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News & ArtsTuesday, March 9, 2010
Health / Politics The Enemy of the Good
Posted by Dan Savage on Tue, Mar 9, 2010 at 9:47 AM
Dennis the menace:
Plenty of pressure is being brought to bear on Rep. Dennis Kucinich (D-OH) to vote for comprehensive health care legislation. The high-profile progressive, and former presidential candidate, voted against the House health care bill in November because it lacked a sufficiently robust public option. Now, faced with a Senate bill that contains no public option whatsoever, he says he plans to vote no again ...even if that means he becomes the Ralph Nader of health care.
Dennis loves to wank into Seattle and bask in the liberal lurv when he's wasting everyone's time running for president. So maybe it'll move him if he hears from some angry Seattle liberals.
Dennis J. Kucinich
Member of Congress
Phone (202)225-5871
Fax (202)225-5745
To Contact Me Electronically
3
Nice, but the real problem is the 12-20 Stupak Democrats. Their issue is abortion funding. It's not likely they can or will compromise on that. Their districts are ones McCain won. Obama has not travelled to these districts or created any plan to get their votes. It's nice yesterday he finally got some kind of sharp simple message -- insurers will eviscerate you with rate increases -- but having spent a year saying let's sit down with insurers it's kind of hard to get that message out there, to the ruralish conservadem voters (a/k/a crackers, religious nuts, the kind of people urbanites left behind, often)...indeed, he hasn't even travelled much at all to state he lost. Most of these coservadem house districts are in that belt comprised of the South plus OK - WV - southern Ohio and the Mississippi part of PA.
You know, where Clinton won primaries? There are nonurban areas, generally, where there are not the highest % of African Americans (if there were, the representative would be more liberal.....).
Classic working class semirural whites.
So great if we pick up a vote from Dennis the Menace but really. The problem is there is no plan to get the Stupak democrats on board.
You know, where Clinton won primaries? There are nonurban areas, generally, where there are not the highest % of African Americans (if there were, the representative would be more liberal.....).
Classic working class semirural whites.
So great if we pick up a vote from Dennis the Menace but really. The problem is there is no plan to get the Stupak democrats on board.
4
politically strategic Nader math: either you have a majority of Naders or you must have zero Naders.
(insert monty-python holy hand-grenade sketch if you must)
(insert monty-python holy hand-grenade sketch if you must)
6
Not this "it's a bad bill" refrain. IT'S A BILL. We need to pass SOMETHING. It sure doesn't make everyone worse off than we are now. I don't want yet another Dem majority wasted on what amounts to complete-fucking-do-nothing.
7
Has anyone considered the possibility that Kucinich's threat to vote no if there isn't a Public Option is, in itself, a method of putting pressure on other Dems to add a Public Option?
9
You whining wishy-washy Democrats make me laugh. You refuse to rally around a true progressive and then cry when the spineless coward you elect ends up not being a true progressive.
You'll never get what you want if you aren't willing to stand up for it.
You'll never get what you want if you aren't willing to stand up for it.
10
@6: It doesn't make anything better when it should have, and frankly omits a whole host of things that the people we voted for said would be included therefore it is a bad bill.
Saying "we have to pass something" is a bad way of looking at things. The Democrats are currently a worthless, spineless party who have no fucking clue what it takes to govern (I voted Dem btw) which is reason why they're wasting their majority. If they only thing they do is pass a worthless shit bill that will shovel money to private insurance companies then I'd rather they just go on vacation until they get their asses handed to them in Nov.
Saying "we have to pass something" is a bad way of looking at things. The Democrats are currently a worthless, spineless party who have no fucking clue what it takes to govern (I voted Dem btw) which is reason why they're wasting their majority. If they only thing they do is pass a worthless shit bill that will shovel money to private insurance companies then I'd rather they just go on vacation until they get their asses handed to them in Nov.
11
Good for him. The bill sucks, from the lack of a public option to the shitty abortion parts. It's a shell of what we need and becasue the Dems in the Congress are pussies and Repubs are horrible people. I've resigned myself to accepting this bill becasue it's this or nothing but it still sucks. I'm glad Kucinich is standing up for his morals, it's about time when an elected official does. He's voting no because it's garbage and not because he is a massive D like Liberman.
12
Dan, why is it when Roy Ashburn votes against gay rights legislation, you say he is a hateful and pathetic hypocrite because he is voting against something he has personal experience to know is needed, but when Kucinich stands up for a public option you call him a wanker who is wasting everyone's time? If I remember correctly, Kucinich was homeless when he was younger.
So I guess if you're a gay legislator, you should stand up for what you believe in and what your personal experience tells you, but if you're straight you should compromise.
That is really disgusting.
So I guess if you're a gay legislator, you should stand up for what you believe in and what your personal experience tells you, but if you're straight you should compromise.
That is really disgusting.
14
Disappointed by your tone and derision, Dan. Sorry that not everyone rolls in corporate money and compromises their worldview as soon as someone sneezes the word 'filibuster'.
All the assholes in congress, and you are mad at Dennis Kucinich? Come the fuck on...
All the assholes in congress, and you are mad at Dennis Kucinich? Come the fuck on...
15
It's quite ironic that Dan "Where's My Fierce Advocacy" Savage has a long held derision for the only Democratic presidential candidate to fully support gay marriage.
16
Face it, if you look at top ten posts, they're all by Dan.
So if Dan says we should do it, it must be right.
Ignore the 500 kilo Single Payer National Health Care gorilla for half the cost in GDP and ten extra years of lifespan we see up north across the border - the one that even Sarah Palin owes her life to ...
So if Dan says we should do it, it must be right.
Ignore the 500 kilo Single Payer National Health Care gorilla for half the cost in GDP and ten extra years of lifespan we see up north across the border - the one that even Sarah Palin owes her life to ...
17
I'm a liberal, no really @7:
Kucinich voted against the House bill, which had a public option. Dennis Kucinich has no interest in saying yes to anything. Negotiating with him is no different from negotiating with Mitch McConnell.
Oh, by the way, I'm a liberal too, no really. But all these liberals who can maintain with a straight face that the current bill is a bad bill are the same breed as all the transit supporters who claimed that Link light rail was not cost-effective and the Green Line monorail was the wrong technology.
I think there's a certain psychological makeup to these people and, if the public option were on more solid ground politically such that we knew it would make the cut, they'd still be saying it's a bad bill because it's not single-payer. They're like people who live in California and still find a way to bitch about the weather.
Has anyone considered the possibility that Kucinich's threat to vote no if there isn't a Public Option is, in itself, a method of putting pressure on other Dems to add a Public Option?
Kucinich voted against the House bill, which had a public option. Dennis Kucinich has no interest in saying yes to anything. Negotiating with him is no different from negotiating with Mitch McConnell.
Oh, by the way, I'm a liberal too, no really. But all these liberals who can maintain with a straight face that the current bill is a bad bill are the same breed as all the transit supporters who claimed that Link light rail was not cost-effective and the Green Line monorail was the wrong technology.
I think there's a certain psychological makeup to these people and, if the public option were on more solid ground politically such that we knew it would make the cut, they'd still be saying it's a bad bill because it's not single-payer. They're like people who live in California and still find a way to bitch about the weather.
18
lets face it Dan, this bill is a pathetic attempt at reform. absolute failure. If this passes, as it is now, I will never see the public option in my lifetime...i promise you that. Healthcare reform isn't incremental....when its over, its going to be over for a long long time. Nobody will want to touch it with a ten foot pole, it is sketchy territory for any politician who wants to be reelected after all this drama gets played out.
Dan, I call you a scrotum blue dog democrat.
i'd suck on Kucinich's balls over yours any day.
....I regret voting for Obama more and more everyday
Dan, I call you a scrotum blue dog democrat.
i'd suck on Kucinich's balls over yours any day.
....I regret voting for Obama more and more everyday
19
DOUG. @15:
Dennis Kucinich also supports sunshine and rainbows and cute, little puppy dogs for all--basically everything that makes him look like a hero to the 5% of the population who (A) share his political views and (B) don't have a fucking clue.
It's quite ironic that Dan "Where's My Fierce Advocacy" Savage has a long held derision for the only Democratic presidential candidate to fully support gay marriage.
Dennis Kucinich also supports sunshine and rainbows and cute, little puppy dogs for all--basically everything that makes him look like a hero to the 5% of the population who (A) share his political views and (B) don't have a fucking clue.
20
Thanks to most of you who are standing up for Dennis, who is in turn standing up for something we claim to uphold: principles. The "any bill is better than no bill" is so absurd I can't believe anyone is saying it. A bill which requires everyone to have insurance and yet lacks at least a public option (god forbid we even mention single-payer) is WORSE than nothing. It's a dream come true for the insurance lobby.
