Some weird reactions in the last post about not being able to go back to the drawing board with Health Care reform. I really don’t think that is a really controversial observation- where we are right now, clearly our options are some version of the bill in the Senate, or no bill at all.
Anyone who thinks the House and the Senate are going to just say “to hell with it” and start over from scratch is just smoking rock. How many months did it take for a bill to get out of Baucus’s committee alone. On top of that, we would be treated to another six-eight months of teabaggers throwing things at congressmen, wildly inflated claims on Sarah Palin’s Facebook page and the op-ed pages of the Washington Post (although, in reality, those two things are pretty much one and the same these days), and so on. And then, you have to filter in that all of this would be happening in an election year, and with the notoriously timid Democrats, you have to be sniffing glue to think that the bill is going to be easier pass and more progressive. And then, assuming the House does manage to get it passed, does anyone think Ben Nelson and Joe Lieberman are going to suddenly decide the public option is a good idea? If so, why? Does anyone think that the blue dogs and “moderates” are going to become less of a wholly owned subsidiary of the insurance and pharmaceutical industries?
And then we add the other things in to account. You think the progressive base is pissed now? Well, let’s remember, that HCR has effectively sucked the air out of EVERY other piece of legislation. You want another year dealing with HCR every night, while financial reform, jobs bills, gay rights, and numerous other things simply languish? Are you smoking rock? The administration is already getting flamed because they haven’t ended DOMA by fiat, you think another year of ignoring it trying to re-do HCR reform is going to make things better with the base?
And look, I’m fully aware that many of you say this bill sucks. I have no idea why there are not even any attempts to control the costs, which was one of the two main points of health care reform in the first place, wasn’t it? Control costs, expand coverage. We sorta do the second, but seem to have completely ignored the first. Premiums are still going to go up, only now the insurance companies get to increase premiums and you are required by law to pay them. Way to make generations of young Republicans.
I look at this bill and see very little to cheer about, and I read the blogs that are very in favor of this reform. If I were in the House or Senate, I have no idea how I would vote. I’d probably try to flee the country, but not before kneecapping Nelson, Conrad, Baucus, Lieberman, Landrieu, Lincoln, and whoever decided that 60 votes was required.
So what I am saying is not controversial. It is this bill, or nothing. Take your choice.
*** Update ***
Apparently Kevin Drum already made this point the other day, as others have, I am sure.
bayville
Well put JC.
With that, I’ll take Nothing for 200 Alex.
gwangung
What you’re saying is not controversial.
However, it’s probably not acceptable to a lot of people, unrealistic as that is.
jibeaux
You forgot the third option, smoking rock, though.
You’re right, it’s this or nothing.
But tens of millions of more people insured isn’t anything to cheer about? Kevin Drum and Steve Benen make the point that it’s more progressive than what Howard Dean proposed about five years ago. Isn’t that something to cheer about?
Silver Owl
I’m not too fond of that idea of accepting shit just because the adults of todays are homicidal greedy assholes.
jibeaux
And nothing, it goes without saying, is actually not “nothing”. “Nothing” implies a certain benign neutrality, a simple absence of good or bad, whereas “nothing” in this case is actually a lot worse than that.
Damned at Random
My opinion is pass the damned thing and when health insurance costs continue to accelerate, come back with- “we tried, we gave them 30 million new customers, we gave them everything they wanted, it didn’t work. We need to start from scratch” – then push a single payer system through.
This will, of course, require a Senate majority leader who is willing to pull projects and leadership posts from the non-compliant.
Tokyokie
Nothing. Thanks.
Oh, and committee chairmanships shouldn’t just be taken away from those who obstruct (along with moving their offices to a broom closet in a basement several miles from the Capitol), but those who demonstrate unmistakable incompetency in their chairmanship of key committees should be summarily demoted.
TaosJohn
I continue to disagree, John. The situation is so grave, so terrible for most Americans, that the political pressure to act will be too great to ignore. Passing the steaming pile of dung will actually remove any incentive for improvement, IMO, because all we’ll hear is, “Shut up, we DID that!”
“Pragmatism” = slavery in this instance. We either go whole-hog corporatist or we say, “Hell no!” I say “Hell, NO!” America is better than this. We do it right or we don’t do nothin’.
qwerty42
Agreed. HCR would be off the table in 2010 as other things took over. The notion that anything better will come out with the unaltered opposition of the Republicans and the grandstanding of too many Democrats is kooky. It will be lost for another generation.
Eric U.
I’m not sure I can make myself believe this bill really exists after what I’ve seen. But I always knew that lieberman was going to be a problem as the 60th vote. Too bad our representatives don’t realize how grave the health care situation is for many people. I really think the next decade is going to show that they should have gone with single payer.
Snark Based Reality
Strip mandates and the bill is… tolerable.
With mandates in place you create a government blessed monopoly system that will be more abusive to the working middle class then what we already have. People who work but whose employer doesn’t give them insurance will not be able to afford said insurance over time even with subsidies. Can you really not forsee the insurance companies playing games and raising rates to swallow whatever subsidies are added into the system?
The Public Option was a way to have mandates be viable over time as a cost reduction device. With it gone the mandates do not reduce cost and are a moral disaster.
And the rescission text is laughable. The insurance companies already play the “your claim is fraud” card all the time.
freelancer
C&L is becoming increasingly unhinged on this front. Siding with Dean and calling out Nate Silver with not a little purge-envy of the teabaggers:
http://crooksandliars.com/rj-eskow/why-progressives-would-be-batshit-crazy-l
It’s not Amato, but it is a front pager. I need a nap.
MattF
Pretend, for a moment, that you’re a Republican. You have no principles, you have no interest in policy, per se. The only thing that matters is the headline that shows up at the top of Politico/Drudge in the next half hour. Is there any question that ‘starting over’ is a wet dream come true? Is there any question about how you are going to deal with ‘new’ proposals from the left?
MikeJ
The last attempt was in ’95. 14 years ago. If this doesn’t pass, I’d guess there won’t be another attempt until 2025.
Jim Crozier
Correct me if I’m wrong…
…but didn’t Ezra Klein write a column a couple of months back basically explaining that it doesn’t really matter what bill the Senate passes so long as SOMETHING is passed?
Can’t we fix a lot of the glaring deficiencies in the Senate bill when we reconcile the House and Senate bill together?
blahblahblah
Nothing, then.
TaosJohn
“Tens of millions” more people will NOT be “insured.” They will have to buy shitty policies they can’t afford from companies that don’t give a flying fuck what you think.
There’s a good reason I don’t have health insurance at age 64 and haven’t had any for years. My wife and I can’t afford it. While we had it, it did no goddamned good whatsoever. To compel people to sign up for this dreck is obscene.
Zifnab
YES. The stimulus bill was already a massive compromise between conservative curmudgeons and liberal Keynesians. That bill was about 50/50 on the crap-o-meter.
The current health care bill is skating dangerously close to completely worthless. An insurance mandate with few price controls and massive subsidies funded through tax payer dollars is a BAD IDEA. What regulations are included appear toothless in the extreme. I don’t see this shifting the status quo in a good way.
Given that the two landmark pieces of legislation have been not terrible and approaching crap, in that order, why on earth would we want to see Congress move on? Keep them at the table till they get the damn bill right. Bring on the god damn filibuster.
I don’t want to see what a Liebermanized jobs bill is going to look like. I don’t want to know what Ben Nelson plans to do to a climate bill. And by the time we get to gay rights, I can predict the bill that makes it out of committee will look slightly more liberal than what they’re passing in Uganda.
The administration is getting flamed because they haven’t ended DADT by fiat. DADT is an executive order. Executive orders can be ended by fiat.
DOMA is a long term goal that everyone recognizes will be a massive bolder to move. DADT should have been out the door in the first 100 days, no questions asked.
Rock
I vote nothing. No recission protection and keeping caps on distributions? The mandate simply makes it a huge giveaway to private insurers. It seems worse than the current system. I’m with Dean, except for the starting over part. I realize this is the death-knell for healthcare reform. It’s awful, but the current system is preferable to the “reform”package. So what choice is there? What an utter failure.
mellowjohn
i don’t think anyone likes being smacked in the face by the cold, wet dishcloth of reality.
geg6
I don’t think your point is controversial at all, John.
And based on those choices, I vote fuck this piece of shit bill. Nothing is better than what this bill provides for anyone I know without insurance. And it will create millions of young, shiny, new, pissed off Republicans. I can’t think of anything that will more quickly turn a generation turned on by hope into your worst nightmare of glibertarian/rightwing thugs than taking their money for this piece of crap.
Strandedvandal
I may be way off, probably am in fact, but what is the possibility of passing this thing, just to get it done, and than going back and adding parts through reconciliation? I know they don’t want to ram an entire bill through via reconciliation, but can they amend an existing bill that way?
gwangung
No.
It.
Isn’t.
Why should we take you seriously when you can’t even get a simple thing like that right?
frankdawg81
Nothing
Joe Beese
Faulkner might choose grief over nothing. I’ll take nothing, thanks.
jibeaux
— Makewi, last thread
Is there really more to say than that?
Giant Douche or Turd Sandwich
A vote for nothing here.
Ian
NONSENSE!
If it was sent back to committee, they could send it out with budget reconciliation rules that require 51 votes. Much better bill. I also do not appreciate the suggestion that I have been smoking rock, its been a couple of years since that happened.
gwangung
By the way, why is <A HREF=”http://www.fivethirtyeight.com/2009/12/why-progressives-are-batshit-crazy-to.html”> Nate Silver’s analysis not valid?
jeffreyw
The choice is not between the HCR bill before us now and nothing. The choice is between the HCR bill and the system we have now. The HCR bill wins that hands down.
Jack
@geg6:
2x +500
Comrade Dread
You know, way back when Democrats first started taking over, I said that the only way Republicans would ever get back in power would be when some time had passed and the Democrats screwed up royally and made people think back nostaglically to the days when our congressmen still did cynical giveaways to industry, but they were at least honest about it, damn it.
You guys are seriously going to give us Palin in 2012, aren’t you?
geg6
@Strandedvandal:
The exact same chance that there are pink ponies and shiny unicorns flying out of my butt.
BFR
@TaosJohn:
On the plus side, lots of people will be getting hefty subsidies to buy these policies.
The mandate+subsidies gets dinged a lot by progressives but it basically just means that the country as a whole has decided that health insurance is an obligation. That’s actually a major philosophical change which I think will be the lasting accomplishment here (if it passes).
MP
To any of you who believe mandates with no public option will force you to buy health insurance you can’t afford, can you provide specifics based on what we know about the legislation? A couple of questions to which I haven’t seen answers are:
– What would, for example, a single person earning $30,000 have to pay for insurance?
– Why assume it’s crappy insurance? Are there no regulations stipulating specifically what must be covered? I thought there were different packages – bronze, silver, teal, etc.
I insure myself and my wife individually, and although we’re in good health, my wife has a pre-existing condition that leaves us open to catastrophic (though unlikely) losses. Further, the crappy high deductible insurance we’ve got now means we spend about 10% of our take home pay on healthcare yearly.
From what I understand of what’s under consideration, the bill would help us a good deal, but it seems many others feel as if they’ll be worse off. Does anyone have a good feel for the actual numbers as they would apply to them?
frankdawg81
Pass this bill, with its mandate & public subsidy, & cost will sky rocket & Rs will say “See, we told you health care reform was a costly mistake!” And the liberule media will parrot that bullsh17 like they parrot all the other bullsh17.
It will become common knowledge that government intervention caused higher prices & worse coverage. Just like it is common knowledge that we have the best health care in the world in the US.
Better they pass a bill outlawing health care insurance. That would at least control costs. This bill will make bad worse & the blame will fall on the bill not on the missing pieces.
bemused
At this point, my confidence in the Dems to actually produce something that is a clear health care improvement for americans either way is pretty low but starting all over from scratch scares me more.
Zifnab
@gwangung:
Via Wiki – http://en.wikipedia.org/wiki/Don%27t_ask,_don%27t_tell
Right back atcha
cintibud
We’re scr#wed.
There’s a reason why this is the best that can be passed. It’s because it’s the best that can be past! In what reality does the Wizard give the republicans a heart, the blue dogs a brain and Harry Reid courage?
As was said before, nothing is not just maintaining the status quo, it ensures large democratic losses in future elections as we are bombarded by headlines about the administration’s incompetence, democratic spinelessness and brave repugs who really run the show even when in a “hopeless” minority. Teabaggers will march to the polls while despondent dems stay home in droves. Then we can see what Speaker Boehner, Maj leader McConnell and President Palin have planned for the country. I’m sure they will propose an even more “interesting” HRC – once they get their other agenda items passed, of course.
jibeaux
Guys, there is no anti-rescission, anti-pre-existing coverage, etc. without mandates. This is not complicated. With no mandates, I am happy go lucky healthy young person, or a 64 year old in Taos. I pay for my small medical expenses out of pocket and why send good money after bad paying for a policy I won’t use? Now I am hit by a car that speeds off into the night. I need a couple of different surgeries. Please bring the hospital paperwork to my sickbed and I’ll write you the check for the premium, now fix my damned legs. I think you can probably see the problem with this scenario. Your issue isn’t the mandates per se, unless you think it’s okay for people to go without health care. Your issue may be with the cost of coverage / inadequacies of subsidies, or the lack of cost controls, or possibly just that we cannot have single payer which at this point in time we cannot.
Malron
I agree with you, John. The left is more concerned with ideological purity than political reality. When I hear people saying passing this will create a lot of new young Republicans – well, after I stop laughing at the pure stupidity of the notion – what I really hear is a bunch of lazy whiners who don’t have enough backbone to actually put up a fight to ensure the GOP doesn’t gain ground in 2010.
Pass what we have now, work to elect more progressives in the House and Senate and then improve on the reform bill later.
I’d also suggest people start reading a lot more Booman and a helluva lot less of Jane Hamsher.
One more thing: it still fascinates me that so many responses are based on fear of what the GOP will do. Stockholm Syndrome still runs rampant on the left, I see.
Makewi
I think the logical choice is nothing. As it turns out, it’s also the political choice. I also think you can go back to the drawing board, and by taking the issues in small manageable pieces you could put together something that actually works to solve the issues and doesn’t need to demonize anyone.
Here’s what I said at the end of the last post:
J.W. Hamner
Cost controls are, in fact, the most important and impressive part of this bill. You are being misinformed by progressives who have decided de facto that only way to control costs is by a “robust public option”. This is not the case. A commenter linked to a Ron Browstein piece from a couple of weeks ago last night, and Atul Gawande posted an analysis a couple of days ago at the New Yorker.
There are actually a large number of ideas that are designed to be tested as methods of controlling costs, but are only implemented as pilot programs, or on small scales because we have no idea which ones will work. The CBO doesn’t score them well because of this, but to state that there is “not even any attempts to control the costs” is completely wrong. If even a third of the proposed methods show promise we’ll be in great shape.
kindness
Chalk me up as another unhinged vote for nothing.
Until the mandate to buy a policy is stripped from it, that’s where I am. I supported the mandate when it was sold on the premise that people would be able to buy affordable insurance. That is now gone, so is my desire to see this bill passed.
MikeJ
@Zifnab: 10 U.S.C. § 654 is law. Presidents don’t write law. Congress does. It’s not an executive order.
Wikipedia is not the best place to stop your research.
eemom
Absolutely right, John. There isn’t much about this that is simple, writing on the wall truth, but “it’s this or nothing” is.
And I’ll ask again: how many of you “nothing” voters already HAVE health insurance?
Perhaps more to the point, how many of you know fuck-all about what the bill actually does?
BruceFromOhio
I see that comments from the previous thread are now being restated in this thread.
Meanwhile everyone is ignoring the obvious: it’s the lack of Tunch pictures that is sparking the real controversy.
edmund dantes
Lol. If anyone thinks anything of substance or controversy is going to get done in 2010 during Mid-terms you are fucking smoking crack. So we don’t have to worry about HCR distracting from those, but we also don’t have to worry about HCR getting anywhere if it slips to 2010 either.
There is no way gay rights gets within sniffing distance of Obama’s desk next year. Also no way in 2011 since that will be ramping up for presidential primary season. If you are looking for gay rights to get anywhere you are waiting until 2012 after the Presidential election at minimum.
Jack
It’s not controversial. It’s just not sound logic. Either/or might apply if it’s “either give me your wallet or I shoot you in the face.” But it doesn’t apply to the conditions you describe.
Congress may be filled with proto-fascists, birthers, Birchers, muscled squirrels, imperial imps, triangulators, Clintonites, corporate running dogs and self-aggrandizing Liebermans, but those competing factions do not present an immediate, unresolvable, inevitable, determined either/or.
Especially when the end result of the current process might just be “give me your wallet and I’m gonna shoot you in the face.”
Silver Owl
Wish we all could go to work hand the boss something chitty and say, take it or leave it. LOL!
BruceFromOhio
@edmund dantes:
Maybe that’s why we’re getting all these 8-yr presidencies. You can only really get the legitimate heavy-lifting done in Y-1 and Y-8. Everything in between is campaigning.
eemom
@Malron:
a-fucking-men to that.
Citizen Alan
Option 1: Sink the bill. The status quo will remain unchanged for millions of Americans, thousands of whom will die due to lack of insurance. The Democrats get crushed in 2010 and 2012, and no further health care reform will be possible for decades at least.
Option 2: Pass the bill. Millions of Americans will be enraged to learn that they will be forced to buy overpriced insurance policies which they cannot afford and which provide shitty benefits and, despite all promises to the contrary, still allow for recission in most cases. Millions of other Americans will become covered by insurance for the first time, but it will still be limited to overpriced insurance policies that provide shitty benefits and, despite all promises to the contrary, still allow for recission in most cases, only in this case, the policies are paid for by the taxes of the first group of pissed off Americans. The Democrats get crushed in 2010 and 2012, and no further health care reform will be possible for decades at least.
Passing the bill may save some lives in the short term, at the cost of destroying the Democratic party for a generation, emboldening the worst and most fascistic elements of the resurgent Republican party, and vastly enriching the corporate entities who would otherwise be directly responsible for all those lives that would have been lost.
Oh, and once HCR is dealt with one way or another, we can move on to destroying Social Security, with the path blazed by “Democrats” like Evan Bayh and Diane Feinstein,
kommrade reproductive vigor
John, I’m a little worried that you continue to repress your feelings. Perhaps you should tell us what you really feel.
I kid.
I’ve got full coverage through work, it includes me and the S.O. Despite our spectacularly bad health histories, I pay the same as my co-workers and it’s not a lot. I’ve also NOT had insurance and if you want to feel like an insignificant piece of crap, go to an E.R. in agony and tell them you don’t have insurance. The look they give you, that little “Great, another deadbeat” sigh, that sucks so hard that it blunts the suckitude of getting that giant ass bill. Ain’t no way in hell I can sit here and say no to anything that will keep people from experiencing that.
