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Earlier Benefits Could Be On The Table In House/Senate Health Care Conference

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Sen. Tom Harkin (D-IA)

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With the public option dead, progressives are looking for something else to get out of negotiations and moving up the list is the possibility of speeding up implementation.

When the two chambers meet in conference, House leaders will have a prioritized package of goodies in mind, and they'll be pushing hard for them. On the list will likely be familiar issues like financing--should wealthy Americans pay for reform, or should a tax on high-end health insurance policies cover the cost, or should it be a mix of the two?

But a separate issue is beginning to come into focus.

"I think one other one, is starting date," Sen. Tom Harkin (D-IA) told reporters today.

The Senate bill is set to implement most of its largest reforms (the mandates, subsidies, and exchanges) in 2014. The House bill kicks into high gear a year earlier, in 2013.

"[Q]uite frankly it ought to even be sooner than that," Harkin said.

That meshes with the focus of Democratic aides in both the House and Senate--and with one of the House's leading progressives.

Earlier today, Rep. Raul Grijalva (D-AZ)--co-chair of the Congressional Progressive Caucus--told Greg Sargent that the idea of moving the implementation date forward is of interest to him and other Democrats.

"It would sweeten it somewhat," Grijalva said, "if they speed up the coverage mechanism."

Obviously, for political reasons, all Democrats would like to speed up the implementation of this reform package. It's hard to run for office on the platform of having passed an unpopular bill that hasn't really done anything yet. But moving day-one forward a year isn't free. Crucially, it would require the government to cover an extra year's worth of premium subsidies in the CBO's 10 year budget window. And that would cause the price tag of the bill to jump noticeably.

Conservative Democrats have blanched at the idea of voting for a bill with a significantly higher pricetag than the bills that are on the table right now, so it would be a complicated trade-off. And there are other outstanding issues as well, including whether to organize insurance exchanges at the state or national level. But implementation is worth keeping an eye on.

Comments (104) | Join the Conversation!

Recommend Recommend (4)

December 22, 2009 3:51 PM   

What the hell did we give up anyway?

The Public Option was already so watered down in both bills that it would only cover a few million and might have had such a high cost pool that it would prove ineffectual

The medicare buy-in? Excellent idea except for the fact that it was never scored in relation to other reforms. I strongly suspect that this too would prove a still born reform for 55-65 year olds would be buying into a risk pool of seniors and permanently disabled persons at what premium?!?!?


Early start dates a good trade and perhaps single shot reforms aimed at hospitals. big pharma, insurers ..like a decent medicare buy in via reconciliation that works

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December 22, 2009 4:21 PM    in reply to JohnMcCSF

The medicare buy-in premiumus would have cost roughly $650 per month. It would have made the move to single payer easier but it was not bargain.

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December 22, 2009 4:51 PM    in reply to FreeRider

I was paying $860 for a Blue Cross policy with a $5,000 deductable during the last couple years before I qualified for Medicare.

In '05 I was in a major vehicle accident and discovered that the $5k deductible was just the first part of what I had to pay. I ended up with another ~$4k of things that Blue Cross wouldn't cover.

Now I'm on Medicare. I bought Part B and Supplemental. Costs me an additional $200 a month. I've had some expensive tests done.

My cost? Zero.

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December 22, 2009 4:54 PM    in reply to Wallace Bob

Medicare is definitely a good deal. It drives me crazy that the Medicare crowd is most resistant to helping others get insurance coverage.

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December 22, 2009 5:52 PM    in reply to FreeRider

Keep in mind that the Medicare crowd is 65 and older.

If something bad happens to their finances almost all have zero chance of returning to the workforce and making a decent salary.

And even if they could get a good paying job they have little time left to replace lost savings. Someone screws up your Medicare and you're standing at the door of Walmart handing out carts when you're 75/80 years old....

Older folks are realistically more financially conservative.

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December 22, 2009 7:59 PM    in reply to Wallace Bob

Typical republican. Lies and distortions. Facts mean nothing. They only come here to make noise.

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December 22, 2009 10:20 PM    in reply to FreeRider

For a 60 year old man, $1,375 per month is the price for an HMO plan in my town - and that's the least expensive insurance provider. Buying into Medicare would be a blessing!

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December 22, 2009 3:53 PM   

It's become crystal clear in recent days that the public option is dead.

Evidently, it was crystal clear long ago. Only the saps like me didn't know.

