Contra Ezra Klein

As a preface to this post, I should point out that to say Ezra Klein has read circles around me on health care is an insult to circles. That said, this is a blog and I have an opinion, so I might as well write it.

Ezra writes about Harry Reid’s take on the public option:

In many ways, this is a fundamentally conservative approach to a liberal policy experiment. It’s only offered to individuals eligible for the insurance exchanges, which is a small minority of the population. The majority of Americans who rely on employer-based insurance would not be allowed to choose the exchanges. From there, it is only one of many options on the exchange, and only in states that choose to have it. In other words, it has been designed to preserve the status quo and be decided on the state level.

It seems beyond argument that Reid proposed a plan so compromised from liberals’ preferred single-payer system that Olympia Snowe’s staff might well have written it before the entire GOP zigged frantically to the right (ref. her or Mitt Romney on the individual mandate). Nonetheless, I have to disagree with Ezra on the option’s potential impact. Yes, most Americans on employer-based insurance would find themselves left out, but we already know that employer-based insurance is trending downward faster than newspaper readership. Entire sectors of American business already admit in private that they will phase out their insurance plans no matter what comes out of DC, and another chunk will certainly dump their plans as soon as a credible public option exists to absorb their workers.

If we take into account the desperate state of employer insurance and the huge number of people who would take anything over plans steadily deteriorating from draconian to outright sadistic, the public option will potentially absorb a much larger number of Americans than appear eligible today. Plus, the government plan will certainly outlaw revoking plans after the fact (“rescission”) to protect itself from dumping. That alone will improve the lives of everyone on the individual market.

Additionally, it is not hard to imagine cost pressure from a non-profit plan driving private insurers out of already low-competition markets. Buyers in those areas, which in some cases encompass an entire state, would effectively be left with a single-payer health plan. Granting my earlier argument that even ‘opt-out’ states will eventually give in to a national public option, the deal seems like a workable, if compromised, way to set in motion an irresistible ratchet towards affordable national health care.

***Update***

Read Sullivan’s take on this. My feeling is that Andrew has the politics right, but he is trying too hard to squeeze in his thesis of Obama as a nearly omnipotent sleight-of-hand artist.






113 replies
  1. 1
    Fergus Wooster says:

    I’m more with Tim than Ezra, even residing in a short-term opt-out state (Texas).

    This greatly improves my future prospects vis-a-vis my daughter’s medical bills, so I can hold off on my Canadian emigration plans. I really did not foresee this happening.

    On the other hand, Harry Reid is actually fighting for a progressive option. The cognitive dissonance from that is making my head hurt.

  2. 2
    jcricket says:

    Frankly, I completely agree – and normally I love Ezra and his thinking on this subject. This is the best way to get a national public option, which will definitely have expanded eligibility (see Medicare’s history for another example) down the road.

    First it will go from most to all states (that may happen in 2-3 years if Republican’s follow their “all talk no walk” stimulus rejection behavior). Then there will be more and more part-time workers, self-employed people, etc. who get on it – partly driven by companies employing more people part-time or as contractors to avoid offering them healthcare and other benefits.

    Also note that eventually there will be pressure from the states for the feds to take Medicare over – and merging it with the private plan alongside subsidies makes a lot of sense.

    But the biggest change, I expect, is corporations will eventually lobby the government to allow expanded access to the public plan so they can offer something cheaper to their employees (not out of altruism, but b/c it’d be cheaper for their bottom line).

    I see nothing bad about this compromise except that it delays the inevitable: a public option available to everyone, alongside whatever private plans can still be afforded by some other subset of Americans.

    Republicans know this will happen, they know the public option will be popular, but they cast their lot with their anti-government forces, so there’s no way for them credibly to support anything like this. Sucks to be them.

    Sometimes we win by just doing the bare minimum and letting the other side “lose” for us.

  3. 3
    Napoleon says:

    It seems to me that as long as the plan will be able to make it on a cash flow basis and provides service that is at worst no worse then insurance companies at a lower cost then it is a huge win to get it. As long as it gets that toe hold then I would think over time other businesses and citizens will want to have the option which will lead to Congress expanding who can buy from the program. That is why it was important to get it. Without what amounts to running it on a pilot program basis there would be nothing to expand in the future.

  4. 4
    geg6 says:

    I’m with you, Tim. I read Ezra earlier this morning and couldn’t figure out where he was coming from. Sherrod Brown says pretty much the same thing as you do. And anecdotally, I know more people (other than my co-workers) who either have no health insurance at (because they simply cannot afford it, they don’t qualify for Medicaid, and their employers don’t provide) or who pay for their own lousy, crappy, almost non-existent individual plans. All these people will benefit enormously. It’s not the teeny tiny number Ezra seems to think it is, at least not around here.

  5. 5
    mistermix says:

    I think it’s actually a pretty smart compromise, if Reed can get it through the Senate. If that blind pig finds an ear of corn and gets it done, it will put Republicans in a tough situation. I predict few will opt out. It’s really political suicide, despite the “socialism” rhetoric.

    I agree with Tim that employer-provided insurance is on the way out.

  6. 6
    jcricket says:

    On the other hand, Harry Reid is actually fighting for a progressive option. The cognitive dissonance from that is making my head hurt.

    This is what happens with progressives keep up the pressure, rather than rolling over. I mean the right-wingers (anti-abortion nuts, goldbugs, anti-immigrationists, etc.) have used this tactic to move their party to the right over 30+ years.

    There are some good parallels for us (i.e. don’t assume it’ll be quick transformation, don’t be “all or nothing”).

  7. 7
    Face says:

    I’m a bit worried about the cost of all this after seeing Sunday’s 60 Minz bit about the just redunkulous amount of Medicare fraud that goes on undetected/unreported. Billions and billions pissed away on fraudulent claims. Can docs do the same for this, being the fed gov’t too damn big to investy every claim?

  8. 8
    IndieTarheel says:

    It’s beginning to look like somebody was playing the looooonnnnnggggg game here.
    __

    Sort of like waiting for a microwaved treat that was placed in an Easy Bake Oven instead.
    __

    Maybe that speaks to attention spans and expectations more than it does methodologies, but I guess we’re going to find out.

