Health care postgame

The Monkey Cage’s prediction is right on target, IMHO (via Patrick Appel):

As soon as something passes, the narrative will switch to how amazing it was that Obama actually pulled off healthcare reform, something that has bedeviled politicians for ages and even stymied the Clinton administration. At that point, the fact that there was opposition on the left and the right will make the success seem that much more impressive, as will the fact that administration has been active on so many fronts at once. No bill, though, and it looks like a failure. So I think that’s why you will probably see increasing flexibility on the part of the administration to make sure they pass something.

I also tend to think that almost any bill will be better than what we have now. I’m for a public option — actually, I’m for single payer — but just about any bill, within reason, will be a tremendous political accomplishment. To be perfectly honest, I’m surprised things gotten as far as they have.






95 replies
  1. 1
    bob h says:

    I agree that any bill that extends coverage to millions presently excluded with the most heinous insurance practices banned would be a huge, intitial advance.

    What makes me pessimistic that even that will occur is a suspicion that the private insurers simply will not abide by any strict regulation of their practices. You might as well try to make a deal with the Mafia or Al Qaeda. These people are simply no good and not to be trusted.

  2. 2
    linda says:

    although a deeply cynical person, i actually agree with this post. esp watching the crazy the past couple of weeks spin way the hell out of control, i’m guessing that most were completely turned off and the take away (except for the crazies) was how unhinged and nasty the republicans and their base are.

  3. 3
    Barbara says:

    Let me tell you what would not be better: mandating that individuals buy insurance they cannot afford.

    My view is, no public option, no mandate.

    All of the other health insurance reform stuff is the right thing to do anyway, and does not “work” or “not work” based on a mandate.

    But without a public option there is simply no way to control costs, and people should at least have a choice in determining in what way they would like to mortgage their future — by purchasing health care or not.

    The issue of adverse selection is a real one, but there are less draconian solutions — for instance, after an initial one year period in which anyone would have the right to buy any policy (no underwriting), there would be an open season comparable to what happens now in the federal employees plan. You could not simply decide once you got a diagnosis to buy insurance. If you were diagnosed with lung cancer in March, you would have to wait until January to get coverage. You could get it — but it would be a strong incentive for many people, and I think there could be some kind of surcharge for late purchasing, and exemptions for changes that are necessitated by loss of employment related coverage.

    In other words, there are many strategies short of a mandate that could make “insurance reform” work. There are very few viable strategies that have been floated to make cost control work.

  4. 4
    Punchy says:

    What exactly did Clinton try to do? Did he try the public option as well?

  5. 5
    Ash Can says:

    I agree. Furthermore, whatever ends up getting passed, with its warts and all, can always be tinkered with and built upon in the future. The first step in moving this country toward universal coverage is the biggest. It’s like jumping into chilly water — once the initial shock is out of the way, you’re ready to get swimming.

  6. 6
    rts says:

    Exactly. We have to get started somewhere. Any legislation that provides for reform and particularly any law that eliminates the ability of insurers to decline coverage for pre-existing conditions will be a big step in the right direction. I could live without the public option (or single payer) if we pass law that turns insurers into a more regulated industry akin to public utilities. That would be a step forward. Let’s push as hard as we can for the public option but be prepared to accept measures less than that if need be. Don’t let the perfect be the enemy of the good.

  7. 7
    Ed in NJ says:

    I look forward to seeing how the Democrats and the media are going to spin it if we are left with mandates and no public option or co-ops.

    In other words, a big fat gift to the insurance companies, and a big fat bill and limited benefits to millions of people who don’t currently have coverage.

    Sure, we’ll protect people from losing their homes and going into bankruptcy due to a serious illness, but do you really think people are going to understand that? Are the young and healthy engaged enough politically to understand why they are forced to give up their limited income for something they don’t think they need?

  8. 8
    J.A.F. Rusty Shackleford says:

    I’m holding out hope that Obama and his crew will be able to convince the Democrats to vote for cloture and then pass a bill that includes the public option with at least 51 votes.

  9. 9
    Patrick says:

    For all the concern trolling and out right hostility, this is about as close as anyone has gotten to meaningful reform in two generations. The fact the Republicans have stood behind their fringiest element and been completely uncooperative, has left things wide open for the Dems to use any parliamentarian trick in the book. While the Village might care how the legislation is passed, nobody else will. It will be a huge victory.

  10. 10
    Max says:

    I think that those on the left that dislike Obama, see PUMA, will continue to use this process and the outcome, no matter how successful, to rail against him.

  11. 11
    tc125231 says:

    Something MIGHT be better than nothing. Or it might turn out to just be another way to transfer our income to the corporate world, with little regulation and few safeguards.

    The idea that it can easily be tinkered with later is, I think, naive.

  12. 12
    DougJ says:

    What exactly did Clinton try to do? Did he try the public option as well?

    No. Basically, they (it’s not appropriate say “he” here) designed some kind of a nationwide HMO system, which would, I think, expand coverage but without a public option.

  13. 13
    BR says:

    I’m with Barbara – if there’s a mandate to buy private insurance and there’s no public option, it’s a bad bad deal. Obama himself fought the good fight during the primaries against any (adult) mandate, even with a public option. To add a mandate and lose a public option would be devastating.

  14. 14
    SGEW says:

    Is it just me, of does this sound like it might actually work?

    The White House and Senate Democratic leaders, seeing little chance of bipartisan support for their health-care overhaul, are considering a strategy shift that would break the legislation into two parts and pass the most expensive provisions solely with Democratic votes.

    (via)

  15. 15
    Brick Oven Bill says:

    I know it is always wrong to invoke images of Special Olympians.

    But praising the Obama Administration for their performance on any aspect of this health care issue is a very close parallel to applauding while some disabled children trip amongst themselves as they try to make it all the way to the finish line.

    Another parallel would be Stan’s evil clone from South Park, but without the superhuman strength, and with less coordination.