And we have heard the "pass it now, reform it later" claptrap before too...it NEVER happens.
Also, for the last time, Nader is NOT to blame for 2000, Gore and the Democrats are. Sometimes liberals piss me off more than conservatives.
And we have heard the "pass it now, reform it later" claptrap before too...it NEVER happens.
Also, for the last time, Nader is NOT to blame for 2000, Gore and the Democrats are. Sometimes liberals piss me off more than conservatives.
21
I want to see health reform pass but I have a hard time being mad at a Congressman who shares my positions and is willing to fight for them.
22
There are so many people we have to appease that are pulling this bill further and further right, why not have a couple people pulling left? I want to see a single payers system, and that's why Kucinich keeps voting no; he wants it, too. We need uncompromising liberals, and if you want the same thing, why are you complaining? If you're going to complain the country is to the right of where you want it, but then you complain about people pulling it left, then you have issues about what you actually want.
23
Kucinich lives in a dream world, as do all the Sloggers on here who back him up. He and they don't understand that the USA is a conservative country and that we on the practical Left have to accept what little progress we can get when we can. Really: how would Kucinich and his supporters in the comments section expect us to get a single payer system at this time in history? Haven't you paid attention to the debate this past year? WAKE UP!
25
Yes, we do need to pass "some" legislation. Otherwise we're on a slippery slope of having health care take over our economy. I just added up my receipts in order to get my taxes taken care of and with one little broken wrist my doctor bills for the year added up to a little over $10,000 and that is with the health insurance I pay out of pocket for. I can't imagine if I'd had cancer. I'd be bankrupt within a month
26
Yeah. I love vertical walkways. Exit stage right.
Let's hector another person into signing up. Aim High! Go Army!
Let's hector another person into signing up. Aim High! Go Army!
27
This bill isn't about healthcare, it's about saving Obama's ass. He understands that if he doesn't deliver something that looks a little like a healthcare bill, he's toast. Obama needs this bill so he has something (anything) to use to convince the people who actually did the work to elect him the first time that they shouldn't abandon him come re-election time. The fact that this is a bad bill and a fraction of what we want, need and what he campaigned on is besides the point. Congratulations to Mr. Kucinich for being the only one in Washington who still has his eyes on the ball.
28
bhowie @20:
If this is such a dream come true for the insurance lobby, why are they fighting health reform tooth and nail? If there's one foundation to controlling costs and banning the insurance industry's worst practices and making the public option politically possible--really to all of health reform--it is the individual mandate.
More bhowie @20:
Not true. When it first passed, Social Security had all sorts of holes and inequities. And as we've gone along, we've filled them in. It's a lot easier to imagine the public option happening in the context of the current bill than in the context of doing nothing.
The "any bill is better than no bill" is so absurd I can't believe anyone is saying it. A bill which requires everyone to have insurance and yet lacks at least a public option (god forbid we even mention single-payer) is WORSE than nothing. It's a dream come true for the insurance lobby.
If this is such a dream come true for the insurance lobby, why are they fighting health reform tooth and nail? If there's one foundation to controlling costs and banning the insurance industry's worst practices and making the public option politically possible--really to all of health reform--it is the individual mandate.
More bhowie @20:
And we have heard the "pass it now, reform it later" claptrap before too...it NEVER happens.
Not true. When it first passed, Social Security had all sorts of holes and inequities. And as we've gone along, we've filled them in. It's a lot easier to imagine the public option happening in the context of the current bill than in the context of doing nothing.
29
@10 Bullshit. It might not be a perfect bill but by expanding medicaid you're going to have millions of more people covered in addition to not being able to deny coverage based on preexisting conditions. Let me guess, you can afford insurance privately/get it through your job; well I can't/don't and I need health insurance.
30
The social security example is flawed at best when compared with this piece of crap health care bill. Social Security had the basics of what it is today when FDR signed it into law. The fundamental issue of taking care of the retired on a basic level was established.
This fucked up bill is only about saving Obama's political ass at this point. There is nothing in it that can be built upon it later on down the road to universal single payer health care for all. If it at least had a strong public option the comparison could be relevant. But it's not there so stop using the comparison.
Now the current health care bill would be like Social Security had Social Security been a buy into the stock market in the hopes of having money when you retire or were disabled......
This fucked up bill is only about saving Obama's political ass at this point. There is nothing in it that can be built upon it later on down the road to universal single payer health care for all. If it at least had a strong public option the comparison could be relevant. But it's not there so stop using the comparison.
Now the current health care bill would be like Social Security had Social Security been a buy into the stock market in the hopes of having money when you retire or were disabled......
31
@18 Don't be stupid. It's taken over 100 YEARS to get this far. Do you honestly, truly, in your heart of hearts think that you're going to wake up one day to discover that America has become a progressive paradise? Not going to happen. The one thing you are right about is that once this issue gets put down it's going to get put down for awhile regardless of whether or not this reform bill passes. Plus, just think about it; the republicans were able to paint this very modest reform bill as nazi/socialism/killin'grandmas. Do you really think that if they start over with a single payer health care bill that it's somehow magically going to make American's less stupid? It won't; American's are fucking stupid and continually vote against their own self interest. Why? Who the fuck knows but that's how it is.
32
@29: I never said word one about expanding Medicaid to everyone. Nice try though.
If this bill did ANYTHING to control costs in the face of insurance companies now having tens of millions of mandated new customers (it doesn't) I'd feel better about it. If this bill included a provision to allow us to reimport drugs from other countries (something Obama fucking campaigned on and is now actively working against) I'd feel like it's a step in the right direction. This this bill actually stopped the act of recision I'd not feel so bad about it.
It doesn't do any of these things. It says we all have to now buy private insurance or face fines but does nothing to protect us in the marketplace. It's a bullshit bill.
I'd love to see universal public health care but I also don't lie to myself and believe that the US is anything but a center-right country that won't see such a thing until people are literally dying in the streets.
If this bill did ANYTHING to control costs in the face of insurance companies now having tens of millions of mandated new customers (it doesn't) I'd feel better about it. If this bill included a provision to allow us to reimport drugs from other countries (something Obama fucking campaigned on and is now actively working against) I'd feel like it's a step in the right direction. This this bill actually stopped the act of recision I'd not feel so bad about it.
It doesn't do any of these things. It says we all have to now buy private insurance or face fines but does nothing to protect us in the marketplace. It's a bullshit bill.
I'd love to see universal public health care but I also don't lie to myself and believe that the US is anything but a center-right country that won't see such a thing until people are literally dying in the streets.
33
It's easier in D.C. to get nothing done than it is to get something done. That's why the repubs keep getting further to the right and drag the dems with them. The repubs entire platform is: "Stop government from functioning." That's how they get elected, by telling people who hate and fear the government that they'll do everything they can to castrate the government.
Since everything has to pass on majorities, the democrats are hamstrung right off the line because they need a larger group to do things than the republicans who can use a smaller group to NOT do things.
Since everything has to pass on majorities, the democrats are hamstrung right off the line because they need a larger group to do things than the republicans who can use a smaller group to NOT do things.
34
cressona@19: Yeah, Kucinich is all about rainbows and puppy dogs. That must be why he keeps winning in that hippie district of west Cleveland...
35
DOUG. @34:
Hey, it doesn't take much in the way of accomplishment for an incumbent in the House to hang on in a district with a well-established party affiliation. Just ask Jim McDermott.
But you know, DOUG., I will give Dennis Kucinich credit for his presidential campaigns' continued success.
cressona@19: Yeah, Kucinich is all about rainbows and puppy dogs. That must be why he keeps winning in that hippie district of west Cleveland...
Hey, it doesn't take much in the way of accomplishment for an incumbent in the House to hang on in a district with a well-established party affiliation. Just ask Jim McDermott.
But you know, DOUG., I will give Dennis Kucinich credit for his presidential campaigns' continued success.
36
@18,
Why not? Social Security was incremental. Medicare was incremental. SCHIP was incremental. Why not health care reform?
You know what will really ensure no public option in your lifetime? Getting nothing passed, which is what will happen if this bill dies.
Why not? Social Security was incremental. Medicare was incremental. SCHIP was incremental. Why not health care reform?
You know what will really ensure no public option in your lifetime? Getting nothing passed, which is what will happen if this bill dies.
37
@32 - The bill isn't perfect but it's a VAST improvement over the status quo. You keep beating this dead horse about the individual mandate, but you don't seem to grasp that the individual mandate IS a cost control: most of the uninsured are young and healthy and will bring overall costs down for everyone else when they're paying into the system. Also, insurance companies won't get to deny coverage for bullshit reasons like recision or preexisting conditions anymore.