  9. 9
    Violet says:

    I think it’s “fundamentally conservative” in the more traditional definition of the word conservative – it’s making change happen slowly. Rather than some sweeping change right now, it’s incremental, allows states to choose, and more limited in scope.

    Old school conservatives would be happy with such a style of doing things, but wingnuts these days are more concerned with orthodoxy and being against libruls than anything else. So by their definition, it’s bad.

  10. 10
    gwangung says:

    @jcricket:

    There are some good parallels for us (i.e. don’t assume it’ll be quick transformation, don’t be “all or nothing”).

    Really. These are big institutions, with lots of money flowing and lots of structure in place to support it. I think you’d have to be very naive to think any of it could be changed quickly.

  11. 11
    Just Some Fuckhead says:

    Entire sectors of American business have already admit in private that they will phase out their insurance plans no matter what comes out of DC, and another chunk will certainly dump their plans as soon as a credible public option exists to absorb their workers.

    My wife’s company would almost certainly drop their health care benefits but the opt-out clause may mean a public option is not available in a lot of states, including mine.

    I think Ezra is right. It’s a helluva lot of compromise, even more so when you consider the numbers advantage we have in the House, our majority in the Senate, along with the Presidency.

    It’s pretty clear to me at this point we wouldn’t be able to get good, smart progressive legislation passed if we had 525 Dennis Kuciniches in Congress and Ralph Nader in the White House. Everything else is too corrupted.

  12. 12
    liberal says:

    Nonprofit isn’t really what it seems to be.

    Here in the Wash DC area, CareFirst BCBS is apparently sitting on $700M.

  13. 13
    liberal says:

    @gwangung:

    I think you’d have to be very naive to think any of it could be changed quickly.

    Yeah, unfortunately.

  14. 14
    geg6 says:

    @Face:

    First, it won’t be Medicare, so it’s not quite the same thing. It will have the same administrative controls that current for-profit health insurance plans do now.

    Second, do you honestly believe that what we have now isn’t doubly wasteful than any scare stories out there regarding Medicare? Seriously?

    What do you propose otherwise that will provide the competition and low cost that a public plan can?

  15. 15
    anonevent says:

    Entire sectors of American business have already admit in private that they will phase out their insurance plans no matter what comes out of DC

    Any and all links providing evidence for this would be helpful, because this will be the next fight I’ll probably start having with people, and I could see our company doing it.

  16. 16
    mistermix says:

    I think it’s actually a pretty smart compromise, if Reed can get it through the Senate. If that blind pig finds an ear of corn and gets it done, it will put Republicans in a tough situation. I predict few will opt out. It’s really political suicide, despite the “soci-lism” rhetoric.

    I agree with Tim that employer-provided insurance is on the way out.

  17. 17
    arguingwithsignposts says:

    I for one am at least happy to see some form of real reform coming to the health care system. It’s a small step (not single payer), but it’s a step. BTW, seems the number of uninsured Americans is around 45 million. Wouldn’t all of those people be able to go to the public option (assuming their state doesn’t opt out)?

  18. 18
    Jeff says:

    Tim: One thing I think you (and some of the other commenters) are missing is that the public option won’t be available to anyone. As I understand it, access to the public option is gated by the exchanges, and the exchanges aren’t open to everyone – if I recall correctly only employees from businesses with less than 25 employees can enter the Exchange.

    If you’re working for a larger employer and they drop you, you may be SOL. :(

  19. 19
    Calming Influence says:

    O/T:

    What happened to the Little Bitsy ad?

  20. 20
    Jeff says:

    Incidentally, this is why I am skeptical that the public option (in any form being considered) will do anything to address costs from an insurer POV. As envisioned, perhaps 25 million people in the country will be eligible to enter the exchanges. Not all of them will choose the public option. The theory behind the public option’s ability to meaningfully contain costs is that it can negotiate lower treatment costs with providers, ala Medicare.

    Medicare has something like 80 million people enrolled in it. To get Medicare level savings, you’d need to at least triple the number of people eligible to enter the exchange.

  21. 21
    jnfr says:

    I have enormous admiration for Ezra and the work he does, but on this I think I lean more to your thinking, Tim.

    And I’ll add: what @jcricket said. I am warm with happiness this morning that progressives, both out here in the world and in Congress, hung together as a group and kept the pressure on. With the caveat that this isn’t over yet, I am so far very encouraged. Things are looking much better than I expected them to at this point.

  22. 22
    J.W. Hamner says:

    Ezra’s point has always been… that if you look at the numbers, there’s really no compelling evidence that “insurance profit motive” has anything to do with rising health care costs.

    Public option diehards never confront this fact and basically resort to magic pixie dust arguments. The only logical arguments I’ve seen for its mythical power basically revolves around not believing regulation of the insurance industry can be effective… which is fair enough, I suppose, but things like “recision” are already prohibited in all the bills out of committee.

    I certainly hope an opt out public option makes it in… but even if it does, the most far reaching health care reform bill in American history will only be the first skirmish in a very long war.

  23. 23
    arguingwithsignposts says:

    @Jeff: If there’s an individual mandate, then there’d better damned well be a public option open to those 45 million uninsured, or there will be hell to pay at the ballot box.

  24. 24
    Brick Oven Bill says:

    TimF’s analysis is correct. This is what is fundamentally wrong with this Administration and Congress, and why they cannot be trusted. Rhetoric is the Second Liberal Art, which, when combined with Grammar and Logic, can be used to determine what is True and best for a group of people.

    Plato defined two types of Rhetoric, True and False. False Rhetoric is poisonous to order, and belies unfit Character in a leader.

    If the Democrats wish to impose universal health care on the American people, they should say it. This is one reason why Glenn Beck is growing in popularity. He has a saying:

    “Say what you mean and mean what you say.” (True Rhetoric)

    Do not forget that Obama’s blood-brother still lives in a hut. Now reflect upon if you believe that Obama really cares about you. I conclude that Obama cares about power.

  25. 25
    Face says:

    @anonevent: This would be a friggin catastrophe if true.

  26. 26
    sparky says:

    again, everything depends on the details. if the carriers write the regulations for the public option so that no one can actually sign up or by specifying payment rates that are higher than private insurers, the thing will still be DOA.

    do i sound negative? yeah–but i think it’s a reasonable position after years of being sold legislation that was designed to do something different than what it was sold to us as. exhibit A? credit card “regulation.”