  16. 16
    PeakVT says:

    Whip your Senator. Wyden, Warner, and Tester are maybes, and Byrd is unknown. Those four plus Vice President Shuchuwer = very different calculus.

  17. 17
    ericblair says:

    I’m optimistic that something substantial will pass, at maximum in the next couple of years, since the current industry looks like it\’s in a classic insurance death spiral. Higher costs (and big profit margins) cause higher premiums, causing subscribers to drop out of the system. However, the uninsured still incur costs that they can\’t pay for and the system has to eat, passing it on as higher costs to the insurers, causing higher premiums, and on and on until boom. Happened to auto insurance in Pennsylvania a while back, I think.

    Once we get some sort of universal coverage there\’s no turning back. No country to my knowledge has ever done this, and any politician that suggests it gets his ass handed to him post haste. Version 1.0 of healthcare reform will not be perfect by any means, but nothing in politics is ever finished.

  18. 18
    Rommie says:

    I don’t want the joyous mandate of being forced to choose, and only choose, which private corporation can steal my money and refuse service. You can bury that version of a final bill in the Core of the Earth, along with the spin the weasels would dance to make it seem “reasonable”

    I think (hope? pray?) the threat of the GOS Rebellion that would trigger is more than that of 3rd Manassas for getting a good bill signed.

  19. 19
    Llelldorin says:

    @SGEW:

    I’m not crazy about that idea; I’m afraid that once the public option is in its own bill it’ll be killed by parliamentary maneuvering in the Senate.

  20. 20
    Clember says:

    Here’s my take, for what it’s worth:

    Like it or not, the “image” of health care reform is a strong public option. Very little else is ever discussed.

    If the public option is not in the final bill, it will be perceived that the Democrats failed and are weak, in spite of all the other good things the bill *will* include. There can be no doubt the Republicans will capitalize on that perceived failure during the mid-term election process. They will crow how they defeated health care reform and, without any sense of irony, find a way to take credit for the better health care policies the insurance companies will have been forced to offer.

  21. 21
    Malron says:

    Tut tut, Doug. There you go again, injecting reality into the discussion….

  22. 22

    I agree with Doug J. The question we’re facing is “How much good will X health care bill accomplish?” Getting some serious regulations on the insurers and subsidizing coverage for the poor would be meaningful accomplishments, even if I don’t get the pony.

  23. 23
    Malron says:

    @Llelldorin:

    I’m not crazy about that idea; I’m afraid that once the public option is in its own bill it’ll be killed by parliamentary maneuvering in the Senate.

    Not if its added as part of the budget reconciliation process.

  24. 24

    Rommie

    I don’t want the joyous mandate of being forced to choose, and only choose, which private corporation can steal my money and refuse service.

    All of the bills being considered – including the Senate Finance Committee – include regulation forbidding the refusal of service.

  25. 25
    JGabriel says:

    Doug, I disagree. A bill without a public option might or might not be portrayed as a failure by the media, but it will definitely be a disappointment to many people – hell, a recent poll showed 54% support for a bill with a public option but only 37% support for a bill without one – and it will feel like a failure.

    The last thing we need is another giveaway like Medicare Part D, which is what mandated insurance without cost controls will turn into.

    So, I don’t think any bill will be better than what we have now, but I remain optimistic that we will get a good bill once September/October come around.

    .

  26. 26
    oh really says:

    I also tend to think that almost any bill will be better than what we have now.

    Wow, that is really naive.

    It is easy to make things worse, and people like Baucus are just the ones to get that job done.

  27. 27
    BC says:

    Clinton’s plan was really the Federal Health Benefits Program writ large, sort of like the exchanges that Obama is touting. That is, there would be all kinds of insurance companies in the Alliance (HMO’s, PPO’s, fee-for-service) that could be chosen by the employer or by the individual. The idea was that the Alliance would provide the same coverage for the same price to all comers. As I recall, there was no individual mandate but there might have been an employer mandate. There was no public option and I’m kind of hazy on what the insurance regulations on pre-existing conditions and recisission were.

  28. 28
    alien radio says:

    The optics of “pass anything” are too good politically for the various democratic factions too ignore, the village will marvel at the sheer genius of getting healthcare passed, because of course only something of ultra godlike worldchanging cleverness (rather than merely clever politics) could have happened when the village are so sure it’ll never happen, and have so much invested in it not happening, and the village loves it’s narratives because they take less work than real reporting.

    not passing a bill is fatal for conservative dems in red districts.

    for the first time I can think of the progressive caucus has the votes to put the bluedogs balls in a vice.

    The blue dogs think with their wallets, they know that their republican cover is being stripped away because republicans aren’t relevant any more, there are lots of ways the public option can still happen, and very few ways the republicans can stop it short of strapping c4 to their chests and running into the capitol building. stopping the public option requires too many things to go exactly right, requires too much planning, competence and flexibility on the part of republicans.

    the bills aren’t even out of comittee yet, and I have to assume max baucaus knows he’s been totally played, and a senatorial ego is a fragile thing, he’s going to grandstand but ultimately he’s going to fall in with what obama wants, because after being punk’d by grassley he’s going to want to stick a shiv in him.

  29. 29
    gypsy howell says:

    You wait & see what happens if they pass a bill making it mandatory to buy insurance from private, for-profit companies. Any regulations which impede the profitability of the insurance companies will be watered down, overlooked, not enforced, or simply re-written next year, and your premiums will skyrocket. Meanwhile WalMart and all the other corporate scumsuckers will find ways to drop insurance coverage for their employees altogether, or make you pick up so much of the tab that you might as well buy it in the individual market, which is what I’m doing right now. How many of you out there can afford $1200 per month premiums? Because that’s what you’re going to get.

    Then what, o Mr Lebenty-lebenth Dimensional Chess Master President?

    This is my line in the sand for democrats. Better no bill at all than no public option.