Ezra Klein notes 9 cost-saving measures in the bill:
http://voices.washingtonpost.com/ezra-kl…
Sure, none of them involve capping spending. You can have your pipe-dream utopia universal health care plan in your dreams only. It's not something that's gonna get through the US Congress. Kucinich - whom I supported back in 2004 primaries - doesn't want to bring this about, or bring any real accomplishments about. He just wants to stand in the corner and heckle and be pure. Well, it's easy to be pure if you keep your hands unsullied by the work of getting anything done. Meanwhile, this bill would save lives and bend the cost curve. It's not this bill or single-payer; it's this bill or nothing. And this bill is much, much better than nothing.
Ezra Klein notes 9 cost-saving measures in the bill:
http://voices.washingtonpost.com/ezra-kl…
Sure, none of them involve capping spending. You can have your pipe-dream utopia universal health care plan in your dreams only. It's not something that's gonna get through the US Congress. Kucinich - whom I supported back in 2004 primaries - doesn't want to bring this about, or bring any real accomplishments about. He just wants to stand in the corner and heckle and be pure. Well, it's easy to be pure if you keep your hands unsullied by the work of getting anything done. Meanwhile, this bill would save lives and bend the cost curve. It's not this bill or single-payer; it's this bill or nothing. And this bill is much, much better than nothing.
38
@32 I know you didn't which is why I called bullshit b/c this bill DOES expand medicaid to about 30 million people (in addition to not allowing companies to deny coverage based on preexisting conditions etc.). But I've got a question; I've heard a lot of progressives say that we need to kill this bill and start over b/c it doesn't have a public option but I've never heard anyone explain HOW that's going to happen. I'd love to hear your plan as to how we get a public option out of this. Let me get you started: Kucinich's vote kills this bill, fox news (plus Limbaugh, etc.) all claim that this was a repudiation of Obama's "socialist" agenda and that America wants nothing to do with it.....your turn. Give us your public option becomes a reality scenario.
39
Cato the Younger Younger @30:
Yeah, taking care of the retired as long as the retired weren't blacks or farmworkers or all sorts of other excluded groups. Take a look at the history of Social Security.
By the same token, if we're talking about fundamental issues, the current bill does resolve the one most basic issue. And that's universal coverage, i.e. the universal right to coverage and the universal responsibility to pay for it as much as you can afford. From that foundation, we can work on solving the rest of our health care/insurance woes.
I have no illusion that the rest of that political progress isn't going to be painful, but this bill more than anything forces us to face that pain. It's kind of like how people are complaining that the EU shouldn't have instituted the euro without greater economic integration. I mean, look at all the pain that Greece is inflicting on the rest of the eurozone. Well, maybe greater economic integration wasn't the means but the end, and the only way Europe was going to have greater economic integration coordination was with the swift kick in the butt being provided now by the profligate Greeks.
The social security example is flawed at best when compared with this piece of crap health care bill. Social Security had the basics of what it is today when FDR signed it into law. The fundamental issue of taking care of the retired on a basic level was established.
Yeah, taking care of the retired as long as the retired weren't blacks or farmworkers or all sorts of other excluded groups. Take a look at the history of Social Security.
By the same token, if we're talking about fundamental issues, the current bill does resolve the one most basic issue. And that's universal coverage, i.e. the universal right to coverage and the universal responsibility to pay for it as much as you can afford. From that foundation, we can work on solving the rest of our health care/insurance woes.
I have no illusion that the rest of that political progress isn't going to be painful, but this bill more than anything forces us to face that pain. It's kind of like how people are complaining that the EU shouldn't have instituted the euro without greater economic integration. I mean, look at all the pain that Greece is inflicting on the rest of the eurozone. Well, maybe greater economic integration wasn't the means but the end, and the only way Europe was going to have greater economic integration coordination was with the swift kick in the butt being provided now by the profligate Greeks.
40
DavidG @37, I think you're wasting your time bringing up someone like Ezra Klein in a forum like this. I mean, really, he's actually studied this bill and these issues in depth. Who the hell wants to hear from him?
Instead, people just have their preternatural desire to side with the idealists or the pragmatists, on any given issue. The rest is just rationalization.
Instead, people just have their preternatural desire to side with the idealists or the pragmatists, on any given issue. The rest is just rationalization.
41
Just a reminder, fill out your census form.
I would never encourage you to fill out one for where you live as a student and then fill out one when you're at your parents house, unless both of those were in liberal urban areas, because that might result in more seats for liberal areas and consign the America-hating depopulating Red States to the Eternal Hell they belong in.
Right?
I would never encourage you to fill out one for where you live as a student and then fill out one when you're at your parents house, unless both of those were in liberal urban areas, because that might result in more seats for liberal areas and consign the America-hating depopulating Red States to the Eternal Hell they belong in.
Right?
42
@37: I guess my belief in the benevolence of insurance companies doesn't being to approach yours. Just because they now have to insure a bunch of generally healthy 20 year olds doesn't lead me to believe that they'll help bring down costs across the board.
Sure logically that makes sense but that ignores the fact that we would have to buy from them regardless what they charge. If you run a hot dog stand and the city of Seattle mandates that everyone eat 1 hot dog a day what onus do you have to not try and make as much money as possible? Your "customers" don't have any other choice but to pay you.
Also as for the whole recession/pre-existing conditions thing. The current bill contains a loophole that states that an insurance company can drop you or deny you coverage if you weren't 100% truthful on your application. So any unintended mistakes you make on your application could lead you to getting dropped. And before you say that would never happen, there was a woman who testified in front of Congress regarding her insurer dropping her after she was diagnosed with skin cancer because of her having been treated for acne years earlier.
Sure logically that makes sense but that ignores the fact that we would have to buy from them regardless what they charge. If you run a hot dog stand and the city of Seattle mandates that everyone eat 1 hot dog a day what onus do you have to not try and make as much money as possible? Your "customers" don't have any other choice but to pay you.
Also as for the whole recession/pre-existing conditions thing. The current bill contains a loophole that states that an insurance company can drop you or deny you coverage if you weren't 100% truthful on your application. So any unintended mistakes you make on your application could lead you to getting dropped. And before you say that would never happen, there was a woman who testified in front of Congress regarding her insurer dropping her after she was diagnosed with skin cancer because of her having been treated for acne years earlier.
43
@24 "-...because most Americans, when asked, actually want single-payer."
Most Americans don't know what the fuck they want and that's the truth. If they want a single payer system, why isn't the Congress full of Kuncinich-wannabes? Unfortunately, we are a conservative country and the only way to get to a single payer system is through incrementalism and baby steps. The Senate bill is the second baby step; Medicare/Medicaid over forty years ago was the first step. Maybe in another 30-40 we will have a single payer system. Don't hold your breath, though.
Most Americans don't know what the fuck they want and that's the truth. If they want a single payer system, why isn't the Congress full of Kuncinich-wannabes? Unfortunately, we are a conservative country and the only way to get to a single payer system is through incrementalism and baby steps. The Senate bill is the second baby step; Medicare/Medicaid over forty years ago was the first step. Maybe in another 30-40 we will have a single payer system. Don't hold your breath, though.
44
@42 - It's not that I believe in the benevolence of insurance companies. Far from it - they'll make money any way they can, we can't expect anything else out of them. But we can pass laws that restricts how they can make money, and also makes them compete with each other - both of which are in the current bill. Read through the Ezra Klein article - it answers some of your questions. But it occurs to me that insurance costs just aren't very well understood. Insurance companies don't raise rates just because they're evil - though they would certainly raise them as much as they can get away with - but competition would otherwise enable companies to underbid others and keep costs in check. However, it's not just eeebul insurance companies but also a skewed insurance market that keeps costs tilted. When young healthy people flee the market in a bad economy, the pool of insured shrinks to a higher concentration of sick people - who in turn cost more to cover. Additionally, new technologies come online and are demanded by everyone - there's no real incentive for people to go with a less new-and-shiny treatment that works just as well. The independent CBO took a look at the proposals in the bill and decided that the bill changes the underlying dynamics of how the insurance market works enough to actually cause insurance companies to lower premiums. You don't have to trust the insurance companies, nobody's asking you to. You do have to trust that adding a bunch of sick people - pre-existing conditions - will be balanced out by adding a bunch of healthy people - young uninsureds from the individual mandate - that will change the underlying conditions of the pricing of health care.
