And One More Thing

If I hear one more breast-beating “THE INSURANCE COMPANIES WIN” tweet or post I am going to go postal. We have a system of private insurance. Guess what- no matter what we do short of an American NHS the insurance companies will win, because they are for profit industries. If they don’t “win,” they cease to exist. That is what “for profit” means.

So if you think there is the political willpower in the Senate to install an NHS, and all we need to do is have Obama use his bully pulpit more and fire Rahm Emmanuel, then the “INSURANCE COMPANIES WIN” posts make complete sense.

If you don’t think there is said willpower for an American style NHS, guess what, you’re an idiot and the insurance companies are going to win anyway, because the status quo is a win for them.

Fucking deal with it and decide whether or not this current bill helps people. I’m by no means thrilled with it, but I think it is a step in the right direction. And for the record, after watching this clusterfuck for the past year, I am now firmly of the belief that the only thing that will solve our problem in the longterm is a British style NHS.






138 replies
  1. 1
    General Winfield Stuck says:

    You smokin’ chrystal meth, or what.? I got carpal tunnel coming on.

  2. 2
  3. 3
    4tehlulz says:

    Needs more rage.

  4. 4
    Quaker in a Basement says:

    THANK you. I’m also sick of the whining.

    The mood seemed to turn about the time it became clear Joeberman had us over a barrel. It’s as if some “progressives” are willing to forego progress if that’s the only way to snub Holy Joe.

  5. 5
    wmsheppa says:

    @John Cole for the love of God, Green Balloons!

  6. 6
    Mnemosyne says:

    I especially love the people who are absolutely convinced that the insurance companies have spent tens of millions of dollars trying to tank healthcare reform because it’s such a huge giveaway to them that they adore it. Guh?

  7. 7
    Malron says:

    The current bill will help people. Unfortunately, those 30 million that will be helped get insurance and have their costs lowered don’t write blogs.

    Anddddddddd, just in case you haven’t figured out the next meme, brace yourselves: there’s a front page post on the Great Orange Freakout comparing the progressive schism over health reform to the progressive schism over the Iraq Invasion. And if I need to tell you who they are comparing to the pro-invasion crowd you haven’t been paying attention very long.

  8. 8
    Jody says:

    I’ve long said I could go for a Swiss style system. Privately run, regulated-all-to-hell insurance companies. The tricky part, given the balance of power in DC, is getting there.

  9. 9
    MikeJ says:

    I’ll chime in with a complaint of my own. The post at the top of the page at GOS right now says the battle lines are between the policy wonks and the activists.

    Remember not so long ago when activists talked about the reality based community and being a policy wonk was a good thing (if only because the policies being pushed were so bad)?”

    Put me squarely in the camp of people who care more about policy than emotion. Same reason Taibbi annoys me. “Ooh, he’s angry, and I’m angry, he must be a supra genuis!”

  10. 10
    Mnemosyne says:

    @Quaker in a Basement:

    It’s as if some “progressives” are willing to forego progress if that’s the only way to snub Holy Joe.

    There’s something to that. Joe is a ginormous asshole and there are definitely people who would prefer to forget the whole thing than to allow him even 5 minutes of preening on the Sunday talk shows about how he rescued the whole thing. That’s part of what’s driving Jane Hamsher — she and Joe have a mutual hatred thing going on, and both of them are more than willing to shoot themselves in the foot to prevent the other person from gaining an inch of ground.

    But you know what? Sometimes assholes benefit even if they don’t deserve to. That’s life.

  11. 11
    valdivia says:

    @Malron:

    head-desk.

  12. 12
    Ella in NM says:

    …after watching this clusterfuck for the past year, I am now firmly of the belief that the only thing that will solve our problem in the longterm is a British style NHS.

    I agree. There are so many reasons besides cost why a well run National Health Service would better meet our nation’s health care issues it’s not funny.

  13. 13
    Mnemosyne says:

    @MikeJ:

    FlipYrWhig was proposing “Say It Loud, I’m Wonk and I’m Proud” t-shirts yesterday. Anyone have a Cafe Press account?

  14. 14
    Tx Expat says:

    I do think that Obama needs to use his bully pulpit more, but I also think that there are limits on what he can do.

    I’m a big single payer advocate, but the question is is there political will to pass a NHS? Doubtful with a Senate that is composed of 40 members that are absolutely opposed to anything the Dem’s propose (magical ponies farting fairy dust? No go) and the posturing Conservadems. It sucks that FDR or LBJ didn’t have to deal with a super-majority to get anything passed, but that’s where we are. Reform the Senate, I say, but that also takes the votes.

    In our sucky reality the Democratic Caucus is arguing with themselves and the Republicans are out there egging on the deranged fringe that will kill us all if given half a chance.

    I agree that this bill is a step in the right direction, but it’s not everything I had hoped for. C’est la fucking vie. I have resigned myself to dealing with it, as much as that is a bitter pill to swallow.

    What a country!

  15. 15
    valdivia says:

    @MikeJ:

    This a million times this. I thought we were the party who did the wonk thing?

  16. 16
    Jorge says:

    As an evil pharmaceutical rep and a proud Democrat, this bill actually makes me quite happy. People get insured and I don’t get fired. What do you call it if I get mine but you get yours too?

  17. 17
    Belafon (formerly anonevent) says:

    @Malron: There’s a better post at GOS about how Social Security and Civil Rights were passed, making Obama really sound like FDR, or more specifically, making FDR sound like Obama.

  18. 18
    4tehlulz says:

    @Malron: facepalm.jpg

    Is Ezra the new Tom Friedman?

  19. 19
    MikeJ says:

    @Mnemosyne: I keep meaning to get some fresh silk screening supplies.

  20. 20
    Mnemosyne says:

    @Ella in NM:

    There are also a whoooole lot of reason why a National Health Service would be a complete clusterfuck:

    – Medical schools would have to be taken over by the government. I don’t think Harvard and Yale, to name only two, would be terribly thrilled to have a major source of revenue and prestige taken away.

    – All doctors would have to become government employees. Are you the one going to tell the young doctor with $100,000 of medical school loans that s/he now gets to work a government job with a pay scale that pretty much guarantees that s/he will require 20 years to pay those loans off?

    – Private hospitals would have to be taken over by the government. If you think the Catholic Church is screaming about healthcare now, wait until we go all eminent domain on them and take all of their property away.

    Etc.

    A single payer system makes perfect sense in the US. We already have one — it’s called Medicare. A single provider, NHS-style system would require tearing down our entire existing medical infrastructure and starting over completely from scratch while 300 million people wait around for medical treatment.

  21. 21
    JD Rhoades says:

    Thanks, John, I’m retiring from blogging and from reading blogs for a while myself. This constant shrieking of “OMFG WE ARE BETRAAAAAAYED!’ is working my last goddamn nerve.

    Hope you have a higher tolerance for it than I do, because I’m betting you’re about to get another dump-truck load of it.

    But I’m done. After reading some of the comments on Nate Silver’s blog and the attacks on John Podesta at Think Progress,I’m starting to hate these fucking so-called “progressives” as much as I’ve hated the fucking wingnuts for the last decade.

  22. 22
    Davis X. Machina says:

    Me, I’m a public school teacher, and I see no reason why health care shouldn’t also be delivered as of right to all by the medical version of what is after all (bows in the direction of his icon of St. Horace Mann) a Great American Invention.

    Until then, though, every conceivable system is hybrid.

    Even with a public option, some insurance companies win.

    Take for example, Massachusetts’ Commonwealth Care, for those above 150% and below 300% of poverty…

    The five Massachusetts health plans currently contracted with the state to serve the Commonwealth Care population include: Boston Medical Center HealthNet Plan, Celtic Care*, Fallon Community Health Plan*, Neighborhood Health Plan, and Network Health.

    *Insurance companies. Two out of five is pretty good. It’s a 60% public option…

  23. 23
    valdivia says:

    @4tehlulz:

    LOL. FTW.

  24. 24
    jayackroyd says:

    Force people to buy crappy insurance? That is the policy
    position you are advocating.

    Strip the individual mandate, and then we can talk.

    Forcing people to buy products from companies that routinely bilk them is a bad policy position.

    Not to mention bad politics.

  25. 25
    Jay B. says:

    And I say this bill is toxic because the insurance industry shills in the Senate, namely Nelson and Lieberman, got what they wanted and will get more.