Woodrow "asim" Jarvis Hill
@Jim Crozier: Exactly. Anyone who actually knows the (admittedly arcane) Congressional process knows we can fix some (not all, and fewer today than a week ago) issues in committee, where there’s less pressure to accommodate Centrist/Right–wing interests (it’s why they’re screaming now, in fact; they know that if this pases in any way, they lose leverage over it’s final form.)
The issue is that that doesn’t sound “sexy”. It’s not a place where people feel they can be involved. It doesn’t sound “democratic”. But it’s how things are done, and I wish to God some Progressives would read some folks know know the process, like the guys over at Booman Tribune, before yelling about what is, and is not, in the bill today; BooMan had a mouthful to say about that today, in fact.
gwangung
@Zifnab:
Dont Ask Don’t Tell was codified by Public Law 103-160 – Nov. 30, 1993 – § 546, 107 Stat. 1670 (1993) (codified at 10 U.S.C. A. § 654).
cleek
right on, JC.
georgia pig
You’re right. I can understand the frustration, but there seems to be a lot of can’t see the forest for the trees going on here. It isn’t as if history ends with the passage of this bill. If the parade of horribles emerges, then we’ll have to deal with those problems. The point is that you’ve codified the entitlement. This would be the first bill that putatively provides universal coverage. That has been an unfulfilled goal since Truman. Of course the mechanics of the bill suck because you had to eat a shit sandwich to get buy in on the bigger concept from folks that are predisposed to be against it because of their constituencies. This is the best you’re going to get with this Congress. You want to wait around for a better Congress? Replace Ben Nelson? Odds on you’ll get a republican. Mary Landrieu? Another republican.
Jack
@Woodrow “asim” Jarvis Hill:
You think there are 50 votes in the Senate for reconciliation?
Skepticat
I cannot begin to express how depressed, discouraged, and dismayed I am over this mess, which is emblematic of every issue facing us. It’s difficult to believe that most of the Democrats have absolutely no stones whatsoever, no matter the gender.
I really disliked the idea of Emanuel as COS, considering him a POS, but thought that perhaps he could be the pit bull and enforcer and Get Things Done. Apparently he did, but what he wanted done doesn’t benefit anyone but himself. Seeing Reid, President Obama, and their ilk roll over as they have is totally infuriating. However, I’ve gone from rage to depressed apathy. (Though every time I see/hear Lieberman the rage reemerges.) Why can’t we have more strong, principled people? Can we clone Franken, Grayson, Dean, and the few others willing to stand up for progressive action?
Perhaps we can chip in on billboards to be placed outside the White House and on Capitol Hill carrying Churchill’s quote: “You have enemies? Good. That means you’ve stood up for something, sometime in your life.”
Ooooooh, an edit function—thank you, JC.
Hunter Gathers
Mandates in House and Senate Bills
Could someone please explain to me how this will create a new generation of Republicans? I’m all ears.
Edit – Blockquote fail.
freelancer
@Joe Beese:
I read that and all I could think was…
Tokyokie
Are the Democrats who are advising that the Senate hold its nose and vote for it, with the hope of improving on it later, thinking this through? They won’t be able to improve on it later because their majority will be summarily swept out of office! Are you telling me that making the working poor pay big bucks for crappy insurance in the middle of a recession is a good idea? That the GOP won’t characterize this as a huge tax increase on the middle class? That voters will be thankful and will be out knocking on doors for Democratic candidates as a result? Once back in control of Congress (by 2012 at the latest), the GOP will gut whatever subsidies are left in the measure, and by 2013, the situation will be significantly worse than it is now. They want to filibuster a good bill? Then make the bastards do it. Bring a good bill to the floor, and let Lieberman and Nelson and the entire GOP literally piss in their britches to try to stop it.
Olly McPherson
@Malron:
Yeah, because the GOP hasn’t had any influence on health care reform to date.
Also, don’t you think people will get tired of condescendingly being told they need to “fight like hell” cycle after cycle with negligible real-world results? It’s like Lucy and the football.
Citizen Alan
Oh, and another thing: all this debate about the utility of the universal mandate ignores one little detail — whether it passes constitutional muster. And while I generally favor an expansive view of the Commerce Clause, there really is no precedent in American history for Congress to pass a law requiring every adult citizen to purchase a product from a private entity. As a big-government Liberal, I’m not sure how I feel about the civil liberties implications of that. I can’t imagine the five conservatives on the SC going along with it.
Captain Goto
@Citizen Alan: This.
The Democrats are fucked for a generation. And all of us sorry-assed progressives along with them.
edmund dantes
To all those crying wait for the conference, we’ll know if the jig is up by who gets appointed to the Conference committee to reconcile the bills or if they try to ping pong it.
If we start to hear rumblings from Dem insiders that they need to ping pong it, we know this has always been about getting whatever bill possible and not fighting for the best bill possible.
MattMinus
Gee, how would the Dem imposed choice of buying horrible insurance or facing fines help the republicans? I just can’t figure it out.
I, for one, welcome our new Alaskan overlord.
gwangung
Are you sure about that?
Progressives would sweep them out, but how about more moderate elements? Last I heard about polling, the more moderate elements found this plan acceptable, though not compelling.
Woodrow "asim" Jarvis Hill
@Jack: What does that have to do with what I posted? Are you thinking Conference = Reconciliation? I’m confused.
Meyer
Nothing, then.
You pass this bill, costs go up (see: Massachusetts – small businesses took a 40% hike this year), people are mandated to buy in, they pull out the pitchforks for real, and you’ve done everyone a HUGE disservice in the meanwhile.
Do nothing, make it clear who obstructed, maybe you survive until the system collapses. No more than 5 years, tops. You probably see a few of the states handle this themselves, which they certainly can, so maybe clear away the legislative thicket to make it easier for them. All in all, a better outcome than the monstrosity currently under discussion.
A healthcare reform plan without cost controls. I mean, seriously. Who in their right fucking mind would want that?
AngusTheGodOfMeat
I suspect you are referring to “conference.”
And yes, everything outside of the rooms with the closed doors (such as the conference process) is Kabuki, nothing more or less. It is not about the bill, it is about posturing in front of or behind or next to the bill, which itself becomes just a list of suggestions once conference begins.
With conference, all the deals and bets and agreements are off and it’s a whole new ballgame. Everything being said in public up to now has been to set up the final posturing and manipulating that happens then.
To say that this process is ugly and disturbing would be an understatement, but what is more disturbing to me is that the press and the public go on and on acting as if the real process did not exist, and the Trompe L’oeil process (the one you see on tv) is for real.
I don’t pay much attention to this churn any more, it’s a little like hanging around skid row and listening to the bums talk about nuclear physics.
MNPundit
If it’s got mandates, than I’ll go with nothing.
donovong
Pass the goddam thing. Now. It can be improved, but it cannot be resurrected. Neither can the careers of many Democrats if they don’t pass it.
Now.
Martin
Just to point out, there’s no way in hell a redrawn bill will look better than this one. This is the best we’ll ever see.
I think the Dems are counting on this blowing up, actually. It’ll give them exactly the cover they need to get the Medicare buy-in, and by then the cost savings efforts will already have been put in place and the CBO score will make it look like a no-brainer.
Strandedvandal
@geg6 Thanks for your feedback, it doesn’t help at all, but thanks nonetheless.
I want to know if it is possible.
gwangung
Um, I thought there was 60%+ approval in Massachusetts over their plan.
And, again, where are the flaws in the Nate Silver analysis? He does give numbers that can be checked.
Zifnab
@Citizen Alan: So your advice is to weep and despair?
gex
It may just be better to let this bill die and blame the Republicans/Republican-lites for the failure. Americans started out wanting reform. The dishonest campaigning confused them for a while this fall, but if the bill fails and the fury dies down, Americans will still find themselves wanting reform. And they’ll know exactly who prevented it.
Contrast that to passing something that doesn’t control costs, compels people to buy insurance, and compels very little from the insurers in return. This is going to be ugly. And people will blame the Democrats, even if it was Republicans/Republican-lites who demanded a piece-of-crap bill.
Woodrow "asim" Jarvis Hill
@AngusTheGodOfMeat: I am — I have a friend who references it as Committee work, so I picked that up — sorry for the confusion on my part!
Jack
@Woodrow “asim” Jarvis Hill:
Because the conference process is not going to negate the push towards reconciliation in the face of filibuster. Again, do you think there are 50 votes for, in reconciliation?
Elie
I completely disagree with those who call for starting from scratch again. It is complete madness to recommend that. Furthermore, this would set up a horrible precedent for a whole lot of stuff that hasnt even been tackled yet — financial regulatory reform — which if anything will be even harder than this.
Listen, I do hear the valid concerns and issues with the senate bill as it exists now. I do not, however, hear those who just want to scrap it all, acknowledge in the least bit that incremental improvements are and have been the way this country has worked in the past with large legislative initiatives as far back as social security, which initially just covered white men, and the like.
Your stuborn resistence to the notion that corrections and improvements to a basic legislation are the way we have done it in the past, and that somehow that just can’t happen now for some reason, is beyond anything but just willful indifference to the facts. Your disappointment, and frustration is just making you unable to believe that anything positive can happen.. almost willing that to be so — (which in my opinion has been a very weird but persistent characteristic of the opposition — not only that it probably won’t happen, but definitely will not happen). You guys give up so easily for something so important! We have been at this truly, less than a year, and everyone is done! Very, very weird, very sad for the many hard issues ahead that require not only good effort, but persistence in the face of harsh resistence. You guys fold snap, just-like-that and are ready to “take your ball home” and — do WHAT pray tell?
Seriously. Do what except spend the remainder of this administration with negative finger pointing and I-told-you-sos. What a waste!
John Sears
@J.W. Hamner: Yes, we have no idea what cost controls will work.
It’s not like we know that private insurance is a major drain on the system, and that forgoing private insurance would save us an enormous amount of money in overhead.
It’s also not like the entire rest of the Western World has been experimenting with a wide variety of universal health insurance schemes for decades.
No, we should pass a bill with an individual mandate requiring families to pay upwards of 20% of their income a year for shitty insurance with 60% actuarial value, face whatever annual limits the insurance company feels like imposing, a bill that gives perpetual super-copyrights to the pharmaceutical industry so that no biologic drug developed in the future ever has a generic, a bill that taxes people who have good health insurance and taxes more of them every single year, and on, and on, and on.
This bill needs to die. It would represent one of the largest seizures of public and private property in history, which would then be given directly to the insurance industry. It’s outrageous and unbelievable that we’re even talking about a bill this bad.
BombIranForChrist
Man, I have been back and forth on this issue a lot, but at the end of the day, this bill has to scuttled.
The whole Lieberman / Baucus / Snowe / Lieberman / Lieberman / Lieberman dynamic is going to play out for every single goddamn issue that faces the country, and as someone who is more centrist than Markos but who still has some pretty progressive views, I think it’s time to burn down the whole goddamn house.
The reason why Lieberman is ascendant now, the reason why the Bill is now largely worthless, is because everyone has always assumed that the liberals will just bend over and take it, once all the centrists are appeased. And guess what … that is exactly what is happening … again …
If we as progressives, and I would even say we as Americans, ever hope to get halfway decent bills out of the Senate again, it’s time to have a fight over the filibuster, obstructionism and minority rights.
My view: Fuck minority rights. If you want to pass bills, become the majority. Otherwise, shut up while the majority works to get things done.
JoyceH
I agree with John. Pass this bill. You can fix a something. You can’t fix a nothing. I can’t believe that people really think that Congress can ‘go back to the drawing board’ and come up with something better, or even anything at all. How will that happen with the same cast of characters?
jibeaux
@Meyer:
Two things, already pointed out, repeatedly:
1. “make it clear who obstructed”: The Democrats, with 60 votes, couldn’t pass a health care reform bill. This is all anyone will take away from this. The party in power is the party that gets blamed. That’s all there is to it. No one, not even me, is going to blame Republicans for this falling apart. They were never there.
2. Re cost controls, read the Atul Gawande essay referenced upthread. It’s really, really good.
Jack
@donovong:
Re: above..
It’s as if liberals and Democrats have suddenly forgotten that the 1.) corporate media exists, 2.) Republicans have a vested interest in this bill being awful, but passed, 3.) Obama is not a liberal and neither are many of his Senate allies, 4.) the American people, en masse, are not going to spend hours in coffee clatches, discussing the finer points of liability pools and expanded subsidies, when 5.) not buying the really shitty and expensive plan results in a penalty, 6.) as if the aforementioned Republicans and corporate press lackeys and pundits will ignore this shiny little battlefield button…
John Sears
@gwangung: He assumes that a family that makes 50k a year can afford almost 10k per year in premiums and liabilities for a 60% actuarial value shitty insurance plan that has annual limits on health insurance outlays.
That’s a pretty big one.
Jim C
@BFR:
Two thoughts as to why I’m skeptical about Mandate+Subsidies:
1. Without meaningful cost containment, either the subsidies will have to keep increasing to match the ever-increasing premiums for our high-risk pools, or our portion of the premium will have to increase to cover the difference. But we’ll be mandated to pay, regardless of whether we can afford to or not.
2. I don’t see the subsidies as a permanent feature. As the premiums increase (Anyone think they won’t?), the cost of the entire program will start to give budget hawks the fidgets. The subsidies will get cut (maybe not completely, but significantly), but we’ll still have to pay for our mandated insurance whether we can afford to or not.
Meyer
Ask again next year. Or the year after. I flat out guarantee it’s going down, way, way down.
And bear in mind that Mass is one of the top five states in terms of per-capita income, is off-the-charts liberal and is also one of the most educated states. Do not expect what is popular here to be popular elsewhere.
windshouter
I get that rescission is still permitted for fraud, but my question is how would you commit fraud if the insurance company could not charge you more for a pre-existing condition and could not deny you coverage? Right now, it’s potentially fraud to fail to disclose you had a toothache when you were 10, because the insurance company could use that information to set your premium properly or deny you. In the new order, failing to disclose you had a toothache is not material at all. You’d commit fraud by misstating your age and sex but not much else.
It would clearly be the intent of congress that misstating health history is no longer to be considered fraud for purposes of rescission, A few court cases at most would settle it.
jibeaux
@gex:
Won’t work. Democrats are in power. If there is no bill, it is their fault. If there is a bad bill, it is their fault. This is how it works.
Zifnab
@donovong: I’m not sure why it can’t be resurrected. We’ve been resurrecting the damn thing every four years anyway.
Medicare Plan C and D, the SCHIP program, Lieberman’s “Medikids” in 2000, the creation of HMOs in ’95, the Hillarycare plan of ’93, insurance reforms under Carter, Medicare itself under Johnson… The health care debates aren’t going away whether this bill lives or dies.
But I don’t want to see a bad bill get passed and further implode the system. Will this do to the insurance industry what Social Security Privatization would have done to Wall Street? Maybe it’s better to just step back and let the system crash further into the dirt. I don’t see Republicans winning any elections on their current health care platform.
The Moar You Know
Wholly OT: GOP.am is back up.
This link is SO not safe for work. You will probably get fired for clicking on it. But it’s really, really appropriate. Again, THIS LINK IS NOT SAFE FOR THE WORK ENVIRONMENT.
http://gop.am/mOZN
Napoleon
John is right.
Zifnab
@jibeaux:
Which liberal Senator will lose his or her job because of this bill? The Senators most at risk are the Senators putting up the biggest opposition.
Ailuridae
@Makewi:
FFS, you still don’t understand what a risk pool is you fucking dolt.
kay
@Hunter Gathers:
Thanks. The mandate is completely misunderstood and wildly over-hyped.
The mandate is a cost-control measure. Without a universal mandate, there isn’t going to be affordable insurance for people with pre-existing conditions, because they are higher risk.
Of course it’s cost-shifting, from those who need less care to those who need more care. But the additional expense of covering people with pre-existing conditions is real. We can’t wish it away. They cost more.
If you’re saying “no mandate” you’re saying you won’t accept that cost-shifting. Okay. But say what what you mean.
Poopyman
According to this , the House is gah-ron-teed to not pass anything remotely controversial anytime before, oh … 2013. Least of all another healthcare bill. Don’t pass this one and it will be a couple of presidential cycles before we see one again.
But the problem with passing this one is the mandated private insurance for everyone. Sure there will be subsidies for those who can’t afford it, but evidently there’s nothing in the bill to cap the cost of insurance, so the cost will just grow at the whim of the insurance companies. Not to mention the annual cap on coverage that Reid stuck back in. Hell, I’m not going to recite all of the problems the bill has. But they are many, and I can see the country learning to really hate this POS when it goes into effect.
I honestly don’t know which half of this shit sandwich I prefer. Bottom line is that those Very Serious centrist Senators have guaranteed a Dem bloodletting in 2010 and 2012. Good job, guys!
Punchy
Is it safe to assume that since I have insurance through my place of employment, I shouldn’t care what happens? Cuz that’s how I feel at the moment.
lol
One aspect people keep forgetting – hospitals charge you more simply because you’re uninsured.
Scenario A: You have no health insurance. A car accident sends you to the hospital which charges you $20,000.
Scenario B: You spend $5,000 a year on crappy health insurance. A car accident sends you to the hospital. Your insurance only covers 30% of the charges but the hospital only charges the insurance company $7,500.
Which scenario are you better off in?
Bob
A substitute bill IS like starting from scratch without all the committee BS. That can happen at anytime in the process.
It is not like you are always stuck with the existing bill. Anything can change.
Sentient Puddle
@Punchy: That’s the position I’ve reverted to as well, and I hope that it’s valid. I just can’t muster any sort of outrage at the moment, especially when so much I read appears to be too disingenuous.
Tsulagi
Dean suggested after next year’s mid-terms, but yeah, not gonna, or wouldn’t, happen
Hey, there’s nothing wrong with subs. But yeah, would be nice if Dems weren’t always so in their workplace in Congress and the WH.
Yep. If keeping the mandates and penalties, can already see the later R-campaign commercials. 20 and 30 somethings saying “I’m a Democratic involuntary health care criminal” while waving collection agency demand notices.
Some trying to scrape by financially not filing tax returns trying to avoid penalties. Noting but warm fuzzies to be generated for the Ds there. I know I’m going to warm feelings certifying on my tax return whether I’ve been naughty or nice to their satisfaction.
Pretty much. Nice to be put in a damned if you do, damned if you don’t position. Well played, D-team!
Jack
@kay:
This is policy. You neglect politics. You neglect the punch in the face, to celebrate the apology afterward.
Meyer
I’m sorry, but this is just ridiculous. This bill is a smoking crater of fail, form the get go. Any moves to improve it will be opposed by the same people who have made it a smoking crater of fail, so why do we think it’s going to get better?