  27. 27
    Jeff says:

    @arguingwithsignposts: I agree; it’d be a bloodbath. It could also result in legislation being passed to increase the scope of the exchanges, which would be a pretty good thing in the long term (the short term pain would suck though).

  28. 28
    Roger Moore says:

    @jcricket:

    This is what happens with progressives keep up the pressure, rather than rolling over.

    And the key reason for that is that the progressives are finally on the offensive rather than the defensive. With very few exceptions, the only real gains progressives have made in the past 40 years have come through the courts. All they’ve done legislatively in that time is protect those gains and the legislative gains from the New Deal and Great Society. It’s about damn time that progressives started pushing for something new.

  29. 29
    Will says:

    I loved this one from Billy Kristol today:

    http://www.washingtonpost.com/.....inionsbox1

    “And — with the caveat that the political world can, of course, change quickly — there will be a conservative Republican presidential nominee in 2012.”

    If that isn’t a bold, balls-to-the-wall prediction by one of our nation’s most fearless intellectuals, I don’t know what is.

  30. 30
    sparky says:

    @Brick Oven Bill: dude, nice flip. everyone knows that rhetoric (in both flavors) is the first, nay, the only GOP art. and in fairness, it worked pretty well for a quarter of a century. not bad for a fantasy.

  31. 31
    LD50 says:

    I’m an independent contractor who can’t afford to buy insurance, and won’t be able to in the foreseeable future. I’ve been on my wife’s insurance for several years, but her employer (a poverty-stricken school district) is just itching to kick their employees’ dependents (spouses & kids) off their coverage, or, failing that, charge the normal ‘market rate’ for it. So this can’t come too soon for me.

    I’m hardly the worst one off. We know some single mothers who are teachers in the district, and they’re being told that covering their kids will be $500 a month per kid. So take an average teacher’s salary and lop off a grand a month for 2 kids, figure at LEAST a grand a month for rent, and then experience the thrill of trying to live in the Bay Area on ~$800 a month.

    Fortunately no way will California opt out.

  32. 32
    gwangung says:

    And the key reason for that is that the progressives are finally on the offensive rather than the defensive. With very few exceptions, the only real gains progressives have made in the past 40 years have come through the courts. All they’ve done legislatively in that time is protect those gains and the legislative gains from the New Deal and Great Society. It’s about damn time that progressives started pushing for something new.

    It’s about time progressives fight a multi-front war–because that’s what the reactionaries were doing.

    Granted, it means getting off your duff and pitching in to help the few who WERE actually doing something, but I think it’s no longer possible to leave it to leaders and the lawyers to get things done.

  33. 33
    LD50 says:

    @Will: “Vote for me and I’ll take away your medical coverage”. That’s a catchy GOP slogan for ’12.

  34. 34
    geg6 says:

    @Jeff:

    One thing I think you (and some of the other commenters) are missing is that the public option won’t be available to anyone. As I understand it, access to the public option is gated by the exchanges, and the exchanges aren’t open to everyone – if I recall correctly only employees from businesses with less than 25 employees can enter the Exchange.

    If you’re working for a larger employer and they drop you, you may be SOL. :(

    Um, won’t the 45 million (at most of them) without health insurance be eligible? And what about the self-employed like my John? You’re making big assumptions that everyone has employer provided coverage.

  35. 35
    inkadu says:

    I’m starting to think that the United States will always have the worst health care system in the developed world, but that eventually it will be less expensive and have better outcomes.

    My plan, like most progressives, was to do everything in one fell swoop, or at least do things in a manner that would, in an uncomplicated way, lead to single payer. The way it’s turning out is a godamned complicated mess; it will take years to insure everyone at an increased cost. And since we’re such a deficit-happy rich country, a crappy system will still be relatively tolerable.

    It looks like we’re going to need a depression level disaster to get anywhere close to single payer.

  36. 36
    numbskull says:

    Yeah, B.O.B., except for the part where Obama ran on universal healthcare/coverage…and except for the fact that universal healthcare/coverage has been a Democratic plank since Harry Truman’s tenure. I mean, FDR. No wait! Even the other Roosevelt called for it…

    Yeah, except for those minor blips, nobody could predict that the eventual goal is universal healthcare/coverage. Just like every other prosperous nation.

    Idiot.

  37. 37
    geg6 says:

    @LD50:

    And here’s a pretty good synopsis of what’s at stake for red states who may be thinking of opting out:

    http://crooksandliars.com/node/32292

  38. 38
    bemused (formerly ironranger) says:

    In one bill I thought there was a penalty, so much per employee, on employers who dropped the health insurance. Or has that idea been stripped? So many bills, it’s hard to keep track.

  39. 39
    Minionero says:
    Entire sectors of American business have already admit in private that they will phase out their insurance plans no matter what comes out of DC

    Any and all links providing evidence for this would be helpful, because this will be the next fight I’ll probably start having with people, and I could see our company doing it.

    I second the request. Why would employers phase out their insurance plans when the expense is deductible from their taxable income? (Repealing that ludicrous deduction would have been a major win, but it got nowhere.)

    That said, pace Face, this outcome wouldn’t be a catastrophe at all if a public option is available. Once reform is enacted, I’d like nothing more than for my employer to ditch my insurance, pay me a higher wage instead, and allow me to shop for my own insurance on the exchange.

  40. 40
    El Cid says:

    I actually don’t think this is a disagreement. Seems to me that Ezra Klein (with whom I frequently disagree) is describing the PO as it is now, whereas Tim is looking at how it may evolve down the road. Ezra may not actually disagree.

    That said, put me in the camp of “Democrats better figure out something to do for people and their health insurance before 2013 or so”.

  41. 41
    geg6 says:

    Oh, joy. The Dick Whisperer feels the need to weigh in. You know, because he’s all about good policy.

    http://mediamatters.org/blog/200910270012

  42. 42
    Jeff says:

    @geg6:

    I’m not making any assumptions, I’m going from memory on what’s actually in the bills before Congress. My memory is that the exchanges will be open to the unemployed, the self employeed, and employees of businesses with fewer than 25 employees. If you work for a business with more than 25 employees that doesn’t offer insurance, you may be SOL (though I seem to remember that such businesses would face fines for not providing health insurance).