    Maybe I’m wrong and people will love to be forced to pay for insurance that can go up on the insurance company’s discretion — people sure love the way the credit card industry does it and those weren’t forced on people — or maybe I’m wrong and the insurance industry will do the right thing out of the kindness of their hearts and rates will stay low without the counterweight of a public option (note: not a NHS even).

    Maybe I’m wrong and this is just a small step for more progress down the road because it will be looked at as such a triumph for the Democratic Party they’ll be bulletproof for the next 40 years.

    But if not, it’ll help people for exactly the next 11 months until the GOP wins back the House and help gut the mild reforms the bill contains.

  26. 26
    Guster says:

    Consistently wrong since 2002.

  27. 27
    Malron says:

    @Belafon (formerly anonevent): I’ve had the pleasure of reading it in the largest Obama group on Facebook.

  28. 28
    Bob Natas says:

    I think you can have private health insurers and still wind up with better health outcomes at a better price (IIRC, Germany has “health boards” of some sort that do a good job of handling the private insurers. I think this was the centerpiece of the E. Emmanuel book I read a bit of a few months ago). When Obama claims that a public option (or an NHS) is not necessary, he’s not wrong from a purely theoretical standpoint.

    It’s just implausible that we Americans can do this. I don’t see that we are willing to treat the private insurers like public utilities (There is little doubt that the books will be cooked to get around the 90% MLR).

    The bill(s) under consideration are not as ridiculous as proponents of “public option or nothing” are making them sound. We can always print up more money to bribe these guys.

  29. 29
    gsp says:

    Read the latest post by Greenwald about the WH being the helpless victim and quit being a bitch, Cole. I for one am sick and tired of seeing the progressive bending over just this one time. I hope the progressive do kill the fucking bill so the dicks that have been taking us for granted know we have had enough. I’m so pissed right now, I can’t even type a coherent comment but fuck it.

  30. 30
    gwangung says:

    Force people to buy crappy insurance? That is the policy
    position you are advocating.

    Like in Massachusetts? Help me understand; what are the differences between Massachusetts’ law and what’s being discussed?

  31. 31
    jayackroyd says:

    @Davis X. Machina:

    Yes, effective state regulation works. In VT. In MA. But there has been no effective Fed regulation. And Dean has noted that the companies pursuing the top margins left VT.

    If I thought, for a minute, that the regulatory controls in the bill would actually be effective, it would be a different story. But rescission is illegal now. And, um…..

    It is like the FDIC premiums that, well, never actually got paid.

    Without some kind of competitive framework or an active regulatory authority, coercing people to buy insurance that sucks is bad policy, and bad politics.

  32. 32
    Jay B. says:

    @jayackroyd:

    Or what the sensibly named correspondent above wrote.

    Can someone please tell me the upside here? I’m willing to be sold, but this bill sounds like the worst of all worlds.

  33. 33
    valdivia says:

    @gwangung:

    you beat me to this. I think I am giving up now though, the amount of rage based on nothing that is on the bill is just killing me. When the house passed its bill they were angry, it has a PO, that was not enough, so what will be?

  34. 34
    kay says:

    @Tx Expat:

    I think people are tuning health care reform out. It went on so long, and most of the debate was screaming.

    A friend of mine said today that she keeps thinking back to the first Obama press conference on health care. Remember that?

    He got asked the question on Gates, and all hell broke loose.

    She thinks that was like a WARNING of the insanity that was to come.

  35. 35
    Malron says:

    @gsp:

    I hope the progressive do kill the fucking bill so the dicks that have been taking us for granted know we have had enough.

    Yup. Definite signs of manic-progressive psychosis right thurr.

  36. 36
    freelancer says:

    @gsp:

    I’m pissed too, but Health Care Reform isn’t a fucking Etch-a-Sketch.

  37. 37
    jwb says:

    @MikeJ: It would be nice if the activists were threatening to be, you know, active instead of threatening to take their toys home if they didn’t get their way.

  38. 38
    Montysano says:

    @MikeJ:

    Put me squarely in the camp of people who care more about policy than emotion. Same reason Taibbi annoys me. “Ooh, he’s angry, and I’m angry, he must be a supra genuis!”

    A bit insulting, dontcha think, implying that it’s one or the other? The two are not mutually exclusive. There are a lot of people who hang around here that seem to me to be both well-informed and mad as hell.

    For me, I think it boils down to this: the bastards are operating completely out in the open now. There’s no longer any pretense. The American people want real HCR? Real financial regulation? Not too long ago, the answer of “No!” would have at least been couched in some flowery speeches and wonk-ese. Now? It’s just “No…. Hell no”. There’s been a real sea-change.

  39. 39
    eemom says:

    @gsp:

    yeah, cuz if Glenn Greenwald of all people said something bad about Obama, it MUST be true.

    I can’t stand it any more. What’s the word again? Green lights?

  40. 40
    John Cole says:

    @Jay B.: 30 million insured, no more rejection for pre-existing conditions, lots of money for preventive care, a foot in the door, and so on…

  41. 41
    valdivia says:

    @eemom:

    green balloons.

  42. 42
    Jay B. says:

    @valdivia:

    Jesus, really? You don’t think it had to do with the poison pill fuck you the anti-choice Family pricks got in at the last second that was punitive to poor women who might get pregnant?

    I really am trying to be open to argument — but compromise is one thing, and not having a single principle you are willing to stand by is quite another.

  43. 43

    Im taking a break from political sites and blogs until after Christmas after today but I just wanted to make a couple of points.

    1. The administration and Senate leadership are pimping the number “30 million” will be covered. However the new bill hasn’t been scored by the CBO and the 30 million number was arrived at because of the mandate, not the affordability. Its almost impossible to estimate how many people will be able to afford/buy health care because some folks will chose not to buy if given the chance even though they can afford it, and other people can make X thousands of dollars a year yet be paying off all kinds of bad debt which makes affording health care out of their reach

    2. Right now I am seeing plenty of “Democrats” or even self professed “liberals/progressives” pulling the same kind of bullshit that the right did with Bush. Even people who were truly conservative and knew those tax cuts were clusterfucks and so was the Iraq War, they chose to just support Bush blindly because he was “their guy”. I am sorry, I like President Obama good enough. I don’t really have any regrets considering who was running, but I won’t be his sheep. Not now, not ever.

    3. People can be mad at Joe Lieberman/Harry Reid/Ben Nelson/ and President Obama. Goodness knows I am. But ask yourself a question, where was the progressive Senator who drew a line in the sand like Lieberman? The closest we got was that clown Roland Burris, but you didn’t see Sanders, Rockerfeller or any of those others pledging to filibuster the bill if they didn’t get a public option or a MediCare buy in. So why no anger directed at them? I can tell you that not one Democratic Senator had better send me an email or any other correspondence about sending money or phone banking. As long as we don’t have a progressive asshole to counterbalance Lieberman this will continue to happen, just wait to the climate change bill.

    4. For people saying we will build on this later, all I can ask you is how in the fuck? Show of hands, how many people think we will still have a super majority in the Senate next year after the mid terms….Now, explain this to me. If we can’t get the shit done now with a super majority, something that neither party has had for decades, how in the fuck are we gonna do something MORE progressive with less of a majority? I really do want an answer to that one.

    5. And finally, please remember one thing. The public option was a part of President Obama’s health care proposal last year as a candidate. This shit didn’t appear out of thin air. So you are got damn right people have reason to be pissed off about it. It was HIS mutha fuckin proposal and HE didn’t fight for it. So why, exactly should anybody fight for them? I am not saying vote for a Republican (although I would make an exception in Harry Reid’s general election) but I am saying sit on our hands. Senate Democrats have basically said they don’t need liberal and progressive activists, especially not to win elections. And if you saw the concerted attacks today on Howard Dean you know good and hell well they really believe that. Well I say, maybe they are right. But its high time we find out.

    Peace out everyone.

  44. 44
    valdivia says:

    @Jay B.:

    No, the day before the Family poison pill became the issue, all the usual blogs were thrashing the bill as being too little and not good enough.

