You’ve Had a Few Days Off

Now back to debating HCR. This is about the best summation I’ve seen of why the public option is in fact necessary, and not having one would be catastrophic.

I’d actually really like to see what Ezra and Cohn and others have to say in response to this.

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219 replies
  1. 1

    Well that’s pretty simple; Walker makes the case against his argument himself. Yes, if the public option hadn’t been limited to the exchanges it could have been a major force in the market, but it was pretty much always limited to the exchanges. Because that’s all it ever had the votes for. And the reason it was a peripheral issue was precisely because it never had the votes it needed to be a central component of the debate.

  2. 2
    A Mom Anon says:

    Has anyone among the in the know crowd looked at how healthcare works in the countries that have universal coverage? No one has really talked about how it’s done in the places it’s worked out and how they worked out the bugs in the system. I don’t get why we can’t take the good stuff in other systems and apply it here. Expanding Medicare and Medicaid would help maybe,but I’d like to see more about how other nations with experience with this have handled it.

  3. 3
    Davis X. Machina says:

    OTOH, the public option may prove irrelevant.

    James Surowieki in The New Yorker says the legislation before Congress puts private insurance on the path towards ultimate extinction.

  4. 4
    Zifnab says:

    :-p He’s saying what we’ve all been saying for a while.

    The public option brings the efficiencies of Single Payer to the free market system. The insurance companies have every right to cower at it. Being forced to compete with a baseline of customer service will curtail their abilities to hike rates on a yearly basis and compel them to follow the letter of the law rather than just dragging everything they don’t like to court.

    The public option was perhaps the single biggest cost containment measure in the bill, forcing costs into line in my the way Medicare already does.

  5. 5
    David says:

    One time when firedoglake.com being inaccessible from home is annoying.

  6. 6
    El Cid says:

    Hmmm. I felt like mentioning that piece here, but I gave up on that thought.

  7. 7
    pillsy says:

    I think the argument is an effective one when it comes to making a case for the importance of implementing a public option, but it’s almost self-refuting when it comes to the importance of implementing a public option in the current health care bill.

    I say “almost”, because I think it would be easier to grow an existing public option program than to create a new one out of whole cloth, but if the current HCR process really is about building a foundation for change, and the virtues of the public option really are that compelling[1], then we’ll have ample opportunity to revisit the decision in the future.

    Also, I do have to quibble a bit with another aspect of the conclusion. Saying that the public option would demonstrate that the Democrats have the power to stand up to insurance company lobbyists, and that such a demonstration is essential, doesn’t support the case that the public option isn’t symbolic. It supports a rather different, and probably better case: that symbolism is important.

    [1] ] I strongly agree with both premises.

  8. 8
    wilfred says:

    Yes, well it was just not possible. How do we know that? Well, if it had been, we would have had it, but since we don’t have it, it wasn’t, possible. Qed.

    It is present because of its absence, too.

  9. 9
    Zifnab says:

    @Brien Jackson:

    Yes, if the public option hadn’t been limited to the exchanges it could have been a major force in the market, but it was pretty much always limited to the exchanges. Because that’s all it ever had the votes for. And the reason it was a peripheral issue was precisely because it never had the votes it needed to be a central component of the debate.

    Medicare has had three major expansions since it’s inception (Parts B, C, and D respectively). I have no trouble believing that a successful and popular Public Option could be expanded in the future.

  10. 10
    mandarama says:

    “Debating” is one word we could use.

    I need to step away. I know this is a substantive issue, but all the other maddening stuff today has given me such agita that a HCR thread might finish me off. At the risk of baiting eastriver, can we have some pets or something?

  11. 11
    pillsy says:

    @Zifnab:

    I agree with you. I also happen to believe that a successful and popular public option could be created in the future.

  12. 12
    jl says:

    @A Mom Anon:

    Get T.R. Reid’s recent book ‘The Healing of America’ whioh has excellent comparisons of different middle and high income countries’ health care systems.

    But, being as you are on the ‘puter. and if you are impatient, click on HiT Summaries for ten (or so) page capsule descriptions, or Health sytems profiles for 100 or so pages at the following World Health Organization site:

    European Observatory on Health Systems and Policies

    http://www.euro.who.int/observ.....20020525_1

  13. 13
    c u n d gulag says:

    Nah, makes too much sense… Like single-payer, MediCare for all.
    Nothing to see here. Move, along. Move along…

  14. 14
    Tom Hilton says:

    It isn’t really an argument at all; it’s just an aggregation of slogans. He’s saying, in effect, that an ideal version of the public option would have a major positive impact–which isn’t something anyone on the progressive side disputes. His ‘case’ for the proposition that even a limited-member level-playing-field public option would have a major positive impact is that…an ideal public option would have a major positive impact. Right.

    More to the point, he doesn’t even try to make a case for the importance of the public option relative to other elements of reform–which is the real issue raised by critics of emphasizing the public option.

  15. 15

    @Zifnab:

    Neither do I. Nor do I have a problem imagining that a public option could be constructed at a later date. It’s much easier to imagine that happening than it is to imagine the defeat of the current bill leading to a public option being created in the next decade anyway.

  16. 16
    eemom says:

    we’ve “had a few days off”?

    we’re “BACK TO debating HCR”??

    Am I in the right reality here?

  17. 17
    Sentient Puddle says:

    I have a different reading of that link than you. It certainly makes a strong case for a public option (even a weak one) in the first place. But it doesn’t really address the idea that the legislation would catastrophically fail without one aside from asserting that a public option is the cornerstone of the legislation.

    I certainly think that a public option would do a lot to support other parts of the legislation, and absolutely think we should keep fighting for it further on down the road. But to me, saying that “not having one would be catastrophic” means to me that the bill either does nothing, or makes the status quo worse. And for my money, Ezra still has the strongest case in this argument.

  18. 18
    beltane says:

    Green Balloons! Green Balloons!! GREEN BALLOONS!!!

  19. 19
    scott says:

    And yet a lot of the Dirty Fucking Hippie crowd has been saying much the same as this for months and you’ve either been too busy to notice, what with spending all your time telling all of us what assholes we are for fighting so hard for it, or . . . well, you’ve been too busy to notice, what with spending all your time telling all of us what assholes we are for fighting so hard for it.

    Funny how that works, huh John?

  20. 20
    Spiffy McBang says:

    Ezra would say that just about everything in the post is true and that it still wasn’t going to get passed. Therefore, the options are the same- what we have now, or nothing. And the arguments as to whether or not we should accept the current bill remain the same as well.

    Actually, if anyone responds to it, I’d bet more on Nate Silver. He’s had a little back-and-forth with FDL over this.

  21. 21
    Max says:

    Kevin Drum has a good piece on why we should pass the bill.

    http://motherjones.com/kevin-d.....-insurance

    ETA – OT. The White House hit back HARD at Cheney.
    http://www.whitehouse.gov/blog.....blame-game

  22. 22
    jl says:

    A public option is not strictly necessary for good health care reform. The Netherlands, Switzerland, and Greece funding systems are based on private insurance. But they have very strict regulations for benefit design and pricing of the universal basic policy. Such regulations could not be put into law in the US because of this country’s mind boggling level of corruption and crony corporate capitalism.

    So, I think a national, or three or four very large regionally based, public option plan was needed. If a public option had market power and could negotiation prices, it would provide some competitive discipline to the dysfunctional private market.

    It is true that the proposed public option ended up a rather small item, but if one was passed into law, it could have been easily and greatly expanded. And I think it would, once people saw that it worked and provided better service than private insurance.

  23. 23
    General Winfield Stuck says:

    I have always believed that. For the reason that big insurance is so big and has such powerful deep pockets, an independent non profit market snug into public law and the Federal Register– is the safest place for such an entity that germinates the belief I have that health care is a right and not a priviledge in this country. Or any other country for that matter. It should not be subjected to profiteering, especially when it’s product does not fit into the free market system of supply and demand. There has to be a choice to purchase a product that choosing not to purchase won’t kill you.

    And this concept is what separates us from the right wing or GOP mindset. And even most repubs will agree, if you sit them alone in a room away from Fox News and explain it to them in simple terms.

    I am greatly, greatly disappointed that we couldn’t at least get the foundational structure that a PO would have at least gotten us as a society, short of the ideal of single payer, and too weak a PO to do immediate good of stabilizing rising costs and fulfilling the obvious moral and economic hazard of our current greed based system.

    Short of that, covering 96 percent of Americans with at least a minimal amount of insurance is swallowable, as long as it does that and makes the extra big insurance mandate profits go largely to providing actual HC.

    But it is only stop gap, and sooner or later we will learn what every other western democracy has learned and taken steps to remediate taking profiteering out of health care services for their citizens as a moral cause, as well as an economic existential threat to their country’s survival.

    We learn slow, always have, and usually take up the challenge at the last possible minute. I just hope we figure it out this time before it’s too late.

  24. 24
    wilfred says:

    @Brien Jackson:

    Every time I hear things like that I wonder what will happen if the Democrats lose their majority in either branch of the legislature. Doesn’t all this promise of future mending depend on things staying the same, electorally speaking?

    A large shift in seats will result in everyone saying: “If we had known then, we could have forced the public option when we had the chance.”

    Don’t let the pluperfect become the enemy of the could. Or something.

  25. 25
    pillsy says:

    @Gen. Stuck:

    “Count on Americans to do the right thing, after they’ve exhausted all the other possibilities.”

  26. 26
    beltane says:

    @Max: NPR also did a story about the Senate holdup of the TSA director that showed DeMint to be the assclown he is.

  27. 27

    I saw what you did there, JC.

  28. 28
    Jules says:

    Is anyone watching Matthews right now?
    Joan Walsh just ripped Ron “I love Dick” Whatshisname a new one. No wonder Dock Armey is afraid of her.

  29. 29
    Midnight Marauder says:

    @Tom Hilton:

    More to the point, he doesn’t even try to make a case for the importance of the public option relative to other elements of reform—which is the real issue raised by critics of emphasizing the public option.

    Precisely. And this part rankled me a little bit, as well:

    This health care fight is not about creating one new, static system that would remain in place forever. To argue otherwise is intellectual dishonesty put forward by many, including the Obama administration.

    Who in the world has been making that argument?! I am pretty sure progressives (of all stripes) and people on the left have been talking about building a new, dynamic, constantly evolving system that would need to be continuously monitored, nurtured, and adjusted as time moved on. Talk about intellectual dishonesty. Yikes!

    Edit: And for the record, I am still taking some days off from HCR Thunderdome battles. Maybe next year, Cole.

  30. 30
    Mike Kay says:

    It’s hard to take anything FDL says seriously. They’re like the 1962 Mets.

  31. 31
    scudbucket says:

    The PO needs to be re-introduced – even if it’s back-burner for now and done through reconciliation. Once it’s in place, and people actually are being covered under it, the GOP can only defund it at there electoral peril. I only hope it makes to the table – and gets passed via reconciliation – before the mid-terms. Last I heard there were only 44 PO supporters in the Senate. Arms must be twisted on this.

  32. 32
    The Raven says:

    For people who want to know what the rest of the world does: T.R. Reid.

    For the rest, I think I’m flying away from this for a while. We need to continue to fight for improvements in the legislative outcome.

  33. 33
    K. Grant says:

    @Brien Jackson: Absolutely this.

    It’s much easier to imagine that happening than it is to imagine the defeat of the current bill leading to a public option being created in the next decade anyway.

    I think this is where my gears have always jammed when it comes to the ‘kill-the-bill’ contingent – just how would we be able to craft a bill with a robust public option with the same players voting on said final bill.

    In this case, I am not trying to be snarky at all, I am very curious how to make something that was rejected all of sudden become something not rejected. What other provisions would you add or strip to get the public option?

    We cannot work with ideals, we have to work with how to get the bill passed, thus some significant compromises would likely need to be made to get the public option – what would they be?

  34. 34
    Jules says:

    @Mike Kay:
    As long as FDL is playing footsy with Norquist how can anyone take them seriously?

  35. 35
    Sly says:

    Walker’s argument is problematic on two fronts.

    The first, is that a P.O. could be expanded to become a central feature of U.S. healthcare, hinges on the notion that the starting line for implementation is irrelevant when it certainly is. One could just as easily insist that a P.O. could be more easily implemented, and as such be initialized on a larger scale, once the Exchange(s) is fleshed out over the next few years. But without such an infrastructure to support a P.O., whether in an initially weakened state or not, it could very well contribute to the problem by being gamed out of the system like the old school Blue Shields were decades ago.

    In other words, the current proposal provides just as much a foundation for the kind of reform that Walker (and myself, FWIW) supports than one with a pre-existing P.O. The House version, with its singular Exchange, is certainly better.

