What Do You Think about the Health Care Deal?

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david-axelrod.jpgWow. David Axelrod acknowledged this statement today from David Gregory on Meet the Press:

[Barack Obama] supported the public option. He did not fight for it till the end of the day.


What a stunning acknowledgment!
Well more than half of the US Senate wanted that public option — which President Obama preferred — and he didn’t fight for it?
Did he fight for women’s health rights? Or did the President support the right of women to have coverage for abortions but not fight for that either?
We know that Barack Obama supports the end of Don’t Ask Don’t Tell in the US military — but is he “fighting” to end this discrimination against gays and lesbians serving their nation?
We know that Barack Obama supports a fair, no false choice approach to a viable Palestinian State next to Israel — but is he going to fight for it?
How does David Axelrod, or anyone in the White House, think it squares with citizens to hear that Barack Obama supported some issue or group — for which they want political donations and votes — only to hear him say that the President opted not to fight for his position?
Would love to know what many of you think about this health care legislation that still has some time to go before making its way into law.
While I’m glad we are getting past this distraction in the near term, I do worry a great deal that women’s issues were strongly pushed to the side by a lot of elder men in the US Senate.
Here is a statement from the President of Planned Parenthood on the “abortion language” in the Senate bill:

STATEMENT BY CECILE RICHARDS, PRESIDENT OF PLANNED PARENTHOOD FEDERATION OF AMERICA, ON PROPOSED ABORTION LANGUAGE IN THE SENATE MANAGER’S AMENDMENT
“Planned Parenthood strongly opposes the new abortion language offered by Senator Ben Nelson in the manager’s amendment. Last week, the Senate rejected harsh restrictions on abortion coverage, and it is a sad day when women’s health is traded away for one vote.
“The Nelson language is essentially an abortion rider. It creates an unworkable system whereby individuals are required to write two separate checks each month, one for abortion care and one for everything else. There is no sound policy reason to require women to pay separately for their abortion coverage other than to try to shame them and draw attention to the abortion coverage. Moreover, it is highly unlikely that insurance companies will be willing to follow such an administratively cumbersome system, leaving tens of millions of women without abortion coverage.
“After the passage of the Stupak amendment in the House, we heard loud and clear from women across the country that they will not stand for the undermining of their rights and their access to benefits. This Nelson abortion check provision will no doubt create the same outrage, as women learn that they are being made second-class citizens when it comes to health care coverage.
“As many members of Congress and the president believe, Planned Parenthood does not think that health care reform is the forum to litigate abortion policy. Unfortunately, opponents continue to use abortion as a political wedge at every step of the reform process.
“There is no policy reason for this action, it is simply a political maneuver. We understand that leaders in the Senate and the White House want to move the process forward, but given this provision, we have no choice but to oppose the Senate bill. Planned Parenthood will now work with leaders to fix the abortion coverage language in conference.”

I wonder how many New Year’s Resolutions Barack Obama will make of things he wants to do or wants to believe in but won’t fight for.
– Steve Clemons
Update: Taylor Marsh notes that Meet the Press failed to secure any women to discuss health care reform legislation even though it is “abortion politics” and a deal undermining women’s access to abortions that the Obama administration struck with Nebraska U.S. Senator Ben Nelson.

Comments

177 comments on “What Do You Think about the Health Care Deal?

  1. doughboy says:

    Several days ago MarkL wrote,
    “Wake me when Nadine makes an intelligent comment.”
    Ditto “questions”.
    My count may not be 100% accurate because one of them may be posting again this very second. Here’s the estimated score for this topic –
    177 total posts
    46 nadine posts
    38 questions posts
    Worse than a Sunday NYT full of junk advertising!

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  2. questions says:

    Fannie and Freddie got in on the act late. Private banks had the bulk of the market. The incentives were screwy all over the place.
    There was too much money floating around and the money chased after more money. Lots and lots of things came together. CRA wasn’t really one of them. Oh, and did I say, CRA wasn’t a problem?
    Once the quants found a way to remove all risk from investment (ahem), and once there was so much upwardly moved capital floating around, there was a bubble. No one forced anyone to make NINJA loans, and I think that the CRA loans were generally documented and conforming, not NINJA. If you find info that says otherwise, send along a link. I don’t think I ever found anything respectable that said CRA loans were non-conforming junk.
    I’m mixed on Barney Frank and regulation issues. Don’t really know enough to be certain. He’s defended himself vociferously, which of course makes one wonder…. But the CRA wasn’t a problem.
    Hedging is a problem.
    Today’s WaPo has a piece on the new Fannie/Freddie bailout and a commenter notes that F and F got in late and that private banks held many of the mortgages. The WaPo piece itself notes that it’s the Republicans who make the charges you make. Different sets of facts for different sets of folks. Funny, that.

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  3. nadine says:

    So what hedge funds? You’re not making any sense. It’s not the existence of hedge funds that made the bubble. It’s the combination of the enormous credit bubble, whose inflated prices and crap loans were created and propped up by the respectability of Fannie and Freddie, and only then securitized and resold.
    Had the prices been less bubbly and the percentage of crap within normal low limits, and had the “animal spirits” been at normal and not bubblecious levels, the securities would have been good. The securitization of loans exacerbated an already dangerous bubble; it didn’t create it.
    It was the Fed and the CRA that did that. And Barnie Frank’s tenacious refusal to allow any reform, with the help of fellow congresscritters Dodd and Obama and other big beneficiaries of donations.
    We’ll see a similar collapse in the commerical real estate market soon.

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  4. questions says:

    Hedge funds, hedge funds, hedge funds. Harvard endowment, probably Calpers, possible TIAA/CREF and how many states and communities and other big investors invested with hedge funds hedge funds hedge funds.

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  5. nadine says:

    “The mortgage brokers collected NO DATA on many many many borrowers — NINJA — no income, no job or assets — no forms, nothing. Make a loan, collect a commission, sell the loan, slice/dice and through the magic math of hedging, no risk — TA DA! Instant money. No one cared how the loans performed because everything was “hedged” in sliced and diced deriviative — CDOs. There were quants with mystical powers to spin crap into gold, and for a while it all shone like the sun.”
    But it was Fannie and Freddie’s willingness to buy the crap that helped paint it with shiny gold paint. A market where you can sell unlimited amounts of crap for gold prices is a seriously, seriously skewed market – and for that, look to the heavy hand of government. Fannie and Freddie thought they could take any risk because they could never go bust – and look how right they were. They just got a new ATM card from the US Treasury today.

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  6. questions says:

    Re your comment about banks’ only wanting to lend to people who repay — not anymore!!! The mortgage brokers collected NO DATA on many many many borrowers — NINJA — no income, no job or assets — no forms, nothing. Make a loan, collect a commission, sell the loan, slice/dice and through the magic math of hedging, no risk — TA DA! Instant money. No one cared how the loans performed because everything was “hedged” in sliced and diced deriviative — CDOs. There were quants with mystical powers to spin crap into gold, and for a while it all shone like the sun. But the bubble collapsed, the borrowers stopped paying, the loans stopped performing, people started noting that shacks were selling for huge sums as people had laundered drug money through the system…. There’s not a CRA to be found in this story.
    What the CRA did was to help low income people (actual income from actual jobs) buy inexpensive houses in neighborhoods that have traditionally been neglected by banks. This is fine. These mortgages generally performed well.
    The bad loans were forced on the unsuspecting and the stupid, and the greedy gobbled them up and flipped the homes to the next round down on the pyramid.
    So Nadine, there’s a whole other story here that you completely ignore. It’s not one of moral hazard on the part of low income people who needed a break in the universe in order to have some stability in their lives. It’s a story of epic greed on the part of mortgage brokers, drug dealers, house flippers, Wall St. slicer/dicers, and the people who care for and feed them. Those early in and early out made a fortune. Those who stayed in too long lost it all. Oh, and they killed a whole bunch of people on the way down.

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  7. questions says:

    Nadine,
    Everything I read about the meltdown completely contradicts everything you read about the meltdown. Lots of articles by lots of economists show that the CRA was not the issue.
    The CRA did not invent NINJA loans, and I believe that most loans pushed by the Barney Franks of the world performed relatively well until the economy tanked completely. House flipping, drug money laundering, and slicing and dicing mortgages and reselling them as valuable without any independent property inspections seem to be bigger issues. And don’t forget just having a secondary market at all — it frees up capital so that’s nice, but it also takes away any responsibility from the originator of the loan. Without responsibility for loss, the mortgage brokers could collect their commissions, sell the loans to the slicer/dicers and then do it all over again. The bulk of this kind of lending wasn’t under federal poverty support programs/CRA (and wasn’t it a Republican president who wanted to create an “ownership society” anyway — in the hopes of making all of those owners into newly minted Republicans?….. And isn’t this behavior by the mortgage brokers actually akin to moral hazard? Hmmm, and wasn’t it Wall St. traders who came up with the slicing dicing stuff…..)
    But as with anything like this, you seem to have one set of facts, and I seem to have another.
    Kind of like the “debate” about mammograms. Everyone has a different set of facts to work from.

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  8. nadine says:

    Yes, questions, traders saw the loophole in the warped market full of subprime loans that were all being created because of moral hazard and regulated as though the housing market could never collapse, and they took advantage of it.
    But the market they took advantage of only existed in the first place because of Barney Frank and the CRA. Banks normally only want to lend to people who have money to pay them back! For the subprime market to even have been created speaks of how warped the market had become because of government “good intentions” to encourage home ownership. Then you had a market which was measured and regulated according to measures and rules which worked when banks made normal lending decisions but which no longer worked in the warped fun-house reality of “subprime liar’s loans” and other inventions created by government intervention. This was the market that AIG took advantage of, to its ruin.
    It’s just like the way health insurance is tied to employment. Another unintended consequence of government intervention. No CRA, no supprime market; no subprime market, no massive bubble in housing prices; no housing bubble, no credit default swap bubble.
    Then you set there and wail “it’s all the fault deregulation,” guaranteeing that you will never learn a damn thing from the debacle.

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  9. questions says:

    http://www.nytimes.com/2009/12/24/business/24trading.html?_r=1&hp=&adxnnl=1&adxnnlx=1261663518-TPauhLU5uRWjlYD4iumhGw
    Hmmm, could securities firms have sold securities to investors as a good investment and then bet against those very same investments that they had just sold? Hmmmm.
    I know, the answer is less regulation!!!

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  10. questions says:

    As a matter of fact, antibiotics create moral hazard, too. You wouldn’t court a bacterial infection if you knew you couldn’t have antibiotics to help you get better. The unnatural intervention in our natural condition alters our behavior in unacceptable ways. I think we should ban all medical care, not just limit it to antibiotics, because medical care is THE MORAL HAZARD par excellence….
    We really need to do away with this concept….

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  11. questions says:

    I don’t think you at all have the derivatives market correct.
    Many of the subprime loans that were made were not sold to Fannie and Freddie — in fact, the ownership lines on the loans are so entangled and confusing (this is the derivatives market) that judges are now starting to halt foreclosure proceedings because the lenders can’t prove that they actually own the mortgage slices.
    The slicing and dicing of mortgages into derivatives that are then sold regardless of the value of the underlying collateral is not a Fannie/Freddie issue to the best of my limited and illiterate economic knowledge; and this slicing and dicing of derivatives of uncertain value and the pricing of them at ridiculous value seems to be at the heart of the Great Recession. There was a bubble, and it blew up and caught the later investors. And it apparently caught Lawrence Summers to the tune of a billion Harvard-dollars. Oops!
    The issue isn’t “moral hazard” — a phrase I used above somewhere, so yes I’ve heard of it…. The issue was that a bunch of traders did “the math” and figured they couldn’t lose, and a bunch of investors and house flippers and derivatives buyers and the like figured that they were safe and the market could rise infinitely with no risk of loss because “hedging” as in “hedge fund” would protect us all.
    Not a subprime problem, not a low income loan problem, an investor constructed, lack of regulation of the market caused problem. IMHO.
    The stock market response to the insurance thing is complex. Read Nate Silver. He sees all, he knows all. Or at least, he knows something. And he’s great with a graphing calculator.
    Oh, and Nadine, anything we do to mitigate risk creates “moral hazard” — so we should just stop eating and drinking and dressing and die already. After all, if one has, say, central heat to stay warm in the winter, one courts potential risk by being able to live where it’s cold in the winter. MORAL HAZARD — no one would behave this way without unnatural intervention. And we must be natural and authentic because that’s really what the market is — natural and authentic behavior…. WTF….
    Could we get off the moral hazard bandwagon and realize that we join together as a society to mitigate risk and share benefits? Please?! For the holidays?!

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  12. nadine says:

    Oh, and did unregulated trading of derivatives work so well? Hmm, let me think, oh yeah, the Great Recession..
    It wasn’t unregulated. It was in a market warped by moral hazard. Ever heard the term “moral hazard”, questions? It’s what happens when you have a market with entities that won’t be allowed to fail, either because they’re too big or they aren’t really private even though they are called private…like Fannie and Freddie…and who urged them to invest in subprime loans? Barnie Frank et. al. Think about it, do banks normally lend money for loans they know will never be repaid? Of course not. But in this case, they lent billions, because Fannie and Freddie would buy them, no questions asked. And why did investors not run away from Fannie and Freddie for their stupidity? Their implicit (now explicit) Treasury backing…you have to be economically illiterate or a hard-core Democrat (but I repeat myself) to believe that line about “unregulated” lending.
    The new health insurance market will be full of moral hazard from end to end; no wonder their stocks are up.

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  13. questions says:

    Last I read the Nebraska gov wanted to dump the Nebraska giveaway. Other giveaways might also be dumped? Who knows.
    The horsetrading Congress engages in is probably utterly necessary as a solution to whatever game theory description is accurate for characterizing people who have no individual need to cooperate but who are in a group where cooperation is very helpful. It’s generally against the individual lawmaker’s interest to sign on to controversial or big legislation. So there are bribes. The bribes overcome the inertia. And then Congress can act collectively for the good of all — because the individual good of each member has been taken care of.
    My guess is that were we to stop the pork barrel, it would re-evolve in some other fashion. It’s part of the package of collective legislative action. It’s logical, necessary, and would arise again given how functional it is within the organization.

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  14. questions says:

    Nadine,
    For women between 40 and 50, more cases of cancer are CAUSED by the mammograms than are diagnosed — I believe that’s the takeaway from the change in mammogram recommendations. Sibelius is an idiot for playing politics with public health. But lots of people are idiots over data.
    People have a hard time with basic social science stats and correlation/causation issues in public health. This is a sad fact about our inability to think. It shows up in the autism debates, in vaccine debates in general, in the desire for annual check ups which turn out to be useless, in all sorts of ways. We don’t think well when we’re freaked about our very own impending death, which we seem to feel is really impending every time some researcher announces some new correlation. (Oat bran, anyone??)
    Amniocentesis is done fairly routinely if a woman is pregnant after age 35 because at that point the lines on the graph cross and there’s more of a chance of discovering an adverse event than there is of causing an adverse event. You might be frantic about Down Syndrome at age 33, but you’d be really dumb to do the amnio absent some other major risk factor.
    It seems that mammograms work the same way. Breast tissue is too dense for radiologists to read the damned x-rays properly in women under 50, so the misreadings are frequent, the unnecessary biopsies are traumatizing (do you ever really recover from having been told you have cancer and you’re gonna diiiiie — oops, sorry we messed up…..), and many lumps that actually are cancer grow so slowly that there’s more risk in removal than in leaving it alone. It’s complicated, emotional, hard to digest, but as with prostate screening which also leads to huge numbers of false positives, unnecessary and debilitating surgery and aftereffects — it’s just stupid to over treat. We shouldn’t be giving antibiotics for viral infections. We shouldn’t be doing mammograms on healthy women under 50 with no family history of breast cancer and no risk factors like smoking or early onset of menstruation. We shouldn’t be doing routine PSA tests on men either.
    Should you have an x-ray every time you bump into something? What if there’s a small fracture? What if…. In fact, we don’t do x-rays for minor things because the risk of radiation is far greater than the risk of some small and unimportant fracture or some non-existent fracture.
    Mammograms for women under 50 are, it turns out, in many cases more dangerous than not doing mammograms for women under 50. Hope this is clear.
    Oh, and did unregulated trading of derivatives work so well? Hmm, let me think, oh yeah, the Great Recession…. (Of course, you’ll blame it on a small number of sub-prime loans Barney Frank wanted…. I blame it on the unregulated derivatives market. Funny how that happens!)

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  15. nadine says:

    “I give up trying to understand the issue and the bill. At this point I hope the end result is beneficial for the Democrats, politically, because then they can improve the bill.” (MarkL)
    The public already loathes the bill by 10%, 15% or more…just wait til they get a gander at some more of the lies and log-rolling involved. People have tolerated the pork with increasing resentment, but there has been nothing to match the size and brazenness of the deals for this bill. Senator Nelson of Florida got a $30 billion carve out for Medicare Advantage in Florida! $30 billion, just for Florida! How do you think the Medicare Advantage subscribers in all the other states will feel when they learn how their benefits will be slashed?
    Interestingly, the WH is making noises about delaying the health care bill til Feb to do yet another jobs bill…won’t the Senators thank Obama for that? the Blue Dogs are going to get an earful from their constituents when they go home for Christmas.

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  16. nadine says:

    “I give up trying to understand the issue and the bill. At this point I hope the end result is beneficial for the Democrats, politically, because then they can improve the bill.” (MarkL)
    The public already loathes the bill by 10%, 15% or more…just wait til they get a gander at some more of the lies and log-rolling involved. People have tolerated the pork with increasing resentment, but there has been nothing to match the size and brazenness of the deals for this bill. Senator Nelson of Florida got a $30 billion carve out for Medicare Advantage in Florida! $30 billion, just for Florida! How do you think the Medicare Advantage subscribers in all the other states will feel when they learn how their benefits will be slashed?
    Interestingly, the WH is making noises about delaying the health care bill til Feb to do yet another jobs bill…won’t the Senators thank Obama for that? the Blue Dogs are going to get an earful from their constituents when they go home for Christmas.

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  17. MarkL says:

    I give up trying to understand the issue and the bill. At this point I hope the end result is beneficial for the Democrats, politically, because then they can improve the bill.
    I was driven over the edge when I read a couple of posts suggesting that Ben Nelson’s deal for Nebraska could open the way for Medicaid to be the public option for ALL states.
    Barbara Boxer said something to that effect today or yesterday.
    Is this true? Is Boxer right?
    Who knows, but if its true, then Harry Reid deserves some credit for being very clever, IMO.
    The bill has changed so many times that I can’t see how anyone can say with a straight face that this bill is what Obama or anyone else wanted.