And in the meanwhile, the bill taxes the rich to force the poor to pay for shitty health insurance from a bunch of companies that are – demonstrably – already raping us, without dropping any controls on the whole mad, out of control system. Oh yeah? And by the way? Let me ask a hypothetical. If you are an insurance exec, say, do you believe that the dems are out to destroy you? (Why yes!) And if so, what will you do, under this system? (I’ll raise rates and fuck them over!)
Yes, let’s do it. Much better than nothing.
Bobby Thomson
You still don’t get it, John. Dean is talking about the difference between 50 votes and 60. At this point, I have to assume you are being deliberately obtuse.
Hunter Gathers
@John Sears:
It means if your premiums are more than 8% of your income, you don’t have to do squat, and don’t have to worry about penalties.
valdivia
what John said. Anyone who thinks killing this bill helps get reform next year or any time soon is smocking crack. And anyone who thinks this can be blamed on the Republicans is also smoking crack.
once again–Romney Care in mass does this pretty much the same as this no? Are all the people of Mass voting republican now? the approval rating for the reform is at 60%.
J.W. Hamner
@John Sears: I’m really getting tired of this kind of response. Single Payer is not on the table and never has been, and I don’t really get why people who think that it is the only possible solution would even bother to post in a thread about political realities.
I cited two articles from experts explaining the cost controls, in the Reid/Baucus bill, and if you have a well sourced rebuttal please post it.
The fact of the matter is that people who claim there are no cost controls in the current bill are either uninformed or lying.
eemom
phrases that need to be banned from political discourse:
1. kabuki
2. shit sandwich
3. Lucy and the football
jibeaux
@Zifnab:
That is because they come from centrist, center-right areas and they are worried about losing to Republicans. Losing votes does not further health care reform. I’m not talking about blaming specific Democrats, I’m talking about generic blame for the party. You can say that a Democratic congress with 60 votes that couldn’t pass health care reform is the Republicans’ fault, but it just won’t work. They were never on board, if we try for six months and fail, it won’t work to say the minority party that was never on board at any point in this thing made us fail.
Tom Hilton
Actually, there is a wide range of programs aimed at controlling costs. The CBO doesn’t score them because until we try them we won’t know which ones work or how well, but they are in there.
And I’ll repeat: the public option would not have done anything to control long-term costs. A really robust public option might have held down the cost of insurance, but it would have done nothing whatsoever to address the cost of healthcare, which is (most of) what is driving the cost of insurance. The programs in the bill are designed to bend the cost curve on healthcare itself, which is what really needs to be done.
blahblahblah
Just so we’re clear, it’s significantly cheaper to live in Europe when comparing with income, taxes, and cost of living. The United States approach to governing and economics is uncompetitive against democratic-socialism. That’s the lesson to be learned here.
Time to get the fuck out.
Bullsmith
The real danger of this bill is that it extends the life of a health industry that puts insurance profits ahead of everything else. In fact it locks them into place and pushes those companies into every American’s life in an unprecedented way, at least for private entities.
The best thing I’ve heard about it is that it would limit the amount insurers could spend on overhead. To me that sounds like a cost-plus situation where the simple, and only, way to raise profits is to charge more.
In simple terms, why is the government subsidizing insurance profits? WTF kind of solution is that?
Ailuridae
@Tokyokie:
They can improve on it later by passing additional deficit neutral pieces in the budgeting process. The thing about setting up a system where someone can buy into Medicare at cost, or can pay for a public option at cost is they, are by design, deficit neutral. Fuck, if the Dems have to votes they can pass Medicare for all out of the house and 50+1 with Hellraiser Joe in the Senate the next day after passing the big bill.
What the progressive blogosphere is doing here is very similar to what the conservative blogosphere did during the stimulus debate; screeching like babies while ignoring all empirical evidence of what needed to be done and what the bill was doing. This, “there still is recission” business is no different from screeching that there is 36M for a field mouse or a MAGLEV train from LA to Vegas. And there are only two ways to reach some of the conclusions those at dKos and openleft and FDL have – ignorance or malice. Given the typical analysis of numbers that comes from us on the left I would presume the former but its looking more and more like the latter.
Your pony isn’t coming through that locker room door no matter how much you keep screeching that you want a pony.
Makewi
@Ailuridae:
Yes, I do. The problem between us is that you are an asshole. Which is sad.
blahblahblah
Just so we’re clear, it’s significantly cheaper to live in Europe when comparing with income, taxes, and cost of living. The United States approach to governing and economics is uncompetitive against democratic-social1sm. That’s the lesson to be learned here.
Time to get the fuck out.
Chyron HR
Would these hypothetical Republican commercials be running instead of the ones comparing (any) health care reform to the Holocaust? Because I really don’t see how we could pass a bill that’s worse than Republicans are already claiming it is (and mandates sure don’t do it).
Jack
@valdivia:
You and John propose an either/or (pass it or kill it) that simply doesn’t describe reality, especially of the sordid and byzantine congressional variety.
“Killing” this Senate budget or HHS part of the legislation does not magically erase the reformist projects of three dozen or so other drafts and bills.
eemom
“And anyone who thinks this can be blamed on the Republicans is also smoking crack.”
Yes, that one is particularly hilarious. Because the electorate has proven to be SO fucking brilliant at seeing through the Republicans’ lies.
Catsy
Look, this is really simple.
If there is a punitive mandate without a PO or Medicare buy-in, kill the fucking bill now. It is terrible politics and terrible policy, and will essentially hand the insurance companies millions of captive customers, and punish those caught in the donut hole where they can’t afford insurance but don’t qualify for enough subsidies to do so.
If the mandate gets stripped, I’m otherwise fine with the bill as-is. Not happy, but willing to accept it as incremental change in the right direction.
If we pass this bill with the mandate intact but without providing ANY kind of public option of ANY sort that will protect those who can neither afford unsurance nor qualify for having it subsidized, Democrats will be utterly massacred at the polls in 2010–and will deserve it.
It is too late for the Public Option or Medicare buy-in. Thanks to that monstrous, subhuman piece of sociopathic dogshit Lieberman, it is dead.
Kill the mandate or kill the bill. Period. That isn’t letting the perfect be the enemy of the good, purity purging, concern trolling, a lack of understanding of how politics work, or any of the other cliches being repeated right now to justify feeding the American people a shit sandwich. It is a straightforward cost-benefit analysis.
kay
@Poopyman:
There is something in the bill to cap the cost of insurance. State mandates have it, so I’m familiar with it. We use “reasonable” at 5% of gross.
The Senate uses “affordable” at 8% of household income.
If the cost of insurance exceeds 8% of household income, it’s no longer “affordable” and the mandate as to that individual disappears.
“No penalty if available plan exceeds 8 percent of household income.”
It works across the board. Feds kick in X as subsidy, leaving you with Y to contribute. Insurance goes up. Subsidy stays the same. If your contribution exceeds 8% of income, the mandate disappears, and the insurer just lost a customer.
matt
Nothing then! I REFUSE to fund corporate execs at the expense of my health! Personally I would rather die than give the scum a cent….its why dems will never get my money again either!
8% of income cap…great are they going to increase my salary by 8%, cause thats the only place I’d find the money.
Republicans at least are honest about being evil, dems are just quisling scum.
BR
I’m late to this thread, but agree 100%. We need to pass this bill, even if it sucks.
Just Some Head
We can’t let the bad be the enemy of the perfect.
John Cole
@Bobby Thomson: Do we really have to go through why reconciliation is a non-starter again?
kay
@Tom Hilton:
Agreed.
Jack
@kay:
Premiums are capped, at the community level. Annual limits, co-pays, rate increases and covered services are not.
John Sears
@Hunter Gathers: It also means that you’re uninsured.
I’m sorry I forgot about the hardship provison in the Senate bill. I was thinking of the House bill on that one.
gwangung
Really? What world are YOU living in? This bill goes down, and there’s no way there’ll be any momentum for ANY kind of reform measure.
FlipYrWhig
I enjoy reading another round of people whipping each other into a frenzy and then pointing to each other’s frenzy as a reason for their own.
Martin
@gwangung:
MA businesses took a hike because the costs associated with the uninsured in the other 49 states are getting shifted to MA because the care providers and insurers know that MA has to pay.
There MUST be a national mandate. That mandate should be against a public plan, but everyone is committed to killing that part of it. So, they pass the mandate, everyone including business wakes up to the fact that they have to buy something from Aetna by 2014 and over the next 4 years a new bill goes through to create the public alternative. By that time, costs will have started dropping due to other provisions in the bill and the whole thing *should* be a bit easier.
Butch
Also late to this thread but – I wish I could remember who said it, but I was reading some blogger (maybe Glenzilla) who was saying that maybe the response to Katrina wasn’t a fluke and the result of an incompetent Bush Administration – but that maybe this country really is so bereft of real leadership and moral vision that we’re incapable of achieving anything anymore.
Trinity
@eemom: This.
Noonan
What I’m most curious about is how starting over leads anyone to believe we’d arrive at a different spot. (Actually, this is the best liberals can hope for considering all the political capital already spent.)
What needs to change is the people involved in the negotiations ie the members of Congress. Having the same asshats involved in HCR 2.0 isn’t going to result in charting a different course. Lieberman will still be the 59th vote. Nelson the 60th.
Honestly, this is one of the dumbest things I’ve heard from the liberal base in a long time. Thanks, Dean.
Jack
@gwangung:
That’s an assertion with even the hint of an argument.
My argument, stripped down and restated: there are already alternative existing reformist drafts, in Congress. They exist. Anywhere from the currently “unfeasible” SP to expanding Medicare to cover everyone younger than 18 and older than 50.
This Senate budget bill and the HHS counterpart are not the only drafts of legislation available. This is not an apocalyptic moment requiring immediate, breathless action else Satan returns and rules for a thousand years.
Secondarily, a politically awful legislative act can improve some policy and still (perhaps passed for the political win) end up empowering the opposition.
This is not happening in a vacuum. The Republicans can make a very solid win out of the Democrat’s lesser-evil.
Ailuridae
@Makewi:
The problem between us is that you are an ignorant troll who has already had me explain, at length, that you don’t understand what a fucking risk pool is. That doesn’t even touch on the moral issue of ghettoizing someone into shitasticly expensive insurance because they won the Jacksonian Lottery and had Hogdkin’s when they were 14 isn’t the same as making horrible drivers pay for being horrible drivers.
The reason that nobody is suggesting your approach to this issue isn’t because you are the only one smart enough to figure it out; its because only someone who didn’t understand the issue would think the solution you arrived at addresses the issue.
NR
And what is to keep the insurance companies from just pocketing the subsidies and raising premiums so that we are all still paying the same that we are now?
NobodySpecial
@Hunter Gathers:
Of course, it also means you don’t have insurance, either.
chris
But what you are saying is flatly incorrect. Reconciliation is the last resort, the “drawing board” if you wish, and it is still available.
Woodrow "asim" Jarvis Hill
@Jack: …and now, I’m really lost, but I’ll try to answer.
“50 votes” is, to start off with, a Chimera. 50 votes for PO-based Reconciliation? Yes, possibly. Depends on a lot of situations. There’s been some counts of PO Senate supporters that hint we can get 50, for example, but no recent ones. Yet it also depends on what we can get past the goalie for the process; if they say PO can’t be part of it, is it even worth it? There’s a LOT of issues in that process, and one sentence blips really are kind of missing those details; we can’t just assume Reconciliation is a magic wand that’ll make it happen.
And, point blank, I don’t see it as that likely to happen, here. I can’t imagine the White House wants that battle, I can’t see Reid wanting to prop up the PO using it, etc. The calls in the blogsphere, and even among Congresspeople, for it are just that — calls.
That’s why I’m focusing my commentary on Conference, because its what’s going to happen — assuming we get the Senate to pass something.
BDeevDad
Well, the White House may be calling Nelson’s bluff.
hal
Why is Howard Dean “Dr. Howard Dean” when he talks HCR, and just “Howard Dean” any other time?
jibeaux
Here is a very important point: much like the “vote Bitsy” reminders, we need periodic postings to remind us to go to gop.am. Firstly, because it’s much-needed comic relief to break up the eating of our own. Secondly, because they told us the novelty would wear off and then everyone would be using their link only for conservative purposes as intended. I am pretty sure the second part isn’t going to happen regardless, but we have to stay on top of the first part. Eternal vigilance is the price of not being an idiot, or something like that.
kay
@Jack:
I don’t know what “at the community level” means. As I understood it, the assertion was that people were going to have to pay an infinite number for health insurance or pay a fine.
It’s not an infinite number. It’s 8% of household income. It was 13% (Baucus) and then it went down to 8.
cleek
could someone please explain how Obama could’ve “stood strong” (or however you want to phrase it) on this ? what power does he have over Lieberman, Nelson, Snowe, et al, that would’ve changed them into good party-line Democrats ?
what did Obama fail to do to any of the so-called “centrists” that would’ve changed them into supporting the leftiest of the lefties’ dream bill ?
there must be something, or i wouldn’t keep seeing people blame Obama for what, to me, looks like the actions of a few centrist dimwits.
John Sears
@J.W. Hamner: The political reality is that the United States pays a completely unaffordable and unsustainable tax on its GDP to an industry that parasitizes all other economic sectors and dooms us to economic irrelevancy.
As for cost controls, ok.
Here‘s the Commonwealth Fund on the subject. They estimate that, with an exchange consisting solely of private plans, health insurance costs will continue to increase at a rate of 5.8% a year, versus 6.5% with no reform whatsoever.
Some cost control.
Jim Crozier
@Woodrow “asim” Jarvis Hill
Thanks. I thought that was the case. Admittedly it has been very difficult to keep my hopes up and not be disillusioned, but the knowledge that once the Senate bill passes we may actually be able to merge the Senate and House bills together and come away with a halfway decent piece of legislation is a comforting thought.
Who knows? When the cameras are finally off of Joe, maybe he might make an attempt to rejoin the human race and negotiate in good faith.
Now I’m definitely smoking something.
Comrade Mary
@Hunter Gathers: Yep.
silentbeep
The fact that people will be helped by the bill, as it is, is not “shit” and those people who are potentially going to be better off with even these slight marginal improvements, are not “nothing.” I have pretty good health insurance, and am in a solidly middle-class career that is much more secure than most (public sector btw). I suppose I could afford to be idealistic and stick to my dreams and angrily propose that this whole bill should be thrown out the window, but there are many others out there who are far less fortunate than me, who don’t have the luxury of following those progressive fantasies. This bill does something, it is a start, and we have to start somewhere. The thing is, in principal, i agree with the people that hate this bill the most, but you know what? Politics is ugly and like sausage making it can be really damn disgusting – politics is the art of the possible, not of the ideal. Read Nate Silver’s latest for the outline of what can actually be achieved with this and for Kevin Drum? I couldn’t agree more.
John Cole: Right. On.
Poopyman
@ Kay
Thanks for that. Seems clear enough, even though “the insurer just lost a customer” also means “a low-income earner just lost his insurance” if the insurance company deems it more cost-effective to raise his/her rates to that level.
I’m also leery of how the subsidy gets managed in the outyears. For instance what happens when the Republicans regain congress? It could be that by then the insurance subsidy has become untouchable, or it might not be.
That concern, however, isn’t nearly at the same level of the question as to whether this shit sandwich should live or die.
scudbucket
Here’s one question inspired by Martin (I’m still having trouble getting on board with this bill as it is currently understood):
Are you supporters of the bill saying that we should get in bed with the insurance companies to eventually put the squeeze on providers as a way to contain costs?
gwangung
And your arguement STILL doesn’t make sense and is even more of an assertion than my counter-argument.
I’m basing my observation from history and the rather obvious deduction that a failure of the current measure, which was made more and more conservative as time went on, will make a non-starter out of a more progressive measure.
Bluntly, you’re engaging in wishful thinking.
max
So what I am saying is not controversial. It is this bill, or nothing. Take your choice.
Yeah, pretty much. We need to get this thing over with either way. Going back to the drawing board this session is not an option, and probably not for some years.
So, I agree. On the other hand, if it does pass, we may wind up worse off, and that still doesn’t get the D’s out of the jam they are in. So fixing it may not be possible either.
Coin flip – pass it and get those stupid DC people to move on to something else.
max
[‘Anything that puts out the fires we have now.’]
jibeaux
@cleek:
You are exactly right about this. Now give ME Lieberman, a locked room, my daughter’s DVD collection and a few assorted sharp and pointy odds and ends, and well, it may or may not have gone differently but I for one would just feel much better.
Bruce (formerly Steve S.)
Well, I’m afraid that part of what you are saying is controversial. To say that the process needs to start over from scratch is not reasonable, you are right about that. But you are wrong that it is “this bill or nothing.” There is an ongoing process and options still available. When a bill is finally passed there will be still more process to go through, since we will still be a million miles from having fixed health care.
Lolis
I am unimpressed by these brilliant Democrats who want to kill the bill. Many of these people were the same ones who wanted Nancy Pelosi and the Democratic Congress to impeach Bush as their first order of business in 2006. Some of these same ones thought Obama should have Bush and Cheney handcuffed and taken away as soon as he was sworn in. These people do not have good political instincts. This bill will be very popular. It is in Massachusetts and the Baucus bill is better than the MA one. As someone with a pre-existing condition that cannot get covered, I will never forget it was Democrats who made my life much more secure. There will be millions like me.
Mr Furious
I’m grudgingly in the “Pass What You Can Now” camp. And of course, none of what we are debating is actually what Obama would sign…
Over the last day, I’ve come around to the “half a loaf”—even stale and moldy—is better than nothing if you’re starving.
Even if Nelson gets the abortion language tweaked to his liking, it has to go through.
Unfortunately, I think rather than work quickly to improve this through reconciliation or amendments on other bills, these fucking assclown Dems will sit around patting themselves on the back.
Poopyman
@ FlipYrWhig:
It’s a slow afternoon.
Koz
Or we could get what should have happened a long time ago, where the liberals of the world get tired of politics and start playing foosball instead.
Brien Jackson
I think you’re right John, but just to clarify:
“Cost control” doesn’t refer to insurance costs, it refers to care cost. Of course premium prices are going to go up, you’re going to force insurers to add millions of people they consider “uninsurable” to their risk pools. Will people resent that? Probably, but a concerted campaign to explain to people that their rates were low before because they were earning it on the back of fucking sick people might help. Or maybe not, there are a lot of assholes in this country.
On the idea that insurers are going to jack rates way up just because they can, well, I don’t think so. I mean, they’re not operating in a vaccum after all. Hiking rates ridiculously for no reason other than because they can would be about the quickest way imagineable to light a fire under the ass of Senate Democrats to pass some sort of strong public plan by any means necessary. And we can talk about Democratic losses in 2010 all we want, but there’s pretty much no chance the GOP can retake the Senate before 2012, and it’s highly unlikely they can retake the House, especially with teabaggers on the loose. And if they ultimately wind up jacking rates after Republicans take over, well we can blame it on the Republicans.