    The second is that Walker presumes that the lack of a P.O. is some giveaway to the insurance industry when it really isn’t. If you’re looking to hurt for-profit insurers, there’s enough even in the Senate bill to do that. And if you want to look for items that protect the industry, the hundred plus exchanges in the Senate bill is ten times better than anything a lack of a P.O. will give them, combined with the continuation of their substantial anti-trust exemptions. This gives them much more flexibility to continue to screw the public than even the most generous P.O. would prohibit.

    Besides all that, the people who’ve oppose the P.O. (and the Medicare Buy-In that was supposed to be a substitute) are the ones who run the A.M.A., who’ve convinced Midwest pols that any increase in persons using Medicare rates to reimburse HC professionals will lead to a doctor shortage, and they’ve opposed it since the beginning. It’s not a metaphysical argument, it’s just a bullshit one. You want to convince these people that a P.O. won’t hurt their states, show them how it won’t cause doctors to leave Nebraska. Then you have to convince them that paying HC professionals in their district less because of the reimbursement formulary isn’t inherently unfair.

    Good luck.

  36. 36
    Mike Kay says:

    @Davis X. Machina:

    Obviously, The New Yorker is in the pocket of the Big Pharma and Raaaaaaaaaahm!!!!!!!!!

  37. 37
    scudbucket says:

    @Sentient Puddle: saying that “not having one would be catastrophic” means to me that the bill either does nothing, or makes the status quo worse.

    If the current bill does make the status quo worse (and there has been alot of discussion about that very topic) then failing to have it would be IMO electorally disastrous.

  38. 38
    bayville says:

    @Spiffy McBang:
    Ditto what Spiffy said.

    But who are we. Ezra and the intellectuals say the health insurance industry bill subsidy will be real popular.
    I know the my teacher friends, education administrators, cops and public officials are really eager to have their so-called “Cadillac Health Care Plans” taxed.

  39. 39
    mcc says:

    The problem here is that the online HCR debate for awhile has been between “people who want the public option” and “people who want the public option, and also say that we should not be allowed to perform any other health care reform actions unless we institute the public option first”. No peace til Jesus comes.

    Okay, so the public option is necessary. And? What are we supposed to do with this information?

  40. 40
    Mike Kay says:

    When it comes to public policy, I always look to old, former hollywood producers, with no scholarship for expertise — that’s why I turn to FDL.

  41. 41
    Stroszek says:

    The track record of private insurers isn’t bad at all. It’s the track record of for-profit insurers in a largely unregulated market that sucks. It’s kind of hard to take Walker seriously when he simply ignores how health care works in a large chunk of the developed world.

    Certainly, this bill doesn’t make us the Netherlands, but the public option didn’t make us Canada either. Just as the public option could be considered foundational for single-payer, things like cost-sharing caps, medical loss ratio limits and the prudent purchaser clause could be considered foundational to a more aggressive system of price capping. Personally, I think we’re drifting towards a system of heavily regulated non-profits, but systems around the world show us that this is not a horrible thing to have.

    Of course, it’s also the case that having the exchanges in place will give us a lot more flexibility for implementing a public option down the line anyway. This is true both politically and in the sense that a sustainable public option would depend on meaningful regulation of its private competitors. In this sense, the exchanges are also “foundational” for moving towards a system that includes optional state-administered insurance plans for the general population.

    Whichever direction we eventually take (and we eventually MUST take one of those two directions), I don’t see a case to kill the bill that couldn’t be extended to a bill that only has a restricted, marginally effective public option.

  42. 42
    jl says:

    Why do we use markets? Odd question, of course we use markets as much as possible, because they tend to work better than centralized control.

    But you listen to the media and you hear stupid reasons:
    it is the American Way, it produces winners and losers, and we must have both, and losers must suffer, or because of ‘market magic’, or because ‘Freedom!’. Or other intellectual garbage.

    There is one and only one reason to have markets in economic theory and policy, and that is to maximize social welfare. You can say they do something else (for example ‘Freedom!”), but there is no theory for how it all fits together. There is only one neoclassical economic theory that all these sad sacks hucksters yell about, and that one theory says that markets exist to maximize social welfare (which is not the same as making a few sharks richer than God).

    Only problem is that unregulated private markets sometimes do not work to maximize social welfare, and I think the most important examples are financial markets and certain insurance markets, most notably life insurance and health insurance.

    People talk about getting a ‘good’ health care funding system. Well, ****, I would settle for a stable one. Over twenty countries have achieved stability that provided universal good care, and what do you see? You see one of the following, assuming universal care (which is a must):
    1) national health system
    2) universval social insurance coverage (Medicare for all),
    3) heavily regulated private insurance in competition with public plans,
    4) very heavily regulated private insurance.

    Looks like people who knew what they were doing tried to squeak number 3 through this country’s gauntlet of rotten corrupt Congresspeople, but did not quite make it.

    Of course, when the intellectual climate in a country is so putridly corrupt, and paid corporate hacks can buy the media and legislature, and spout lies to brainwash the population into believing nonsense, and can and dictate the laws, then you get results that only benefit the corporate elite.

    The US is trying to scrape its way out of that nightmare right now. Wish us all luck.

  43. 43
    Tom Hilton says:

    @scudbucket:

    If the current bill does make the status quo worse (and there has been alot of discussion about that very topic) then failing to have it would be IMO electorally disastrous.

    The fact that there has been a lot of discussion about the topic doesn’t actually make the topic valid. There’s been a lot of discussion about death panels, ferchrissake.

  44. 44
    K. Grant says:

    @Jules: I have now gone four weeks without watching any cable news (the NewsHour is my only TV news source at the moment) – and I feel that my blood pressure is much better for it. It took a few days to fight the urge, but then after a while it passed and I no longer even have the desire.

  45. 45
  46. 46
    Fair Economist says:

    Are you changing your stance on kill-the-bill, John?

    I agree with the article that the public option is a big boost to the country, even if it starts out small. However, I think you need one aspect of the current bill – community rating – to get big benefits from the public option. Without community rating, the public option has to spend lots of resources investigating potential insurees and estimating expected costs, plus has to play in the Red Queen race with other insurers to get the desirable low-cost insurees.

    Of course, there are benefits, still, from a public option without community rating, so the kill-the-bill movement (which is basically shooting for a reconciled public option) could still get beneficial legislation, and the political advantages of being willing to kill the current bill might outweigh the policy risks of possibly actually killing it.

  47. 47

    @scott:

    you’ve been too busy to notice, what with spending all your time telling all of us what assholes we are for fighting so hard for it.

    I think what people have been called a_sholes for is Kill the Bill, not “fighting for” some version of the bill.

    Sorry, but those two things are not interchangeable. In fact I take them to be mutually exclusive.

    For reasons already stated ad infinitum on other, past, threads.

  48. 48
    Tom Hilton says:

    @Mike Kay: I just checked out her page on the IMDb, and saw this:

    Down 46% in popularity this week.

    The film geek community has spoken. ;-)

  49. 49
    Violet says:

    I think now is the right time to step away from the computer. I can’t take any more HCR discussion. Green balloons!

  50. 50
    Mike Kay says:

    say what you will, but if it wasn’t for jane hamsher’s uncanny and strategic leadership in 2006, Lieberman would still be in office.

  51. 51
    General Winfield Stuck says:

    I think what people have been called a_sholes for is Kill the Bill, not “fighting for” some version of the bill.
    Sorry, but those two things are not interchangeable. In fact I take them to be mutually exclusive.

    yes

  52. 52
    scudbucket says:

    @Tom Hilton: Tom, if you really believe that the Democrats won’t get pounded next cycle if the current legislation passes without changes, then I want what you’re drinking. This bill effectively punishes everyone while guaranteeing a 25% MtL ratio for Insur Cos. And even tho you retain faith that the cadillac tax will actually subsidize the poor, I hope you at least glanced at the link I provided in which both Kaiser and PriceWaterhouseCooper (and there are others) say that companies will circumvent the cadillac tax by lowering the quality of the plans that it is subject to.

  53. 53
    Bruce (formerly Steve S.) says:

    Is the Apocalypse nigh? John Cole linking approvingly to FDL?

    The article makes a point I’ve been pondering for a while. The “foundational” argument advanced by Klein et al is that you have to pass something in order to lay a foundation for future change. But what foundation is being laid? The Senate bill entrenches private interests at the heart of health care; a public option, even an initially weak one, would plant a seed for a system based on the common weal rather than private enrichment of a few people.

    So again, what foundation is being laid by the Senate bill? I suppose you can argue that it lays a foundation for further regulation of private industry, and I’d be more sanguine about that if I had any confidence that future Congresses would buck the trend of recent decades and do such a thing. You can argue that it lays a foundation for better subsidies in the future, but while subsidies genuinely help people they are of course an entirely back assward way of going about getting health care to the uninsured.

    I can still be persuaded that the Senate bill is on balance supportable, but a public option (or Medicare expansion, or whatever) would have been vastly preferable.

  54. 54
    beltane says:

    @Tom Hilton: That is very funny in a schadenfreudeistic kind of way.

  55. 55
    jl says:

    I doubt that the private market can be stable under the Senate version of HCR, or prevent cream-skimming of healthy people, or avoid profiteering rates unless we have a private market with the following features:

    universal coverage, which is permament once you qualify,

    no exclusions for pre-existing conditions,

    no benefit cap,

    close to community rating for all, for the basic comprehensive plan,

    one basic comprehensive plan for all with identical benefit designs and payment policies

    price guidelines, or very strong comparative effectiveness research program with dissemination to all providers,

    strong risk adjustment programs with side payments for unhealthier risk pools,

    any additional coverage above the basic comprehensive plan must be offered on a different market with supplemental policies.

    We do not come even close to that under either version, and I think any bill that looks like the Senate version will have to be fixed up within a few years.

    Public option open to all who wanted it would be best solution to an under regulated private industry. A public option open to uninsured could be expanded in the future, and would provide that quick fix.

  56. 56
    mcc says:

    @Tom Hilton: Tom, if you really believe that the Democrats won’t get pounded next cycle if the current legislation passes, then I want what you’re drinking. This bill effectively punishes everyone while guaranteeing a 25% MtL ratio for Insur Cos

    And institutes death panels and outlaws breast cancer screenings. Yes, we’ve heard.

  57. 57
    Mike Kay says:

    say what you will, but if it wasn’t for jane hamsher’s uncanny and strategic leadership in 2007/2008, we wouldn’t have President Edwards sitting in the oval office, today.

  58. 58
    demimondian says:

    @bayville: If you know a teacher, a cop, or any working stiff with a Cadillac plan, then I have $20 for you.

    Because you know what? They *don’t*. Your friends are imaginary.

  59. 59
    Stroszek says:

    DonBelacquaDelPurgatorio:

    This is a rhetorical trick that’s been persistent throughout this debate. It’s much easier to forgo straightforward bill-killer arguments in favor of a discussion about the positive value of the public option. This is because virtually everyone agrees that a public option is a good idea.

    Basically, people like to make points that elicit agreement… and if they can quietly pass such a point off as something that necessarily implies a far more controversial idea (even when it doesn’t)… well, that’s just spiffy for the guy making the argument.

  60. 60
    demkat620 says:

    I’d like to see a PO but the very serious hair of Ben Nelson and the jowls of Joe Lieberman will not hear it.

  61. 61
    Amy says:

    There are two, well, make that at least three public elements of hcr right now:

    1. (Public) The biggest expansion of Medicaid since its creation.
    2. (Public) The biggest expansion of public health clinics and funding for health providers for underserved areas since those programs’ creation.
    3. (Sort of public). The requirement for a non-profit option on the exchanges.

  62. 62
    Mike Kay says:

    jane hamsher is the e-left’s version of sarah palin. face it, if she wasn’t cute, would any of the geeks be defending and parroting their pin-up? no.

    I blame tragic dysfunctional high school adolescence and the apple operating system!

  63. 63
    jeffreyw says:

    Gonna break in here for an important announcement: Yay!

  64. 64
    scudbucket says:

    @mcc: mcc, let me ask you this, no snark no cynicism: do you think this bill is a net positive for Democrats electoral prospects in the upcoming cycles?

  65. 65
    mcc says:

    @scudbucket: Yes.

    But even if it weren’t, it would still be worth it.

  66. 66

    @jeffreyw:
    Are you behind the camera? Congrats to your wife.

  67. 67
    bey says:

    Back foul fiend! I’ve had all the sturm und drang I can stand this past month.

    And so, I counter thusly.

  68. 68
    jwb says:

    @wilfred: There is no forcing of the public option. You need 60 votes, and there is no forcing those Senators because we really have very little leverage. That’s the problem. So the question is: do you do HCR now, probably in more or less the form that the Senate has passed; or do you say, no, this will just make things worse, so we have to let it go?

