
Last night, ABC News' George Stephanopoulos appeared on The O'Reilly factor and echoed a growing conventional wisdom.
"It's pretty clear right now that there aren't the votes in the senate to pass a public health insurance option as much as a majority of Democrats in the House would like it," he said. "It's not going to get through the Senate right now and I think that what Democrats may try to do is remind people of another side of the Kennedy legacy. That was Kennedy the compromiser. Kennedy the negotiator. The man who was willing to take a portion, incremental gain even if he couldn't get everything he was calling for."
Both of those ideas--that the Senate will not pass a public option, and that Ted Kennedy would support giving up on it--are pretty deeply seeded in the media at this point. But compare that to Lawrence O'Donnell--chief of staff of the Senate Finance Committee during the Clinton Care years--who says that's all wrong.
"Senator Kennedy...is not an easy compromiser on health care reform. In 1994, I was in the room when he told the president that he believed the strategy should be a Democrats-only strategy and that we should not be trying to reach out and get Republican votes."
Separately from Kennedy, we noted yesterday that though there may be some public option skepticism in the Senate Democratic caucus, almost none of its members are willing to absolutely disavow voting for a health care bill that creates one. Contrast that to the situation in the House, where over 60 Democrats have said they'll vote against a health care bill if it doesn't have a public option. At the very least, this suggests that Democratic leaders are faced with a Catch-22--not that the Senate is "pretty clear[ly]" against it and Democrats should just learn to live with that.
ClosetLuddite
August 28, 2009 11:47 AM
What a historical revisionist little bastard. I hope he gets hives.
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CT Voter
August 28, 2009 12:16 PM in reply to ClosetLuddite
Or fleas.
With a nice chaser consisting of ticks?
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Chris
August 28, 2009 1:39 PM in reply to ClosetLuddite
The public option is a compromise. Go make them own it.
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TheRealFish
August 29, 2009 12:54 AM in reply to ClosetLuddite
Poor George! (Where have I heard that phrase before???) Anyway, Kennedy ditching the public option is like saying he would have ditched sailing.
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JohnMcCSF
August 28, 2009 11:59 AM
Steven Pearlstein said the same thing - again.
O'Donnell's wrong. These two aren't talking about a compromise with Republicans but how best to get a deal among Democrats that provides substantial if not perfect reform.
Pearlstein lays out the deal that he thinks is there for the taking. Kay Hagan as Brian reports is of the same view - sacrifice the public option for the coops
http://www.washingtonpost.com/wp-dyn/content/article/2009/08/27/AR2009082703919.html?hpid=topnews
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wyt
August 28, 2009 7:28 PM in reply to JohnMcCSF
This totally misses the point that most Americans with insurance don't care that deeply about the uninsured. But we do care that our insurance companies are corrupted by greed, and behave neither honestly nor honorably. There's all this talk about a public option "to keep them honest," which is a laugh because they're deeply committed to lies as a business practice.
Most of the political support for "reform" is because we want a viable replacement for our rapacious insurance companies. People who like those companies can stay with them. But we insist on a real option. A "reform" that mandates that everyone buy from the bastards would be a net loss, not worth it even if it covers the presently uninsured. There would be no benefit to presently insured Americans.
I for one will leave the party if we don't get a solid public option. And I've been active since McGovern, and am on my county committee.
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TheRealFish
August 29, 2009 1:15 AM in reply to wyt
"...most Americans with insurance don't care that deeply about the uninsured."
Though I haven't seen the polls showing this to be true (as if polls actually reflect truth anyway; I guess I need to see a poll on the efficacy of polls), then this just points to a failure in education (the type of thing that could happen at some of those town halls, if the insurance industry panic-bots weren't drowning out meaningful exchange of ideas).
By this you mean all those uninsured that make $1,000 trips to emergency rooms when they get the chills with a cough, and whose bills get passed along to the insured, right?
If they instead can make $150 trips to doctors before they contract The Plague, even if that cost gets passed along to the insured, that leaves an extra $850 in somebody's pocket.
If all those apathetic "I've got mine and screw all y'all" insured could wrap their non-empathetic minds around that morsel, I'm sure they would feel somewhat greater, if still greed driven, interest.
Oh, and of course, they WILL lose their apathy at the moment they become sick and their insurer tells them they are now too high an economic risk and dump them before they can be treated.
I'm guessing they already believe in Death Panels, but just need to be convinced that they are already dealing with them.
See what a nice stratagem is that whole orchestrated shouting thing from the corporate Death Panels? Heck, they may even convince us our neighbors don't give a crap about whether we live or die.
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acf_ma
August 29, 2009 3:29 PM in reply to wyt
I hear your anger, but the problem is if you leave the party, where do you go? What are the alternatives? Certainly nothing on the red side. On the liberal side, I don't see anything capable of having an impact. If there were only a way to turn the Democrats back to being of the people and for the people.
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Steve LaBonne
August 28, 2009 11:59 AM
These "serious" people are too dim to understand the political time bomb that would be created by selling people to the insurance mafia via a mandate, without the safety valve provided by a genuine public option. Who, disproportionately, are the people going bare now who would be pissed off by being forced to buy overpriced crappy policies from United Health et al.? Why, young people- the same demographic that played a major part in electing Obama. Brilliant way for the Democrats to shoot themselves in the foot.
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JohnMcCSF
August 28, 2009 12:04 PM in reply to Steve LaBonne
My sentiments exactly...The trade actually suggested by Krugman, at least implicitly, in the "Swiss Menace" is public option for tighter regulation.