  30. 30
    SGEW says:

    Re: reconciliation, Ambinder gives some more context here.

  31. 31
    SpotWeld says:

    My only argument about “Even a weak bill is better than no bill” is that while half a loaf is better than none, a platefull of stale crusts is not a loaf of any proportion and if you’re given said crusts with the label of “1/x of a loaf” there is the opportunity for opponents to any change will simply say something along the lines of “Why are you asking for more break… you haven’t even finished the loaf we gave you.”

    See the “Cash for Clunkers” program. It was stripped down as part of the effort to get the stimulus though congress, proved to be very sucessfull, but critis were still able to get some miliage from the fact that the program, as passes, ran out of money too fast.

    The public option, specificially it’s core concept of creating competition though a plan that anyone can get into, must be in the bill in some manner. It’s the keystone on which any actual change must be built. (If you can get it in there via some other method that is essential a “public option” with another name, but so far the co-ops and other proposals are just soft concepts that can simple be turned into the current system with a new hat.)

  32. 32
    edmund dantes says:

    No. Any bill won’t neccessarily will be better than what we have. As some have noted, if the bill that eventually comes out (and it’s a fairly strong possibility of it happening) mandates insurance without a public option to act as a check knows we are screwed if you have paid attention at all to how things work. Too often people rely on the benevolence of other politicians in the future.

    Look at how that worked out for us under Bush. Regulations mean jack shit unless you can guarantee the person enforcing them is always going to do so to the best of their abilities and to the original intent.

    So no any bill that comes will not be a victory. There is a huge potential for a bill that comes out that is actually worse than what we have now. It only takes a little imagination and a long enough memory to remember the past 30-40 years of the current Republican party trajectory.

  33. 33
    Robin G. says:

    I agree, but that’s not the way political advocacy is done. It’s like any negotiation — you go in asking for everything you have to have, everything you think would be awesome, and the other guy’s car. You don’t start with reasonable requests because you’ll never get anything. The Republicans get this.

    We have to pass a bill, any bill, and it will be better than the status quo. But look at how much the debate has even changed from this time last week – the public option looked dead then and now it’s still got a solid chance. We need to keep loudly pulling on the other end of the rope, no matter what we’ll settle for in our heart of hearts.

  34. 34
    gypsy howell says:

    @JGabriel: The last thing we need is another giveaway like Medicare Part D, which is what mandated insurance without cost controls will turn into.

    Yeah, with the added benefit of YOU paying the premium for it, not the medicare system. The reason the Medicare Part D giveaway doesn’t rile people up as much as it should is because it’s not coming directly our of your pocket. Mandatory for-profit insurance will be a little more painful for a lot of people.

  35. 35
    Crashman06 says:

    @Ed in NJ:

    I look forward to seeing how the Democrats and the media are going to spin it if we are left with mandates and no public option or co-ops.

    What you said. Mandates and no public option will be a complete disaster.

  36. 36
    J.A.F. Rusty Shackleford says:

    @Brick Oven Bill:

    Speaking of retards…

  37. 37
    BC says:

    Oh and about success – well, if there are more people who know they can get health insurance at affordable price even if they lose their jobs, then that will be success. If there are fewer people going bankrupt because the cost of their health care exceeded the insurance cap, that will be success. I think Medicare Part D is really shitty, but the people covered under it – even with that dastardly doughnut hole – are happy with it because they had no prescription coverage before. Something is always better than nothing in this regard. But I do agree with most of you on one thing: if there is no public option, then there should not be an individual mandate.

  38. 38
    MBSS says:

    individual mandates along with weak governmental assistance is a recipe for disaster. it is a giveaway to pharma and private insurance. there will be no negotiating with pharma for lower prices and private insurance will have a new influx of unwilling but captive customers.

    a nightmare. worse than nothing. can we be honest and admit that the democrats are captive to the same forces as the republicans?

  39. 39
    Sentient Puddle says:

    Yeah, as others alluded to, the Baucus bill at one point had an individual mandate with no public option. It ain’t easy to find a way to make the current system worse, but that was one such way.

    Beyond that, what I’m more worried about is Dems losing the will to press on after this bill, either because the fight just gets too rough, or because they call whatever they pass “reform” and call it good. I’m all fine and dandy with incremental reform, but that does mean that the game is nowhere near complete.

  40. 40
    Rommie says:

    @joe from Lowell:

    Eh, it’s about what a ‘final’ bill would have than the current proposals – there are versions that more than a few people would see as Pyrrhic victories.

    “Any bill that passes is a Victory” I mostly agree with – but not 100 percent.

  41. 41
    aimai says:

    I don’t know if I agree that “its such a tremendous thing to achieve this bill over the objections of the left and the right” that any bill will be a great achievement. I guess I don’t believe that it would have been impossible to pass a *great* bill with a *very strong* public option leading to single payer eventually.

    Basically, the stars were aligned for Obama to pass a great bill–in fact all the bills out of hte house and senate *except for the finance bill* are pretty darned good. The problem we are having with the “blue dogs” and max baucus and grassley et al are *completely self inflicted* by Obama and Rahm. I don’t see that we would have had worse opposition to a great bill–death panels and all–than we actually have had with the republican opposition lined up the way it has over imaginary death panels.

    Greenwald makes a damned good case today that Obama and Rahm were simply using the public option as a stick and a carrott to keep the insurance companies on the sidelines vis a vis republicans for long enough to get something passed. It may prove to be the case that the first six months of the Obama presidency needed to find a way to muzzle the most wealthy opposition to reform in any way and that if they hadn’t sold out on, variously, cost controls and the public option we would have scene an all out bloodbath that far exceeds what we have seen. I don’t know. I think the Obama/Dem combo could easily have overcome the bad publicigty even of the insurance companies if they had really played hardball with their own teams and rammed the legislation through before public opinion could be mobilized against it. Had it been a fait accompli the insurance companies ability to throw money at advertising would be neither here nor there. People would be signing up for the public option, or opting into medicare at 50, in droves regardless of what the insurance companies and pharmaceutical companies say becuase they simjply can'[t afford private insurance.