Plus, the individual mandate stipulates that you have to buy insurance, but doesn't say you have to buy it from the same company forever. No, the bill sets up exchanges so that if you need health care - say, as an individual - you choose among the various competing plans. Insurers will have more competition for your dollars. This may not be your preferred way of controlling costs, but you can't pretend like there just aren't any cost controls in the bill.
More...
Plus, the individual mandate stipulates that you have to buy insurance, but doesn't say you have to buy it from the same company forever. No, the bill sets up exchanges so that if you need health care - say, as an individual - you choose among the various competing plans. Insurers will have more competition for your dollars. This may not be your preferred way of controlling costs, but you can't pretend like there just aren't any cost controls in the bill.
46
I'm guessing that everyone who says that this is a bad bill has no idea what is in the bill. These are the same people who think it funds abortion, when it does not. (That section of the bill is only 10 pages, and is quite explicit about not funding it. Read it. It barely differs from Stupak's proposed amendment.)
I'm also guessing that everyone who is against this bill is healthy (now). If you had a chronic illness, you'd be praying for this bill to pass. Of course if you look at it from the vantage point of a healthy person, there's not much in it for you. But with that point of view, why have insurance at all?
What good is insurance if it's not guaranteed when you get sick? Right now, it's not. You get sick, you can get dropped or have your rates tripled. This bill fixes that. It isn't worthless.
I'm also guessing that everyone who is against this bill is healthy (now). If you had a chronic illness, you'd be praying for this bill to pass. Of course if you look at it from the vantage point of a healthy person, there's not much in it for you. But with that point of view, why have insurance at all?
What good is insurance if it's not guaranteed when you get sick? Right now, it's not. You get sick, you can get dropped or have your rates tripled. This bill fixes that. It isn't worthless.
47
this thread is incredible. it's like you're all in outer space.
The problem in the house is a fairly specific set of folks known as Stupak democrats. They voted yes for the house bill but won't vote for the senate bill because it funds abortion.
NOTHING in this thread addresses the v. simple issue: how do you get them to vote yes on the senate bill?
You can debate all you want about insurance, Nader, you can call up Kucinich all you want, maybe get his vote, woo hoo, but do the fucking math: we've lost a few votes in the house thru things like mutha dying, cao going back to the no column, and there's seventeen yes votes last fall that now look like they are going to be no votes.
Jay Cost, real clear: Current Categories (As of 1:40 PM 3/9)
Democrats Who Voted Nay in November
Very Hard to Persuade: 25
Hard to Persuade: 6
Persuadable: 6
Democrats Who Voted Yea in November
Suggested Might Now Vote Nay (Including Confirmed Stupak Democrats): 17
Other Possible Stupak Democrats: 10
That's potentially losing 27 votes.
Do any of you even know how many votes it passed by last fall in the house?
It was like, two.
so we're like...down about 20-30.
this whole thread is off in lala theory land. the pracical problem is getting votes of conservadems. 2 diff. things.
The problem in the house is a fairly specific set of folks known as Stupak democrats. They voted yes for the house bill but won't vote for the senate bill because it funds abortion.
NOTHING in this thread addresses the v. simple issue: how do you get them to vote yes on the senate bill?
You can debate all you want about insurance, Nader, you can call up Kucinich all you want, maybe get his vote, woo hoo, but do the fucking math: we've lost a few votes in the house thru things like mutha dying, cao going back to the no column, and there's seventeen yes votes last fall that now look like they are going to be no votes.
Jay Cost, real clear: Current Categories (As of 1:40 PM 3/9)
Democrats Who Voted Nay in November
Very Hard to Persuade: 25
Hard to Persuade: 6
Persuadable: 6
Democrats Who Voted Yea in November
Suggested Might Now Vote Nay (Including Confirmed Stupak Democrats): 17
Other Possible Stupak Democrats: 10
That's potentially losing 27 votes.
Do any of you even know how many votes it passed by last fall in the house?
It was like, two.
so we're like...down about 20-30.
this whole thread is off in lala theory land. the pracical problem is getting votes of conservadems. 2 diff. things.
48
All of these Sloggers opposed to this bill would have opposed the original Social Security bill and the original Medicare bill because they weren't perfect. If it were up to them, robber barons would still be in control, and old folks would be eating cat food in attics.
Good luck to you all when Sarah Palin becomes president in 2012 with Republican majorities in Congress. I guess you really enjoyed the Bush years.
Good luck to you all when Sarah Palin becomes president in 2012 with Republican majorities in Congress. I guess you really enjoyed the Bush years.
49
@47 - just my point - another commenter who doesn't know what's in the bill.
The difference between the Senate bill (which explicitly refuses to fund abortion, as it defers completely to the Hyde amendment, which disallows it) and what's in the Stupak amendment (removes the dependency on the Hyde amendment, and instead bakes the ban directly into the bill) is a tiny span to bridge.
Stupak's only honest beef is this: if the Hyde amendment doesn't get its annual renewal, then yes, the bill could then fund abortion.
Filling that hole is a concession so tiny that I can't imagine Stupak won't get his way. The Hyde amendment (tied to annual appropriations) will be renewed every year in our lifetimes.
The difference between the Senate bill (which explicitly refuses to fund abortion, as it defers completely to the Hyde amendment, which disallows it) and what's in the Stupak amendment (removes the dependency on the Hyde amendment, and instead bakes the ban directly into the bill) is a tiny span to bridge.
Stupak's only honest beef is this: if the Hyde amendment doesn't get its annual renewal, then yes, the bill could then fund abortion.
Filling that hole is a concession so tiny that I can't imagine Stupak won't get his way. The Hyde amendment (tied to annual appropriations) will be renewed every year in our lifetimes.
50
@47 Yes, the big problem is conservative dems, so answer me this; making the bill more liberal will
A) make it easier to convince conservative dems to sign on
B) make it harder to convince conservative dems to sign on
The fact of the matter is that Kucinich should be smarter than this.
A) make it easier to convince conservative dems to sign on
B) make it harder to convince conservative dems to sign on
The fact of the matter is that Kucinich should be smarter than this.
51
@48 True that. This is the same "there's no difference between the dems and repubs" type of rhetoric that was floating around during the 2000 election. I can't believe how short some people's political/social memory is. It's as if we didn't just have 8 years filled with two wars, warrantless wiretapping, suspending habeaus corpus, spying on library records and bank accounts, secret torture prisons in Poland, privatizing the military to companies like Blackwater, etc, etc, etc. You need to get it through your heads, as of right now we have two national parties; a conservative party and a bat shit crazy ass party. I'd like a progressive party as much as any one else but that's something that needs to be built up over time. You don't go from president of the board of supervisors in San Francisco (the highest office achieved by a Green party member) to president of the united states in one fell swoop.
52
Aw, Dan. Even though you don't really understand healthcare economics, you just can't resist shooting from the hip, can you?
The perfect is the enemy of the good? Did you get that talking point from Wendell Potter, CIGNA's double-agent in the reform camp? The current bills are catastrophically bad. They don't provide universal coverage. They don't provide comprehensive coverage. They don't have cost controls. They don't have quality and outcome incentives. They don't provide protection from medical bankruptcy. They have virtually none of the core components of systems used by our peer countries -- countries that spend dramatically less on healthcare and yet manage to get significantly better outcomes. They don't even allow states to opt out and set up state-run systems that *do* have those core components.
As for the current bills being an incremental step, stop and think a moment. Why have we had so much difficulty getting genuine reform proposals -- single-payer, regulated non-profit multi-payer, etc. -- discussed in the media and voted out of committee in Congress? Could the amount of money the for-profit healthcare sector has spent on advertising, astroturfing, media influence, lobbying, and campaign contributions have anything to do with it? The current bill will boost for-profit health's profits and influence budgets even further. What makes you think it's going to be easier to achieve genuine reform after we've swelled their war chests? Why do you think for-profit health insurance companies recently jacked up their individual premiums so dramatically? It wasn't for actuarial reasons -- it was to panic ill-informed journalists and blackmail Congress into passing the current bill. This, after all, is what the for-profit insurance sector has maneuvered for all along: a requirement that everyone buy their defective product at whatever price they see fit to charge.
If you want to go along with a TARP-caliber giveaway to Big Health, be my guest. Accuse Kucinich of being a petulant, narcissistic spoiler like Nader. Those of us who have actually studied healthcare funding and delivery systems know that the bill you are supporting is a compromise only in the sense that the Munich Agreement was a compromise. You'll figure it out eventually, as the country, the middle class, and the working class continue to slide into debt and decline.
More...