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December 22, 2009 4:23 PM    in reply to wbgonne

At least you admit you are a sap. That explains why you want to deny coverage to 30 million people.

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December 22, 2009 4:38 PM    in reply to FreeRider

Time for your meds.

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December 22, 2009 3:57 PM   

polish polish polish

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December 22, 2009 4:00 PM    in reply to Indie Pro

You got something against the Polish?

Yuk yuk.

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December 22, 2009 4:08 PM    in reply to Indie Pro

Now that a bill is inevitable, shouldn't we push to make it more effective?

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December 22, 2009 4:16 PM    in reply to Dorn76

No, we shouldn't, because the bill should be killed.

And since it appears that it won't be, we should sit back and complain.

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December 22, 2009 4:20 PM    in reply to CT Voter

Yes, because NOT complaining has been so successful.

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December 22, 2009 4:22 PM    in reply to wbgonne

Wait. Progressives/liberals haven't been complaining all freaking year long?!?! HA!

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December 22, 2009 4:32 PM    in reply to FreeRider

And we've been right all year long about what kind of piece of crap would emerge (and what Obama really wanted all along), contrary to all of the wildly optimistic predictions about the final bill made by- people like you. So we should listen to the people who have been wrong from the start why, exactly?

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December 22, 2009 4:43 PM    in reply to Steve LaBonne

A piece of crap that will bring health insurance to tens of millions who cannot now afford it or are denied because of some pre-existing condition.

A piece of crap that will limit premium cost to no more than 12% (likely closer to 8%) of your income. (I was paying 47% of my income to Blue Cross just prior to qualifying for Medicare.)

A piece of crap that will collect some money off those too stupid to buy health insurance. Money that can be used to take financial pressure off our hospital emergency rooms.

A piece of crap that will create a competitive health care system by setting up a minimum standard for those policies listed on the Exchange. Along with the ability to switch carriers once a year if you're company isn't performing.

A piece of crap that will create electronic medical records, cutting down unnecessary labor costs in hospitals and doctors offices and reducing the number of unnecessary duplicate tests.

Yep. Flush this one. Sign it into law and we lose....

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December 22, 2009 4:53 PM    in reply to Wallace Bob

Excellent point but is unfortunately lost on the whiner/complainers

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December 22, 2009 6:33 PM    in reply to Wallace Bob

what about limits on copay out-of-pocket? what about limits on benefits?

Without a public option, these issues will not be addressed, and people will continue to be unable to afford health care.

Also, last time I checked we've always been free to change insurance whenever it pleases us.

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December 22, 2009 6:54 PM    in reply to Bolshevik in Jesustan

Those limits are in the bill.

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December 22, 2009 6:41 PM    in reply to Wallace Bob

To go point for point here....

> A piece of crap that will bring health insurance to tens of millions who cannot now afford it or are denied because of some pre-existing condition.

Mandates (and consequently the requirement for insurers to cover preexisting conditions) don't go into effect until 2014. If you're referring to the high risk pool to be set up in the interim . I see nothing about that that would reduce the cost. It's going to be wildly expensive. And no subsidies. These people may be able to qualify for a plan now, but it doesn't mean they can afford it.

So the argument that we're killing 30 million people is inflammatory and unfounded. You can't argue that they couldn't go back to the drawing board and come out with something that helps these people NOW.


> A piece of crap that will limit premium cost to no more than 12% (likely closer to 8%) of your income. (I was paying 47% of my income to Blue Cross just prior to qualifying for Medicare.)

The single payer alternative that was never even considered was 2% of your income tax and then 7% payroll tax. Do you really think a 12% tax is the best they can do? No, this is another give away to the industry.

I'm sorry for your fiscal trouble with healthcare, but I fail to see how this 'relief' makes sense to the majority of Americans.

They did limit the Medical Loss Ratio to 85%. But they didn't put any parameters around administrative costs, so now it's likely that you'll be getting crappier customer service so that the companies can increase their profit margins.

> A piece of crap that will collect some money off those too stupid to buy health insurance. Money that can be used to take financial pressure off our hospital emergency rooms.

Unconstitutional. You can't force someone to buy a product in the private sector under penalty of law if they have no alternative to avoid paying for it (ie, car insurance, just don't drive a car and you can avoid paying for car insurance).

Also, doesn't go into effect until 2014.

