RSS Feed MenuHere’s something to follow today: a debate at TPM Cafe about what liberals and progressives should think of the dwindling health care bill emerging from the Senate. Too many compromises?
Paul Starr says NO; Bob Reich says YES.
Starr:
The health-care reform legislation pending in Congress would be the largest program on behalf of low- to moderate-income people in the United States since the 1960s.
Reich:
The private insurers are winning and the public is losing.
Follow along, because it’s becoming apparent that if President Obama’s health reform does fail, it will fall victim at least as much to opposition from the Democratic left as from Republicans.
PracticalGirl // Dec 18, 2009 at 7:44 pm
Balconesfault:
“This is where Harry Reid shows he does not have the guts to be the partisan hack that Republicans constantly try to paint him as being.”
Amen. As billed, I am practical and have thus far been willing to watch the swinging of the pendulum with the misguided idea that we’d end up with a good compromise. No such thing is on the horizon. Did not the Senate (back in March or April) decide (or at least allow for the possibility) of utilizing reconcilliation tactics to get HCR passed? I’m not as familiar with the process, but HCR certainly affects the US bottom line.
So perhaps it’s time for hardball. Put the public option back in, flip Lieberman the bird and pass it with 51 votes. If this thing is worth doing, it should be worth doing right. And if failure to do it will (as Obama said in an ABC interview this week) bankrupt the country, than it should be worth standing up for and losing one’s job if necessary.
Frankly, I am tired of “spectacles” for show and votes. Time to act, and it appears that the Democrats must act alone.
Kanzeon // Dec 18, 2009 at 8:08 pm
balconesfault:
I’m not disputing the merits of the public option. I’d prefer medicare for all. But this is what I don’t get:
Two weeks ago, we were looking at a mandate (it’s always been a part of the package) and a public option that may not kick in at all for years and that would, at most, cover a small percentage of the population at unsubsidized, market rates. There was lots of grumbling over that, but no open rebellion. Now, I understand that killing the weak possibility of a public option outrages some as the last straw. But I don’t understand how the mandate is significantly more unfair or constiutionally defective, just because the coverage of the second-rate public option changes from 5% of the population to 0%. This bill was always a subsidy for the insurance companies. Why the belated anger, and why is it claimed to be on philosophy?
It is possible that something can be, at the same time, a corrupt corporate giveaway AND an improvement over the current horrible system. That happens to be the case here: coverage would be greatly expanded and people who are now priced out of the market will be given help. From a simple humanitarian standpoint, it is STUPID and CHILDISH to kill this bill. It’s really a very Republican thing to do.
As to the future, it can play either way. I can argue that, as coverage expands, healthcare will be seen more as an entitlement, and less like Limbaugh’s “house on the beach.” I don’t think, as you say, that it can entrench permanently a system that will destroy the economy. If the insurance model in the end is structually so deficient, it will fall.
It’s phony outrage, with a false mantle of principle.
SpartacusIsNotDead // Dec 18, 2009 at 9:44 pm
Sinz wrote: “So now you lefties are going to go back to those folks (including some 20 million adult voters) and tell them that you decided to destroy their one chance at guaranteed issue and community rating, just because the bill wasn’t good enough by your own standards.”
And then Sinz wrote: Somehow, I don’t think they’re going to support you in the next election. They’re going to conclude the obvious–that you waved around the “40 million” number only as a political weapon, not because you really cared about getting them covered.”
So, let’s see. The 20MM uninsured are going to refuse to support Democrats if the bill fails, but they’re somehow going to support the GOP who (1) don’t acknowledge the existence of a large uninsured population, and (2) did way more to prevent the uninsured from getting coverage than any Democrat? Not surprisingly, this makes absolutely no sense whatsoever.
SpartacusIsNotDead // Dec 18, 2009 at 9:49 pm
Sinz @ 17,
You failed to address the main point of my post @ 12, which is that the Left is not interested in merely expanding coverage. It wants to expand coverage in a responsible way and, therefore, the Left has no interest in ballooning the deficit.