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  18. Jim says:

    Congress is attempting to obtain socialized medicine using capitalist theories (profit seeking, cost benefit analysis, etc).
    Cross cultural studies indicate that America ranks high in Individualism and low in Communitarianism. Ideology leads many Americans to tolerate corporate bureaucrats more than government bureaucrats.
    There is no communitarian reason to subdivide populations and rate subgroups’ risks differently. One universal national risk pool is all that is truly required. However, there is a very sound business reason for setting prices in accordance with likely costs. Corporate profits are maximized by shunning high risk clients or charging them much higher prices. (Profits=Revenues-Costs). Furthermore, high profits lead to high salaries and fringe benefits.
    A Socialist would ask: “Why shouldn’t everyone get the same health care coverage for the same premium?” A Capitalist would ask: “Why should a healthy young person pay the same premium as an infirm elderly person? “ Age is an obvious risk factor. DNA, family history, gender, ethnic group, chronic disease, physical disability, diet, exercise, lifestyle, recreation, type of employment, residential neighborhood, gender, hypochondria, etc. are additional risk considerations. Should these categorical risk factors matter? Some of them are genetic, some stem from good or bad luck, and others are behaviorally determined by personal choice.
    Today, in America, Medicare A & B are communitarian solutions. Everyone over 65 is insured within a single high risk pool. Mandated fees paid to service providers vary somewhat, based on local conditions. Often these fees have become insufficient to cover the service providers’ costs, so the service providers prefer younger, privately- insured patients. However, optional Medicare Gap and Medicare Advantage plans remain private, and the oligopolistic insurance companies try to maximize profits by focusing on low risk seniors. For example, they recruit seniors through membership groups and mailing lists with desirable demographic characteristics. Where possible, they evaluate each subgroup or person and set prices accordingly.
    Has Congress suddenly found the optimum American solution? I don’t think so…. Lobbyists have taken control….. Goals and incentives remain obscure and incoherent…. As Nadine points out, “This is no longer capitalism. This is government and business locked in self-serving embrace depriving the customer of all choice. This is exactly how businesses worked in the Third Reich. It’s fascist.”

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  19. nadine says:

    Right, questions, just look how “grateful” women are already at the recommendation that they wait until 50 to get a mammogram. So “grateful” that Sec. Sebelius is running away from the idea very bravely! Geeze, how “grateful” do you think women will be when IMAB makes other cost-saving (aka “rationing”) decisions for them, that they will no longer be legally allowed to make for themselves?
    BTW, the CBO just admitted it double-counted the savings from the $500 Billion in Medicare cuts. Due to the fictive Medicare trust fund (really filled only with claims on the General Fund of the Fed. Gov’t), the Dems are claiming that the same Medicare cut BOTH saves Medicare from insolvency in 2017 AND makes Obamacare reduce the deficit. It’s nonsense of course. You can’t have it both ways.
    “Economic illiterate” may be strong, but imo it’s deserved for saying that conservatives aren’t allowed to object to turning insurance companies into government-controlled public utilities because they are still “private”. They’ll be “private” like Fannie and Freddie were “private”. Didn’t that work out so well?

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  20. questions says:

    Nadine, if the Medical Advisory Board kept women off HRT there’d be some serious gratitude. And if there were fewer PSA tests and mammograms that misdiagnose, many many people would be grateful. And if it limited the use of anti-depressants in teenagers, there’d be some more gratitude. And if it eliminates endless and useless back surgery, unneeded hysterectomies, tonsillectomies, the misuse of antibiotics, unnecessary procedures of all sorts, maybe we’d all be grateful.
    Using actual evidence to help us all make better judgments about what we should be doing to get and stay well might help. Research might be better guided, patients might be better informed, and doctors might be able to get past the medical culture they were educated in and make better judgments about treatment. Medical care varies widely from place to place, procedures vary, efficacy varies. Makes sense to try to do it right everywhere instead of being hit or miss everywhere.

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  21. questions says:

    The “Cadillac tax” isn’t about raising money. It’s about lowering the coverage a bit so that people use a little less medical care. This is part of “bending the cost curve” and has been characterized as possibly helpful. No one has claimed that it raises money, at least not that I’ve seen.
    And though I’m not an economist, “economic illiterate” is probably a little strong.
    There’s no economy without some sort of regulation. Exchange must be patterned at some level in order to function. Without pattern (which is what regulation is) no one parts with anything of value, but then, value is so indeterminate that no one parts with anything at all. Regulation is how the economy exits the state of nature and enters civil society.
    That currency exists is a function of regulation. There’d be no market without guaranteed regularity of currency, products, transportation, policing and so on. Everything we do happens because we have a social system of regulation. Pure capitalism is a fantasy, not a reality.
    Franklin, I can’t disagree about inefficiencies. But there are so many upward pressure points on cost that I’m not very confident that the curve is going to bend. The costs of doing basic drug research, advanced testing, bringing to market whole new classes of drugs to treat things that were once upon a time death sentences is significant source of upward pressure. Imaging that helps prevent head injuries from leading to death, genetic testing that helps with early intervention, neo-natal tech that keeps babies from dying, open heart surgery and transplants — all this stuff is incredibly expensive. It keeps us alive, and we like life. The fact that medicine is labor intensive, more so even than education is an upward pressure. House building is also labor intensive, there are attempts at prefabricating things, but then the pieces don’t always fit together properly on-site. There are attempts at getting more labor efficient in medicine — outsourcing radiology, online advice, nurses’ aides, group visits, HMOs with the need to get referrals to specialists and so on. But these don’t really work because medicine requires a kind of hands on judgment that nothing can replace.
    It just costs a lot of money, and all the efficiency in the world isn’t going to change that.
    The economy needs to shift a bit so that medical stuff is a bigger source of employment even as it’s eating up more money. If money flows in and out of the system, likely we won’t just be enriching the oligarchs. Lab techs aren’t oligarchs. Chemists and biochemists aren’t oligarchs. Family physicians aren’t oligarchs. The nice person you talk to on the phone when you have a question about your insurance plan isn’t an oligarch. But all these people have to be paid for their labor, and I’m guessing that those salaries eat up a lot more of the health care dollar than do payments to oligarchs.
    Health care is expensive. We’re used to treating is as an optional expense rather than treating it like food, clothing and shelter, and then when crisis hits we go to the ER and get something like care and we don’t pay the bills when they come. This model is unsustainable. Possibly it’s unsustainable to have every procedure and every new drug and every research line. But certainly, it’s unsustainable to have a system where many people don’t hedge the risks and still get some version of the rewards. (Not that ER care is really health care, but it’s something.)

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  22. nadine says:

    I don’t know if anybody is stupid enough to believe that the Senate’s “cadillac plan” tax will actually raise any money. Of course, all the “cadillac plans” will either by excepted from the tax by carve-outs, as the longshoremen have been already, or the plans will be cut down to avoid the tax.
    The costs of the bill will be simply staggering.
    And then the bureaucrats will gather to try to cut the costs. How? by ruling of the Independent Medical Advisory Board (IMAB, aka “death panel”) to ration care. They’ll have to. There’s no other way to do it.

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  23. nadine says:

    And again, Nadine, all this grousing about being forced to buy from private entities is nonsense. First, of course, it’s the conservatives who have pushed the privatization in the first place, so your grousing about the outcome is about the most hypocritical thing I can imagine.
    Questions, all you are demonstrating is that you are an economic illiterate. Conservatives are in favor of private companies that are private: that get to run their own businesses with limited government interference. That get to choose what products to offer and how to price them and compete for customer’s favor. That’s a private business.
    The Senate and House bills OUTLAW private insurance companies for all intents and purposes. Oh, they won’t be outright owned by the government, but in terms of control, they might as well be (a point the CBO made that was under-reported). They can’t chose what product to sell anymore – they can only sell “health exchange qualified” policies. Their only real customer will be on Capitol Hill, that’s the only one they need to please to stay in business. If they bribe and cajole the politicians enough, the pols may let them stay in business and get rich (so they promise the pols a big cut of the action). If not, not.
    This is no longer capitalism. This government and business locked in self-serving embrace depriving the customer of all choice. This is exactly how businesses worked in the Third Reich. It’s fascist.
    You can no longer tell who is taking over who, which is why the criticism from the right (Yuval Levin: “The bill is basically a massive subsidy to the insurers — it is not a reform of the system”) sounds exactly like the criticism from the left(Markos “Daily Kos” Moulitsas: “it’s unconscionable to force people to buy a product from a private insurer that enjoys sanctioned monopoly status”).

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  24. Franklin says:

    questions.
    In reference to the consequence of a risk pools on cost — of course there is some truth to this.
    However, if we’re apportioning responsibility, I would say that “all the people whose health care is pricier” is due more to other inefficiencies in our system (“inefficiencies” is about the most gentle way to put it).
    It’s interesting too that the OECD countries have been hit harder by an aging population than we have in recent years — 0.5 percent of costs versus 0.3; yet it’s our country which has had the massive inflation in costs.
    Shrinking risk pools may increase the per person cost, but that doesn’t provide an explanation for the increase in overall spending (in fact the overall cost should go DOWN as money is pulled out the system even as the per person cost increases).
    The bottom line is that we have the world’s most inefficient, wasteful, and costly system in the world. If you fix the inefficiencies and make the price more competitive, you create virtuous circles which reduce the need for mandating any behavior on the part of consumers.
    Right now we have the opposite.
    The Congressional legislation doesn’t really fix the problem either. It fixes coverage, and some of the cost issues in the near-term, but — especially in the Senate bill — it does this largely by shifting more of the cost burden onto middle class and upper middle class families (especially retirees who have expensive insurance plans).
    The oligarchs get richer.

    Reply

  25. questions says:

    http://www.dailykos.com/storyonly/2009/12/23/818344/-Lindsay-GrahamBlack-Low-Income-People-will-cost-our-state-a-billion-dollars
    Who was it who was suggesting above somewhere that there isn’t a huge amount of cultural resentment in this country?
    Read this link. Or just read the URL and you’ll pretty much know what the link is about.

    Reply

  26. Outraged American says:

    REPOSTED: 62.1% of 2007 US bankruptcies were due to medical
    reasons according to the Journal of the American Medical
    Association.
    Corporate Greed Vs American’s Health
    h/t InformationClearinghouse.info (GREAT SITE!)
    Excerpt
    Most medical debtors were well educated, were homeowners and
    had good jobs. Three quarters among them had health
    insurance. In spite of that, in 92% of cases high medical bills
    contributed to their bankruptcy. The JAMA study estimates that
    since 2001, the proportion of all bankruptcies attributed to
    medical problems has increased by 50%. In addition, 1.5 million
    families in the U.S. lose their homes to foreclosure every year
    due to unaffordable medical cost, according to a 2008 study.
    Whole article
    http://www.informationclearinghouse.info/article24215.htm

    Reply

  27. questions says:

    Nadine, please supply a quotation FROM THE BILL that shows jail time.
    POA brought this one up, I did some research, and found that the original jail time thing was a foolish extension of I think it was tax law or the like to the health care bill. The extension was incorrect, and I don’t think there’s any jail time. But if you find it in the bill, let me know.
    Franklin, I feel for you. Insurance is expensive. Early on in my work life, I could barely afford all sorts of necessities. Crappy infested leaky apartment, broken down car, debt to deal with — still kept insurance. The hard part isn’t the premium bill itself, it’s the adjustment in budgets. Because people have built lives around having extra money for whatever improvements they have over what they would have had had they been spending on insurance, people will have a hard time in the transition. So yes, I agree that it’s going to be difficult.
    BUT, there are some safeguards built in, and were the conservatives not in charge, the safe guards would have been better. There’s a hardship exemption, there are subsidies, and there’s the option of just paying the fine instead of the premiums.
    Any social transformation/transition is burdensome, and if you’ve had the money and you feel it taken away it’s all the worse. This would be a problem no matter what. The fact is that by not paying for health care all along, the people who avoid it end up burdening the entire system because some of them will need care, and some of those who need the care simply won’t pay for it. So the marginally better apartment someone has (without, say, roof leaks, but keeping the mice and roaches) is paid for by all the people whose health care is pricier for that someone’s lack of premium payments.
    But for those people who are in your situation who ALSO have health problems, maybe they will have squeezed a bit more for the premium payments and they will actually get to a doctor for needed care. The free clinics the left has been supporting across the country show the desperate need for help on health care.
    I don’t at all think the legislation is great. I think the transition will be too hard on too many, I think the mandates need far greater subsidy for a transitional period, I think there needs to be support for people in your position — in debt, entrepreneurial (so no chance of an employer subsidy), and barely managing. I don’t know if you fall under the current subsidy system, but it sounds like you should. But you should also have health insurance. I’ve seen far too many people who think they’re ok suddenly needing an appendix or gall bladder dealt with, or stitches or help with food poisoning or a stroke…. This stuff has to be built into people’s budgets, too.
    And again, Nadine, all this grousing about being forced to buy from private entities is nonsense. First, of course, it’s the conservatives who have pushed the privatization in the first place, so your grousing about the outcome is about the most hypocritical thing I can imagine. (Conservatives love to privatize trash collection, city services of all sorts, water service, lots and lots of basic things are purchased from private interests….) Second, almost all necessities are purchased from private interests and you can get in big trouble for not purchasing them. FOOD? CLOTHING? SHELTER? — You gotta have ‘em all.
    There was a nice alternative that did not mandate purchase from private interests, that was more generous with subsidies, that was more progressive all over the place. No conservative should be allowed to freak out about the lack of progressive alternatives in this bill. The conservatives killed the progressive parts. Pick a new argument strategy, please!
    And Franklin, was the bill well negotiated? It’s so hard to know how to answer this. The handful of conservative dems in the Senate really gummed up the works, but their constituents don’t really want a more progressive bill thus far. My guess is that it’s the best that could be done given the procedural ability of any one senator to screw all the others, and the ability of a minority coalition to halt all proceedings on a bill. This is our structure. Clearly it has some problems.
    I wish you good health and a quick paydown of student debt (another thing that should be eliminated from everyone’s life — what a thing that would be — to graduate without debt!)

    Reply

  28. nadine says:

    Rasmussen released a new poll today: public support for the Senate bill is 41% for, 55% against.
    And this is before people have gotten a look at all the new taxes! (The bill STILL hasn’t been posted on the Web for people to read). Remember, there are four years of taxes before most people see any benefit!
    But the bill has managed to unite both the right and the left … they both loathe the bill. Sean Hannity and Keith Olbermann excoriate it with equal venom. It stinks of partisanship and influence-peddling. If you are a major Democratic contributor, like the trial lawyers or the longshoremen, or you made Harry Reid pay for your vote, then you do okay. If not, too bad for you. And too bad for the country.
    I think the Democrats must have gone collectively insane, to look for their political salvation in passing this pig of a bill.

    Reply

  29. Franklin says:

    questions,
    I haven’t had insurance for about 3 years now (fortunately, I’ve been healthy, but it is a source of anxiety and concern for myself and for family).
    A few years ago I had insurance through my work; then I changed jobs to start my own business. I was on COBRA for a while, then I picked up an individual insurance plan.
    Eventually, I dropped the insurance because paying off grad school loans took precedence (as well as managing other fixed expenses).
    The past 3 years, I have pretty much avoided activities where I risked injury (e.g. no more pick-up football games). I’ve lived a pretty spartan life attempting to pay down student loan debt so that I might be out from under that particular burden by the time that I hit middle age.
    So this isn’t really an abstract question.
    On the one hand, the insurance coverage requirement will provide some security and peace of mind.
    On the other, even with subsidies, it’s adding an expense to my personal balance sheet — it will stretch a tight budget tighter.
    The thing that gets me is that I don’t see this as a well-negotiated deal.
    In Canada, a median wage earner has the equivalent of $60 – $75 a month deducted from his or her paycheck. If they change jobs they retain coverage. This is for pretty good, lifetime coverage.
    Even with the subsidies, odds are I’m going to be paying more than $60-$75 a month into the system. That’s a rip-off for both me as a consumer and as a taxpayer.
    In my professional career — excluding what I’ve paid into Medicare; employers and myself have put in at least $25,000 over the past 10 years for insurance — during that period I took out perhaps $4,000 in services.
    Having dropped my coverage, I also lose the benefit of what I’ve paid into the private insurance system.
    For the typical wage earner, our health care system pretty much sucks.
    Finally, the mandates wouldn’t be an issue if there were some guarantees that legislators actually negotiated hard for a consumer friendly legislation (in fairness some did, but not enough).
    The evidence seems to be pretty compelling that the power brokers in the deal negotiated as if they were spending other people’s money — not their own. That’s part of the reason for so much distrust connected to the mandates.

    Reply

  30. nadine says:

    questions, those of us already buying from a private entity will be VERY affected when the private entity is forced to jack rates up to stay in business because of all the new community rating coverage requirements that have just been enacted.
    MarkL, there’s no doubt that a single payer system paid for by taxes would be found constitutional, just as Medicare has been. But it’s unprecedented to force people to buy a product from a private company under penalty of fine or jail time. And yes, questions, the bill does have jail time if you refuse the pay the fine, which starts low but rises over time…and can always be increased.

    Reply

  31. questions says:

    http://www.usatoday.com/money/industries/health/2006-10-18-end-of-life-costs_x.htm
    http://www.governing.com/column/economics-dying
    A couple of links on costs in last months. As with everything else in health care, this one too is vastly complicated — more so than even I realized.

    Reply

  32. MarkL says:

    Questions,
    About the mandate:
    people want health care coverage, not insurance with high deductibles.
    A number I saw is that people could be required to pay up to 8% of their income on insurance and the deductible could be up to 8% more on top of that.
    Sure, it would be a small number of people at first, but why should that affect the outrage?
    It’s one thing to tax rich people more, but why not have something closer to full coverage? The reason the mandate is supposed to work is that people who don’t get insurance are a healthier group who consume fewer medical services.
    Telling people to sit back and enjoy it, which is about the extent of your answer, is a smug, elitist message which is sure to fail.

    Reply

  33. questions says:

    http://www.kaiserhealthnews.org/Stories/2009/December/02/cadillac-tax-cost.aspx?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+NewFromKaiserHealthNews+%28New+From+Kaiser+Health+News%29
    Explanation of the excise tax. I was wrong in my explanation above.
    It’s a 40% tax on benefits above 23 thousand a year for families, lower for individuals– placed on the insurer, designed to lower the level of benefits, high cost areas and high risk professions are exempted, the tax takes into account ALL health benefits including flexible spending accounts (which the Kaiser people think will be the first thing to go as employers try to offer non-taxable benefits.) The goal is to keep people’s benefits below the 23 thousand figure in a year so that people are a little more careful in their medical consumption. So add up your premiums for medical, dental, vision, the FSA contribution, anything else your employer covers and if it’s over 23K for a family, the overage is taxed at 40% which may or may not be passed on to the consumer.

    Reply

  34. questions says:

    I wonder by the way, how many people protesting based on this issue of HAVING to buy from a private entity already have insurance from a private entity and so are not in the least bit affected by the program.
    How many people will be grateful for the subsidized insurance regardless of who the issuer is?
    How many people will be grateful for the little push into actually sitting down and figuring out the insurance issue?
    In short, how much of a real issue is this “forced to buy from a private entity” concern?
    (Slippery slope arguments… the next thing you know, we’ll be forced to get our children vaccinated…. we’ll be forced to wear clothing outside… we’ll be forced to buy school supplies for our kids… we’ll be forced to pay an electric bill to a non public utility company… we’ll be forced to pay tolls to private companies that have bought out toll roads … we’ll be forced to spend money at all on anything ever rather than getting emergency health care for free — the way it should be — subsidized by the idiots dumb enough to pay private entities for health insurance. WAIT A SEC — don’t conservatives LOVE privatization??? Especially of necessities like utilities and social services???)