Jack
@kay:
Community rating generalizes premiums regionally. In some drafts of the legislation, community rating exists coupled with mandates and premium caps. As best I can tell from the existing literature and positions, the “final form” of the act will require all three.
The end result in an effective cap on premiums, at least within regional markets.
But there is no cap on annual limit, co-pays, denial of coverage for specific services or any alteration to existing ERISA settlement and recovery limitations.
Which means the Democrats can crow all they want about fair premiums and still not actually address that failure to limit costs.
As those costs increase (and there is no existing mechanism to cap them) the option becomes, especially in political narrative: buy shitty insurance from fat cats or pay a Democratic fine. PS – these are the same Dems who sent 30k more soldiers and 50k more contractors to Afghanistan, and gave away untold billions to Wall Street.
Think the Republicans will lay off that message? Think the American people are immune to it?
Elie
@valdivia:
Also, there seems to be a crazy notion floating around in some of the comments that coverage should be somehow very cheap or free — that somehow, there is no way to regulate the cost to benefiaries because it is a “mandate”.
As kay states and many have attempted to state previously, the mandate makes the economics of having everyone covered work. This is because there is varying risk in our population (and the most risky are the most expensive) that has to be handled by spreading costs over the entire population, not just those who volunteer and are well. We are not proposing a high risk insurance pool, covering just the high risk!
Honestly, in this thread, I have seen more concern about personal costs to cover everyone and the absolute insistence that the insurance companies will not, indeed cannot be regulated! Therefore, we should only think about covering those who volunteer (?) to be covered? What is the alternative you all propose to a universal mandate?
Even if there was a single payer system, everyone would have to have mandated coverage and the price would not be zero but would probably increase over time and with needed changes in the program.
I think that there is both confusion and outright mendacity about motives for opposition and the cynicism about what can and cannot be accomplished incrementally. I just read a lot of bull and a lot of selfish and hysterical opinion .
Jack
@gwangung:
I guess you know how to blandly reassert without actually arguing. “Observe history,” eh? I guess I’ll save specific argument points for people who use them.
Hunter Gathers
@BDeevDad: Nelson’s Borg calls ‘bullshit‘ on it.
NobodySpecial
@silentbeep:
I got no insurance. I know lots of people who have no insurance. This is not ‘better’ in any way, shape or form for those of us who are healthy and working, but not making enough to get insurance now, or those of us who are healthy but have a family history of catastrophic illnesses. You are forcing them to spend money they likely don’t have for plans that won’t really keep their costs down when they have to go to the hospital, and you’re telling them if they don’t buy it, they will be fined.
Oh, and the same POS insurance companies who refused to offer us good policies to begin with for whatever reason? There is no obligation for them to offer us a good policy now. Any junk will do, as far as they are concerned.
FlipYrWhig
I’m sure it’s sad to people who like to say that things are “corporate,” but the devil’s bargain with the insurance companies is the only way this thing is still viable in the first place. Yes, it gives them more customers, and in exchange they have to change some of the way they’re accustomed to doing business. Because if they didn’t get something out of the process they would have strangled it in its crib, they way they did last time.
People who don’t pay that much attention to the ins and outs of politics hate insurance companies, banks, and the government roughly equally, I’d say, so making a frontal assault on insurance companies is quixotic.
In a perfect world, IMHO, insurance companies would be more like they used to be, “mutuals”; or they just wouldn’t exist, leaving a strong and fully government-run health care system. I would love that. I would also love replacing all marriages with civil unions. I’m essentially a godless so-cia-lizt. But my neighbors wouldn’t love these things. And my neighbors outvote me. So I have to grit my teeth a lot and make the best of it, politically and neighborly-ly.
Makewi
@Ailuridae:
No, the problem is that you are an egotistical ass who doesn’t understand that this solution is already in play in the only place in which universal coverage has been implemented. It isn’t ghettoization if there is no marker that the person is anything other than an insured individual.
gwangung
Your argument is even more an assertion than mine. History argues against it. And a simple deduction will tell you that a measure that is made more conservative over time and then failed will NOT be replaced by more progressive measures; if there was liberal support for more progressive measures in the first place, why wasn’t the original bill passed?
Tonal Crow
Well John, judging from the range of opinions in the comments, I have to conclude that your post is, in fact, controversial.
gwangung
@Jack: Don’t project, sir. It’s unbecoming.
Jack
@gwangung:
I absolutely asserted a moral position. I’ve claimed as much. I do not deny assertion, since argumentation requires it. What I suggested, though, is that I asserted and then argued my points.
I made specific points. You asserted and then claimed the mystical and magic perspective of undescribed and undefined “history.”
Elie
@Jack:
“But there is no cap on annual limit, co-pays, denial of coverage for specific services or any alteration to existing ERISA settlement and recovery limitations.”
Jack, to be fair, your concerns may be valid, but we do not yet have a final form of the legislation and we definitely do not even have the beginnings of the regulatory infrastructure that would accompany the legislation and essentially “enact” these safeguards. You are essentially arguing your concerns and fears as though they are actuality and that just isnt so (though I totally agree these need to be addressed).
freelancer
@Hunter Gathers:
Which could go either way for Nelson. Offutt is in Sarpy County, which is 1/2 of the 2nd district. Douglas County voted overwhelmingly for Obama, whereas Sarpy went 56/44 for McCain.
WH closes Offutt because Nelson kills the bill, and a lot of Nebraskans will be stupid enough to re-elect him just out of spite.
Martin
John,
Controlling costs is the PRIMARY thing the Senate bill is designed to do. That’s the whole point – they’re willing to jettison expanding coverage in order to put all of their eggs in on controlling costs.
What do you people think the conservadems are all worked up about? THE COSTS. That’s what they’re putting even MORE of in the bill, and taking out the coverage expansion. Hell, even the abortion restriction is a cost reduction in exchange for a coverage expansion. That’s why the CBO scored so low – $650B in savings in the second 10 years – it’s ALL cost reduction.
Brachiator
You’re absolutely right. The Democrats made this mess, without any GOP support. Now they have pretty much have to accept it.
The only problem is that the average citizen was looking for promised relief, and will get nothing. The Democrats lose twice over since they will waste time trying to spin their incompetence into some kind of victory.
So let’s see. Health Care Reform? Check. On to financial markets reform and jobs stimulus. If the Democrats don’t do better here, they can kiss their asses goodbye, because all they will be left with will be “at least we’re not Republicans.”
And the beauty of it all is that the GOP need only keep on doing what they are doing, which is absolutely nothing.
In football, I think this is called the prevent defense. Because it generally doesn’t prevent anything.
John Sears
@MP: You would have to pay about 12% of income under this bill, which is mostly the same as the Senate Finance bill. That’s just for premiums; co-pays and other out of pocket is extra. The Senate is working toward a 60% actuarial value target, so you pay 40 cents on the dollar, on average. It will obviously vary from plan to plan exactly how they extract that 40%.
Plus, the insurance industry will be free to put annual limits on you the same as they do now. So if you get catastrophically ill, you pay your share up to the limit, then go bankrupt.
As for why it’s crappy coverage, the actuarial value tells you all you really need to know about that. If you set a floor of 60%, then that’s what the insurance company will pay. If you allow them to put annual limits on people, then they surely will.
kay
@Jack:
Jack, I just told you how the mandate operates as a cap on premiums.
Now you’re going to coverage in the individual plans, which you have decided, without evidence, will be inadequate.
You wanted a cap on premiums without limits on coverage?
That’s a pipe dream, and it’s a pipe dream in a public option, too. All you have to do is look at Medicare.
Bullsmith
I read the Gawande piece in the New Yorker and I have to say I had some serious problems with it. Basically it compares how American agriculture developed succussfully with a hodge-podge approach to government intervention. It ignores some truly key issues:
1) Agriculture was not saddled with a monopolistic insurance industry that would now be subsidized by the government. Nor was Agriculture’s key problem spiraling cost increases.
2) The argument he makes, that the government needs to experiment in small steps because no one knows how to control costs completely ignores the WHOLE REST OF THE WORLD which has been experimenting for some time now. I know others have pointed this out.
Frankly I found the whole idea that the evolution of health insurance and delivery is actually very, very comparable to the history of farming is such an incredible stretch that it really isn’t going to tell anyone anything much. Especially if you simply ignore the role insurance and drug profits play in health costs.
silentbeep
@Nobody special
This bill is not ideal by any means. But look: I would love for things to be different. In principle, I agree with you. I’m not sure what realistic alternative there is. I don’t for a moment think that if we ditch what we have now, somehow within the next couple of years, the progressives will get what they want: there is not a shred of evidence that this will happen. Over and over again, we have seen over the years, when the last attempted reform gets passed on, it takes years to come up again (in the 40s, in the 60s medicare was a compromise, to the 70, to the 90s, and to the present time).
This is one of those things that I am simply not going to agree with. I am firmly in the Nate Silver/Kevin Drum camp on this: pass this thing now.
From Nate Silver over at fivethirtyeight.com: “Over the medium term, how many other opportunities will exist to provide in excess of $100 billion per year in public subsidies to poor and sick people?” and “For any progressive who is concerned about the inequality of wealth, income and opportunity in America, this bill would be an absolutely monumental achievement. “
J.W. Hamner
@John Sears:
John, the plan coming out of the House classifies as “public plan with intermediate rates”, so you are comparing 5.8% vs. 5.6% growth and saying the Senate plan is worthless and needs to be killed. I don’t really understand that logic.
As I stated in my original post, there are hundreds of pages devoted to pilot programs for cost controls in the Senate bill, such as:
Since they are all pilot programs of uncertain efficacy, they’re not going to show up in a CBO score or any other analysis. Once we’ve seen which ones work well, they can be implemented on a larger scale down the line.
This is not to say that Single Payer isn’t a more effective and sensible system. It is. It’s also a fairy tale as far as the political realities of this country are concerned.
EDIT: Ah well, HTML fail… can’t get my paragraphed block quote mojo working.
Sly
It’s more of a political calculation than anything else.
Many in the Democratic caucus (House and Senate) got it into their head that HCR is too controversial to be approached in anything but an incremental fashion. This may be a completely valid opinion based on legislative politics, given the history of it, but that’s because there are too few people willing to negotiate in good faith. And I’m not just talking about people like Lieberman, Nelson, or the entirety of the Republican caucus here. I’m talking about liberals who refuse to budge on single payer or a PO as well.
Midwestern Democrats could have insisted on an incentive structure to get medical professionals to practice in under served (read: rural) areas. But they didn’t, and this made dealing with Progressives impossible. Progressives could have settled on a larger pool of regulated non-profit private insurers to provide universal coverage and not be a boondoggle for UnitedHealth or Aetna. But they didn’t, and even Democrats serious about insurance reform (like Landrieu) panicked over the possibility over a national plan tied to Medicare rates.
And the Republicans will never negotiate in good faith because their rise to power depends on the United States becoming a shit hole under a Democratic President and Congress.
If I wanted to be really pessimistic, I’d say that the past decades of tensions between centrists in the party like the DLC and Bluedogs and the left of the party like the Progressive Caucus prohibited any real Democratic coalition from emerging, even if the appearance of a coalition existed, and this debacle will make that possibility even more remote.
So, Lonestar, now you see that evil will always triumph. Because good is dumb.
John Sears
@silentbeep: People are missing the point. The point isn’t that this bill gives some money to poor people, or incrementally improves the healthcare situation. The point is that, if this ‘reform’ passes, health care costs will continue to spiral completely out of control with no end in sight.
We can’t afford the costs NOW. As a nation we spend close to 16% of GDP on the healthcare industry, far more than any other industrialized nation. Our costs, under reforms like these, will continue to shoot upward at 5% a year, every year.
This bill is akin to fighting your house fire with a super soaker. It helps, absolutely, objectively, it is better than no action whatsoever. But to focus on the tiny amount of good it does while ignoring the imminent peril to the entire system is absurd.
Citizen Alan
@windshouter:
I think this is astoundingly naive. Materiality is a fact question that can only be resolved in a court after lengthy and expensive litigation. Given the extremely conservative bent of our judiciary in general and our Supreme Court in particular, it’s ludicrous to think that fraud recission case law would develop in a manner favorable to insureds over insurers. More likely, conservative judges would decide that Congress had expressed an intent to pass legislation that would reduce insurance costs which would lead to a presumption in favor of fraud denials.
And in any case, to my knowledge there is no penalty in this bill for insurers who deny claims in bad faith no matter what anti-recission clauses folks are clinging to like a Titanic life-preserver.
Shawn in ShowMe
@Elie
This is what I mean about our lost sense of community. In the 50s and 60s ordinary citizens were able to form alliances, to draw strength from each other, to keep pushing forward, to remain hopeful in the face of hopelessness. Now we’re just a bunch of disparate individuals with a desire for instant gratification.
I’ve got members of my family who are literally dying because they can’t afford to go to the hospital. We’ve got an option on the table that would allow them to receive the healthcare they need without declaring bankruptcy. Their kids will grow into adults who see the doctor instead of delaying medical problems until they’re forced to go to the ER.
But the purity trolls, most of whom have health insurance, say if we just wait we’ll get a better deal. If we just wait, Blue Dogs will see the light. If we just wait, industry opposition will vanish. If we just wait, we’ll get a more liberal President than Barack Obama.
Because that’s how progress happens — conduct purity tests, withdraw support from the only adults in the room and wait.
Ailuridae
@Makewi:
Again, you don’t understand what a risk pool is despite having it explained to you. Your solution is taken seriously by a set of exactly one individual in the world: you. At the point at which you are the only person suggesting such an “obvious” solution most people begin to think they might have gotten something fundamentally wrong in their analysis. You? Not so much. Six months of prattling on about the same model that doesn’t fucking apply to the situation at hand.
As for your idiocy that “the only place universal coverage has been applied” you ignore the model of nearly every other industrialized nation none of whom use your “solution”.
Poopyman
Wow! It’s like one of those barfights that used to break out in the Westerns. There are about half a dozen one-on-one arguments going on simultaneously.
Well Mr. Cole, you’re going to have to hose them down if you want to have anything left of this saloon. Got any Tunch pics to put up?
ETA – I see that John has taken my advice before I even offered it. See y’all upstairs….
Tsulagi
@cleek:
It would have been nice if he hadn’t cut a leg out from under House and Senate leadership by cutting a sweetheart deal with PhRMA before they even got started on HCR.
Liked that comedy on the Dorgan amendment to open drug importation and negotiated pricing to help lower drug cost. You would think that would be a good thing, but more Rs than Ds voted for it. Because it went against the earlier WH deal struck with PhRMA. Rs didn’t really want it, but knew the Ds wouldn’t let it pass, so they were just fucking with Obama. That’s the bipartisan spirit!
Speaking of which, the WH has said during this entire process they’ve worked closely with congressional leaders. They should have. No love for Reid, but the WH, Obama, virtually required there be bipartisan consensus on HCR. Reid (not defending him) tried to deliver that to the party standard bearer, but it should have been excruciatingly obvious to every sentient organism on the planet long ago that was never going to happen. It was a fool’s mission. So yeah, Obama doesn’t have clean hands, he owns part of this turd.
Makewi
The only place in the US, you stupid twit.
John Sears
@J.W. Hamner: Actually, no I’m not comparing those two, 5.6% and 5.8%, then saying that 5.8% is dramatically worse. Thanks for putting words in my mouth though!
I’m actually of the crazy belief that, when your country pays dramatically more than any of its competitors for health care (16% of GDP versus 8-12% in Europe), any health care ‘reform’ that allows costs to continue to spiral out of control is fatally flawed. That applies to both the House and the Senate bills.
Thanks also for perpetuating the ‘it’s this or single payer’ myth. That’s particularly helpful. Can you tell me how Germany’s heavily regulated exchange model, with numerous private insurers acting as government subcontractors, qualifies as ‘single payer’? Or in France, where there is a basic universal plan and then supplemental insurance is purchased on top of that, again from private insurers? How is that ‘single payer’? Or, for that matter, in Switzerland, which has an entirely private system? Or England, where the NHS acts as a one stop-solution, a single provider if you will, and private insurance competes alongside? Or Denmark, which just moved to a Swiss style private system (though it’s too soon to tell exactly how well that works)?
Canada has single payer. The rest of the world is not confined to ‘Canada’.
Hunter Gathers
@freelancer: The rumor came from the Weekly Standard, which in and of itself should not be taken seriously.
Makewi
@Ailuridae:
Honestly, you are simply a douche and so there is no point in discussing this with you at all. It would be one thing if you simply disagreed, but you just want to assert that I’m too stupid to understand. Buh Bye.
geg6
@Strandedvandal:
Well, I answered that. But I will again, more succinctly.
No.
And if you think I’m wrong, you haven’t been paying attention up until now.
NobodySpecial
@silentbeep:
Pardon my language, but Nate Silver is another fucking rich guy who’s probably never been poor a day in his life. He (and sadly, many of my fellows in the Democratic camp) can make claims like this one:
There are only two levels of affordable: Affordable and not. If they can’t come up with one sixth of their income off the top for this insurance, then it’s not. Period. No ‘more affordable’. Just ‘Not’.
In the America that Nate Silver doesn’t live in, wages have been flat for a decade or more while the cost of living has gone up, in some cases dramatically. Unemployment is up, and the majority of those lost jobs were middle class ones that were replaced by jobs that don’t make nearly as much and don’t offer nearly as many benefits. Yet the majority of us who make too much to get on government programs that have been systematically underfunded, but not enough that we can toss one-sixth of our income on anything we want? Well, we get a fine. Or we get an exemption, which means the bill did nothing for us AT BEST.
But go ahead and pass the damn thing, no one can stop it now. Who do I make my fine check out to?
cfaller96
John, you misunderstand the situation. As far as this specific debate is concerned, you are right that it is “this or nothing.” But you fail to acknowledge that choosing “this” definitely will have a negative impact on other future issues.
Do you honestly believe that successfully making liberals and progressives repeatedly eat shit and humiliate themselves in front of Nelson, Lieberman, et al won’t have any impact on negotiations for the jobs bill, banking reform, global warming regulations? Really, this was just a one-off and the rolling of Progressives won’t continue in the future ad infinitum? Who’s smoking rock and sniffing glue now?
This long ago became a power struggle between the conservative and progressive wings in the Democratic Party. If Progressives want to be taken seriously on future debates, then the only course left for them is to choose “nothing.” Otherwise, they may as well pack it up and go home because they’ll never win another internal debate.