The coops then become stalking horses for the public option at a later time instead of the public option setting up single payer for the future
Trading the public option for tighter direct regulation or passing the public option has always been the endgame for Democrats never for Republicans
O'Donnell's wrong because he assumes this will require a deal with Republicans
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The Commenter Formerly Known as NCSteve
August 28, 2009 12:07 PM in reply to JohnMcCSF
Actually, I think that's the exact opposite of his sentiments.
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JohnMcCSF
August 28, 2009 12:20 PM in reply to The Commenter Formerly Known as NCSteve
IC UR point. What I meant to say was that giving the insurance companies a mandate without more is a recipe for disaster.
The question of course is to what extent can added regulator protection against such a disaster be provided as a substitute for a public option. Given the fact that all versions of the public option actually restrict its availability to people without employer provided plans, a fact which limits the ability of the public option to serve as a check to begin with, the regulation for public option exchange is within the realm of possibility as a compromise which is what Pearlstein and Stephanopoulous are suggesting.
Clear as mud eh? The point is though that the issue is clear - mandate plus effective controls the outcome
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Steve LaBonne
August 28, 2009 1:16 PM in reply to JohnMcCSF
But I don't think there's any kind of "more" that can work- practically and especially politically- other than giving them some actual competition. In my opinion, based on considerable study of this issue, if there's going to be no public plan it is VERY important that there also be NO mandate. A mandate with no public option is, and will be seen to be, just an insurance company bailout- yet another raid on the Treasury and on people's wallets by fatcats, with next to nothing in it for Main Street. Massachusetts- where premiums have ballooned and maintaining universal coverage is already becoming unaffordable- is a microcosm of what will happen nationally.
If we can't do proper reform now, pass a worthwhile package of insurance reforms and call it a day, for the time being. The issue WILL have to be revisited in the near future because the current system, even with some additional regulation, is simply unsustainable. As that becomes more obvious to the public, public demand for root-and-branch reform will rise to the level needed to push the political system into it. That day will only be delayed by delivering millions of new captives to the insurance mafia to temporarily bolster its bottom line.
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JohnMcCSF
August 28, 2009 1:50 PM in reply to Steve LaBonne
If there is no mandate, 47 million Americans remain uninsured, 18,000 die every year
I don't think it's even an issue for discussion at least not in any moral sense
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highplainslawyer
August 28, 2009 1:58 PM in reply to JohnMcCSF
Mandates are just a highly regressive tax imposed on those who can afford it the least.
There has to be a better way of achieving universal or near universal care than by taxing the working poor.
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Steve LaBonne
August 28, 2009 1:58 PM in reply to JohnMcCSF
Facts are stubborn things. As I pointed out, unless something fairly drastic is done in Mass., universal coverage there will go down the drain. And as I already explained, mandates without a public option create a major risk for a damaging political backlash that could halt the progress the Democrats have made among younger voters, thus damaging Democratic electoral prospects for decades to come.
The public plan idea was crafted by Jacob Hacker to accomplish specific objectives. It turns out it's not so easy to meet those objectives, and thus provide universal coverage that is sustainable, without it. There's too much glib talk about "alternatives" to a public plan that simply don't hold up on closer inspection.
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expatjourno2
August 28, 2009 2:43 PM in reply to JohnMcCSF
If there is a mandate without a public option, 47 million more American will have shitty, overpriced health insurance or face sanctions if they object. Idiot.
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CT Voter
August 28, 2009 2:50 PM in reply to JohnMcCSF
A plan with a mandate but no public option is no plan at all.
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wyt
August 28, 2009 7:35 PM in reply to JohnMcCSF
Look at the figures on how many die every year from misdiagnosis and treatment errors. It's into the hundreds of thousands. Statistically speaking, our system is incredibly dangerous to your health - and that's for the people with "good" insurance. That's why Obama's emphasis on tracking medical outcomes is about more than just saving money - it's about saving lives. Most physicians are dangerous to their patients, the way medicine is currently structured in America. The average patient visit runs 7 minutes, and the diagnosis and treatment is wrong 25% of the time.
That's why statistically there is no advantage in an annual checkup. Your doctor is literally as likely to hasten your death as prolong your life. This is a situation our insurance companies, with their current fee structures and standards, have played a large hand in creating for us.
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Stiggs
August 29, 2009 9:01 AM in reply to JohnMcCSF
While we're at it, why don't we create a mandate that everyone between the ages of 18 and 65 must have a job. That will really solve our unemployment problems.
The problem is not that people are reluctant to get medical care, it's that they can't afford it. Making people buy insurance without changing the affordability or improving access makes the problem worse, not better. Currently, we have the option of buying into a small handful of shitty and overpriced insurance plans or not. By taking away the option not to buy in, you take away the only incentive insurance companies have to provide an illusion of quality service.
What is going to be improved by making it illegal to not buy private insurance? There will have to be price controls put in place (otherwise premiums will double over night) which means that co-pays and fees will climb and teams of analysts will dream up reasons to deny customers care. It seems odd (a reflection of how badly the conversation is going) but nobody is talking about the fact that people without insurance aren't the only ones who can't afford care. I have certainly been in the position where I both had health insurance and didn't go to the doctor's when sick because of the cost. A mandate without public option is basically guaranteeing that this problem will grow as it becomes the most effective path to profits for the insurers.
Insurance companies have done a brilliant job of figuring out how to keep customers from actually availing themselves of the service they are paying for. High deductible plans are a perfect example of that, the deductibles are placed just above what the majority of people actually need for care. That combined with the psychological aversion to paying enough out of pocket to reach the deductible damn near guarantees the insurance company not having to pay out on that plan.
Health savings accounts (HSAs) combine the high deductible with lower employer expenses and the ability to invest the money paid into the account in the stock market. If only they could figure out how to roll in mandatory combat service with Blackwater (sorry, Xe) it would be a corporate wet dream.
