Health Care Bottom-Line

as i said before (0.00 / 0)

   "Centrist in the West"  there is nothing "left" about this Blog. Its simply, an Insurance Cartel lacky.  

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by: Darwin26 @ Thu Dec 17, 2009 at 18:55:24 PM UTC

If the liberal activist wing manages to kill this bill... (0.00 / 0)

I will scream. I've already stopped reading several blogs because of how bent out of shape they've gotten about the bill now, including attacking the individual, which I thought EVERYONE agreed during the primary was the right thing to do. If this bill dies, we're STILL forced to buy private health insurance (unless you consider the huge risks of not having insurance a feasible alternative), but they'll be a lot less regulated! Even without a public option, this bill will save a LOT of people from dying due to lack of insurance. That's a lot more important to me than liberal identity politics or hating insurance companies. I'm sure someone will now accuse of ME of being an insurance cartel lackey too, but whatever. Lives saved, poor people given help thanks to taxes on the rich = a bill I support.

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by: Chris O. @ Thu Dec 17, 2009 at 19:00:35 PM UTC

The shine and stink of the senate's bill (0.00 / 0)

Which yardstick should we use to measure Harry Ried's bill? The yardstick that quantifies the bill's distance and direction from the status quo -- or the yardstick that measures the bill's distance from a single-payer system that would cover everyone and reduce costs? Both yardstick give valid, but very different answers.

If we measure the bill's distance from the status quo, the bill shines, or at least glows dimly. It outlaws (eventually) insurance practices such as denying coverage for existing conditions, helps some lower income people pay for insurance, and expands Medicaid. These are not trivial improvements.

But neither Ried's bill nor the bill passed by the House covers everyone. In remarks a couple of days ago, President Obama said the Senate bill would cover 30 million of the 45 million uninsured. That, he argued, was progress -- although 15 million might disagree. And since both the House and Senate bills lock in profits for the insurers, cost savings will have to be found elsewhere, probably by reducing benefits.

Compared to a single-payer system -- which is the only system that can cover everyone -- both the House and Senate bill stink. They ignore the success of Medicare and the Veterans Administration (and Canada and other single-payer nations), and reinforce the worst features (employer based insurance, for example) of our present system. That's change, but it's not really reform. And a lot of it doesn't kick-in for years because the implementation schedule is back loaded to meet budgetary and political goals. In the meantime, people will die because they cannot afford insurance, and others will survive but go bankrupt.

I agree with Matt that it might be easier to fix the Ried bill than to start afresh in a different Congress, but no one should suppose it will be as easy as it was to improve Social Security and Medicare. In those cases, it was a matter of expanding the right kind of system. If the "we'll help Americans buy private health insurance" bills pass, improving the health care system will still require moving toward a universal single-payer system. That requires of change of kind rather than a change of size.

Moreover, unless Democrats can expand their majority in the Senate to 70 members -- and expand it with liberals, not Liebermans -- changes to whatever passes in this Congress might be impossible. Because the Senate's rules have been twisted to require a supermajority for the approval of anything, a twisting that amounts to a defacto amending of the Constitution, it's hard to imagine any progressive social legislation passing while the supermajority requirement is in place. (The supermajority requirement presents us with a constitutional crisis with ramifications well beyond health care.)

A balancing of the equities and politics probably favors passing the Liebermanized bill, or something like it, but it's nothing for which I can muster enthusiasm. It may shine brightly enough to light the path forward, but it also stinks to high heaven compared to what needs to be done.

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by: jrconner @ Thu Dec 17, 2009 at 19:29:40 PM UTC

Measuring (4.00 / 1)

Since the choice before us (disregarded by the politicians as it appears to be) is to either favor passage of the bill or it's defeat, I suggest this measurement.  Set the goal, wherever you personally favor.  Measure from the status quo to the goal.  Then measure from where we land if this bill passes to the goal.  Favor whichever is shorter.