The perfect is the enemy of the good? Did you get that talking point from Wendell Potter, CIGNA's double-agent in the reform camp? The current bills are catastrophically bad. They don't provide universal coverage. They don't provide comprehensive coverage. They don't have cost controls. They don't have quality and outcome incentives. They don't provide protection from medical bankruptcy. They have virtually none of the core components of systems used by our peer countries -- countries that spend dramatically less on healthcare and yet manage to get significantly better outcomes. They don't even allow states to opt out and set up state-run systems that *do* have those core components.
As for the current bills being an incremental step, stop and think a moment. Why have we had so much difficulty getting genuine reform proposals -- single-payer, regulated non-profit multi-payer, etc. -- discussed in the media and voted out of committee in Congress? Could the amount of money the for-profit healthcare sector has spent on advertising, astroturfing, media influence, lobbying, and campaign contributions have anything to do with it? The current bill will boost for-profit health's profits and influence budgets even further. What makes you think it's going to be easier to achieve genuine reform after we've swelled their war chests? Why do you think for-profit health insurance companies recently jacked up their individual premiums so dramatically? It wasn't for actuarial reasons -- it was to panic ill-informed journalists and blackmail Congress into passing the current bill. This, after all, is what the for-profit insurance sector has maneuvered for all along: a requirement that everyone buy their defective product at whatever price they see fit to charge.
If you want to go along with a TARP-caliber giveaway to Big Health, be my guest. Accuse Kucinich of being a petulant, narcissistic spoiler like Nader. Those of us who have actually studied healthcare funding and delivery systems know that the bill you are supporting is a compromise only in the sense that the Munich Agreement was a compromise. You'll figure it out eventually, as the country, the middle class, and the working class continue to slide into debt and decline.
53
@52 OK, PCM, then tell us how to get *your* ideal health care bill/plan passed in the next ten years! How will you get the wonderfully progressive senators and representatives who will accomplish this worthy feat elected? From what hills and valleys will all these Kucinich voters emerge?
54
@52 PCM: Tell us how you will get your ideal health care plan enacted? How will you get the progressive senators and representatives elected to support this plan? Give us a brief strategy to reach this goal of yours.
It's OK to be idealistic, but one must also be realistic.
It's OK to be idealistic, but one must also be realistic.
55
PCM @52: (The current bills) don't have cost controls.
Liar: Modest, far-reaching cost control
PCM: Did you get that talking point from Wendell Potter, CIGNA's double-agent in the reform camp?
To call Wendell Potter a double-agent is about as preposterous as Frank Luntz giving Republicans the talking point that the Consumer Financial Protection Agency is another bank bailout.
If I were the big insurance companies and I knew nobody in today's political climate was going to come to my defense, I'd try to sow the seeds of discontent from the left as well. I'd be all about, "Don't settle for anything less than single-payer." If you can't attack 'em from the front, attack 'em from behind. But hey, who's the double-agent?
Liar: Modest, far-reaching cost control
PCM: Did you get that talking point from Wendell Potter, CIGNA's double-agent in the reform camp?
To call Wendell Potter a double-agent is about as preposterous as Frank Luntz giving Republicans the talking point that the Consumer Financial Protection Agency is another bank bailout.
If I were the big insurance companies and I knew nobody in today's political climate was going to come to my defense, I'd try to sow the seeds of discontent from the left as well. I'd be all about, "Don't settle for anything less than single-payer." If you can't attack 'em from the front, attack 'em from behind. But hey, who's the double-agent?
56
@17: I didn't know that. Just looked up Kucinich's vote in November, and yeah, you're right. He did vote no even though the bill had a public option. Here I was hoping this was a bluff... *sigh* I should have known better.
57
@52 The current health bill doesn't need an opt out to allow states to set up those core components b/c states already have that right. Massachusetts and Hawaii both have state run, universal coverage.
58
The constant 'it's a bad bill', 'spineless dem' crap around these parts is really quite dismaying for someone who kind of thought previously that the those on the left were at least marginally more intelligent than those on the right.
Do you read anything other than slog? Do you have a shred of a clue how the political process works? You aren't going to get your fantasy bill ever ever in this country. Wise up. This is a right wing country with a large majority that is staggeringly ignorant and reactionary.
Best chance we've got right now. If you had the minutest clue you might have noticed that it isn't about spineless anything. A sizable minority of Dems in Congress are very marginal Dems, essentially Republicans. They are simply not going to vote for your fantasy bill. Spineless? Bullshit. They are representing the Neanderthals in their districts.
Do you read anything other than slog? Do you have a shred of a clue how the political process works? You aren't going to get your fantasy bill ever ever in this country. Wise up. This is a right wing country with a large majority that is staggeringly ignorant and reactionary.
Best chance we've got right now. If you had the minutest clue you might have noticed that it isn't about spineless anything. A sizable minority of Dems in Congress are very marginal Dems, essentially Republicans. They are simply not going to vote for your fantasy bill. Spineless? Bullshit. They are representing the Neanderthals in their districts.
59
Thomas Guy @53: PCM: Tell us how you will get your ideal health care plan enacted?
Thomas, PCM here doesn't have a plan--at least a health care plan. His or her only plan is to confuse people who don't have the free time and patience to be well-read on the issues of health reform, which unfortunately is most people.
Thomas, PCM here doesn't have a plan--at least a health care plan. His or her only plan is to confuse people who don't have the free time and patience to be well-read on the issues of health reform, which unfortunately is most people.
60
@59 That's the thing. I'd would be completely into pursuing a public option at this time IF IT COULD ACTUALLY BE DONE but I don't see how it could be. For all of you "Tarantino's" out there, if you've got an actually plan on how to achieve this goal then let us know. Like I said, I'd totally be into it if it was something plausible but if it's not, if the only thing you have to say is "we need to hold out for a single payer" then the only thing that's going to happen is we'll end up with bupkis AGAIN.
61
There's a lot of bile and hatred toward a guy that's obviously voting his conscience and pushing for a bill that every hater on this thread would absolutely love if it passed.
A majority of Americans are for a single payer health care, and a public option. The teabagger idiots make up around %10 of the population. It's funny how the corporate news covers them more than any other group isn't it? The marginal Democrats aren't representing their districts, they are respresenting the corporations that paid for their campaigns. The majority of Americans are good people that think everyone deserves health care. The majority of Americans hate the insurance companies.
We're in a situation where Democrats like Obama have chosen to tack right against the will of the voters over and over again.
Kucinich is just one congressman. All the people feeling such strong irrational hatred toward a guy that is actually being a Democrat need to examine why they are so fucking crazy-angry at one of the good guys. Progressives deserve to be represented in our Democracy. You should maybe think about focussing your anger at the people that are trying to harm you with every piece of legislation they produce; the Republicans and the Blue Dogs.
A majority of Americans are for a single payer health care, and a public option. The teabagger idiots make up around %10 of the population. It's funny how the corporate news covers them more than any other group isn't it? The marginal Democrats aren't representing their districts, they are respresenting the corporations that paid for their campaigns. The majority of Americans are good people that think everyone deserves health care. The majority of Americans hate the insurance companies.
We're in a situation where Democrats like Obama have chosen to tack right against the will of the voters over and over again.
Kucinich is just one congressman. All the people feeling such strong irrational hatred toward a guy that is actually being a Democrat need to examine why they are so fucking crazy-angry at one of the good guys. Progressives deserve to be represented in our Democracy. You should maybe think about focussing your anger at the people that are trying to harm you with every piece of legislation they produce; the Republicans and the Blue Dogs.
62
"The majority of Americans are good people that think everyone deserves health care."
You're kidding right? Might be a good idea to put on your spacesuit and venture outside your bubble now and again.
Note: the right-wing Dems that provided the crucial votes to pass the current much watered down legislation are mostly from districts that voted McCain in 08.
You're kidding right? Might be a good idea to put on your spacesuit and venture outside your bubble now and again.
Note: the right-wing Dems that provided the crucial votes to pass the current much watered down legislation are mostly from districts that voted McCain in 08.
63
@61 - "Bile and hatred"? Where's the bile and hatred? (Unregistered comments don't count.) I would really, really love to live in a world where Kucinich gets his way. But we don't live in that world, and neither does Kucinich. So rather than holding out for that utopia, we have to ask ourselves what we can do to improve things in the meantime. I don't expect Kucinich to stop demanding single-payer. But I would appreciate it if he would help in the effort to rally the progressive base rather than throw cold water on the bill from the left.
By the way, this in no way lets the Blue Dogs off the hook. We're all (I hope?) still writing to Baird and the others who are dragging their feet from the right. But in a tight House, where every vote counts, it would really help to not have to worry about Kucinich being the "no" vote that sinks our only shot at real health reform for at least 10 years.
By the way, this in no way lets the Blue Dogs off the hook. We're all (I hope?) still writing to Baird and the others who are dragging their feet from the right. But in a tight House, where every vote counts, it would really help to not have to worry about Kucinich being the "no" vote that sinks our only shot at real health reform for at least 10 years.