    I will say that I believe the odds of getting improvements to health care reform over the next decade are much higher if the bill passes than if it fails, though much depends on the nature of the flaws in the final bill.

  69. 69
    jeffreyw says:

    @arguingwithsignposts: Nope, I was slaving away in the kitchen at home. Pic was by a supervisor.

  70. 70
    ds says:

    The whole point of health care reform is community rating. A lot of people miss this point because 85% of people get their insurance from their employers, and employer-based health insurance is already community rated. They don’t know what absolute hell it is to be out on the individual market.

    Any bill that includes community rating and guaranteed issue of insurance will be a dramatic improvement in the lives of the tens of millions of people who can’t get adequate insurance through their employers or through government programs.

    They’ll know that their coverage won’t be dropped and that the insurance company won’t be able to dramatically jack up their premiums once they become sick. People with preexisting conditions will be able to get insurance on the individual market for the first time.

    For 85% of people, reform will make almost no difference, except for the fact that they’ll no longer be dependent on employers or COBRA to get decent insurance. There’ll be other decent options available for the first time.

    For the other 15% it will be a dramatic improvement in the quality of life.

  71. 71
    Mr Furious says:

    I am at a complete loss as to why THAT column of all the material floating around the intertubes, not to the mention many, MANY thought-provoking and equally valid comments in the threads right here has convinced you the public option is suddenly necessary-or-catastrophe.

    I might be missing something in there, but reading that was basically a shrug, and a “yeah, tell me something I DON’T know—wouldn’t that have been nice…”

    And as for Ezra or Nate countering that piece? I think they’ve already done it countless times.

    Nothing new here, except John’s moment of clarity/drunkenness.

    Back to fresh- vs salt water aquariums…

  72. 72
    Ailuridae says:

    @Davis X. Machina:

    Not extinction but as a form of competitive utilities. This is somewhat similar to what France, Germany and Switzerland do. But forcing medical loss ratios does fundamentally change underwriting so JS is right there.

    I don’t think much of Walker’s argument. Its undeniable that a bill with a public option would be better than a bill without a public option. It doesn’t follow from that, however, that a bill without a public option is not worth passing. More importantly, if as Walker and many here claim there were close to 60 votes for passing a bill with a public option pass the current bill without the public option and then introduce a stronger public option as the next order of business and pass it with 50 + 1 votes through reconciliation.

    But Russ Feingold isn’t advocating that. And Jon Walker won’t even discuss the possibility. And why is that? Are they unaware of the possibility? No, its pretty simple. The reason they aren’t taking the gift of passing a stronger public option in a separate bill through reconciliation is that they not only didn’t have the 60 votes to include it in the healthcare but as a stand alone piece of legislation they can’t get the 50 votes to pass it.

  73. 73
    Mary says:

    You’ve been watching Lily roll around in sh*t too much John.

  74. 74
    Mr Furious says:

    @ds: ds,

    It is my experiences inside of and outside of the employer-based realm that allows me to say “pass this flawed p.o.s. if it’s the best we can do.”

    It is absolute hell trying to purchase insurance on the open market, and if people are now able to do that with community ratings and no exclusions for pre-existing conditions than that is a big enough step to make it worthwhile.

    But is has to be viewed as a first step that needs follow-up, because it’s nowhere near where we need to be.

  75. 75
    Tsulagi says:

    Walker has it right. This turd currently on the table, even with perfume and chocolate sprinkles on top to make it more visually appealing and palatable, isn’t foundational. Well, unless your goal is to build on that foundation making a full-blown cowpie. It’s an expansion of the current mess. Toward the end of his piece Walker wrote…

    There are literally hundreds of billions riding on this question, and possibly the future international competitiveness of the American economy.

    Yep.

    Best course would have been single payer. Say that not because I’m a DFH. I don’t wear Birks to the range, or anyplace else. It would have been the most fiscally responsible. There needs to real cost containment. The Senate dropped turd should be renamed the Our Healthcare Industry Friends Stimulus Package.

    A solid, quality PO plan without a WH ban on drug price negotiation would have been the good course. A fair compromise and one as Walker points would be a good foundation.

  76. 76
    Batocchio says:

    The progressive demand that public health insurance programs must be part of the solution is based not on pure ideology, but overwhelming domestic and international evidence.

    Yup. This doesn’t mean that some other reform measures aren’t/can’t be very helpful, and the public option had been badly watered down in the Senate, but its inclusion was never some small thing. Like Raven upthread, I’m reading T.R. Reid’s book on health care around the world, which is very good so far. As Steve Benen’s pointed out, on the left there’s been sincere debate and disagreement on health care reform, both policies and politics. I haven’t seen much good faith elsewhere, and some people (Lieberman, Grassley, McConnell, Fred Barnes) haven’t even bothered to craft marginally credible bullshit – nor has the media pressured them to do so.

  77. 77
    Mike Kay says:

    @beltane:

    So how’s things at GOS today? Any meltdowns? Did so and so shot herself in the foot, again?

  78. 78
    jwb says:

    @mcc: “Okay, so the public option is necessary. And? What are we supposed to do with this information?” Turn to Grover Fucking Norquist, of course!

  79. 79
    danimal says:

    Joe Klein make some sense here, even though he’s overly defensive about his own villager status.

    I hope the Lieber-rage has subsided and the conversation can be civil again. I’m kinda exhausted with HCR since we’re all kind of repeating ourselves.

  80. 80
    General Winfield Stuck says:

    @Mr Furious:

    Agreed.

  81. 81
    Ailuridae says:

    @ds:

    This is one of the better posts we’ve had in this or any other HCR thread.

  82. 82
    Mike Kay says:

    we have to STOP thinking about the uninsured and START thinking about insured ex-hollywood producers.

    let the uninsured eat netroots convention cake.

  83. 83
    Dreggas says:

    @Mike Kay:

    The GOS has been a hoot to read lately. It’s like the primary wars all over again.

  84. 84
    ericblair says:

    @jwb: There is no forcing of the public option. You need 60 votes, and there is no forcing those Senators because we really have very little leverage. That’s the problem.

    Zactly. If we had ham, we could have ham and eggs, if we had eggs. That’s the argument in the reference, and I’ve heard it before.

  85. 85
    Shell says:

    Sorry, no. I need a few more days of HCR-free news. Get back to me, maybe January 3rd.
    I just found out my mother’s health plan had dropped her prescription drug plan, so had to, in a couple of days, find a Medicare D plan for her before the 31st. God, what a fucking labyrinth.
    When the wingnut critics of government healthcare need a villain, why do they always point at the post office? I’d choose the Medicare D prescription plans. Oh, wait. That was set up under the Bush administration.
    Never mind.

  86. 86
    Mr Furious says:

    @scudbucket:

    no snark no cynicism: do you think this bill is a net positive for Democrats electoral prospects in the upcoming cycles?

    Unclear. For one thing, we don’t know exactly what will be in the final bill.

    But if I had to guess, I think whatever passes will either be either a non-factor or a negative drag on Democrats. None of the good stuff kicks in quickly enough for people to feel/see a positive impact that will benefit Democrats, and that is another major flaw in the politics of the bill as it is now.

    There is plenty of stuff in there for the GOP and media shills to hammer them with, and to scare voters with, and not much to counter it but “Trust me.”

    That won’t wash. And it shouldn’t.

    And if anyone expects me to believe that the Democrats can present a unified and convincing front on the issue in the midterms or that the media will let them if they tried, you’re crazy.

  87. 87
    Mike Kay says:

    @Dreggas:

    Tell us more! Who’s jumping over the top rope? Who hit who with a folding chair?

  88. 88
    ds says:

    I don’t think Ezra or Cohn have any argument against what’s in the FDL link. They both supported the public option.

    But, unlike the Kill-Billers, they both also know how desperately health care reform is needed, and how rare it is to actually get a chance to pass it.

    If we said “Fuck you Lieberman! No public option, no bill!” there’s a 99.9999999999999999999999999% chance of there being no bill.

    Without a bill, insurance companies will continue to be able to discriminate against the sick. There will be no Medicaid expansion. There will be no insurance subsidies. No attempts at cost control.

    We’ll have the same deteriorating system for the next 20 years. Then in 2029, with 80 million or so uninsured, we’ll go back to the drawing board and come up with a plan that’s even friendlier to the health care industry than this one. I seriously doubt it will include a public option.

    Why do they think Russ Feingold, Tom Harkin, and socialist Bernie Sanders are all pushing the bill forward, sans public option? Because Rahm bullied them?

    Even the crappy Senate bill will do an immense amount of good to our dilapidated health care system. Let’s pass the fucking thing.

    If you were homeless with no prospects, would you refuse to move into an apartment because it had roaches and a leaky roof? Objectively the apartment is really shitty, but it’s still better than what you have now.

  89. 89
    Ailuridae says:

    @Tsulagi:

    Walker has it right. This turd currently on the table, even with perfume and chocolate sprinkles on top to make it more visually appealing and palatable, isn’t foundational. Well, unless your goal is to build on that foundation making a full-blown cowpie. It’s an expansion of the current mess. Toward the end of his piece Walker wrote

    How, exactly, is community rating in the individual market an expansion of the current mess? Its a fundamental shift in how individual insurance is purchased.

    How is a national non-profit competitor an expansion of the current mess?

    How are MLRs an expansion of the current mess? Did they exist before and I missed it?

  90. 90
    jwb says:

    @scudbucket: I don’t think there is a net positive for the Dems this cycle. Passing, not passing, with public option, without public option—I think they are all losers for this cycle. However, I believe the Dems will fare worse not passing a bill than if they pass something. I also believe the economy will be more of a factor in the election than HCR.

  91. 91
    cleek says:

    This is about the best summation I’ve seen of why the public option is in fact necessary, and not having one would be catastrophic.

    no, what’s really necessary is the ability for people to live forever without illness. catastrophe is guaranteed to befall each one of us until this is changed.

    i blame Obama’s lack of leadership. surely if he petitioned Galactic Senator Liebershmink (I, Zebulon 4) more vigorously, it would’ve been enough to overcome the fact that the votes to carry this position do not exist.

  92. 92
    Tsulagi says:

    @Ailuridae: You’re looking at the chocolate sprinkles. On top of the turd.

  93. 93
    General Winfield Stuck says:

    @jwb:

    For me. Only by mostly de-profiteering health care service in this country will avert eventual catastrophe. A PO was only a small seed to be planted toward that goal. In the meantime, we will be fighting a running battle with the profiteers to hopefully stave off health care dystopia in this country. This battle didn’t go all that well for our side, but some small but important victories were achieved. Banning denial for pre-existing conditions is no small thing. And getting more people covered.

    The up side is things will get worse, especially on the cost containment front, and more people will be realizing the sockalist crowing morans are what they are, and will get us all killed, if they are listened to.

    How is that for shining a turd?

  94. 94
    Mr Furious says:

    Following up on the electoral prospects question…

    If the Democrats come out of this with a package that few of them will want to aggressively campaign on—a distinct possibility—then you’ll have your answer.

    On the plan’s effectiveness, and on the political impact.

  95. 95
    mcd410x says:

    Health care?Nah. Enjoy the Florida setting sun.

  96. 96
    Tomlinson says:

    OK, so nice article, I agree with it, wonderful stuff, happy days, way to go, yippee. Happiness and flowers and kitties for all (or puppies or guppies, your preference.)

    Now how do you propose to make such a thing reality. For real, not some weirdo neutered version that is a waste of ink.

    There’s the rub. I’m not talking jam it through using some legislative trick (if that is even possible…and arguments that it is not seem pretty persuasive to me), if you want it to stick and not be a shitstorm of epic proportions, 60 votes.

    How?

    Answer: you cannot.

    So, then, will the current bill also be foundational and will it provide a path to a public option?

    The answer there lies squarely in moving healthcare from a privilege (no reform, no PO, no nada) to a right and, yes, even an obligation – for that it must be. Once you’ve done that, you have something upon which to build. Once everyone expects healthcare, we can start to have a conversation about howto do it better, and that’s where a PO likely appears.

    So yeah, pass the bill.

    A lot of the rest of the arguments, particularly those about negotiating power, proving that a PO could bend the cost curve, etc – medicare and medicaid (and the VA!) can do.

  97. 97
    jwb says:

    @cleek: This. (Except you forgot the part about the ponies.)

  98. 98
    demkat620 says:

    Sorta OT but, let me help you out here Congressman Massa, and Ima let you finish, cause that was great, but Dick Cheney is the biggest pussy of all time.

    FU Dick, DIAF. FU. Now go away.

