA is better than what we had before which was nothing. How does that justify it as anything other than just another failure of our so called democratic system? Max Bacchus wouldn’t have voted for even a public option but don’t forget that he got mc4a for a group of his constituents because “they needed it!” before he left for China.
Our health care system is neither a system or health care, and our form of government is illustrated as a failure by your 216-51-60-1-5 premise. And your incrementalism, which you consider so rational, is kiling 30,000-40,000 people every year, bankrupting 500,000 families and limiting the lives of millions of others who cannot get that surgery or devise or therapy or medication that is a known treatment for their diagnosed condition because, and only because, they can’t afford it.