To me, it's pretty simple.  If this slug of a bill actually passes, then whether it works or not will remain a topic of discussion, enhancement, refinement and challenge.  If the bill dies, then the talk of reform dies with it, just like it did with Hillarycare.  It took 16 long years for any official talk of reform to make it's way back into the houses of Congress that time.  The reform effort itself has been going on for over 70 years.  Kill this bill and the effort goes right back down the memory hole as another failed effort of socialism by those evil Democrats.  So to me, the measurement is pretty clear.  I too and damned unenthusiastic about what the Senate has pulverized onto paper.  But I support it's passage anyway, because it is shorter to the goals I have.

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by: Rob Kailey @ Thu Dec 17, 2009 at 22:09:17 PM UTC

[ Parent ]

Parts are progress... (0.00 / 0)

parts are regress. But two baby steps forward and one or two giant step back does not a progressive bill make.

Unfortunately, tying the mandate to a private insurance option only will dictate the future of any and all other health care reforms. Passing this bill with the mandate is reason alone in my book to kill this bill.

Take the mandate out, and I can support much of the rest, enough so to hold my nose over the other unpalatable provisions. Take the subsidies and let us poor people and undesirable risks to use them to purchase basic health care out of pocket, and give a huge infusion to community health clinics.

Make no mistake, Matt. The mandate for private only will be the undoing of the democratic party. It will kill off left-progressive support for democrats enough so to tank many of their prospects in '10 and '12. You can bet that someone like Howard Dean or Dennis Kucinich will primary Obama and make life hell for him during his reelection bid. And if things continue as they are, the first term of the Palin (or other conservative republican) admin will kill it all off before it even gets implemented.

Liberal and progressive dems caving to Lieberman, Nelson, et al., will set the seeds for the demise of the dem party for another generation. And anybody who thinks the public option, or medicare expansion will ever happen after (or if) this bill passes is just plain looney.

The only hope we have is that after history, a generation down the road, determines that the ploy to lock in private insurance as the de facto model for the U.S. has failed, and that our health care system has continued to unravel, that maybe a more forward-looking and less political truly universal single payer model will be constructed.

All the rest I'm hearing are just attempts to sugar coat the political damage the dem party is self-inflicting. This liberal and centrist attempt to coerce the uninsured into providing the base for reform via a mandate is, in my previous words and commentary, a fascist maneuver. Corporatism run amok. Crony capitalism at its worst. Unamerican, even if Baucus thinks that it embodies the "uniquely American solution" he was looking for. Not in my america.

And this bill really makes me think that we've all wasted our time here debating single payer vs. the public option. The HCAN-led propaganda machine seems to have been geared towards this moment of absolute apologism.

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by: JC @ Thu Dec 17, 2009 at 20:49:48 PM UTC

I'm curious (0.00 / 0)

Unfortunately, tying the mandate to a private insurance option only will dictate the future of any and all other health care reforms.

I'm not seeing any foundation for this claim, so I'm curious where it comes from.  The status quo already requires that if you want coverage, you will purchase private insurance.  To those who can't afford it, the mandate will give them coverage (require it) but subsidize it.  But what I'm not seeing is the dictate that all future discussion of reform must include the private insurance mandate.  Could you clarify, please?

2 other points.  If this bill passes, the mandate for purchase will come under legal attack from both the right and the left on Constitutional grounds.  I am of the opinion that that challenge will eventually force the removal of the mandate.  I could of course be wrong on that.  But it keeps the topic under both legal and legislative discussion.  It will not be what many fear the most, a 'done deal'.

Second, tracking poll numbers suggests that the political damage to Democrats has already been done, whether the bill passes or not.

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by: Rob Kailey @ Thu Dec 17, 2009 at 21:51:51 PM UTC

[ Parent ]

We're at a crossroads (0.00 / 0)

The whole meta-debate about health care reform has been about the structure of our health care system. Single Payer. Private insurance-only. Hybrid public-private. Co-op.