    The simplest thing for Obama and the dems to do would be to have *repealed cobra* and instituted *medicare for the unemployed and everyone over the age of 50*. As more and more people are thrown out of work they would naturally have gravitated to medicare and then insurance companies would have to work to lure them back by lowering premiums or upping coverage.

    This would all have had the side effect of making the employment of older workers much cheaper for businesses instead of more expensive for businesses.

    aimai

  42. 42
    Crashman06 says:

    @alien radio:

    for the first time I can think of the progressive caucus has the votes to put the bluedogs balls in a vice.

    Glad to say that my congressman is one of the ones holding out for the public option. I wrote to him yesterday to express my support.

  43. 43
    NoVa Commie says:

    @gypsy howell:

    I agree with you.

    The need for structural change in a health care system which is demonstrably *twice as costly* as other nations (go browse OECD website, or Daily Howler is actually publishing the country specific cost comparisons) should not have been a ‘partisan’ issue.

    Both sides are unwilling to force the various links in the supply chain (doctors, drug cos, insurers, private hospitals) to give back the roughly *$3000 per capita* we are overpaying this system for no better health outcomes than any other country. Reluctantly, I must say this includes the President.

    I reluctantly would prefer no bill to a pretense that we’ve fixed something.

    sigh

  44. 44
    matoko_chan says:

    Last year Kristol came out and said healthcare reform will the GOP.
    There was a whole lot of flustered rightside spin that was patently untrue, and then they buried it.
    But it is true, and the republicans are on the ropes and any healthcare reform will kill them off, I think.
    They are fighting for their political lives.

    Obama is playing this very genius.
    Game Theory 101– tit-for-tat and bidding theory.
    The guy is going on a back-to-school special…brilliant cheat move…..simply full of win.
    How do the republicans counter? Put Sarah (When Facebookers Attack) Palin on live tv? lol, they can’t…..she is simply incapable of intelligible public speech.
    As much as she sparks up the XY component of the Teabagger Demographic, no parent in America wants their child to grow up to epitomize the special olympics of politics.

  45. 45
    PeakVT says:

    I’ve been taking the line that Baucus is the roadblock, with nuts like Enzi and Grassley as his “bipartisan” cover. Hamsher has a much more infuriating take on Baucus’ role.

  46. 46
    Shygetz says:

    I’m with the rest of the unconvinced commentariat. If this becomes a Medicare Part D, except mandated and paid for directly by the public, then this is WORSE than nothing. It will put Obama and the Democrats solely on the hook for a giant boondoggle, and make an entire generation+ wary of any future attempts at health care reform.

    Hell, TARP without any substantial increases in regulation or anti-trust action has made me very sour on any future stimulus–even though I know it averted a Depression, sometimes I’m convinced that a Depression might have actually ushered in reform rather than handouts.

  47. 47
    Punchy says:

    For DougJ:

    Plaxico pleads Uncle, gets soap-onna-rope for TWO years.

  48. 48
    matoko_chan says:

    @aimai

    but the GOP is not arguing in good faith.
    healthcare reform will further marginalize their party, and they understand that perfectly well.
    They see their only option for survival as killing healthcare reform.
    So they are demagoging the low information base like mad.
    But it isn’t Obama’s waterloo……it is theirs.

  49. 49
    HRA says:

    They have to pass something to rein in the fat cat insurance companies. Personally I am quite sick and tired of bringing a prescription to my pharmacy and being told my insurance won’t pay for it or it will only pay for half of it. It has happened twice. The truth is they were happy to take my payments for 23 years and not have to spend a cent on me. We have become hostages to this industry and it feels like crap to not be able to fight it.

    It has to be public option or single payer. Anything else will not stop them from playing God.

  50. 50
    JGabriel says:

    @J.A.F. Rusty Shackleford:

    Speaking of retards…

    Don’t lower the discourse. It’s not nice to compare the developmentally disabled to BOB. What did they ever do to you to deserve that?

    .

  51. 51
    T. O'Hara says:

    These guys think the slow track is goood. Firms with Obama ties profit from health push:

    WASHINGTON – President Barack Obama’s push for a national health care overhaul is providing a financial windfall in the election offseason to Democratic consulting firms that are closely connected to the president and two top advisers.

  52. 52
    Lola says:

    A lot of people seem to forget that right now Americans are forced to buy private insurance for a variety of things, car insurance, homeowners insurance, etc. I never hear people complain about being forced to buy car insurance from private companies.

    It would be optimal to have a public plan, but it really depends on what kind of public plan. We don’t have many details on how much cheaper a public plan would be right now for individual consumers.

    The House bill has a lot of ways it improves our current system. Read http://www.familiesusa.org/ass.....reform.pdf I learned a lot. I think it is a non-partisan group that put that out, too.

  53. 53
    ironranger says:

    A part of me is “surprised things have gotten as far as they have” but so many people in dire straits due to lack of insurance or being underinsured has pushed this issue to a tipping point. All the more reason to keep pushing for a decent public option now. The “no change” crowd is losing traction. If, as Wendell Potter said on Countdown last night, the health insurance companies (who haven’t already done so) hike our portion of medical payments up to at least 35%, the number of people in financial & medical crisis will rise rapidly. More people losing their insurance & insured families making $50 thou a year who get a bill for $7,500 or more on a $20 thou surgery is going to become a speeding train that the R’s aren’t going to be able to stop.

  54. 54
    Crashman06 says:

    @Lola: I don’t know about that, Lola. I live in a city, with a great transit system. I don’t NEED a car, so I don’t need car insurance. However, I am certain that one day I (and everyone else in the country for that matter) am going to get sick, or need some kind of medical attention, so medical insurance is a little different.