  45. 45

    From Glenn Greenwald’s latest column:

    UPDATE: It’s also worth noting how completely antithetical claims are advanced to defend and excuse Obama. We’ve long heard — from the most blindly loyal cheerleaders and from Emanuel himself — that progressives should place their trust in the Obama White House to get this done the right way, that he’s playing 11-dimensional chess when everyone else is playing checkers, that Obama is the Long Game Master who will always win. Then, when a bad bill is produced, the exact opposite claim is hauled out: it’s not his fault because he’s totally powerless, has nothing to do with this, and couldn’t possibly have altered the outcome. From his defenders, he’s instantaneously transformed from 11-dimensional chess Master to impotent, victimized bystander.
    __
    The supreme goal is to shield him from all blame. What gets said to accomplish that goal can — and does — radically change from day to day.

    Of course Greenwald is being shrill here, as is anyone who doesn’t believe in the mighty powers of our 11-dimensional chess master in chief. But the way I see it either President Obama is incompetent or just doesn’t give a fuck about progressive issues, any of them at all, and is just as much of a Blue Dog Democrat as Nelson, Lieberman, Lincoln, et al.

  46. 46
    mcd410x says:

    We’re here, we’re clear, we don’t want any more bears!

    Fuck it, I’m enjoying this. When’s the last time progressives caused this much of a ruckus?

    It’s nut-cutting time!!

    (Just think … we’ve still got the conference committee ahead!*!)

  47. 47
    jayackroyd says:

    @johncole

    No. It is thirty million people forced to buy insurance from companies that they have already decided they don’t want to buy insurance from. That is not “coverage.” “Coverage” is something entirely different.

    And these companies have, as their operating principle, maximizing shareholder value and senior executive comp, not the effective delivery of health care. If the latter were their goal, know what? Those 30 million people would have bought their policies.

  48. 48
    Jolene says:

    The insurance companies have an anti-trust exemption. Makes them just a little bit different than other for-profit companies because they are not subject to any real competition! And there is some assumption on your part that insurance companies have to be for-profit because that’s what they are now. I remember when BC/BS used to be non-profit. And really, why should companies that refuse to cover sick people either through rescission or through refusal to provide needed services be raking in 40% off the top of insurance premium money? The point of health care reform, one might think, would be to take on the status quo and make changes — not to assume that insurance companies need to continue on just as they are. And precisely because these companies are focused on profits instead of health care, they will continue to cherry-pick whom they choose to cover through the pricing of their insurance products. I voted for a presidential candidate that claimed to be for a public option and against mandates — wonder what happened to him?

  49. 49
    wasabi gasp says:

    Your cat has a huge ass.

  50. 50
    Tx Expat says:

    @kay:

    Yes, I remember his press conference and you’re right that it was quickly derailed. I do believe, however, that instead of retreating from the public spotlight, he, or his surrogates, should have flooded the airwaves. This is how Republicans operate, we should take notes because they managed to cram down two wars and a boatload of shitty bills in the face of strong public opposition.

    I’m not saying it would have stopped the insanity, but maybe that media blitz could have counter-acted it. Of course, that’s assuming that we have a media that isn’t hard-wired for Republicans.

    It’s ridiculous that we live in a country where millions of anti-war protesters around the globe are dismissed as a “focus group” and a few thousand (at best) hateful screamers (some of them armed) are given wall to wall coverage.

  51. 51
    valdivia says:

    see here we are if you say the bill is good this is just like supporting the war in iraq! yeah, because all the experts who know anything about health care are lying to back Obama, just like Iraq. Just insane, I am out people.

  52. 52
    Jay B. says:

    @John Cole:

    I like the 30 million, can swallow the subsidies (which wouldn’t be necessary if we had a public option), don’t believe for a second the health care industry will abide by paying off pre-existing conditions — they will gladly pay fines, if those are even meted out, because it’d probably cost them less — the preventive care is good…But this is it. There’s no way a major political party ever talks about real reform anymore, and that fucks us over for a long, long time.

    All the things that most liberals were willing to live with — public options, medicare buy-ins, etc — were compromises to begin with. Fine. But they weren’t even controversial. Hell, they were cheaper and better. And lowering health care costs could have freed up so much money for American businesses. And intellectual creation. And innovation.

    Instead we are still going to pay at least twice as much for worse care than the rest of the world. And our fucked-up, patchwork insurance system remains utterly dysfunctional. Hooray!

    The positives were so obvious and seemingly attainable (just look at the Baucus proposal from early 2009, or even Lieberman’s Medicare buy-in talk from 3 months ago) that those disappointed or angry have every right to be. This was one giant, wasted opportunity. And to many of us, it now seemed rigged from the start.

  53. 53
    Lev says:

    @Wile E. Quixote: He doesn’t care about progressive issues. He’s trying to pass UNIVERSAL HEALTH CARE. You know, the #1 liberal priority for liberals for eighty years! Then after that, he’s going to try to pass financial regulation and cap-and-trade. Maybe he’s not doing it in the way you’d like, but some perspective, please.

    Wonder what the weather is like in your reality.

  54. 54
    Little Dreamer says:

    @sgwhiteinfla:

    Im taking a break from political sites and blogs until after Christmas after today but I just wanted to make a couple of points.

    I took a break, I guess it wasn’t long enough.

    Funny how many people are saying they need to get away right now. Seems strange. Crazy overload has it’s limits, I guess.

  55. 55
    K. Grant says:

    not having a single principle you are willing to stand by is quite another

    This is my principle – huge boatloads of people do not have health insurance and will not get it in the near future if we do not pass some kind of health care bill now. These people are suffering now. These people are being screwed by the system now. We have it within our grasp to do a little good for our fellow travelers, and I vote that we should do so.

    Is it perfect? No. Still a bit of a clusterfox? Yes. That said, taking care of these people is the first priority. If we can put an end to the happy bullshit of screwing with people with health care, or when they have the temerity to change jobs, or have pre-existing conditions (me – heart condition, atrial fibrillation, loads of fun), etc, at the same time? Done.

    That is my principle, really the only one that makes a difference to me.

  56. 56
    Little Dreamer says:

    @mcd410x:

    Fuck it, I’m enjoying this. When’s the last time progressives caused this much of a ruckus?

    Well, as much as I love seeing progressives pushing for their desires, the current reactionary environment is giving me serious indigestion.

  57. 57
    DaBomb says:

    Let’s try this again…

    Senate Bill + House Bill= Final Bill

    This is NOT THE FINAL BILL. We are having a conversation purely based on conjecture.

    Nobody here has read the whole damned bill.

    We have an idea what’s in this bill, we have an idea of what’s in the House bill, but so far we don’t know what the final bill looks like, until it leaves conference. Obama gave a a speech about what the hell he wanted in this bill to the whole entire fucking nation and congress.

    I consider myself a black progressive, I have worked in my community helping people especially volunteering at Health Clinics and this behavior being displayed by Kos, Hamsher, and other is not typical of how black progressives feel about health care reform, Booman proves my point here:

    http://www.boomantribune.com/s...../132039/17

    Within the article there’s a link to a black progressive on Dkos who wrote a diary discussing the same thing.

    All of this purity needs to go out the window. This is a foot in the door. We(healthcare and other volunteers at the clinic) see this as progress, people will be covered. But we also know this isn’t the final bill.

    Jesus Christ on a damned pogo stick!!!!

  58. 58
    General Winfield Stuck says:

    2. Right now I am seeing plenty of “Democrats” or even self professed “liberals/progressives” pulling the same kind of bullshit that the right did with Bush. Even people who were truly conservative and knew those tax cuts were clusterfucks and so was the Iraq War, they chose to just support Bush blindly because he was “their guy”. I am sorry, I like President Obama good enough. I don’t really have any regrets considering who was running, but I won’t be his sheep. Not now, not ever.

    Cheap shot dude. No comparison with going along with a health care bill to the wingnuts supporting an Iraq invasion.

    And your analysis of this bill is full of GOS shit. As is the sheep analogy you think we are. geesh. Take as long a vacation as you need. Then stay away longer.

  59. 59

    Eh, let the Repugs win and Nelson, Bayh and the others can go back to being in the minority without power. In the meantime I’ll pay less in Federal tax and will be dead by the time the bill comes due.

  60. 60
    valdivia says:

    I really don’t get it. The people who knew anything about Iraq were against the war, it happened that the activists were too. The comparison to healthcare is idiotic. If anything it is the constant yelling based on assumptions and not on what the bill says or will do that reminds one of the neocons. Also–did we discuss the war for a year in congress?

    And I love how the one viable example of how the mandate works and how people react to it gets totally ignored in the discussion

  61. 61
    Lev says:

    @K. Grant: Me too. But apparently this is not a widely held idea.