Creating a pseudo-universal system that relies exclusively on private insurers will lead to a continuation of the philosophy of "build on what we have." What will be the incentive to break a private-only system once it has been strengthened, and insurers have been fattened by their addiction to subsidies? When in the history of this country have we handed over such funds to the private sector to provide a basic human service? People decry this bill as a huge entitlement that will grow out of control. That may be half-right, with the recipient of the entitlement being health insurers. Why should the government be in the business of providing a guaranteed level of profit and wage to a whole class of private corporations?

Moving to a private-only system strengthens the monopoly that these insurers have on those outside of the VA, Medicaid, and Medicare systems. And that cements this health care system into a final form. I just don't see how any future congress will be able to deconstruct that system into one that includes a public component. If we can't do it now, what makes you think we can do it later, when the deck is further stacked against single-payer/public option advocates?

You have previously been adamant about single-payer advocates taking away your right to choose a private health insurance option. Well, Congress is taking away the choice of a large segment of the public to construct a public system that they could choose that doesn't rely on private insurers.

I'd disagree with your statement that the "status quo already requires that if you want coverage, you will purchase private insurance." I cannot purchase private insurance in Montana. I'm don't qualify for Medicaid or Medicare. So the status quo has rationed me out of the system, unless I was able to change careers and get hired to work at a large enough business that could afford to cover me. And I don't believe that under the new system that I'll be able to afford a private policy, as I don't believe that a subsidy will materialize. I ask the question again: who are the 20 million who will not get mandated? How and why will they be exempted? How many of them will go to jail if not exempted?

If I were able to afford a policy, would I ever be able to afford to use it, or will the forced purchase with inadequate subsidies leave me (and millions of others) unable to cover out of pocket expenses--deductible, copays, and underpays. In other words, the amount of money I have available to consume a minimal amount of health care will now have to go to purchase a policy I cannot afford. And then I will have to forgo even a minimal amount of health care.

Dictate may have been a harsh term, but I just don't see congress ever looking again at a public component for a national health care program. You can try and convince me that I'm wrong, but I just don't see it. And any scenario that you may foresee that may force congress into action, is a scenario that they should be anticipating now. Unfortunately, it seems that they have blindly drank their own propaganda about the success of their actions, enough so, that they are unable to see the negative consequences of their actions.

For your other two points, I'm sure the constitutional challenge will be made. And actually, I'm surprised that tea baggers haven't raised the issue of the mandate as a rallying cry behind which to oppose this bill. It is a much more real threat than death panels and other absurdia. I think that democrats will eventually decide that it is political suicide to continue on with a mandate without a public alternative of some sort.

As to the poll tracking numbers, sure a lot of damage has been done. But once the mandate kicks in and people start having to write checks to the likes of MegaHealth, or face fines, penalties and imprisonment, you'll see a whole 'nother crowd of people who will hate on dems for many years down the road. And as long as the mandate punishes people for being poor, old (but not yet 65) and previously uninsurable, democrats will take the heat and lose votes and support.

One more point. Folks like to say that Obama never campaigned on a public option. That may or may not be so. But he sure the hell campaigned on not having a mandate--that being a large area of distinction between him and Hillary Clinton.

I'd chalk up a bill signed by Obama that contains a mandate, without some sort of mediating public component to be an egregious violation of a campaign promise. Enough so for me and millions others to question any future promises he may make, and an unpardonable breach of trust.

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by: JC @ Fri Dec 18, 2009 at 00:16:35 AM UTC

[ Parent ]

Several things (0.00 / 0)

I won't blockquote you extensively, because it is kinda jerkish, but you make several points I wish to respond to.

1)  Despite the delusions of some, I am not defending Obama concerning this bill or this effort.  I tend to agree with you about the campaign lies.  If anything, I guess I just expect politicians to lie to me.  Don't like it, but I do expect it.