J.W. Hamner
@John Sears:
So you don’t think the House bill or the Senate bill is worth passing? I’m sort of at a loss then. If the best the House can do isn’t worth doing, then there is literally nothing that can be done to satisfy you. There is no “drawing board” for you to go back to, except for getting a new, more progressive, U.S. Congress.
Jack
@kay:
You assumed that I wanted something or another. I was responding to your notion, only, that a cap on premiums amounts to a cap on costs.
In a Venn diagram, the cap on premiums does not necessarily have a complete overlap with the reduction of costs, because premiums are not the only price point.
John Sears
@NobodySpecial: This. This a thousand times.
I’m so sick of hearing from privileged liberals that 20% of your income a year is ‘affordable’.
I’m so sick of hearing from liberals blessed with great health that you’re not likely to spend much money on your healthcare, that the co-pays won’t be so bad. Bullshit.
These people should try being on shitty cut-rate insurance like I was for years, get to know what it feels like to be sick, every single day, but to know that if you see a doctor, get that next test, try that next procedure, it hurts your whole family. They should have to stare down the spectre of medical bankruptcy, to know what it’s like to be the cause of your family’s financial ruin, because there’s an annual limit or a shitty actuarial value on the only plan you could afford.
It’s an unbelievable lack of empathy.
geg6
@kay:
Well, that’s all very nice assuming you can afford an 8% pay cut.
My sister can’t. So she will be fucked either way she goes. Horrible, crappy insurance that will guarantee she will lose her house because she will no longer be able to pay the mortgage or paying a fine because she doesn’t have horrible, crappy insurance that would cost her her home.
Yeah, I’m sure she’ll be thrilled.
MikeBoyScout
What you say is controversial, and sadly it is not factual.
Simply because HCR was or is difficult does not mean we are faced with a take it or leave it John.
There is something to be gained by passing a bill here, IF the mandate is stripped out along with a public option.
Certainly there are lessons to be learned regarding how this legislation was shepherded through, which obviously keeping it away from a Baucus led effort.
cfaller96
Well, we know Harry Reid does his bidding (see: Lieberman, Joe, chairmanship, Medicare buy-in, etc). If Democratic President and De Facto Party Leader wants Democratic Majority Leader to do something, it will be done. Is someone suggesting that Obama couldn’t possibly have requested that Harry Reid keep the Public Option and go the route of reconciliation?
Jack
@Elie:
Elie, I’m arguing the actual language in the existing drafts of legislation. For example:
http://help.senate.gov/BAI09A84_xml.pdf
That is not some nebulous recourse to my “fears.” That’s what the bastards have given away to the insurance companies, already.
geg6
@hal:
Well, that might be because he’s an actual medical doctor and it might be relevant that he is when discussing HCR and isn’t really all that relevant when he isn’t.
kay
@Jack:
I’d vote for the bill for the experimental programs alone, so you’re probably talking to the wrong person.
I think you’re vastly overstating the impact of the mandate. I think you’re vastly understating the impact of the extension of coverage in the bill.
I don’t think you should speak for people who are uninsured. Are you sure they think a subsidy to purchase insurance isn’t a good thing? Or, do you intend to lecture them on how they’re being hoodwinked, while offering them nothing at all?
We put mandates in here that apply to children. I spend a fair amount of time slotting people into the various programs available, S-CHIP, Medicaid, or we determine the mandate doesn’t apply because there isn’t insurance available at 5% of gross. I have yet to have a client complain about that process, or feel they were being “forced” to do anything. they want their kids insured. They recognize they aren’t going to get unlimited coverage, free. Still, they want them insured.
How are you making this blanket determination that they should be denied a chance to try the methods offered in this bill, and wait for the hypothetical super-majority of liberals in Congress to appear?
I think that’s nervy.
Jack
@John Sears:
Because, perhaps, as Smith hints, a sizable portion of what passes for “liberalism” is really “Hamiltonian.”
Skepticat
@cleek:
“Obama thanked Lieberman privately for his statement issued earlier Tuesday pledging support for the bill as long as the Medicare expansion and public option were eliminated from the bill, Lieberman said.”
http://www.americablog.com/2009/12/obama-thanked-lieberman-today-for.html
Just the most recent example. I don’t understand this kowtowing to Lieberman, especially whilst kicking those on one’s own side (Dean, etc.).
In general I’ve begun to feel that if the president isn’t leading—and he isn’t—then he’s headed in the other direction. I knew before the election that he wasn’t a progressive, but I had some (you’ll pardon the expression) hope that he would do things differently and not simply follow the path of expedience. I was wrong and I’m disappointed. Not completely surprised, but disappointed nevertheless.
Scott de B.
So if progressives chose nothing, and HCR doesn’t pass, they’ve won the debate? What?
Darryl
“I’d probably try to flee the country, but not before kneecapping Nelson, Conrad, Baucus, Lieberman, Landrieu, Lincoln, and whoever decided that 60 votes was required.”
That would be at least 50 kneecaps. Because if you had 51 senators who wanted to end the filibuster you could do it easily.
Jack
@kay:
I’m dealing with the actual language, such as is available. I’m not estimating every single possible cost or benefit, since the data set doesn’t yet exist.
I am suggesting all the same that shit tastes like shit and that we ought to have the decency to say so, even if it comes with tasty flakes of strawberry goodness, or at least a side of shit free fries.
Put another way, I don’t think it was vital, inevitable, predetermined, set in stone or mandated by imaginary forces of history that to get this amount of “good stuff” we absolutely had to swallow all the shit along the way, and will have to do so for the foreseeable future.
I asked Brien, earlier, “who benefits?”.
Perhaps, since Brien appears to have signed off, you can shed some light on that.
silentbeep
@John Sears:
“This bill is akin to fighting your house fire with a super soaker. It helps, absolutely, objectively, it is better than no action whatsoever. But to focus on the tiny amount of good it does while ignoring the imminent peril to the entire system is absurd.”
At this point, I think that the fact that the military takes up such a huge incredible amount of our GDP is much more worrying to me. I’d like to see that pared down, one can make an argument that we pay more for the military, so in essence, Canada and Western Europe don’t have to.
And to take your house analogy further: you would rather the so called “health system house” burn down totally? Nice.
And as far as cost controls: I don’t think there is anything preventing us, necessarily, from making those changes incrementally as we go alon, including cost controls. When you say “now! it’s gonna burn down” I don’t necessarily buy it. It’s not as if this bill is going to etch anything in permanent stone, and nothing can be changed, ever again including changes in terms of cost controls.
Brachiator
@silentbeep:
Strictly speaking, this was not the promise of health care reform. The idea was to improve health care for the broad sector of the population, especially the middle class and the poor.
silentbeep
“Pardon my language, but Nate Silver is another fucking rich guy who’s probably never been poor a day in his life. ”
Sorry you feel that way. Not going to agree with you, and I have worked many days in my life, not “a fucking rich guy” I come from a poverty-stricken background, and yeah I agree with him.
John Sears
@silentbeep: It burns down either way. If you think that people will be able to afford their premiums in 10 years, having risen by at least 5% a year, every single year, between now and then, you’re certifiable.
I’m not the guy fighting the fire with the super-soaker, or the guy who lets the house burn down. I’m the guy wondering why we can’t have a fire department.
madmatt
As one of the poor people this monstrosity was supposed to help all I have to say is FU Barack, you and your cronies are worse than rethugs who never claimed to want to help.
You took phrma where the big savings could be found out of the mix on day 1. I can look across the Detroit River and see pharmacies that charge less for the same drugs, but am forbidden from buying them.
My death on your head. Fuck you in hell!
terry chay
Reading this thread really shows you absolutism is the domain of no single political wing. :-(
There is a time to stick it to Joe Lieberman, the Republicans, and the pharmaceutical and insurance industry. But “I’ll take nothing thanks” isn’t sticking it to them—in fact, it’s the opposite. It’s exactly what they want.
I can see some areas where I expect the insurance companies to game the system. But with the shared risk pool of mandates (with penalties, not the “forced mandates” Lakoffism verbiage that many are applying), the political will to close that loophole will be so strong that there is no way insurance companies would take this bill over the status quo.
Unlike Wall Street, the insurance companies are not “too big to fail.”
One has only to look at the history of Medicare to know why Republicans are against this. In thirty years, during an election, they’ll be claiming that it’s the Democrats that want to take away your universal health care (achieved with this bill).
I see a lot of friends gambling with their health right now. Your “I’ll take nothing” is going to doom a some of them to bankruptcy and please the people you want to revenge on.
Lieberman will get his in 2012. 90% the reason FDL has jumped the shark is because Hamsher is from Connecticut and she knows Lieberman is sticking it to her and others for 2006. Far be it for me to ascribe an ounce of intelligence to that man, but he knows enough to know he’s irrelevant. What he’s doing makes perfect sense if you’re a lifetime politician like he is (and living in the insurance capital of America to boot).
The pharmaceuticals will realize (or have already realized) the same thing the AMA has—the status quo is no longer sustainable. Maybe it’s time we realize it too.
…
I know mandates sound cruel, but let’s consider what they mean in real terms.
With subsidies the cost of insurance will be about $60-$350/month for health insurance or a $100 a year tax penalty. That’s assuming you’re even eligible for the penalty because there are some pretty generous exemptions if your income is too low or the cheapest plans are too high.
In return for that, we have basically a mandate for universal coverage, a shared risk cost savings, a whole lot of pilot programs for cost containment in the future, and a huge subsidy in the budget that you know won’t be diminished.
We’ll have to fight to keep those subsidies from ballooning vs. controlling cost, with the inertia being on the former but our desires pointing to the latter. But with the status quo, you are going to get ballooning costs that are going to be much more costly and a failure of public health.
…
Count me in for Health Care Reform, warts and all.
If it passes this is a landmark bill.
The Civil Rights Act was almost meaningless without Medicare subsidies acting as the stick/carrot. This bill has the potential of being that sort of bill.
…
I have a number of right wing friends and a few lifetime Republican friends who are not right wing. I can talk to the latter, but not the former. There is nothing rational there to talk to. Absolutely nothing.
It’d be sad and uncomfortable if I have to say this same thing about a number of my left wing friends. (I do live in San Francisco so I know a lot who fit in that category.) :-(
silentbeep
@ Brachiator: I’m sorry but I think this “promise” stuff is kind of naive, I always have. I don’t think that for a moment the fulle “promise” of healthcare was to be enacted right now, I’m one of those that believes in incrementalism. I never did, because then what? the status quo? how is that better? I’m serious.
geg6
@Brien Jackson:
Talk about your magical thinking. Have you paid an iota of attention to what has gone on with the financial industry? The big kiss on the lips they just got from Congress in two bills sold as consumer protections and passed as big, honking green lights to fuck over consumers any way they’d like and, oh, by the way, please give yourselves a huge bonus while you’re at it?
Oh, yeah. Senate Dems are brave, brave Sir Robins who will ride to the rescue of the fair maidens getting raped by pharma and the insurance industry.
Jack
@silentbeep:
In this case, Silver’s assumptions are arbitrary. He assumes that a family living on $50k can find, out of that sum, an additional $9k to spend on health care.
Strictly typing, he’s mathematically correct. Out of $50k, one can get a secondary sum of $9k.
If one assumes some patently untrue things about the current economic state of American families, or even that $50k is a nominally useful starting figure.
kay
@Jack:
Who elected you caretaker of the middle class?
You’ve determined, you admit with little or no evidence, that it is “better” for the peons to not have access to what’s offered here. Rather than send money to insurance companies to purchase health care for 30 million people, you’d rather we sit on our asses for another twenty years and moan about Canada.
Kill the bill. I’ll survive. I’ve been muddling along here helping people with health access for twenty years, and I’ll go another twenty while liberals discuss launching primary challenges. We vastly expanded health care in 2008 with the S-CHIP extension and we did it without a lot of help.
You’ve unilaterally decided that this is not good for the “little people”, and you’re offering them nothing concrete.
Your anger is no practical help to anyone.
Jack
@kay:
You are now rather literally taking aim at arguments and tones I have not made and do not take. I really don’t know how to respond to that.
I will ask again, “Who benefits from the current proposed legislation? Cui bono?”
silentbeep
@John Sears:
I agree with you in principle, I don’t for a second that the situation you described for yourself doesn’t suck. I don’t for a second think that I am somehow exempted from such a situation. I have a relatively secure career, but that’s relative, I’m one personal, financial or even medical catastrophe away from having my coverage yanked. I don’t think I am special in any way shape or form.
That’s why i am for this bill, not because I think it is wonderful, or even close to ideal. I want to start from somewhere and make changes as we go along, to the best of our ability. The status quo doesn’t do one thing about cost controls, not one thing. Here we at least have a fighting chance to do something about those cost controls in the future – I think it gets our foot in the door. I’m not saying that things in this bill are just fine the way they are. I am talking in politcally feasible terms, strictly in fact.
silentbeep
@ terry chay
This
“Count me in for Health Care Reform, warts and all.
If it passes this is a landmark bill.
The Civil Rights Act was almost meaningless without Medicare subsidies acting as the stick/carrot. This bill has the potential of being that sort of bill.”
Exactly.
FlipYrWhig
@John Sears:
While you’re “wondering,” consider grabbing a fucking bucket.
cfaller96
Scott de B.:
They’ve carried out a threat that damaged the party because their demands were not met. Therefore, future threats by Progressives are inherently more credible, and thus future demands will be given more consideration and weight. And to directly address HCR, a (near) future demand to revisit HCR would be given more consideration and weight.
Have you not done any Game Theory? If one wants greater progressive influence in the Democratic Party (and by extension, in the governance of this country), what precisely are the options here?
John Sears
@FlipYrWhig: And where would I get one of those? Does Joe Lieberman have a bucket company, or do I have to pay off Evan Bayh’s wife to get one?
Tom Hilton
@cfaller96:
There aren’t any. Tough luck.
If progressives want more influence in governance, they need to make their ideas more popular. As it stands now, there simply aren’t enough of them to have anything like the kind of influence they believe is their due.
geg6
@cfaller96:
I couldn’t agree with you more.
The battered wife syndrome of the Democratic Party is terminal. How do all these “I’ll take whatever moldy crumbs they throw my way” Dems think the GOP’s base got so powerful? By scaring the hell out the powers that be, that’s how.
I don’t know how it’s going to feel, but I am seriously considering changing my registration to “I.” And it’s threads like this that makes it seem a better and better idea.
FlipYrWhig
@John Sears: Yes, if there’s one bucket company in town, and you need a bucket, you pay what the company is charging. Because you don’t have time to make your own bucket. It’s like price-gouging during Hurricane Katrina. It sucks. It’s repulsive. But the alternative takes too long and causes too much misery.
Elie
@terry chay:
Good and thoughtful comment
sigh
Strandedvandal
@geg6
Being an ass is a gift. Congratulations.
What law are you citing? Or are you just being a surly, chicken little, sky is falling douche, that doesn’t know the real answer and is just fulfilling the role of disaffected malcontent?
John Sears
@geg6: Absolutely. The Democratic party is, to borrow a phrase, rapidly becoming ‘too sick to survive’.
FlipYrWhig
@geg6: That’s because Republicans like to see harm. It’s kind of what holds them together as a party. Republicans would rather let shit burn. Democrats aren’t like that (at least not the liberal ones). In the main, liberals have more guilt than spite. Conservatives have more spite than guilt. That’s the dynamic. They’re the Asshole Party. We can’t emulate that. It’s in the DNA.
John Sears
@FlipYrWhig: You do know price-gouging is a crime, right?
terry chay
@NobodySpecial:
The issue is that you aren’t forced to buy insurance. You’re guilty of giving a false dilemma.
If you choose not to buy insurance, you will pay a $100 tax penalty in the first year it goes into effect. If you make less than $50k and the cheapest plan is more than $350/month, then you won’t even pay that tax penalty.
Being in the startup tech industry, I probably know more uninsured young people than you do. I can tell you all of them can afford the tax penalty, though many of them would opt for insurance at < 8% of their income if one was available (the cutoff for the penalty).
…
The incentives for the insurance industry to offer reasonable rates are the following:
1) No penalty for you if they can’t come up with a plan cheap enough.
2) Mandate forces the bulk of your rates to actually go to medical care.
3) There will be loads of political will to reign you in if you don’t keep rates down because of the mandate.
Now I have no doubt they will game the system, but this is loads better than the status quo. In fact, I bet they’d want the penalties to be as small as possible just like you.
…
As for “healthy with a family history of catastrophic illnesses” then the no recission provision is very attractive to that set. Since those are the most likely to be cut off from insurance that they buy down the road. There are ways around those provisions, but abusing that has political consequences.
…
I understand you feel like these insurance companies are evil and deserve to be punished (I agree). But saying that it’s your ball and you’re going to take the ball home is exactly the opposite of punishing them.
Insurers want recission. Insurers want people trying to play self-selection with their health (where the public picks up the tab when they guess wrong) because it means they have a scapecoat for giving sucky care. Insurers want tax subsidies and no penalties because it allows them to sell cadillac plans to people like me because I make six figures, am healthy, don’t smoke and have a spotless family medical history.
The riskiest and most unhealthy time in my life was when I was unemployed (and even the 99c value deal from McD’s was a stretch on some days, not to mention the psychological toll that being unemployed takes from you). I didn’t have insurance then, nor even an option for insurance I could afford. The insurance company milked me when I have money coming out of my ears and didn’t have to worry one bit about covering me when I was gambling with my health: like you and the people you and I know.
I fail to see how the insurance company would prefer a system where they will perennially be fighting oversight, a public option, single-payer, and socialization because of near-universal coverage is now expected vs. the heads-they-win-tails-you-lose option that is the current system.
cfaller96
Evidence please. Polling data would be nice.
Specifically on the health care debate, are you suggesting that “Medicare for all” or the Public Option or even just a Medicare expansion weren’t populare with the people? You’re flat wrong. Countless polls have shown both Medicare and the Public Option to be supported by 60+% or more.
Maybe you were speaking more generally about Progressivism as it pertains to, say, withdrawal from Iraq and Afghanistan, fundamental overhaul of the banking sector, massive government spending on a jobs program, and massive government investment in the renewable energy industry. Oh wait, those things are popular too. Huh.
Maybe you mean to say that the Progressive caucus in the Democratic Party is very small, when compared to the Blue Dog caucus or the New Democrats Coalition. Uh, nope, that’s not true either- in fact the former dwarfs the latter.
I know it’s fun and easy to “punch the hippies,” but the reality is that on issue after issue we’re all pretty much DFHs. This is the dichotomy we’re dealing with- the people are progressive, but our political system is (and naturally the people that populate it are) conservative.
Working to increase Progressive influence in the Democratic Party is a worthy and achievable goal, when you consider the popularity of Progressive policies and the numbers of Progressives already in the halls of Congress.