  55. 55
    SGEW says:

    Has everyone read Hamsher’s take?

    People make a mistake when they think the battle for health care reform is about ideology, because it’s not. It’s about who controls K Street and the cash that flows from it, which could fund a 2010 GOP resurgenece — or not.

    If a public plan gets into a final health care bill, it’s going to be because of public pressure, because people who put Obama in office demand one. Because in the grand scheme of White House priorities, it was something that could acceptably be dealt away in pursuit of a higher political objective by the guy who was calling the plays: Rahm Emanuel.

    Greenwald follows up:

    The Obama White House isn’t sitting impotently by while Democratic Senators shove a bad bill down its throat . . . . [B]y giving the insurance and pharmaceutical industries most everything they want, it ensures that the GOP doesn’t become the repository for the largesse of those industries (and, converesly, that the Democratic Party retains that status).

    Ouch.

  56. 56
    Napoleon says:

    If the bill has a mandate and no public option available to those people the bill will be an unmidigated disaster for the Dems. Better no bill. I personally think that is what we are going to get and if that is what they have to vote on I am calling Sherrod Brown and telling him to vote no.

  57. 57
    JGabriel says:

    Sentient Puddle:

    I’m all fine and dandy with incremental reform …

    I’m not fine with incremental reform, and I don’t think any of us should be. We have a Democratic president, and majorities in both branches of Congress. Now is the time to push through something big. It won’t be perfect, but we can make the incremental changes to improve it later.

    Restricting reform to incremental steps right now is simply delaying reform until a time when the GOP might increase their share of votes in the Senate – and then nothing will get passed.

    .

  58. 58
    NoVa Commie says:

    @Lola:

    Those types of insurance mandates are actually designed to protect others from direct harm caused by you

    car insurance – so your damage to another person/car on public roads won’t cause them catastrophic harm
    homeowners insurance – required by your mortgage holder (not the government) – so their collateral is protected

    That said, mandates would be fine with proper regulation. But I see no signs that meaningful price controls are being regulated.

  59. 59
    ThatLeftTurnInABQ says:

    I wouldn’t go so far as some commentors in describing a bill without a public option as a failure or worse than nothing. Ending the use by the industry of pre-existing conditions and rescission to cherry pick the risk pool is a step forward and a necessary part of any solution involving private insurers. But without a public option we will still will not have solved the basic problems in our health care system and we will be back at this again in only a few years.

    There are two sides to the health care problem – availability, and affordability. Theoretically they can be attacked piecemeal since the groups most affected by them are overlapping but not identical. But fundamentally they are two sides of the same coin, and in the long run you cannot solve one without solving the other.

    If (as appears likely) we get out of the current Congress a solution to availability without doing much (if anything) about improving affordability, then the insurance companies will slowly starve us out with rising premiums, and soon the availability problem will be back in a different form, because the law in its majesty will provide that both the rich and the poor have the right to purchase health insurance that only the upper middle class can afford without starving to death.

    Also, nobody could have predicted that letting Max Baucus and the Blue Dogs, and their buddies like Chuck Grassley get in the driver’s seat with healthcare reform would be like putting Count Dracula in charge of garlic reform.

  60. 60
    gypsy howell says:

    A lot of people seem to forget that right now Americans are forced to buy private insurance for a variety of things, car insurance, homeowners insurance, etc.

    Yes, but if you can’t afford insurance, you can decide not to buy a car or a house. If you can’t afford health insurance, can you decide not to get sick?

  61. 61
    harlana pepper says:

    As much as I long for the public option, an end to discrimination based on pre-existing conditions would help a lot, although sounds like the idea of letting insurers fleece the already insured as an offset seems to be bouncing around Congress. And premiums and deductibles go through the roof w/o a public option to keep prices in check. Problem NOT solved.

    Assfucks.

  62. 62
    Demo Woman says:

    @Lola: Ezra linked to that list yesterday and you are right, it is very informative.
    Public option is one piece but not the only piece. Right now up to 40% of every dollar you pay towards health insurance goes to overhead. If that is cut back to 15%, that is a huge savings.

  63. 63
    Cris says:

    @Max: I think that those on the left that dislike Obama, see PUMA, will continue to use this process and the outcome, no matter how successful, to rail against him.

    PUMA may get the most notice from the media, but they’re not the real voice of Obama’s dissenting left flank. I recommend you check out guys like Jonathan Schwartz or even August J. Pollak to see that opposition from the left doesn’t have to be shrill and self-serving.

  64. 64
    Bill H says:

    I’m not sure how the claim that the public option drives prices down even works. According to the chart of how the plan works with it, only 10 million people wind up in the public option, which gives private insurance 40 million new customers. How is that not a bonanza for the private insurers?

  65. 65
    neff says:

    @Ed in NJ: Please, I’m begging you, don’t go with the “young healthy people think they don’t need health insurance” meme. I know a lot of people in their 20s and almost to a one they’re obsessed with trying to get or keep health insurance, desperate for a job that offers it, sometimes keeping on taking college classes so they can keep using the student health center because they can’t find another way to get health care. The barrier for individual insurance is so high that even they are having an impossible time finding anything they can afford. Certainly there are some young people who don’t care about health insurance but a lot of them are uninsured because they can’t find a way to get insurance and the stress is eating them alive inside.

    Every time you assume young people don’t have health insurance because they think they’re invulnerable and don’t need it, Rush Limbaugh wins.

  66. 66
    Napoleon says:

    @JGabriel:

    You are right. Incremental reform does not work. Better to blow up the bill and put more pressure on them to gome back next year with a better bill.

  67. 67
    Billy Gray says:

    Any bill is better than no bill?

    That’s just not true.

    Smokescreens, the appearance of reform, corporate give aways and the same old bullshit do not count as tremendous political accomplishments.