2)  The mandate will be most egregious to the middle class who already have jobs and insurance.  The lie that others are getting something for free at your expense will become very very real at that point.  If it's one thing that Republicans are very good at, it's creating the justifications for their paranoia after the fact.  Whether this bill passes or not, the Democrats are already in a world of hurt come election time.  The lies made real are simply a punctuation to the point that Democrats will likely not keep control of the Congress come 2012, and it's a serious concern about the White House.  This has already come to pass.

3)  I've no interest in trying to convince you that you're wrong about the actions of Congress, except along these lines.  Our Congress has become reactionary.  They have no interest in disturbing the status quo.  If the bill fails, it's back to square one, with Congress having no interest.  If the Senate bill passes, then we have pressure on Congress to make certain that it works.  You don't think it will work, and neither do I.  Having that pressure gives the impetus for change.  Falling back to the status quo gives none.  Building on what we have is only an issue if we have the urge to build.  No one builds Swamp castle if our politicians have decided to be comfortable and complacent with the status quo.  The failure of this bill is exactly that, the status quo.  I seriously do have concern for your position, but I and you know that it won't get better under the current system, and people such as yourself have no power to apply to a complacent Congress, except to replace them with Republicans who really relish your pain for their profit.  Passing the bill keeps pressure on.  Accepting the current system will not avail you at all.  And for the record, I think that very few of the powerful are utilizing any philosophy at all.

4) Our government has already subsidized and endorsed necessary industry in the same manner that exists with the Insurance mafia.  60 years ago, we were warned about the military industrial complex, and little has been done to check it.  What is happening here is not new under the sun, but it could be a great deal more painful and challenge worthy than public financing of bombs.  Americans like war.  Meaningless taxes, domestic death and suffering ... not so much.  There is no moral imperative that can be applied here, as in the "war on drugs" or terror.  War on our own citizens will quickly become distasteful.

5)  I still sincerely believe in choice.  I also believe that damning a 200 billion dollar a year industry (probably more) to quick extinction when the unemployment rate is already over 10% is a really foolish idea.

There's more, but this will do for now.

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by: Rob Kailey @ Fri Dec 18, 2009 at 01:03:32 AM UTC

[ Parent ]

not quite........ (0.00 / 0)

if this p.o.s. bill passes then obama owns the higher premiums that the middle class now pays. if he pulls the plug and blames blue dogs, corrupt insurance execs and republicans when insurance premiums go up (as we all know they will in both instances) then the blue dogs, assholes and republicans will own it.

this bill is so despised now that it would be political suicide to pass it. the question should be are we willing to trade obama's second term for this p.o.s.? i'm not.....i would like a second chance to keep obama and push for single payer again in 2012.

if obama kills this forcefully enough by condemning everyone who ruined the bill, he can possibly escape the trap. if it passes, obama is in grave danger of owning spiraling health insurance premiums.

and of course, jobs are paramount now. if obama announces that health care will be revisited in 2012 after we correct unemployment, that would be understandable to the middle class also. we worked hard to get here. i just see passing this bill as a huge trap now. it is not enough for obama to simply shrug his shoulders if it dies in congress. he needs to very forcefully kill it. americans despise it now. it is poison.  

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by: problembear @ Fri Dec 18, 2009 at 01:21:44 AM UTC

[ Parent ]

Helping some, but not solving the bigger problem (4.00 / 1)

Despite my support for a single-payer system combined with an end to fee for service medical billing (see "A Second Opinion," by Arnold Relman, M.D., for details), I'm not joining the chorus calling for the Ried bill's death. It has many flaws, but it does help some people.

But the bill's approach -- "let's help people buy private health insurance policies, and while we're at it, regulate the private health insurance industry" -- doesn't solve the major failings of the current system. Ried's bill apparently covers 30 million more, but leaves another 15 million out in the cold. Thus the bill fails to achieve the objective of universal coverage. Nor does Ried's bill rein in projected costs, except on paper. That's because it preserves profits, and requires additional bureaucracies to administer means tests and so forth. Therefore, at some point health care must be revisited.