    If it makes you feel better – if your john is self employed he’ll be given access to the exchange (and thus the public option).

  43. 43
    Brick Oven Bill says:

    George Bush was stupid, and unqualified to lead this country (please bring back Natural Law). He was misled by people with agendas which he probably did not understand. But when he looked into the camera and told us something, I believe that he meant it, even though he might not of understood the underlying interests behind the words.

    Barack Obama deliberately twists his words. One example is changing 47 million uninsured to ‘more than 20 million uninsured’ after receiving criticism about paying for health care for Illegal Aliens.

    Another example is stating before Congress that Illegal Aliens will not be covered, and then going before La Raza, or whatever group that was, the next day, and stating that Illegal Aliens would be made legal, and then be covered by the legislation.

    Obama tries to be clever, but lacks Bill Clinton’s Talent to pull it off.

    Good on Joe Wilson.

  44. 44
    geg6 says:

    @Minionero:

    Why would employers phase out their insurance plans when the expense is deductible from their taxable income? (Repealing that ludicrous deduction would have been a major win, but it got nowhere.)

    Can’t remember where, but I read this morning that this is something that will help to keep the cost of the whole thing down. So I believe that cutting the deduction or decreasing it is part of the whole.

  45. 45
    WyldPiratd says:

    The really tragic thing about this entire health care reform is that we are even having it at all. For-profit health insurance should die a quick, public death because there is too much suffering and death for the profit of shareholders.

    We are a country full of greedy, inhumane ignorant barbarians.

  46. 46
    geg6 says:

    @Jeff:

    Well, that’s not exactly what you posted. Thus the misunderstanding.

    We don’t really know what the details are yet. It apparently won’t be posted online until Reid meets with the entire caucus today. And then we have reconciliation to get through. So whatever is there is not the final bill.

  47. 47
    El Cid says:

    Glenn Beck appeared to me in a dream last night, and he asked me to ask BOB to stop trying to be his best buddy, that it kind of was starting to make Glenn feel creepy.

  48. 48

    @El Cid:

    I actually don’t think this is a disagreement. Seems to me that Ezra Klein (with whom I frequently disagree) is describing the PO as it is now, whereas Tim is looking at how it may evolve down the road. Ezra may not actually disagree.

    That is how I read Ezra’s post as well. And you are right about 2013.

  49. 49
    burnspbesq says:

    @liberal:

    Here in the Wash DC area, CareFirst BCBS is apparently sitting on $700M.

    That actually sounds like it might be too low, but I would want to know more about their subscriber base. It’s insurance. Reserves are a good thing. Within reason, more reserves are better than less. If their rates are being effectively regulated, and the regulator thinks they are over-reserved, it will order rate decreases. At least that’s the way it spozed to work.

  50. 50
    LD50 says:

    @El Cid: That just might be a sign that you’re spending too much time here.

  51. 51
    jeffreyw says:

    I am fairly happy so far with what I’ve seen about the opt out plan, but implementation is where the wonks are really gonna have to get into the weeds, and I fear for the influence the state lobbies will have if the conundrums out lined in this post are any indication of where the policies my go astray.

  52. 52
    jeffreyw says:

    bah, “may go astray” ^^

  53. 53
    alien radio says:

    I’ll just leave this here.

    http://exiledonline.com/as-the.....illegally/

  54. 54
    John S. says:

    Barack Obama deliberately twists his words.

    It’s not Obama’s words that are twisted, BOB, it’s you that is twisted.

    Don’t blame Obama for your pretzel logic that requires you to be so contorted that your head is up your own ass.

  55. 55
    Napoleon says:

    President Cowardly Lion not to help Reid pass the opt out option.

    http://tpmdc.talkingpointsmemo.....?ref=fpblg

    I really have had it with Obama’s complete lack of leadership

  56. 56
    BFR says:

    @Napoleon

    I went to the TPM page – it started out saying: “If Chuck Todd’s right about this”

    I then stopped reading. It should not come as a shock that the WH and Reid would feed Todd as much BS as he was prepared to handle. Obama isn’t on the ballot next year but Reid is. Both sides here have a vested interest in making Reid look like a hero, so anything that feeds that narrative should be taken with a grain of salt.

  57. 57
    Brick Oven Bill says:

    “I will post all legislation on-line for five days.”

    “I will have no lobbyists in my Administration.”

    Sometimes he does not twist his words John S. Sometimes he just lies, far too comfortably. If you were not a racist, this would bother you. OK, perhaps you are not a racist, you might just be dim.

  58. 58
    BFR says:

    @Napoleon (again)

    Here’s my favorite comment on the TPM thread:

    White House and Reid have a strategy discussion.
    An anonymous source tells the Huffington Post something.
    Joe Scarborough gives his “sense” of what was really meant.
    Chuck Todd gives his own spin on Scarborough’s “sense.”
    TPM reports Todd’s spin on Scarborough’s speculation as a direct quote from Obama.

    Not sure where Kevin Bacon fits into all of this.

  59. 59
    eyepaddle says:

    Brick Oven, you are a never ending faucet of WTF?! Seeing you zig from some unsupported assertions about rhetoric re: the Democratic Party, to Obama’s brother’s housing situation as proof that….something or other–Glenn Beck is honest–so it doesn’t matter that he is obviously insane; well that’s just priceless. Please, don’t ever change.

  60. 60
    MikeJ says:

    I’m still pissed that president weenie didn’t rip Sarah Palin’s spine from her body and drink her blood while roasting Trig on an open spit on election night. What a wuss. He will never get my support after that cowardly display.

  61. 61
    kay says:

    @Napoleon:

    I’ve had it with Chuck Todd’s “sense” of the situation.
    The media got it all wrong nearly every step of the way so far, Napoleon, probably because they were talking to SENATE opponents of the public option.
    They interviewed and re-interviewed and re-interviewed the most conservative members of the Democratic caucus and (surprise!) all of those people said there wouldn’t be a public option.
    The few times the more liberal members of the caucus were interviewed (again, surprise!) they all said there would be a public option.
    But media didn’t present it like that. They reported that the public option was “dead” based on interviewing Kent Conrad 70 times. So, why did they do that? Because they decided on the narrative. Chuck Todd started with a result. It skews everything he says, or “senses”.
    List what they got wrong so far:
    1. the public hates the idea of a government-run option (where the hell they got this is beyond me)
    2. the tea parties were “game changers”
    3. the public option is dead
    I don’t know what’s going to happen, but relying on people who tell a story and then fix the facts to fit that story seems silly. And that’s what media have done thru this whole thing.