I really shouldn’t blame you for not understanding this rather simple concept. Conservatives have long abandoned the notion of governing responsibly and they can’t understand why some people want to enact prudent policies that don’t hurt the country.
athensboy // Dec 19, 2009 at 9:48 am
David,GWB had 8 years and near total control of congress, and did nothing to reform healthcare. Now that Obama is trying to do something, the right goes into hysterics about “death panels” and socialism. To the gop its all about politics, energizing their base, they don’t care about people without health insurance.Yes, there is infighting among the Dems, I believe thats healthy. Better than the party of no’s monolithic views.The Dems have a large tent, the gop a small and shrinking tent.
athensboy // Dec 19, 2009 at 9:51 am
Sinz54 #5, sir, you are spot on.My sentiments exactly.
sinz54 // Dec 19, 2009 at 9:55 am
balconesfault: Do you think the GOP will have an easier time swaying the country, considering health care reform was also tops on their platform (2008) and that they opposed the public option all along and that they walked away from the table almost entirely during this current cycle?
Absolutely not.
I think that such people are going to be likely to vote for some third-party populist candidate.
sinz54 // Dec 19, 2009 at 9:57 am
SpartacusIsNotDead: It is not merely an expansion of coverage; otherwise RomneyCare would be sufficient. Instead, the Left is looking for an expansion of coverage that is sustainable, politically and financially.
The CBO continues to score the various versions of the Senate health care bills. It seems clear that the Senate will not vote to approve any version that the CBO believes adds significantly to the deficit.
Do you like the Pelosi House version better? It too depends on making hundreds of billions of dollars of cuts to Medicare–otherwise it’s not sustainable either.
You lefties didn’t complain about that obvious scam.
So don’t complain now.
sinz54 // Dec 19, 2009 at 10:00 am
SpartacusIsNotDead: The 20MM uninsured are going to refuse to support Democrats if the bill fails, but they’re somehow going to support the GOP
I did NOT say that.
I believe that such voters, who will consider themselves shafted by both parties, will sit out the next few elections and not vote for either party. If a Ross Perot-style third-party populist comes along, they may well vote for him.
sinz54 // Dec 19, 2009 at 10:03 am
Kanzeon: I don’t understand how the mandate is significantly more unfair or constiutionally defective, just because the coverage of the second-rate public option changes from 5% of the population to 0%. This bill was always a subsidy for the insurance companies. Why the belated anger, and why is it claimed to be on philosophy?
I understand it.
“balconesfault” gave away the store when he expressed his hope that the courts will find mandating participation only in private insurance plans to be unconstitutional (while not issuing any such ruling for the public option), leaving the public option as the only alternative for such folks. With such a sweeping ruling, employers and the self-employed will rush to drop private insurance plans (since they won’t be required to offer them anymore), moving more and more Americans into the public option.
It’s a scam designed to move us to a single-payer system by stealth.
sinz54 // Dec 19, 2009 at 12:07 pm
PracticalGirl: Did not the Senate (back in March or April) decide (or at least allow for the possibility) of utilizing reconcilliation tactics to get HCR passed?
Under congressional rules, reconciliation can only be used for legislation that is directly budget-related.
Under reconciliation, mandates on individuals to purchase coverage, mandates on insurance companies to not engage in recission or deny coverage for pre-existing conditions, would all have to be deleted from the bill as not being related to Federal spending. Virtually every paragraph could be challenged by conservatives from either party as not being directly budget-related–and they could demand its removal.
The result would end up being a pure entitlement program like Medicaid, with no regulatory reform of either the insurance industry or the medical industry.
That’s why liberal Dems never insisted on reconciliation–though they tried to use the threat of it as a bluff.
mlindroo // Dec 19, 2009 at 12:09 pm
BTW, looks as if Nelson now has agreed to support the bill in return for some additional funding for Nebraska + relatively minor concessions regarding abortion (Kathryn Jean Lopez and John McCormack seem furious so I assume the antiabortion forces will gain less, if [as now seems likely-] the language of the Senate bill replaces that of the House version’s Stupak amendment).
This means the Dems finally have 60 votes.