Also, 2.5% is the max penalty (see above, we can give everyone healthcare for less).

> A piece of crap that will create a competitive health care system by setting up a minimum standard for those policies listed on the Exchange. Along with the ability to switch carriers once a year if you're company isn't performing.

I'll give you this one. The exchange makes competitive sense. However there is no plan for implementation and no back up plan if it doesn't work out.

And again; 2014.

> A piece of crap that will create electronic medical records, cutting down unnecessary labor costs in hospitals and doctors offices and reducing the number of unnecessary duplicate tests.

Worth it? EMR has been gaining traction for some time. They didn't need HCR to see this as advantageous. It could have also been EASILY passed in another bill on many grounds, environmental impact, cost savings, infrastructure investment, etc.

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December 22, 2009 7:00 PM    in reply to ohyeathatsright

It seems you only reasonable point is that the program could go into effect quicker.

I agree with this and Congressional leaders are talking about ways to speed it up. Do remember that aid for people with pre-existing conditions go in pretty much immediately.

As for forcing people to buy insurance from a private company. They aren't required to do so. They can pay a small fee and self insure.

The fee (I think) goes to offset the emergency room bills that they will run up and not pay when they find themselves bankrupted.

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December 22, 2009 7:50 PM    in reply to Wallace Bob

You can refer to other posts of mine if you'd like me to enumerate further. My point is that there is nothing in the bill that makes it a must pass for the reasons you've outlined.

I'd prefer our leaders go back to the drawing board and draft some legislation that isn't analogous putting a used bandaid on an open wound.

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December 22, 2009 8:08 PM    in reply to ohyeathatsright

What's wrong with passing this, just to make sure something gets passed, and then fixing the more egregious flaws over time?

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December 23, 2009 5:08 PM    in reply to Homefries

Simply put, Democrats don't have the balls. I'm going to be very surprised if they make any effort for further reform. My assumption (and hopefully I'm proven wrong) is that they'll throw this one into the win category and move on to something else they can easily muster 60 votes for. Equally, in the immediate term, the Republican are also going to frame this as a win ("It could have been much worse!") and are going to try and move away from this issue to divert attention from their loss.

That said, should the bill pass tomorrow, which is all but a guarantee, I will be fighting for its reform immediately. I will adapt to the system as it changes, but that doesn't mean I have to support this blatant corporate give away and piece of scam legislation just because it's the Democrat's flavor of the week.

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December 23, 2009 9:08 PM    in reply to ohyeathatsright

Well said and fair enough.

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December 22, 2009 8:43 PM    in reply to ohyeathatsright

Well, la-la-la...

You don't see why your other points are unreasonable?

OK, I'll spell it out for you.

The Exchange puts all the companies on the same page. They have to provide the same coverage. If we don't like how the company we currently have is performing we get an annual open enrollment to move to someone else.

Immediately there will be web sites springing up to evaluate how companies are performing. Prices will be right there in our faces.

Now, if this doesn't create competition please explain a system that would be better set up to produce best price while maintaining quality.

Limits - 85% has to go to coverage costs. Operating expense, advertising/lobbying, profits come out of the other 15%.

What did I miss? You tend to stick multiple points in the same paragraph.

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December 23, 2009 10:28 AM    in reply to Wallace Bob

you didn't like the last one, here "The Nation" lays it out:

http://www.thenation.com/blogs/thebeat/508471/nurses_say_senate_bill_entrenches_chokehold_of_insurance_giants


1. The individual mandate forcing all those without coverage to buy private insurance…

2. No challenge to insurance company monopolies…

3. An affordability mirage…

4. The excise tax on comprehensive insurance plans which will encourage employers to reduce benefits…

5. Major loopholes in the insurance reforms that promise bans on exclusion for pre-existing conditions, and no cancellations for sickness… The loopholes include:

6. Minimal oversight on insurance denials of care…

7. Inadequate limits on drug prices…

8. New burdens for our public safety net…

9. Reduced reproductive rights for women.

10. No single standard of care. Our multi-tiered system remains with access to care still determined by ability to pay


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December 23, 2009 5:34 PM    in reply to Wallace Bob

Specifically about the Exchanges, here are a few of my concerns. I've tried to split them up so you can read them one by one:

States have to set up the Exchanges. This is going to suck for our friends in in the south where political opposition to this is great.