No, if the legislation on the table is mandates without a public option then death panels would probably be the better option. Both for the political careers of our elected officials and as a more humane means of meting out health care in this country.
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JNagarya
August 28, 2009 7:07 PM in reply to Steve LaBonne
"Massachusetts- where premiums have ballooned and maintaining universal coverage is already becoming unaffordable- is a microcosm of what will happen nationally."
Keep in mind that the "universal" health care insurance in MA was Romney's notion of "liberal". And it's probable he intended that either it would mostly enrich the insurance monopoly, or it would "prove" universal insurance won't work.
Remember: Republicans preach that gov't doesn't work; so when they get elected to gov't, they deliberately and immediately set about "proving" that it doesn't.
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Dorn76
August 28, 2009 12:11 PM
Does anyone here think Ted Kennedy would have been reluctant to push through a public option with 50 votes if necessary? I sure don't.
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JohnMcCSF
August 28, 2009 12:35 PM in reply to Dorn76
I don't either. The question is do we have the votes? And the question is unanswerable until a bill is on the Floor under cloture so that an up or down vote on an as yet unknown choice is taken.
And no reconciliation does not get the public option or the coops to the floor without a filibuster. The reconciliation plan is to strip the bill of all but fiscal provisions taxes etc vote that out by majority vote and hope that 60 votes are there to get cloture on the second package containing the goodies (pre-existing conditions, portability, denial of coverage strictures, exchanges, coops, public option etc)
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Dorn76
August 28, 2009 2:37 PM in reply to JohnMcCSF
Interesting, thanks.
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Moose49
August 28, 2009 12:12 PM
Stephadiculous is wrong.
By my count, there are the votes in the Senate. Based on TPM's coverage yesterday, all we need to do is pick up five of the 13 Senate Dems who are wavering on the public option. That seems to me to be eminently doable. That gets us to 51 votes, which is what we need if it's done through reconciliation or if all the Dems (plus Snowe or Kennedy's replacement) vote for cloture.
I don't have any special insight into what Senator Kennedy would have done, but my guess is he would have fought all out for the public option -- pursuing something akin to the strategy noted above -- and only if it became clear it was unattainable (and we're not there yet) would he compromise to get something better than the status quo.
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xargaw
August 28, 2009 12:14 PM
If Democrats pass a healthcare bill that does not contain a public option, it won't matter what is in the bill. Co-ops are a joke and everyone knows that. The base, the activists and all the new voters that Obama was able to harness into believers will disappear. They have the WH and respectable majorities. If they fail to deliver the most important element (STRONG public option) nothing else will matter. The WH is really miscalculating the strong sentiment of the American people and the left, more particularly. They might be able to spin the people that don't care much about politics, but the base will see this as an unreconcilable betrayal.
Guys, like George have completely lost touch with the Democratic base. They have their heads buried in the DC pundacracy. Statements about what Kennedy would do are disgusting. Kennedy was a champion for healthcare. Invoking his name to bolster their own talking points makes me sick.
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Progressive Party
August 28, 2009 12:21 PM in reply to xargaw
Totally agree with your post and these assholes quoting what Kennedy would have done are so off base. kennedy would have drove the public option for he knows all too well what would reform be without it. I want the GOP to go down as being being against reform and have them choke on it. Trading tighter regualtions for the public option is a sad trade. Tighter regulations over the lethal practices should prevent them from murder charges and fraud!
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JohnMcCSF
August 28, 2009 12:27 PM in reply to xargaw
I think it remains to be seen how strong support for the public option is among the base
I am for it but it isn't an "I'll take my marbles and go home" deal breaker for me
Is it for Congress? Who in the hell knows? Maybe the Senate will be able to pass a public option. Maybe not. Maybe the Senate passes the coop version, the House passes a public option version and the outcome is indeed a compromise of both positions of some as yet unknown sort
3 things are sure - neither you nor I know what the choices are because neither of us have even seen what they are. Two, further delay is not acceptable, both houses need to act or HCR fails and three if HCR does fail, neither you or I will have many marbles left to take home
Hard truth
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expatjourno2
August 28, 2009 2:48 PM in reply to JohnMcCSF
Hard truth? Bullshit.
The regime of the insurance companies is on the brink of collapse. They are dying to have 47 million new subscribers with no meaningful competition and will immediately hand out billions and billions and billions of dollars in bonuses to their executives.
How many more 20% annual increases do you think they can impose on their subscribers? Do the math.
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wyt
August 28, 2009 7:38 PM in reply to xargaw
George S. has his headquarters in his hindquarters.
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CT Voter
August 28, 2009 12:20 PM
George is making these assertions based on what, exactly? The many years he worked with Kennedy? Or did he just channel the CS about Kennedy's supposed "incrementalism"? Expect a rash of serious discussions on the Sunday blabberfests about Kennedy's "incrementalism". Lead by George with a heaping of David Brooks repeating this morning's column.
You can make book on that.
And the CW about healthcare will be "Dems trying to do too much, in contrast to how Kennedy would have handled this".
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Dorn76
August 28, 2009 12:29 PM in reply to CT Voter
I am simply disgusted by this revisionism, all in the service of a corporate whore agenda.
Brooks, Steffy, Hatch, McCain, etc., should be ashamed of themselves.
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ru4862
August 28, 2009 12:25 PM
How the hell would George Stephanopoulo know what Sen. Kennedy would or wouldn't of wanted? He doesn't speak for Kennedy's conscious. Stephanopoulos represents everything i hate about our media. Typical.