MARCU$
sinz54 // Dec 19, 2009 at 12:10 pm
If our Founding Fathers had listened to well-intentioned progressives like “SpartacusIsNotDead” back in the 18th century, there would have been no United States.
Because our country was founded on some very ugly compromises–like slavery. Many Northerners thought the practice was disgusting. But the South insisted on the right to continue it–and so neither the Declaration of Independence nor the Articles of Confederation nor the U.S. Constitution opposed slavery.
We fixed that problem eventually.
That’s been the history of our country: If necessarily, hold your nose to get along with those whom you sharply disagree with–and then move forward with those folks, not against them, to make incremental progress for our nation.
COProgressive // Dec 19, 2009 at 12:25 pm
sinz54 @ 35 said:
‘“balconesfault” gave away the store when he expressed his hope that the courts will find mandating participation only in private insurance plans to be unconstitutional (while not issuing any such ruling for the public option), leaving the public option as the only alternative for such folks. With such a sweeping ruling, employers and the self-employed will rush to drop private insurance plans (since they won’t be required to offer them anymore), moving more and more Americans into the public option.
‘It’s a scam designed to move us to a single-payer system by stealth.’
While I don’t believe that is the intent, that may be the unintended outcome of this bill.
The difference, as I see it, in what “balconesfault” was trying to say and what you understood is that with a mandate to purchase private insurance may be unconstitutional, a mandate for a public option may not. I’m not so sure about that, but a way around it might be an additional tax on those who do not subscribe to a private plan to be used as a Trust Fund to pay for treatment for those not covered by a private insurance plan.
Yes, I know there will be ways for people to scam the system, the current system is rife with scams now and that’s an area we really need to dig into.
re: your @ 15 comment. You are correct. I over stated by saying PEC charges are “unlimited”. They are limited, to the best of my knowledge to 2x to 3x the charges for non-PEC policyholders. If that is true, then a $10,000 a YEAR policy for a non-PEC could be as much as $30,000 for anyone with any type of PEC from acne and pregnacy to terminal cancer.
Getting back to HCR, it is my understanding that there are two major reasons this task was undertaken by this administration. First is to bend the cost curve down. To stop the increase in the cost of healthcare. And second to provide additional coverage for the millions not now covered.
Both of those objectives seem to have gotten lost in the development of the HCR legislation, particularly the bend of the cost curve. For any bend in the cost curve down will result in lower profits for those in the financal stream of healthcare delivery. Fewer medical test will result in fewer charges for those tests and fewer profit markup on the cost of the tests which will result in less income for the hospital or lab and less profit for both. When that patient bill is presented to the insurance company there will be a smaller dollar amount upon which to add their overhead and profit margin. But it will also reduce the insurance company’s Medical loss ration if policy rates remain the same, so insurance companies profits may grow.
It looks to me that if the cost curve could be bent down at the delivery point, it may not necessarily result in cost saving to the paitent if the insurance companies absorb the savings as a “windfall” profit and don’t feel the need to pass along the savings to the policyholders.
Which is my main rational for removing the “For-Profit” middleman between the “For-Profit” healthcare providers and the patient. With the cost of healthcare in the US at about 17% of GDP, we can no longer afford to support two or more “For-Profit” industries in the healthcare delivery stream. For American to be competitive in the would’s marketplace we can’t allow so much of our wealth to be drawn off by an industry who’s only function is to take money in and pay money out, and charge 20 to 30% to do so.
We need to put a stake in the heart of the predatory, obsolete, yearly S&I Insurance industry. Let it go the way of the Buggy Whip and Slide Rule industries!
If we stumble into a “scam” to move us to a single-payer system by stealth, so be it. It’s got my vote.
COProgressive // Dec 19, 2009 at 12:36 pm
sinz54 @ 36 said:
“The result would end up being a pure entitlement program like Medicaid, with no regulatory reform of either the insurance industry or the medical industry.”
But the reconciliation bill could just say it is lowering the age requirement for Medicare to 55, or 50, or 40………. or from birth.
Then, the preditory insurance companies could do as they pleased….. as they withered on the vine.