  99. 99
    jwb says:

    @General Winfield Stuck: I’m with you on this. But I’m an O-bot.

  100. 100
    demkat620 says:

    I’m in moderation hell and I don’t know why.

  101. 101
    jwb says:

    @demkat620: WP just letting you know who is in charge.

  102. 102
    Ailuridae says:

    @Tsulagi:

    No, I’m addressing the contents of the bill. Did you even bother reading the Surowiecki article? I suspect not as you can’t answer simple direct questions that challenge you content-free quips.

  103. 103
    Tom Hilton says:

    @scudbucket: Jesus, there’s so much wrong here that I’m not sure I can respond to it all. But hey, I’ll give it a try.

    On the politics of the thing: if you think the Democrats won’t get pounded if they don’t pass a bill, then I want what you’re drinking. If they do pass the current bill, then I think it will probably be popular enough based on the things that kick in right away (e.g., no dropping people for pre-existing conditions) to help the Democrats in 2010 and 2012–but even if it’s not that popular it’ll still be less bad politically than spending all this time and energy and coming up with nothing.

    On the substance, you have your facts thoroughly muddled. I assume the “punishes everyone” bit is a reference to the individual mandate, the necessity of which is not disputed by anyone who has any idea what they’re talking about. (And when I was talking in that other thread about adopting GOP memes? This is an example of what I was talking about.)

    My understanding is that the bill in its current form has a minimum 80% medical-loss ratio; how that “guarantee[s] a 25% MtL ratio for Insur Cos.” is unclear to me.

    And as has been repeatedly explained to you, it doesn’t matter if companies “circumvent the cadillac tax” by reducing their health insurance costs; the money they don’t spend on insurance is taxable in some other form. (And your assumption that cost = quality is precisely the assumption that drives out-of-control healthcare costs.)

  104. 104
    General Winfield Stuck says:

    Democrats are going to lose seats, especially in the House in 2010. People are not as worried about health care as they are finding and keeping a job, and the number of loses will be determined by that more than anything.

    Midterms are largely decided by enthusiasm from the base, and it is not clear whether the internet netroots are as many as they think they are. I don’t think so, and that the base is much larger than them, but we shall see. If I am right about that, then I think passing this bill will help, but only a little, as jobs and the economy will have the biggest impact. IMHO.

  105. 105
    FlipYrWhig says:

    Yes, the public option is a good idea, and a health care bill without a public option is worse than a health care bill with one. That much is obvious. Convince Ben Nelson, Joe Lieberman, Blanche Lincoln, Mary Landrieu, etc., and then we’ll have something to talk about. Until they’re convinced, or can somehow be pressured or shamed in a way that leads to actual action, I don’t see the point in continuing to extol its many virtues, except in the spirit of a pep rally. When I say Public you say Option! Public! Option! Public! Option!

    The key question remains this: at this point, after close to a year of the same arguments that haven’t persuaded quite enough actual legislators, is a bill without the public option still worth doing on its other merits? And I don’t understand how the answer to that can be anything other than “Yes,” unless you’re more interested in flexing electoral muscle than in making the best of the moment that is actually before us, and unless you think that some future president and some future Congress will do such a better job that it’s worth it to wait.

  106. 106
    les says:

    @A Mom Anon:

    Frontline did an excellent summary/comparison of five systems, including Britain, Germany, Switzerland; well worth the watch. Interestingly, the Swiss went from a totally private system to universal coverage relatively recently. But we’re fucking exceptional, donchaknow. The killer question, asked of responsible types in every country: how many citizens go bankrupt due to medical costs? To a person, they were completely zonked by the question–the notion was too unbelievable to consider.

    We’re number fucking one. Also.

  107. 107
    beltane says:

    @cleek: But he could have cajoled, browbeaten, and bully pulpited the necessary votes. And if that failed, he could have gotten Rahm to replace the Senate Democrats with cloned doubles who were not corporatist sellouts. Why was this not done?

  108. 108
    Cat Lady says:

    @FlipYrWhig:

    I totally agree with this. I asked Just Some Fuckhead before s/he disappeared in a snit, and didn’t get an answer, what is going to make Ben Nelson, Joe Lieberman, Evan Bayh and Blanche Lincoln vote for a public option? They’re not going to. They won’t ever vote for it. How can that problem be solved outside of their own electorate voting them out and a more left leaning Dem in? It won’t happen in Nebraska. It is what it is. The public option is just going to have to be an incremental goal.

  109. 109
    Mary says:

    @General Winfield Stuck: I think that Jane Hamsher’s perfidy actually caused the vast majority of the netroots to wake up and realize the utter destructiveness of Jane Hamsher and her ilk. I know it did me.

  110. 110
    Corner Stone says:

    @Mr Furious:

    I am at a complete loss as to why THAT column of all the material floating around the intertubes, not to the mention many, MANY thought-provoking and equally valid comments in the threads right here has convinced you the public option is suddenly necessary-or-catastrophe.

    It does make you wonder a little bit, don’t it?
    A really “blah” article with some easily refutable hyperbole in there, being sourced from FDL…strange, that.

  111. 111
    Zifnab says:

    @cleek: I know it’s really hard to resist cheering for a bill this long in coming, but we’re talking about a major overhaul of the insurance industry that catapults the entire nation into the waiting arms of an industry notorious for criminal business practices.

    It would be like the government slashing deeply into military spending and channeling the revenue into unemployment coverage and education, but putting Goldman Sachs in charge of the money.

    I absolutely believe in universal coverage, regulated insurance, and subsidies to make it all affordable, but I can’t help and notice this bill puts the fox in charge of the hen house.

  112. 112
    General Winfield Stuck says:

    @Mary:

    I do hope you are right:)

  113. 113
    Corner Stone says:

    @wilfred:

    Yes, well it was just not possible. How do we know that? Well, if it had been, we would have had it, but since we don’t have it, it wasn’t, possible. Qed.

    The votes! WHERE ARE THE VOTES??

  114. 114
    Tomlinson says:

    @Corner Stone:

    A really “blah” article with some easily refutable hyperbole in there, being sourced from FDL…strange, that.

    Cole would never stir shit. Never.

  115. 115
    cleek says:

    I can’t help and notice this bill puts the fox in charge of the hen house.

    the fox has been in charge for decades.

  116. 116
    Mary says:

    @Zifnab: Or it could be that the frog is in the pot and that the heat will be gradually turned up.

    The idea of health insurers as regulated utilities, common carriers, if you will, intrigues me.

  117. 117
    Zifnab says:

    @cleek: So then where’s the reform?

    @Mary: It could go either way. I think if we have Democrat majorities for the foreseeable future then eventually pressure will build on the insurance companies and they’ll be forced to give.

    But that’s no guarantee. Give us a Republican majority (or just a magic 41st GOP Senator) and the whole thing gets rolled back or gridlocked.

  118. 118
    Ailuridae says:

    @Corner Stone:

    Again, if the votes are there just introduce it separately and pass a stronger option with 50 votes. Are all of those progressives in Congress like Sherrod Brown and Russ and Tom Harkin just stupid and they can’t realize they can do this via reconciliation? Can they not see that they easily have 50 votes because the would have had 60 if Barack Obama just tried harder?

    Oh wait, there aren’t 50 votes for the public option now and there likely never were.

  119. 119
    FlipYrWhig says:

    I don’t see passing a health care bill leading to electoral losses. It’s true that it isn’t polling very well–but IMHO that’s because far too few people understand what’s in it. Provision by provision, people support it, and I’m pretty sure I saw a recent poll about that.

    On the right, I think people don’t like it because they’ve been whipped up about “government control,” and because they imagine that the point of the bill is to raise their taxes in order to give free medical care to poor and/or dark-skinned people. They see it as a form of the dreaded “welfare.”

    Elsewhere on the political spectrum than the right, I imagine that a lot of people like the idea of the public option (as they should) and have heard a lot about whether it’s in or out, and think that it’s the chief cost-savings idea, and hence don’t like the idea of a bill without it. But _there are other parts of the bill_. And those haven’t penetrated into the public consciousness at all.

    So I think that when people see what the bill actually means for them, they’re very likely to change their tune.

  120. 120
    Mary says:

    @Zifnab: With 8 years to install a regulatory infrastructure, I’m hopeful.

  121. 121
    Tsulagi says:

    @Ailuridae:

    I’m addressing the contents of the bill.

    Me too.

    Did you even bother reading the Surowiecki article?

    Nope. And thanks for the helpful link to it so I could gain valuable insight into your turd blindness ability.

  122. 122
    ds says:

    I absolutely believe in universal coverage, regulated insurance, and subsidies to make it all affordable, but I can’t help and notice this bill puts the fox in charge of the hen house.

    The fox is already guarding the henhouse. The insurance companies are already in charge. Unless you’re extremely rich, health insurance isn’t a luxury. It’s a necessity.

    For the first time, the individual insurance market will be seriously regulated.

  123. 123
    cleek says:

    @Zifnab:

    the reforms are numerous and have been enumerated in many places, in the past week or so. some of my favorites include: no more rescission and no more pre-existing condition exclusions.

    those are huge.

    getting rid of the health insurance industry is a fantasy on par with getting rid of the IRS.

  124. 124
    eemom says:

    @Mike Kay:

    thisety thisety This. I think it’s hilarious how her koolaid-drooling groupies ecstasize over how EFFECTIVE an activist she is…….and, uh-oh, better not piss Jane OFF…….when she’s been flailing furiously at HoJo since the beginning of her political, um, career……..and hasn’t made a doggone dent.

  125. 125
    FlipYrWhig says:

    @Zifnab:

    we’re talking about a major overhaul of the insurance industry that catapults the entire nation into the waiting arms of an industry notorious for criminal business practices

    True, but we live in a country where too much of the citizenry doesn’t trust the government to do things, even things the government would be good at doing. And thus we’re in a bind, where large-scale things need doing, but our compatriots refuse to let the government do them properly. So the government ends up needing to forge partnerships with for-profit concerns and sundry bad actors. But without those partnerships, the things don’t get done.

    I think that’s the intractable part: way too high a percentage of politicians and the public that fundamentally recoils from the notion of the government doing things that businesses could do. It’s an attitude that fucks up the entire nation and seriously constrains the government. But I don’t know how to fix it.

  126. 126
    Tom Hilton says:

    @Mary: Now you’ve done it; you just pissed off James Fallows.
    ;-)

  127. 127
    mcc says:

    @Bruce (formerly Steve S.):

    Okay, so I really hope you were honestly looking for an answer to this question and I didn’t just type a bunch for nothing, but…

    The article makes a point I’ve been pondering for a while. The “foundational” argument advanced by Klein et al is that you have to pass something in order to lay a foundation for future change. But what foundation is being laid? The Senate bill entrenches private interests at the heart of health care;

    First off: No, it doesn’t. At the moment, private interests are at the heart of health care. Our entire health care system, except for little walled off systems for veterans and those over 65, is entirely privately run. Under the Senate bill, private interests are entrenched at the heart of health care. Private interests are also entrenched at the heart of health care under FDL’s preferred option (since FDL’s preferred option is the status quo). The bill does nothing to change this. With or without the bill, the only way for a nonelderly nonveteran to get adequate health coverage in America today is for someone to buy them health insurance. There are a significant number of people in America today without private health insurance. These people, though sometimes you can get some piecemeal health services from urgent care or emergency rooms or charity or medicaid, simply don’t receive adequate health coverage.

    So the question is: Given we have a system where the only way to get health coverage is to buy private health insurance, what do we do about this?

    From a practical perspective, this bill does three things.

    1. It establishes that the 20%ish of the population that currently isn’t getting adequate health care is unacceptable. That that one way or another has to go down to zero, eventually.
    2. It establishes that the government will be the engine for moving us from 20% lacking coverage to zero.
    3. It reduces that 20% to something more like 6% over ten years.