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dswx
August 28, 2009 12:41 PM in reply to ru4862
Indeed. George and Charlie Gibson destroyed their credibility with their pathetic performances as Republican shills during the debate when they harped on non-issues such as flag pins. To this day George always brings up Republican talking points as if they are facts. A despicable journalist. Right along with David Gregory.
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ru4862
August 28, 2009 1:21 PM in reply to dswx
David Gregory, John King, Wolf Blitzer, Suszane Malveiuex, Candy Crowley, Politico.com and all of FAUX just to name a few.
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sunnysteve
August 28, 2009 12:38 PM
Stephie should run for office. He'd find out just how much we value his opinion.
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checkbook
August 28, 2009 12:40 PM
LIAR!!
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onceler
August 28, 2009 12:42 PM
I love how many TV pundits think they can read minds. Even the minds of the dead. Who does this clown think he is?
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terje
August 28, 2009 12:48 PM
George misses the point when he says that Kennedy "...was willing to take a portion, incremental gain even if he couldn't get everything he was calling for."
Yes, that is true, Kennedy was a realist and a negotiator at times. But he always made sure he was negotiating from a position of strength, not buckling out of a sense of weakness.
I can personally attest from working in DC with Senator Kennedy and his staff on important legislation around HIV/AIDS, disability, health access, immigration and appropriations that he and his staff were aggressive and determined in getting what the Senator wanted.
Senator Kennedy didn't go into negotiations without preparing his side, without doing everything possible to turn things to his side.
Senator Kennedy's office always had a developed strategy -- everything around timing, hearings, sponsors, endorsements, data, media messages, grassroots lobbying and more was determined long before he moved forward with an initiative. (And they always consulted with the relevant advocates for the affected populations about what was essential and what was unacceptable.)
When things were seeming to go poorly, his staff (or the Senator personally) would bring together the advocacy groups and tell them exactly what they needed to do to convince wavering Senators, how to coordinate their grassroots actions with his legislative strategy. They were willing to bang heads when they needed to whip advocates into shape.
He was willing to be extremely direct and blunt about when groups weren't doing what was necessary to get provisions included in law, and what the consequences could be. Neither the Senator nor his staffers tolerated advocacy groups who whined and complained but weren't willing to do the heavy lifting needed.
Perhaps most importantly, they most valued the groups that were able to actually mobilize directly with the impacted population-- whether it was disability groups that could bring hundreds of people in wheelchairs to a protest, groups of people living with HIV/AIDS who could provide first hand testimony about the urgency of the issue, or parents of children with special needs to advocate for their children. They relied on these groups both for advice and for effective organizing, and made them full partners in legislating.
He could (and would) also bluntly call lobbyists on the carpet when they were standing in his way, undermining his legislation, or playing both sides of the argument. He could often turn around even the most indifferent or hostile groups (businesses, non-profits, state governments, community advocates, etc.) I personally saw him effectively ream out high-paid lobbyists and make cower in fear of the consequences of opposing him. (At the same time, he would always be willing to listen to their legitimate concerns and try to address them.)
I also witnessed numerous times when he brought incredible persuasion and pressure on his colleagues, especially those inside the Democratic caucus. His fellow Senators universally admired the Senator, knew he was knowledgeable on the issues, and had friendly relations with him -- they listened when he talked.
And he would be relentless in making his case with other Senators -- constantly following up, making sure his staff was coordinating with other staffs, personally pigeon-holing Senators (on the floor, the elevators, the cafeteria, in caucus,a social gatherings, in hearing rooms, in hallways, etc). And while the relationships were always very friendly, he was willing to confront directly and sometimes forcefully Democratic Senators who were being obstructionist, timid or disingenuous.
In his dealings with Republican Senators he was always absolutely clear on what his bottom line was, what he wasn't willing to negotiate away. And he would work as hard to convince Republicans to support his positions as he did Democrats.
And when that didn't work, yes, he sought common ground, tried to find innovative ways around political stumbling blocks, and would make compromises on aspects of legislation. But he would also be willing to block action, resist unacceptable changes, and stop legislation when it didn't meet his standards. He would walk away from the negotiating table when he needed to.
These media revisionists and Republicans with the "Ted would make deals" meme seem to forget that in his negotiations, Senator Kennedy always fared much better than those he was negotiating with. His combination of determination, preparation, superior staffing, persuasion skills, and strategic wisdom meant that he usually got most of what he wanted without giving up things that really mattered.
And surely George Stephanopoulos remembers from his time in the first term of the Clinton White House that Senator Kennedy was equally willing to do the same thing with administration officials, from the President to Cabinet officers to legislative strategists. So many times he was frustrated when the Clinton folks wouldn't listen to his advice on getting things done despite his forceful expression of how to do it. (And many close to the scene believe that had the Clinton administration listened, the disasters of health care, don't ask/don't tell, and other major missteps.)
The picture being painted of Senator Kennedy as being successful because he was willing to compromise totally misses the point of why he was so effective. Senator Kennedy used every debate, every piece of legislation, every negotiation as a way to advance the agenda, not to fold up and fall back to the lowest common denominator position.
The idea that Senator Kennedy would give up such a critical piece of health care reform in some easy compromise for bipartisanship's sake ignores the reality of how he operated and how hard he pushed to win on the issues that matter.
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Stroszek
August 28, 2009 12:59 PM
What a disgusting ghoul.
Just last month, Kennedy penned an op/ed saying the time for incrementalism had passed and that the public option was a vital aspect of reform.
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JohnMcCSF
August 28, 2009 1:08 PM in reply to Stroszek
Indeed
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Seeryer
August 28, 2009 1:11 PM
I prefer to remember this Ted Kennedy:
"As long as I have a voice in the United States Senate, it's going to be for that Democratic platform plank that provides decent quality health care north and south, east and west, for all Americans as a matter of right and not a privilege."