Elie
@kay:
This is unreacheable…at least right now. I havent read an instance, not one instance of anyone opposed to the current healthcare reform process allow anything about our arguments supporting going forward incrementally. Not one.
So unless you just want to keep running your head into a wall of “NO”, please just note that you may not really be able to change any minds — not at all…no matter what you say or arguments you roll out.
Jack
@Elie:
Again, it’s not either/or. Perhaps you and kay and John need it to be, but it’s just not.
Tonal Crow
@cfaller96:
You seem to be referring to the fact that always cooperating is a losing strategy in iterated Prisoner’s Dilemma. Do you think that that game reasonably models the interaction between progressives and regressives in the Democratic Party?
John Sears
@terry chay: They only have to offer a plan that costs less than 8% of your income to make you liable for the fine. It in no way, shape or form has to be a decent or useable healthcare plan.
They can screw with you in any of a thousand ways. Pre-authorizations, limited provider network, referral after referral after referral. Then if they get stuck with a bill, they’ll simply refuse to pay, drag it out for weeks, months, until the hospital or doctor gives up in despair, and sends a collection agency after YOU instead.
And yes, I’ve been the personal victim of every single one of those tricks. There is no limit to their creativity.
The risk-adjustment mechanisms in the Exchange are far too weak. The CBO admits that. The insurance companies will still get to cherry pick their customers, and will use all sorts of fun advertising and marketing tricks to dissuade customers they don’t like from signing up.
As for rescission, you’re being naive. They’ll just jack your rates into the stratosphere at the next renewal period, assuming that you don’t hit your annual limit before that time.
Boy, that’ll be fun, won’t it? To have a choice of an unimaginably awful health insurance plan that happens to cost less than 8% of your income or a fine?
FlipYrWhig
@John Sears: I agree that we’re in a hostage situation. And I think we need to pay the damn ransom.
It’s noble to emulate the “We don’t negotiate with terrorists” ploy and say, fuck it, we have to stand firm or it makes things easier for the next group of terrorists. Until the terrorists actually blow up the plane. And you have to live with yourself. I think that’s where we are. These are the _best_ conditions we’re likely to have to deal with health care in this country for the foreseeable future. And we’re boned by Lieberman, nasty economic conditions, all kinds of things. You’re right about that. But I reluctantly conclude that whatever can be made to happen now is the best deal we’re going to get. And I don’t want to risk those hostages.
John Sears
@Tonal Crow: Well, since we got rolled on Iraq, on the bailouts, on the IMF, on the stimulus, on Waxman’s climate bill, on financial regulations, and now on HCR….. computer says, ‘Yes.’
Chuck Butcher
Take The Fucking Mandate Out
OR
Shitcan this.
Drawing board is laughable.
Jack
@FlipYrWhig:
Who does this legislation benefit? Who do you propose ought benefit from it? Does “playing ransom payer” result in either outcome?
Were there other ways to arrive at that outcome? If so, what benefit outweighs all other costs in “paying the ransom,” such that we (or those reps who are our actual allies, in positions of some authority) should reward bad conduct?
How does this capitulation to power and corruption actually reform another system of power and corruption?
At what point does lesser-evilism just result in lots and lots of lesser evils, and very few, well, goods?
*
On a somewhat related note:
Why not, from time to time, scare the living fuck out of those who have pretense to power over others, to ruling us?
John Sears
@FlipYrWhig: We can’t save the hostages this way. That’s what I’ve been trying to explain, over and over, for months.
Actually, for about 8 years, since I took a great class as an undergrad at IU. It was a history course by a professor who specializes in the development of health care systems in the the developing world; he wrote a whole book on Jamaica. He walked us through the costs and the amount of GDP we spend, had us research the varying systems around the world, lots of WHO materials and the like. The conclusion is inescapable: we can’t, as a nation, survive spending this much on healthcare compared with our rivals. It will break our backs.
The Senate bill will let costs increase from their already unbearable levels at 5 percent a year.
At very, very best, you’re not saving the hostages. You’re giving them an extra few minutes while the hostage-takers secure an escape route.
terry chay
@NobodySpecial:
Yes but Nate Silver’s hypothetical family of four, if they can’t afford the $9000 for subsidized health insurance, at $54k would be just eligible to opt out entirely without penalty.
By the way, even that family of four won’t have to pay the $9k/year unless they get sick. The actual rate ends up closer to $80/month/individual—less than half that.
In my area, I don’t know many families of four at $54k, but the equivalent families of four at $70k incomes would jump at a $9k/year insurance.
…
Now if you make the argument that these are the people who most benefit from the plan then I’ll agree with you. The subsidy is high for this supposed family which is how the insurance rate is so cheap for them.
They vote in greater numbers than me. So obviously the deal helps them a lot.
Someone is going to pay for this health care resolution, and you bet your bottom dollar that it’s NOT going to be a family of four making $54k. After all, if we’re debating whether they’ll take a sweatheart $9k/year health insurance then they obviously don’t have money to pay for the $20k/year in coverage they’ll be getting.
Elie
@Jack:
Jack. Truly. Go read your comments. They are pretty either/or…
No matter. Several have made a go at using logic and factual information such as the bill doesnt yet exist and it hasnt made a dent in what you insist is the case …
It is a waste of time and very annoying and destructive too.
If that was your goal, consider it mission accomplished
cfaller96
I wasn’t specifically thinking of Prisoner’s Dilemma, I had in mind the variation on it where it’s an iterated trading/transaction game…I forget the name of it). But I think I can make Prisoner’s Dilemma work:
ConservaDems/Blue Dogs/Moderates have been “defecting” from the Party base (i.e. Progressives) for years, and have yet to suffer a Progressive counter-action to that pattern of defection. If one wishes the nature of the relationship to change between these two entities and become more rational, then the always “cooperating” entity needs to stop cooperating and defect. Arguably you wouldn’t even need to establish a pattern of defection- one negative outcome given to the other side may be a sufficient deterrent to future defecting.
That’s my point- John and others are only thinking of the short term, instant decision of “this or nothing,” but it’s at the expense of any long term strategy. For Progressives (and the American people BTW) the long term relationship needs to change and HCR is as good a time as any to defect and make future policy goals actually possible.
A defection has to happen, or Progressives have to give up. It’s one or the other, IMO.
FlipYrWhig
I think some of the idea behind these plans is to induce insurance companies to accept a constant flow of money from a diversified portfolio of policy-holders, some sick, some well. Which is a racket, no doubt, but a reduced-harm racket compared to all the arbitrage of bleeding money from the well and fucking over the sick.
EDIT: I think I was echoing, less authoritatively, terry chay.
Chuck Butcher
I’d appreciate somebody showing me a corporate giveaway program that went away – anytime, anywhere. This will get better? Yes, it will get better for HealthInc as more influence and money is accrued to the ratbastard Ins Cos.
You want a (D) victory and don’t mind wishful thinking and various horseshit justifications for raping the taxpayer and lower income earners and call yourselves left or progressive or god forbid liberal. Excuse me while I fall all over myself laughing. Corporate Tool.
Jack
@Elie:
No, they’re not. You assume that because I argue against one proposition of your argument that I must necessarily support the other which you’ve arbitrarily opposed to it.
My approach is not the same as yours. I have neither argued, “it’s shit but we have to accept it” nor “it’s got some good stuff, but we have to throw it all away and start again.”
I have drawn attention to what I believe are the very, very bad portions of the draft legislation, while simultaneously noting that the mandates (which I despise) are nonetheless essential for this reform to pass, in its current form, and work for the very poor and very sick.
I don’t, as perhaps ought be obvious, accept that rationale of inevitability that the “well fuck it, this is our only chance” argument promotes.
Because I reject inevitability and hard determinism in politics, law, economics and history.
These outcomes are the consequence of demonstrable human choices, and in this case, the choices of legislators. None of those choices are or were inevitable, even if any number of them were predictable or probable.
If none of these choices, and sets of choices, were fundamentally determined, than we do not exist at the current moment of inevitability argued by you, kay, John and others.
We did not have to arrive at this point.
People made decisions and deals which resulted, even temporarily, in the current political and policy environment.
These decisions, being such, are not written in stone. They are not un-revisable, un-repealable or most important of all, fixed for all eternity.
There is no either/or when it comes to the proposed legislation, or the presumed time frame in which it must past. There are certainly conditional factors, but they do not line up neatly into two sets of data which mutually exclude each other.
John Sears
@terry chay: Health insurance exists BECAUSE you might get very very sick. Having it break down to unaffordable costs when you get fairly ill is lunacy.
And those out of pocket costs can add up to 12k, the current senate limit on OOP, very rapidly.
Let’s say you get a ‘silver’ Senate Exchange plan, with 70% actuarial value. That means you pay 30% on average. So to hit 12k in costs, you have to rack up 40k in expenses. Are you under the impression this is uncommon?
In the last year, merely to diagnose what was wrong with me, I had an endoscopy, a colonoscopy, a barium x-ray series, a half-dozen specialist visits and a lengthy series of prescriptions. Thankfully, they found something that works. Previously, I had been on a shitty health plan that ran me through an even more expensive series of tests and never found a way to help me, though I did personally end up, OOP, several thousand dollars. Which is apparently no big deal? It was less than 12, so according to the Senate, that’s ok.
40k is nothing. There are cancer drugs that cost several times that, PER YEAR. This bill, coupled with annual limits ala Harry Reid, will represent a crippling expense or no help at all to millions of people, and yes, some help to some others. That isn’t to my mind reason enough to support its passage.
geg6
@Strandedvandal:
Well, you would surely know, wouldn’t you?
Fuck you up the ass with a rusty saw, dickhead. Ever heard of the Credit Card Accountability Responsibility and Disclosure Act of 2009? Apparently not, you stupid piece of shit. Perhaps you should read up on it and it’s effects (which were known and warned about) before it even fucking went into effect. And what we’re about to get with Barney Frank’s CFPA bill is not much better. But then I’m just a surly douche who actually reads fucking legislation and has the actual ability to do it without needing a blog to decipher it for me.
You are obviously mistaking me for someone who hangs out on GOS or FDL. Well, I don’t and I’m not a lefty all the way. I used to be a die-hard Democrat, but lefty/=Democrat. I’m taking my old school liberal ass out of the party…possibly. And for very good reasons and after 33 years of undying loyalty. You don’t know me and I haven’t seen you much around here (or actually ever), so I’ll ascribe your stupidity and assholishness to your being a newbie or lurker.
FlipYrWhig
@John Sears:
I agree. The same is true of failing to deal with climate change. But our present political system doesn’t take the not-so-long view for how to face problems like these, ones that _will_ be catastrophic but are still just shy of catastrophic and by a kind of Zeno’s Paradox logic they’ll never seem tangibly catastrophic in time to avert them. That’s why I take an incrementalist view, because I think we can do increments if we push incredibly hard. But I don’t think we can do paradigm shifts. There would need to be bodies stacked in the streets outside of hospitals before anyone would be jolted into sweeping healthcare reconfiguration.
FlipYrWhig
@Chuck Butcher:
It’s a corporate world. You don’t have to like it, but how are you going to change it without prolonged immiseration? It’s like Michael Moore said about _TV Nation_: if you’re going to do battle with a corporation, it helps to have another corporation behind you.
Bruce (formerly Steve S.)
I haven’t made up my mind yet on the larger question, but this gets at what I think would be the greatest danger of acceding to the current incarnation of the Senate bill. Rahm Emanuel will commission a “Mission Accomplished” banner and have a big Rose Garden signing ceremony in front of it. Obama himself said that he intends to be the last President ever to have to deal this issue, but even in a best case scenario this will have to be dealt with again in a couple of decades if all we get is the incremental reform. The freight train is still hurtling toward the cliff, though maybe a little more slowly, and I just hope that people younger than me manage to make decent lives for themselves in spite of it.
Brachiator
@silentbeep:
“Incrementalism” is “defeat” writ large. Incrementalism will be the talk of the beltway and the village, and the Democratic Party true believers. But it is really meaningless anywhere else. Yesterday I was eating lunch at a coffee shop that used to have a line out the door at noon. For the past 24 months, the proprietor — and his self-employed customers — have been hanging on for dear life. They can’t hang on much longer, and many of their customers who have already lost jobs or have had to take part time or lesser paying jobs are almost entirely over the edge.
They voted for the new administration for relief now, today. Effective health care reform would have helped them now, and would have helped their employees now. A weak bill whose major provisions don’t even kick in until 2012 or later is a weird joke.
I understand the political calculation. But political expediency is sadly out of sync with economic reality. The Democrats are not entirely adrift yet, but their fallback on the usual ways of doing business in Washington is going to hurt them if they can’t come up with more substantial results.
geg6
@Elie:
And those making those arguments all seem to be saying that when it does go public, it will magically have all the good stuff they thought it had and that this unicorn will magically pass unscathed. Because once it come out, we’ll see! It will be wonderful! And 8% of your yearly income is nothing!
Because, you know, that’s how this process has worked all along.
Scott de B.
Double blockquote attempt coming:
The only demands they’ll be making if this goes down is demanding that the GOP majority give them permission to go to the bathroom during debate.
Two options. One is a slow building of progressive institutions and fundraising for progressive candidates. Get Lieberman replaced by a real Democrat and we make progress. That’s something tangible.
The other is the old standby, bribery. Offer to build a $500 million Health Insurance Quality Monitoring Institute in Hartford if Lieberman will sign on to the public option.
Sanka
Financial reform? Gay rights? But…but…B-U-T….OBAMA IS A PRAGMATIST! The vast majority of the American people didn’t vote for change. We voted Bush out and for Obama’s pragmatic approach to problems!
The echo-chamber on the left is contracting more and more each day, apparently. A year ago America was
obviously a left-of-center nation tired of Republican incompetence and Republican politiciansbrimming with optimism.Meanwhile, this:
Keep screaming louder about single-payer, public options, etc. etc. Apparently the American people love seeing the moonbats in the Democratic party shun the moderates in favor of the extremist kooks on the left. That must be why Obama-Democrat numbers are in the tank. They aren’t screaming loud enough. Obviously.
kay
@Elie:
Okay. I think it’s ludicrous to say that people are going to object to a mandate payment that goes to a private entity, but love a mandate payment that goes to a public option.
Blue Cross (in my state) is a non-profit. Anthem is not. I pay a premium to Blue Cross. I feel no better writing that check knowing that Blue Cross is a non-profit.
I would be willing to bet that 1 in 1000 people 1. know the difference, or 2. care.
Why was the mandate okay as long as it was going into a public option, with all the various “public options” that liberals were willing to accept, but draconian and unbearable if it goes to Anthem?
That doesn’t make any sense. If people object to the mandate (and I don’t think they will, I think it’s wildly overblown) they’re going to object to the mandate. They’re not going to give a rat’s ass if Kos tells them it’s going to a non-profit on an exchange. They’re still writing a check, and that’s all they’re going to care about. If the mandate is politically impossible, the mandate with a public option was politically impossible.
Chad S
After reading 538’s analysis, I’m fine with the Senate bill. They can make adjustments down the line w/reconciliation.
kay
@geg6:
geg, why was the mandate okay with a public option, politically, and the mandate without a public option not okay? Not policy. Politically.
You deal with people all day.
Are you really telling me they’re NOT going to object to paying into “public option insurance co.” but WILL object to paying into “private insurance company”?
I’m not talking about people who read Daily kos. I’m talking about regular people. They’re going to make a huge distinction based on the name they’re writing on the check? Is that your experience with people? It isn’t mine.
If they were going to vehemently object to a mandate, they would, and telling them “you’re paying into a public option!” wasn’t going to make a bit of difference.
Jack
@kay:
Of course.
People cannot possibly distinguish between enriching private corporations and assuming a portion of a shared public burden.
Jack
@kay:
It seems that those who can find ways to stomach the policy fail to understand the politics, from time to time.
John Sears
@Chad S: There may not be reconciliation. They’re talking about ‘ping-ponging’ the bill into the House and forcing an up or down vote without amendments or changes of any kind.
Failing that, I’ve seen talk of a ‘pre-conference committee’ where all the important changes will be made by a select gang of reps and senators before the full conference gets a chance to see it, and shove it through that way.
But then again, I think both bills are a piece of shit. Slightly difference pieces, but still shit.
Bob In Pacifica
I say put in a public option and let the Republicans block it. Then shrug your shoulders and say to the American Public, the Party of No said no. You know how your brother died because his insurance company fucked him over? Republicans. You know your buddy whose kid/wife died when he was laid off and lost his health insurance? Republicans.
The point is that if you can’t pass something that works then don’t pass something that won’t work. Let the Republicans own the shitstorm that they ensure.
What would be incredibly stupid would be to pass a bill that guarantees obscene profits for insurance companies at the public’s expense when what’s destroying the health care in America are the insurance companies.
Don’t shit into the bag and then let the Republicans put it on America’s doorstep and light it.
geg6
@kay:
Because, politically, once the public option was in place and the cost controls it would force would affect their bottom lines, they would see it as a positive good. And, honestly, I was more for the Medicare for All/Medicare buy-in than the public option.
In an earlier post, you (I think it was you) said what’s the difference between BC/BS as a non-profit and the public option? Well, that’s pretty easy. One is a private non-profit and the other is a public non-profit. One has no transparency and the other has endless transparency.
FlipYrWhig
@Jack:
People don’t much like paying their taxes, even though that’s “assuming a portion of a shared public burden.” I’m not sure it’s experientially all that different. When you’re paying the bills, and you get the business tax envelope, and the gas, and the electric, and the car, and the rent, I think most people think of it as a smoothly continuous process of enriching a bunch of fuckers. I love even the word “public” but I don’t feel the difference at the point of the transaction.
kay
@Jack:
I told you who benefits from the proposed legislation. Repeatedly.
I stopped falling for the “who benefits” nonsense in high school.
You want to focus on the private insurers who benefit from the proposed legislation.
Your goal is to deny private insurers. Your goal is to beat joe Lieberman. It’s not your goal to deliver health care.
I was looking at Kos and there was all this humiliation nonsense.
“We have been humiliated by Joe Lieberman!” Christ. Talk about losing sight of the objective. It’s all about their humiliation?
You know, there were several liberal Senators who stayed at the table in those negotiations. They aren’t screaming “kill the bill” and they aren’t moaning about “humiliation”. They stuck it out and got the best bill they could, because they are focused on delivering health care.
John Sears
@geg6: This. The primary difference between the public option and a private non-profit is that the voters have the ultimate say in its policies.
If the PO acts just like any other shithead insurer, we have at least some recourse at the next election.
Unless you’ve given up all hope of representative democracy there seems to be a pretty clear distinction between Blue Cross and the PO.