    I just love the idea that everything would have been different if progressives had just drawn a line in the sand. Yeah, because that strategy worked so well with Clintoncare.

  62. 62
    Malron says:

    You know, I’m sure I’m not the only one who sees a tinge of vindictiveness in the way Bernie Sanders goes on Neil Cavuto’s show to announce he’ll be voting against the bill.

  63. 63
    John says:

    Without the individual mandate, or something equivalent, the whole thing collapses, no? You can’t force the insurance companies to sell insurance to everybody, no matter what pre-existing conditions they have, and let people wait to buy insurance until they get sick. That’s the way to make insurance premiums spiral out of control.

  64. 64
    Comrade Kevin says:

    Dick Armey is a moron, with an appropriate nickname.

  65. 65

    @gsp:

    Yeah! Kill this bill and give the fuckers the status quo they’re perfectly fine with! That’ll show the wankers!

    Look, getting fucked from time to time is the price you pay for not being a sociopathic dickweed who doesn’t give a damn how many people your decisions kill. I can live with that because, you know, I’m not a sociopath.

  66. 66
    Jay B. says:

    @K. Grant:

    If we can put an end to the happy bullshit of screwing with people with health care, or when they have the temerity to change jobs, or have pre-existing conditions (me – heart condition, atrial fibrillation, loads of fun), etc, at the same time? Done..

    I get where you are coming from, and I would love to think you’re right. But I don’t think this comes close to stopping the insurance industry from screwing with people. They just proved they could kill meaningful reform by buying off enough Democrats — why on Earth do you think this will reign them in? They get 30 million new customers and will be happy to reject their claims when the time comes. Unless they’ve had a change of heart or something.

  67. 67
    Malron says:

    @K. Grant: 30 million cosigns to you, my friend.

  68. 68
    Paula says:

    The question is, will it help people or won’t it?

    Right now the blogosphere is seething with charges and countercharges. The one side is arguing that, bad as it is, this bill has some merit, will help some people, so it should pass.

    But others are saying that the holes in the bill negate the possible benefits. They’re saying things like broad promises are compromised by all kinds of loopholes. They’ve stripped out the provision prohibiting caps, they’ve stripped out the anti-trust measures, there’s no measures that would prevent insurance companies from agreeing on whatever “floor” price they want to charge, there’s nothing external forcing competition.

    From a huffpost entry:
    “The provision requires employers who hire people who receive government subsidies for buying individual insurance to pay substantial penalties. This would encourage employers to avoid hiring low and medium income people who qualify for subsidies and particularly discourage them from hiring people with children, since those people would get subsidies at higher income levels.”
    http://www.huffingtonpost.com/.....94174.html

    If that’s true, we’ve insured people and made them unemployable.

    I don’t know what’s true or false, or what will be changed before it’s over. So we don’t know yet if it will help or hurt people. But it certainly sounds like our government has agreed that WE will pay the highest possible prices to insurers, directly through premiums, and indirectly, through taxes. Lower income people will have yet another “entitlement” that will be at constant risk of being reduced or removed (let’s end welfare as we know it!), the rest of the population will be encouraged by republicans to resent same.

    Ezra Klein says it all depends on the following:
    “You need a strong individual mandate, a tight cap on what insurers can spend on things that aren’t medical payments, sharp limits on their ability to discriminate on the basis of age, really good risk adjustment (so there’s no incentive to cherrypick), and aggressive oversight of annual limits, rescissions, and similar practices (none should be allowed).”

    It’s not clear yet whether we have those things, or don’t.

  69. 69
    AWL says:

    This is the 1957 Civil Rights Act all over again. As frustrating as it is to say, it’s best to have patience and to put pressure on the politicians so that improvements are made to this bill over time!

    And this article on DailyKos about the role that Research Consultants played in all this is probably worth reading.

  70. 70
    Tx Expat says:

    @valdivia:

    If you’re referring to my comment, that’s not what I was suggesting at all. I don’t think that this is an awesome bill, but I do think it’s the best we can get at this time.

    My point in comparing teabaggers to Iraq War protesters was to highlight the stupidity of our media who give more coverage to the former rather than the latter.

  71. 71
    valdivia says:

    @Tx Expat:

    No, I was talking about Dkos and SGWhite comparing those of us who think this bill will do enough good to those who supported Iraq.

  72. 72
    DaBomb says:

    @sgwhiteinfla:

    4. For people saying we will build on this later, all I can ask you is how in the fuck? Show of hands, how many people think we will still have a super majority in the Senate next year after the mid terms….Now, explain this to me. If we can’t get the shit done now with a super majority, something that neither party has had for decades, how in the fuck are we gonna do something MORE progressive with less of a majority? I really do want an answer to that one.

    Okay, how did Medicare and Social Security turn out. Are you saying that those reforms came out of the gate perfect with no changes needed? How about the Civil Rights Act? It came out perfect too with no changes needed?

    Social Justice is done in increments.

  73. 73

    @Lev

    He doesn’t care about progressive issues. He’s trying to pass UNIVERSAL HEALTH CARE.

    And he’s doing a shitty job of it. Jesus, what’s next? Perhaps he’ll announce that everyone without health care will be drafted into the military and sent to AfPak. And then he’ll say “Look, we have UNIVERSAL HEALTH CARE. It is good.” We’re not getting UNIVERSAL HEALTH CARE. We’re getting UNIVERSAL HEALTH INSURANCE, which is not the same thing, especially with the total lack of any cost controls and the toothless provisions against rescission and the annual caps that Harry Reid put in. And yes, I’ve been reading the bill, the actual text of the bill, not summaries and I’m not that impressed.

    If President Obama announced tomorrow that we were going to withdraw all of our troops from Iraq and use them to invade Iran would that be progress? Would you say “He’s withdrawing our troops from Iraq, he’s just not doing it the way you want to?”.

  74. 74
    mcd410x says:

    Good article via Digby on the death of the Medicare buy-in.

    @Little Dreamer: Understandable. I sort of thrive on pressure and chaos — hell, I do my best work under those conditions!

  75. 75
    MattR says:

    John – Your entire premise is a false binary choice. The options are not just that the insurance company wins and continues to make a profit or it does not win and it goes out of business. I would like to see a bill that increases regulation of the insurance company and forces them to spend money from premiums on healthcare services (not bonuses or lobbying) but they are still allowed to make a profit. If such a bill was passed, I would not think the insurance companies won and I don’t think they would either.

  76. 76
    General Winfield Stuck says:

    @Paula:

    “You need a strong individual mandate, a tight cap on what insurers can spend on things that aren’t medical payments

    Bingo!. this is the key, and Harkin wants it at 90 percent. If that gets in the final bill, then Ezra is right.

  77. 77
    DaBomb says:

    @General Winfield Stuck: I thought that was a Franken amendment?

  78. 78
    General Winfield Stuck says:

    @valdivia:

    That remark is at the top of my list of dumb things I read today, and it’s a very long list.

  79. 79
    MattR says:

    @DaBomb: One thing to remember about Medicare and Social Security is that they were able to be expanded because they were not complete clusterfucks. That is my big fear about passing something crappy just to get something passed; that by the time it comes to expanding it there will be no political will to do so because the existing program will suck so bad.

  80. 80
    General Winfield Stuck says:

    @DaBomb:

    It could be. I think I heard Harkin mention on teevee awhile back and assumed it was his. He is for it though.

  81. 81

    @Wile E. Quixote:

    Or, you know, the required number of votes just aren’t on the table. Crazy, I know.

  82. 82

    @DaBomb:

    To say nothing of the fact that the last expansion of Medicare, to finally cover prescriptions, was passed by a Republican President and Republican Congress.

  83. 83
    Leelee for Obama says:

    @Belafon (formerly anonevent): Could you provide a link? I wandered around a bit and couldn’t find this diary you mentioned. Thanx/

  84. 84
    valdivia says:

    @General Winfield Stuck:

    I know if we have gotten to the point that progressives are comparing those of us who support this bill to the neocons someone jumped the shark and I don’t think it is us.

  85. 85
    gwangung says:

    @General Winfield Stuck: Um, the details the devil is in, right? (Also, as in policy, which wonks…wonk). And I thought this was a key detail that was in the various proposal…Or is everyone making too much noise to realize what’s important and what’s not?

  86. 86
    DaBomb says:

    @MattR: I am sorry anything that is oppressive towards large swarths of the population is a huge clusterfuck.