The Exchange is profit driven with no premium caps or public competition. The Senate bill allows them to charge up to 17% of income, and then drop plan benefits down the the minimum as the plan premiums increase faster then incomes. We've done nothing to change this.

There are minimum benefits on the Exchange plans, but they're allowed in the form of high deductible plans which do nothing to reduce the out of pocket expenses for routine preventative medicine.

Annual benefit caps are still allowed. Medical bankruptcies will continue.

Large employer plans are not included on the exchange. Reducing the pool to small/medium employers and individuals.

Large employer plans are exempt from the Exchange's oversight meaning they can offer crappy plans to avoid penalties since there are no benefit guarantees.

Employers pay a fine for full time employees that are receiving subsidies ONLY. That encourages them to higher part time employees which don't impact their medical bottom line. (Walmart has been doing this for years...but now they actually provide socialized medicine because it's cheaper!)

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December 22, 2009 4:48 PM    in reply to Steve LaBonne

At least you acknowledge you've been pissing yourself a little girls all year long. Remind wbgonne of that!

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December 22, 2009 4:50 PM    in reply to FreeRider

I hope your stupid invective comforts you for not only having been dead wrong, but for your humiliating backtracking on your former strong words about what would be in a minimally acceptable bill. If I'd made a fool of myself like that I would feel unable to show my face, so in a way I admire your chutzpah.

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December 22, 2009 5:20 PM    in reply to Dorn76

at what point has any of the "attackers around here" ever asked for anything more than what is offered?

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December 22, 2009 5:24 PM    in reply to Indie Pro

at what point did any of the attackers around here complain about the caps language added by Reid, that was removed in the managers ammendment after people complained. You aquiescing, knob sucking, I'm so happy the lobby is allowing me anything dupes are part of the problem.

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December 22, 2009 5:47 PM    in reply to Indie Pro

What could possibly be gained by alienating people who agree with you 95% of the time?


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December 22, 2009 6:44 PM    in reply to Dorn76

Because if we all blindly agreed with each others bullshit, we'd be Republicans.

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December 22, 2009 8:27 PM    in reply to ohyeathatsright

There's a huge difference between blindly agreeing and alienating.

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December 23, 2009 5:39 PM    in reply to FreeRider

Yes, they are essentially opposites. [insert eyeroll here]

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December 23, 2009 10:23 PM    in reply to ohyeathatsright

That's your problem. You can only think in the extreme, which is why you'll always be a loser.

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December 22, 2009 3:57 PM   

I think the BEST thing is to bring up that date to 2013 rather than 2014. That is what the House should really push for.

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December 22, 2009 4:06 PM   

Lucy! Charlie Brown got a new football for Christmas!

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December 22, 2009 4:14 PM   

Pushing it up only increases the costs during the ten year window doesn't it? If it's actually deficit negative in the long run it shouldn't really matter. Are there some taxes that only come up in 2014?

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December 22, 2009 4:32 PM    in reply to Kevin Sutton

The "rules" CBO uses are rather archane, done in certain increments, and limited only to government expenses (which doesn't factor in individual savings, which is actually huge, because if health insurance costs are reduced then employers and employees can put more real dollars into profits, wages and capital investment). Many involved in the debate have set arbitrary spending ceilings or a point when HCR must be deficit neutral. Consequently, even though more would benefit with a sooner start date, and more would be saved ultimately, with a sooner start date, total costs would be higher and that is the problem (for some). Think of it like buying a house. If you buy now, you will pay for ten years during the next ten years, but if you wait five years, at the end of ten years you will only have paid five years of mortgage. Short-sighted legislators are disregarding that if you buy now, you'll get a better price, save five years of rent, and probably earn more equity.

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December 22, 2009 4:15 PM   

Five plus five is ten. Ten plus ten is twenty. No more Tim Pawlenty.

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December 22, 2009 4:19 PM   

"It's hard to run for office on the platform of having passed an unpopular bill that hasn't really done anything yet."
.
If only they could have found something to include that would have made it more popular.

http://act.boldprogressives.org/cms/sign/natpollresults121809/

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December 22, 2009 4:24 PM    in reply to shepherd wong

Uh-oh, you're gonna get in trouble with the Obamatons.

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December 22, 2009 4:48 PM    in reply to wbgonne

So what are they going to do, force me to write a big fat check to Blue Cross or Aetna? Oh, wait...