64
Congressman Kucinich:
Like you, I would like to see healthcare reform that includes a robust public option. However, I also recognize that this becomes a lot more likely to occur if and when the initial hurdle of near-universal access is achieved. The Senate bill, should it pass in the house, will achieve that, and the public option will become a separate hurdle that can live to be passed on its own merits at another time. Allowing the bill to fail will not bring us any closer to sanity. Claims to the contrary are delusional at best; and sociopathic at worst.
If this bill dies because of your vote, you will not only be responsible for killing healthcare reform today. You will be responsible for killing the chance of a public option being passed two, four, ten or 20 years from now as well. Please do not become the Ralph Nader of healthcare.
I am a type one diabetic. I cannot wait another 16 years for the senate to take up this issue again. If you sincerely believe that your NO vote will do anything but derail the fight for comprehensive healthcare legislation for at least that long, I am sorry to say that my respect and admiration for you up to this point has been sadly misplaced.
Like you, I would like to see healthcare reform that includes a robust public option. However, I also recognize that this becomes a lot more likely to occur if and when the initial hurdle of near-universal access is achieved. The Senate bill, should it pass in the house, will achieve that, and the public option will become a separate hurdle that can live to be passed on its own merits at another time. Allowing the bill to fail will not bring us any closer to sanity. Claims to the contrary are delusional at best; and sociopathic at worst.
If this bill dies because of your vote, you will not only be responsible for killing healthcare reform today. You will be responsible for killing the chance of a public option being passed two, four, ten or 20 years from now as well. Please do not become the Ralph Nader of healthcare.
I am a type one diabetic. I cannot wait another 16 years for the senate to take up this issue again. If you sincerely believe that your NO vote will do anything but derail the fight for comprehensive healthcare legislation for at least that long, I am sorry to say that my respect and admiration for you up to this point has been sadly misplaced.
65
#12, I agree with your criticism of Dan. Why is it not OK for Kucinich to stand up for what his personal experience has taught him to be an inalienable right? Why is Roy Ashburn such a fuck for doing what Dan wants Kucinich to do?
66
Some responses to my fans:
=====
The guy who called me a liar referenced an article by Ezra Klein in the Washington Post, which in turn referenced an article in the Wall Street Journal written by Obama healthcare reform collaborator David Cutler ("Health Reform Passes The Cost Test"). That article lists nine cost control features that are in the Obama bill:
• Insurance exchanges.
• Reduction in Medicare payments.
• Value-based payment in Medicare.
• Tax on "Cadillac" plans.
• An independent Medicare advisory board.
• Combat Medicare fraud and abuse.
• Malpractice reform.
• Computerized medical records and insurance processing.
• Prevention.
Four of these nine are limited to Medicare, which, while a significant part of the market, is not the dominant one.
Reducing Medicare payments while non-Medicare payments remain uncontrolled is going to make it more difficult for seniors to find doctors who take Medicare or to get appointments with those that do. Value-based payment in lieu of fee for service is tough to work out in the details, but the UK's NICE (National Institute for Health and Clinical Excellence) and QOF (Quality and Outcomes Framework) provide some good starting points. If an independent Medicare advisory board helps reduce political interference with payment structures and better implements the value-based payments and anti-fraud measures mentioned in separate points, fine. Curbing Medicare fraud is also a fine proposal. The few studies I've read suggest there is more fraud and abuse outside Medicare than within, but every little bit helps.
Massachusetts has an insurance exchange. Premiums have gone up significantly -- probably as a result of the individual mandate, but definitely not offset in the aggregate by the supposed efficiencies of the exchange -- and Massachusetts now has the highest per-capita healthcare costs of any of the 50 states.
As for taxes on Cadillac plans: what is a Cadillac plan? Is it a plan that provides comprehensive coverage and actually protects the insured from medical bankruptcy? If so, the tax doesn't curb overall healthcare costs -- it just encourages underinsurance, which shifts costs from from insurance to the individual. The best systems in the world have minimal "cost-sharing"; this goes in the opposite direction.
To the best of my knowledge, malpractice insurance premiums and overall healthcare costs have not fallen in states that have implemented medical malpractice reform. Defensive medicine and malpractice expenses are estimated to account for a relatively small percentage of overall healthcare costs, anyway (around 2% at most). Regardless, I support any reform that would put more money in the pockets of real malpractice victims and protect doctors from unfounded strike suits.
Computerized medical records and insurance processing: I'm all for it. There will be a significant initial investment, but I believe it will pay off. Two of the best, most efficient healthcare systems in the world, France's and Taiwan's, do this.
Prevention: Leaving aside non-insurance issues such as unhealthy food and activities, occupational health and safety, and the like, the best "prevention" is to offer preventive, diagnostic, and maintenance care at no (or nominal) out-of-pocket cost to patients. Systems that do this spend a moderate amount of money upfront; we don't do it and instead spend huge amounts of money on deferred rescue care. Aside from lip service to the general value of prevention, where are the concrete mandates in Cutler's plan?
For the most part, the above cost controls are nickel-and-dime stuff. The biggest cost savings by far are found in features that are shared by virtually every one of our peer countries' healthcare systems but that are conspicuously absent from any of the current bills:
* Single-agent (monopsonistic) bargaining with providers, resulting in fair, adequate, uniform fees and prices. Every other developed country does it. We don't, which is the primary reason we have the highest medical prices in the world. Medical care is not a perfectly competitive market, and sellers have a significant amount of market power. It's nothing short of stupid for patients not to bargain with them as a bloc. Apparently, though, we're stupid. Stupider than everyone else.
* Administrative efficiency. Most other countries waste in the low single digits, percentage-wise, on administrative expenses. Our own Medicare is estimated to have around 2-3% administrative overhead. The US as a whole, in contrast, is estimated to waste from 25% to 30% of all healthcare expenditures on administration. Some of this waste will be reduced if insurers no longer have to do rescission investigations, but if over a thousand separate insurance companies continue to operate, each with its own sets of policies, riders, forms, and procedures, most of the administrative overhead will remain. The potential administrative savings from a single-payer "Medicare For All" system are estimated to be in the hundreds of billions per year; nothing in the current bills approaches this level of cost reduction.
* "Free" (to the patient) preventive and maintenance care. See above.
In short, I'm unconvinced that the cost-control features listed by Cutler will be terribly effective. I think he's just trying to sell the plan he helped design. Apparently, his strategy is working on some people.
=====
I'm not well read on health care? If you mean I don't take anything pundits, shills, politicians, PR flacks, and horse-race commentators have to say about healthcare reform at face value, you're absolutely right. If you mean I haven't read topical works by healthcare economists, doctors, business analysts, nonprofit NGOs, international organizations, and foreign healthcare system officials, you're wrong.
=====
Wendell Potter: I've followed him since he ostensibly defected from Cigna to the reform camp. The bottom line is that he supports a bill that will greatly enrich his old pals and that will make most Americans pay even more for health care than they already do. The fact that the bill will also provide important protections to people with pre-existing conditions or who lose their jobs is not quite enough of a saving grace to justify that support, in my opinion. Did you see last Friday's Bill Moyers Journal? Well, I'm with Marcia Angell, not Wendell Potter.
=====
*I'm* a double-agent? Did you see what happened to insurance and pharmaceutical company stock prices when the House and Senate bills gelled? They *want* the currently proposed "reforms". They *want* an individual mandate bringing them millions of new customers with no limits on what they can charge. I'm *against* these reforms, and the interests I am supposedly a double-agent for will be worse off if they fail. With luck, they *will* fail and, once Schwartzenegger leaves office, California will finally pass its own single-payer bill -- third time's the charm -- and that will be the beginning of the end for "Big Health." (Hey -- in Canada it all started with Ontario.)
=====
Nothing will prevent states from implementing their own single-payer systems? Why, then, was Kucinich fighting for a state single-payer opt-out? You know, so that residents of a state that set up its own single-payer system would not *also* have to pay federal healthcare taxes? And by the way, Hawaii doesn't have a state-run healthcare system. It just requires that employers provide health insurance to employees who work more than 20 hours per week.
=====
I don't have a healthcare plan? How about HR 676? The Kaiser Family Foundation costed out leading healthcare bills a couple of years ago. Unlike the CBO (which only measures federal budget impacts), they took *all* costs into account, including those borne by patients. Guess what? The single-payer plans provided *everyone* comprehensive coverage and were the only ones to result in a net *reduction* in aggregate healthcare costs. Representative John Conyers' own studies suggest a similar result for HR 676. Or how about the single-payer plan William Hsiao helped design for Taiwan? I would be perfectly happy with that: comprehensive, permanent coverage, free choice of physicians and hospitals, limited deductibles and co-pays, taxes that are lower than the premiums they replace... What's not to like?