  62. 62
    pirate wench says:

    I’m with Ezra on this one. A “public” option that 90% of the public is barred from accessing and that will consist of a pool of only the poorest and sickest of us is doomed to fail. It’s a lie to even call it a public option!

    If we opened the option to everyone (phased over several years), folded medicaid in so it’s not a separate program, and allow the opt-out, THAT would be a good compromise. The current version is nothing but a watered-down to irrelevence sell-out to insurance corporations.

    We need to keep fighting.

  63. 63
    Just Some Fuckhead says:

    @Will: I guess Obama will be running unopposed in 2012.

  64. 64
    gwangung says:

    @kay: In other words, GIGO.

  65. 65
    bob says:

    @jcricket: “Sometimes we win by just doing the bare minimum and letting the other side “lose” for us.”

    Dude, that is the only way “we” ever win. Of course, I can only speak for the past 35 years.

  66. 66
    RandyH says:

    Sure, 90% of the population will continue to be trapped in their employer-based plans, but that is what they insisted upon if this experiment was to get off the ground at all. Fine.

    Let’s look at who will really benefit from this new system. Those people whose only reason to continue being tied to their shitty corporate or government full-time job all of these years was good health insurance. They couldn’t get it as a self-employed, underemployed (by choice) or early retiree. How many millions of people have wanted to tell their heartless corporate masters to stick it for decades but couldn’t because if they quit and started their own company, they couldn’t provide dependable, affordable insurance to their families and employees?

    We could see a tidal wave of innovative, happy new small businesses come from this and big employers will have that much less leverage over our souls as a result. Only good can come of this.

  67. 67
    Anoniminous says:

    @kay:

    All part of the Post Modernist kabuki of our national news media. It’s all about privilege sourcing your research. I, as a journamalist know:

    1. The public hates the public option because everybody I talk to: Focus on Family, Fox News, the Heritage Institute, CATO, hates the public option.

    2. The tea baggers were game changers because everybody I talk to: Focus on Family, Fox News, the Heritage Institute, CATO, said they were game changers.

    3. The public option is dead because everybody I talk to: Focus on Family, Fox News, the Heritage Institute, CATO, says the public option is dead.

  68. 68
    kay says:

    @Napoleon:

    I guess I’m asking this: do you believe that this process is fluid, or do you believe that there is a predetermined result and this is all theater?
    Because if it’s number two, all you read is going to go through that filter.

  69. 69
    Napoleon says:

    @kay:

    The media got it all wrong nearly every step of the way so far,

    Hard to argue with that.

    I did not watch the video but relied on what was written at TPM and if he qualified what he said with “its my sense” then TPM shouldn’t have even bothered with the post.

  70. 70
    Napoleon says:

    @kay:

    I guess I’m asking this: do you believe that this process is fluid

    Sure, but what would that have to do with the White House telling Reid he is on his own and they won’t lift a finger if he ask for help?

  71. 71
    Steeplejack says:

    @Minionero:

    I’d like nothing more than for my employer to ditch my insurance, pay me a higher wage instead, and allow me to shop for my own insurance on the exchange.

    Somehow I don’t see your employer automatically leaping to the same conclusion that you are.

  72. 72
    Ash Can says:

    @Napoleon: Since when did Chuck Todd and Joe Scarborough talking out of their asses become Gospel? You’ll dismiss everything that Obama and his administration have said on record, but you’ll believe Chuck Todd’s unsourced speculation, immediately and without question?

    …Chip Reid, is that you?

  73. 73
    BFR says:

    @Napoleon

    I did not watch the video but relied on what was written at TPM and if he qualified what he said with “its my sense” then TPM shouldn’t have even bothered with the post.

    Beutler got ripped in the comments thread for posting the article. It’s not news and shouldn’t have been treated as such.

  74. 74
    jwb says:

    Isn’t this just Ezra trying to get ahead of the “this is the most librul bill evah” meme—it doesn’t take a rocket scientist to see it coming—and making the case that Reid’s version is a very moderate product of compromise?

  75. 75
    jcricket says:

    BTW – none of us talk about it, but there are like 8-10 major regulatory overhauls contained in all the healthcare bills that by themselves are hugely helpful. I’m afraid many will be watered down, but combined with a public option I feel like we’re taking a “Massachusetts-like” step towards better health care system.

    Sure there’s a lot of additional work – cost containment, CER, additional regulation (esp. on Big Pharma, who is getting off scott free right now), opening the exchanges to people who can get only get private healthcare but can’t afford it, etc.

    Journey of a thousand miles begins with a single step, and all that.

  76. 76
    Ash Can says:

    @Napoleon:

    I did not watch the video but relied on what was written at TPM

    You should have watched the video and read the comments following the TPM story. Not that I haven’t been guilty of jumping to conclusions myself, but if a story smells fishy, like this one did, there’s usually a good reason for it.

  77. 77
    Napoleon says:

    @BFR:

    Hummmm

    [surfing over to TPM and reading the comments]

    If Todd was giving his read on Joe S.’s “sense” of something someone else said then never mind.

  78. 78
    Elie the Amateur says:

    Many good and informative comments today — great discussion of a very complex process…

    I sense that most people know that this will take a while to implement, but I sense also there is more confidence that we are making progress in the correct, progressive direction.

    Inkadu, upstring you said that you had in mind to go to single payer in one move. Not possible my friend given the structure of our government and our politics. Just my opinion.

    That said, I personally believe that we will end up there and I like Tim’s scenario and generally agree with it.

    Of course, the devil is always in the details and I still see many fights and not a little confusion ahead as we move this momentous legislation into being actively implemented.

    I am very excited and long to work in some fashion to support this process. I currently work in the data warehouse business in the Employer market which I agree is going to undergo enormous change. I started out in government however as a policy wonkette many years ago, working on nursing home regulation. I would be thrilled to work in the public sector again for something that I believe in.

    Sometimes I wonder if we fully appreciate the good of what is happening right now. Yeah, no doubt there are problems and we are still going to have to push forward to achieve all of what many of us dream for full coverage and health care for all, but Geez…what a great position to be in!