    There are a number of practical things it does toward these ends. But let’s not worry about that right now, since you aren’t asking here about reducing the problem of the uninsured, or addressing the pain of small businesses or independent contractors, or making it realistically possible to buy insurance without full-time employment– these aren’t your goals, I guess, because what you seem to be asking about is what kind of “foundation” the bill provides for passing a public option, with the public option being an end in itself. The goal is to hurt or destroy private insurers. Okay, well let’s talk about that. Here is how this bill sets a foundation for a public option or something like it:

    – This bill sets out a goal– Universal health care– and commits the government to it in a huge way. Once we start on this there won’t be any pulling out, the question won’t anymore be “should the government guarantee universal insurance coverage?” but rather “how do we best run the government’s program of guaranteeing universal insurance coverage?”. This lays a foundation for a public option in a simple way. The public option is a good way to bring us toward universal insurance coverage. According to the CBO, if the health care bill we’re passing right now had a public option, the whole universal-insurance effort could reduce the uninsured to 3% instead of 6% and save a bunch of money while doing so. In other words, the health care bill that’s passing right now gives the public option a justification. Without the HCR bill, a majority of the public when polled right wants a public option to exist, but at that point it’s just group A wants a public option and group B doesn’t and group B has a lot of money and from there nothing happens. You can’t just say “I want a public option” and expect it to get passed. A lot of people want things. Congress is really busy lately and you have to actually outline some sort of problem that your pet thing solves if you want it to become real. The problem the public option solves is it moves us toward universal health care. So what? We haven’t even decided that’s a problem the government is going to solve. And if the HCR bill had died (which note: it didn’t, the “kill the bill” crowd lost) that would not be taken as a rejection of corporatism or private health insurance or whatever. It would be taken as the united states deciding against the idea that health care access is a problem we’re going to try to solve.

    – Exchanges. Please tell me you’re familiar with the exchanges? After the bill passes, something like 30% of the public– basically the entire “problem area” for health coverage, because people who have employer-provided coverage are mostly happy with it– will be buying insurance through the government. You won’t just go to an insurance company and buy insurance, you’ll go to the government and it will buy an insurance plan for you. This does a few things which are vitally helpful to the public option. First off, somewhat trivially, it sets a precedent– that you go to the government to buy health insurance. All the government is doing is buying you a private plan? But it still takes down one large barrier to the idea of instituting a private insurer. Second off, once this all takes effect, a good 30% of the public will be getting insurance through large-group insurance plans held by the government. If you can’t think of ways to wheedle that into a tool to promote socialized medicine you just aren’t trying. Third off, and critically, the exchange provides the entire mechanism for a public option to be introduced! After the HCR bill passes, the way we’d institute a public option is just create it and make it available through the exchanges. Without that the public option would have to market itself like any other health care company, convince people to buy coverage, make a risk pool from nothing. The exchange makes it significantly easier to introduce a new insurer and the public option can take advantage of that.

    – To get a little fuzzy, there’s the foundation it sets in a politics sense. The bill passing creates political momentum for health care reform. It wipes away 30 years of “HCR reform for democrats” meaning crushing failure and “advocating HCR” becoming an act of political self-immolation. It de-electrifies a third rail. Now, again, let’s consider the alternative. What if the bill had failed? Well, it certainly wouldn’t have been because of FDL, it would have been because of Bill Nelson and Blanche Lincoln and a unified Republican caucus. The public and press would see this, and would learn from it. The bill would absolutely not have been taken as having failed because it didn’t go far enough to the left. It would have been taken as having failed because it went too far, did too much. After the 1994 health care reform failed, the lesson our political system learned was that it was too intrusive, too disruptive, too complicated, it did too much to let government take over our health care system. As a result the next attempt we got at HCR (from Edwards, Obama and Sen. Clinton, the one we’re passing right now) was more minimal, stripped back, it did everything possible to preserve and step around the existing health insurance system (and yes, I’m describing the version of HCR that had a public option when I say that). If that had somehow failed? The lesson learned would have been that even that goes too far, changes too much, rattles too many boats or whatever. Think what the next attempt at HCR would have looked like. Probably it would have been a mandate only, or a cost-controls-only bill like the Washington Post editorial page seemed to have wanted. One foundation this bill leaves behind is a political system in which HCR advocates have the momentum, a political system in which HCR bills can pass. A political system in which passing something like a public option is a tweak to an existing system and not a revolutionary attempt to overthrow something unchanging and unchangeable…

  128. 128
    Ailuridae says:

    @Tsulagi:

    It would have been tough to search the thread say with CTRL-F. Or to have used to google but here it is anyways. I always find it interesting that people that are intellectually lazy and sloppy are actually just plain old lazy as well.

    http://www.newyorker.com/talk/.....z0bBoeg8Tn\

    Hopefully Jon Walker has a response to that soon before the thread dies off.

  129. 129
    Zifnab says:

    @cleek:

    some of my favorites include: no more rescission and no more pre-existing condition exclusions.

    We’ll see what Scalia thinks of those provisions. When they survive the SCOTUS, I’ll be a fan of them too.

    getting rid of the health insurance industry is a fantasy on par with getting rid of the IRS.

    I’m not asking for anyone to get rid of the Health Insurance Industry, I’m asking for public sector competition.

    @FlipYrWhig:

    True, but we live in a country where too much of the citizenry doesn’t trust the government to do things, even things the government would be good at doing. And thus we’re in a bind, where large-scale things need doing, but our compatriots refuse to let the government do them properly. So the government ends up needing to forge partnerships with for-profit concerns and sundry bad actors. But without those partnerships, the things don’t get done.

    It’s a big problem, no doubt.

    But it’s one more reason to press hard for public initiatives. When you have good public schools and a timely post office and robust infrastructure, the Republicans look sillier and sillier chanting “Blame the government!” and trying to throw bricks through the public window.

    The only way to rebuild faith in the public sector is to have a successful public sector for people to have faith in.

  130. 130
    ds says:

    I don’t see passing a health care bill leading to electoral losses. It’s true that it isn’t polling very well—but IMHO that’s because far too few people understand what’s in it. Provision by provision, people support it, and I’m pretty sure I saw a recent poll about that.

    Keep in mind that much of the opposition to the bill is from the left, among people who think it doesn’t go far enough.

    If you add up the people who support the reform, and the people who oppose it because they think it doesn’t go far enough, you have a solid majority of the public.

    Krugman has a poll on his blog that shows that most people believe that the country will be “better off” with reform, and only about 30% believe that we’ll be “worse off” with reform.

    Passing the bill might give the Republicans some fire to attack “big spending liberals” or whatever, especially since most of the provisions won’t come into effect until 2014.
    But not passing it would be an absolute political debacle.

    We’re past the point of no return. If the Democrats wanted to not pass health care, they should have ditched the effort months ago. But if they come home to their districts empty handed at this point, after all the big promises they made, they’re in for an absolute thrashing.

  131. 131

    I suppose one more exercise in throwing rocks at the moon won’t hurt me. I love the ‘this turd will get fixed” theme, why would it when you’ve forcibly funded the opposition? Because the thing is such a mess that the people revolt? In that case they’ll let who exactly fix it? The Party they hold responsible?

    I don’t give a damn if the deductible is $5K or $10K, these people cannot afford that hit and particularly if they lose work income. They WILL NOT go into the hospital and eat that loss in the hopes of circumventing some possible worse situation in the future. They will wait until it is unavoidable – just like now. You are not helping these people with the mandates, you’re certainly helping the ins cos and hospitals, but their life continues as before minus the premiums for something they dare not use. Ruined for $10K is no better than ruined for $100K, think about it. Worse for your cause is that they will know precisely who forced them into this situation.

    As for the regs, they’ll ding the ins cos profits, yes. And? Moving on to the clincs etc bullshit, that’s government money and depends not the least on mandates. But fuck this, I couldn’t maintain official Party roles without being in the position of defending this shit so I’m no longer in that position. I do seem to be failing at the project of not giving a damn…

  132. 132
    DougL (frmrly: Conservatively Liberal) says:

    Sure a PO would be a great start to reform but it isn’t happening in the poisoned congressional atmosphere we now have.

    Not.Going.To.Happen.

  133. 133
    SGEW says:

    [tl;dr, I’m sure]

    Can we all agree on these points, more or less?

    A comprehensive single-payer universal health care system, fashioned in a similar manner to an existing European system (or a synthesis/upgrade thereof), would probably be a preferable policy outcome.

    The current legislation is a massive hodge-podge of compromises and weak sauce. It is, at best, a modest step towards a genuinely progressive process of reform; at worst it rearranges the deck chairs of the institutional status quo (aka “hyper-timid incrementalist bullshit”), while still subsidizing a critically vulnerable segment of the population.

    However, as far as I can tell, the pending bill will not be disastrous.

    Four years ago Congress was debating privatizing Social Security and repealing Habeas Corpus.

    This country is, by and large, full of misinformed, unethical, and/or bug fuck crazy people. There very well may be a plurality that is both stupid and evil [or “ignorant” and “unethical,” if you prefer]. However, they are fully enfranchised citizens of the United States and have an equal right to representation. Nobody’s ever figured out how to deal with this.

    The U.S. government is capable of doing tremendous harm, both to hundreds of millions of human beings around the world and to its own citizenry. It is even, perhaps, disposed towards doing so. Why the Federal government is so FUBAR/SNAFU is a very complicated question, but, as has been recently reiterated, it is what it is, for now. Reforming the process itself is a far, far greater challenge than merely upgrading our health sector to 21st (or even late 20th!) century standards.

    For me, a “reality-based community” congressional majority (barely) and the election of Barack Obama are indications that large scale reformation of government is possible; not evidence that it is currently feasible.

    IOW: Things are shitty and the system is fucked (see, e.g., this entire fucking decade, not to mention all of human history), but I’m starting to feel that it’s not getting worse. There is good evidence that things are, in fact, improving. This is very good news! We should be very happy! I may be cynical, but I’m no nihilist.

  134. 134
    jwb says:

    @Zifnab: Uh, no. If the Dems lose their 60 Senators, things can’t advance very effectively, true, but it’s much easier to tweak a program legislatively once it’s on the books, especially if it requires regular funding. As for it being rolled back, well once it’s law it would require 60 Senators and the President’s signature to reverse it. (The power of the filibuster works both ways.)

  135. 135
    jwb says:

    @Zifnab: “We’ll see what Scalia thinks of those provisions. When they survive the SCOTUS, I’ll be a fan of them too.”

    Man, if you’re worried about Scalia gutting this bill, what do you think he’d do to a stronger bill?

  136. 136
    Ailuridae says:

    @Chuck Butcher:

    Chuck, as I showed you in the previous thread it is not a 5K deductible (or as you earlier misstated a 10K deductible) but around a 3K maximum out of pocket expense in any given year. Dedubtibles were, IIRC 250 and 600. They are not one in the same. How many times, exactly, do you have to be corrected about something before you will stop dissembling in the same fashion?

    Also, preventitive care is free in both the House and Senate bill. Also, there is a national non-profit competitor in the Senate bill that will likely be strengthened in conference. So nobody has to buy from Aetna or BCBS or Humana or WellPoint.

    Facts are inconvenient things when they run counter to strongly held beliefs that lack an empirical foundation.

  137. 137
    Ailuridae says:

    @jwb:

    You mistook that for an intellectually honest argument. It clearly wasn’t

  138. 138
    ds says:

    We’ll see what Scalia thinks of those provisions. When they survive the SCOTUS, I’ll be a fan of them too.

    Well, the federal government already imposes those regulations on employer-based health care. They’re just expanding them to the individual market.

    The idea that health care regulations will be taken down by the courts, but they’d leave alone a public option, is pretty crazy. I expect to hear that stuff from the teabag right, but the left should know better.

    As much as I hate conservative jurisprudence, so far they haven’t made any serious challenges to the state’s ability to regulate the economy. Even Scalia and Thomas accept that.

    And if they suddenly did start overturning those 150 year old precedents on regulation, why would they leave untouched the 70 year old precedents that allow social insurance programs like Social Security and Medicare, and a public option??? I would think they would overturn all of them.

    If the courts go teabagger on us, we’ve got a lot more to worry about than whether insurance regulations survived.

  139. 139
    scudbucket says:

    @mcc: I hope you’re right about these things – I need to be talked down from the crazy tree. Part of what you argued here is that the current bill increases the likelihood of a robust PO because it sets a precedent where individuals “go to the government to buy health insurance”. Are you talking about those who qualify for a subsidy, or individuals above subsidy?

  140. 140

    @Ailuridae:
    The only policies that offer the deductibles you’re advancing today are nearly Cadillac coverages. I shopped ins before I said shit on this and what you’re talking about doesn’t exist in plans any modest income family could begin to afford, much less lower incomes. You’re proposing that the entire lower end of health ins is going to be eliminated? WTF? So this is the end of 80/20 policies?

    In my county a PPO with 5K deductible, 20% coinsurance, $25 doctor for 2 56 yr non-smokers is $570/mo and nothing is offered without deductibles. That is $6800/yr.

    That is the best coverage I can find shopping online for it and I’m not about to bother agents over something I’m not going to buy. My reality is considerably worse.

  141. 141
    silentbeep says:

    oh lordy John I’m tired, can’t we give HCR a rest? Sigh.

    ….