Jack
@geg6:
We are being asked to believe that American people cannot distinguish between the public and the private, between policy which has some benefit for the very sick and very poor, but at the cost of incredible largesse to insurance companies, and policy which expands existing public provision of insurance.
terry chay
@John Sears:
Your point is taken. Normally I fully expect them to do this, except that the fine generates no revenue for them (and a whole lot of political will to f–k them over with regulation). Your other examples have a direct effect on their bottom line so they engage in this.
In other words, insurance comapanies are sociopathic, they’re not stupid. The big danger is they don’t offer any plan at 8% of the your income.
From our discussions, it sounds to me that you’re healthy, single, but maybe with a family history. My guess is that in your case, they’ll offer something at 8% of your income and it will suck. And I’ll agree with you that this sucks that your taxes will be $100 higher because of that bullshit. (In some ways, I’m counting on it.)
I agree. This is unfortunate. If I could wave my magic wand I’d wish them out of existence. However they’re the only game in town right now and a new game is going to take a long time to create, whether this bill passes or not.
I will point out that where Wall Street had the Bush Administration with TARP was that they literally were “too big to fail.” It was bail them out or have a global depression.
This is not the case with the insurance industry. If they engage in these practices, the calls for a Canadian type system will be very strong. I think it is a possible future (probably a decade hence) of single payer as a viable opportunity that has them not aggressively pushing against this one now.
I am not. I fully expect some of them to game things in this way (actually, I expect they’d opt for the recission exemption already built into the bill instead of doing something this overt). They have to be careful though, if they go overboard, the backlash will be huge if a lot of people got insured and now can’t afford it because of this new recission-in-all-but-name.
The difference here is I see a lot of evidence that this is monotonically better than the status quo.
…
It is said the success of medicare hindered/s universal health care reform in the 94 and 2009 because a sizeable chunk of voters actually do have single payer and are complacent. The same danger can be ascribed to this bill, I do not deny that. The Civil Rights Act ended up being the basis for the Southern Strategy too.
But sometimes we fail to consider the null. The Medicare Act was an ugly compromise on universal health care (something we’ve been fighting for since the 1800’s).
Would we honestly be willing to condemn African-Americans to an infant mortality greater than that of a third world country (it took Civil Rights Act and the Medicare act to fix that: it forced hospitals to be desegregated if they wanted to advantage themselves of Medicare)? You can still see the impact of that one example in the IQ tests and incomes of that subgroup today. Just recently I noticed a New York Times front page article talking about the miraculus “jump” by minorities school performance in the South during the 70’s and 80’s that has actually been fully explained by the rollout and adoption of Medicare in those areas.
Civil Rights Act created a huge backlash that took a long time in coming, and that backlash crested with giving us 8 years of George W. Bush. But I can’t condemn thousands to an easily avoidable death by dysentery or a lifetime of low IQ simply for maybe if we do nothing the problem gets so bad we maybe get something better down the road and don’t have to see starbursts in nationally televised political theatre.
Similarly, I can’t condemn millions of Americans to death or poor health and our public healthcare system to failure, simply based on maybe sticking it to some people who are clearly on the wrong side of history and the hope that maybe if we do nothing the problem gets so bad we maybe get something better down the road.
Yes, we still have a long way to go in civil rights, but The Medicare Act did more than any other thing in American history to eliminate Black-White income disparity. It helps to remember we have a black president of our country and a lesbian mayor of a major metropolitan city, many of us thought we’d never see either in our lifetime.
Sanka
Brilliant! I didn’t know the public option and/or single-payer and/or any government-administered health-care “option” could cure fatal cancers and such. Dems should run with that strategy. The Alan Grayson strategy has worked so well for the public option over the last several months….
Will
You know what I loved best about the Civil Rights Act of 1968? The part that charged you 8 percent of your income for being black.
And that’s gross income, by the way. Someone else can do the fancy maths, but that’s a pretty nice chunk of your take home pay.
Personally, I just think a lot of our well-off liberals can’t get their heads around the idea that a whole bunch of folks in this country literally spend what they make on necessities. I know I did.
Jack
@kay:
I haven’t seen that. If I’ve missed it, I apologize. If you’ve “told me” repeatedly, then it’s fresh enough in your memory that you could probably repeat it one more time.
Who benefits from the current legislative drafts?
That is, to put it mildly, unfortunate. Although not surprising, at this point.
I think you want this to be true. It’s not. I ask who benefits because I want to know who actually benefits. I also want to know who people believe will benefit. I want to understand the disconnect between the two, if any.
Because I see no evidence that the intended beneficiaries will be the actual ones.
Because I think the goal is laudable – health care for all.
Because, it being a worthy end, this is not the best way to achieve, nor even the most popular.
Again, I think it suits you to believe this, because it allows you to confirm to yourself the validity of your own position, and your belief that I am opposed to it.
And while I’d argue a perfect world model which allows for increasing public insurance, it is not my goal, nor that of those legislators I support to “deny private insurers.”
I would be content, now, for caps on their predatory practices, and a public insurance program which operates at the cost levels of the very successful Medicare program.
You are, again, wrong. As I argued in another thread, Lieberman is not some outside obstructionist. I don’t care to “beat” or blame him for his role in the unfolding drama. He serves the pawl function very, very well, but I don’t care either way if it’s him, Baucus or whatever Republican Du Jour the Obama Admin is currently courting.
I’ve made no recourse to the DK or Kosnik arguments. I’m not sure why you think that this attempt at guilt-by-association has any bearing on my argument.
Okay. I guess your recommendation is to “STFU” and toe the line, then?
kay
@geg6:
The public option wasn’t a sufficient cost control, because it doesn’t go to the cost of health care. There were not enough cost controls in the House bill. To reduce the cost of health insurance, you have to reduce the cost of health care. That applies to the public option too, because it’s insurance. We know this, from Medicare.
No one wanted to talk about reducing the cost of health care. You saw that in the debate. The over the top insane reaction to the mild recomendation that maybe we test too much. The over the top insane reaction to the mild suggestion that maybe we shouldn’t be pouring 50% of resources into the last year of life.
If people were going to hate a mandate, they were going to hate a mandate no matter where it went.
I don’t think it’s that big a deal. I have been uninsured. I would have taken a premium at 8% of gross in a heartbeat. I was paying 33% of gross.
Brachiator
@kay:
People weren’t too crazy about the mandate behind Massachusetts health care (and still aren’t). Oddly enough, some people preferred the free ride that they got using the ER and not paying. However, I agree with you that it’s dumb to think that objections to a mandate depend on whether a private or public option insurer is getting paid.
I think the health care bill sucks. However, “I am not in the kill it and let’s start over” crew. All we can really do now is to see what, if anything passes, and then gauge actual citizen response.
geg6
@John Sears: @Jack:
Yes. But apparently we are all just a buncha hysterical little WATBs who understand nothing about politics, the legislative process, or how easy it is for people hanging on by the shreds of their fingernails to pay 8% of their annual income to multi-billionaire mega-corporations with a record of doing nothing but screwing over the little guy.
John Sears
@terry chay: You’re way off on your assumptions. I’m not in great health and I have no need of the Exchange because my spouse gets fantastic health insurance through her work, the best you’ve ever seen, anywhere. If I had to estimate its actuarial value I’d say 98%; I have 100% coverage, no deductible, on everything, literally everything, except prescriptions. For that I have two tiers: 10 dollar copay or 20, regardless of drug costs, not limited to generics.
No annual limits, no lifetime limit either. We pay 300 a month for the family plan.
So, this isn’t about me. This is about the system. The system can’t sustain a 5% annual hike in price much longer. The whole damn thing will come crashing down in utter ruin.
I advocate a single payer solution knowing full well that I’d end up with coverage inferior to what I have now, because it’s the right thing to do. Great insurance won’t mean jack when the country is plunged back into a great depression because businesses can’t hire, and the tax revenue goes through the basement because everyone’s out of work, and our bonds tank because no one trusts the US to pay back its debt. Look at what happened with GM’s health plan if you want a vision of the future.
Call it enlighted self-interest, but I don’t particularly want a first class cabin on the Titanic.
danimal
@kay:
That seems to be the real problem. Aspects of this bill that were perfectly tolerable last week are now deal-breakers.
It all has to do with Lieberman, IMHO. I loathe that guy with a white hot passion, but making him the bad guy that killed health care reform is not going to save lives and prevent bankruptcies. I wish CT had voted the bastard out when given the chance and I wish his power were reduced at the start of the congressional session. But we deal with the bastards we have, and we need his vote, or someone else’s.
Lieber-rage should not determine the fate of health care reform.
kay
@Jack:
Forget it, Jack. Maybe you can come up with a plan that offers unlimited coverage at 5% of gross, and that 5% of gross will go to a non-profit, which will magically launder the check and make it ideologically pure so the person won’t mind writing it.
But I think that’s bullshit.
I don’t think you can explain why you were all in favor of a mandate that went to an insurance exchange, but are vehemently opposed to a mandate that goes to a private insurer.
Because all people are going to care about is if it is affordable and meets their basic needs. They’re not going to be testing it for ideological purity.
John Sears
@John Sears: Well, ok, 98 is high. Definitely 90-95% though.
Tom Hilton
@cfaller96: this calls for a much longer, more detailed post than I have time or energy for right now, so apologies in advance for what will of necessity be an oversimplified and under-sourced response.
First: let’s stipulate that public opinion is probably somewhere to the left of where the Senate is ending up on this. That’s an institutional problem, unfortunately, that isn’t susceptible to pressure from the left. The progressive coalition (arguably) succeeded in pushing Harry Reid to keep the public option alive, but at the end of the day you still have the same 6 or 7 Senators who have to be made happy; their grossly disproportionate influence is a function not of weakness on the part of Reid or Obama, but of the nature of the institution (and of the opposition party). In the end, all the public option campaign accomplished was raising progressives’ hopes higher for longer.
But getting back to public opinion, the thing is that specific-issue polling is notoriously unreliable as evidence for any broader conclusions. Take a look at current polling on the economy (for example): most people want something done to reduce unemployment, but most people also want the deficit reduced, and a plurality think deficit reduction is doing something about unemployment. Or on healthcare, most people want something called a ‘public option’, but most people can’t explain what that means. Medicare is hugely popular, but the age group that loves it the most is also the strongest age group for the party that keeps trying to cut Medicare. And so on.
Really, most people just don’t understand policy all that well (or think about it that much). For most people, politics is less about policy than about tribal identity. Lieberman’s rationale for flip-flopping on the Medicare buy-in (Weiner is for it, so I have to oppose it) is thoroughly contemptible, but it’s unusual only in its (unintentional) candor. People don’t think “I think excessive regulation stunts economic growth, therefore I’m a conservative”; they think “I’m a conservative, so regulation sucks”.
Again: oversimplification. Best I can do right now, and this is still going to be a lot longer than I intended.
The point being that as a tribal identity, ‘progressive’ (and to a lesser extent ‘liberal’) is a fatally damaged brand. If you polled identical groups on the public option but with one group said “progressives support a public option as part of healthcare reform; do you agree” (or some such), I guarantee you that group would give you drastically lower numbers in favor of a public option than the group that was asked it straight (without identifying it as ‘progressive’). Many more people despise ‘progressives’ (or more precisely, their own conception of ‘progressives’) than identify themselves as such. That’s a huge obstacle to the efficacy of any attempt to pressure politicians from the left.
Jack
@kay:
I don’t know why you insist on jousting with arguments I have not made, using figures I have not employed, attacking outcomes I have not proposed.
Tom Hilton
@kay:
This.
John Sears
@kay: I explained why I’m much more opposed to the one than the other above, but I’ll repeat it here so you can see why some people are:
I believe in the principle of representative democracy. A public option, as a government administered plan, is ultimately subject to the will of the people, through those pesky things we still hold called ‘elections’.
Blue Cross/Blue Shield is subject to the will of… large institutional shareholders. At best. They couldn’t give a flying fuck what their customers actually want. They only care about what they can get away with.
In real life, would the average person care? Well, polling consistently shows they want a public option included in the Exchange, by upwards of 60%. So maybe the average person isn’t quite as ignorant and short-sighted as you seem to believe, and has in fact followed this debate to some degree.
kay
On the subject of percentage of income.
I have been uninsured. I paid for health care.
Out of pocket. It wasn’t free. So, comparing 8% of gross to 0% of gross, or “not paying for health care” is the wrong way to look at this.
They’re paying for health care now. They’re not getting it free.
It’s also a mandate. An informal mandate, to be sure, but when you’re uninsured and need health care, it’s a mandated payment.
So, to compare costs, you’d have to compare what the uninsured are currently paying for healthcare with 8% of gross..
Sasha
Is there anything preventing a public option or Medicare buy-in through reconciliation after the the current HCR legislation passes ?
FlipYrWhig
@Jack:
Do you know if your utilities are municipally owned or privately owned? I used to write a check to “Philadelphia Electric Company.” I can’t say I ever gave it much thought to whether that was just the name of the company or if the city actually owned it. I would venture to say that the American people indeed do not, by and large, distinguish between the public and the private in many cases. Which is not to say that their inability to tell the difference hasn’t had quite harmful policy ramifications.
John Sears
@kay: Wrong. You’d have to compare what they’re paying now with 8% of gross plus whatever costs are left over in co-pays and cost-sharing, plus the amounts over the annual limits.
Midnight Marauder
@Sasha:
Yes. The United States Senate.
geg6
@kay:
Well, I seem to remember that you are an attorney. So I’m guessing 8% (or even 33%) of an attorney’s annual income is a different animal altogether from my sister’s 8% from her dining room manager’s hourly plus tips. And funnily enough, her uneducated self understands perfectly well the difference between paying a mandated premium to a wealthy mega corporation with almost no controls over how little it covers or how high co-pays may be and one that is administered by the federal government. She also understands the difference between private non-profits and public non-profits. She’s weird like that.
And I really don’t think you are listening to me. I already said I was never a big fan of the public option and supported Medicare for All and/or the Medicare buy-in. So I don’t quite understand why you’re expecting me to defend it as a cost control. But there is an enormous amount of literature out there that shows exactly why the public option would control costs for consumers. And that’s really all I care about. IANAE, but it would seem to me that if the public had the public option and it became the most popular choice, then that, in and of itself, would cause provider costs to drop. If consumers (through the public option AND Medicare reimbursements) aren’t buying what they’re selling because it’s too dear, then prices will drop.
Just sayin’.
Jack
@John Sears:
The core argument upon which kay’s assertion rests is as follows: Americans cannot distinguish between the public provision of health insurance (with mandates) and the private provision of health insurances (with mandates).
She seems to be arguing that Americans would perceive the payment of such and such a base cost as identical, if that burden was borne to the benefit of the public insurance program as to the benefit of “fat cats.”
kormgar
As horrific as the status quo is, as near as I can tell, the current version of the bill in the Senate is poised to make things much much worse.
No effort to control costs combined with a mandate to purchase health insurance coverage would seem to be nothing less than a disaster.
If a person cannot afford insurance now…how the hell does forcing them to buy it help anyone other than the insurance companies?
kay
@John Sears:
John, Medicare Advantage is a private plan inside a public option. 25% of seniors opted in to it.
I am willing to bet 90% of them don’t know it’s a private plan.
Jack
@John Sears:
This.
Earlier, kay argued that the legislation kept premiums to a (minor) percentage of income, therefore costs were contained, ignoring co-pays, denial of coverage, individual pricing within care categories, and embedded rate increases.
geg6
@kay:
Sorry, but if you never go to the doctor, you aren’t paying anything. As I’ve mentioned over and over, my uninsured sister doesn’t go to the doctor. She’s 55 and hasn’t seen one in over 20 years. And won’t any time soon. Probably not until she keels over dead and the ER doctor pronounces her.
John Sears
@kay: They opted in because the insurers were able to provide aggressive marketing and little perks in exchange for the 14% extra the federal government paid them to administer the same basic benefits plan.
Also, it’s nice of you to assume that old people don’t know what they’re doing.
John Sears
@Jack: Yes, it is funny how often people forget that incredibly simple and obvious set of facts. Almost makes you think they have an agenda.
Jack
@FlipYrWhig:
Yes, I know. My gas company is a privately held corporation. My electric company was once publicly chartered, but is now a privately held corporation. The ambulance company is contracted by the city, but it’s employees are not municipal.
And I didn’t even have to googlerize…
John Sears
@geg6: This. I went without seeing a doctor despite being so sick my family was planning for the funeral for two years because I couldn’t afford it and couldn’t get insurance.
The idea that everyone who gets sick sees a doctor now, even if just an ER doc (who, btw, are not a lot of help for anything but EMERGENCIES), is so patently absurd you have to wonder if it’s a poor attempt at humor.
Jack
@John Sears:
I was tempted to believe that, at one point – limiting “agenda” to ideological validation.
But, I don’t think it’s the case. I think, at the root, that some people really, truly believe that this is the last, only, final, inevitable, unalterable moment in which something, anything called health insurance reform can be passed.
And that, despite this being the last chance to do something, anything, it follows immediately that the bad stuff can be fixed later…
FlipYrWhig
@kay:
In fact a huge proportion of the advertising for various insurance products (and debt-relief schemes) seems to sow deliberate confusion between what’s government-provided and what’s private. I agree with kay that people quite often do not know the difference, and/or would choose the wrong answer when polled. They probably think the city of Philadelphia runs the Philadelphia Museum of Art, too. And I’m _sure_ they’d be very confused about the management public/private structure of the US Postal Service, even if they went there all the time.
Jim in Chicago
Until progressives stop capitulating, we’ll never get what we want. Lieberman raises a stink and gets everything he wants and we’re just supposed to cower and meekly pass what has become his bill?! He’s not even a Democrat. There are more progressives than Conservadems (or Lieberwhores). If WE threaten to filibuster we get what we want because we have the votes to pass a bill through reconciliation. They CAN’T stop that. If just one progressive stands up, they will have to put this through reconciliation. Then the question becomes (a good bill through) reconciliation or nothing. Which do you think Obama and Reid will choose?
As Howard Dean says: WE have the power (but not if we never use it!).
FlipYrWhig
@Jack:
I’m impressed. I can’t match that. But I don’t think your level of detailed knowledge is typical.
geg6
@John Sears:
Or classism. Which is the more likely explanation, IMHO.
John Sears
@Jack: So you’re thinking some kind of hive-mind misfire? Mass hysteria?
Jack
@FlipYrWhig:
Informally, I just asked this of my wife, who is antithetically (to me) apolitical:
She knew all these, and it’s not like we discuss these sort of things in the bedroom or at the kitchen table.
FlipYrWhig
@John Sears:
I assume that old people don’t know what they’re doing. Not because they’re unable, but because they get manipulated. There’s a late-night commercial that uses the phrase “national healthcare plan” in such a way that it would be very easy to think you were signing up for a new service the government was providing. But it’s one of those medical discount cards (I think; this is off the top of my head), tarted up with pseudo-public language.
John Sears
@geg6: Why can’t it be both? Classism and a poor sense of humor?