    Lets just acknowledge this good place for just a moment …

  79. 79
    valdivia says:

    @Napoleon:

    Todd just put out a statement via greg Sargent that he was speaking for himself not quoting the WH. The thing that really gets me is how little TPM has been checking their sourcing for stories or going with Villagy interpretations of things since last week. I am getting to the point it is not worth reading them. There is no depth or context. Too bad.

  80. 80
    FormerSwingVoter says:

    @jwb:

    Yeah, you’re probably right. “This is the most librul bill evah” is the meme that pops up for every single piece of legislation that doesn’t involve bombing shit.

  81. 81
    kay says:

    @Napoleon:

    I’m not even sure. I have to tell you, though, (and this is disheartening) the media made up a lot of the drama during the primary.
    I don’t think Chuck Todd or Rachel Maddow spoke to a single state Party chair. They couldn’t have. I know they didn’t speak to the Ohio state Party chair. There was never going to be any Clinton challenge at the Convention. That was never going to happen. They made that up.

  82. 82
    Napoleon says:

    @kay:

    There was never going to be any Clinton challenge at the Convention.

    It defied common sense to think that would ever happen.

  83. 83
    Max says:

    @Napoleon: You might want to surf back to TPM.

    Chuckles has walked back his statement saying the White House didn’t really say that, he was just attributing statements to them to make it more interesting so that he could get more air time and act like he got a scoop.

    He’s aghast that his quote is being taken literally.

    Wanker.

    Unless I actually see the words come out of the Obama Team’s mouth, I believe zero of what is reported. The MSM is just making shit up at this point.

  84. 84
    Ron says:

    The one thing that bugs me about what some progressives are saying (“This is not good enough”) is while it may be true that it’s hardly the perfect solution, there are political realities that have to be dealt with. The Senate does have a 60-vote “supermajority” of democrats, but they are hardly all 60 progressives. You can make all sorts of claims about how even a conservative democrat should allow the leadership up or down votes on any issue they want, but the reality is that the more conservative democrats (Landrieu, Lincoln, Nelson, et al) would probably side with the GOP to filibuster a more robust public option. The opt-out version isn’t what I would want, but I want some public option rather than no public option. Honestly what worries me a little is what will happen after the House and Senate vote and it goes to conference. Will that result in a more progressive version of the public option? If so will that mean the death of it in the Senate? Or will the compromise keep the opt-out but make other concessions to the progressives? I would like to see a more robust version come out of conference but I’m afraid that would kill it altogether.

  85. 85
    kay says:

    @Napoleon:

    I used to listen to Rachel Maddow and just marvel. I was a delegate, and the crazed Hillary people were this teeny, tiny minority. There was exactly ONE in the Ohio delegation.

    Every news outlet was grouped around the 30 angry Hillary delegates, waiting for an interview. It was in no way representative of what was actually going on there. What was actually going on there was very business-like and pro-forma. It was almost disconcerting, like a separate reality. Just bizarre, and not real.

    They made it up.

  86. 86
    ricky says:

    @BFR:

    I believe Kevin Bacon fits in somewhere between the picture of Obama and Mao. Maybe he is under the photo
    of Joh Podesta because he once rented a garage apartment from him while studying the Rythm Method.

  87. 87
    Napoleon says:

    @Max:

    He’s aghast that his quote is being taken literally.

    That says it all.

  88. 88
    kay says:

    @Napoleon:

    The largest group of dissenters at the convention, by far, were the anti-war people. They were everywhere.
    Somehow, the tiny group of clownish PUMA’s got all the press.
    I don’t think we have a liberal media.

  89. 89
    eric says:

    Here is a handy piece

    http://www.epi.org/publication.....proposals/

    as i read things, under the HELP bill….

    if family has income of 33,000, then premiums are capped at 330….then, out-of-pocket expenses are capped at 11900.

    (i have to check the source material to see if that is gross or net income.)

    but it suggests that you get siginificant benefit as to catastrophic costs, but hardly much at all for preventative care and if you fail to pay your bills, I have not seen what happens to someone as far as coverage going forward.

    12000 is a lot of money, but not a lot of medicine

    one of the things that you are likely to see is ramped up visits to doctors because the uninsured are now insured. look for spikes in costs, delays is services, and stories of large medical bills hitting the poor hard (now that they are getting more care).

    eric

  90. 90
    TenguPhule says:

    look for spikes in costs, delays in services, and stories of large medical bills hitting the poor hard

    So same shit, but on more people.

  91. 91
    kay says:

    I think the White House are probably worried about Leiberman.
    Which is nice, because they rescued his sorry ass, so that might come in handy.

  92. 92
    SenyorDave says:

    It sounds like it is some significant progress if it can pass. And it has the added benefit that Lieberman might vote against it, hopefully hastening his departure from the Senate. Anything that would get that sack of shit out of the Senate is a major side benefit.

    I’d love to hear that unprincipled turd try to explain to the people of Connecticutt how voting against HCR is good for them.

  93. 93
    eric says:

    @TenguPhule: but when the expectation is better care, it is more of a political problem, than merely a medical or societal problem.

  94. 94
    John S. says:

    OK, perhaps you are not a racist, you might just be dim.

    I love how when someone accuses you of having pretzel logic you respond with…pretzel logic.

    Don’t ever change, BOB.

  95. 95
    Elie the Amateur says:

    kay:

    I agree that we do not have a liberal media and have not for some time.

    What is scary to me is that their bias is not necessarily conservative either, just crazy and sensationalistic. It seems that their goal is more to distract the public with misinformation (which does somewhat favor the conservatives at times). It would seem that they are most interested in alienating as many people as possible from the political and public discourse by exagerating the crazy. It makes people afraid to engage any part of the process and just run away.

    The MSM has wedded itself to sensationalism in part because it does not know how to sell anything else after decades of celebrity focused corporate influence…even as their market share continues to plumet, they do not have the leadership to flag a new direction.

    Blogs have stepped into the vacuum of information that they have left behind, but also can be faulted with also exploiting sensationalism, argument and grievance for its own sake in order to enhance participation.