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December 22, 2009 4:25 PM   

I think the exchange should be on a National level, and be up and running in 2011/12. Creating one large group for each 'plan' will get us the biggest 'negotiated' savings on premiums. Very much like several different 'public option' plans to choose from.

But it's really mind boggling to think about all the development/implementation and coordination that will be needed to make all this happen.

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mcc

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December 22, 2009 4:30 PM   

Are there any indications what is likely to happen to the employer mandate (which is much stronger in the House version than the Senate version) in conference?

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December 22, 2009 4:42 PM   

I don't know how much longer I can do this with these.........People.

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December 22, 2009 4:52 PM    in reply to Johnny2Bad

Exactly who are "these people" you refer to.

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December 22, 2009 4:50 PM    in reply to Tanjaoui

Pretty good = you agree with it.

There are a thousand that take the opposing view.

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December 22, 2009 4:56 PM    in reply to FreeRider

There are probably more than that. But there are a lot of people who'd agree, too. These articles resonated with what this bill looks like to me and how Obama comes across generally as a statesman.

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December 22, 2009 5:00 PM    in reply to Tanjaoui

Two years ago, it looked like we would never get anything done on healthcare. Aren't you tired of whining and bitching that what we'll get isn't good enough?

Two years ago, we had a president he vetoed SCHIP and pay equity for women and wanted to privatize social security. Don't you feel like an asshole complaining about a president who signed SCHIP, pay equity and will sign a bill outlawing the most egregious insurance abuses and providing insurance for 30 million more people?

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December 22, 2009 5:08 PM    in reply to FreeRider

Obama had a huge opportunity to lead and he's blown it. He's afraid of change and is counting on huge campaign contributions from insurers and pharma. And he'll get them, big time. He's really beating the Republicans at their own game. Only a Democrat could get away with such a brazenly corporatist agenda.

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December 22, 2009 7:08 PM    in reply to Tanjaoui

Two groups of people think that Obama has blown it - Teabaggers and unrealistic progressives.

The non-Bagger Republicans know that he's winning and winning big time. Their only hope was to kill health care and declare Obama a failure. But at 8AM on Christmas Eve...

Realistic people left of right-center know that things take time, especially when you're fighting a unified Republican Congress doing everything they can think of to make you fail.

Me, I'm damn happy.

Health care is passing and it's about 80% of what I wanted. We can work to get the rest.

Guantanamo is closing.

The troops are coming home from Iraq.

We've put the Afghans on notice that they have a limited window to get their act together and take over their own defense.

The world likes us once more.

Scientists are back in charge of government science.

And I could go on....


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December 22, 2009 7:22 PM    in reply to Wallace Bob

Co-sign to the "I'm damn happy" statement. That does not mean everything goes the way I wanted. Nor does that mean I agree with everything the administration has done thus far. But I do think, little by little, we are detoxifying the eight years under the Bush administration.

I still remember vividly what Obama said in the Apr-29-2009 press conference.

Humbled by the -- humbled by the fact that the presidency is extraordinarily powerful, but we are just part of a much broader tapestry of American life, and there are a lot of different power centers. And so I can't just press a button and suddenly have the bankers do exactly what I want or, you know, turn on a switch and suddenly, you know, Congress falls in line.

And so, you know, what you do is to -- is to make your best arguments, listen hard to what other people have to say, and coax folks in the right direction.

This metaphor has been used before, but the ship of state is an ocean liner. It's not a speedboat. And so the way we are constantly thinking about this issue, of how to bring about the changes that the American people need, is to -- is to say, if we can move this big battleship a few degrees in a different direction, you may not see all the consequences of that change a week from now or three months from now, but 10 years from now or 20 years from now, our kids will be able to look back and say, "That was when we started getting serious about clean energy. That's when health care started to become more efficient and affordable. That's when we became serious about raising our standards in education."

And -- and so I -- I have a much longer time horizon than I think you do when you're a candidate or if you're listening, I think, to the media reportage on a day-to-day basis.

And I'm humbled, last, by the American people who have shown extraordinary patience and I think a recognition that we're not going to solve all of these problems overnight.

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December 22, 2009 8:02 PM    in reply to Wallace Bob

I can't say that I'm completely happy, but I can definitely say that I'm amazed that so much has been done given the horrible state of our country when the Obama administration moved in.