    So Social security didn’t include domestic workers, who at the time were overwhelming African-American and immigrants. So social security sucked pretty bad too. Same for Medicare which didn’t help out agricultural workers at first. And the Civil Rights bill sure didn’t correct all of the effects of Jim Crow Segregation, but it was progress and a step in the right direction.

    All of these reforms have been worked on for many years now. Regardless of the make-up of congress, all of these bill have progressed in shape or form.

  87. 87
    Little Dreamer says:

    @Sleeping Dog:

    Shorter Sleeping Dog: “I got mine, fuck you”

  88. 88
    Comrade Kevin says:

    Rachel Maddow just used the Wetsuit Warehouse shortened URL on her show, HA!

  89. 89
    Bostondreams says:

    I just wonder, really, what world some people live in when they think a bill that is more progressive than it is now could actually get passed, if this lovely little thing can barely get through. I mean really, the votes are simply not there, period, and they will never be. Or is someone going to magically turn the bluedogs liberal and make the Republicans a legitimate opposition party?

  90. 90
    General Winfield Stuck says:

    @gwangung:

    Or is everyone making too much noise to realize what’s important and what’s not?

    It is Ideological froth and combat, imo. No more, no less. Hopefully, it will pass and people will start using their brains again. Maybe. also.

  91. 91
    MattR says:

    @DaBomb: If we can get an HCR bill that can be built on incrementally, I am all for it. But if we end up creating an exchange with mandates and subsidies and then it turns out that those subsidies cost 20 times what was projected right off the bat, it is going to be very hard to convince people not to scrap the whole thing entirely, let alone expand it.

  92. 92
    MattR says:

    @MattR: Or a shorter version of my last comment:

    At least Medicare and Social Security worked initially for the limited number of people who were allowed to participate.

  93. 93
    Tx Expat says:

    @valdivia: @DaBomb:

    This. As horrible and inhumane as it is, this is the way we do social justice legislation in this country. Conceding the fact that the legislation is usually preceded by a court ruling or a constitutional amendment(s), but we have neither here.

    All we need is a foot in the door and I think this legislation provides that.

  94. 94
    DaBomb says:

    @MattR: How would the same not work for this bill? Isn’t that incrementalism? I just mentioned that all of those reforms were pushed incrementally, covering a small amount of people at a time.

    And as I have said upthread, this bill has to be merged with the House bill. So we really don’t know what kind of bill we will have.

    Here’s what Krugman said:

    There’s enormous disappointment among progressives about the emerging health care bill — and rightly so. That said, even as it stands it would take a big step toward greater security for Americans and greater social justice; it would also save many lives over the decade ahead. That’s why progressive health policy wonks — the people who have campaigned for health reform for years — are almost all in favor of voting for the thing.

    http://krugman.blogs.nytimes.c.....itterness/

  95. 95
    KCinDC says:

    I’d feel a lot better if I thought that this bill subjected the insurance companies to tight regulation. If everyone in the country is going to be forced to give those companies money, they’d sure as hell better be seriously regulated, with real enforcement and consequences for violations.

    But this doesn’t even get rid of their antitrust exemption. What possible justification can there be for that?

  96. 96
    Olly McPherson says:

    Anyone see Olbermann tonight? I’m not the biggest fan, but he was practically spitting as he denounced the bill.

  97. 97
    DaBomb says:

    @Brien Jackson: True. And they are the obstructionists right?

    That’s the devil of it all, the timing was right and Medicare progressed.

  98. 98
    valdivia says:

    @Tx Expat:

    to me this seems such an obvious point i just don’t get why people don’t see it? Sigh.

    Ok seriously calling it a night.

  99. 99
    DaBomb says:

    @Tx Expat: That’s the thing that kills me, it’s like people live in fantasyland and where social justice reforms just happen overnight.

    That’s not the way movements have ever occurred in this country.

  100. 100
    MattR says:

    @DaBomb: I completely agree about not knowing the final result of the bill, and I haven’t really taken a stand about the current state of the bill because of that. I would generally prefer that we get a foot in the door and then make incremental steps, but I am not an absolutist on this. I am not so sure that the Medicare prescription drug bill would have passed if its true cost was known at the time. And I worry that the bill will end up becoming prohibitively expensive very quickly.

    (My other worry is that the current bill is so weak it is just a finger in the dyke that doesn’t stop the raging river coming at us and will lead to a worse situation in 10-15 years than if we did nothing today, but that is a different topic)

  101. 101
    gwangung says:

    (My other worry is that the current bill is so weak it is just a finger in the dyke that doesn’t stop the raging river coming at us and will lead to a worse situation in 10-15 years than if we did nothing today, but that is a different topic)

    Yeah, it’s different, but still the same, because even if it’s a finger in the dyke, I thought it set up structures and mechanisms that CAN be tweaked to something better—and it’s a lot easier to tweak than to introduce something entirely new. (Which is what this whole storm is about).

  102. 102

    @sgwhiteinfla:

    For people saying we will build on this later, all I can ask you is how in the fuck?

    Oh, for fuck’s unholy sake.
    You get up. You pull your boots on. You do like the teabaggers, and you protest. You get press coverage. You move the media, and Congress. You play for inches, because that’s how every other big piece of legislation got passed.
    Go read, for one example, a good book on MLK. Or Juan Williams’ kick-ass book on how Thurgood Marshall got Civil Rights pressed via the Supreme Court. Health Care has been pushing for decades now, and if this attempt makes a law, we’re that much closer. If it doesn’t, we fall behind like in ’92-’93, and wait for…fuck, I dunno what you guys expect to happen. Another Dean?

    This bill puts the ball down the field, for us to pick it up again when we have the manpower. People have shown other examples — hell, look at the Part D mess that the GOP pushed and passed just a few years ago! (ON REVIEW: A point I see others making, here). Don’t tell me that passing this bill doesn’t change how we talk and deal with Health Care in America, change how we look at laws for the process.
    It puts us closer, and makes people’s lives better, overall. It doesn’t help everyone…but I thought part of being a Liberal was being “bleeding-heart” — was in seeing was was in it for everyone, not just for me. That ideal of helping out other Americans less “lucky” than I — fuck, where’s that in this bitch session? Or is this all spite ’cause you didn’t get your promised POP — your Public Option Pony?

    If the sum effect is to make people’s lives better, why the fuck would you stop it?

  103. 103
    MattR says:

    @gwangung: Good point, though my worry is more that we wont make the necessary tweaks at the right time because we will think we already took care of the problem. But even in that case, at least it will hopefully be easier to make the tweaks once we accept that it is necessary.

    I used to have optimism once. Really, I swear I did.

  104. 104
    KCinDC says:

    … it’s a lot easier to tweak than to introduce something entirely new.

    That’s true only if the thing you’re tweaking is close enough to being the thing you need. This may be, but if it’s not the existence of this new system could prevent us from getting to the system we need to solve our problems — a system that might have been achievable if starting from scratch.

    But I’m not for telling the many people whose lives could be made longer and happier if we pass a bill now that they have to wait because that might be the case.

  105. 105
    MattR says:

    @KCinDC:

    But I’m not for telling the many people whose lives could be made longer and happier if we pass a bill now that they have to wait because that might be the case.

    This is really the key, isn’t it? I may be expressing reservations here, but when push comes to shove the final bill would have to be really bad for me to oppose it.

  106. 106
    kay says:

    @Paula:

    Oh, Paula. Who wrote that Huffpo article?

    An employer mandate would “discourage employers from hiring low income people”?

    WTF? Do people ordinarily come with an “income” when they get a job? What makes them “low income”? Their wages. right?

    They’re low wage employers. Their employees are going to be, by definition, low income.

    They’re going to hire who, instead? High income people?

    This idea that there are spare employees hanging around any viable business began with the Right wing arguments the minimum wage.

    You hire EXACTLY AS MANY low income people as you need for any particular low wage task. No extras. No spares.

  107. 107
    Martin says:

    I don’t know what’s true or false, or what will be changed before it’s over. So we don’t know yet if it will help or hurt people. But it certainly sounds like our government has agreed that WE will pay the highest possible prices to insurers, directly through premiums, and indirectly, through taxes. Lower income people will have yet another “entitlement” that will be at constant risk of being reduced or removed (let’s end welfare as we know it!), the rest of the population will be encouraged by republicans to resent same.

    Look, there’s three variables here on ‘affordability’ and people are having trouble working more than one of them at a time.