Reminds me of the Daily Show segment where Stewart highlighted a couple of assholes on MSNBC making fun of the guy who threw tomatoes at Palin for being homeless.
silentbeep
@Brachiator
“Incrementalism” is “defeat” writ large.
You know, i’m sympathetic to this argument. What I think would’ve been incrementalist was to start out asking for very little in the beginning of this process, and act like that’ve would’ve worked to anyone’s satisfaction: anyone that advocated that negotiating approach when this thing began, was defeatist for sure. I was a staunch supporter of the public option. I think it’s supporters were totally right to hold out until the bitter end. In my view it’s like this: fight for everything, everything that you ideally want, with the full realistic knowledge you probably won’t get everything that you want. And then fight tooth and nail some more down the line. I’m sure some people in the 60s would’ve loved to have more than Medicare, that obviously is not universal coverage, but as we know now, it has provided enormous benefits for the people that do qualify. Social Security was nowhere near as generous as it is today as it was at the outset.
Defeatism to me, is giving up at this point, and refusing to fight on because of political reality. My arguments are strictly realpolitik ones. I think this ultimately: do what you can, with what you have, where you are
John Sears
@FlipYrWhig: That sort of thing is a great argument for better truth in advertising laws, but.. after a YEAR of this, in every conceivable form of media, I’d wager that the general public understands at least the basic idea of the public option by now.
Americans aren’t quick on the uptake when it comes to politics, but a solid year of this gridlock, I think, may have just done the trick.
I wouldn’t mind seeing polling however.
terry chay
@Will: This was obviously a dig at me.
1) You aren’t charged 8% of your income under any of these plans. Under the Senate plan, if there is health care available for 8% of your income and you opt-out, you pay a $100 income tax penalty. But since I guess you’re black, make less than $1250/year, and dutifully pay your taxes every year (in spite of AMT giving you a huge tax credit), that’s somehow 8% of your income.
2) The Civil Rights Act has very little force by itself (at least initially), particularly with medical care. I could use your same facetious bullshit and say, “I don’t know how giving health care to 65-year-olds magically reduced infant mortality among blacks in the deep South away from being as bad as a third world nation to only being a little bit worse than being white.” And nonetheless here is how it happened:
In a previous failed attempt at universal health care (the Great Depression), the incrementalists at the time decided to build a lot of hospitals under the guise of Keynsian-directed public works projects. Now since the big liberal Northeast had a lot of hospitals (their darn religious beliefs causing them to fund hospitals with names such as Saint Mary’s and such…), most of these hospitals were built in poor rural areas particularly the South. Enough beds such that their beds/capita came in line with the “well-off, liberal” Northeast.
But do to a quirk (actually a feature adopted by those resistant to such liberal ideas as maybe racism isn’t such a good idea), these federally funded hospitals were state-run. And the states in the South refused to allow these federal hospitals to serve black people under the rubric of “states rights.” Sure there were enough beds now—more than enough actually, as long as you were White.
The Civil Rights Act did nothing to fix this.
But Johnson was a smart fellow who, being from the South, understood the score, so he tied the funding for hospitals in the Medicare Act to the Civil Rights Act. In other words, if you wanted to get your Medicare payment, you had to desegregate your hospital.
As the conservatives are fond of pointing out, Medicare was one of the most lucrative entitlements in the history of health care. So during the 60’s, one by one, all these hospitals desegregated to suck from the Medicare teat. And as each hospital degregated, the infant mortality of Blacks in that area dropped precipitously. Now, it is statistically slightly better to born Black in the South than it is to be born Black in the Rust Belt (it is always better to be born White).
You know how we know this was the case? Because the governor of Mississippi was so worried that his hospitals might be secretly treating black people, he forced the state to keep accurate tabs on how many beds were devoted to each race and the exact instant when a hospital desegregated. So you can see this correlation down to the smallest cohort when examining infant mortality. But the data is such a statistical outlier that you can see the effect in IQ and standardized testing in the school systems 7 9 and 13 years later, and even in the military IQ test two decades later (as John Cole will tell you, every person who enlists is given an IQ test and states their state of birth). When you consider these people are in their 30’s and 40’s today, it is a increase in human capital (to use a labor economics term for it) that we benefit on today. These people are your and my peers.
By the way, the Civil Rights Act the same year as the Medicare Act: 1964 not 1968 as you claim. The Medicare Act didn’t go into effect until 1965. The Civil Rights Act, while a landmark piece of legislation, was toothless initially, with almost no enforcement, even over its showpiece voters rights pieces. That was changed incrementally by later legislation and judicial decisions.
3) Please refrain from engaging in ad hominems. While, I’m in a pretty high income bracket now, that was not always the case. Tarring the argument because I’m apparently a “well-off liberal” is the last resort of someone who doesn’t have anything to say. It’s that or I start calling you “the Jane Hamsher’s of the world.” ;-)
FlipYrWhig
@Jack: I’d be happy to change my tune, and that’s interesting to know, and not what I’d expect. But for the moment I’m going to continue to think that many people are confused about who they’re paying for what, and whether they’re non-profits or corporations or public agencies. I hope I’m not unusually dim about such things. But it wouldn’t be the first time. (And sorry for the digression.)
John Sears
Well all, it’s been real, but I have to make dinner for the breadwinner now, the one who keeps me in healthcare, at least until the Senate’s excise tax hits our plan and kills it.
Like it will everyone’s plan, eventually, as the tax isn’t indexed to health insurance inflation but is instead linked to the CPI.
Whoops.
Jack
@John Sears:
No, I don’t think so. I think that there’s something to the meme premise, that information travels in “viral packets,” that we may even one day discover the meme as a chemo-electric replicator. That we are, to some extent, informational petri dishes. Ideas spread, as do those ideas which we call beliefs, convictions and articles of faith. Despite differences of perspective and individual brain chemistry, ideas can be near identical in the memories of tens or tens of millions of people who hold them.
And that one particularly dominant one, among a certain political population, is that “this is it, this is the moment, and we won’t get it again for a while” informed even by an honest, if relatively unquestioned mood of despair.
I think a lot of liberals presume that the Dems will fail, and miserably, and that what follows will be Her Alaskan Highness, or worse.
John Sears
@terry chay: Err, that’s 95 per person, and the fine ramps up rapidly:
Penalty: Starts at $95 a year per person in 2014 and rises to $350 in 2015 and $750 in 2016, with a maximum of $2,250 for a family. No penalty if the cost of cheapest available plan exceeds 8 percent of household income.
John Sears
@Jack: I’m not a big believer in memes myself, but it’s an idea anyway.
Nice talking with you Jack. Later
Chad S
@John Sears: No, I’m talking about using budget reconciliation to insert a public option(or something along those lines) in the 2011 Budget, where they couldn’t take out nearly as much of it.
No matter what they passed, this would be merely the first bill, not the only one.
Jack
@John Sears:
I don’t think the meme theory is essential to the premise that ideas spread and that people come to believe them, and to believe in them, which was my core point.
And well met, to you, as well.
silentbeep
@kormgar
The subsidies aren’t as bad as you think. And i’m sympathetic to the debate that mandates really suck. But there is a reason why they caved, and I think Ezra Klein explains pretty well on why the individual mandate is so important. The mandate is vital for keeping costs down for the insured:
“I’m sympathetic to his thinking. This was, of course, Barack Obama’s position during the 2008 campaign. His administration has flipped on it, and they were right to do so. Here’s why.
Pick your favorite system. Socialized medicine in Britain. Single-payer in Canada. Multi-payer with a government floor in France. Private plans with heavy public regulation in Sweden, Germany and elsewhere. None of these plans are “voluntary.” In some, there’s an individual mandate forcing you to pay premiums to insurance companies. In some, there’s a system of taxation forcing you to pay premiums to the government. In all of them, at least so far as I know, participation is required except in very limited and uncommon circumstances.”
and about those cost controls, FYI
“In his post, Markos says the bill lacks “mechanisms to control costs.” I’d disagree with that, pointing to the bundling, MedPAC, the excise tax, the possibilities of a competitive insurance market, and more. The bill doesn’t do enough, but it does more than anything we have ever done before. But put that aside for a moment. As Atul Gawande argues, there’s no Big Bang of cost control. The public option wouldn’t have done it, and nor would Medicare buy-in. It’s a process. And this bill, in large part through the individual mandate, creates that process.”
http://voices.washingtonpost.com/ezra-klein/2009/12/draft_1.html
Jack
@Chad S:
http://en.wikipedia.org/wiki/United_States_Senate_elections,_2010
Plus, do you see some circumstance where Baucus, Conrad, Bayh, Lincoln, Landrieu, Reid, Feinstein, et al cooperate in reconciliation?
terry chay
@John Sears: By the way my plan is similar to yours, except I pay nothing for my plan)
I agree with you that health care costs are out of control. I think most people do. Even the American Medical Association is on board with that. We have only to compare our costs/GDP to any other nation.
Unfortunately, this is a bill about health insurance, not health care. They threw health care cost containment under the bus a long time ago, we know the why is because being battle-hardened by Medicare. Basically the goal of the bill is to change people’s mindsets into thinking health as a public good instead of a private consideration and a secondary goal is to put more people in the Medicare boat.
Maybe you feel that this bill will either increase the rate of rising health care costs or take the wind out of the sales for cost containment in the future. That is a possibility. As for me, I see a lot of trial balloons for cost containment being tested in the bill, and I see a lot of evidence that without the bill, costs will go up just as fast, if not faster.
Tom Hilton
@kormgar:
[Bangs. Head. Against. Desk.]
Chad S
@Jack: As long as Reid has 51 votes for reconciliation, any dems in states where the public option is unpopular(which isn’t many) can vote against it symbolically. And after this first bill is passed(and people realize that health care in America doesn’t focus around death squads who go around to eliminate seniors in order to give their cheap prescription meds to gay illegal immigrants), its usually much easier to pass anything else. Especially if the unemployment rate is shrinking(which it will be by next March).
And on the plus: yes. Its a much different beast when you put something in a yearly budget and play chicken to see who will try and vote against it versus doing a stand alone bill that its much easier to vote on. Hell, they could even do it as an amendment to the budget and just have to survive one vote to add it.
terry chay
@John Sears: Yes, I am aware of the costs ramp up rapidly (but are still small). I didn’t deal with that for a number of reasons.
1) I fully expect this to change during reconciliation with the house bill.
2) I expect the political environment to be very different during those years.
If you want health care cost containment, then you probably should be for a strong and steep ramp. If it affects people’s pocketbooks, then there will be a strong political will behind the what and wherefore of their insurance and health care costs.
Catsy
Some numbers will help. And let’s be generous with them, to be fair.
Assume a single-income family, $10/hr @40hr/wk. The take-home on that income (I know, I’ve been there) is around $320-350/wk, depending on how you do your deductions. Comes to around $1400-1500/mo. A premium that consumes 8% of that income will come to around $120/month.
Now, that’s a fucking spectacular rate for health insurance. I have a damn good plan subsidized through my job, and I pay about that much out of every paycheck. I imagine anyone–anyone–would be thrilled to get that rate, especially those who don’t have insurance now.
The problem is that even that 8% is going to screw anyone who is living paycheck to paycheck–and that’s a lot of people, disproportionately so those who are making that $10/hr wage. For people in that situation, $120 is the difference between eating healthy and eating ramen. $120 is the difference between being able to pay their electricity or not. And if they didn’t have the money to pay for health care before, they’re sure as fucking shit not going to have the money for copays after losing another $120/mo of income.
This mandate will hurt a lot of people.
It will put people on the street. It will take food from their children. The people it hurts will hate the Democratic party for a generation, and they will have every reason and right to.
Henry
I agree, no going back to the drawing board. I also think that it’s vital that we get what few insurance reforms are left in the bill done (pre-existing, dropped coverage, etc.). On the other hand, I think we should drop the individual mandate. It’s the one thing the insurance companies really want out of this, and we shouldn’t give it to them if they’re not losing anything. Let’s just say these other things are worth doing on their own, and get them done. Then, if the insurance companies want the individual mandate (and they do, along with the 10s of millions of new customers that go with it), they’ll have to back down on some of the other stuff to get it.
We need to realize that we’re not negotiating with republicans, we’re negotiating with insurance companies. They want the mandate, we want the public option — that should be the trade. Also, while i’m no expert on reconciliation, both of those sound like things that could reasonably be put into that process, especially if it’s supported by the insurance lobby.
Thoughts?
Tonal Crow
@terry chay:
Quickly ramping up the penalties won’t help contain costs. It’ll only breed more glibertarians railing against government mandates and extolling the very private health insurance they incurred the penalties for not buying.
terry chay
@Catsy: Those people you mention are going to opt-out of the 8% entirely and opt for the $95/person tax penalty. Those people (I’ve been there both unemployed and making $1500/month with no health insurance) are inordinately single person households like I was at the time. As you point out, an 8% plan wasn’t even an option, though a $100 tax penalty is certainly doable (that’s about half the times I treated myself to a 99c double cheeseburger).
Those people will be very pissed to be sure. I don’t know that many people who are happy come tax time. I’d say a great many of those who will be “lost for a generation” are looking for an excuse to vote Republican, and if it’s not this, it’s going to be bailouts for Wall Street.
Any 4 person household making $20k/year would jump at an 8% gross health care plan (though in many cases now, 4 person households are two income $60k/year and in a large number of cases one of the incomes has a nice job with benefits they can latch onto).
Brachiator
@silentbeep:
I’ve read this line of reasoning before. I think that Social Security and Medicare provided more immediate benefit than the health plan out there now. And I think it unhelpful to try to use historical context as an argument when the present is bad enough on its own. A colleague and I joke about libertarians who try to sell the line that “adjusted for inflation, you aren’t poor at all” to someone with no money.
However, nothing has yet been passed or signed into law, and we don’t know what the public’s reaction will be if health care reform is passed. I’ve noted my concerns and my consternation with the Democrats’ overly cautious, overly political approach, but I don’t mind being proved wrong.
Ian
@BombIranForChrist:
Really? Fuck minority rights?
terry chay
@Tonal Crow: Good luck repealing the law at that point then.
They’ll lobby for lower mandates and a slower ramp or want to make the mandates codified in the form of a public option instead of individualized.
There will be NO political wind behind removing mandates entirely once it’s in because the leverage mandates give people politically to enact further health care reform will be too much for anyone to pass up on (as has been seen in every 1st world country out there whether they be GB, Canada, Swiss, etc. they all have mandates).
As for the glibertarians, I thought you wanted to purge them from your party anyway. j/k ;-)
Tonal Crow
@terry chay: The point about the glibertarians is that a rapidly-ramping mandate will *create* glibertarians, and accompanying pressure to scuttle the entire mandates framework, if not all federal regulation of healthcare and Medicare along with it. The line will be something like, “See, we tried liberal Democrat socialized medicine, and it’s been a family-busting, death-panel-imposing, deficit-inflating disaster. But we never tried the free market. Vote Republican for freedom!”
Never underestimate the GOP’s ability to craft appealing, lie-filled rhetoric in the service of terrible policy.
If we’re going to impose mandates, we’re going to have to give the public something substantial in return — meaning an opportunity for real coverage with no more insurance-company gamesmanship — and we’re going to have to be able to sell it amidst a sh*tstorm of GOP disinformation.
kay
@geg6:
“Classism”? Because I’m a lawyer? Oh, please. I’ve been a waitress, and a postal worker and landscaper too.
I represent juveniles, geg, and I’m self-employed. I represent people in abuse neglect and dependency actions. I work exclusively in juvenile court. It’s not the most lucrative specialty.
I live a rural area and I’ve been here a long time. The median income in this county is 33k. I look at their contracts when they ask. I help them file bankruptcy. They call me with all sorts of things, because once I rep a family member, I’m ‘their lawyer”. As I mentioned, I deal DAILY with a state health insurance mandate, in the course of my work.
I’ve had federal health insurance. I’ve had state employee health insurance. I had a crappy plan out of the law school when I was in law school. I’ve also purchased insurance on the individual market. It was 800 dollars a month.
I’ve questioned some of your assumptions about what people will do with this bill, so that makes me a “classist”?
I think you’re wrong about the bill. I think you’re wrong about the affordability aspects.
I think it’s insane to say people won’t mind a mandate if it goes to one insurance entity (public option) but WILL mind a mandate if it goes to another.
If they’re writing a check for 120 dollars a month (which is a good price for a family policy) they’re not going to care if it goes to Blue Cross or Anthem.
Nick
@Zifnab:
no it isn’t, DADT is legislation, was part of the 1994 defense depart appropriations bill.
silentbeep
@Brachiator
“And I think it unhelpful to try to use historical context as an argument when the present is bad enough on its own.”
I simply see no benefit to chucking this whole thing and starting over. Not sure why you think historical context isn’t helpful at all. Poltical negotiations don’t take place in a timeless vacuum, precedent does matter for at least giving political negotiators and activitsts, a reasonable mental footing for the next phase of negotiation. You have to start somewhere. Overly political? This is political, these decisions take place in a political context, not in an ideologically one or a philosophical one. There’s isn’t any other way for this political process to be anything other than what it is: political.
” I think that Social Security and Medicare provided more immediate benefit than the health plan out there now’
And it will even be less “immediate” if we are to start over. I don’t see how this makes any sense to scrap this thing, we will simply be prolonging a really crappy status quo with no reasonable expectation that progressives will get what they want anytime soon, soon being within the next four years at least.
“I’ve noted my concerns and my consternation with the Democrats’ overly cautious, overly political approach, but I don’t mind being proved wrong.’
I disagree with you that this approach is “overly” anything. I’m not prepared to throw away what good there is left in this bill – even if I agree that this bill is something that I would much, much prefer be much, much better than it is. I simply don’t think changing a gargantuan system like the one we have with the health care industry, will happen any sooner, by blocking this bill.
I think you and I at least, are just not going to see eye to eye on this thing.
Irony Abounds
@John Sears: $300 a month for a Cadillac Plan like that? That has to be your wife’s contribution to the premium. Her employer must pay a substantial amount for that plan, and assuming that to be the case, do you honestly think that doesn’t impact the amount of money she otherwise makes? Employers just pass along the costs of increased premiums, one way or another, so they don’t really care what the ultimate cost is. Employees are stupid enough to think the insurance if free to the extent the employer pays, so they don’t care about increases in the premiums. Care to guess why health care costs have spiraled?
I have a problem with a plan that includes mandates but does not create any meaningful obligation on the part of the insurers to take all comers. I have an individual plan, which is expensive enough as is. Unless the law provides for some group plan that individuals are allowed to join, I will get totally hung out to dry because I make too much money for any subsidies. Even with that, I’m willing to get something passed now just to get out of the current horrible framework. Is the Senate plan great? No way. Better than nothing? More than likely.