But improvements cannot occur until the Senate operates on a majority rule basis -- and we do not know when that will happen, if ever it happens. In 1787, Oliver Ellsworth and Roger Sherman, both representing Connecticut, brokered the Connecticut Compromise, which provided that the national government would have a bicameral legislature, with the senate comprising two representatives from each state, population notwithstanding. That undemocratic agreement solved the larger problem by making the Constitution possible, but it left the nation with the potential for the kind of mischief that can arise from a body in which minority interests are grossly over-represented.

One kind of mischief, unlimited debate in the absence of a supermajority to close debate, worked its way into the rules early on, serving as a device for preventing a decision on civil rights measures. Although the Constitution gives each chamber of Congress the power to organize itself and adopt its own rules, nothing in the Constitution suggests that rules requiring a supermajority for ordinary business was what the founding fathers intended. The history of the Constitution's drafting and adoption suggests that the fathers' mechanism for insulating the Senate from the winds of the political day was not supermajorities, but, rather, six-year terms and staggered terms so that only one-third of the body was elected every two years.

History notwithstanding, the Senate now operates as a body in which the minority vetoes legislation in the absence of a supermajority. When that perversion of majority rule is combined with the perversion of one man, one vote, just 41 senators, representing 11 percent of the nation, can prevent the passage of legislation that a majority of the senators support.

This is an extraordinarily dangerous situation. The potential for the current situation has existed for parts of three centuries, but because by gentleman's agreement it usually was exercised only for civil rights legislation, the Senate function on a majority rule basis. Now, thanks to Mitch McConnell and his feckless band of nihilistic reactionaries who rally under the Republican flag, the Senate no longer operates by majority rule.

This is why even modest health care legislation is on the edge of defeat -- and why I'm not in favor of killing Ried's dead mackerel by moonlight bill. It helps some people, although in an unsustainable and wrong way, but it might be the only health care legislation that will ever be approved as long as the Senate makes the pre-Parliament Act of 1911 House of Lords seem progressive.

And it's not just health care reform that is in peril because of the Senate. All progressive legislation is. And the nation is deprived of the ability to make decisions on matters on which public opinion is closely divided. We're in big trouble. That's why I've devoted much of this post to addressing the Senate's structural dysfunction and the latent problems of the Connecticut Compromise.

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by: jrconner @ Fri Dec 18, 2009 at 01:20:50 AM UTC

comments that start with "you" (0.00 / 0)

are usually ignored by me, mark. as far as i am concerned they are usually "free advice" worth exactly how much i pay for them. unsolicited advice from anyone so socially challenged as to use it is usually viewed as arrogant, intrusive and unwelcome.  

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by: problembear @ Fri Dec 18, 2009 at 05:07:57 AM UTC

i understand your point matt..... (0.00 / 0)

"...if this bill dies, private insurance is still the only route to coverage for most Americans, but without subsidies, without regulations, and without an understandable marketplace. That's a damn good point."

i agree it is, but consider this. by pushing for this bill democrats own it. when they own it, they own all the increasing insurance premiums too. that will enrage the middle class.

now you and i know that the insurance rates will go up anyway no matter what. hell, everyone does. they have been so bold as to tell us ahead of time. why not have the republicans own it instead by obama killing the bill and blaming them?

think about it. bill passes- no second term.
i would rather have obama around the next 7 years than take this weak-ass bill. it is a trap. anyone who supports it is either not paying attention to the middle class or is deluding themselves that there is enough good in it to make up for huge increases in our premiums.

oh- and i would really love it if people get those increases after obama kills it and blames the republicans for standing in the way of the public option or single payer. that is golden.

so it is obama's choice - take the gold or pass this poison.