    Reply

  35. questions says:

    Nadine, take a deep breath. There’s no “condition of citizenship” here.
    Plenty of cities ban homelessness. So a condition of residency is that you spend your money on a place to stay or you exit. Often these laws are called “camping bans” and the right loves them because it makes homelessness invisible.
    You have to buy food as a condition of staying alive. You buy the food from private sources.
    Nearly everyone eventually consumes healthcare. The goal is to get people to pay for some of the care they will consume so that they don’t have to be subsidized by everyone else.
    And there are all sorts of escape hatches with the subsidies and the hardship clause.
    My guess is that not huge numbers of people will see much of a difference in their lives. Some of the young and healthy uninsured idiots will eventually be grateful that they ponied up a few thousand a year for a policy. Those who get subsidized care will be THRILLED to have a relationship with an actual internist or family care physician instead of ending up at the ER yet again. The waits at the ER will ease up for real emergencies. People’s budgets will adjust to the expense, just as they adjust to tax increases, medical emergencies and the like. The number of medical bankruptcies should decline if the policies are decent enough.
    Please note that no one loses his or her citizenship for not buying health insurance. There’s no condition. And the fines are low. So in the first year, you can pay I think it’s 750 and simply not buy the insurance. Probably a bunch of tea bagger types will do just this. Pay the fines as a protest. And some of them will need emergency medical care. Hmmm.
    Oh, and every income earner pays for Medicare and Medicaid as a condition of being a tax payer, so you already are buying insurance — but insurance for when you are old and/or poor. Now you’ll buy insurance for when you are sick.
    The Constitution is probably not an issue, especially since there’s a bypass for hardship and there are subsidies. If Medicare taxes are legit (and they would seem to be) then so are Kennedy care “taxes”. And if there’s a problem at all, it would seem to be solved by… a public option!!!!!!
    By the way, I’m not sure if I have the details right on the excise tax. I should go hunting for corrections eventually.

    Reply

  36. MarkL says:

    Nadine,
    I don’t pretend to have legal expertise.
    If you look through the archives of TL you can find Armando discussing the issue several times, although I’m not sure if he wrote a separate post on the subject (Armando has won a case before SCOTUS, so he is no baseroom blogger).
    Now, I’m certain it would be constitutional to ,have a national mandatory single player plan.
    That would be an acceptable compromise for me.

    Reply

  37. nadine says:

    MarkL, ordering the American people to buy something as a condition of citizenship is unprecedented. Of course there is a constitutional issue. Unless, like so many on the left, you use the phrase “living constitution” to mean that the constitution says whatever you feel like making it say, regardless of the actual wording of the document.
    However, since the Supreme Court is not entirely leftist, most constitutional lawyers I have heard on the issue expect them to hear the challenge.

    Reply

  38. MarkL says:

    Franklin,
    I’m not a lawyer. Armando Llorens on talkleft.com is, and claims there is no constitutional issue.
    I just read a headline saying that Obama challenged critics of the health care bill to find a gap between his campaign rhetoric and this bill. Really? Seems like a foolish challenge to me.

    Reply

  39. Franklin says:

    In reference to the mandate, it will be interesting to see how it holds up against court challenges.
    In the case of auto insurance, you have an issue that’s dealt with by the states. The federal government may regulate insurers, but I can’t think of a federal initiative where the federal government is able to require that individuals pay some portion of their income outside of the tax structure for a privately managed service.
    Additionally, in the case of auto insurance a person can always opt not to own a car. However, in the case of health insurance there is no flexibility.
    I understand that the government can levy taxes, and it can later direct resources as it sees fit. However, in this case, the purchasing is being done outside of the system of taxation.
    Can anyone else enlighten on the Constitutional issue with the mandate?

    Reply

  40. nadine says:

    This whole process stinks of politics, partisanship and influence-peddling – you know, all that stuff Obama ran on getting rid of?
    Both the left and the right hate this bill – and just wait until the taxes begin to bite! In the middle of a recession too, which is still severe no matter how much happy talk the media try ot make for Obama.
    Oh, and nobody will see any benefits for four years.
    Yup, this sounds like a real winner, politcally speaking.

    Reply

  41. MarkL says:

    Hmmm,
    So much for the promise that comments are saved if you mistype the captcha.
    Thanks for the detailed response, questions.
    Actually I agree that a mandate is necessary.
    I have always supported a mandate, which I failed to make clear. I’m a mathematician, so even if I don’t know the exact economics, the principle is pretty obvious.
    I simply don’t like the structure of this mandate, and don’t trust the promise of adequate regulation to protect consumers.
    If Congress had acted already to protect consumers from predatory lending practices, I would be more sanguine about the possibility for insurance regulation.
    Do you know a good site for the breakdown of costs by type—especially end of life health care?
    Lastly, thanks for explaining what you meant by culture. I can only say that regardless of what the Senate does, we are due for such a shift anyway, because of rising costs.

    Reply

  42. questions says:

    MarkL,
    The public option seems to have mixed polling depending on how the question is asked.
    If the public option ends up with adverse selection and higher premiums, it’s not going to be such a great option. There seem to be some real actuarial issues. But I’m not an actuary, so I’m limited in my understanding of this one.
    Further, the worry on the right seems to be that the public option might at first be vaguely supported by premiums, but the premium support will be insufficient and so it will end up being a supersized government program. This might be fine initially, but as the government gets more entangled in health care, it will end up acting more like a monopsony — the consumer that determines producer prices.
    Medicare and Medicaid already act this way, and the prices they pay are more and more insufficient for covering the costs of the services.
    So what gives on this model?
    Either patients have to consume a whole lot less medical care so that they match what the government programs will provide (and government programs can really be stingy — ever eat on what food stamps pays??) OR doctors and hospitals and all service providers will have to earn a whole lot less money.
    So where’s the cultural change that you’re ripping me for? I just noted it. Patients will have to consume less care. Providers will have to earn less money.
    If this kind of shift doesn’t require a change in how we operate culturally, then I suppose I’m really an idiot for thinking this bizarre thought.
    So tell your grandma, if you still have one, that she’s going to be pulled off life support and dumped into hospice. It’s cheaper that way. And tell your doctor you’re only paying 35 bucks, take it or leave it. Maybe your doctor will leave it and you’ll go without or pay out of pocket til your pockets are emptied.
    I am unclear how likely this whole scenario is if we shift to a large public option/nationalized care.
    For a small public option, it seems mostly that the premiums will be higher because of adverse selection.
    A small public option, then, seems not to do much, and a large one will require more of a cultural shift than you think.
    Single payer puts us all into a system that will mandate payouts without a lot of choice in the matter, and there will need to be a society wide rethinking of medical expenses. England has a board called NICE whose job is to do cost-benefit analyses of medical procedures. This kind of thing has been likened to death panels, would likely be reviled by US medical consumers. Look how much vitriol gets turned on insurance companies for the same basic behavior. So now it’s the government.
    I think there are some issues there. My family members tend to die in hospice, not on life support. But that’s my culture. Lots and lots of people cling. Think Terry Schiavo on steroids or whatever. All those people whose core beliefs are entangled around quantity of life over quality will need some serious psychic work if we’re all to be grouped in the same system with taxes for premiums. I honestly don’t know how workable this would be without huge cultural shifts. I’ve mentioned resentment issues in previous posts. They’re lurking in this kind of situation. We’re a divided society. Some of us don’t mind death as much as others, but we must respect other people’s ways of dying. Or we’re back in the state of nature. Not a great place to visit.
    As for the “concrete question”, I’m not in Lieberman’s head, but I don’t think he did a fucking thing for money. I think he’s caught between deeply conservative principles (I could never ever stand the sanctimoniousness with which he conducts his person and persona (he’s gesturally sanctimonious on top of it all)) and some thrill with pissing off the pwogs. Did he have anyone’s demand that he do what he did? I don’t know. Is the public option our lord and savior? I don’t think so, but the issue is so nuanced that it deserves a few volumes of answers to questions like: which version of the public option? how is it paid for? what are the premiums? who’s eligible? how are benefits determined? how self-sustaining would it really be? how many practitioners would accept it? how would it lower costs? what would it cover? and so on. Lots and lots of issues aside from attachment to the meme.
    Is this a political victory for the democrats? We’ll see with the next three or four cycles of elections. If it turns out that a lot of people benefit from having insurance and are grateful for having been pushed into it even at the cost of a lower paycheck, then it’s beyond a political victory all the way to a life saving, life sustaining deeply moral win for all of humanity (or something). If the program leads to less care for more cost, it’ll be damning. My guess is Obama and dems will rise in popularity once the media lay off the issue for a while. It’ll seem like a big and shiny new thing — til it gets some scratches and dents. Big shiny new things are always popular.
    The Senate did what the Senate always does. The House has done what it does. The process works as it always does. Sausage making and all.
    The mandate is apparently actuarially absolutely necessary. Nationalized single payer health care is a HUGE mandate. Think of it that way. We all pay in for whatever benefits the pols decide to give us. According to an actual actuary who’s currently posting on 538′s comment section, there isn’t a competent actuary in the universe who thinks we can have a system without a mandate/universal pay in. So, as much as I worry about the ability to build in more cost to an already-set tight budget at the margins of the subsidy system, I have to defer to actual actuaries who actually know what they are talking about. Funny how expertise does that.
    You hate the mandate? Talk to an actuary or a health care economist and let me know the results.
    The excise tax half seems to make something like sense in some places and maybe not. Average family premiums run about 13,000 per year. The excise tax kicks in at policies that cost something like 25,000 or so, nearly twice the average cost. (NOTE THAT the tax applies only to the emploer subsidy, NOT to the cost of the premium. If you pay with post tax money, that’s your business — afaik
    THAT’S a lot of untaxed income. If it’s going to coal miners whose health costs must be insanely high, or ditch diggers with major back problems, or nuclear power plant workers with radiation sickness, then it makes sense to leave it alone, and I believe that there are moves to do so. If it goes to GM’s CEO or the like, I’m not so sure it’s a problem to say, ya know, that’s a huge untaxed benefit ya got there. Let’s tax that sucker til you decide that a 13,000 dollar policy is sufficient. If a little less is covered, you use a little less medical care, and maybe you behave better.
    To the best of my knowledge, the actuarial evidence for the efficacy of this tax is mixed. But I’m not an expert in health policy, actuary issues, or tax issues. But note that employer provided health care is a substitute for income and on some level, one might think it belongs in a progressive tax system???? How progressive are we that we let a bunch of pretty well-off people get away with 8000 dollars in untaxed income (assuming that’s the employer’s share of the premiums)? I dunno.

    Reply

  43. MarkL says:

    Questions,
    Sorry you didn’t think my question was serious.
    You have a grand theory that there is a culture which is not receptive to introducing a larger government role into health care.
    You cite Lieberman as acting as part of this culture.
    I really have no idea what you are babbling about.
    Try evidence-based reasoning. The voters are receptive to the public option, to expansion of Medicare, etc. That part of our “culture” needs no convincing. Our government is not responsive. Why? If you think that a flawed system of campaign finance contributions is “cultural”, that could be what you mean; otherwise, on this question I think you are pretending to understand something you don’t.
    Here’s a concrete question for you: do you think Lieberman has acted on his own on the health care issue, or do you think he is working in concert with Democratic leadership? I’d say at a minimum he has tacit approval.
    Another question: merits of the bill aside (and I’m sure you will agree that this is not a great result, and I”ll agree it may be a positive step)
    what is your basis for thinking this is a political victory for Democrats? It does NOT deliver what the public wants and has two provisions which will resonate very badly with voters—the mandate and the excise tax.

    Reply

  44. questions says:

    No no Nadine,
    Individuals DO NOT make their own choices about health care. And individuals cannot predict health care costs, no matter what you say.
    Will you need a million dollars for your first kid, or only 4 or 5 thousand for the delivery and a few hundred for the vaccines?
    Will your kid be autistic (50 grand a year for schooling) or will your kid be ok?
    Will you get cancer (100′s of thousands) or will you die peacefully in your sleep?
    If a house burns down, the cost maxes out at rebuilding and refurnishing. It’s predictable.
    If a life ends, the policy maxes out at whatever the agreement was. It’s predictable.
    If the cost of payout is predictable, is fixed, is known, people can plan, premiums can be set, and we all know what to expect. The insurance company has a ceiling, the premium payer can figure out a fixed amount. We all plan for this.
    Health care is different. The cruelty of lifetime maximums, of annual maximums, of definitive benefits is part of the problem. Oh, I’m sorry, you can go die because you’re maxed out. Or, Oh I’m sorry, you have no benefits left this year. Go bankrupt or die. Or stay sick. Sorry……
    The costs of staying alive don’t always fit within caps, within an individual’s ability to plan or pay. THAT’S why we have insurance. And well-designed insurance from the patient’s point of view cannot have a benefit cap. From the insurance company view point, and from yours I guess, it must have a benefit cap.
    Again, I can’t see how you’ve ever dealt with cancer care or other really devastating health issues among the people you know. If you have, you certainly don’t seem to show much fellow feeling about it. All the kids I know with autism — they’ll go way beyond any lifetime cap. All the people I know with cancer — again, way beyond in expenses.
    All the people I know who own houses and cars — those costs are fixed, known at time of purchase, planned for in the budget BEFORE the mortgage papers are signed.
    Most houses don’t burn down. Most people incur medical expenses. Some among us are really expensive, and we don’t know, CANNOT know who’s who among American sick people.
    So Nadine, please find analogies that work. Please note that actual health care economists who actually know what they’re talking about see medical expenses as a different enterprise from a lot of other expenses. We cannot plan and save well for medical crisis, and the results of medical crisis are different from the results of just about any other life crisis that hits.
    Think about how you want to be treated if you ever have the horrific misfortune to hear a horrific diagnosis from a doctor — either for you or for someone you know. Personalize it and see what you come up with?
    It’s not regulation that’s the problem. It’s the astronomical expense of disease treatment and the innate desire to stay alive that come together and create the structures we are dealing with.
    You can get a cheaper house or rent or move in with a friend/parent/sib or stay in a homeless shelter. You only get one body, though. And you can’t replace your kid with a healthier model.

    Reply

  45. nadine says:

    “Everyone should know that to insure “everyone” and for insurance cost to come “down” by doing that, you have to have a “not for profit universal risk pool” and address the drug cost.
    Therefore this bill is your usual piece of political crap.” (Carroll)
    Government single payer systems have their own side effects. Non-competitive entities don’t get magically better when they are part of government and Congress controls them. They get worse.
    Medical care has a limited supply and near infinite demand. It will be rationed. The question is how, by centralized bureaucrats or by individuals making their own choices? I prefer the individuals, I think they know their own situation best. I would prefer an insurance scheme that paid the patient, and gave him an incentive to shop around. You can’t always do that for medical care, but you can most of the time.
    I think the best thing you can do to keep insurance costs down is to make insurers compete with other, which current regulation effectively prevents.

    Reply

  46. nadine says:

    questions, So nobody can anticipate having medical expenses? Really? Can you hear how absurd you sound?
    All this time, you seem oblivious to my real argument, which is to turn health insurance back into insurance instead of this weird super-expensive plan to cover everything from checkups to rare diseases.
    If people bought health insurance like they buy home insurance – as insurance against an unlikely event, a rational decision like you said, then it would be cheap enough to afford and we wouldn’t have this so-called “crisis” which has been caused by so much government mucking about in the first place.
    It’s only a crisis because it’s so expensive.
    We don’t have a homeowner’s insurance crisis.
    We don’t have a life insurance crisis.
    We don’t have a car insurance crisis.
    Nope, only for health insurance. Guess which one of the four is super-regulated? For our own good, of course.

    Reply

  47. Carroll says:

    The only thing you need to know about this HC bill is that it forces people to purchase insurance from the “for profit private” sector…and will be subsidized by the tax payers paying the fees to the “private insurers” for those who can’t afford it.
    Everyone should know that to insure “everyone” and for insurance cost to come “down” by doing that, you have to have a “not for profit universal risk pool” and address the drug cost.
    Therefore this bill is your usual piece of political crap.
    And the lambs think the same dems that brewed this up are gonna “fix it” later?
    Let me ask…do you really think that a congress, who didn’t even know what was being done with our TARP money, didn’t bother to enforce the so called oversight they claimed would be there, will really do anything different with the insurers they are handing trillions over to with this bill?
    Dream on.

    Reply

  48. questions says:

    Costs are not at all similar, not at all. Nor are the structures.
    If you plan to buy a house, you pay for it over 30 years. And you can get a decent house for 90 thousand to half a million depending on the market. If you don’t buy a house, you rent. If you don’t buy a house, you don’t die.
    You KNOW that one day you’ll buy a house, so you save up a 20% down payment, find a bank and borrow the rest. The house is the collateral.
    You DON’T ever know if you’ll have a heart attack, get cancer, need a drug that costs a thousand dollars a dose, or 30,000 dollars a dose. You don’t know if your baby will be born needing a million dollars worth of care in the first year. You can’t really predict anything at all about health care needs and costs.
    So if you save for that million dollar baby, you never have a baby. If you have a baby, you can’t buy a house or an education because you have to keep saving in case the baby gets childhood cancer.
    Do you see how irrational and impossible it is to save for completely unpredictable and profoundly expensive events? How much do you save? Three months’ salary? 100 years’ salary?
    You can’t predict.
    Re education, universities are running 50 thousand a year now. That’s 200 grand for the full package. You can save some, borrow some, have your kid pay some. The kid’s brain is collateral in a sense. The kid sells his or her labor to pay for the schooling. And the cost is utterly predictable, and it’s avoidable via state schools, branch campuses of state schools, community colleges, part time status and so on. Oh, and by the way, you don’t die if you don’t go to college. And you don’t die if you avoid the Ivy League.
    So back to heart surgery — what’s the collateral? Your heart? Your great health? Your ability to work for many more years?
    Cancer: what’s the collateral? Diseased tissue?
    There is no symmetry at all between predictable costs for elastic demand on the one hand and unpredictable disastrous costs with no actual salable value on the other.
    So, no, we’re not going to finance medical care on our own. The risk is unpredictable, the costs are ruinous, and the opportunity costs (nothing else in many people’s lives except medical savings) is stupid stupid policy.
    Insurance is a kind of socialism — we pool risk and resources as we are able and we fund disaster as needed. And we don’t do it to make money — er, rather, we shouldn’t do it to make money. We should do it to protect the one thing each of us must protect — our lives.

    Reply

  49. nadine says:

    MarkL your style of argument is a pathetic as your reasoning. That the best you can do? Really?

    Reply

  50. MarkL says:

    Wake me when Nadine makes an intelligent comment.

    Reply

  51. nadine says:

    MarkL, your criticism of Lieberman is wacky. He didn’t hold out for money, he held out for no public option, and got it. That’s a policy difference.
    Nelson just got paid. Ditto for “Louisiana Purchase” Landrieu.
    So whom do you call corrupt? Lieberman.
    Figures.

    Reply

  52. MarkL says:

    Questions,
    I don’t agree with your “culture” analysis.
    Joe Lieberman represents no culture: he is a corrupt politician who has sold his votes to the highest bidder.
    I also don’t agree with people who think he plays a foil to the Dems because of personal pique; in fact, circumstantial evidence indicates that he is an agent for the Democratic leadership.
    Nor do I agree that Snowe is a not very bright woman who just can’t see how good the Democrats’ bill is. Snowe and Lieberman are laughing all the way to the bank over those myths, IMO.
    Outside of the corruption in Congress, I disagree that there is a pervasive “culture” which will not accept a larger government role in health care. The polls I have seen show this.
    Obama really was right in the primaries—it IS about campaign contributions corrupting the vote.
    Unfortunately he was lying through his teeth about having any intention to change the rules of the game. He just wanted his piece.

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  53. nadine says:

    “Wasn’t insurance linked to work as a way to get around wage and price controls? In which case, it’s a corporate thang!”
    Yes, it was corporations reacting (as they must) to yet another stupid government policy! No stupid government policy, no problem!
    “We cannot pay directly for: cancer care, open heart surgery, or much of anything else.”
    “We cannot pay directly for our houses, our education, our cars, or much of anything else.”
    Sounds stupid put that way, huh, since we do pay for our these things ourselves and the costs are of similar size?
    The problem is, we don’t actually know what our medical costs are since we don’t see them directly – and we certainly don’t know how much lower they would be if we had real market-oriented reform. If the market was working we could buy health-care up to a certain level of cost and have high-deductible policies to pay for catastrophic care, which would be a real functioning insurance market.