There is still so much more that needs to be done, and certainly many of the complainers about this administration have valid points, but going from that point to make the accusation that somehow the POTUS is incompetent or a sell out is insane.

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December 22, 2009 8:26 PM    in reply to Tanjaoui

So, you don't ever get tired of whining? OK. Carry on.

I'll be over here celebrating!

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December 23, 2009 9:12 AM    in reply to FreeRider

I'll be commiserating over here with those with no voice in these matters.

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December 22, 2009 4:51 PM   

I have a neighbor friend who I love dearly. He's a music composer and needless to say the economy hit his field hard over the past few years and as a consequence, he couldn't pay his health insurance prremiums anymore. To make matters worse, he has every disease known to man so he is uninsurable. As I said, I love him dearly but he is 50 years old and never had a real job that ever paid a lot of money, but he loved what he was doing. So now because he's stuck in a profession that isn't paying the bills and has no insurance, he's pissed because under the new bill he will have to pay for insurance. I don't remember Obama ever campaigning that there would be free health care - just affordable health care. He says he can't afford any insurance payments but the guy always seems to have money to do the things he wants to do. I am having a difficult time feeling sorry for him. He wants full socialized medicine. I told him to move to another country

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December 22, 2009 4:56 PM    in reply to lousgirl84

Yep. I know a lot of them. Indie Pro is one of them. Complaining that $100/month is too much to pay for full coverage for a family of four.

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December 22, 2009 7:41 PM    in reply to FreeRider

I am very familiar with doom and gloom Indie Pro. Sits around and complains because he wants a freebie.

My friend reminds me of Indie Pro, in that everything is gloom and doom. $200 a month for good health care insurance sounds reasonable

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December 22, 2009 5:05 PM    in reply to lousgirl84

You might help him figure out what his maximum premium cost will be.

Based on the House version, it will be no more than 12% of his income.

Based on the Senate version, it will be no more than 8% of his income.

I'm betting that the Senate version wins out as the House is going to have to give up good stuff, they're not likely to push for bad.

So he makes $30k a year? $2,400 a year. $200 a month.

A year ago could you have imagined a world in which a 50 year old person with significant health issues could get full health coverage for $200 a month?

He wants socialized medicine? I like the idea of single payer, but I would expect if we had single payer his income tax would have to go up at least $200 a month to make single payer work.

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December 22, 2009 5:26 PM    in reply to Wallace Bob

The actuarial value of the cheapest plans is 60%. So you might be able to afford insurance, but not to use it without going broke. This is hospital gown coverage.

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December 22, 2009 5:29 PM    in reply to Tanjaoui

You need to check your facts.

I do believe someone has sold you a bag of Foxcrap...

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December 22, 2009 5:36 PM    in reply to Wallace Bob

Bronze: 60 percent Actuarial Value
Silver: 70 percent Actuarial Value
Gold: 80 percent Actuarial Value
Platinum: 90 percent Actuarial Value

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December 22, 2009 5:42 PM    in reply to Indie Pro

Tx.
As someone commented over at Firedoglake: this is Obama's 'Mission Accomplished' moment.

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December 22, 2009 5:50 PM    in reply to Tanjaoui

Good soundbyte I'm sure we'll see on Faux News, and apparently the Lefty Blogosphere. Strange bedfellows!

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December 22, 2009 6:12 PM    in reply to Dorn76

On this particular bill? I might agree with much of what some of them have to say (don't own a teevee, so I don't watch Fox).

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December 22, 2009 7:38 PM    in reply to Wallace Bob

ME TOO. THANKS FOR THE GREAT POST.

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December 22, 2009 7:45 PM    in reply to Wallace Bob

Thanks Wallace Bob. I will make those points to him. You see he's of Norwegian descent and very nationalistic I might add. He always reminds me how good everything is in Norway and I have told him perhaps he should return to Norway and live there off the dole. He can't do that of course, because he loves his two daughters and he won't leave them and his ex-wife sure won't let him take them to Norway.

He's a true socialist so I doubt he will mind paying more in taxes. Heck I wouldn't mind paying more in taxes if everyone had good available health care at affordable prices.

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December 22, 2009 4:52 PM   

2014, 2018, whatever. The important thing is for the giveaways to the pharmaceutical and insurance industries start right away.

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December 22, 2009 4:55 PM   

What exactly is in the legislation if there is no public option?

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December 22, 2009 5:26 PM    in reply to USgreentech

Everything we wanted except the public option.