    It is scary to me because we have a system of public information exchange (whether through blogs or MSM), that is both spooking people and increasing the splits among the population with ongoing argument and downright meaness. We think nothing of expressing the most vile vituperation on opponents anymore and end up many times using extremely harsh rhetoric even with people on our own side…

    It is probably true that we have had periods like this in history. What is different however and troubling, is the pervasiveness and speed of the communication. This hate and anger is traveling pretty fast and could get really difficult to manage politically and socially — even as the needs for pulling together become more necessary to survive as a nation or minimally civilized society.

    I don’t have answers — but I know that I have to sometimes step away from it and that I frequently feel much better about things when I do — and that is not how it should be.

    Somewhere, somehow, we have to start addressing this directly – both as an issue of media but also as an issue for the ethics of responsible communication (maybe not the best term).

  96. 96
    cursorial says:

    @Will

    I couldn’t help myself, I read the the Kristol column. He goes on to characterize the crop of likely candidates – (ex-Governor) Huckabee, (ex-Governor) Romney, (ex-Governor and VP candidate) Palin, and (ex-Speaker and what passes for GOP intellectual) Gingrich – as political “outsiders” because they don’t currently hold office

    Every court needs a fool, I suppose.

  97. 97
    kay says:

    @eric:

    Eric, I think the cost containment is going to come in as a percentage of gross.
    That’s the cap, and that’s why costs will come down. Inherent in all the bills is this idea: people cannot spend more than 15% of their income for medical expenses, including insurance.
    We can’t function as a country paying 30% of gross towards medical insurance/care. Both Republicans and Democrats know that.
    The bills are pegged to gross. Both the insurance industry and the medical industry are going to have to figure out how to provide quality care and turn a profit on 15% of any individual’s gross.
    I think they can do this. They won’t, until they have to, but they can.

  98. 98
    Elie the Amateur says:

    kay:

    This:

    “Both the insurance industry and the medical industry are going to have to figure out how to provide quality care and turn a profit on 15% of any individual’s gross.
    I think they can do this. They won’t, until they have to, but they can.

    Absolutely

  99. 99
    Makewi says:

    So same shit, but on more people.

    Which is exactly what many suspect is the real motivation behind this, if some can’t get great health care, no one should be able to. Social justice. Otherwise, why not just open the medicare rolls to those under a certain income and include an option to buy catastrophic coverage for a larger pool under medicaid ?

  100. 100
    PattyK says:

    BlueCross BlueShield didn’t limit its mailing of postcards for Kay Hagan to its subscribers in NC, as Daily Kos said; the cards came to non-subscribers like us and so to the whole state? Off they’ve gone to Senator Hagan edited to suit. The original first sentence read “Please oppose government-run health insurance.” Our version: We crossed out “oppose” to make the sentence read “Please SUPPORT government-run health insurance.” And so on throughout the message. Lots of other people are doing the same. The best part: It was a postage-paid card. hahahaha

  101. 101
    ericblair says:

    @Max: Unless I actually see the words come out of the Obama Team’s mouth, I believe zero of what is reported. The MSM is just making shit up at this point.

    Yes, and this is a problem with some of the lefty sites: the threads snap from “the MSM are a bunch of liars and bought-and-paid-for idiots” to “zOMG, one of the bought-and-paid-for idiots of the MSM said that the Public Option is dead, so Obama is a complete failure.”

    The MSM has the wingnuts chasing around after random shiny objects; I don’t think the left needs to follow them.

  102. 102
    ominira says:

    @Brick Oven Bill:

    Do not forget that Obama’s blood-brother still lives in a hut.

    Hmm. Obama’s father lived in a hut. From that hut, he tended goats, then he went to the University of Hawaii and then on to Harvard for graduate school.

    This young Malawian lives in a hut. From that hut, with library books and a grade school education, he built a windmill that provides electric power for his family and village. He’s now in school at the African Leadership Academy.

    My suggestion to you: don’t underestimate/pity/dismiss people who live in huts. Where they live tells you absolutely nothing about their abilities or dreams but your harping on that says a lot about you. You might want to watch this: the danger of a single story.

  103. 103
    HumboldtBlue says:

    Read Sullivan’s take on this. My feeling is that Andrew has the politics right, but he is trying too hard to squeeze in his thesis of Obama as a nearly omnipotent sleight-of-hand artist.

    No, he’s a fucking tool and the day I want to read what that dipshit thinks is best for me and my fellow citizens is the day I become a chart-topping country and western star.

    You link to that clown like he has something other than what’s important him to write and he never does.

  104. 104
    les says:

    @J.W. Hamner:

    Ezra’s point has always been… that if you look at the numbers, there’s really no compelling evidence that “insurance profit motive” has anything to do with rising health care costs.

    That (profit) may be too small a frame; admin/overhead costs in the private health insurance sector are pushing 30%, compared to Medicare at about 3% (which means a fair amount of waste is not crippling, by the way–not that it’s a reason to ignore it). That’s 30% of 10+% of US GDP–a shitload of money. It’s doctors’ offices with more employees dealing with insurance companies, than delivering health care; it’s unbelievable amounts of wasted time, energy, money that produces nothing–except the aforementioned profits. Profits, exec comp, etc. all tie to the amount of money going through the pipe, more than to good service or efficiency.

  105. 105
    Mnemosyne says:

    Opt-out is fiendishly clever from a political point of view since it will drive a further wedge between Republicans in Congress and Republicans in state government. During the whole “we don’t want no stinkin’ stimulus” posturing, you had congressional Republicans talking about refusing the money while the state legislatures and governors were quietly accepting the money (in some case, like Perry in Texas, accepting after making a big fuss about refusing it).

    I think that only the reddest of red states is going to be able to get a bill passed opting out. If your state took stimulus money, you will probably get the public option, because state legislators know which side their bread is buttered on, and impressing the national Republicans only takes you so far these days. If you screw your constituents, they will vote you out and it won’t matter how many columns William Kristol devotes to your strong conservative principles.

  106. 106
    Eric S says:

    @Minionero:

    Why would employers phase out their insurance plans when the expense is deductible from their taxable income?

    If I understand it correctly, the premiums are deducted from the taxable income like home mortgage interest. If I’m right then a company will make more money by not paying the premiums.

    If I’m wrong, and premiums are deducted directly from the tax burden, then your question stands.