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  54. DonS says:

    call 911; Nadine has lost it.
    Questions, no I didn’t miss the boat. I do feel sorry for poor Dr. Hollibaugh, D.O., but if things are that bad, she can always go back to being an RN. The demand is high; the pay good; pretty much write your own ticket in many areas. Think of her med school debt as a mortgage; maybe even walk away?

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  55. questions says:

    Nadine, So Sec is savings in that money is snatched from your first dollar to you 105 thousandth (or whatever the cap is now) and then it’s given back to you when you’re too old to remember that first bit that was taken out. THAT is savings, even if the actual dollar that actually goes into your actual bank account isn’t the actual physical dollar that was actually snatched from your actual first paycheck way back when your hair was brown and your eyes clear and clear sighted.
    And DonS, Medicare doesn’t reimburse enough to cover costs. If doctors didn’t have full-fare payers, they would go out of business.

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  56. questions says:

    Wasn’t insurance linked to work as a way to get around wage and price controls? In which case, it’s a corporate thang!
    We cannot pay directly for: cancer care, open heart surgery, or much of anything else.
    Insurance is a way for us to manage risk. It’s a profoundly rational way to help us manage risk. It insulates us from disaster. This is good, not bad.
    Have you ever, Nadine, dealt with serious disease in anyone you know? It’s horrific and the only saving grace is health insurance. Otherwise, we all just die as soon as we get sick.
    If you wouldn’t wish that fate for yourself, please think what it means that you’d wish it on others. Risks must be mitigated. Insurance mitigates risk. Disease and disability strike without warning, and we build systems to help with that. Why anyone would wish for different is beyond me.

    Reply

  57. DonS says:

    Nadine: “Medicare pays doctors too little to live”
    This is on a par with Palestinians have no hunger or health care issues.
    Need to watch that hyperbole , , ,

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  58. questions says:

    DonS,
    You missed the boat on the Hollibaugh letter — it costs MORE than the Medicare allowance for her to see a patient. That is, she loses money on Medicare patients. This is a huge problem.
    Think about it in class terms. If it costs more to get to work than you earn at work, you stop working. If childcare costs more than your salary, you give up work and stay home with the kid. You can’t afford to work.
    Where Hollibaugh is off base is on the shame issue. It’s one I’ve heard before, only it was a plumber not an appliance repairperson.
    This is part of the culture shift though. Medicine is a demanding practice, it requires risk to life (ever get poked by a needle that’s been in someone’s AIDS or hepatitis infected body fluids?). Med school is grueling. The talent to manage it is rare. And people want, in Hobbesian fashion, honor for what they do. We measure honor in terms of salary for now. Until we stop doing this (hey, isn’t that culture???) doctors will continue to feel slighted and to leave practice because they are paid less than people who require far less training and take on far less responsibility and risk.
    Until medicine is merely a noble gift to others more in keeping with the priesthood, plenty of doctors will be beyond pissed at the salary issue.
    But even more than the honor thing is the plain fact that if you can’t run an office on what you’re reimbursed, then you aren’t going to run an office.
    Medicare rates are too low. Medicaid rates are worse.
    Insurance is expensive. Health care is expensive. We really do have to dump a bunch of money in, unless we’re mostly just going to die sooner rather than later.

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  59. nadine says:

    “Nadine, the savings wrapped up in Social Security is the best damned thing that happens to so many elderly people that YES INDEED I’d like some faceless governmental bureaucrat, some idiot senator, some dumb politician to FORCE me to put away a chunk of every dollar I ever earn.”
    There are no savings in Social Security. It’s a pay-as-you-go welfare scheme. The government took all the tax money and spent it elsewhere.
    The problem with the current system is the costs are too high.
    The way to fix the costs is to get people to know what things cost and give them an incentive to spend less.
    The way to get people to know what things cost is to have them pay for themselves. No more third parties.
    You can give assistance, tax credits, whatever, but they need to pay for themselves. This includes putting individuals on a level playing field with employers.
    Insurance should never have been linked to jobs in the first place. That’s another artifact of misguided government policy.
    You also need to lower doctor’s non-medical costs. This means tort reform.
    These policies would work and save us all lots of money and give us more choices, and make health insurance affordable again.
    That’s why the Democrats hate these polices and have always fought them. They don’t want independent citizens. They want dependent welfare clients. Health care is their main chance.
    The Democrats want what you want: smart bureaucrats making choices for all of us, because we’re too stupid to plan for ourselves.

    Reply

  60. DonS says:

    I agree Questions. Social Security has been a success which is probably why the repubs hate it.
    It has been the sole survival source for many, and the needed gap-stopper for alot more.
    My mother in law would not have had a decent and dignified retirement — surviving her husband by almost 20 years, with — without it.
    And my brothers in law, both on the right side of the political spectrum, one in the neanderthal category, and both in their mid 60′s, get a tidy sum from Social Security because they have children under 18, one via adoption and one via overactive gonads egged on , so to speak, (now divorced via poor spousal choice); they both bad mouth social security, but have taken benefits to keep the $1K/mo supplement coming.
    Both those brother’s in law still trot out the argument that “the government should let me invest my own money” — but neither has addressed the stock market meltdown, which would have wiped out many if Bush had his way. And fo9r many the forced savings aspect you cite is also crucial.
    Social Security doesn’t pay a whole lot of retirements benefits, but with the number of people dependent on it, that is hardly a criticism. Rather an indictment of our horribly skewed society.

    Reply

  61. questions says:

    Nadine,
    No one is going to pay everyone’s favorite medical costs, and I don’t think anyone thinks that this is a problem.
    In fact, most people want reform of the entire care system — and indeed that’s what we need. We actual need a bunch of faceless bureaucrats who second guess treatment plans through the mediation of actual data. What you’re afraid of is having the government use those data, and what I’m afraid of is having unregulated corporate goons do the same thing. The corporate goons will be far more worried about the quarterly balance sheet (as the corporate charter mandates), while the governmental goons might actually care about life outcomes. So if the government regulates strictly what the corporate goons can do, then maybe we have the best of the two ways of seeing the world. The money matters at some level. Lives matter, too. And you can’t take profits from denying basic cancer care to someone who forgot she had seen a doctor for acne, or whose doctor made notes in a chart but never ever told the patient.
    (Note by the way, MLR — medical loss ratio — this is what the insurance companies call payments for care — medical loss. If that doesn’t mean something…..)

    Reply

  62. questions says:

    Nadine,
    I already debunked your Medicare denial rate thing with a link….
    Medicare is a stickler for rules and procedure codes. They deny claims when the forms aren’t filled out properly. It may be irritating to ahve to have the procedure codes correct, but there you go. It’s the law.
    You can’t look at initial denials, you need to look at final decisions…..

    Reply

  63. questions says:

    DonS,
    I’m not “handwringing” — I’m noting what will happen. Awhat will happen is different from the ideal. It always is. Because the “culture” won’t allow for larger changes. Joe Lieberman has to evolve, for example. How’s that going to happen? He’s part of this “culture” you think I’m foolish to account for.
    Until the culture catches up with ideas, the ideas don’t get put into practice.
    There is lots and lots of lit out there about how when the left pushes too far too fast the backlashes are pretty strong. We see it currently with gay marriage, we’d likely see it if we instantly cut medical spending to significantly lower levels. Fewer people go to med school, more people drop their practices, income doesn’t keep up with the cost of running a practice and so on. It’s not “culture” the way you mean. The fact is that people don’t put up with things they don’t put up with. And then they react in ways that cause unintended consequences. Who’d a thunk that the push for gay marriage would lead to constitutional bans across the country? Well, gee. It was pretty obvious that if you push too hard, there’s a backlash.
    And to be honest, my guess is that if the Cuba issue is pushed too hard, the remnants of anti-communism will arise phoenix-like and do us all in.
    I’m an incrementalist after reading enough policy stuff to see that incrementalism is the speed at which we typically travel. So let the “culture” — that is, med students, nurses, patients, hospitals, hospices, home health care workers, aides, mini clinics, emergency rooms, and even insurance companies adjust to the changes. Then change a little more.

    Reply

  64. nadine says:

    ” Do you want a system where once people make the choice to get health care they are, in turn, denied that right. ” (Brian)
    No, that’s what a government monopoly will provide. Medicare already denies more procedures than private insurance. And guess what? At least if private insurance denies you, you can pay out of pocket. If Medicare denies you, you can’t even do that. Your doctor will go to jail! It’s illegal to charge a Medicare patient! That’s government for you.
    And if you think government won’t cut doctors reimbursements again and again, and ration treatments again and again, then you haven’t been paying attention to the last ten years of Medicare. Already Medicare pays doctors too little to live. Next year it’s scheduled to be cut again by 20%. Medicare funding is supposed to be cut by HALF a TRILLION dollars in the next ten years in this bill.
    Do you have the faintest idea how big a hole this will blow in the budget? Forget the CBO, they were ordered cost 6 years of benefits against 10 years of taxes AND the Medicare cuts and the Medicare doctor fee cuts. The taxes alone are nearly a trillion dollars of new taxes, with rosy economic scenarios that aren’t going to happen.
    A more realistic cost for this bill, if you take away the Medicare cuts (you really think they will happen in an election year?) is over 2 trillion dollars over ten years, and that’s just the initial guess. Medicare cost more than its initial estimates – over 9 TIMES more.
    This bill will drive the US into banana republic levels of debt and deficits. The government will inflate to lower its debt. Any of you old enough to remember the 70s? And that’s nothing compared to a real hyperinflation.
    So, Brian, if you believe that the beneficent federal medical bureaucracy is going to pay for whatever medical treatment you need whenever you need it, as opposed to those greedy mean private insurers, I suggest you clap your hands and say, “I do believe in Tinkerbell.” Because one is just as realistic as the other.
    The Democratic party is being led by kids who think they’re playing with Monopoly money and corruptocrats enriching themselves in backroom deals with the special interests. Harry Reid as much as said today that any Senator who didn’t demand a payoff for his state was a chump.

    Reply

  65. questions says:

    Nadine, the savings wrapped up in Social Security is the best damned thing that happens to so many elderly people that YES INDEED I’d like some faceless governmental bureaucrat, some idiot senator, some dumb politician to FORCE me to put away a chunk of every dollar I ever earn.
    W/o So.Sec, my mother’s last years would have been a nightmare, and she was not the least bit capable of saving in any kind of rational way.
    We do not calculate losses and risks well. We dismiss stuff we shouldn’t, we panic over stuff we shouldn’t. It helps a lot to have the bureaucracy doing some of our thinking. We don’t know what disability is until we’re disabled. And yet, somewhere someone has to come up with money for disability support for each disabled person. So it’s better to have a society-wide taking of resources and putting of resources into rainy day funds for all those whose rain will come.
    Think if you’d be happy with the current insurance system if you (or your spouse) loses work and therefore health insurance and you can’t get any kind of insurance because you saw a dermatologist for acne when you were 15 and forgot to tell the insurance company.
    Think if you’d be happy with the current system if you get cancer (I certainly hope it never happens to you) and you can’t work anymore and you lose your insurance. ever try to get in to work while going through chemo? It isn’t pretty. My mother had to do this for a while.
    Think if you’d be happy with the current system if you became its victim instead of one of its successes.
    If you can’t think through the failures of the system, you’re not empathetic, imaginative, capable of calculating your own risks.
    Are there risks with the gov’t's running things? If the bureaucracy is “captured” by the insurance companies, if we get super cheap about what we’re willing to pay for, if we can’t slowly make the changes we need to make the system workable, then yes, there are some risks. But the current system is LOADED with risks already. And Lasik ain’t gonna save us all. That I promise.

    Reply

  66. DonS says:

    . . . or that wants to dictate to women what they can do with their bodies . . . .

    Reply

  67. DonS says:

    Brian: ” I government intervention in medical care is wrong . . . why do you . . deem it necessar4y for the govt to ban abortions.”
    Brian, it’s the same non-sequitur reasoning that the government has no right to regulate the possession of handguns but that trips over itself to demand to control what consenting adults do in their bedroom, or which books librarians choose to order.
    There is no rationale; there is just the arrogance of the ‘stupid’, and the undying assumption that the RIGHT WING is de facto right, good, patriotic, and always has the unquestionable right to play offense. With the pathetic support of the former fourth estate in the US.
    After the breath of civil rights fervor and fresh air in the 60′s, the moneyed interests clamped down on cultural transformation like a ton of bricks. And your average individual is too stressed and distracted trying to make a living and digest mindless stimulaton to give a damn. The Obama election, mislead or misread (depending on your take) seemed a refutation of the worst trends of the past 40 years. Not looking good.

    Reply

  68. DonS says:

    Private vs public bureaucracies.
    Nadine, sounds like you are piggybacking on every negative stereotype of public bureaucrats that you can imply. Easy targets to slander. I was a federal bureaucrat for a good number of years. My daughter has been one for a number of years. Competence runs the gamut; the majority are good. What’s missing are the bonuses and profit motives that, you say provides competition, but at whose expense. We know that; the public get’s shafted.
    And questions, your hand wringing over the catharsis called culture change? Keeping putting the day off when cultures are expected to change and you’ll never even start. Folks are more flexible that given credit for. Oh maybe except for those folks who get the profits by shafting the people. Seems like they are the ones with the motivation to promote the “go slow” attitude.
    And poor Dr. Hollibaugh D.O., above, sounds like she’s caught in the middle. A victim of a violation of the American dream (for professionals at least); play by the rules and life turns out peachy. Why is it when the poor, the middle class, the under or unemployed seek to make that argument they’re told, metaphorically or actually “try harder”, “life’s tough”, “not this time”?

    Reply

  69. Brian B says:

    Nadine,
    If you are not aware, there is already a structure in place for corporate interests to make health care decisions for you. They decide if you will get insurance or whether or not you will receive health care for your ailment at all. Do you want a system where once people make the choice to get health care they are, in turn, denied that right. Or, would you like a system that requires them to get a nondiscriminatory health care plan that ensures that they will be covered, at less expense otherwise, preventing future hardships. The only element of bureaucratic intervention is that they are going to require the select few, absent those who will be subsidized, to get insurance. The notion that the govt will have a review process to determine your coverage is outright false (read: Politifacts #1 lie of the year), however, absent reform you are certain to have the private sector determine what’s best for you.
    My latter point also speaks to the abortion issue. What makes it right for a bunch of men (i.e. Sen Nelson and Rep. Stupak) to determine what’s best for a woman? Where is the Congressional woman’s voice on the abortion issue? What you see is conservative women hide behind their religious views, for political reasons, when in private they are more likely than not to identify with women on this issue. If govt intervention in medical care is wrong, then why do you, and those who feel like you do, deem it necessary for the govt to ban abortions? It’s a circular arguement.

    Reply

  70. sandraY says:

    Thanks for asking.
    The Senate health care bill is a success only if your goal was to institutionalize and strengthen those corporations which are acting most against the public interest today 1) by paying them a significant percentage of government taxes, and requiring no strong oversight … 2) and then further, and in an even greater threat to our
    (?) democracy, forcing citizens to pay a significant portion of their income directly to those corporations, without offering us (the citizens) the opportunity to vote those corporations out of power.
    The Senate bill is also a success if one of its goals was to eliminate this lifelong Democrat as a member of the Democratic Party. Because I am out. I have taken a pledge not to believe another Democratic promise.
    I will not vote for any senator, including Senator Boxer, who goes along with this sellout.

    Reply

  71. nadine says:

    A letter from a Nebraska doctor to Senator Ben Nelson:
    Dear Senator Nelson:
    I send this message under “Tort Reform” because the current monstrosity you have pledged your support to says nothing whatsoever about Tort Reform. You have sold the physicians of Nebraska for zilch (zilch for us, but beaucoup federal bucks for you and the liberal partisans in this state). As a family practice physician in Small Town, Nebraska, I was counting on you to be the lone voice of Democratic sanity on this issue, but you sold me out.
    I will dedicate
    every spare minute of my time and every spare dollar I have to defeating you, should you run for re-election. The long hours I spent on my medical education and the long hours I spend treating my patients are nothing but chump change to you and your Democrat colleagues in Washington. I especially can’t wait for your equivocation and milquetoast evasion when your “compromises” on the abortion language in the bill are silently erased or quietly (on-little-legislative-cat’s-feet) eviscerated in the House/Senate give-and-take. Go on: Bet me that you won’t wuss-out on this issue!
    I know you won’t give two-seconds to this letter, but I had to write it. I’m a primary care doctor in YOUR state, and you sold me out. I didn’t slog through 4 years of college and 4 years of medical school and 3 years of residency just to have you hand my career and my patient/doctor relationships over to government lifers. Your gutless acquiescence to Obama and Harry Reid and ‘Nanny’ Pelosi will NOT be forgotten.
    Thank you, Ben, for forcing doctors like me to earn less than the repairmen who fix our appliances. Case in point: We recently had our dishwasher fixed. The repairman who came to our house charged $65 just to come and ‘diagnose’ the problem, then charged another $180 to ‘fix’ the problem. You and your fellow lawmakers have fixed MY going rate (Medicare) at $35 per-visit. Thank you for securing such a ‘lucrative’ rate for me! Thank you so much for making me–someone with 8 years of education!–make less than a mechanic or appliance repair technichian. And thanks especially for falling in line with Obama and the rest of the Democrats to make such a socialist system permanent.
    You have my disgust and disdain forever, you socialist-coddling coward.
    Sincerely,
    Becky F. Hollibaugh, D.O.
    Warren Memorial Hospital
    Ziimmerman Clinic
    Friend, NE 68359
    ***
    Dr. Hollibaugh adds in an e-mail update in response to left-wing critics:
    Thank you so much for making it more widely available.
    …To those who would accuse me of greed: I don’t make as much as you think I do. I give every one of my patients the very best care I can offer, regardless of their ability to pay. And I do NOT begrudge my mechanic or my appliance repairmen their salaries. Not one bit. I gladly pay them what I owe them. What you leftist idiots don’t understand is this: I am forced to accept $35 for an office visit by a medicaid or medicare patient.
    I. Can’t. Afford. It.
    On that enforced wage, I can’t pay my nurses. I can’t pay my billing secretaries. I can’t pay my receptionist. I. Can’t. Survive. On. Obamacare. Get it?! I. Can’t. Pay. My. Nurses. On. Ben. Nelson. Wages. Get it?
    I hope so. You think I’m greedy? I went to medical school as a former nurse at age 36. I have over $180,000 dollars in student loans. I. Can’t. Survive. On. Obamacare.
    I hope this helps. I don’t make as much as you might think.
    And most
    of what I earn goes to repaying my student loans. I love my little family medicine clinic in Friend. I love being a doctor in rural Nebraska. I love my patients and I love rural family medicine. But Ben Nelson sold me out. Thanks again for letting me vent. I’m not greedy. I don’t envy the wages of my blue-collar friends. But I can’t survive or pay my employees on Uncle Sam’s reimbursement rate for my services.

    Reply

  72. nadine says:

    Questions, you don’t want individuals to think through their own choices. You don’t trust people to make their choices because they make the “wrong” choice.
    You want some “wise” legislator to make them do the things he thinks will be “good” for them.
    Centralized planning doesn’t work. You have to let people make their own decisions, even if you don’t like the decisions. The idea that you know better for them than they do is a crippling delusion.