    O.K. now that I got that off my chest: I like the FDL article you cited. Doesn’t change my support for HCR as it is now. I supported the public option and as someone said above, Klein and Cohn supported it too. I still remin hopeful for getting a public option in the future (how far that is in the future I don’t know – but health reform i expect will be decades in the making). Not incredibly incisive analysis here of course, but that’s my two cents. And I don’t agree that not having the public option would necessarily be “catastrophic.”

  142. 142
    ds says:

    The only policies that offer the deductibles you’re advancing today are nearly Cadillac coverages.

    Just to clarify, the “Cadillac” tax only applies to employer-based coverage. When people use their money to buy individual policies, they pay income tax on that money, but employer-based policies aren’t taxed at all. It’s basically a redistribution of wealth from the poor to the affluent, because the poorest workers don’t get offered insurance by their employers.

    With the “Cadillac” tax people with expensive employer-based plans will have to pay some taxes on them.

  143. 143
    General Winfield Stuck says:

    @ds:

    There is just so much misinfo out there, even from our side of the isle. Thank you and the other smart and informed folks here for keeping us dweebs informed with actual facts.

  144. 144

    @Stroszek:

    I agree that the “Jacob Hacker” Public Option (as distinct from Obama’s campaign “public plan”) is a good idea.

    However, I don’t agree that it is an essential idea at this time, or a dealbreaker if it’s missing. I can get great benefit from a bill with no PO, if there is a scheme in place to help people who can’t afford premiums to get coverage, and if exclusions are limited. Just with those two things, I get a safety net that is quite valuable. I’m now on a preexisting condition blacklist through no choice of my own, and held hostage to a job in order to keep my existing coverage. That has to go. That’s just abusive.

    Note that as covered in a thread here the other day, Jacob Hacker is now advocating passage of the HCR bill even without his Public Option.

  145. 145

    @ds:
    I didn’t suggest anything about excise taxes, just because you decided to bq me and talk about nothing I referred to.

  146. 146
    Tsulagi says:

    @Ailuridae:

    It would have been tough to search the thread say with CTRL-F.

    Maybe in your dimension “Surowiecki” appears with a CTRL-F search in this thread before you asked if I’d read his article, but not in this one. How’s your chess game going in that dimension?

    Or to have used to google

    Actually I did before my previous comment. Did you know if you do a “Surowiecki article” search you get almost 300k hits? But you knew that, no doubt with the same certain knowledge anyone would know which specific article was floating in your mind.

    BTW, now skimmed the article. You’re both mesmerized by the chocolate sprinkles. But that’s okay, underlying turds like the one you’re coveting need love too.

    I always find it interesting that people that are intellectually lazy and sloppy are actually just plain old lazy as well.

    Me too.

    Thanks for the comedy, Ailuridae.

  147. 147
    Martin says:

    There is one major problem with the public option that senators in particular are worried about and which nobody is really trying to address:

    The public option, like Medicare, sits above state regulation. That means the public option can do things that insurers at the state level cannot do. It is in this way that it does not compete fairly (it competes better, and from a state standpoint, unfairly). This is why they investigated creating state-level exchanges, but the FDL bomb-throwers shouted that down, plus it’s not a good system in low-population states and certain other markets, and the places it would work best, like California, has a ton of competition now so it would have limited effect.

    The Medicare buy-in helped address that concern to a small degree because Medicare isn’t designed to compete, it’s designed to replace, and it’s a known entity. But it most likely would have wiped out any individual policies for people over 55 to private insurers. That’s all okay by me, but it’s not okay to the states (who aren’t corporate interests) and the insurers.

    What I think guys like Nelson and Lieberman might have accepted in order to keep the public option was the elimination of state regulation. Then it would have been a fair competitor. I’m sure the states themselves would have been pissed as all get-out, and it creates a whole new set of issues to deal with, but it probably would even have gotten the insurers to be okay with the deal – state regulation is a HUGE issue with them and would have actually brought real competition to the marketplace.

    Nobody was talking about that, though. Nobody was willing to go there. IMO, that more than any other thing killed the public option and will continue to kill the public option because the state regulatory boundaries are what is creating the monopolies in the first place. Solve THAT, including the side-effects of it, and any national effort gets MUCH easier.

  148. 148
    FlipYrWhig says:

    Can we declare a moratorium on feces references when discussing the bill? Shit shit turd shit turd shit sandwich turd turd poop. Done?

  149. 149
    Tom Hilton says:

    @FlipYrWhig: no, because that’s all the kill-billers got. They can’t make a fact-based logical argument for their ridiculous position, so they have to resort to fecal references.

  150. 150
    slightly_peeved says:

    IMO, that more than any other thing killed the public option and will continue to kill the public option because the state regulatory boundaries are what is creating the monopolies in the first place. Solve THAT, including the side-effects of it, and any national effort gets MUCH easier.

    The current senate bill requires that a national, non-profit option be part of the exchanges. The exchanges, while state-based, are created using the FEHBP model. The only power states have in the system is:
    (a) To licence or not licence insurers in a state;
    (b) To specify extra required forms of coverage for insurance offered in their exchange.
    Everything else – the required forms of coverage, whether a premium rise is acceptable, who actually gets to offer insurance under the exchange – is determined at a national level by the OPM and the HHS Secretary.

    Since the FEHBP system already has a bunch of nationwide plans, presumably registered in each state, and at least some of the people running them would be drooling at the thought of adding all these new clients, I’m guessing some of the national plans under the FEHBP would be clamoring to be nationwide plans under the new exchanges.

    So while it currently isn’t as good as a national exchange, having the general oversight of exchanges being done by a national body (the OPM) in accordance with an existing national plan is better than a purely state-based solution. Getting this shifted to be a true national exchange seems like one of the more likely and useful gains that the House might be able to make in the conference, since it’s clear that any medicare expansion or public option expansion is Na Ga Ha Pen. A national, heavily regulated marketplace for insurers with full portability is actually a big step towards a proper universal system.

  151. 151
    Mark says:

    @Martin

    “the places it would work best, like California, has a ton of competition now so it would have limited effect.”

    Can you elaborate? California is one of the most difficult places to get insurance – companies reject pretty much anybody over 40 who’s been to the doctor in the last year.

  152. 152
    Tsulagi says:

    @Tom Hilton:
    Sorry if your delicate sensibilities have been offended.

    What has thus far passed through the bowels of this Congress has been debated ad nauseam. Point by point. Don’t think there are too many undecideds. Everyone has their opinion of the turd garbage crap whatever on the table. Pick the most inoffensive term that pleases, or rub your eyes real hard to see starbursts. Whatever works for you.

    And back again to the original post by Cole, Walker has it right. That is all. Out.

  153. 153
    Tim I says:

    I’m embarassed for you John. Anything this asshole writes is bullshit of the first order. He has no credibility. His argument is stupidity couched in highfalutin’ language. He is the paid whore of Jane Hamsher and there is no lower state to which a person can descend.

  154. 154
    Tim I says:

    To say that Walker has shit for brains would be an insult to feces.

  155. 155
    FlipYrWhig says:

    @Tsulagi: I use the word “shit” all the time, but at a certain point in this debate, it reached critical mass and became self-authorizing. The bill is shit because shit is the bill, and look at all these other people who say it’s shit, thus proving my opinion that it’s shit. It’s a shit circle. I think the technical term is “coprophagia.”

  156. 156
    mcc says:

    @mcc: I hope you’re right about these things – I need to be talked down from the crazy tree. Part of what you argued here is that the current bill increases the likelihood of a robust PO because it sets a precedent where individuals “go to the government to buy health insurance”. Are you talking about those who qualify for a subsidy, or individuals above subsidy?

    I mean everyone on the exchange, which will be at least ten percent of the population. (Everyone who receives subsidies is on the exchange, but the exchange is separate from the subsidy system and not everyone on the exchange receives subsidies.)

    Right now, by the CBO’s numbers, about 13% of the nonelderly population, were it to buy insurance, would get its insurance through “nongroup” (individual) plans, about 17% would get it through “small group” (small business) plans, and about 70% would get it through “large group” (large business) plans.

    Under the HCR bill, the first two categories there potentially go away, as any small business and anyone buying insurance as an individual has access to the exchange. The old nongroup/small group policies don’t totally go away– existing health plans continue, and surely some people will stay on their plan just because it’s what they’ve got– but the exchange plans will be preferable to the old policies and basically anyone signing up for new insurance would go into the exchange. What the exchange does is negotiate standard-rate premiums, the way a large-group employer would, for everyone who buys through the exchange, so you get all the benefits of a large-group plan without actually having to be employed by Hewlett-Packard or whoever. The government is free to dictate terms to health plans available through the exchange and deny them access to the exchange if they don’t comply. The CBO gives a raw estimate that after 10 years 10% of the nonelderly population will be getting insurance this way– literally buying private insurance through the government.

    [Numbers: my percentages of the population in each category come from page five of the CBO’s report on premium costs under the version of the Senate HCR bill we had before the public option was stripped; the other numbers come from page 22 of the CBO’s general report on the HCR bill. Note my previous post said 30% of the population would be on the exchange; although it could potentially go up to there this is not what the CBO projects– I falsely assumed the entire category would go on the exchange. (I’m still a little confused trying to reconcile the tables from these two PDFs because the second one explicitly breaks out “medicaid” coverage and the first one doesn’t, and I’m not sure how that’s implemented in practice since as I understand medicaid is a patchwork of programs.) The CBO’s projection in the second PDF of what actually happens does have the exchange picking up a number nearly equal to the number who get insurance as a result of the bill, and shows other private insurance categories only decreasing as the exchange ramps up, which is why I say new insurees will be all going onto the exchange and the remaining nongroup/small group plans will be legacy plans. Note I also described being on the exchange as having a large-group plan “held by” the government. Looking into things closer it doesn’t look like this is an accurate way of putting it.]

  157. 157
    jl says:

    Getting rid of different state regulations and promoting competition will only work IF a stable competitive equilibrium exists for comprehensive health policies.

    There very strong theoretical evidence that such a competitive equilibrium can not exist in comprehensive health insurance markets. This lack is due to the fact that over the lifespan, young people with similar risks for health care costs will develop into distinct, and large, high risk and low risk populations, due both to pure chance and lifestyle choices (including responsible choices such as choosing relatively more physically demanding work).

    Insurance markets may well have no competitive equilibrium when large fractions of the population are high risk or low risk and it is costly to detremine to which population a person belongs. Also when it costs alot to write contracts to screen out the high risk people.

    Health economists such as Joseph Newhouse at Harvard, who have looked at the empiricial evidence see behavior consistent with lack of a competitive equilibrium.

    The lack of equilibrium is due to companies trying to cream skim the healther population and avoid covering any high risk people.

    So, yeah, it would be good to do away with inefficient state regulations, some of which cause more problems than they solve. But the question is what should replace those state regulations.

    My opinion is that increasing unregulated competition has been the hallmark of the last 30 years of US health care policy, in terms of insurance coverage, provider contracting, and drug and device policy. It has lead to the mess we see today.

    Over twenty countries middle and high income countries have cheaper healthcare, better population health and more indidual security in the face of a health catastrophe. Not one of them does it with unregulated competitition.

    People need to start giving some reasons how and why interstate competition will solve the problem. The way the GOP and Demo-crooks (excuse me, Democratic centrists) want to do it, it will just lead to a race to the lowest common denominator in terms of regulation, with a bunch of crummy policies and limited and difficult recourse for ripped off policy holders. I do not see how the credit card industry can be seen as a model for improving health care in the US.

  158. 158
    Bruce (formerly Steve S.) says:

    Okay, so I really hope you were honestly looking for an answer to this question and I didn’t just type a bunch for nothing,

    About 90% of what you typed reads like a press handout rather than an argued response to the question, so it’s up to you if you were wasting your time or not. I’ll respond where it seems appropriate.

    Me: The Senate bill entrenches private interests at the heart of health care;

    You: First off: No, it doesn’t…Under the Senate bill, private interests are entrenched at the heart of health care.

    So does it or doesn’t it?

    FDL’s preferred option is the status quo

    Serious question; do you even know what a strawman argument is? It takes but seconds to find what FDL’s preferred option is in their own words. Doesn’t look a whole lot like the status quo to me.

    because what you seem to be asking about is what kind of “foundation” the bill provides for passing a public option

    No. Read it again.

    Please tell me you’re familiar with the exchanges?

    Only as familiar as a reasonably engaged reader of the internet and non-specialist might be. I’ll skip most of what you say here as it’s non-responsive to my question, except this bit:

    the exchange provides the entire mechanism for a public option to be introduced! After the HCR bill passes, the way we’d institute a public option is just create it and make it available through the exchanges.

    All I’ve got to say to that is, please watch this.

    To get a little fuzzy

    I don’t need anymore fuzzy. What I need is a plausible and concrete explanation of what ways the Senate bill could be improved in the future.