  107. 107
    hoi polloi says:

    Sullivan’s argument for the political jiu-jitsu of the opt-out PO is quite interesting but only for the shifting sands of “conservativism’s” self-rationalization.

    …you just need to rely on the wonderful private sector to deliver the goods in a more market-friendly way.

    Is he arguing that markets are now ends in themselves? Who cares whether the goods are delivered in a market-friendly way as long as they are indeed delivered. I thought the point for “conservatives” is rather that markets are the tried-and-true means for delivering good optimally.

    And the assertion of the wonderfulness of the private sector in healthcare is the last of three counterfactual examples presented in the graph.

  108. 108
    Brittancus says:

    As I perceive it the hardest place to install E-Verify, 287 G, or even directing ICE to raid employers is Sanctuary Cities and even States? CALIFORNIA seems to be the epitome of Sanctuary States, but it is estimated to be 127 cities and towns that ignore the US government. San Francisco and Los Angeles stands out as being Sanctuary cities where it’s mayors Galvin Newsom and Antonio R. Villaraigosa, along with an compliment of police departments who have cultivated over the years a refuge for the impoverished illegal immigrants, illegal criminal of other countries. Very few businesses have enforced E-Verify, because at this time there is no mandatory law, except for federal contractors/subcontractors. Sen. Sessions has at this time been the fortress against illegal immigration through the Bush and now President Obama administrations. He is determined to adjoin E-Verify as a permanent amendment to the Senate Unemployment benefit extension bill H.R.3548 for 14 weeks. In the same amendment Sen. Sessions would require new applicants for unemployment compensation to have their citizenship status verified using E-Verify. The computer software program E-Verify could also be used for identifying applicants for drivers licenses, automotive insurance, all health care benefits, real estate purchases and mortgage and of course ineligible workers. Even the Public option if enacted in health care could be used to verify all positive recipients and over time become a very sophisticated matrix of data bases to reject ineligible applicants for government benefits.

    Senate leaders are currently negotiating which amendments will be considered for the bill, and Majority Leader Harry Reid (D-Nev.) is trying to prevent a vote on the amendment altogether. E-Verify is becoming a significant potent weapon against illegal immigration in the ongoing battle. It has come under constant legal bombardment by a long list of open border organizations, including the US chamber of Commerce. E-Verify however remains intact, although other enforcement tools such as 287 G, has been weakened by Homeland Security chief Janet Napolitano. Without millions of dollars being appropriated, E-Verify on a continuous basis can eradicate illegal labor for pennies. No need for mass deportation as E-Verify will streamline removal of foreign nationals, owing to parasite businesses will be in incessant fear of being fined or sentenced to a prison term if apprehended by ICE for using illegal workers. As with 2010 census? Those who entered without–THE PEOPLE’S–permission, have violated our laws, and should not, must not be allowed to be enumerated in the decennial census? Is Washington so sure that they will pass this 2nd Amnesty, when Ted Kennedy previous comprehensive immigration reform turned into fraudulent travesty?

    Ordinary American workers have become watchdogs for suspicious activity in the working environment. My blogs, comments and articles are limited in information, but keep this issue under public scrutiny. For more details of malevolent politicians who need to be constantly reminded who they work for? For immigration enforcement grading NUMBERSUSA. To light a fire under nonchalant politicians who are selling American workers futures to highest bidder contact WASHINGTON at 202-224-3121 As easily as you voted for these people, you can vote them OUT? Demand NO–MORE–AMNESTIES. Rebuild a two-tier Southern border fence as originally intended. TELL THEM YOU WANT PERMANENT E-VERIFY FOR EVERY WORKER, WHO’S ON A PAYROLL. STAND WITH SEN. SESSIONS. Study the corruption in every level of government at JUDICIAL WATCH. Read about unstoppable OVERPOPULATION GROWTH at CAPSWEB. Read lists of legislators are trying to push through another path to citizenship–alias AMNESTY at http://tinyurl.com/CIR-letter-to-POTUS. THESE CONGRESSMAN/ WOMEN WANT TO STEAL YOUR JOB AND GIVE IT TO ILLEGAL ALIENS? KEEP THEM EMBOSSED IN YOUR MEMORY AND UNSEAT THEM WHEN THEY COME FORWARD FOR RE-ELECTION.

  109. 109
    JoJo says:

    No, he’s a fucking tool and the day I want to read what that dipshit thinks is best for me and my fellow citizens is the day I become a chart-topping country and western star.

    I really love how a man who 1) makes enough money to easily afford health insurance; and 2) could hop on the next plane to London to get free medical care if he needs it, is so perturbed about the prospect of poor americans getting access to health care.

    I read his post. He’s upset that poor people are more concerned with getting needed health care now instead of worrying about the impact on future budgets. How dare they put being able to see a doctor above conservative small government principles!

  110. 110

    Health care reform includes an employer mandate. The Senate Finance Committee bill made it very wimpy, I don’t know about the Reid meld, but I do know that the House bills have solid mandates, that a solid employer mandate will pass the house and that it will probably be in the conference committee report.

    So even if large employers want to stop providing insurance they will be constrained. With no health care reform, they won’t provide insurance. I think that with health care reform they will. If they are not allowed to use the public option, then there will be few public policyholders.

    As with opt out then opt back in, I don’t think this will last. I don’t think large employers will put up with it. They will demand a Wyder access to the public option. Already Baucus made a false claim of fact to block a vote on the Wyden amendment. The barrier will not last forever.

    I think that is the point of any public option able to offer lower premia than private insurers (so must be unified, must have a large pool as it will with opt out but not with opt in and payment rates must be linked to medicare). As public option oponents believe, it will be the camel’s nose in the tent. They are right on something. If it is clear how to be forced to buy private insurance to be forced to give money to insurance companies for no good reason (plus fighting them on every bill) the barriers to the expansion of the public option will be over-run and torn down. That’s the point.

  111. 111
    SiubhanDuinne says:

    Whoo! Where the hell did Brittancus #108 come from?

    (Shakes head violently to settle brain back into place.)

    Uh . . . May I offer you some pie, Brittancus?

  112. 112
    sparky says:

    @HumboldtBlue: yup. Sullivan is a twee nincompoop but as long as he writes pretty [sic] he can continue on in his role of lamprey attached to the US political-media-entertainment complex.

  113. 113

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