If premiums don't come down we can build on what we will get out of this bill and work on premium price.

BTW, at one point insurance overhead was limited to 15%(?) over payouts. That 15% had to cover operational overhead, advertising/lobbying, and profits. Is that provision still alive?

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December 22, 2009 5:39 PM    in reply to Wallace Bob

everything but the PO?

Please. Now you're selling ponies.

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December 22, 2009 5:45 PM    in reply to Indie Pro

OK, what except the public option is missing?

I'll give you lack of importing less expensive drugs, but we knew that was part of the cost of getting any bill at all.

You're turn....

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December 22, 2009 6:08 PM    in reply to Wallace Bob

Drug reimportation...something Obama the candidate promised.

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December 22, 2009 6:18 PM    in reply to Tanjaoui

I listed that one. It was a nonstarter.

Sometimes you just have to buy a friend. You can't fight everyone all at once.

Now, other than the PO and re-importation, what's missing?

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December 22, 2009 6:20 PM    in reply to Wallace Bob

Oh, I thought of another one.

We had to give up death panels....

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December 22, 2009 6:30 PM    in reply to Wallace Bob

2:1 community rating

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December 22, 2009 6:45 PM    in reply to Tanjaoui

These community rating categories?

* benefit design
* family composition
* demographic characteristics:
o age
o gender
o geographic area
o occupation
o industry
* lifestyle factors:
o tobacco use
o weight
* health status and claims history

Family size will increase premiums. Makes sense - more people, more money.

Age will increase premiums. Seems like that has to happen. If you don't give younger people a rate more commensurate with their expected costs few would sign up.

I don't believe any others will.

And why 2:1? Did you just make that up in order to have something negative to add or is that a real issue?

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December 22, 2009 6:50 PM    in reply to Wallace Bob

Age -

"Premiums could vary by age, but premiums for the oldest customers could not cost more than twice premiums for the youngest."

That would be your 2:1, eh? And then there's the ~8% cap which will hold down costs for the oldsters least able to pay.

And a benefit overlooked in the discussion to date...

Children would be able to stay on their parents' insurance until age 27, beginning in 2010. Give youngsters a chance to get on their feet, get a job with benefits.

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December 23, 2009 12:24 AM    in reply to Wallace Bob

It's 3:1

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December 23, 2009 8:57 AM    in reply to Wallace Bob

MLR of 80-85%, with enforcement/regulation left up in the air. If there is no effective enforcement, they'll game it, as they've done for years. And if there is regulation (a tenuous supposition), there's nothing to stop them from raising their premiums.

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December 23, 2009 9:16 AM    in reply to Wallace Bob

* health status and claims history

So...if you have a history of heart problems they can raise your premiums?

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December 22, 2009 5:03 PM   

Mandated payments to insurance corporations could cost Democrats enough votes to lose control of Congress unless they reduce the costs of health insurance for middle income workers in the next fiscal year. Being in the majority isn't enough to steer this ship - they need to grab hold of the tiller and steer into the wind. Veer to portside and hold the course - do what it takes to help the people who believed the "Yes we can" stuff.

They are tiptoeing around those Bush tax cuts that unbalanced the economy. Return the percentage paid by the highest tax bracket to pre-Bush levels in order to finance the insurance reforms.

Make the case that the Bush tax cuts caused the financial breakdown. Gamblers get reckless when they have too much money to burn.

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December 22, 2009 5:22 PM   

The only reason I want to see this get going earlier is so we can see what a piece of crap it is before Obama leaves us.

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December 22, 2009 5:37 PM   

In another election cycle, the Democratic rallying cry will be 'Balanced budget!' and the subsidies promised in this bill - sure to set the middle class against the working poor - will be on the chopping block in no time.

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December 22, 2009 5:39 PM   


You questioning the monetary value of this bill for folks who work for a living?

You might want to give this page a read...

http://www.tnr.com/blog/the-treatment/what-reform-means-families-reponse-firedoglake-others

For 21 years I paid for health insurance out of my own pocket. This bill would have saved me a ton of cash.

And I wouldn't have had to worry about getting kicked off the plan were I to get sick or hurt....

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December 22, 2009 5:43 PM    in reply to Wallace Bob

here's the largest Nurse's Union saying the Senate Bill is crap!

http://www.huffingtonpost.com/rose-ann-demoro/an-inglorious-end-to-the_b_400842.html

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December 22, 2009 6:01 PM    in reply to Indie Pro

No, they are saying it might be crap.