How does not having a public option do that George?
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JohnMcCSF
August 28, 2009 1:13 PM
Cross post from yesterday...
Support for the public option remains strong
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JohnMcCSF
August 28, 2009 1:16 PM in reply to JohnMcCSF
AARP - internet poll shows more support than real polls but not wildly different
http://theplumline.whorunsgov.com/wp-content/uploads/2009/08/publicoptionmemo1-300x187.jpg
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Texar
August 28, 2009 1:17 PM
Stephastoopidus --ridiculed far and wide for his performance as a Presidential Debate moderator, speaks for the late PROGRESSIVE Senator from Massachusetts? Disney/ABC must be so proud.
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Conrads Ghost
August 28, 2009 1:21 PM
Stephanhuffalottapuss is an exactly perfect example of the putrid rot at the heart of DLC/90's style Democratic centrist 'triangulation.' See, Steffie can read the tea leaves, see, he knows the score; he really, really wants health care reform as much as anyone, so as a clear eyed pragmatist (who might just be a little, you know, well, smarter and well informed than us rubes), as a realist unaffected by partisan bias he already KNOWS what the end result's gonna be, see, so let's just take the smart path to success and follow Steffie's crystal ball gazing insight to the best possible result which Steffie in his Infinite Greatness has already determined for us, us lucky rubes. A more powerful strategy for successful bargaining, especially in a democracy where one side (you know - the oh-so-reasonable insane clown/corporate party, er, Redouchlicans) has not in fifteen-plus years shown one iota of willingness for comity-based compromise, I cannot imagine.
This collapse to a predetermined ‘center’ as negotiating strategy is one of the most arrogant AND pathetic positions one can assume in a democracy. It’s like throwing the pair out of a full house and politely implying that everyone else should do the same. Whether as cover for Dem hauling corporate water, or because of retarded misunderstanding of the processes of democracy, or because of crippling personality deficiencies, it’s insanely ineffective negotiating; it’s incredibly arrogant and dismissive of the democratic process; it emboldens and strengthens the worst aspects of reactionary behavior...when will the Steffies of the world just STFU and go back to accounting where they belong? I’d rather deal with Limbo and Lierly than Steffie. At least they know how to fight for what they (supposedly) believe in.
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Economides
August 28, 2009 1:23 PM
If everyone hates the insurance industry because they do all sorts of nasty things to avoid adverse selection, and Congress enacts a law that forbids those things: denying or making coverage more expensive to those who are less healthy/have pre-existing conditions, then what is the problem. If they can no longer discriminate they won't be competing based not on selecting the healthiest pool/ denying claims but on creating the largest risk pools they can.
If we are concerned about the lack of competition in some markets, and then Congress passes a law allowing any person or company to use the national insurance exchange under Federal regulations(essentially creating a single national marketplace rather than 50 individual ones), what is the problem.
If Congress does not or cannot implement payment rules that increase the quality of care while reducing it's cost in the 47% of the health care market the Federal and State governments already currently pay for, why would you think a "public option" would be capable of doing so. In other words, how does paying for half of health care in the united states not give the government leverage to implement the changes in the cost structure of health care that we all need?
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JohnMcCSF
August 28, 2009 1:31 PM in reply to Economides
That's MY question....What is the trade off?
Every item you mention can pass without republican votes and probably without any reconciliation end run on cloture rules
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Steve LaBonne
August 28, 2009 1:42 PM in reply to Economides
What makes you think health care inflation wouldn't be considerably worse without the leverage of Medicare reimubursement rates? Plus, under the current non-system providers have plenty of opportunities to shift costs to the uninsured, and to the insured whose companies are more interested in controlling outlays by denying care to the sickest than by pressuring providers.
Of course, if this is your biggest concern you should strongly support Medicare for All to eliminate just such corners where excessive costs can hide. International comparisons show this very clearly.
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Economides
August 28, 2009 2:19 PM in reply to Steve LaBonne
1. You are confused about levels and change. Medicare rates are below private rates in general, butttttt... the they are rising pretty much just as fast. All health care costs are going up at unsustainable rates. The reason is that the main drivers of costs are not who is in charge of paying the bills (public or private). How we pay the bills, and more important how we deliver care (or how many resources we use doing so), is far more important.
2. It's not that Medicare is competing with private insurers, it's that they potentially have leverage over the providers. The problem, however, is they do not use it. Thinking about the rates we pay for things has it all wrong. We don;t control costs by simply paying lower prices on CT scans. You do it by changing the way care is delivered. That is you get paid more for doing better by your patient with the least resources necessary
Now We are stuck with a fee-for-service system that rewards quantity over quality and that does not reward efficiency. They folks who practice medicine the best are losing money on Medicare. It's the providers who are wasting the money who should be getting penalized and the ones doing it right who should be rewarded. It's Congress that set those rates and they refuse to put in place a better system (the way MedPAC and others have long advised). My worry about a public plan as well as Medicare for all, and for that matter Medicare as it stands today, is that policy makers are too corrupt to make the changes we already know would make delivery of care much more efficient.
3. To answer your question more directly, I know Medicare does not control costs because there are providers in this country who provide care far more cheaply at just as good or better quality than most places.
Here's a list of some of the best hospitals in America and how much they spend on patients in the last two years of life. Why is there so much difference (is it not as big as the difference in per patient spending between European countries and the US?)