    A bill where we pay billions of subsidies to giant companies that don’t need them when we don’t have to, is arguably as bad or WORSE than what we have now. Giving these companies what they want is not reform. Not only will you really be giving away tax payer money for no other reason than solidifying your political power with BigInsurance’s and Big Pharma’s dollars, there’s no incentive for improvement, no check on the system, NOTHING. You’ll be right back in this position ten or twenty years from now, but without the momentum and power to do anything about it.

    Any bill is worse than No Bill. With NO BILL the score is clear, and people will continue to recognize that we need real reform. Yes, Obama will have egg on his face if there’s no bill. That’s what accountability is all about.

  68. 68
    gypsy howell says:

    @Bill H: According to the chart of how the plan works with it, only 10 million people wind up in the public option, which gives private insurance 40 million new customers. How is that not a bonanza for the private insurers?

    Makes you wonder why it’s such a deal-breaker to the insurance companies then, right?

  69. 69
    aimai says:

    Lola,
    The comparison between health care insurance and other forms of insurance is misplaced. For one thing–you can refuse insurance in most cases if you are willing to fully accept the cost of disaster/loss and, in fact, you are instructed to do so in the event of very unlikely events if the premiums are too high and you can better afford to rebuild than to deal with theinsurance companies eventual refusal to pay out.

    Its true that people are legally obligated to pay for auto insurance but there are all kinds of complicated ways that states and the auto insurance companies pay for damage claims when the person is uninsured and, of course, if they create damage while uninsured and don’t have deep pockets the victim is usually just out of luck. Since one of the biggest outcomes of vehicular damage is *health care costs* auto insurance is, of course, tied in heavily to the fact that your health insurance company often tries to find a way *not to pay* for necessary treatment if you’ve been in an accident. With national health care this ceases to be an issue, as does medical fraud in automobile accident cases.

    When you are uninsured and need to pay for a new house because of a house fire you aren’t charged a completely different set of charges by the builders to repair your house. But that isn’t true in the case of health care. There is no fixed price for a given health care procedure–Large companies negotiate different rates with different doctors, specialists, and hospitals a mere change in venue or treatment or providor can result in huge, unexpected, and inexplicable changes in cost to the consumer. Going uninsured means you get charged a completely different rate from someone who is insured.

    aimai

  70. 70
    Demo Woman says:

    Please take the time to read the link that Lola provided @ 49. There is a lot more to the bill from the house besides public option.

    I’m all for single payer and a public option. I believe that the public option can be phased in slowly first buy letting those over 50 buy into medicare. In Vermont those under 25 can use medicaid.

  71. 71
    aimai says:

    I should add that when a person needs health care their needs escalate over time, and over the severeity of their illness. In the auto insurance market the value of hte asset you are insuring–the car–goes down over time and the insurance pays out less and less. We probably don’t want a health care system that considers citizens to “depreciate” over time or offers to let you buy a “whole new body” because your old one was “totaled.”

    aimai

  72. 72

    Shygetz, oftentimes in times of fiscal crisis it is not reform that is ushered in, but rather reaction. Witness Europe in the thirties.

    In times of economic distress there are still people with lots of money. They control jobs, they control the media, they control the message. They convince people to act against their own interests. Why else would people who depend on Medicare be demanding that government get out of healthcare?

  73. 73
    aimai says:

    My longer response to lola is in moderation hell but I just wanted to agree with Demo Woman that we could start dropping the age to get people into medicare–but why do you think that that is any more likely after the passage of the bill with mandates and no public option than before, right now, while the bill is in process? I think, and I posted, that dropping the age of medicare made a huge amount of sense. Why isn’t it in most of the bills? If its going to happen now is an excellent time for it to happen–in fact it might be a great way to use the hard and fast “public option” canard as a bargaining chip. I have no objection to the hard line progressives, who I support in this, turning on a dime and saying “we’ll renounce the vague promise of a public option in favor of just expanding medicare by five years every five years.” But that kind of stuff has to happen *now*. It won’t necessarily happen later just because we wish it would.

    aimai

  74. 74
    General Winfield Stuck says:

    Some sort of PO is going to get passed. It may be an empty shell per funding, and with baby teeth. But pass it will, I predict. An empty shell that can be filled later on.

  75. 75
    Chad N Freude says:

    @J.A.F. Rusty Shackleford: @JGabriel:

    Guys (I know, it’s an unwarranted gender assumption), big mistake! The comment in question should have been totally ignored. No acknowledgment. Stony silence. Feeding the troll only encourages it.

  76. 76
    ThatLeftTurnInABQ says:

    @gypsy howell:

    Makes you wonder why it’s such a deal-breaker to the insurance companies then, right?

    It all depends on who migrates over to the public option. If folks in relatively healthy, low-cost demographics groups migrate into the public option then the insurance companies will be on the opposite end of the game they’ve been playing up till now, which is to cherry pick the risk pool and dump the people who generate most of their costs.

    It will be like when the Berlin Wall went down – most people in East Germany didn’t up and leave but when the youngest and most energetic left the country the regime fell because it couldn’t afford to lose its most productive citizens. People who pay premiums but don’t make much in the way of claims are the equivalent for the insurance industry, and they are terrified of not having that demographic as a captive audience but instead having to compete on price to keep them.

    Having a public option will be like tearing down a Berlin Wall which protects the insurance industry and its high profit margins. President Obama, tear down that wall!

  77. 77
    Shalimar says:

    I also tend to think that almost any bill will be better than what we have now.

    I disagree. A public option could be poorly implemented so that it isn’t a competitive alternative or is limited in what and whom it can cover, so it isn’t necessarily a cure-all. But the bill I see passing without a public option is one with a combination of mandating that everyone get insurance along with tax credits to help people pay for it, and that just funnels public money into private insurance profits without fixing any of the problems in my opinion. That would make the situation even worse for everyone other than insurance company executives. Obama has already guaranteed that the drug companies keep their outrageous profits, enabling insurance companies to universally screw the public would just be the cherry on top of a disastrous reform effort.