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  73. questions says:

    And what you know at a particular time isn’t what you’re going to know later. In fact, when you’re 22 and starting out, you KNOW you don’t need to save for retirement. And then, BAM! you’re 62. Who’d a thunk it was possible?
    And what you know today is that you’re OPPOSED to abortion under all circumstances. And then BAM! you’re pregnant and the baby is anencephalic and your moral hero shot to death the last doctor in the country doing 3rd trimester abortions. Oh well.
    Nadine, it’s really important to think through perspectives and epistemic limits when you start setting up social policy. What an individual knows from his or her own perspective is insufficient for making all sorts of crucial social decisions.

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  74. nadine says:

    “Questions: “It doesn’t matter who owns the insurance plan, It matters only whether it is effective.”
    If someone else made this seemingly reasonable statement, you would be the first one to point out that it BEGS THE QUESTION (no huge pun intended).
    As structured now, or what anyone can know of it, very little is known about “effectiveness”; nor will it be for a long time. But we do know many very bad things about how insurance companies make life hell for insurees. Enough not to have implicit trust. And we do know that the “right-center” country everyone keeps alluding too sees regulation as a bad thing; fetters capitalism ya know.” (DonS)
    But why do you have more trust in government insurance than in private insurance? Medicare denies a higher percentage of claims than does private insurance.
    Faith in either is unwarranted; that’s why we need competition.

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  75. nadine says:

    “To argue that the market allocates humanely is merely to say that you, personally, are well placed in the economy and it is to say, as well, that you have no ability to see how far you personally can fall. Thus, it is both selfish and foolish to think the market can allocate necessities well in all cases, or with some nuance, in most or many cases.”
    You can make exactly the same argument about a centralized bureaucracy, except of course, the bureaucracy will make its decisions by centralized rules which don’t take your special circumstances into account.
    The argument isn’t that “the market” is humane.
    The argument is that the market allows YOU to make a large piece of the choice, and only YOU know what is most important to YOU. Anything that takes the choice away from YOU will make the results worse.
    Sticking a federal bureaucracy between you and your doctor is removing choice from YOU. The more your doctor has to answer to THEM, the less he can answer to YOU and his own conscience.

    Reply

  76. SYSPROG says:

    And women should have complained…WHY??? We are the majority in this country and even so we don’t all agree. Women’s rights went backwards quickly during BUSHCO but the conservatives would point and say ‘look at all the women for Bush?’ He appointed those women who were adoring enablers of that fool. Look at Liz Cheney…she can’t say ANYTHING about what SHE thinks. Instead she acts like the little woman for Daddy. And she is SMART. The old, white, doddering idiots in the Senate don’t GET it. They have adoring wives who do all their dirty work and the rest of us are whiners…and the very same doddering old men in the Senate use that.

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  77. questions says:

    BTW — “I plan to go to med school” — is a figure of speech, not a biographical statement!
    I wouldn’t survive med school! I wouldn’t even survive college bio. High school dissection did me in!
    And yes, the med school tuition racket is something that needs to change. It’s part of all the cultural shift stuff I was arguing for and you were accusing me of being a lobbyist since I brought it up.
    The fact is that shifting costs for such a huge segment of our economy is a huge huge task for the ages, and not something to be done in a few months in the US Congress.

    Reply

  78. questions says:

    erichwwk,
    I’m surprised that you don’t see resentment more often. You work hard at something and someone else gets the credit; you work hard and the government takes your money (what do you think tax protest is all about); you played by the rules on your mortgage and some idiot who over-bought ends up with a bailout…. These are all forms of resentment and I come across this stuff all the time. But then, I don’t limit my interactions to people who agree with me. In fact, I spend huge amounts of my time with people who disagree with me but whom I respect.
    Class politics is all about resentment, and the US is firmly in the camp of class politics.
    I would prefer a very different system, with a very different way of distributing goods and services. But my preferences are those of only one person, and I share a country with some 300 million others, each of whom has a somewhat different ranking of preferences.
    So what do we do? We compromise.
    I don’t find the system insanely corrupt, though it’s not absent of corruption. I find inefficiencies and irrationalities all over the place, but then human desire and preferences simply are irrational and inefficient.
    Note, by the way, you ascribe to me personally views that I do not hold personally. What we OUGHT to do and what we CAN do are very different the moment you walk into the policy realm.
    We ought to pay for every single thing every human being could want so that no one suffers from any deprivation whatsoever. Well, maybe not. So for the rest, we’re going to fight over what we subsidize in one another and what we don’t.
    My guess is that we couldn’t even come to a consensus on what medical care to cover — nose jobs? Botox? Massage? Acupuncture? Homeopathy? $100,000 dollar doses of cancer meds? 100,000 doses of 1 dollar a dose medication? How do we do all of this without HUGE political fights about the worth of life and the way of death? I don’t think our system is ready to make this stuff the centerpiece of the government. And believe me, this is where a public option will end up eventually.
    The possible is different from the desirable. There is not broad social agreement over what needs to happen in health care. The polls vary tremendously based on the phrasing of the question, and given the variation in values across the country, what are the chances we could come to a reasonable agreement?
    For now, there is a step in the general right direction, and that’s not too shabby all in all.
    Thanks, by the way for the not so subtle accusation that I’m a lobbyist or a PR worker. It’s right up there with the whole hasbara thing!
    In fact, I’m not a lobbyist or a PR worker. I spend a fair amount of time immersed in policy issues and I don’t really see a rational or ethical policy coming out fully mature from the congressional equivalent of Zeus’s head (sorry!) what I see are baby steps and adjustments.
    As for all the worry about thieving and spoils grabbing and looting the capitol…I think we’re better off with metaphors that don’t set us all against each other. In fact, those kinds of metaphors play right into the kinds of cultural resentments whose existence you were denying at the top of your post.
    Insurance is a clever adjustment to uncertainty. It would certainly be nice if execs didn’t get paid more than, say, what I get paid. But I doubt that all the executive salaries of insurance companies combined add up to such a lot of money that, say, capping them at 50 thousand a year would make that much of a difference in terms of the care they cover.
    So let’s not confuse many millions in salary with many hundreds of millions in end of life care, or imaging technology, or drug research.
    The salaries may be obscene when compared with mine, but they are trivial when compared with the cost of keeping a few preemies alive through age 3, and a few elderly terminal cases alive through the age of 85.
    The real savings in medical care, near as I can tell, will come from our having a very different attitude towards what health is, and what death is.

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  79. erichwwk says:

    Btw, questions, i empathize w/ your anticipated med school debt, as i do with my daughters law school debt.
    Privatization of these professional efforts is something i also have a problem with, as they are, in essence, a form of indenture, to force your hand in behaving in a certain way, making it significantly harder to do something else, even if you discover your heart and skills lie elsewhere.
    When I went to college, someone willing to work hard could finance their education through self employment ($2,500/year for rm, bd tuition at a top private school). Those days are long gone.
    BTW, employer provided health care, while an equalizer in the price control days,at that time working to the benefit of workers, has now also morphed so as to tie you to a company, and give it an inefficient and unfair advantage in their ability to retain your services. Hopefully, that is one positive (removing preexisting conditions) of the health care bill, but I am not familiar enough to say that with conviction. There may be no clear price constraints on these benefits, making the change essentially meaningless.
    Is the deep south, the home of the GOP, not attempting to bring slavery back, albeit in a more covert form?
    It’s really interesting that dome folks who balk at government intervention in the medical industry had no such compunction in interfering with the air traffic market. Is air travel really more basic and important a “need/ right” than health?

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  80. erichwwk says:

    Questions writes:
    -” ‘we’ have such deep cultural resentment”
    Speak for yourself please. Your view is shared by few with whom i associate.
    You seem to be saying, that although we waste so much money by giving corporate bureaucrats control over our health, we should continue to pay what amounts to extortion, even though the evidence is fairly clear it will drive us to third world living standards, and wastes (Sen. Bingaman’s home page) a third of our health care expenditures.
    I would describe it more as a propaganda/ marketing issue, of distorting the advantages of markets, into a philosophy that attempts to justify what was once known as fraud and theft. To me this effort is quite similar to the effort that “tobacco smoke doesn’t kill”, although any addiction to this “culture” is likely easier to kick than that to nicotine.
    Most people understand the nonsense in this “cultural” argument, witness the polls on single payer. Or sample responses to health care articles at the NYT or WP. It is not the culture that is the obstacle, but the attempt to create that reality.
    The U.S. has been a predator nation for so long now, that there are those that think these bureaucrats “earn” their compensation, rather than extort it from their position of privilege in fixing the “rules of the game”. This is VERY different from the type of capitalism described by Adam Smith – who pointed out that market self regulation fails when folks meet to fix prices and which does have a wider “cultural” consensus.
    Adam Smith’s quote {the ONLY time he uses the term “invisible hand” in the “Wealth of nations”):
    “By pursuing his own interest he *frequently* promotes that of the society ”
    has morphed from a quite reasonable statement into propaganda way beyond even *mostly* all the way to *always*. What nonsense and rubbish to try and claim that markets “always” promote the interests of society better than a collective effort.
    You should review the history of how we got our current system, and the role the AMA and WWII price controls played in all that. There was a not to recent time when folks were quite satisfied with health care and pension plans, when American was more egalitarian, the change occurring in the early to late 1970′s, depending on what metrics one uses. But then the elitist marketing effort began, and bureaucrats were allowed to use phony accounting standards, and divert workers savings to their own private accounts. We are still in that phase.
    as Bill Moyer last sunday with guest’s Robert Kuttner and Matt Taibbi:
    “Truth is, our capitol’s being looted, republicans are acting like the town rowdies, the sheriff is firing blanks, and powerful Democrats in Congress are in cahoots with the gang that’s pulling the heist. This is not capitalism at work. It’s capital. Raw money, mounds of it, buying politicians and policy as if they were futures on the hog market.”
    The main folks claiming “cultural shift problems” are those wishing to perpetuate theft, and hiring lobbyists, PR firms, and politicians to create this myth.
    As John Galbraith has stated:
    “It is a far, far better thing to have a firm anchor in nonsense than to put out on the troubled seas of thought.”
    “Faced with the choice between changing one’s mind and proving that there is no need to do so, almost everyone gets busy on the proof.”
    “The conventional view serves to protect us from the painful job of thinking.”
    “The modern conservative is engaged in one of man’s oldest exercises in moral philosophy; that is, the search for a superior moral justification for selfishness.”
    “Where the market works, I’m for that. Where the government is necessary, I’m for that. I’m deeply suspicious of somebody who says, “I’m in favor of privatization,” or, “I’m deeply in favor of public ownership.” I’m in favor of whatever works in the particular case.”
    I also recommend T.R. Reid, as well as Maggie Mahar’s “Money Driven Medicine”. One could do also read Kenneth Arrows 1962 AER article “Uncertainty and the Welfare Economics of Medical Care”.” for a still relevant discussion of why it is difficult/ impossible to privatize health care.

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  81. questions says:

    We’re not going to get either because we have an antagonistic political system in which power manages to reward itself with wealth. Given the reality of the actually existing system, the best policy can do is tinker at the edges and grow slowly into something like social justice. It’s a process, it’s messy.
    And besides, the fact — which you admit I think — is that there needs to be a profound alteration of the cost system in medicine. A new generation of doctors has to be paid much less, a new generation of patients probably has to die differently.
    Altering these social patterns mid-course is actually its own kind of injustice. I plan for my whole life to have a particular kind of death, and instead I’m sent to hospice to die from lack of fluids. (This just happened in my family.)
    I plan to go to med school, I make huge sacrifices in college and in med school and I’m deeply in debt and so on. And then you cut my pay significantly.
    Any shift in policy will cause its own kind of injustice, will result in the trade-offs of one person’s good for another’s. We make these choices all the time, and we should be aware that single payer, too, would bring about its own set of problems.
    The goal of policy, then, is to make the trade offs slowly and gently so that the shifts are manageable for those who will lose out. And of course, there will be losers. Win-win doesn’t happen. There are certainly some sets of winners I’d prefer over others, but I think we need to realize that changing the winner/loser ratios requires a lot of time.

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  82. Linda says:

    Questions,
    Rational and ethical are all I want from our system. I didn’t say that’s what we have, i.e., we don’t practice our basic beliefs. And a just society (which we don’t have) does better than we do. We’ve already shredded the social safety net–so it’s not just health care but sheler and food that far too many in our society lack.
    Reid’s book that is far from ideological but very good on simple common sense explains it better than I can.

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  83. questions says:

    Also, I’m not sure why you think it’s a basic American principle that we’re all created equal and endowed by our creator with inalienable…. In fact, people with resources are generally considered far more valuable in all sorts of ways. We distribute every social good there is by wealth, and we have such deep cultural resentment that someone deemed lesser might get away with more…. That we have a concept of “moral hazard” is just about all you need to say.
    Given what our culture really is about, I’m not sure how anyone can think that a single payer system is the slightest bit realistic. Rational isn’t enough for policy, it never has been.
    So the compromised mess that is the current health care bill steps gingerly towards erasing some of the horror of our system. My guess is that there will be incremental progress and as we find flaws that lead to absurdities, we will put another plaster over another section of the Kennedy Care Act.

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  84. questions says:

    Linda, it’s not that I have no understanding of insurance (though it’s not my specialty), but I do have an understanding at some level of the American political process and legislation. I realize that you are somehow involved in health care economics and you have a good grasp of a lot of the policy, but I think the politics side is crucial.
    Single payer may be the best system for cost control, but it’s a HUGE cultural change for medical practitioners, for medical schools, for the allocation of all sorts of medical resources. This is what Obama means by “uniquely American solution.”
    Med schools have to attract a different pool of students with very different salary and work expectations, doctors have to re-think what it means to be a doctor, patients have to rethink what is medically possible, we all have to rethink what death means (including all those religious Christians who were freaking about Terry Schiavo and who freak about abortion even if the fetus/baby has no brain or has trisomy 18.)
    Read Nate Silver’s post from yesterday or today on 538 — he’s really sharp on this. There may be a preference for single payer, but it isn’t going to happen because it’s too much of a cultural shift for far too many people for now.
    We can’t even get gay marriage through, and that honestly affects no one but the gay couple. So how in heaven’s name anyone thinks we can reset the entire medical system from undergrad bio majors all the way through brain surgeons, including insurance, nursing, home care, nursing homes,family expectations, the way we die, the way we live, what medications we take, how we do research, what questions we research…. It’s really a lot of stuff that needs to change. And at the base really is the issue of how we die.

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  85. Linda says:

    Questions and Others,
    What is amazing to me is how the very well-informed, intelligent, and educated commenters here really do not understand a number of basic principles or what is in the various bills–at least some key provisions.
    I strongly and highly recommend to anyone interested a very good and enjoyable book, T.R. Reid’s “The Healing of America.” Many in Congress and their staffs have read it even though they haven’t acted as if they understand it. Just take a look at the hundred or more customer reviews on Amazon.
    The public option that only is in the House bill is very weak because the exchanges and a public option as one choice in the exchanges will only be available to those who don’t have insurance through an employer or can’t get insurance including small employers who may find it too expensive if one of his/her workers or family members has a pre-existing condition. Since the pool of people eligible for that public option contains many who are older or who have pre-existing conditions, the risk can’t be spread enough–so premiums will be high.
    Reid’s book makes it clear that the way to best spread the risk is to have one system that covers everybody and shows how it is done in all other advanced industrialized countries. Some do keep private insurers, but they are highly regulated and not allowed to make profits.
    And in most of those countries there is one price for each and every service that must be posted by providers, i.e., no cost-shifting. Physicians and providers can opt out, but the only ones do that are a very few who treat only the most wealthy. Physicians and others adjust to earning less to be able to just take care of people.
    Anyhow if the system allows for cost-shifting, it will happen. Cover everybody with the same system because there is a commitment to truly cover everybody, and cost shifting and negotiating better prices goes away.
    Congress and Obama Administration did not start by trying to be rational as was done in Singapore and Switzerland the early 1990s about the time when Clinton plan was proposed and failing. Both countries acted rationally and from simple principle that coverage should be universal, and today they have functioning health care systems that cover everybody and that their citizens like.
    Every time I hear someone in Obama administration or Congress talk about a “uniquely American solution,” that merely is a sign that they are dependent upon (for campaign finance) or afraid to take on all the special interests. Then they have to make deals and compromises that end up creating a “plan” that is so complicated and convoluted that nobody can understand what is in it and that makes no rational sense.
    Start with one simple basic very American principle that we are all equal and all our lives and health are equally valuable. Do something simple that everybody can understand. It’s just a simple social contract that we all believe in, but we don’t practice what we preach.
    Since those governing didn’t do that, the result is what we have right now. Nobody understand it or likes it, and everybody is concerned about what’s in it for me and my family. A fair and just system doesn’t create winners and losers.
    Win-win solutions are better,but not likely to happen because of the dysfunctional way our political system works–actually doesn’t work.

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  86. DonS says:

    Questions: “It doesn’t matter who owns the insurance plan, It matters only whether it is effective.”
    If someone else made this seemingly reasonable statement, you would be the first one to point out that it BEGS THE QUESTION (no huge pun intended).
    As structured now, or what anyone can know of it, very little is known about “effectiveness”; nor will it be for a long time. But we do know many very bad things about how insurance companies make life hell for insurees. Enough not to have implicit trust. And we do know that the “right-center” country everyone keeps alluding too sees regulation as a bad thing; fetters capitalism ya know.
    Further, your ‘arguments’ about buying food and shelter are miserable examples, but appear to provide you with a thread to hang a bunch of verbiage. No one is forced to eat or seek shelter from a particular provider. There are multiple options, and multiple ways in which an individual can meet their needs in a way to contain costs: different store, different products, different quality, etc.
    No, “private” vs “public” isn’t the only sticking point. But when you see insurance stocks performing strongly that might be a hint that they’re not particularly concerned about whatever big bad regulation is put in place to supposedly address management and costs. When you see the whole republican party and insurance whores like Lieberman, Baucus, Nelson, and many many more in positions to dictate the limits that the “public interest” can be served, the regulation question becomes more important.
    The argument about the capitalistic rights of insurance companies becomes obscene if we stop for a moment to remember that medical care is the supposed goal. Not saying you made that argument. Just saying. Fucking corrupt politicians really don’t think Americans deserve shit. Except war. War seems ok.

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  87. MarkL says:

    Well, Questions;
    In my opinion you are blowing hot air on the question of regulation.
    You see no problem with forcing people to buy a crappy product from an unregulated monopoly. Enjoy your delusion.
    Let’s not forget that the insurance companies now have several years to jack up rates to be ready for the mandate. You want to bet that anyone will be able to get coverage at anything but a fraction below the maximum rate?

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  88. questions says:

    (were you addressing me, MarkL?)
    Of course there’s regulation. And some of the regulation will be effective from the get-go, and some of the regulation will be re-written over time so that the process becomes more workable. That’s how policy works. It’s an evolutionary, incremental, compromised mess that gets things wrong, and gets things right over time. And some people will make out like bandits, and others not so much.
    The government isn’t forcing ANYone to buy from a SPECIFIC corporation, nor is it requiring a SPECIFIC product — a burger on your analogy.
    Rather, the government is saying you have two choices: get insurance (if it’s not affordable, we’ll subsidize), or pay a small fine so that you have something of an incentive to get the insurance in the first place.
    There is much social good from having people carry health insurance. There’s no social good at all from having people buy from Mickey Dees. But there is social good in forcing people, say, to feed their own kids (oooohhhh, buying from a corporation), and the government provides subsidies when you don’t have enough money to feed your own kids. But, indeed, you are forced to feed any kids you have brought into the world on pain of loss of children to the child welfare authorities.
    But I’m not a libertarian. I actually think that government coercion helps us overcome collective action/free rider problems. Like, really. It helps.