=====
Finally, how will I get my idealistic, pie-in-the-sky plan enacted? I have no illusions about the state of American democracy or who most of our elected officials are actually working for. The only way to achieve any significant reform in the US today is through pervasive outrage. Let the current system continue ever more egregious in its predation, parasitism, and inhumanity, and I believe we'll reach that point rather quickly. As I mentioned earlier, I hope California will be the first state to adopt single-payer and that the rest of the country will follow. At any rate, I will not support a bill that institutionalizes and strengthens the stranglehold that Big Health profiteers have on the country.
More...
=====
The guy who called me a liar referenced an article by Ezra Klein in the Washington Post, which in turn referenced an article in the Wall Street Journal written by Obama healthcare reform collaborator David Cutler ("Health Reform Passes The Cost Test"). That article lists nine cost control features that are in the Obama bill:
• Insurance exchanges.
• Reduction in Medicare payments.
• Value-based payment in Medicare.
• Tax on "Cadillac" plans.
• An independent Medicare advisory board.
• Combat Medicare fraud and abuse.
• Malpractice reform.
• Computerized medical records and insurance processing.
• Prevention.
Four of these nine are limited to Medicare, which, while a significant part of the market, is not the dominant one.
Reducing Medicare payments while non-Medicare payments remain uncontrolled is going to make it more difficult for seniors to find doctors who take Medicare or to get appointments with those that do. Value-based payment in lieu of fee for service is tough to work out in the details, but the UK's NICE (National Institute for Health and Clinical Excellence) and QOF (Quality and Outcomes Framework) provide some good starting points. If an independent Medicare advisory board helps reduce political interference with payment structures and better implements the value-based payments and anti-fraud measures mentioned in separate points, fine. Curbing Medicare fraud is also a fine proposal. The few studies I've read suggest there is more fraud and abuse outside Medicare than within, but every little bit helps.
Massachusetts has an insurance exchange. Premiums have gone up significantly -- probably as a result of the individual mandate, but definitely not offset in the aggregate by the supposed efficiencies of the exchange -- and Massachusetts now has the highest per-capita healthcare costs of any of the 50 states.
As for taxes on Cadillac plans: what is a Cadillac plan? Is it a plan that provides comprehensive coverage and actually protects the insured from medical bankruptcy? If so, the tax doesn't curb overall healthcare costs -- it just encourages underinsurance, which shifts costs from from insurance to the individual. The best systems in the world have minimal "cost-sharing"; this goes in the opposite direction.
To the best of my knowledge, malpractice insurance premiums and overall healthcare costs have not fallen in states that have implemented medical malpractice reform. Defensive medicine and malpractice expenses are estimated to account for a relatively small percentage of overall healthcare costs, anyway (around 2% at most). Regardless, I support any reform that would put more money in the pockets of real malpractice victims and protect doctors from unfounded strike suits.
Computerized medical records and insurance processing: I'm all for it. There will be a significant initial investment, but I believe it will pay off. Two of the best, most efficient healthcare systems in the world, France's and Taiwan's, do this.
Prevention: Leaving aside non-insurance issues such as unhealthy food and activities, occupational health and safety, and the like, the best "prevention" is to offer preventive, diagnostic, and maintenance care at no (or nominal) out-of-pocket cost to patients. Systems that do this spend a moderate amount of money upfront; we don't do it and instead spend huge amounts of money on deferred rescue care. Aside from lip service to the general value of prevention, where are the concrete mandates in Cutler's plan?
For the most part, the above cost controls are nickel-and-dime stuff. The biggest cost savings by far are found in features that are shared by virtually every one of our peer countries' healthcare systems but that are conspicuously absent from any of the current bills:
* Single-agent (monopsonistic) bargaining with providers, resulting in fair, adequate, uniform fees and prices. Every other developed country does it. We don't, which is the primary reason we have the highest medical prices in the world. Medical care is not a perfectly competitive market, and sellers have a significant amount of market power. It's nothing short of stupid for patients not to bargain with them as a bloc. Apparently, though, we're stupid. Stupider than everyone else.
* Administrative efficiency. Most other countries waste in the low single digits, percentage-wise, on administrative expenses. Our own Medicare is estimated to have around 2-3% administrative overhead. The US as a whole, in contrast, is estimated to waste from 25% to 30% of all healthcare expenditures on administration. Some of this waste will be reduced if insurers no longer have to do rescission investigations, but if over a thousand separate insurance companies continue to operate, each with its own sets of policies, riders, forms, and procedures, most of the administrative overhead will remain. The potential administrative savings from a single-payer "Medicare For All" system are estimated to be in the hundreds of billions per year; nothing in the current bills approaches this level of cost reduction.
* "Free" (to the patient) preventive and maintenance care. See above.
In short, I'm unconvinced that the cost-control features listed by Cutler will be terribly effective. I think he's just trying to sell the plan he helped design. Apparently, his strategy is working on some people.
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I'm not well read on health care? If you mean I don't take anything pundits, shills, politicians, PR flacks, and horse-race commentators have to say about healthcare reform at face value, you're absolutely right. If you mean I haven't read topical works by healthcare economists, doctors, business analysts, nonprofit NGOs, international organizations, and foreign healthcare system officials, you're wrong.
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Wendell Potter: I've followed him since he ostensibly defected from Cigna to the reform camp. The bottom line is that he supports a bill that will greatly enrich his old pals and that will make most Americans pay even more for health care than they already do. The fact that the bill will also provide important protections to people with pre-existing conditions or who lose their jobs is not quite enough of a saving grace to justify that support, in my opinion. Did you see last Friday's Bill Moyers Journal? Well, I'm with Marcia Angell, not Wendell Potter.
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*I'm* a double-agent? Did you see what happened to insurance and pharmaceutical company stock prices when the House and Senate bills gelled? They *want* the currently proposed "reforms". They *want* an individual mandate bringing them millions of new customers with no limits on what they can charge. I'm *against* these reforms, and the interests I am supposedly a double-agent for will be worse off if they fail. With luck, they *will* fail and, once Schwartzenegger leaves office, California will finally pass its own single-payer bill -- third time's the charm -- and that will be the beginning of the end for "Big Health." (Hey -- in Canada it all started with Ontario.)
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Nothing will prevent states from implementing their own single-payer systems? Why, then, was Kucinich fighting for a state single-payer opt-out? You know, so that residents of a state that set up its own single-payer system would not *also* have to pay federal healthcare taxes? And by the way, Hawaii doesn't have a state-run healthcare system. It just requires that employers provide health insurance to employees who work more than 20 hours per week.
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I don't have a healthcare plan? How about HR 676? The Kaiser Family Foundation costed out leading healthcare bills a couple of years ago. Unlike the CBO (which only measures federal budget impacts), they took *all* costs into account, including those borne by patients. Guess what? The single-payer plans provided *everyone* comprehensive coverage and were the only ones to result in a net *reduction* in aggregate healthcare costs. Representative John Conyers' own studies suggest a similar result for HR 676. Or how about the single-payer plan William Hsiao helped design for Taiwan? I would be perfectly happy with that: comprehensive, permanent coverage, free choice of physicians and hospitals, limited deductibles and co-pays, taxes that are lower than the premiums they replace... What's not to like?
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Finally, how will I get my idealistic, pie-in-the-sky plan enacted? I have no illusions about the state of American democracy or who most of our elected officials are actually working for. The only way to achieve any significant reform in the US today is through pervasive outrage. Let the current system continue ever more egregious in its predation, parasitism, and inhumanity, and I believe we'll reach that point rather quickly. As I mentioned earlier, I hope California will be the first state to adopt single-payer and that the rest of the country will follow. At any rate, I will not support a bill that institutionalizes and strengthens the stranglehold that Big Health profiteers have on the country.
68
@66 I would have to take issue with at least one of those criticisms you mention. The one regarding cadillac plans is similar to other twisted arguments coming from allegedly pro-labor critics. It conveniently glosses over a few things: Based on CBO estimates this is the only provision that remains in the bill that could potentially offer real cost savings. The price tag of the plans that would be subject to the tax is almost always mysteriously left out by the critics. Wonder why this is? Perhaps because it is a little absurd to argue that any plan that costs less than what is it $18,000 (or now over 20,000 in Obama's latest proposal) for a family of four constitutes 'underinsurance'.