Cedars-Sinai Medical Center $71,637
UCLA Medical Center $63,900
Johns Hopkins Hospital $63,079
New York-Presbyterian Hospital $62,773
UCSF Medical Center $54,669
Hospital of the University of Pennsylvania $54,455
Brigham and Women’s Hospital $50,156
University of Washington Medical Center $46,891
University of Michigan Hospitals $46,397
University of Chicago Hospital $45,718
Stanford Hospital and Clinics $44,997
UPMC Presbyterian Shadyside $43,504
Yale-New Haven Hospital $43,325
Massachusetts General Hospital $43,058
Barnes-Jewish Hospital $40,681
Duke University Hospital $37,751
Cleveland Clinic Foundation $34,437
Mayo Clinic (St. Mary’s Hospital) $34,372
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JohnMcCSF
August 28, 2009 1:25 PM
LAT: The Deal is there
The only question is can we get a public option of some sort though the Congress, past all ths smoke about "government takeover of health care"
http://www.latimes.com/news/nationworld/nation/healthcare/la-na-healthcare-common-ground2-2009aug28,0,6609509.story
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Steve LaBonne
August 28, 2009 1:34 PM in reply to JohnMcCSF
But such regulations would also need to be accompanied by some kind of effective control over premiums, or else the insurance companies will just use the new regulations as an excuse for exorbitant increases (leading to a further drop in the % of the population covered). But I'm not even sure how you do that effectively, and conservadems might actually have a bigger problem with government controls on premiums than with a public plan. (Plus you can only control premiums so much without exerting some downward cost pressure on medical providers as well. Is there an effective way to do THAT apart from the reimbursement levels in a public plan?) So this path is not necessarily as easy as some make it sound. It might actually be harder to do politically, if you're going to do it in a way that doesn't boomerang, than HR 3200.
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JohnMcCSF
August 28, 2009 1:56 PM in reply to Steve LaBonne
Yep....all of which makes me want to gouge an eye out because in the midst of all the sturm und drang of death books, panels, public option etc, we aren't even close to seeing a trade off we citizens can evaluate even half intelligently
I heard a townhalle,opposed it first appeared to HCR, lament that really he was just confused by the public debate
I feel his pain
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Steve LaBonne
August 28, 2009 2:00 PM in reply to JohnMcCSF
But that's exactly why many of us believe that Obama should have gotten solidly behind HR 3200 from the getgo and used his communication skills to explain its benefits to the public.
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Docb
August 29, 2009 1:04 PM in reply to Steve LaBonne
Medicare is setting rates and rules..The private insurance companies administer/ determine/pay out the money...With their admin costs [ 29%] off the top!
If 46 million more are insured that means the Insurances companies who already have monopolies in many states get more people...Unless there is competition!
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Economides
August 28, 2009 2:29 PM in reply to Steve LaBonne
The idea that somehow it is just insurance companies raising their rates for no economic reason that is the cause of health care inflation is just naive and somewhat harmful.
1. The cost of care itself has been skyrocketing. It has affected both public and private payers. Insurance companies wasting tons of effort trying to avoid adverse selection is unconscionable and we should simply outlaw that. Make every insurer compete with each other based simply on who can gather the largest risk pools and based on the extent of coverage they provide (various levels of premium vs deductibles and copays or the type and size of the provider networks they affiliate with).
2. Regulating rates is stupid. If I pay you half as much for a MRI you can just order two. Voila. Even better if you are a doctor with a financial interest in the imaging center. You have to change what it is you are paying for. Basically the idea is to pay who ever is responsible to a patients care for the total care of that patient--not piecemeal for each service or procedure. Then you pay higher rates to those who do a better job and lower rates to those who do worse.
Honestly, it's really really important to understand why costs are going up, and what is actually being done at the provider level to change health care delivery before you worry about who is paying the bills.
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Steve LaBonne
August 28, 2009 2:33 PM in reply to Economides
Good thing, then, that nobody made any such assertion. Strawman much?
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Economides
August 28, 2009 4:31 PM in reply to Steve LaBonne
"But such regulations would also need to be accompanied by some kind of effective control over premiums, or else the insurance companies will just use the new regulations as an excuse for exorbitant increases"
All anyone is talking about is limiting the excesses of insurance companies. As I've said, much of what they do--avoiding adverse selection-is obscene--but it is not what is driving up the cost of care making it increasingly unaffordable resulting in financial hardships for those who are insured and uninsured alike. Not tom mention putting the fiscal future of the country in a vice.
Talk about health care for once and I'll get off your case.
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wyt
August 28, 2009 7:44 PM in reply to Steve LaBonne
But we do know that insurers who were happy with 5 cents on the dollar in the early 90s now take 20 cents on the dollar. How is that anything but insurance companies arbitrarily raising the cost of health care? Wouldn't they still be profitable just taking 5 cents on the dollar? Don't they have more efficient computer systems to process bills than they did in the early 90s? Weren't they profitable then?
They should be limited to 5 cents on the dollar, by law. The Swiss legislate that they get 0 cents. The only profit allowed insurers is on supplemental coverage, not the basic mandated policies.
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Economides
August 29, 2009 12:29 AM in reply to wyt
We spend $2.4 trillion a year on health care. What percentage are you claiming are the profits of the insurance industry?
Often we hear that we could save 30% of our total health care bill. Somewhere on the order of $600 billion. What percent of that $600 are you suggesting is coming from excess payments to insurance companies? Please compare that to the amount of excess spending on hospital's or doctor's services?
You do realize that private payers provide only about 37% or so of all the payments (govt is about 47%, out of pocket about 12, the balance is charity or something like that.)
For profit health care insurance under our current regulatory system is pretty gross, but no matter how gross, it is not what is driving the high costs of care.
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Steve LaBonne
August 28, 2009 2:38 PM in reply to Economides
P.S. And once again, if you're seriously concerned- as we all should be- about reining in inflation in the cost of care (NOT insurance) then, as almost any health care economist will tell you, your ultimate goal (like mine, and like Ted Kennedy's) should be a single-payer system.