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  89. MarkL says:


    You helpfully defeat your own argument when you say that the key to success of the new mandates is regulation. Of course regulation of the insurance industry will not succeed! There isn’t even anti-trust law for them.
    And to think the Democrats and Obama will be able to enact meaningful regulation with teeth? Give me a break!
    Back to the analogy about food: suppose the government forced you to pay for food at McDonald’s, on pain of penalty. If the penalty were not too large, would you swallow that morsel without objection?
    Whether you agree with the complaint is hardly relevant, especially since your strongest argument is actually a point against you.

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  90. questions says:

    On being “forced” to buy from private interests — I really really really hate this argument.
    We HAVE to buy food or die. Or live on a completely self-sustaining farm. We don’t live on farms. We wish to live. We buy food FROM CORPORATIONS. It’s ok.
    We HAVE to live in some kind of shelter. Or sleep under bridges that are less and less welcoming as homelessness gets criminalized. We buy or rent FROM PRIVATE INTERESTS. In fact, it is mandated by a primal will to survive rather than by the government. But mandated, it is.
    The penalties for not having insurance will be fairly nominal, will have an escape clause for hardship, and might push more people into paying in to the system so that they cover a portion of their own benefits.
    I really wish we could get past the OMG corporate thing because nearly everything we do is OMG corporate and much of what we do is compelled by a desire to stay alive — which is a far far more intense need than any governmental coercion is likely to be.
    I don’t love corporate structures; I think we could move to stakeholder responsibilities and we could revoke corporate charters a little more frequently for malfeasance. But, really, buying insurance from BC/BS or from the feds? So what.
    The key is that the regulation be stringent enough that what we’re really buying is a hybrid public/private service that does what we all need it to do — spread risk, cover unknown insanely expensive costs without grumbling too much, deal with the very real issue of fraud (not the shit that we hear about anecdotally, but real fraud where doctors bill for non-rendered services…), have the good of the patient at its center, and so on. It doesn’t matter who “owns” the insurance plan. It matters only whether or not the plan is effective.
    So if people are reasonably well covered when they become horribly ill, if there’s some push back on stupid treatments like HRT and there’s some actual data being brought to bear on prostate screening and mammograms, if asthmatic kids can find decent disease management, if there’s coverage for the immonosuppressants in perpetuity after kidney transplants, if some of the more irrational shit we do is stopped, then this is all to the good.

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  91. MarkL says:

    Brian B,
    Why do you assume people will like the bill?
    Even granting that it might be a modest step forward, the bill has the appearance of a huge sell-out, and for what—to force people to buy insurance that won’t even give people full coverage?
    Are you one of those people who can say explain helpfully, with a straight face, that no one will be forced to pay more than 8% of their pre-tax income on low quality insurance??
    Hmm, it occurs to me that the anti-abortion language in the bill is a feature, not a bug, from the White House standpoint: that is, Obama believes these provisions will win him enough votes to make up for the outrage at the other objectionable aspects of the bill.
    Perhaps that is the actual political comprise.

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  92. Brian B says:

    You have to start somewhere and the best place to do that is with a bill that was passed through massive compromises. Bad legislation are bills that were ramed through the Senate like the tax cuts and Medicare/Medicade Rx D expansion with no mechanism to pay for them. Also, and I’m sure to be labeled anti-American for this, but it would have been prudent to read the Homeland Security Bill before passing it, but since repubs were in controll then everyone who wanted to “slow down a bit” would have been anti-American.
    Anyway, back to the original point. This bill is a place to start. You have to have something on the books to move towards something better. The GOP knows that and thats why this legislation scares them to death. It will bewcome popular and drag down them down, as their opposition to the “Great Society” did. Now, Im not too keen on this mandate in the bill, but I think that will be the first thing to come out of the bill in the years to come. Party of NO, you have met your match and your demise. You might need to go to school to lear how to come up with alternatives and not fear mongering.

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  93. David says:

    “The mandate seems to me almost a weird kind of fascism: the government forcing citizens to buy crappy insurance from private corporations.”
    That is an unavoidable conclusion regarding what is unfolding. And it is why – if there is no public option, no Medicare buy-in, or no robust subsidy to policy holders by the federal government, coupled with serious restrictions on co-pays, then the mandate must be stripped from the bill. What will ultimately prove the only viable solution to the ever evolving debacle known as health care American style (or more appropriately, disease management, since so much of popular culture is disease producing) is single payer. The rest of the industrialized world pretty much gets it. As has been the case on so many domestic issues, America is the last dog on the blog to be dipped for fleas.
    I cannot help but wonder if there is any parallel to the evolution of civil rights in America, in particular the end of apartheid. LBJ shepherded through civil rights legislation in the late 50s that was far from satisfactory, and it was not until the mid-60s that landmark meaningful civil rights legislation was passed (to the destruction of the Democratic Party in the South and the resulting election of Richard Millstone Nixon in 1968).
    The polity is at best erratic in what it supports and what it does and does not grasp. The Senate, with the filibuster, is the major obstacle to progressive politics in America. When we get anything right, it is after a godawfully appalling process, and is in some measure the product of rational political debate (small measure, to be sure), but it is more a case of blind-assed luck, and it seems to me powerful vested interests are getting better and better at insuring that we no longer enjoy any lucky progressive advances.
    It is worth remembering, as the public attitude toward health care reform has devolved, and the president has been hemmed in by those very powerful interests, that the American public is becoming less convinced that global warming is a major issue.
    Look no further than the uninsightful, ill-informed, overly self-centered voting public and the powerful interests who exploit this reality. The trainwreck is the intellectually-challenged, fact-averse, belief-driven American mindset.
    The young plus the internet seem to me to represent the only positive possibility, but too little too late might prove the case. The current trends in popular American perceptions are, at best, pathetic. And the powerful vested interests seem to actually believe that their bottom lines can be sustained forever and that their gated communities will always protect them and theirs. So far they are correct, of course. But the ice caps are melting and the oceans will rise, and methane will be released as the permafrost melts.
    We could have had Al Gore in 2000 (he did actually win Florida once the recounts were finished, but the Supreme Court decided to inflict the Great Destroyer on us), and we were extended the opportunity to undo that disaster in 2004, but said No. Howard Dean stood against the invasion and occupation of Iraq and for meaningful health care reform, and has proven he has a backbone.
    I’ll stop now.

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  94. Jim says:

    Insurance provides a means to spread unknown risks among a large population, and moving in that direction is what is still required. However, profit-seeking insurance companies try to analyze subgroups to sort out high and low risks, which increases their administrative costs and profits. While that’s quite understandable from a Capitalist’s viewpoint, it destroys the basic concept of universally pooled risk sharing.
    Abortion is a RED HERRING (a distraction from the main agenda). This is not the time to move the goal posts on this highly contentious issue. For the record, the following non-RCC source cites many of the early Christian leaders’ view on abortion:
    http://www.orthodoxytoday.org/articles/FathersAbortion.php

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  95. questions says:

    And furthermore, the market flourishes in quikky treatment centers and drug store cliniks. These places are staffed by nurses with some doctor supervision at some level and they are fine for small easy issues. They won’t do you any good for neurosurgery — because it’s just expensive to train and feed and care for neurosurgeons. They have to be super smart, super coordinated, super educated, super devoted, and super workers. That’s asking a lot of a person. So in turn, we give a lot back and we try not to reduce neurosurgery to the level of prison labor in China. It makes sense to me. If I ever need brain surgery, I’d like it performed by someone who’s really good, really happy, and able to deal with the unique thing that my particular brain is.

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  96. questions says:

    Nadine,
    Lasik surgery is utterly profoundly and completely unnecessary. It’s a stupid medical risk for the most part for the idiotic desire to avoid eyeglasses. Of course the market works.
    The moment something is utterly crucially and vastly necessary the market is less good at allocating it.
    How humane is it to allocate brain cancer treatment by ability to pay? Breast cancer? Diabetes? Kidney dialysis? AIDS?
    The social contract is very much about the preservation of life — both in quantity of years and in quality of those years. Peace, work, education, wellness, satisfaction, enjoyment — all of this and more belongs in the things we do to make everyone’s lives better. Clearly we have to make some choices, and on my list, Lasik doesn’t count, but brain tumors do. Tap water does count, but Evian doesn’t. The minimal sheltering of all of us counts, but large well located houses doesn’t count.
    Politics is largely about adding to and subtracting from this list of things we are better off doing for each other, and things we are better off letting each of us do for ourselves. Often, there are middle grounds like the insurance exchange with subsidies for people who can’t manage, while pushing people to manage their money in a way that allows for insurance expenditures before Hawaiian vacations.
    To argue that the market allocates humanely is merely to say that you, personally, are well placed in the economy and it is to say, as well, that you have no ability to see how far you personally can fall. Thus, it is both selfish and foolish to think the market can allocate necessities well in all cases, or with some nuance, in most or many cases.

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  97. MarkL says:

    Nadine,
    Your last post is absurd.
    The evidence clearly points towards the market causing high costs, rather than the other way, based on a comparison of the US with other advance countries.
    I guess that Obama sucking really is the only thing we agree on.

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  98. MarkL says:

    Nadine,
    last word on abortion. Of course I know the modern RCC position on abortion. You’d have to live in a cave not to.
    Not all Christians are Roman Catholic, so I’m not sure why you, as a Jew, care so much about that view in particular.
    Significant legal restrictions on abortion are a modern appearance, so the fact abortion was considered a sin hardly signifies in a debate about the law. If you want the historical church attitude towards abortion to be the basis of law, then abortion should not be a crime.
    Finally, as you well know, neither ancient Jews nor Catholics considered the fertilized egg to be a human being. Abortion before quickening was not a crime, and even abortion after quickening was not held to be murder.
    Now, if you want to use a church which supports actual cannibalism as a basis for creating modern laws, you are not doing so out of respect for their believes, but casuistically.

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  99. nadine says:

    “Now the market doesn’t do a great or humane job on its own, Nadine, but the government can’t just choose patients over doctors either. So we compromise all over the place to try to balance the claims. The system is less broken than people seem to claim.”
    The market isn’t a hundred people in a room in Washington. It’s millions of people making their own decisions based on their own circumstances which they know and DC doesn’t.
    The problem with the health care market is that there is far too little market in it now. Everything is paid by third parties so there is no incentive to hold down costs. In those corners where people pay for their own services, like lasik eye surgery, costs have been held down and service is good. Because otherwise, somebody else gets the customers. But who knows what one neurologist costs compared to another? You just get ordered which one to go to if you are in an HMO. Now with Obamacare, he will be ordered how to treat you.
    The chief problem with the current system is that costs are too high. Costs are two high because the market is too bolixed up to keep costs down. Instead of limiting costs, this bill will let them explode.

    Reply

  100. questions says:

    More random thoughts….
    Walmart holds what’s called a monopsony. That is, as a single vast consumer, it controls producer prices. The downward pressure Walmart places on the Chinese labor market is horrific for Chinese laborers.
    A big concern about the public option/Medicare for all is that the fed gov’t might end up with monopsony power. If the government “holds the line” on the costs of medical billings, to quote a doctor I know, who holds the line on what nurses get paid, what the landlord gets paid, what basic office supplies cost… and so on.
    Bending the cost curve has huge huge ramifications for the distribution of medical services. Many doctors refuse Medicaid, some doctors refuse Medicare. Limiting significantly what they are paid will make more doctors take similar action. This will continue until there is no way to get patients aside from through these programs, and so there will be scarcity until everyone adjusts.
    Now, this point is merely one among so many policy issues that have to be balanced that I don’t know why anyone is freaking about the compromises that were made. Compromises within democratic political systems are made among legitimate citizen claimants. Doctors are citizens, nurses are citizens, patients are citizens. How do you balance the very legitimate claims to reasonable remuneration and care when they collide?
    Now the market doesn’t do a great or humane job on its own, Nadine, but the government can’t just choose patients over doctors either. So we compromise all over the place to try to balance the claims. The system is less broken than people seem to claim.
    Re the war and health care funding — the Senate has a conservative/rural geographic bias built in by design. So of course things that are conservative and rural and popular like war are easier to fund than things that are liberal like health care funding. It wouldn’t matter that 75% of the people wanted something out of the Senate if those people are in a some number of large states. The Senate is biased against such preference patterns. It ain’t broke, it’s how it was designed.
    As for Obama and progressivism — he’s a Chicago progressive — this means that there’s a preference for letting people make as many of their own decisions as possible within a market of choice rather than through government mandate, BUT there’s an acknowledgment that the market fails routinely, and so the government acts as chief architect of choices.
    The insurance exchange does a far better job of satisfying this concern than does a public option. Because the exchange will, in theory, grant group rates to individuals who sign on, there will be a decent sized risk pool and individual rates should be more manageable.
    But let’s not forget that insurance just IS expensive. 13 thousand a year for decent enough family coverage is pretty typical. The money has to come from somewhere.
    The structure of insurance is basically that one has to price rare but devastatingly expensive costs, and the best way to lower individual cost in such a situation is to have everyone participate in the cost-sharing. The mandate makes sense at this level. You cannot predict whether or not you’ll get cancer, viral pneumonia, an autoimmune disease, some rare condition that costs hundreds of thousands of dollars to deal with, so you join a risk pool. Because we won’t really ever turn down claims for health care at least at the emergency level, we all need to pay collectively for those among us who will make claims.
    There is some interesting work on whether or not predictable costs should ever be part of an insurance scheme –routine visits, vaccines, screenings are all things we can plan for, and so we should manage them out of pocket according to this view. The system we’re pushing for isn’t entirely an insurance system, it’s in part a care system and it might be nice to have those terms clearly noted. First dollar coverage of predictable events is care, not insurance.
    If the subsidies are well-structured, the mandates make some sense. I do not love mandates and people at the margin of the subsidies will indeed have a hard time with the payments, but the system functions better with some individual sacrifice, and the system has been built with some safety room.
    All in all, the bill compromises where it needs to, deals with a certain amount of necessity, will help people get coverage in many instances where they couldn’t have before.
    And Obama got it through with a whole lot less of the imperial presidency shit we could do without. He let Congress write it, he let the American political process churn through it, he acknowledged that sausage making isn’t really pretty, but it is our system. We have to balance a lot of people’s preferences. All those people are citizens, as much as one may like to deny it.

    Reply

  101. nadine says:

    “Nadine, the exchanges will be accessible to people purchasing insurance as individuals.” (Dan Kervick)
    What good is accessible when they have done nothing to control costs?

    Reply

  102. nadine says:

    “(e.g. Washington Post poll in Oct. 57 favorable; 40 percent oppose the public option; a CNN poll found 61 percent support for the public option in October. The same poll that you linked too for CNN shows 53 percent support for the public option at the beginning of this month).” (Franklin)
    First of all 53% is a lot less than 70% or 80% support. Second, I’m dubious about the support, and I’ll tell you why.
    The public option is very susceptible to being swayed by the form of the question. If it’s put as an option just for those who can’t find affordable insurance, people tend to be for it.
    If it’s put with words like “choice” and “competition”, words that poll well and Democrats always used in their talking points points, people tend to be for it.
    The CNN poll used the question “Now thinking specifically about the health insurance plans available to most Americans, would you favor or oppose creating a public health insurance option administered by the federal government that would compete with plans offered by private health insurance companies?”
    Note the phrasing: “that would compete”
    But if the question is put as “government-run health insurance” then people are not for it. If it were put as “government-run health insurance that will put private insurance out of business”, which is what the single-payer fanciers really want it to be, then it would get support only of those who favor a single payer system. I can’t find a recent poll asking the single payer question, but obviously if the White House thought they had anything like a majority they would have gone for it.
    The problem with the current system, from a reformist’s angle, is that 80% of people are happy with it. That’s why Obama had to keep promising (mendaciously) that everybody would get to keep their current insurance.

    Reply

  103. kotzabasis says:

    Kervick
    Indeed, I’m confused. What difference does it make whether Obama uttered the word “present” in the Illinois State Senate or the U.S. Senate? Does it change to any degree Obama’s fundamental character whether the word was crowed in Illinois or Washington? And why are you evading the issue of “distortion” by diverting it? Is it because you cannot find a scintilla of refutable evidence to what I asked you to show?

    Reply

  104. SuperBigGulp says:

    I know there are some good things in the bill, but it seems we
    could have gotten to the same place had we just passed a bill
    with three components:
    (a) some sense of the Senate language emphasizing the
    importance of everyone having health insurance
    (b) a TARP-like program for insurance companies (even through
    they don’t need a bailout
    and
    (c) some language allowing Roe v. Wade to be overturned on a
    state by state basis.
    Such a bill would have had the same impact on public health
    (almost zero), and generated much less drama.

    Reply

  105. Sandy says:

    MarkL. I agree with most of what you are saying. Nadine, we all know the Catholic Church’s stand on abortion. Dirty politic’s for a 70+ year old man (men) to use against women, if they go through with her pregnancy or not, as part of the conditions of a health Care Bill for an entire Nation? I am a Catholic and for the life of me, I can not understand how anyone with an education above the 8th grade would allow a church to influence a Health Care Bill for an entire Nation?? Our Nation is concerned with issues such as pre-existing conditions, families that can not afford Health care, Children that have never been seen by a doctor. These are just a few of the issues that I am worried about? How about You?

    Reply

  106. Franklin says:

    Nadine,
    My point was that the public option — which enjoys roughly the same level of support as the Iraq War did in 2003 — is unable to gain the same traction amongst elected officials as a going to war.
    That’s a pretty disturbing statement if you think about it — politicians in recent years have been more willing to commit hundreds of thousands of troops and trillions of dollars to a war of choice, then they have been to a policy measure which will save taxpayers and consumers money — and which might also save lives.
    The polling data that you cite only applies to the current health care reform legislation — which it should be noted contains only a weak public option in the House bill, and no public option now in the Senate bill.
    Part of the reason for the reform legislation’s poor numbers is due to the fact that it is bleeding support on both the right AND the left.
    This shouldn’t be too surprising considering that a provision that polls well — the public option — is absent from the legislation.
    (e.g. Washington Post poll in Oct. 57 favorable; 40 percent oppose the public option; a CNN poll found 61 percent support for the public option in October. The same poll that you linked too for CNN shows 53 percent support for the public option at the beginning of this month).
    I suspect, there are probably a number of other factors at play in the polling data.
    I’d wager that part of the dissatisfaction stems from a desire by the public for the president and the Congress to focus on the economy and jobs — and perhaps they see health care as a distraction. Part of this is undoubtedly due to the complexity of the legislation, which makes it easy to misrepresent what the bill actually contains.

    Reply

  107. Dan Kervick says:

    Kotz, you are confusing the Illinois State Senate with the US Senate.
    Why don’t you stick to your own country, huh? You don’t see us bombing your site with ignorant comments about our stances on the Kangaroo Protection Act.
    It’s one thing to take an interest in US foreign policy, which affects the whole world. But health care in the United States is our own fucking business, and I doubt you know the slightest thing about it. So give it a rest.

    Reply

  108. Dan Kervick says:

    Nadine, the exchanges will be accessible to people purchasing insurance as individuals.