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by: problembear @ Fri Dec 18, 2009 at 05:39:18 AM UTC

Seems to me we are ONLY talking about (0.00 / 0)

passing a bill OUT OF THE SENATE....this still has a long way to go because the Senate bill is quite different than the bill that came out of the House..so..."killing" the Senate bill simply means the Senate could begin the process again in a committee and bring forth another bill that eventually would go to Conference where there would be a melding of House and Senate bills...

OR...they simply pass this POS bill and IT GOES to Conference where more reasoned people meld it with the House bill and it comes back for a straight up vote needing 51 votes to pass the Senate in its final form.

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by: bigsage @ Fri Dec 18, 2009 at 13:19:03 PM UTC

The are several roads to reconciling (0.00 / 0)

a house and senate bill. And the one that is the scariest is that the senate bill returns to the house and is voted on unchanged.

There have been whispers that this is the route that the administration prefers, as it prevents another round of compromising the bill back to the left, and freezes out House progressives. That the senate bill is indeed the bill that obama wants.

And it would be the final nail in the coffin of the democratic party, as far as the left is concerned. The true left, that is. Not the left that has slid to the center, and became indistinguishable from the Ben Nelsons and Joe Liebermans of the world.

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by: JC @ Fri Dec 18, 2009 at 17:59:20 PM UTC

[ Parent ]

Silver lining (0.00 / 0)

Sure I got gang raped but at least they didn't kill me. Wow. Once your expectations have been so thoroughly strangled it is truly amazing what can be rationalized.

There will be an invigorated "movement" but it will not be about packing the Senate with "progressive" Dems.

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by: troutsky @ Fri Dec 18, 2009 at 20:14:12 PM UTC

Minimalizing Rape (0.00 / 0)

Is an awfully petty and ignorant tactic.  It also denies that this compromise might actually save some people from being killed by lack of health care coverage.

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by: Rob Kailey @ Fri Dec 18, 2009 at 21:16:03 PM UTC

[ Parent ]

No one mentioned "moral purity", jed (0.00 / 0)

I've just known too many rape survivors.  Funny thing, they tend to have problems when people foolishly equate displeasure with a violent and horrible crime.

Essentially, what troutsky wrote is that the goal should be the purity of the principle.  That's kinda hard to swallow when his weak allegory suggests that death is the worst of outcomes.  Making the claim 'give me my principles or give others death' just doesn't have that snappy kind of ring to it, wouldn't you agree? If the goal is to cover more people with health care provision, and this bill works to achieve that goal, then supporting it isn't a rationalization.  It's working towards the goal.  troutsky and myself just have different goals, which is almost always the case when the perfect becomes the enemy of the good.

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by: Rob Kailey @ Sat Dec 19, 2009 at 18:20:05 PM UTC

[ Parent ]

Funny that (0.00 / 0)

I put up a diary asking people to spell out exactly what inches they expect others to give.  It's kinda humorous how few people actually took me up on it.

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by: Rob Kailey @ Sun Dec 20, 2009 at 17:42:23 PM UTC

[ Parent ]

Surely you understand allegory? (0.00 / 0)

Not so long ago this blog was discussing why young people are so quickly disenfranchised. Can you be so totally blind as to not see it has something to do with PRINCIPLE?  Some sort of moral compass?

This bill may (?) save a few people from dying in the very short term but by reinforcing the general cynicism ( Copenhagen, Afghanistan, EFCA and now this debacle) you drive a stake in the heart of your whole "hope for change progressive" fantasy.By not asking how can it be possible so many people are dying from corporate murder in the first place you speak volumes. I actually thank you. You have helped my organizing efforts immensely.

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by: troutsky @ Sat Dec 19, 2009 at 14:51:33 PM UTC

looks like this p.o.s. is gonna pass for christmas.... (0.00 / 0)

we'll all have a slice of poison-pill-mandated hcr with corporate entitlement sauce please. i'll try and choke it down with eggnog laced with copious amounts of jd.

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by: problembear @ Sun Dec 20, 2009 at 19:07:28 PM UTC