  159. 159
    mcc says:

    @FlipYrWhig: You forgot “rape”.

  160. 160
    General Winfield Stuck says:

    @FlipYrWhig:

    Yes, I do have a certain proclivity for the “S” word. Don’t know where the fuck it comes from.

  161. 161
    Corner Stone says:

    @Tom Hilton:

    They can’t make a fact-based logical argument for their ridiculous position, so they have to resort to fecal references.

    Not making an argument per se but when a bill gets across the finish line due to the whims of Baucus, Nelson, Landreiu and Lieberman…it gives me pause to consider what had to happen to get their sign off.

  162. 162
    Martin says:

    @Mark: Competition doesn’t always expand the market – oftentimes it just intensifies competition for the best customers.

    I don’t advance the argument that competition will solve the problem, but many of the public option supporters are banking on just that – saying it will keep the insurers ‘honest’. CA is an example of where the reasoning is flawed – there are many insurers competing in the state and the problems are still here. The only way you really get the market expanded is to mandate that it expand or make it cost-effective to do so. The bill already works toward the former and cost reduction and cost stability is the only way to affect the latter. There’s some of that in the bill, but not enough for insurers to want to deal with that population.

  163. 163
    mcc says:

    @Bruce (formerly Steve S.):

    So does it or doesn’t it?

    The bill has no effect whatsoever on whether private interests are entrenched in the health care system.

  164. 164
    Tomlinson says:

    @Martin:

    I don’t advance the argument that competition will solve the problem, but many of the public option supporters are banking on just that – saying it will keep the insurers ‘honest’.

    This is my worry about the public option. It’s not hard to imagine a scenario where it becomes the insurer of last resort, taking a large majority of the high-cost segment of the population. Absent some pretty strict cost controls, you end up with the private insurers offering loss leader policies for the healthy/young and penalizing the sick/old. The sick/old migrate to the public option and the healthy/young to the private.

    There’s a REAL gift to the private insurers. Not good.

    So you end up with a mandate, with community rating and guaranteed issue and all the plans on the same cost footing. From a customer point of view, that’s about where we’ll be with the current senate bill.

  165. 165
    General Winfield Stuck says:

    @mcc:

    Or, you can’t entrench something already entrenched. And FDL’s preferred position at this point in time within the real world we live in, is kill the bill. Ergo status quo. Unless they can convene a high summit of the netroots and pass a bill of their own. Seems unlikely though.

  166. 166
    Martin says:

    @jl:

    I’m not suggesting that eliminating the state regulation would bring equilibrium to the market. I’m suggesting that eliminating the state regulation would probably appease the insurers (and their advocates) enough that a competitive national plan could be introduced, and that once it’s introduced and insurers manage to flee the higher-risk pools leaving them for the public option (young women, anyone over 40 – people with certain profiles that they’d still be allowed to consider when issuing a policy), and after a mess of insurers get swallowed up or driven out of business that the obviousness of instability will become apparent and we can steadily move toward a proper solution.

    My argument is that going from state-regulated private insurers to a federal, government run system is too big of a step. The public option was thought to be a smaller step, but it’s really still too big of a step. The first step would be to tear down the state market boundaries.

    I know that it’s convenient to look back to Medicare’s introduction as precisely such a large step, but it really wasn’t that large at the time. In 1970, Medicare payments were only $7B. Even adjusted for inflation, it was a much smaller program than anything we’re discussing today. The cost of care was so much lower than it is today that it wasn’t a terribly risky or expensive proposition back when it was passed.

  167. 167
    Corner Stone says:

    13 Republican state AG’s are mumbling furiously about the Cornhusker Kickback.
    I’m sure this will end well for all of us.
    Fuck you Ben Nelson! You cheap chiseler

  168. 168
    mcc says:

    Ben Nelson’s bribe is now being attacked by the Nebraska governor and furiously backpedaled on by Nelson himself, so it seems really unlikely it will go into any reconciled bill.

    (The bribe to Mary Landrieu on the other hand doesn’t seem to be controversial or endangered at all for some reason.) (?)

  169. 169
    FlipYrWhig says:

    @General Winfield Stuck: What FDL could be doing is going the think-tank route. Bombard DC with white papers to advocate why the public option is an indispensable part of any good health care reform plan, get committee staffers to meet with Jon Walker, etc. If this is their mission now, they can do actual work to achieve it. It’s less satisfying and more demanding than faux populism, but it has some chance of having an impact. I love the blogs, but let’s not confuse the blogs for the places where actual policy actually gets formulated, much less implemented.

    Edited to add: They’re essentially mounting petition drives. I really don’t think too many political and media figures pay attention to petition drives anymore, because they’re so easy to do.

  170. 170
    Tomlinson says:

    @FlipYrWhig:

    What FDL could be doing is going the think-tank route. Bombard DC with white papers to advocate why the public option is an indispensable part of any good health care reform plan, get committee staffers to meet with Jon Walker, etc. If this is their mission now, they can do actual work to achieve it. It’s less satisfying and more demanding than faux populism, but it has some chance of having an impact.

    While I agree that this would be a good thing, they have a real PR problem and would probably be best doing under another name and *well* away from Hamsher. This time, they didn’t get what they wanted, started going on Foxnews and joined forces with Grover Norquist, all in an effort to burn the people they’d just been working with.

    Not exactly a good start if you are looking to persuade dem lawmakers.

  171. 171
    Corner Stone says:

    @Ailuridae:

    Oh wait, there aren’t 50 votes for the public option now and there likely never were.

    No, I agree. We got the best possible deal we were going to get. That’s pretty obvious as it’s the deal we got.

  172. 172
    General Winfield Stuck says:

    @FlipYrWhig:

    This could go for the entire netroots activists, instead of screaming unfocused hysteria with web based political threats.

    They need more serious people to organize them into a purposeful focused group that could do some good. And I do believe they can do some good.

  173. 173
    FlipYrWhig says:

    @General Winfield Stuck: Does anyone from Big Blog actually meet with politicians? I’ve heard about conference calls and such, but those seem more like they treat the blogs as media outlets, as opposed to treating them as lobbying groups or think tanks.

  174. 174
    CalD says:

    I don’t think anyone really thinks a public option is unnecessary. The disagreement seems to be centered on whether we should:

    a) pick our battles, collect our winnings here and now and fight another day for a really robust PO, or

    b) draw a line and refuse budge another step without one of the half-assed PO’s that have been on the table (and in so doing, run a very high risk of losing the whole enchilada, again).

    Personally, I land firmly on option A and I note, so now does Bill Clinton, who already tried doing it the other way once. The first step is always the hardest one to take. People get used to the idea a little, it arguably should get easier from here.

  175. 175
    gwangung says:

    @General Winfield Stuck: Does anyone from Big Blog actually meet with politicians? I’ve heard about conference calls and such, but those seem more like they treat the blogs as media outlets, as opposed to treating them as lobbying groups or think tanks.

    Hm. That’s an innovation a smart boy or girl can take advantage of; realizing there’s a disconnect between the appearance and the reality and exploiting it. Of the two, it’s easier to show the lobbying power–you just need money, and a big name blogger could get that….

  176. 176
    Martin says:

    @Tomlinson: Well, my problem is that one of the main arguments for the public option is a free-market one. We’ll spend 99% of our time decrying the right applying free market solutions to every problem, and here we jump right in and use that very argument to defend ours.

    The truth is that there are two not entirely distinct but somewhat distinct health care markets – the critical care side that opting out of would be compared to suicide by some people, and the optional care side where individuals can safely opt out of. A market that consumers cannot opt-out of is not a free market – it’s a captive market, and pretending that free-market solutions that would work with corn chips or gasoline would work for cancer treatment or ambulance service is, well, stupid.

    That’s not to say that there aren’t a lot of problems the public option wouldn’t solve, but saying it’ll drive down costs on its own is a bit absurd. Now, if there was regulation to ensure that the customer profile for the public option resembled that of other insurers, then maybe, but they have no way of doing that yet – particularly when other insurers are bound by 50 different sets of state regulations on what they must and what they cannot offer.

  177. 177
    eemom says:

    @FlipYrWhig:

    “Big Blog”?! I luuuuurves it.

    Hmmm…….Blogangsters? Bloga Nostra?

    Bloggyists? B Street?

    Main Stream Blogia? The Blogillage?

    Last but not least, for Glenn de la Zilla……..The Blogablishment.

  178. 178
    Mako says:

    Boring article, to many words not enough porn.
    Anyone with half a brain who as ever experienced health care in some other country not the US knows what a turd stupid argument…, oh whatever…

    Word to the wise, John Cole, might want to add some porn links. Make this new year your big budget year.

  179. 179
    Thad says:

    I’ve heard all sorts of complaints that the public insurance option was going to be too weak or inclusive enough… but it would have been a life saver for my family. I am an uninsured small business owner. My family was betrayed by an insurance company that took our premiums and denied are claims when we needed care the most. We lost our insurance when we could not afford both out of pocket costs and our premiums. The current Senate bill does nothing to fix that sort of insurance company behavior.

    With access to a public option, millions of small business owners and self employed would have access to real insurance. Millions more would have the the freedom to leave jobs they hate (but stay in for the insurance) and start new businesses. It would actually tip the playing field a little bit back toward small business, which would be a huge boost to our economy.

  180. 180
    Mako says:

    @Thad:
    heh.
    You sound like a pony.

  181. 181
    slightly_peeved says:

    The way the GOP and Demo-crooks (excuse me, Democratic centrists) want to do it, it will just lead to a race to the lowest common denominator in terms of regulation, with a bunch of crummy policies and limited and difficult recourse for ripped off policy holders. I do not see how the credit card industry can be seen as a model for improving health care in the US.

    Except that the senate bill that allows interstate competition also includes a massive new number of regulations that must be satisfied for the interstate competition to occur – no pre-existing conditions, no recission, an improved appeals process through the OPM, notification and approval of rate rises via the OPM, online medical insurance review, minimum cost-to-benefits ratio, etc. These are more onerous than most of the existing state regulations, so moving the health insurer to Baltimore isn’t going to help them.

    Also, the ability of states to require further coverage than the OPM requires is included in the bill. In addition to Wyden’s amendments for state innovation, this means if a state wishes to establish a more onerous system for insurers than the federal system, the health insurers will have to abide by it if they want to go through the exchange.

    So in many ways, the current bill (as compromised as it is) doesn’t hold up to comparison with the credit-card industry.

  182. 182
    cleek says:

    @Zifnab:

    We’ll see what Scalia thinks of those provisions. When they survive the SCOTUS, I’ll be a fan of them too.

    maybe i’m misremembering…

    but how can someone with that attitude expect more from a HCR bill ?

  183. 183
    bayville says:

    @demimondian:
    Hey genius. NJ teachers, (state) cops, school administrators, (some) public workers, judges, etc. have superb health plans that will cost much more once this bill is enacted. That is a fact.

    Ask Gov.-elect Christie in NJ if the public employee insurance benefits in this state are superior to practically all current private sector bennies.

    For instance, with my (public school teachers) plan, I just mailed in perscriptions for 3 months supply of flovent & albuturol (asthma medication) that costs $10 per order.
    Is there anyone in today’s job market who can get a better deal than this? This ain’t a Cadillac Plan?

    Come back when you get educated and have been dealing w/ insurance companies & hospitals for 20 some years. Otherwise, keep believing what the Ezras and Yglesias’ keep telling you.

  184. 184
    FlipYrWhig says:

    @Thad:

    The current Senate bill does nothing to fix that sort of insurance company behavior.

    Thad, I’m not sure why you say that. As I understand it, there are both subsidies and regulations governing what insurance companies can and can’t do to people in your position. Or do you mean that there’s nothing stopping them from denying claims?

  185. 185
    bayville says:

    As per Bob Herbert:

    The tax would kick in on plans exceeding $23,000 annually for family coverage and $8,500 for individuals, starting in 2013. In the first year it would affect relatively few people in the middle class. But because of the steadily rising costs of health care in the U.S., more and more plans would reach the taxation threshold each year.
    Within three years of its implementation, according to the Congressional Budget Office, the tax would apply to nearly 20 percent of all workers with employer-provided health coverage in the country, affecting some 31 million people. Within six years, according to Congress’s Joint Committee on Taxation, the tax would reach a fifth of all households earning between $50,000 and $75,000 annually. Those families can hardly be considered very wealthy.

    A lot of us “working class” folk already fall into this so-called Cadillac Plan category.

  186. 186
    mcc says:

    @bayville: How much would New Jersey be spending on a typical education system worker’s annual health care plan now?