    Reply

  109. kotzabasis says:

    Well Kervick you can ‘ungarble’ it. Show me that it’s a distortion that he uttered the word “present” in the Senate more times than he ever fought for anything of substance in it, and more relevantly, that he fought for anything of substance in the present. And Clemons indicates the many occasions when Obama was ‘presently’ absent from the many contemporary fights, e.g.from the “publick option,” from “women’s health rights, “from “Don’t Ask Don’t Tell,” from a “viable Palestinian State,” and the Obama syndrome of not FIGHTING goes on and on.
    If you don’t respond to the above it will be an acknowledgement by you of the captiousness of your short sentence which has more to do in settling old scores than with the reality of Obama’s EFFETENESS. And I guess if you ever want to have a roughless voyage on a boat you can always take a trip with ‘don’t rock the boat’ Obama.

    Reply

  110. Franklin says:

    Actually, there is one more thing: Please Dem reps and President Obama — no triumphalism. Please don’t insult the intelligence of voters by telling us what a wonderful bill this is.
    It’s a sad enough statement about our political system that it has taken this long to get to just this point.
    It’s equally dispiriting to see just how transparently bought-off so many elected representatives are.
    The GOP comes off looking uniformly bad; but too many Dems come off looking a little dirty as well.

    Reply

  111. nadine says:

    “Yet a public option, which enjoys similar levels of popular support, which will cost no blood, and will actually save consumers and taxpayers treasure can’t even get 60 votes in a Democratically controlled Senate. What more needs to be said?”
    Franklin, you are kidding yourself. The majority of voters oppose the Senate legislation. Why do you suppose Harry Reid is so desperate to pass this thing NOW? The longer debate goes on, the less popular it becomes.
    “December 10th, 2009
    CNN: 61% Oppose Senate Health Care Plan
    Posted by Tom Bevan
    A new CNN poll shows 61% opposed to the health care plan currently working its way through the Senate. Only 36% approve of the legislation.
    As a point of comparison, last month CNN asked an identical question about the health care legislation under debate in the House of Representatives and found 49% opposed and 46% in favor.

    http://realclearpolitics.blogs.time.com/2009/12/10/cnn-support-for-health-care-collapses/

    Reply

  112. nadine says:

    “The bill is a mixed bag. Many people will benefit, including many of those with pre-existing medical conditions, the poor, and people who are self-employed or employed by small firms”
    Dan, how on earth do you figure that the self-employed will benefit? What’s in it for them besides higher premiums?

    Reply

  113. Franklin says:

    Right now it’s hard to see health care reform as a victory.
    It has some potential benefits for the uninsured and for working and middle class families with small group or individual insurance plans. The subsidies should provide an income boost in the short-term for those who currently are paying for premiums out of pocket.
    It has some even bigger benefits for some Democratic politicians who might end up being favorites of a powerful industry lobby — at least insofar as cash is concerned.
    The process has exposed Lieberman for who he is; and it will effectively end his career as an elected politician in 2012 at the latest (he may opt to retire earlier and cash in with an industry lobby).
    Basically, the Dems achieved something approximating near-universal coverage — no small achievement — but it looks like they may be doing it at the highest possible cost to taxpayers and consumers. The measures are likely to entrench a dysfunctional industry and perhaps enlarge its power.
    In the end, depending on the final negotiated bill, I see this as mostly a wash. Politically it’s an achievement to get the 60 votes in the face of an obstructionist GOP. The Dems don’t look like they’ll need to resort to reconciliation. But so much was given up in the process that Obama ends up looking simultaneously like a weak ally of his electoral base and a weak negotiator.
    The Congress looks like an especially dysfunctional institution. In 2003 we went to war when the public had support in the high 50s and low 60s for the action. The action will cost us at least a couple trillion and several thousand lives. The measure enjoyed support from 77 Senators.
    Yet a public option, which enjoys similar levels of popular support, which will cost no blood, and will actually save consumers and taxpayers treasure can’t even get 60 votes in a Democratically controlled Senate. What more needs to be said?

    Reply

  114. nadine says:

    DonS, half the country thinks abortion is a human right and the other half thinks it is murder. There has been a working compromise, which makes first trimester abortion legal but doesn’t require taxpayers to fund it. The Senate bill upsets this compromise. You have to expect the pro-life camp to be upset at being required to fund abortions.

    Reply

  115. nadine says:

    MarkL,
    You speak, as liberals often do, as if civil values sprang full-formed from nothing and are equally understood by all right-thinking people (meaning fellow liberals). This view is both ignorant of history and intolerant, for it dismisses the concerns of everybody else as beneath consideration.
    It is disingenuous to say that religion has nothing to do with civil law, because religion informs the values which underlie the legal codes. The civil law of the USA is derived from Judeo-Christian and Enlightenment values. If it were the opinion of Christianity (as it was in ancient Rome) that the father has the rights of life and death over his offspring, paternal infanticide would be legal. It’s not legal because Christianity, as the majority religion, puts a high value on life.
    Can you really be so ignorant as to not know the position of the Catholic Church on abortion? It’s easy to Google. Not only do they consider it murder, they often speak as if it were worse than murder.

    Reply

  116. DonS says:

    Jim, I don’t think you would want to be in the presence of too many informed and principled women when you equate “keep your hand off my body” with “keep your hands out of my pocket”. Your insensitivity amazes me.

    Reply

  117. Bill says:

    Great post. I’m afraid our president would rather hold on to his political capital rather than use it for fighting for something he believes in. Seems like he’d rather other people fight for important things while he stays above the fray — then he can claim credit later on.
    The problem is, if you fail to take risks when they are needed, you’ll lose political capital anyway and will come to regret your timidity.

    Reply

  118. Dan Kervick says:

    Steve. I don’t understand how you could say that Axelrod “acknowledged” Gregory’s claim. That’s sloppy.
    However, that said, a more important issue is that there is good reason to believe Axelrod is just flat-out lying when he says Obama supported the public option. Obama’s occasional professions of support for the public option were faint and entirely unconvincing. I don’t know if he thought the public option was bad policy, or if he had made a deal with the industry to kill it in exchange for getting the rest of the bill through, but it seems evident that while the White House was mumbling support for the public option in word, to appease their left wing, they were working to quash it in deed.
    The bill is a mixed bag. Many people will benefit, including many of those with pre-existing medical conditions, the poor, and people who are self-employed or employed by small firms. But many others likely won’t benefit at all. By failing to challenge the industry strongly, by failing to restructure and rationalize the whole system, and by failing to impose the cost pressure of a viable public option, the White House and Senate have delivered a reform bill that will turn into the Health Industry Profit Enhancement Act. Small business people and large portions of the middle class are being asked to foot the bill for the benefits given to the needy, and are going to see their own costs continue to rise while the industry reaps a windfall from all the new customers shoved their way by mandates and subsidies. And much of what has been legislated will probably be bargained or given away, and rendered toothless, in the long process of writing the actual regulations between now and 2013 and 2014.

    Reply

  119. ... says:

    the quote from frank rich that nadine is enamoured with….funny but i thought nadine wasn’t american!
    “After his “indefinite break” from golf, Woods will surely be back on the links once the next celebrity scandal drowns his out. But after a decade in which two true national catastrophes, a wasteful war and a near-ruinous financial collapse, were both in part byproducts of the ease with which our leaders bamboozled us, we can’t so easily move on.
    This can be seen in the increasingly urgent political plight of Barack Obama. Though the American left and right don’t agree on much, they are both now coalescing around the suspicion that Obama’s brilliant presidential campaign was as hollow as Tiger’s public image — a marketing scam designed to camouflage either his covert anti-American radicalism (as the right sees it) or spineless timidity (as the left sees it). The truth may well be neither, but after a decade of being spun silly, Americans can’t be blamed for being cynical about any leader trying to sell anything.”
    The truth may well be neither, but after a decade of being spun silly… keep on spinning nadine…

    Reply

  120. Jim says:

    DonS,
    Re: “Have you heard the expression “keep your hands off my body”. Now what do you think that means?”
    Reply: Essentially, it carries the same meaning as “keep your hands out of my pocket”.

    Reply

  121. DanE says:

    Obama’s campaign was structured around then slogan “Yes we can.”
    The Republican Party edict is “No we won’t.”
    Can is a possibility but not a certainty. Won’t is a definitive action.
    Obama offered the possibility of better things for the American people. He then opposed any beneficial action to deliver these better things.
    Republicans declare opposition to even the possibility that anything needs changing, except lowering taxes, of course.
    Obama is Lucy setting the football down and then yanking it away.
    The Republicans won’t even show us the football until we agree to let them win the game before it even starts.

    Reply

  122. MarkL says:

    Linda,
    thanks for your response; it agrees with what I know. What puzzles me is that I know from watching 5 minutes of television at any hour of the day that such one stop sites already exist today.
    They’re not a big deal.

    Reply

  123. MarkL says:

    Nadine,
    I am sure you are blowing smoke on the history of Christianity and abortion, but I don’t wish to pursue the matter.
    DonS speaks for me on this point: these are civil matters, not religious.
    On Judaic beliefs, you cleverly elide a crucial distinction between Judaism and Catholicism, which is that Judaism in no way considers a fetus to be a person.
    The fact that Catholicism does hold this brief is no more relevant to creating law in the US than the fact that the RCC believes its members eat the actual flesh of Christ for breakfast on Sundays (don’t we outlaw cannibalism in this country? If you are a since believe in Catholic doctrine, you should arrest yourself)

    Reply

  124. Inyourfacepeaceseeker says:

    Enough is enough; Obama believes that the progressives’ support is guaranteed, after all where do they have to go?! Well, he is wrong, we can stay home or we can support Nader (or whoever will run on the left of Obama). I hope progressives on the Senate and the House will reject this bill!
    Specifically on the abortion issue, I wonder what all the feminists and women groups that supported Obama over Clinton are thinking now…

    Reply

  125. Linda says:

    My understanding (and I surely don’t understand a lot about how much in these bills will be implemented) is that the exchanges are merely a one-stop shopping site–perhaps a website where all the available insurance products will be listed. The idea of a public option is that one choice on the exchange would be a public option government run plan.
    I believe the MA plan has an exchange that they call “The Connector.” So somebody from MA perhaps could explain better exactly how it works.

    Reply

  126. nadine says:

    “there’s been a concerted effort on the part of many since the acknowledgment of obama, to paint him out as an empty suit, or worse… i think the comparison with tiger woods is really unfair, but to be expected in the hostile and heated atmosphere of politics today… the atmosphere has become so corrosive that one wonders about those who continue to focus on it…”
    Hey Khalid, the guy doing the Tiger Woods comparison was Frank Rich of the New York Times!

    Reply

  127. nadine says:

    “Nadine,
    Whether abortion is infanticide is NOT in question and never has been.
    Furthermore, it’s bizarre that you bring up your Jewishness, because historically, abortion was a non-issue for Jews (the same holds for Christians, btw).”
    You are badly mistaken with regard to both religions. Traditional Judaism forbids abortion except to save the mother’s life; different rabbis define how much risk to her there needs to be differently. The difference between Judaism and Catholicism (I’ll use Catholicism as the example because I’m not familiar with the ins and outs of the Protestant sects) is that Catholicism defines the foetus as a person from conception, so abortion is tantamount to infanticide; but Judaism defines the foetus as a potential person, so the mother’s rights come first. But it is definitely not a “non-issue” in either case.

    Reply

  128. ... says:

    there’s been a concerted effort on the part of many since the acknowledgment of obama, to paint him out as an empty suit, or worse… i think the comparison with tiger woods is really unfair, but to be expected in the hostile and heated atmosphere of politics today… the atmosphere has become so corrosive that one wonders about those who continue to focus on it…
    if you want to see knee jerk reactions towards obama in real time, read the posts of nadine or kotz… this will give you a view from the right, far right, or the gutter depending on your own position…
    personally i don’t think axelrods comment is “a stunning acknowledgment”.. i think it’s stunning citizens can hold any leader in such high esteem without ever considering the many possibilities… or alternatively, they can only view the leader a certain way based on their own partisan politics…. but that’s life… people surprise me… i hope that continues…

    Reply

  129. MarkL says:

    POA, remember that guy —George something—who sells intel info, used to work for the CIA, who was telling people 5 and 6 years ago that the “real” reason for the invasion of Iraq was to pressure KSA to do something about Al Qaeda?
    Your posts reminded me of him and gave me a laugh.
    This is the same guy who said in 1990 that the US was on the brink of war with Japan.

    Reply

  130. MarkL says:

    POA, thanks,
    your info on Yemen is interesting.
    Is there any official Saudi release on the bombing?

    Reply

  131. PissedOffAmerican says:

    “About Yemen: without knowing anything except the headlines, I will say that at least he is striking close to the heart of Al Qaeda, in KSA”
    Dig a little deeper. Its questionable that Al Qaeda has anything to do with Obama’s motives.
    Cruise over to Marsh’s site, and look in the Diary Section to see what I have dug up so far. I woulda posted it here, but I’m trying to be on good behaviour here and stay on topic so that Dan doesn’t break anymore veins in his neck.

    Reply

  132. MarkL says:

    Well, POA, there is more agreement about Obama than any other topic on TWN.
    About Yemen: without knowing anything except the headlines, I will say that at least he is striking close to the heart of Al Qaeda, in KSA.

    Reply

  133. MarkL says:

    Nadine,
    Whether abortion is infanticide is NOT in question and never has been.
    Furthermore, it’s bizarre that you bring up your Jewishness, because historically, abortion was a non-issue for Jews (the same holds for Christians, btw).

    Reply

  134. PissedOffAmerican says:

    “I’m sure that POA would have “re-educated” me if you didn’t”
    Naaaah. If you haven’t figured out what Nadine is by now, my two cent’s worth ain’t gonna to ring any bells.
    How about that Obama, eh? I think he has set a record for the shortest elapsed time to a failed Presidency.
    TPM is asserting the White House also might have worked actively with the FDA to scuttle a bill lowering Pharma costs.
    Interesting that this Yemen thing is unfolding while we all have our bowels in an uproar over Obama’s latest domestic sell-out. Its no suprise that just like Bush and his SOS, Obama and his SOS feel empowered to look us straight in the eye and unabashedly LIE about how they are using our military might.
    I know it gets a few panties in a wad when I state that Obama seems to be a new piece of shit just like the last piece of shit, but hey, what else can I say? “I told ya so” is gettin’ kinda old.

    Reply

  135. Dan Kervick says:

    “While he was senator all he said in the Senate was that he was PRESENT and he never fought for anything.”
    Kotz, it looks like you version of this story got garbled on its way from the US to Australia.

    Reply

  136. nadine says:

    “With respect David, there are more than enough ‘safeguards’ built into various options for ‘public health’ funding to insure that your tax dollars don’t directly fund abortions.” (DonS)
    Not in the Senate bill. The Hyde language that has guarded Federal spending up til now is not in there. That’s why Bart Stupak in the House says he intends to fight for stronger language.
    “As an honest atheist, I don’t respect people who base their politics on lies. Abortion is not infanticide.” (MarkL)
    As a Jew, I’m not keen on having some people impose their moral definitions on every else, whether Christian or atheist. Whether abortion is or is not infanticide is very much a matter of opinion.
    Even as a matter of common usage, when a 7 month pregnant woman feels a pain, does she say “the fetus kicked me” or “the baby kicked me”?

    Reply

  137. DonS says:

    With respect David, there are more than enough ‘safeguards’ built into various options for ‘public health’ funding to insure that your tax dollars don’t directly fund abortions.
    However, as a Christian, you should also be cognizant of the derivative principle that it should be none of your business what a woman chooses with regard to her own body.
    This is a civil rights issue. If it offends you on a religious basis, don’t do it, or don’t encourage the woman in your life to do it. Has it occurred to you that a woman might choose an abortion regardless of the funding source; and by what damn right do you think you should have to determine what another individual should choose?
    Divine right???
    The government of the United States is built on civic principles, not religious. By all means,fight the federal funding of abortions. But I’ll just bet, from your rhetoric, you would have voluntary abortions outlawed as the law of the land; a far cry from your principled words about rape and incest, and a million miles from the right of a woman to choose what she wants for herself.
    Have you heard the expression “keep your hands off my body”. Now what do you think that means?

    Reply

  138. kotzabasis says:

    Surprise, surprise that is vintage Obama. While he was senator all he said in the Senate was that he was PRESENT and he never fought for anything. It might finally dawning on Clemons that America in its most dangerous moments has a weak president at the helm, as I predicted more than a year ago in my article ‘Americans Pick a Lemon for President.’

    Reply

  139. MarkL says:

    Jim,
    As an honest atheist, I don’t respect people who base their politics on lies. Abortion is not infanticide.

    Reply

  140. Jim says:

    Currently, there are 233 legal abortions for every 1,000 live births in the US. In New York City the ratio is 750 abortions per 1,000 births, whereas in Utah the ratio is 69 abortions per 1,000 births.
    The abortion issue is a Red Herring. Abortion should not be banned, especially for serious reasons (such as rape, incest, or danger to the life of a mother). Nevertheless it is the destruction of an innocent human life.
    As a Christian, I don’t want my tax dollars casually used on a birth control procedure that destroys babies.

    Reply

  141. MarkL says:

    Linda,
    IIRC, your area of work is related to health care. What about the exchanges?
    I don’t see any reason to think they offer more than the public option.
    Also, aren’t they similar to options that are already available?

    Reply

  142. Linda says:

    Any bill of this length, and even Bernie Sanders’ single payer bill at over 700 pages, is poorly written and bad legislation. Medicare (and Medicaid) bills were under 100 pages long.
    It was clear from the start of this year when single payer was not on the table that progressives would not get what they wanted. Single payer advocates had to fight to even get invited to one of the many meetings of players at the White House. It also was clear pretty early on that deals would be made to placate all parts of the medical-industrial complex to keep them from opposing any legislation. And it was clear also that the public option would be negotiated away if needed.
    Very little of either House or Senate bills takes effect until 2012–so there is plenty of time for adjustments–even major changes. No matter what finally passes, it probably will take a month or two after until anybody has a chance to understand what it all means in practical terms, i.e., for the people to understand how it will impact them individually.
    Medicaid will be greatly expanded, but it is totally outrageous that NE (to get Nelson’s vote) should not pay its fair share of expanded Medicaid costs. Special deals were made with several other states to get their legislators’ votes.
    That simple means that most of us who live in the rest of the states will not only be paying more for our needy citizens which I’d gladly do. But we’ll also be paying for NE’s Medicaid recipients. I’ve already written my Congressman about that and suggest others do the same.
    As for the abortion provisions, they probably will be there in some form because they are in both House and Senate bills–so I don’t think Planned Parenthood will prevail in conference to reconcile the two bills. But these provisions probably violate both the First Amendment (religious freedom) and 14th Amendment (equal protection)–so they will need to be challenged in the courts.

    Reply

  143. MarkL says:

    No need for your comment, Neo.
    I’m sure that POA would have “re-educated” me if you didn’t.
    Did you forget to tell me that “Nadine” is just another alias for bertignac?

    Reply

  144. Neo Controll says:

    For the uninitiated, be aware that Nadine, Zio-pimp, projects all trends out to the benefit of the right wing cause which includes a foreign policy posture that is subservient to RW Israeli interests.
    Her apparent interest in domestic politics, health care and the like is only a surrogate for pimping the RW Zionist cause.
    – NCHQ

    Reply

  145. mgl_61@yahoo.com says:

    There is no Republican who can be credible as a populist with ALL voters and win the nomination.
    The religious kook hurdles are too high.
    Not to mention that most elected Republicans are quite nuts themselves, these days.
    The fact Newt Gingrich is still a major spokesman for the GOP tells you the extent of their troubles. I disagree with Newt, but that’s not my point, which is that he has no charisma at all, or credibility. Not only that , his record of political caving in his later career SHOULD have made him poison to the GOP.