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Economides
August 28, 2009 4:47 PM in reply to Steve LaBonne
I am in favor of single payer with a menu of plan options because I don't see how having 1 big insurance arrangement for everyone is not more efficient. That said, we could also use the German system which is private insurers competing in a very narrow space, which is I think what happens when they can no longer deny coverage and risk adjust. Basically they are just aggregtors and processors.
The crux of the issue in my mind is the economc and phyicalk health of the people and I am happy to follow any avenue toward maximizing both. To say single payer is the only avenue is to be totally ignorant of what is going one at the health care delivery level. Study the Mayo Clinic and Intermountain Health Care and Geisinger and then tell me how getting our whole system to work like that is not the most beneficial thing we could do.
A single payer could have payment rules, like Medicare does that waste a huge amount of resources and penalizes rather than reward the innovation in care that make people better off. or it the incentives in the right place. It all depends on the quality of our policy makers.
Universal. High Quality. Affordable for individuals, families and the country is my goal. There are several ways to get there. Insisting on one, if that insistence leads us to intractable arguments and political stalemate, seems unwise.
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ru4862
August 28, 2009 1:29 PM
Stephanopolous is what's wrong with our media and politics Today. He's a relic from the past. A Clintonite from the 90s who was all about compromising democratic principles for the sake easing white democratic, and conservative working class fake fears about liberalism. Stephie and Rahmn Emanuel are both from the Clinton era.
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JadeZ
August 28, 2009 2:29 PM
look, the real ssue here is, what is the bottom line for Obama?
and dont anyone pretend they know.
he must draw the line in the sand, either way, and let the votes fall where they may.
I for one do not believe he ever cared about real reform.
this entire affair has been handled as poor as can be imagined.
why dont the dems have the votes for rral reform?
and why did Obama start this fight without them?
i believed the white house was goign to settle for an insurance bonanza and call it a day.
but they ran into the progressives.
I will say it again, the real reason Obama is falling in the polls is because people do not believe he is on their side
on this issue, and not on the economy ,because of the bank bailouts.
this is the last straw and i see no evidence he is willing to fight to prove the people wrong here.
The worse thing that could possibly happen on many levels is the republicans come out of this with 'we stopped Obama".
And that is exactly what is going to happen unless the president stops acting weak and fights for what the people want and need.
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Economides
August 28, 2009 2:38 PM in reply to JadeZ
"I for one do not believe he ever cared about real reform."
You are full of crap. Obama is just a few steps away from accomplishing more on health care reform than perhaps any president in history.
Your first problem is you you barely understand the problem and so you are fixated with the idea that there is one and only one solution.
Your second problem is that you are exactly like the guy watching the Ali-Foreman fight in the sixth round screaming at Ali to fight back. Like all he needs is your advice.
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Steve LaBonne
August 28, 2009 2:41 PM in reply to Economides
More than LBJ and Medicare? Come on now, silly hyperbole doesn't help your case at all.
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Economides
August 28, 2009 4:54 PM in reply to Steve LaBonne
"maybe"
1. Because the reforms will apply to the entire country and not just seniors and the poor.
2. Because there is the potential to reform government payment policies in a way that leads to vast improvements in the quality and cost of health care for every person in the country.
Success in my mind has nothing to do with whether health insurance is nationalized or not.
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expatjourno2
August 28, 2009 2:52 PM in reply to Economides
Maybe so, but what he is a few steps away from "accomplishing" is taking trillions of dollars out of taxpayers' pockets to enrich the health insurance industry.
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Economides
August 28, 2009 4:59 PM in reply to expatjourno2
You don't really know what you are talking about. We spend $2.4 trillion on health care in his country, what share of that goes to the insurance industry? Until you can answer that you should be quiet and study some more.
Medicare, not a private insurer, pays three times as much to Cedar Sinai hospital for patients in the last two years of their life as it does to the Mayo Clinic. In other words the Mayo Clinic provides just as good care for 1/3 the money. Which private insurance company is to blame for that smarty -pants?
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cawleybo
August 29, 2009 9:10 AM in reply to Economides
Mayo has salaried physicians that are not paid extra for running extra procedures as most ffs providers do.
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Economides
August 29, 2009 11:38 AM in reply to cawleybo
Also at Cleveland Clinic, Intermountain, Billings Clinic, Gesinger, Grooup Health, etc....
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Steve LaBonne
August 28, 2009 3:02 PM
By the way, does anybody really believe that all this mind-fucking stuff about mandates, regulations, subsidies and public options really is an EASIER sell to the public than would have been these three simple words: "Medicare For All"? Polls have consistently shown high levels of support for the latter.
This whole thing has been an enormous and tragic wasted opportunity, thanks to our fucked up, bought and paid for political system.
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GTFOOH
August 28, 2009 3:41 PM
Everytime I watch Stephanopolus or Gregory for that matter, I am reminded of just how good Russert was. He would ask a question and then just let the guest talk themselves into a noose. Stephanopolus and Gregory both seem to think they are the smartest person in the room at all times and constantly want to depart their wisdom on everyone else.
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sbv
August 28, 2009 4:34 PM
this is so much bs. what stephanopolus, hatch, mccain and david brooks today in the ny times do not realize, a bill with a strong public option is the compromise. teddy wanted medicare available to all, universal health care for all.
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Dorn76
August 28, 2009 4:45 PM
Thank goodness there are journalists out there with a freakin clue who Ted Kennedy really was, like Sam Tanenhaus.