  78. 78
    Jasper says:

    “Reform” without a PO is a horrible outcome.

    We will tell that insurance and drug companies that in exchange for ending your most egregious and unconscionable practices, practices that offend the sensibilities of every observer, we will expend a massive amount of public dollars and guarantee that your profits after reform will far exceed profits under the status quo.

    In a business setting, they call arrangements like that extortion.

  79. 79
    Chad N Freude says:

    @NoVa Commie: Auto and home insurance also protect the insured against loss of his/her own property.

    The analogy to other types of insurance also fails to consider that there is considerable customer discretion in selecting a car (or no car) and living accommodations. This is not the case with the customer’s body.

  80. 80
    SGEW says:

    Taibbi’s take on the Rachel Maddow show (rough transcription):

    They bargained away single payer from the very start . . . this was really a handshake deal between the White House and the insurance industry and the pharmaceutical industry . . . . a dog and pony show where they entertained the notion of maybe doing a public option . . . they really wanted to pass something that doesn’t have any meaningful effect on the insurance industry.

    (Video here, via C&L)

    Feelin’ cynical.

  81. 81
    General Winfield Stuck says:

    @SGEW:

    People make a mistake when they think the battle for health care reform is about ideology, because it’s not. It’s about who controls K Street and the cash that flows from it, which could fund a 2010 GOP resurgenece—or not.

    I think this is true. But I think it is also true that it is ideological in the sense of it being a last stand against the New Deal for wingers. This is one reason, I think of the unhinged response from the purely ideological wing of the GOP, that is well represented by distilled wingnuts in congress. And there are some on the left that it largely ideological as well.

    But standing back and looking soberly at the situation via sustainability of the current system, it has gone past ideological in practical effect. Applying the capitalist model to a vital service was bound to fail at some point, and we are nearing that point. Health care cannot go bankrupt or out of business. People need it to keep breathing and stay above ground. If the wingers succeed in stopping it once again, they will be just whistling past the graveyard. A graveyard that doesn’t care what party you belong to, or what you believe politically.

  82. 82
    Leelee for Obama says:

    I think that the Insurance Industry sees a PO as the first step towards Single Payer. These people know that Canadians are very, or mostly, happy with their system, and that implemented here, it would destroy them. It is why they have built themselves into such a large sector of our economy. They need to be scaled back through attrition, to the point where Single Payer is the main provider, and they get to do the supplements, without subsidies. How we get there is a matter of regulation-serious, brutal, non-negotiable, regulation. This is a group to shrink and drown, if ever I saw one.

    This bill must require coverage for pre-existing conditions, that does away with reccission. It needs to expand Medicare and Medicaid and SCHIP to cover the people who really can’t afford the other programs. It needs to enforce wellness and outcome over fee-for-service.

    The Insurance industry will be begging for relief if this controls their incomes. I think getting the Industry out of the Stock Market is an essential as well. If all a CEO cares about is the bottom line for shareholders, and their compensation, health care insurance is a farce.

  83. 83
    gypsy howell says:

    @ThatLeftTurnInABQ:

    I agree with you. I was just responding to Bill H’s comment by turning the proposition on it’s head. If he thinks a bill with a public option will have marginal impact or even potentially be a bonanza for the insurance industry, then why are they fighting it tooth and nail?

  84. 84
    Brachiator says:

    @Leelee for Obama:

    I think that the Insurance Industry sees a PO as the first step towards Single Payer.

    Proponents of a health care plan have got to get out of their intellectual ghetto and stop using code-speak intelligible only to themselves — i.e., single payer — and explain exactly what they are proposing, what it will cost, how it will be paid for, what benefits it will provide, and how it will be better than the existing plans that people have.

    For example, I have noted before, and note again that “single payer” does not really explain much.

    In Canadian Medicare, which is a single-payer insurance available to all citizens, doctors may work in private practices or for public or private hospitals, each of which is in turn paid by government health insurance. Under the United Kingdom’s National Health Service, which also uses a universal single-payer fund, the public owns the health systems and facilities. The term single-payer thus only describes the funding mechanism—referring to health care being paid for by a single public body—and does not specify the type of delivery, or who doctors work for.

    http://en.wikipedia.org/wiki/S.....ealth_care

    There are features that the Obama Administration and the Democrats have mentioned previously that are obviously desirable — coverage of pre-existing conditions, portability, the promise of cost controls — but the good guys have got to get control of the message, find a better way of dealing with the lies and distortions that the opponents are deluging them with, and come up with and present their plans in terms that people understand.

    These people know that Canadians are very, or mostly, happy with their system, and that implemented here, it would destroy them.

    But neither the Canadian plan, nor the British NHS model, are necessarily the best plans. It’s darn frustrating that even though every major industrialized country has some form of nationalized health care, these plans have not been comprehensively covered, with respect to their strengths and weaknesses, in the US media, and instead we are constantly hit with drivel about so cia l ism and other distractions.

    The GOP lies, and the best that liberals can come up with is “Well, just go watch Michael Moore’s ‘Sicko.’ ” This is not the same thing as intelligent debate.

    How we get there is a matter of regulation-serious, brutal, non-negotiable, regulation. This is a group to shrink and drown, if ever I saw one.

    You may be right here, but this is just detail for the lawmakers. The public just wants to know that they will be able to go to the doctor, if they already have a plan, without interruption.

  85. 85
    Ed in NJ says:

    @neff:

    I didn’t say that there were no young people looking for affordable insurance. What I said, and hold to, is that it is not the #1 priority, just because you say it is.

    I am an insurance agent. I sell supplemental and catastrophic coverage to people that would otherwise lose everything if they were to get seriously ill. Please don’t tell me that young people are rushing to protect themselves. They aren’t.