    Reply

  146. nadine says:

    “Well, Obama has brought together left and right here, Nadine.
    I doubt we agree about many other issues.” (MarkL)
    So he’s a uniter after all -g-

    Reply

  147. nadine says:

    “Speaking of Glenn Beck, the Democrat who can win big in 2012 is the one who understands that many (not all) of the teabaggers have lost their faith in government much the same as people on the left.
    Both groups share a desire to have a government which responds to the needs of the citizens.” (MarkL)
    Agreed, except I think the politician who will be most likely to be able to do is a conservative Republican. The Democrats will be carrying Obama’s baggage in 2012. At the rate his numbers are sliding, that doesn’t look pretty.

    Reply

  148. nadine says:


    I don’t believe your figure about the cost.
    The CBO has given the bill reasonable scores (although I haven’t looked at the details)” (MarkL)
    You should believe me, they are accurate. The problem with the CBO is that they have to score the bill that is laid before them, even if it is full of nonsensical conditions that everybody knows won’t actually happen.
    The conditions of the bill the CBO scored are: 1) the taxes start immediately, but the benefits don’t roll out for four years, so they are scoring 10 years of taxes against 6 years of benefits, and 2) there is no Medicare ‘doc fix’, so Medicare reimbursement rates to doctors will drop 20% from 2011 on. Medicare reimbursement rates to doctors already average only 80% of doctor costs; they overcharge the private patients to keep going. If the the rates get cut again, it’s estimated that 20% of hospitals will go broke and half of doctors will stop taking Medicare patients.
    Check the numbers out for yourself.

    Reply

  149. MarkL says:

    Well, Obama has brought together left and right here, Nadine.
    I doubt we agree about many other issues.

    Reply

  150. nadine says:

    “Nadine,
    I think my description fits perfectly.
    Obama definitely wants a health care bill passed, but only for the politics of it. He clearly has very little preference about the specifics.
    Six months ago he said the excise tax was a terrible idea, and that the public option was on the table, for instance.” (MarkL)
    This is the weird mix of radicalism and passivity. Why start health care reform but not care about what’s in the bill? Maybe Obama is just utterly clueless about the nature of national American politics. Because the politics of this health care bill are awful for the Democrats, and getting worse by the day. By now polls say most voters would rather do nothing than pass this bill. Voters can tell that Harry Reid et. al. no longer care what the bill actually does; they are just desperate to pass anything.

    Reply

  151. MarkL says:

    Nadine,
    I don’t believe your figure about the cost.
    The CBO has given the bill reasonable scores (although I haven’t looked at the details)
    Speaking of Glenn Beck, the Democrat who can win big in 2012 is the one who understands that many (not all) of the teabaggers have lost their faith in government much the same as people on the left.
    Both groups share a desire to have a government which responds to the needs of the citizens.

    Reply

  152. nadine says:

    “I am at a loss as to how people can see this bill as a win for the Democrats, politically.
    On its merits, it may be a small step in the right direction, although not optimal by far.
    The problem is that the bill gives the Republicans TWO strong, populist themes to run on: the mandate and the excise tax.
    As I understand it, the mandate forces people to buy insurance, but they still may have high out of pocket costs.
    The excise tax is a terrible, regressive way to the finance the bill. As Obama himself said last July, a tax on wealthier Americans such as himself was the appropriate way to pay for it.
    The ads just write themselves” (MarkL)
    Agreed, and you’ve just scratched the surface. The ‘Glenn Beck’ argument – since the people don’t benefit, who really will benefit and who wants this? this is just the excuse for a statist takeover of 1/6 of the economy – is going to resonate hugely.
    You do realize, I hope, that you could not begin to pay for this behemoth if you confiscated the entire estates of everybody making over $250K a year? It is a 2.5 Trillion dollar disaster – unless you can figure out some way to collect 10 years of taxes for every 6 years of benefits in perpetuity.

    Reply

  153. MarkL says:

    Nadine,
    I think my description fits perfectly.
    Obama definitely wants a health care bill passed, but only for the politics of it. He clearly has very little preference about the specifics.
    Six months ago he said the excise tax was a terrible idea, and that the public option was on the table, for instance.
    The details of the bill that matter to Obama are those that affect his relationship to his donors—e.g., dropping the money-saving drug reimportation clause of the bill, which big Pharma opposed. The mandate without a public option is clearly preferred by the insurance industry to a plan with a public option.
    And so on.
    Another example: I believe it was you who said that the mandated plans may have only 70% coverage. That is a DETAIL with which a President who cared about the issue would concern himself.
    The reason for attending to health care this year is to secure donations from big Pharma and the insurance industry for next year.

    Reply

  154. nadine says:

    “I don’t think Obama cares about the details of domestic policy. He has an obvious passion for the details of foreign policy, so there’s no overarching character trait at work, in my opinion” (MarkL)
    That’s a very odd thing to say about a candidate/President who made health care reform the signature item of his first year in office. If he didn’t care so much about domestic policy, then it would have been a no-brainer to attend to the economy, which is what the voters actually wanted him to do, and leave health care alone.

    Reply

  155. MarkL says:

    Elvin,
    The fantasy is that Obama was in any way fighting for the public option or any other progressive direction for the bill.
    Obama DID use his influence.
    First of all, he made the key point that he was working for “health insurance reform” (his words).
    Next, there was the constant message from the White House that Olympia Snowe’s vote was very important. Obama gave her the power to stall health care.
    On the other hand, the White House made no bones about raking liberals and progressives over the coals. Rahm said proponents of the public option were fucking stupid, IIRC.
    Also, saying that the public option was only a “sliver” of any health care reform plan was another shiv for the progressives.
    You are the one who is deluded, I’m sorry to say.
    Now, I’m actually not convinced the current bill is completely awful, but I think the politics of it are clearly very bad for Democrats.

    Reply

  156. MarkL says:

    Nadine,
    I don’t think Obama cares about the details of domestic policy. He has an obvious passion for the details of foreign policy, so there’s no overarching character trait at work, in my opinion

    Reply

  157. nadine says:

    Elvin, pure partisan infighting. The White House and Majority Leader do have tools at their disposal when they go all-out. They could promise Nelson that if he became the Democrat who brought down Obama’s signature issue, he would never do business in the Senate again. They must have done so, for Nelson to sell out for so little (the special Nebraska deal doesn’t even kick in until 2017, and can be rescinded 10 times over before then). The latest poll from Nebraska says voters are opposed to the Senate bill by 26% to 67%. In a case like this, you don’t have to imagine political force, you know that force must have been applied, and a lot of it.

    Reply

  158. ElvinJ Baltimore says:

    What fantasy potion or persuasion technique does Obama possess that would enable his “fighting” to sway Ben Nelson, Lieberman, Snowe, etc.?
    Obama’s critics with this argument are not living in the real world. The iron is that they impute magical power to Obama, yet call Obama’s defenders magical thinkers.
    Really bizarre.

    Reply

  159. nadine says:

    Quite as vapid, but the main point is that Frank Rich is much, much farther left than David Brooks. We are getting commentary from the left wing now that cannot be told from commentary from the right -wing. Rich Lowry of National Review could have written that line.
    Obama does present a weird mix of radicalism and passivity. I think the crux of the matter is that Obama is a cheerleader, not a leader.

    Reply

  160. MarkL says:

    Nadine, Frank Rich is as vapid as Brooks, so I hope I can be forgiven for mistaking one for the other.

    Reply

  161. nadine says:

    MarkL, good guess but wrong. The actual answer is surprising.

    Reply

  162. nadine says:

    “Suppose you take so-called public utilities — power generating entities — for comparison. It has been questionable for a long time where such entities deserve the name ‘public’ when they are in virtually all respects private. And these entities are subject to strict, albeit ‘generous’ regulation, with actual controls on permitted rates of return. Comparison with the wild frontier of supposed insurance regulation — who was it we bailed out? — should make anyone with a shred of common sense cringe.” (DonS)
    Yes, this is always the problem with heavily regulated industries – you get crony capitalism, where the capitalists grease the palms of the politicians to get good conditions for themselves, and never mind the customer.
    It’s the name of the game. It’s what always happens.
    Strangely, when liberals see the situation they think it can be cured by making the government hug the industry closer – more regulation! be tougher! etc. But the money offerings of the capitalists always talk louder than the will of the liberals.
    You’d think they would have noticed this by now, but there is something about the way liberals think that always makes them weigh intentions more than results.
    The conservative answer is to make government let go of industry and make industry compete in the marketplace. This at least makes the actual customer be the customer to whom industry must answer, instead of the politicians.

    Reply

  163. MarkL says:

    Nadine, that reads like David Brooks to me (I didn’t check).
    I would like to see an analysis of how much the “HCR” bill will cost the median citizen who will be subjected to the new mandate.
    The numbers won’t be pretty, I’m sure.

    Reply

  164. nadine says:

    A well known pundit wrote these words today in a major newspaper. Can you guess who it was?
    “Though the American left and right don’t agree on much, they are both now coalescing around the suspicion that Obama’s brilliant presidential campaign was as hollow as Tiger’s public image — a marketing scam designed to camouflage either his covert anti-American radicalism (as the right sees it) or spineless timidity (as the left sees it).”

    Reply

  165. nadine says:

    Like Obama says, the Democrats stand on the precipice…and are fixing to jump.
    Can you believe Axelrod is saying that even though the bill in unpopular, people will get to like it later? This for a bill that promises only higher premiums and higher taxes with NO befits for four full years? Could his contempt for the voters’ opinions be more explicit?

    Reply

  166. DonS says:

    MarkL: “The mandate seems to me almost a weird kind of fascism: the government forcing citizens to by crappy insurance from private corporations.”
    Nothing ‘almost’ about it. It is incredibly naive, substantively and politically, to get anyone to find a mandated buy in to a crooked industry defensible. Even if one quarrels with the word ‘crooked’, just what kind of sense does it make to force citizens to subsidize a private industry whose bottom line is maximizing profits — not for the common good — but for shareholders. Pointing out language that ostensibly restricts CEO pay is so laughable; as if corporations are not well versed in staying one step ahead of any restrictions, tax consequences, and public accountability.
    If it’s not unconstitutional, it’s certainly legalized extortion.
    Suppose you take so-called public utilities — power generating entities — for comparison. It has been questionable for a long time where such entities deserve the name ‘public’ when they are in virtually all respects private. And these entities are subject to strict, albeit ‘generous’ regulation, with actual controls on permitted rates of return. Comparison with the wild frontier of supposed insurance regulation — who was it we bailed out? — should make anyone with a shred of common sense cringe.
    But on the main point of the post. For Axelrod to finesse a direct attack on Obama’s willingness to fight for issues may satisfy the politics-as-nuance school of public relations, but on it’s face is shocking. If nothing else, it can only be read as a ‘wink and nod’ to the right. Admittedly the colloquy was within the context of a longer discussion, but for the WH PR guy NOT to challenge the assertion that his boss “did not fight” cannot be seen as incidental. If the alternative response is “Yes he did fight” and then it is pointed out that he must therefore have lost, well, that’s time enough to bring out the political nuances. But not to rebut the point directly? No, he’s got more ‘splainin to do.

    Reply

  167. Linda says:

    Something will be passed. So it is probably moot to argue whether Howard Dean is correct or Obama Administration is, i.e., is half-a-loaf better than none? Actually it’s not half-a-loaf but a lot of crumbs and a bad bill.
    But with only 58 Democrats in the Senate and Bernie Sanders and Joe Lieberman as independents caucusing with the Democrats, a bad bill probably was inevitable.
    So everybody is going to be angry about something.
    My anger goes back to the day after the election in 11/08. While Obama did not carry GA, he won in Atlanta with 69% of the vote compared to 69.9% in LA. Everybody was happy and excited including tens of thousands of young Obama campaign workers all over the country that could and should have been sent to GA as we were going to have a runoff election against Saxby Chambliss who won his seat with that terrible campaign against Max Cleland in early December.
    Jim Martin, the Democratic candidate, had won statewide elections, is a wonderful progressive, native Georgian and military veteran, had served in cabinets of both Republican and Democratic governors–though not Mr. Charisma.
    We pleaded over and over for help that was way too little and way too late. Bill Clinton did come down for one big rally. We heard Al Gore was coming, but not for any rally–just to meet with big donors in Buckhead (Atlanta’s Beverly Hills). Donna Brazille came with no advance notice. I was working on Martin campaign, and sometimes on these few visits, we didn’t know about them until we read about them in the newspaper the next day. Brazille spoke to about 20 women at one of the women’s colleges. It was pitiful.
    Sarah Palin and other big Republican names were all over the state. The above, all only in Atlanta, was all we ever saw of big names in the Democratic Party for the entire month until the runoff election the first week in December. Hillary Clinton and the Obamas never campaigned once. If any of those big names in the party had just spent one day each barnstorming around the state and sent us all those campaign workers, Martin could have won that election.
    In at least three years before that, as part of the 50 state strategy of Howard Dean, the Democratic Party in GA was opening offices in counties where there had been no Democratic presence for years. Everything was in place except enough workers, funding, big names, etc., and Obama Administration did nothing to help elect a very progressive, liberal, and loyal Democratic Senator.
    Obama was in the Senate and surely understood that every Senate seat matters a lot–not just for health care reform but for passing all his agenda.
    Sorry for the length of this tirade. I will post later a bit more about the legislation.
    For starters, I am very unhappy that NE and a few other states are getting extra Medicaid funding in exchange for their Senator’s votes. I don’t mind paying more taxes to expand Medicaid coverage in GA, but I don’t want GA federal taxpayers to go to Nebraska so that their citizens don’t have to pay for their citizens.

    Reply

  168. Bill Kavanagh says:

    That is a stunning acknowledgment. But the deal is better than no
    deal and should eventually lead to universal healthcare, so I say
    let’s take it and hope for some improvements. Meanwhile, perhaps
    some strategies need to be set in motion to get around the cloture
    abuse and the stranglehold Republicans and a few conservative
    Democratic Senators have on the process!

    Reply

  169. MarkL says:

    Obama said that the public option was only a “sliver” of any health care reform package.
    That’s a backstabbing level of support.

    Reply

  170. MarkL says:

    I am at a loss as to how people can see this bill as a win for the Democrats, politically.
    On its merits, it may be a small step in the right direction, although not optimal by far.
    The problem is that the bill gives the Republicans TWO strong, populist themes to run on: the mandate and the excise tax.
    As I understand it, the mandate forces people to buy insurance, but they still may have high out of pocket costs.
    The excise tax is a terrible, regressive way to the finance the bill. As Obama himself said last July, a tax on wealthier Americans such as himself was the appropriate way to pay for it.
    The ads just write themselves—you dont’ even need Robert “Osama” Gibbs on your side to create powerful, populist ads against the Democrats.
    I could go on, but I recommend reading everything Big Tent Democrat writes over at Talkleft.com
    In my opinion, he is the only analyst who has gotten the politics of this right.
    For example, he was recommending the opt out for the public option weeks before it was on the radar for anyone else.
    Right now he says that the bill would be acceptable if the mandates are sunsetted, forcing the issue to be revisited in the future.
    Otherwise, the political will to improve the bill will not exist—-especially, I might add, if the GOP wins in 2010 because of the passage of this corporate giveaway.
    The mandate seems to me almost a weird kind of fascism: the government forcing citizens to buy crappy insurance from private corporations.

    Reply

  171. Jeff L says:

    oops, sorry. misread your post. You were saying it
    was acknowledgement of his statement. But I don’t
    see how you can read that and think that Axelrod was
    flat-out agreeing. In fact he turns around and says
    “he made the case again and again”. Sounds to me
    like he’s disagreeing with Gregory there

    Reply

  172. Jeff L says:

    Uh, Steve. It was David Gregory that said that.
    Not David Axelrod
    http://www.msnbc.msn.com/id/34490422/ns/meet_the_p
    ress/page/2/
    MR. AXELROD: I, I–well, look, the president had
    a–the president supported a, a public option.
    But there are other ways to get competition and
    choice. You know, we’ll see what happens over
    time.
    MR. GREGORY: He supported a public option. He
    did not fight for it till the end of the day.
    MR. AXELROD: Well, look, he made the case again
    and again for it. But understand, he–this is a
    small part of a large healthcare reform. The
    public option was within this health insurance
    exchange for the 30 million who can’t get health
    care.
    MR. GREGORY: Right.
    I’m sorry to say but your entire post is based on

    Reply

  173. DonS says:

    The post highlights the quandary that we find ourselves in. Axelrod, as mouthpiece for Obama, feels free to telegraph that Obama gives lip service only to progressive ideas. And that the administration feels free to throw off all sorts of blame on progressives along the way to establishing, or actually settling for a bottom line which, it just so happens, accommodates every centrist and right wing demand the democratic Congress can produce; not to mention the IMPLICIT acquiescence to all sorts of republican and assorted independent boogey men that the ‘centrist’ democrats shill for as well.
    No, it’s not wise to telegraph that your agenda is de minimis. It’s not wise to telegraph that you don’t have a fighting agenda, and that you cave easily from fall back to fall back. Why telegraph it? Good question that.
    I mentioned something similar on another thread that; the idea of president as well lubricated political factotum, is deficient as it is in itself as a model of basic positive force for representing and advocating for the people of this country. It becomes arguably corrosive if that political factotum is not just a cipher nudging his way around the political landscape trying to figure out who he wants to be when he grows up, but is actually an evolving practitioner, intentionally or not, of a corporatist vision of the presidency.
    Clemons mentions several of the seminal issues on which, if we do not have a fighting president, we are in all probability going to slip backwards since the ‘opposition’ seems to have endless energy to crush ideas and movements aimed at guiding the US on an humane and enlightened path.
    Also, highlighting the easy way in which womens’ choice becomes negotiated away [by men] reveals a continuity of that benighted thinking that discounts and demeans 50% of the population without an apparent backward glance or recognition of the outrage. This classically civil right’s issue continues to be a political football on the nation’s road backwards. (and if Michell O. isn’t kicking BHO’s butt down the stairs over this treatment of women, what is SHE good for?)
    Maybe Alexrod is slyly trying to imply that, just you wait, someday Obama will come out swinging and fighting, when it counts. When he really believes in something bad enough? Just what might that be one wonders.
    Somehow I don’t think so; I think he gave us an unintended peek into how the WH and this president work. Still coveting that bipartisan chimera based, as it seems, on negotiating away everything on the enlightened end of the spectrum.

    Reply

  174. wrensis says:

    I can only echo “lurker”. You offer the most balanced perspectives available. Obama will do and say whatever is required to win in 2012 and that does not involve courage of convictions. It simply requires getting people to believe you, and marvel at health care reform.

    Reply

  175. PissedOffAmerican says:

    As both Taylor and I noted on her blogsite, the stocks of the major insurers have shot up.
    More change we can believe in?
    The insuring CEOS just went from driving 900,000 dollar Bentleys to giving their wives 1.3 million dollar Bugattis to use as shopping carts. I guess thats change.
    Steve, how about some scuttlebutt on whats going on with Yemen? Are we propping up Saleh and using the Al Qaeda boogie man as an excuse?,

    Reply

  176. Lurker says:

    Very sharp, incisive commentary Steve. I hadn’t thought about this distinction of a President believing in something and telling his constituents that. Getting their money, their time, and their votes. And then not fighting for what he promised.
    That’s why I read you every day. Thanks for applauding the President when he deserves it and showing us the flaws when he doesn’t.

    Reply

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