Hey Steffy, put this in your pipe and smoke it....
http://www.nytimes.com/2009/08/30/weekinreview/30tanenhaus.html?hp
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acf_ma
August 28, 2009 5:26 PM
The public supports a public option by a large margin. That's all the Congress, especially the Senate, needs to know. Support it and get reelected, oppose it and ....well. I like the term 'seeded' used to describe the idea of dropping the public option. It's appropriate. I feel as if there's a campaign to create the impression that lack of support, inside and outside Washington, is making the possibility of a reform package with a public option an impossibility. Like everything else, it's spin, designed to move opinion, not report fact.
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JNagarya
August 28, 2009 7:10 PM
Stephanopoulos is full of shit. Kennedy worked on the issue for 47 years: he knew what was needed, and what compromises were actually sell-outs.
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barth
August 29, 2009 6:02 PM
This was the essential problem with the triangulating Clintonistas. To them everything was political, and they believed that expediency always rules. That is often the case; the newsfolk certainly believe it. But there are exceptions, and members who will put principle above expediency. Sen Kennedy was such a person, unless the point being raised was not important.
The difference between the 1958 Civil Rights bill, certainly a step forward but not a very big one, and the 1964 bill is a good example of the two approaches. Both bills were passed by the efforts of, in large measure, President Johnson, who was Senate Majority Leader in 1958. In 1958, his goal was simply to pass a bill, anything, to show that southern Democrats could not stop every civil rights bill, as they had done before. By 1964, with President Kennedy having been murdered, the critical points of the bill, the ones the Kennedy administration considered critical, were all in the bill as passed. Had George Stephanapoulis or President Clinton been in charge then (and, to be fair, had the Congress in 1964 looked like the one in 1993) nothing of any value would have passed.
Rahm was in the Clinton WH, and runs this one. I suspect he has learned from the errors of 1993.
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neesy08
August 29, 2009 6:24 PM
What has this man been sniffing?He sounds like Dick Morris!! Kennedy would NOT have wanted the public option taken out. Has he been receiving talking points from Faux News. The votes are there. All they need are 51 votes. Everybody needs to qit selling Obama short. This plan will pass
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RayMD
August 29, 2009 9:50 PM
It is worth considering the statement that Senator Kennedy made in his letter that President Obama delivered on Kennedy's behalf to the pope last month; Kennedy's letter:
"Most Holy Father, I asked President Obama to personally hand deliver this letter to you. As a man of deep faith himself, he understands how important my Roman Catholic faith is to me, and I am deeply grateful to him.
"I hope this letter finds you in good health. I pray that you have all of God’s blessings as you lead our Church and inspire our world during these challenging times.
"I am writing with deep humility to ask that you pray for me as my own health declines. I was diagnosed with brain cancer more than a year ago, and, although I continue treatment, the disease is taking its toll on me. I am 77 years old and preparing for the next passage of life.
"I have been blessed to be a part of a wonderful family, and both of my parents, particularly my mother, kept our Catholic faith at the center of our lives. That gift of faith has sustained, nurtured and provided solace to me in the darkest hours. I know that I have been an imperfect human being, but with the help of my faith, I have tried to right my path.
"I want you to know, Your Holiness, that in my nearly 50 years of elective office, I have done my best to champion the rights of the poor and open doors of economic opportunity. I’ve worked to welcome the immigrant, fight discrimination and expand access to health care and education. I have opposed the death penalty and fought to end war. Those are the issues that have motivated me and been the focus of my work as a United States Senator.
"I also want you to know that even though I am ill, I am committed to do everything I can to achieve access to health care for everyone in my country. This has been the political cause of my life. I believe in a conscience protection for Catholics in the health care field and will continue to advocate for it as my colleagues in the Senate and I work to develop an overall national health policy that guarantees health care for everyone.
"I have always tried to be a faithful Catholic, Your Holiness, and though I have fallen short through human failings, I have never failed to believe and respect the fundamental teachings. I continue to pray for God’s blessings on you and our Church and would be most thankful for your prayers for me."
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714Day
August 30, 2009 6:42 PM in reply to RayMD
This seems like quintessential Teddy. Stephanopolous sounds like a quisling.
I'm going to "guess" that Kennedy, steeled by his own terminal malaise, would've been even more fervent (than he was all of his life) in staying the course for the compromise - PO. He was willing to let single payer slide for the time being. He was a partisan when progress required him to be.
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SleepinJeezus
August 30, 2009 12:25 AM
This is the problem: I trusted Ted Kennedy. I never had to worry that he would sell out to the highest bidder in Washington. If Ted said compromise was in order to achieve a greater goal, then I believed the best compromise would be negotiated.
I cannot feel the same degree of trust with Obama or with any of the other Dems negotiating this Health Care Reform. Obama lost me from the day he announced single-payer was off the table, not even to be discussed because the Insurance Industry would not allow it. The rest have shown a DLC-style lack of commitment in favor of campaign financing as to make of themselves mere shadows of real legislators and leaders on this issue.
And George Stephanopolous? We should trust him to tell us what compromises are needed, or trust that he channels Ted Kennedy and can speak for him on this issue? Oy!
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raiatean
August 30, 2009 1:40 AM
I put Stephanopolous alongside all the milquetoast sons of bitches back in Washington. That cowardly little turd wouldn't have the cojones to have made that statemet when Teddy was alive.
Doncha just love these Blue Dog Bastards? I think we need to fund the spay and neuter program a little better myself!
Just this old Chief's 2 Cents
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kovie
August 30, 2009 7:18 PM
All I want to know is why Steph keeps doing this. Is he really as stupid and cowardly as he comes across (and no wonder Clinton's health care plan failed if they had nebbishes like him running their policy and politics staff)? Or is he just another corporate tool, begging for some right-wing love and willing to stick it to his former party if that's what it takes?
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