    1) The cost of premiums.
    2) The subsidy for those premiums and where that comes from
    3) The wage we put against the cost above.

    Let’s look at premiums for a moment. Total US healthcare expenditures for 2008 is estimated to be 2.4T according to HHS. That’s $8,000 per man, woman, and child no matter what. A family of 4 is in for $32,000 if we distribute this completely evenly.

    So, how does that get divided down? Hospital care is 1/3 of that. Doctor/clinic care is another 20%. So just covering doctor + hospital costs is a bit over $4,000 per person in this country. Ignoring any cost effects (which, again, is what the Senate is trying to do), that number is 100% unavoidable. Throw in home health care, nursing homes, and other services such as physical therapy, and that’s another 20%. Drugs are 10%. Retail items (shit you buy at Walgreens) is 3%. Investment and gov’t health activities is about 10% – treatment studies and money going toward construction, that kind of junk. Program administration – which covers everything from insurance to forms processing is 7%. Now, there’s more administrative costs in those other categories, because some is difficult to break out, but the 7% covers all insurance costs.

    If we change nothing else, the most you can expect that $8000 per person to decline by beating up the insurance companies is $560 to $7440. A family of 4 is still committed to $29,780, if we distribute every dollar evenly. This is the cold reality we’re facing.

    Clearly just whacking away at insurance isn’t going to do the job, and clearly most families can’t dump 2x the federal poverty income level into health care. If we accept these costs, then we need to find a way to shift them from people who earn more, or we need to accept that people below a certain income level should be denied care. Now, people at the bottom of the income scale consume less care because they can’t afford as much, so there’s really not as much shifting needed as this seems, but still, a fair bit will be needed. It’s probably going to require a fair degree of taxation. Now, one thing helping the situation is that Medicare is paid into over most of a lifetime, so it benefits from interest growth, and most costs are borne at the end of life, so this process already provides for a certain degree of cost shifting by shifting payments from earlier in life, adding interest, and then covering costs later in life. Still, it only goes so far.

    One of the major problems, one that is left unmentioned, is that the standard of living that our health care costs reflect is WAY out of whack with what passes for a living wage in this country. You can’t provide even critical care for people working full time earning $12K per year when the anesthesiologist is earning a minimum of $250K.

    So, either you need to raise wages so they aren’t so horrifically out of whack with the cost of care, or you need to take that $2.4T and start to seriously knock it down. At most, a public option would shave off 7%. Competition simply doesn’t erase core costs. It doesn’t matter how many grocery stores are in your neighborhood, the cost of milk is only going to go down so much. You need regulation, you need what the Senate is doing.

    Ezra has it right – whittle that 7% down to start, spread the dollars out, subsidize for everyone at the bottom, and do everything reasonable to knock down costs. Yeah, we need to suck up some, but once the big first pass is done, the next pass gets easier. That $2.4T isn’t going to go away. Put the politics away and simply deal with that reality.

  108. 108
    grumpy realist says:

    Actually, the one piece of legislation that might actually come out of this is getting rid of the anti-trust exemption for health insurance companies. Ironic.

  109. 109
    Irony Abounds says:

    Costs have to come down or this will be the Democratic Party Self Immolation Bill. If costs don’t come down everyone in the middle class and above will be paying more for their insurance and there will be hell to pay.

    I’m willing to pay some more to start the process, but over the long term there has to be cost relief.

    My own preference for health care reform would be to define whatever it is that the Mayo Clinic and the Cleveland Clinic do to reduce costs and obtain better outcomes, provide the doctors working at clinics meeting that definition with preferential tax treatment on their income, increase Medicare reimbursement rates for those clinics and provide tax benefits to those who use those clinics. By spurring the growth of that type of medical practice, you break the lethal hold that fee for service has on our medical system, costs go down by 20% or more, and you have better outcomes. This shouldn’t require a huge bill, it wouldn’t be viewed as the government taking over the health care system, and it neither benefits nor directly takes a slap at insurance companies. Of course, a common sense approach like this will never happen, and at this point what is being proposed is better than nothing, so pass the damn bill, but it sure as hell better work.

  110. 110
    KCinDC says:

    @grumpy realist, if that happens, it’s good, and it’s a reminder of why I want people like Bernie Sanders still demanding improvements, even if it makes John shout about how they’re unpleasantly shrill and don’t care about the uninsured.

  111. 111
    General Winfield Stuck says:

    @Martin:

    Just want to say, I appreciate these long well thought out posts of yours, I read the others and learned something, but no time for this one. Maybe tomorrow.

  112. 112
    Martin says:

    @Irony Abounds:

    Of course, a common sense approach like this will never happen

    Actually, that’s not far removed from what the Senate bill actually does.

  113. 113
    PartyLikeIts1990 says:

    John you’re hilarious. Didn’t you post earlier this very day saying basically “what good is this bill anyway? crank wank wank blar har this sucks.” I guess you’re yelling at you-from-earlier-today?

    Shine on you crazy diamond…

  114. 114
    silentbeep says:

    “Fucking deal with it and decide whether or not this current bill helps people. I’m by no means thrilled with it, but I think it is a step in the right direction.”

    Exactly. And yeah, rage noted. I think I’m gonna go postal too, and almost did with a family member today while we were discussing how she is dead set against HCR now – both of us are pretty leftie too.

    Oh lordie. I want the rapture to come already and deliver us from this mess.

  115. 115
    Martin says:

    @General Winfield Stuck:

    Thanks, as I said in the other thread this is a running discussion (resembles argument more often than not) in my family.

    It would surprise many that there’s a lot of single payer support, even among the execs. From my side, single payer is non-negotiable as a long-term solution. People *really* miss the scale of what we’re talking about here, though. Our health care economy is a little over half the GDP of China. If it was a country, it’d be in the G8. It’s fucking massive – in part because we possess the crown jewels of the medical community which is worth paying for, in part because we treat it like an economic profit center, and in part because we abuse it as consumers.

    But any radical plan for health care is comparable to taking any first world nation other than the US and full-on redefining their economy. Now, I’m arguing that it’s necessary to do that over time, but there is going to be a fuckton of unintended consequences from big spikes in unemployment, to costs shifting to all the wrong people, to new opportunities for corporations to show up and fuck everybody over, to who knows what. And that’s assuming the GOP doesn’t decide to start strapping bombs to the teabaggers.

    It’s going to happen. It’s GOT to happen. Our health care economy is poised to actually overtake every other economy but China’s in the next decade at the rate we’re going. That’s what Obama has his sights on – it’s a big economic nuclear bomb ticking away in the village square and yeah, we’re going to have to sell out some people to defuse it. Everybody in the industry knows this and everybody is terrified of how it might get solved and where that will leave them. It’s understandable that this is such a hard problem to solve – it’s WAY harder than banking, and it needs to start getting solved soon.

    People are WAY too hung up on the politics of this and seriously underestimating the scale of what can be accomplished with just what the Senate and House can pass now.

  116. 116
    dadanarchist says:

    @grumpy realist: Actually, the one piece of legislation that might actually come out of this is getting rid of the anti-trust exemption for health insurance companies. Ironic.

    Shhh, don’t tell Joe Lieberman.

  117. 117

    @Brien Jackson

    @Wile E. Quixote:
    __
    Or, you know, the required number of votes just aren’t on the table. Crazy, I know.

    Well the administration will go the distance to get funding for our never ending war in the Middle East, and boy oh boy, President Obama sure did put a lot of thought into his Afghanistan “strategy” but they don’t give a damn about health care. From Greenwald’s column, who you won’t read because he’s shrill.

    Indeed, we’ve seen before what the White House can do — and does do — when they actually care about pressuring members of Congress to support something they genuinely want passed. When FDL and other liberal blogs led an effort to defeat Obama’s war funding bill back in June, the White House became desperate for votes, and here is what they apparently did (though they deny it):

    The White House is playing hardball with Democrats who intend to vote against the supplemental war spending bill, threatening freshmen who oppose it that they won’t get help with reelection and will be cut off from the White House, Rep. Lynn Woolsey (D-Calif.) said Friday. “We’re not going to help you. You’ll never hear from us again,” Woolsey said the White House is telling freshmen.