Bogus argument all around and although I am usually pro-union I would say bullshit like this is exactly why many unions have proven to be pretty much their own worst enemies in recent decades. Don't want to pay the tax? Shop for a cheaper plan.
Bogus argument all around and although I am usually pro-union I would say bullshit like this is exactly why many unions have proven to be pretty much their own worst enemies in recent decades. Don't want to pay the tax? Shop for a cheaper plan.
69
@68 - Right. The Cadillac tax basically is a "soft cap" on insurance premiums. The whole idea is that people and insurance companies will do whatever to avoid paying it. How do you think direct cost controls would work?
I'll readily admit there are tons of great cost control ideas that aren't in the bill, precisely because they're not politically feasible at the moment. But PCM, saying "the bills don't have cost controls" is not the same as saying the cost controls don't go far enough. I'd like to see some good independent studies from major institutions (these "healthcare economists, doctors, business analysts, nonprofit NGOs, international organizations, and foreign healthcare system officials" you mention) who think not merely that the bill doesn't go far enough, but that it will actually do the damage you say and is WORSE than the status quo. Links!
I'll readily admit there are tons of great cost control ideas that aren't in the bill, precisely because they're not politically feasible at the moment. But PCM, saying "the bills don't have cost controls" is not the same as saying the cost controls don't go far enough. I'd like to see some good independent studies from major institutions (these "healthcare economists, doctors, business analysts, nonprofit NGOs, international organizations, and foreign healthcare system officials" you mention) who think not merely that the bill doesn't go far enough, but that it will actually do the damage you say and is WORSE than the status quo. Links!
70
The PCM solution: "Let the current system continue ever more egregious in its predation, parasitism, and inhumanity. . . ."
Translation: "You have to destroy the village to save the village."
Nice.
Translation: "You have to destroy the village to save the village."
Nice.
71
Correction: In Canada, it all started in SASKATCHEWAN, not Ontario. (It was late; a synapse misfired.)
Response: My apologies, but I don't have the time. I maintain that the high-premium-plan tax revenues of ~$1.5 billion a year projected by the CBO -- if you can properly characterize them as "healthcare" savings -- are nickel-and-dime compared to potential savings available through the other approaches I mentioned.
Response: My apologies, but I don't have the time. I maintain that the high-premium-plan tax revenues of ~$1.5 billion a year projected by the CBO -- if you can properly characterize them as "healthcare" savings -- are nickel-and-dime compared to potential savings available through the other approaches I mentioned.
72
There's no doubt single payer offers exponentially greater cost savings but almost guaranteed that your plan for letting more shit to hit the fan would lead to at best a situation where a handful of states adopted a variety of half-baked and wildly disparate schemes to alleviate the problem while health care coverage rapidly evaporated for the non-rich in the rest of the country. The current legislation offers a toe hold that could conceivably be re-worked/supplemented in the future. It fails to pass and health care reform on the national level will be radioactive at least until the next democratic president, not improbably another generation down the road.
73
@66 So PCM has no strategy to get us a single payer system! (No surprise there.) PCM is willing to let millions of the uninsured suffer and die as we stupidly wait years and years for Middle America to finally wake up and support a single payer system? (As if that would ultimately happen.) That's stupid and cruel, PCM. Incrementalism is the way in the good old USA, like it or not. Pass the damn Senate bill and then reconcile it now, Kucinich and House Dems!
74
Well, at the beginning of the term, I had an incremental, non-brinkmanship strategy that I shared with Obama's team and my congressional delegation. The first step was to partially neutralize Big Health influence over the media (by banning direct-to-consumer prescription drug advertising, forcing GE to spin off NBC, and legislatively reinstating the Fairness Doctrine). The second step was to better insulate elected officials from private financial inducements (by further limiting private funding of election campaigns and by bolstering conflict-of-interest rules). The third step was to play the major lobbies -- pharma, device manufacturers, hospitals, nursing homes, diagnostic labs, and of course for-profit insurance -- against each other and pick them off one by one -- incrementally, over time. (Why couldn't we just start with a national pharmaceutical pricing law like Canada's?) Notwithstanding the current Supreme Court's near-certain hostility to the first two steps, if we had an LBJ in the White House instead of Obama/Emanuel, I think this could have been a viable approach.
My strategy now is to hope that California succeeds in enacting single-payer once Schwartzenegger is out of office. (The legislature has passed it twice; Schwartzenegger has vetoed it both times.) I'm sure that Big Health will spend hundreds of millions trying to defeat it. I'm also pretty sure that the savings available to a single state, even one as large as California, won't be as dramatic as those in a national system. Still, I believe that if it does pass, it will be successful enough to create support for single-payer in other states and, ultimately, nationwide. This is pretty much what happened in Canada.
Look -- maybe I'm wrong. Maybe the individual mandate with for-profit insurance companies, in-network and out-of-network providers, and no genuine cost controls -- a point I won't concede -- will incrementally evolve into an individual mandate with non-profit insurance funds, free choice of physicians, and monopsonistically negotiated provider prices, as in Japan and Switzerland. However, I see no grounds whatsoever for expecting that that will happen. The for-profit health sector has called the shots on nearly every aspect of the current Congressional bills. If reform as currently envisaged goes through, Big Health will probably come out even stronger. How is that going to make it easier to achieve additional legislative increments in the future? Not to be snarky, but what's *your* strategy?
I care about the uninsured and I care about people with pre-existing conditions; I'm one of them. I want to see them covered -- I want to see *everyone* covered. But I also care about the economy and the future of the country. Healthcare gouging, profiteering, and waste is sucking *far* too much out of the productive economy, and the current bills don't do nearly enough -- I'm tempted to say *anything* -- to correct that. But if it's any consolation, I think there's a very good chance an Obama-esque plan will squeak through and that the Dems will be able to declare "Mission Accomplished." Ten years from now, we'll start to see whether any of my concerns were well founded.
More...
My strategy now is to hope that California succeeds in enacting single-payer once Schwartzenegger is out of office. (The legislature has passed it twice; Schwartzenegger has vetoed it both times.) I'm sure that Big Health will spend hundreds of millions trying to defeat it. I'm also pretty sure that the savings available to a single state, even one as large as California, won't be as dramatic as those in a national system. Still, I believe that if it does pass, it will be successful enough to create support for single-payer in other states and, ultimately, nationwide. This is pretty much what happened in Canada.
Look -- maybe I'm wrong. Maybe the individual mandate with for-profit insurance companies, in-network and out-of-network providers, and no genuine cost controls -- a point I won't concede -- will incrementally evolve into an individual mandate with non-profit insurance funds, free choice of physicians, and monopsonistically negotiated provider prices, as in Japan and Switzerland. However, I see no grounds whatsoever for expecting that that will happen. The for-profit health sector has called the shots on nearly every aspect of the current Congressional bills. If reform as currently envisaged goes through, Big Health will probably come out even stronger. How is that going to make it easier to achieve additional legislative increments in the future? Not to be snarky, but what's *your* strategy?
I care about the uninsured and I care about people with pre-existing conditions; I'm one of them. I want to see them covered -- I want to see *everyone* covered. But I also care about the economy and the future of the country. Healthcare gouging, profiteering, and waste is sucking *far* too much out of the productive economy, and the current bills don't do nearly enough -- I'm tempted to say *anything* -- to correct that. But if it's any consolation, I think there's a very good chance an Obama-esque plan will squeak through and that the Dems will be able to declare "Mission Accomplished." Ten years from now, we'll start to see whether any of my concerns were well founded.
75
Dan Savage hates Dennis Kucinich. Has for years. Has something to do with Kucinich actually having integrity and making Dan look really bad when he insisted that the entire alternative press bend over to kiss the ass of the Bush administration and do nothing to actually investigate the fraudulent claims that led to the Iraq war. Dennis is a hero, Dan is a spineless piece of shit. Dan knows it and is eaten up with bitter hate.
Phone calls from Seattle are going to do nothing but harass Kucinich staffers because they do not come from constituents. Dan knows this, too. He posts the number and requests the calls for the same reason he posts the info for the bigoted school administrators who canceled the prom because they hates lesbians: he wants someone he dislikes to have an awful time.
People should compare how often Kucinich has been proven right on political issues with how often Dan Savage has. That should prove to them conclusively that Dan should be ignored on all questions of national politics.
Phone calls from Seattle are going to do nothing but harass Kucinich staffers because they do not come from constituents. Dan knows this, too. He posts the number and requests the calls for the same reason he posts the info for the bigoted school administrators who canceled the prom because they hates lesbians: he wants someone he dislikes to have an awful time.
People should compare how often Kucinich has been proven right on political issues with how often Dan Savage has. That should prove to them conclusively that Dan should be ignored on all questions of national politics.
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