    Mandating anyone buy insurance, and not ensuring that it is comprehensive coverage, is a recipe for disaster. A whole generation of younger people will grow up feeling that they were forced to give their money to the insurance companies. Republicans, despite pushing for the mandates, will run on the fact that Democrats forced them to pay for something they didn’t want in order to give free health care to others.

    Health care reform may put me out of business, if it is effective enough. I’m willing to take the risk, because it’s that important.

  86. 86
    gwangung says:

    Proponents of a health care plan have got to get out of their intellectual ghetto and stop using code-speak intelligible only to themselves—i.e., single payer— and explain exactly what they are proposing, what it will cost, how it will be paid for, what benefits it will provide, and how it will be better than the existing plans that people have. For example, I have noted before, and note again that “single payer” does not really explain much.

    Ding! Ding! Ding!

  87. 87
    Allright already says:

    cookie please

  88. 88
    Manamongst Hussein says:

    I will have to respectfully disagree. The insurance industries and Pharma want them to rush something, anything in…that’s not a public option. Speed kills a strong bill. I think we and Obama should do what the teabaggers and idiots are crying for. Take our time…and let the house run with the hearings they’ve now called for into insurance industry pay, meetings, dropped policies, nightmare stories. And endless display, at the same time milking the process out, letting lobbiyst fund all the Blue Dogs and Dems they want. cause frankly, they won’t be feeding the Republicans outside of the ones they believe have influence on conservative dems. We sit all of the Blue Dogs and backstabbers down and let them meet and shake the hand of each of their replacement candidates in their districts. We keep holding townhalls, but make them Healthcare specific, policy specifc, and basically bore the shit out of the tiny populations of LaRouchia and Paultardia. Expell those shouting off topic remarks…to the newly create freespeech zone of the townhall sidewalks.

    The Blue Dogs want to try to make us fastbreak, we are a walk the ball up the court kind of team that clearly make mistakes trying to break. Relieve Rahm of all healthcare related duties and promote Dr. Howard Dean tothe newly formed Healthcare Reform Czar. Well we could let Rahm do a little sketchiness for the cause…you know like leaking that the administration plans on investigating several dems and republicans for impropiety w/ lobbyist.

  89. 89
    MrSnrub says:

    cookie here too

  90. 90
    Justin says:

    Some bill might be good if it dealt with the PEC and dumping the sick issues but a bill with mandated coverage with no cost controls will kill the Dems for a long time.

  91. 91
    alamacTHC says:

    Anything better than nothing? NO! If we do not get a meaningful public option with government power to negotiate prices, then whatever is passed will be a giant steamshovel sending money to the health-denial industries. This will have two effects: 1.) Breaking the federal government, pretty much instantly; and 2.) Putting the Republicans, more fascist than ever (Sarah Palin?), back in power at the next election.

    Nor will the touted “improvements”, like doing away with rescission and preexisting conditions, do anything, because there will be no meaningful control over the insurance pigs’ ability to jack up prices. Sure they’ll take you–only ten thousand bucks a month. Can’t pay? oh well…

    Pass a good plan or kill this one. No other option.

  92. 92
    Leelee for Obama says:

    @Brachiator: Two lost posts to answer you Brachiator. Now I need to think through what I want to say-I’ll try again later.

  93. 93
    T. O'Hara says:

    Make up your mind. Is he going to control costs by rationing care, or not? If so, why is now too early to discuss it? If not, how’s he going to pay for it? Or is all that talk about “deficit neutral” just BS?

    You guys just want something, anything, that you can then modify toward left-wing utopia. Fine, at least that’s an honest position. But pretending any contrary arguments are lies and disinformation, when the very reason for the speculation is the reluctance of the proponents to answer specifics, is every bit as dishonest as you’re accusing your opponents of.

  94. 94
    Jody says:

    I’m against anything that doesn’t cover everyone. That can be the public option, or something along the lines of what the Swiss have, i.e. strictly regulated, not-for-profit private insurance firms.

    If we pass something that satisfies most people, they will be completely content to leave the rest out in the cold. Reforms that bring costs down for the majority of Americans will prevent the uninsured from ever being able to afford health care. And most of the country won’t give two shits.

  95. 95
    Brachiator says:

    @Jody:

    I’m against anything that doesn’t cover everyone.

    Then, you have already lost the battle and the Republicans will continue to eat you alive.

    People FEAR that covering everyone will mean that their own coverage will become substandard, or that it will cost more, or that they will be taxed more in order to provide this additional coverage.

    Let me be blunt: no one in their right mind will accept a decline in the quality of their current health care coverage if this is a possibility. I don’t think that a decline would happen, or that it need happen, but no one is making this crystal clear.

    If someone presented me with a viable plan that would cover 50% to 75% of the 47 million who do not have health insurance AND improve costs and portability for a reasonable price, I would sign off on it in a heartbeat. If you are insisting on universal coverage as a social rule without any improvement in other health care issues, then you will not get any health care reform done. Again, I don’t think that these are the only alternatives, but pushing universal health care as a social right without guarantees that you will make the system better or more efficient is not working and cannot work.

    That can be the public option, or something along the lines of what the Swiss have, i.e. strictly regulated, not-for-profit private insurance firms.

    Anyone know what the Swiss system is like, how it works, how well it works and how cost-effective it is?

    Anyone? Anyone? Bueller?

    T. O’Hara — But pretending any contrary arguments are lies and disinformation, when the very reason for the speculation is the reluctance of the proponents to answer specifics, is every bit as dishonest as you’re accusing your opponents of.

    This is easy. People have not been making substantive contrary arguments. They have been yelling, shutting off debate, engaging in fear mongering and jingoistic stupidity.

    Some say that the US already has the bestest health care system anywhere. This is a lie.

    Another way of looking at it. Has medical care become cheaper, more available, more effective since the the Clinton proposals were defeated in August 1994? The answer is “No.” The Republicans and insurance companies promissed that things would get better if left alone.

    They lied.

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