COProgressive // Dec 19, 2009 at 12:42 pm
sinz54 @ 38 said:
“That’s been the history of our country: If necessarily, hold your nose to get along with those whom you sharply disagree with–and then move forward with those folks, not against them, to make incremental progress for our nation.”
Very true. Someone one said, “Two Things You Never Want To See Being Made: Sausages, and Laws!” What keeps our country on the straight and narrow is compromise. It’s a shame there is so little interest in bi-partaisan compromise now-a-days.
SpartacusIsNotDead // Dec 19, 2009 at 1:54 pm
Sinz wrote: “Do you like the Pelosi House version better? It too depends on making hundreds of billions of dollars of cuts to Medicare–otherwise it’s not sustainable either.”
I do like the House version better and I’m absolutely in favor of the cuts to Medicare. Cuts in spending are an absolute necessity. Fortunately, there is no evidence that the proposed cuts in Medicare would adversely affect the health of Medicare recipients. Stated differently, there’s no evidence that the Medicare programs/benefits that are targeted for cutting produce any health benefits.
As Frum complained a few months ago, conservatives abandoned their long-held support of cuts in Medicare and instead attempted to score political points. Just more evidence that they’re not capable of governing.
SpartacusIsNotDead // Dec 19, 2009 at 2:02 pm
Sinz wrote: “If our Founding Fathers had listened to well-intentioned progressives like “SpartacusIsNotDead” back in the 18th century, there would have been no United States. Because our country was founded on some very ugly compromises–like slavery. ”
I don’t know enough about history to know if the only way to form this country was to permit slavery to continue. However, if you’re arguing that the Founding Fathers did the right thing by permitting the continuation of slavery so that they could form their own country, you’re morally repugnant.
The formation of a geopolitical state does not in any way justify the enslavement of 4 million people and the rape and deaths of hundreds of thousands of others?
sinz54 // Dec 19, 2009 at 8:53 pm
COProgressive: But the reconciliation bill could just say it is lowering the age requirement for Medicare to 55, or 50, or 40………. or from birth.
You know,
it’s interesting how you keep pushing for “Medicare For All”–and when I dare to critique this, your fellow lefties like “balconesfault” accuse ME of inventing a strawman.
Strawman? He knows damn well that too many on HIS side of the political fence want single-payer.
Well, I’m going to take his advice on this point from now on: The next time any left-winger starts ranting about single-payer in any form, I’m just going to ignore him. Why should I waste my time with strawmen.
sinz54 // Dec 19, 2009 at 9:00 pm
SpartacusIsNotDead:
I don’t know enough about history to know if the only way to form this country was to permit slavery to continue.
Thomas Jefferson’s first draft of his Declaration of Independence contained a clause condemning the British King for accepting the practice of slavery. The Southern colonies made Jefferson strike it out, in exchange for their votes. Since the vote to approve the Declaration needed to be unanimous in order to carry, the “nay” vote of even one Southern colony would have killed it (and American independence) permanently.
However, if you’re arguing that the Founding Fathers did the right thing by permitting the continuation of slavery so that they could form their own country, you’re morally repugnant.
The American colonists had a choice:
1. Declare independence and form an independent nation in which less than half the states would be slave states, and hope that future generations would resolve the problem; or else
2. Continue to be part of a British Empire that had slavery.
Slavery was not abolished in the British Empire till 1833.
The American colonists didn’t create the institution of slavery. They got grandfathered into it by the British Empire.
And they could not have foreseen that the British Empire would abolish slavery before the United States would.
SpartacusIsNotDead // Dec 20, 2009 at 2:38 am
Sinz @45,
Again, it’s unclear to me from your posts if the option of abolishing slavery was bypassed in order to form the country. Your posts suggests that slavery in the South was going to continue no matter what the Founding Fathers did, but if they didn’t make a big deal about it they could form a larger country than would otherwise be the case. If that was the situation, then I don’t find the compromise terribly offensive. But if the choice was indeed between abolishing slavery in the South or forming a country, it is morally repugnant to choose the formation of a country.