    Barack Obama is rapidly turning out to be Lyndon Johnson, except without the Great Society, without the Civil Rights act, without the War on Poverty but with plenty of stupid foreign wars. But he’s not as bad as Bush or McCain, so I guess I should eat my shit sandwich and be happy with this lousy insurance company welfare bill we’re getting because the administration just doesn’t give a damn about anyone who doesn’t work for Goldman Sachs, Bank of America or Citigroup.

  118. 118
    Martin says:

    @dadanarchist:

    Doesn’t matter – it won’t do much. The state regulation creates the artificial market barriers that anti-trust is usually designed to prevent. Those will still be there.

    And that’s another point in the discussion – the insurance companies would *love* to lose the anti-trust exemption if we got rid of the state regulation as well. They’d do cartwheels and costs would get knocked down a bit just by that move alone.

    Anyone willing to tackle that politically? Anyone even discussing it? Anyone have a clue about the nature of the problem?

  119. 119
    Bostondreams says:

    @Wile E. Quixote:

    Apples and oranges. Comparing Obama’s ability to get his war proposals through fails to acknowledge that that plan was something that was going to have ‘bipartisan’ support from both bluedogs and Republicans.

    Health Care Reform is a whole different piece of fruit. Explain how a more progressive piece of legislation makes it through based on the current makeup of Congress. Reconcilation is out, as that is only acceptable for the financial elements. And what motivation do the obstructionists on both sides of the aisle have to allow that to happen? Do you think Nelson and Conrad and Lieberman and Landrieu are all that worried about a primary challenge from the left? Doubtful.

    What, in your eyes, is a ‘good’ and realistic bill that recognizes the limitations of the makeup of the Senate?

  120. 120
    mclaren says:

    There’s some reasonable evidence to support the viewpoint that incremental change over time produces big results. For example, women’s rights. We didn’t pass any single piece of major legislation after women got the right to vote, (ERA failed, notably) but if you look at women’s reproductive rights and anti-stalking awareness and the treatment of domestic violence today, it’s all worlds better than it was back in 1921.

    Same deal with civil rights. After the civil rights act of 1964 passed, a series of incremental improvements have resulted in…well…I mean, c’mon, we’ve got a black president, so do I really have to explain how big a change that is from, say, 1954, when the deep south had segregated rest rooms and segregated drinking fountains?

    Most recently, we’ve got the chinks in the armor of the drug warriors appearing in the form of nationwide moves to legalize small amounts of medical marijuana. While it’s too early to tell, this probably presages an eventual end to the kind fanatical lock-’em-up-for-life policies we’ve seen in the War on Drugs.

    Once we have some kind of nationwide system in place, it can be tweaked to improve it. For example, the current health care bills sets up many different experimental programs to reduce costs. Over time we’ll be able to figure out which of those programs works best and expand it to cover the entire system.

    The point is that at least we now have the prospect of some kind of comprehensive national method of dealing with medical records, medical costs, uninsured people, and so on. Whereas before the health care bill, we had nothing.

    In the long run, of course, the U.S. health care system will get fixed. It’ll get fixed because at the rate medical costs and numbers of uninsured people are increasing, we will see systemic collapse within two generations. To put it bluntly, there is simply not enough money in the American economy to pay for health care in another 65 years if nothing is done. I mean that literally. Look at the charts, look at the rate of increase above inflation across historical time.

    We’re now at 16% of GDP gobbled up by health care costs with a doubling time for those costs of 28 years. (check out the historical chart: in 1978 health care costs used up 8% of U.S. GDP, in 2006 health care costs ate up 16% of U.S. GDP.) Do the math: 28 years from now health care eats up 32% of U.S. GDP, 56 years from now health care eats up 64% of GDP, 84 years from now health care eats up 120% of GDP.

    Here’s a news flash: health care can’t take up 120% of GDP. That’s mathematically impossible. So America’s health care system has to change, no matter what happens in this reform.

  121. 121
    dadanarchist says:

    @mclaren: There’s some reasonable evidence to support the viewpoint that incremental change over time produces big results.

    I mentioned over on another thread that this has proved to be true, but mainly for civil rights issues that don’t, ultimately, impact the rich and powerful other than a few right-wing wingnut billionaires. Most corporations have pushed for equality laws as benefitting their employees and making the law clearer for HR purposes.

    Not that these expansions weren’t important.

    But, other than SCHIP legislation (which ultimately, in the end, is funded through taxation), what major piece of social legislation, regulation, reform or other act or law has been passed since LBJ that has benefitted the people over the powerful?

    As an example: I mentioned, also on the other thread, that the minimum wage has still not regained its 1973 peak.

  122. 122
    Cain says:

    @mclaren:

    Here’s a news flash: health care can’t take up 120% of GDP. That’s mathematically impossible. So America’s health care system has to change, no matter what happens in this reform.

    I think though if we had a tax cut to the upper income bracket that the resultant prosperity will make health care reform unnecessary as everybody will be able to comfortably pay their premiums cuz all those folks upstairs will re-invest in their country since they’ll be satisfied with the income they get from their jobs. It’s those darn taxes.. if they could keep more of it, we’d have the prosperity we deserve.

    And God will smile upon us! Merry Christmas!!

    cain

  123. 123
    Irony Abounds says:

    @Martin: If that’s what it does they sure are doing a good job of hiding that fact. Or perhaps what hiding it is the complexity of the bill. Or the strong potential risk of trying to force the issue. This legislation is far more stick then a carrot, and I’m not sure the incentives are there to put fee for service in the past.

  124. 124
    Mnemosyne says:

    @Paula:

    “The provision requires employers who hire people who receive government subsidies for buying individual insurance to pay substantial penalties. This would encourage employers to avoid hiring low and medium income people who qualify for subsidies and particularly discourage them from hiring people with children, since those people would get subsidies at higher income levels.”

    So, in other words, you want the government to continue allowing Wal-Mart to dump their low-paid employees into the Medicaid system instead of requiring them to provide their employees with affordable insurance. You prefer to continue to have taxpayers fund health insurance for Wal-Mart employees rather than have Wal-Mart pay for the healthcare of its own employees.

    I’m realizing that a huge number of people using scare tactics have absolutely no fucking idea what they’re talking about and have no clue why certain provisions — like “let’s not let Wal-Mart duck their responsibilities to their employees anymore” — are in the bill. So they see scary, scary things in the bill that they don’t understand and they freak the hell out because they have no clue what they’re talking about.

    Geez, I think I’m going to have to step away soon, myself. The rank ignorance and fearmongering is really starting to get to me.

  125. 125
    Martin says:

    @Irony Abounds:

    The bill is massive. Until Lieberman stuck his dick in this, the Democrats really had no incentive to talk about the bill much at all – get it passed and then talk about it. Now the left have allowed themselves to be played by Lieberman, the Dems may talk about it more, but the guts of the bill is really fucking boring. It’s not radical or sexy, it’s very progressive and very pragmatic.

    The left apparently doesn’t care about that – they’re clearly MUCH more interested in fucking over the insurance companies (understandable, but at the same time somewhat counterproductive) and waving their foam finger and so they just gloss over the practical bits. Honestly, the left has been functionally worthless in this effort because they dumped so much energy into something that was so easy for the right to kill off, and the left responded with the predictable outrage against the wrong target because they had all their energy devoted to this one little thing, and ignored the rest of the bill.

  126. 126

    If progressives had said “Fucking deal with it” when Obama’s minions started trying to whip them bloody, they would have got a tolerable bill, or at the very least avoided the spectacle of the House bill being completely ignored in favor of LieberCare.

    But instead, progressives get this sort of condescending bullshit thrown in their faces.

    Sorry, John, but this is pathetic. What progressives are (belated, finally) realizing is that power is always held by the guy who is willing to walk away from the table. That’s why Joe had power in the first place.

    That’s also why opposing this makes sense. This is bad legislation. Period. It “insures everybody” by forcing everybody to buy terrible insurance, taxes one-fifth of employer plans as “cadillacs”, provides enormous incentives to build regional monopolies and cartels, signals that regulation and oversight will be a joke, and doesn’t even prevent rescission, thanks to that monster “fraud” loophole. It doesn’t “let the insurance companies win” because they have new customers, it “lets the insurance companies win” because it turns them into rentiers.

    And because it IS so terrible, it’s a red line. If progressives let this abomination pass, they’ll let everything and anything pass. They will have shown the Dems and the world that there is literally nothing you could do to get them to walk. You can take them for granted, completely, forever.