  187. 187
    FlipYrWhig says:

    @Thad: I just saw this linked somewhere else and thought it was enlightening: White House Blog on the health care reform process and the advantages of the bill.

  188. 188
    FlipYrWhig says:

    @bayville: If that happened, wouldn’t Congress just kludge it, like they do with the AMT every year?

  189. 189
    FlipYrWhig says:

    @bayville:

    Within three years of its implementation, according to the Congressional Budget Office, the tax would apply to nearly 20 percent of all workers with employer-provided health coverage in the country, affecting some 31 million people.

    Also, it seems to me that companies and organizations would scale down or roll back or renegotiate the value of their benefits, rather than pay a tax. That still doesn’t sound like a happy development for people either, mind you, but it’s not the same as sticking people with a tax bill.

    I think most people find their benefits to be rather mysterious anyway, because they transpire in some shadowy realm past the horizon of their paycheck. The employer-provided benefits system leads so many of those costs to be completely masked. The idea that my employer is also paying thousands of dollars a month for some other company to insure me? Weird.

  190. 190
    Citizen Alan says:

    @Zifnab:

    We’ll see what Scalia thinks of those provisions [recissions and pre-existing conditions]. When they survive the SCOTUS, I’ll be a fan of them too.

    I’ll go out on a limb right now and say that whatever Scalia thinks of the bans on recissions and pre-existing conditions is irrelevant. There may (or may not) be five votes for striking down the universal mandate as beyond Congress’s Commerce Clause powers. There are definitely not five votes for the proposition that Congress cannot ban certain types of contract defenses for contracting entities participating in government-sponsored exchanges. There are, at worst, two, and I’m not sure even Scalia is that crazy (although Thomas might be since he thinks child labor laws are unconstitutional).

  191. 191
    Citizen Alan says:

    @jwb:

    (The power of the filibuster works both ways.)

    Um, not really. If/when the Repukes regain control of the Senate, I expect the media narrative to turn on a dime and the use of the filibuster by the Democratic majority will be so reviled as undemocratic and partisan that the Dems will only pull it out in the most extreme circumstances, if then.

  192. 192
    mcc says:

    @bayville: Re the Bob Herbert column: See, I like this one. Legitimately informative, backs up its point with facts, tells you specifically what its sources are…

  193. 193
    Mnemosyne says:

    @bayville:

    Is there anyone in today’s job market who can get a better deal than this? This ain’t a Cadillac Plan?

    Actually, my company just changed prescription drug plans and my generics are $8 for a three-month supply, so I think I beat you. I make about $19/hr.

    However, I do work for a Giant Evil Corporation that has about 150,000 employees in a state with a lot of health insurance competition, which means they can cut some great deals for us that smaller companies and/or smaller markets couldn’t match.

    (How giant and evil, you ask? Well, our corporate logo is a rodent, if that helps.)

  194. 194
    Citizen Alan says:

    @ds:

    As much as I hate conservative jurisprudence, so far they haven’t made any serious challenges to the state’s ability to regulate the economy. Even Scalia and Thomas accept that.

    You may find it instructive to read Justice Thomas’s concurrence to “>U.S. v. Lopez, in which he suggests that Congress has no power to regulate any aspect of commercial activity which does not cross state lines, including wage laws, worker safety laws and even product safety laws.

  195. 195
    Citizen Alan says:

    The oddest thing just happened: I tried to edit my last post to clear up a formatting error, and WordPress told that I had edited it into spam. Then, it wouldn’t let me undo the changes I had tried to make because you aren’t allowed to edit spam posts. Has that happened to anyone else?

  196. 196
    Ruemara says:

    I’m all for public option. YAY PUBLIC OPTION. Show me how it can pass in the Senate and I’m yours forever. If that can’t happen, pardon me while I work to improve the giant crapcake of a Senate bill that will actually get the votes to pass.

  197. 197
    Ailuridae says:

    @Corner Stone:

    They can’t sue about something that isn’t a law. You know that, right? You also know that federalizing Medicaid is the single most responsible thing a progressive legislature could do, right?

    Of course you don’t

  198. 198
    Ailuridae says:

    @Corner Stone:

    Ah, refusing to address the issue. If there were a better deal to be had, its still available and easier to pass than in the larger bill. Try again, junior. And please, as its been ten days, address the issue at hand including calling your beloved Progressive Senators.

  199. 199
    Ailuridae says:

    @cleek:

    They can’t. you presume that person is arguing with intellectual honesty. Clearly, they are not.

  200. 200
    Ailuridae says:

    @mcc:

    misunderstands how taxation works or deliberately misrepresents how taxation works. You conveniently left that part out.

  201. 201
    Ailuridae says:

    @Ruemara:

    Obama needs to try harder, stupid face

  202. 202
    NobodySpecial says:

    Read that Klein link and too many people sound like they’re just cut-n-pasting it.

    As far as the Senate bill, I’ve done the math. Helps me not at all. Thanks for nothing.

  203. 203
    rachel says:

    @NobodySpecial: Sucks to be you. It’ll help me and it’ll help my husband and help my sister and her kids and both my sisters-in-law and their kids. And since you clearly don’t give a damn about the twelve of us, I don’t see why any of us should particularly care about you.

  204. 204
    NobodySpecial says:

    @rachel:

    Ok. One of us here is talking about making the bill better and able to cover more people. One of us here is saying to take the bill and shut the fuck up.

    Which one particularly cares again? Have a nice life.

  205. 205
    Tomlinson says:

    @bayville:

    A lot of us “working class” folk already fall into this so-called Cadillac Plan category.

    OK, so let’s look at the possible outcomes of that.

    Assuming you are above that limit, you are already well out on the tail of the curve for health plans. You have a plan that is well above the norm – check Kaiser. We’re insuring in a bunch of the highest cost states and we’re nowhere near that cutoff, with a heck of a plan.

    So, you are above the limit. Your company has a few options. They can:

    1. Cut back benefits to somewhere below the limit, either negotiating with you or with your union. If you are an average joe, making, say $100K, I’d argue you are almost certainly in a union or falling under some sort of group pay negotiation (you’re also getting ripped off – you could get a very comparable plan for less and have more take home…but I digress.) The company is cutting your benefits and you or your union knows it. A deal is struck and you get some portion of it back in cash and the company chooses a plan at or near the limit.

    You can either spend the cash on your mortgage or what have you, or you can buy a supplemental plan to fill in additional health benefits. I’m guessing something like 100% of the people will take the cash and not buy the extra insurance. As I said, you’re well above average already.

    Pay raise for you.

    Your company now has capped their health benefit costs. This is rather huge for them.

    Chances are your company will move way, way down – and then kick the cash to you and let you choose supplemental insurance as you feel the need. This is better for you and better for the company. Better for you since you can sanely chose your level of insurance. Better for the company since their cash outlay is the same, but they can give more cash to their employees. Happier employees, for free.

    2. You are above the limit and you do not have negotiating powers. Your company is going to screw you heavily by getting under the limit but not comping you. Unlikely. Why? Because if you make $100K and your company is paying that kind of health premium for you, they probably care about having you around. Why do I say that? Because otherwise, they would already be under that limit, way under, or not offering you health insurance at all.

    3. Your company is above the limit and (lo and behold!) the health insurance provider magically rejiggers the plans such that they are dead at the limit, but the benefits don’t change enough to cause anyone to renegotiate anything. Likely. Why? Because the health insurers do not want (1) to happen. (1), for them, is a pandora’s box. They have currently a sweet deal with the companies where the companies are, in effect, buying too much insurance since it is subsidized by our government. They *want* the companies to over buy, and if the companies start letting people buy what they need, they are going to see people buying insurance in a more optimal fashion, which means less overbuying and less cash for them. A lot less profit, too. Bad, bad, bad. So they take less upfront profit than they were getting before to protect this golden goose.

    My guess is that almost everyone is going to fall into (1) or (3). As an employer, I’m going with (1). Best for my employees. And, contrary to popular belief, that’s good for me. My costs are about the same either way.

  206. 206
    Tomlinson says:

    BTW, one thing to consider. I’ve seen (1) in action, a bit. We offer both a PPO and an HMO. The actual benefits in terms of co-pay, etc, are the same. The HMO is obviously bit more of a hassle, but it’s a couple hundred bucks a year cheaper for the employee (employer costs are the same either way.)

    Most people choose the HMO and the cash. So there is a clear preference for cash in pocket. Unsurprising.

  207. 207
    Corner Stone says:

    @Ailuridae:

    They can’t sue about something that isn’t a law. You know that, right? You also know that federalizing Medicaid is the single most responsible thing a progressive legislature could do, right?

    Of course you don’t

    Ummm…I wasn’t arguing anything about this, just posting a news blurb. And using it to insult Ben Nelson as a chiseler.
    A lot of people here been making some strange damn arguments against things never said or argued.
    Ahhh, internets.

  208. 208
    Corner Stone says:

    @Ailuridae:

    Ah, refusing to address the issue. If there were a better deal to be had, its still available and easier to pass than in the larger bill.

    Now who’s being silly? You are, you silly man!
    Who’s a big silly man? Big silly man. Come here and lemme skritch those ears you big silly man!

  209. 209
    rachel says:

    @NobodySpecial: No, one of us is talking about getting the best deal for the most people, the other is saying, “Screw you and your family! I matter, you don’t.”

  210. 210
    NobodySpecial says:

    @rachel:

    In your zeal to have the deal, YOU’RE the one who says to screw me. Always easier to screw one guy to get what you want, right?

  211. 211
    Tom Hilton says:

    @Tsulagi: I have no problem with the word shit, dumbshit. I’m just observing that you (and the kill-billers in general) are using it instead of argument. Which is a thoroughly chickenshit approach.

  212. 212
    rachel says:

    @NobodySpecial: What do you think “the greatest good for the greatest number” means?

  213. 213
    Corner Stone says:

    @rachel:

    What do you think “the greatest good for the greatest number” means?

    American Idol?

  214. 214
    rachel says:

    @Corner Stone: Heh. But only if one of the contestants is named Jeremy Bentham. :)

  215. 215
    NobodySpecial says:

    @rachel:

    What do you think “the greatest good for the greatest number” means?

    Except, of course, this bill is neither. But you get yours, so you’re happy, and wish those who don’t would just shut up already.

    Gotcha.

  216. 216
    tavella says:

    @Ailuridae:
    Chuck, as I showed you in the previous thread it is not a 5K deductible (or as you earlier misstated a 10K deductible) but around a 3K maximum out of pocket expense in any given year. Dedubtibles were, IIRC 250 and 600. They are not one in the same. How many times, exactly, do you have to be corrected about something before you will stop dissembling in the same fashion?

    Sadly, you appear to be making shit up. Senate bill: “limits annual cost-sharing to the current law HSA limits ($5,950/individual and $11,900/family in 2010)” with some tiering betwen FPL and 400 percent of FPL. House bill: “limits annual cost-sharing to $5,000/individual and $10,000/family”. Chuck is quite right; a poor family is going to be just as destroyed by a 10k yearly health bill, if they have someone seriously sick, as they would by 100K.

  217. 217
    The Raven says:

    Y’know, just because it’s the best bargain the devil offers doesn’t mean we’ve got to take it.

    Croak!

  218. 218
    Tom Hilton says:

    @tavella: if you read a little more closely, you’ll see that both the House and Senate versions have cost-sharing subsidies that further reduce the cost-sharing limits. A poor family isn’t going to be on the hook for $10,000.

  219. 219
    Just Some Fuckhead says:

    @Cat Lady:

    I totally agree with this. I asked Just Some Fuckhead before s/he disappeared in a snit, and didn’t get an answer, what is going to make Ben Nelson, Joe Lieberman, Evan Bayh and Blanche Lincoln vote for a public option? They’re not going to. They won’t ever vote for it. How can that problem be solved outside of their own electorate voting them out and a more left leaning Dem in? It won’t happen in Nebraska. It is what it is. The public option is just going to have to be an incremental goal.

    Christ Jesus, you fucking twit, I only answered this same fucking concern trolling a half dozen times, at minimum. You don’t need 60 fucking votes to pass legislation, you only need 50. Who the fuck cares what Ben Nelson, Evan Bayh and Blanche Lincoln think about a goddamned public option? They aren’t being asked to vote for it. They’re simply being asked to vote for cloture so it can be voted on. And yes, they can filibuster with Republicans, but if they do, it should be made clear the rest of their agenda is off the table.

    All I ever said anyway was just fucking try for something better. But you PAPOS folks caved because yer scared and weak.

    And ya still haven’t solved the problem of every future piece of Democratic legislation being held hostage by a handful of Senators under the current bullshit “rules”.

    Just clap louder, it’ll all work out. And when it doesn’t, ya can simply claim it did.

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