    Progressives were tired of being powerless under the Republicans, so they worked their asses off to get the Dems into power. If they’re powerless under the Dems, too, they aren’t going to suck it up, and they sure as hell aren’t going to “Deal with it.” Tell them to piss off, they’ll piss off.

    YOU deal with it.

  127. 127
    Martin says:

    @Mnemosyne:

    Tell me about it. WalMart will stop hiring $7 an hour workers and only pay employees $60K or more so they won’t qualify for subsidies. The outrage! We’re liberals and we won’t stand for this!

    We are so fucked.

  128. 128

    And as was said upthread, this just raises the question: What would be YOUR red line? What would cause you to turn away from the bill? Is there anything, anything at all, that would make you go “no, wait, this is horrible, and demolishes everything good that might have come of it?”

    That’s how this debate is like the Iraq debate. The “liberal hawks” kept on babbling about Saddam, about how awesome it would be if Saddam were gone, about all the threats he’s made to the region. Whenever anybody said “uh, wait, this is terrible and is going to make things worse”, they would just circle back to Saddam, call the critics loonies or hippies or commies or even traitors, and get right back on Bush’s war train.

    Well, Bush’s little adventure in the middle east did get rid of Saddam. Eventually. He’s no longer going to threaten anybody. But few people are so feverish these days as to think that, because of that one thing, the other horrible things that came from the Iraq war are somehow not worth discussion.

    The medicaid expansion, increased health insurance regulation, and subsidies (though they won’t last) are good things. No doubt. But if the rest of this thing is terrible, then it’s terrible. And if you’re honest with yourself, and admit that there’s a line that you wouldn’t cross, then perhaps you could find a way to stop hurling profanity when someone else reaches theirs.

  129. 129
    terry chay says:

    @Irony Abounds: It’s not hidden. The cost containment ideas are risky and unproven (both because some of them are outside of the ken of more socialized first world systems or because the size of the health care system we are talking about reforming here is unimaginably large). As such they are structured as trial balloons and therefore have no score in the CBO estimates (they’re trials used to determine CBO estimates of future legislation).

    The progressives who want to blow the whole bill up now hope that this forces them to either adopt an untested cost containment measure or force us into a European or Canadian type all-or-nothing freakout (either now in the form of reconciliation, since reconciliation can only be for budgetary purposes anyway, or in the future because of a crisis).

    This sounds like a giant game of political chicken with 40 million people’s lives. The evidence is overwhelmingly that the thing most reconciliation will most likely result in the wrong things being cut from the bill and will definitely shift the status quo away from Universal Coverage (since it will engender a “sunset” provision on the final bill). I can’t speak to the future, but in the near term the Democratic Party is looking at a modest loss in the the midterm elections no matter what happens, and history points to a future bills being weaker, not stronger.

    @dadanarchist:

    what major piece of social legislation, regulation, reform or other act or law has been passed since LBJ that has benefitted the people over the powerful?

    Your example of minimum wage is a good one—and a baffling one. I should note that to that specifically there has been a lot of movement on this done at the local level, but will agree that this is because there has been a near standstill of this nationally. Besides the obvious fact of having a pretty conservative Democratic president and very conservative Republican presidents during the years you mention, I’ll add that we also had to contend with the fall of the unions and the middle class being put on life support during those years. Not sure the causality, but it goes loads to explaining why we haven’t seen movement there.

    Also you sell the Civil Rights Act short economically. Anti-discrimination laws have a huge economic impact in the short-term economic calculus we are talking here (just ask Hooters, or that wedding photographer in New Mexico who refused to shoot a wedding because the couple was gay). Sure, overall in the long term this has been great for business in the form of a much larger labor supply and more discretionary spending for families (as well as creating economic needs that were previous outside it: like needs for diswashing machines, housekeepers, day care, etc.) But by that same argument, there is no doubt that in the long term, universal health care (and any steps in that direction in the form of cost containment) will be good for business as a whole. They’re the ones really paying for these cadillac plans right now, for instance.

    As for other examples, Medicare and Social Security are but two examples that have benefitted the people over the powerful. In fact, because of the way labor is inelastic, nearly your entire medical subsidy and social security tax is effectively paid by your employer no matter what the nominal law says, so there is a very large economic reason businesses should be against it.

    While I’m not familiar with it, I’d probably add the disability act. I know my SDI in California is considered quite large and a lot of businesses claim that it is onerous and encouraging companies to leave the state—and yet I haven’t seen any real movement to eliminate it.

    Which just repeats the old adage, it’s harder to take something away once you’ve got it, than to give it when you never had it. In fact, that adage is codified in how the institutions of the American political process.

    In the end, that’s what the health care resolution is about. It’s about changing the status quo so we have it and daring a future Republican majority to take it away.

    And that—making health care a right, not a luxury, is why I’m for the greatest entitlement program in over a generation, despite its flaws.

  130. 130
    Martin says:

    The cost containment ideas are risky and unproven (both because some of them are outside of the ken of more socialized first world systems or because the size of the health care system we are talking about reforming here is unimaginably large). As such they are structured as trial balloons and therefore have no score in the CBO estimates (they’re trials used to determine CBO estimates of future legislation).

    You’ve overstated it a bit. Some of the ideas are unproven and are trials, others are quite straightforward. Killing off Medicare Advantage isn’t exactly risky – it didn’t even exist most of the life of Medicare. And a lot of the other efforts are direct clones off of other national health care systems.

    I mean, if all of the containment ideas were risky and not in the CBO score, how did the score come back with $650B in savings over 10 years?

  131. 131

    Ron Wyden has talked about choice in insurance for years and he’s had my backing and I’ve gone to great lengths. He’s gone to great lengths to make choice happen.

    Now, make that square with this mandate.

    I’d like to, I can’t. Ron Wyden can go fuck himself if this mandate stays in. I will work to Primary him and I will work for a fucking Republican because I’d rather have a known enemy than an ally like that.

    I never took this thing seriously, all I ever demanded was that mandates require choice. Fuck them and fuck the idea that Halliburton named Aetna is a good thing. If you don’t get how bad an idea that is, then there is little reason to discuss shit.

  132. 132
    Jack says:

    @jayackroyd:

    You really aren’t supposed to make this point. Tantrums about artificial divides and who to blame for Obama and Democratic failures (the consensus here is, ironically, the DFH) will ensue.

    Be a good pet and take what your betters give you and stop “whining” about it.

    Else it’ll all be your fault that corporate stooges, including Obama, delivered up a crapfest.

    It’ll be your fault, you see, because you noticed this fact.

    It won’t rest on the shoulders of our alleged betters. The onus will belong to you.

    Angry bloggers who just want a bill passed say so…

  133. 133
    Jack says:

    @Demosthenes:

    This. A million, million times – this.

  134. 134

    […] John Cole hits the proverbial nail on its proverbial head: […]

  135. 135
    Bostondreams says:

    @Demosthenes:

    And just how would Obama ‘deal with it’? What would make the conservadems support a bill that progressives support? This has yet to be made clear, by anyone. Because of the makeup of the Senate and its idiotic rules, a better and more progressive bill CANNOT pass. What evidence do you have otherwise? What procedure can get it done (outside of reconciliation, which would have a sunset provision and address only financial elements, not regulations) that will be not be tripped up by a Lieberman or a Nelson or a Landrieu or a Conrad or the Republicans?
    What is the option?
    If this bill does not pass, that is, I believe, it. It will not come up again for decades.
    The Democrats apparently are in quite the pickle. Pass the bill and lose seats. Don’t pass the bill and lose seats. Lovely.

  136. 136
    Alex says:

    @22: The UK government doesn’t run medical schools and not all British doctors are employed by the government. In fact, not even a majority are, because general practitioners and dentists are independent small businesses that happen to do lots of government work, like the Kennedy Space Center’s local hotdog stand. Further, the consultants are allowed to have a private practice as well as working in an NHS hospital. And, of course, nobody *forces* you to work in the NHS – if you can find enough private patients to keep you in ale, that’s your right. (Obviously, you’ll have done your clinical rotations in med school in an NHS hospital because there aren’t really enough private patients for the students to practise on…)

    This is because it was the shitty compromise required to pass the 1948 NHS Act – rather, it was the shitty compromise required to get the British Medical Association on board.

  137. 137
    brantl says:

    Well said, Mr. Cole. Although I still think Lieberman’s kidneys should be grilled, and fed to hogs.

  138. 138
    terry chay says:

    @Martin: Thanks for the correction. My bad.

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