And the article is a piece of crap.

Here are the complaints...

As the NNU has said in its statement on the bill, the loopholes include:

* Provisions permitting insurers and companies to more than double charges to employees who fail "wellness" programs because they have diabetes, high blood pressure, high cholesterol readings, or other medical conditions.

I don't think so. There are no additional premium costs in Exchange policies listed on the Exchange.

* Permitting insurers to sell policies "across state lines", exempting patient protections passed in other states. Insurers will thus set up in the least regulated states in a race to the bottom threatening public protections won by consumers in various states.

All policies listed on the Exchange will be required to cover basic health needs. The "bottom" will be fixed.

* Allowing insurers to charge four times more based on age plus more for certain conditions, and continue to use marketing techniques to cherry-pick healthier, less costly enrollees.

Age, yes. Olders pay more.

Cherry-pick, no. All policies listed on the Exchange will have to accept anyone who applies.

Marketing shouldn't play a role. We will get a list of policies and almost immediately all sorts of web sites will spring up to evaluate how well each company delivers. And we will be free to change companies at least once a year.

* Insurers may continue to rescind policies for "fraud or intentional misrepresentation" - the main pretext insurance companies now use to cancel coverage.

Fraud, perhaps. But what sort of fraud might one try to commit? No need to try to hide a health condition that would have caused you to be refused under the old rules.

About the only fraud I can imagine is an undocumented alien trying to buy insurance through the Exchange, and they are prohibited from doing so in the legislation.

Nurses suck on this one....

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December 22, 2009 6:28 PM    in reply to Wallace Bob

"All policies listed on the Exchange will be required to cover basic health needs. The 'bottom' will be fixed."

What about needs that aren't basic? You're discovered to suffer from a chronic condition that requires expensive drugs to treat? You'll have to go broke to get the care you need. The bottom will be fixed? When and by whom?

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December 22, 2009 7:11 PM    in reply to Tanjaoui

What won't be covered is plastic surgery and hair plugs. That sort of stuff.

You really should read up on the bill rather than damning it based on Foxcrap and paranoia.

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December 22, 2009 8:02 PM    in reply to Wallace Bob

I am very impressed with your knowledge of this bill Wallace Bob. Thank you.

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December 23, 2009 9:41 AM    in reply to Wallace Bob

you are so misinformed, it can only be willful.

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December 22, 2009 5:53 PM    in reply to Wallace Bob

Oh, yes, the Neo Dem Republic. They were really keen on all the free wars we're fighting too.

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December 22, 2009 6:30 PM   

It was a great year. In congress the corporate-acracy was saved and reinforced. Nominated the same guy who got a PhD on the Great Depression and whose sole job was to monitor the economy but yet failed to see the biggest recession coming down the pipe when all signs where there. Sent more troops over to Afghanistan with no clear plan but just as long as the DoD and the Petagon wanted it, it must be the right move! Could've ended "Don't ask don't tell" with an executive order and could've closed Gitmo and sent the prisoners to another facility on that same order. Let the entire Bush administration off the hook for their crimes against humanity.Looking forward to more spineless negotiating and kowtowing to extreme right-wing interest.

And yet you right-wing conservative buffoons still can't see how good you got it.


Birthers, teabaggers, radical right wing "christians", secessionist, healthcare anti-reformist,etc., are all the same core group of poor, uninformed ultra-conservative pawns tricked by the corporate masters and cheerleadered by AM conservative talk radio to get these people to believe and vote against their own self interest.

It isn't any wonder that the main weapon to keep the rank and file conservatives in check is fear. Conservatives fear that their guns are going to be taken away, they fear that U.S. will become socialist, they fear that health care reform will kill off the elderly, they fear that the president is a muslim, they fear that when minorities are in power that reverse racisms will run rampant, they fear that every nation under the sun wants to destroy the U.S. and on and on. This is the main message of Limbaugh, Beck, Hannity, et al. to be afraid. After 8 hours a day at least 5 days a week conservatives literally become
brainwashed through the radio and then some on Fox news to be afraid and angry.

Conservatives don't even know what exactly they are trying to conserve. They speak of fair play and freedom but when a group other than their circumscribed group speaks about and want such things (i.e. gay rights, immigrants, minorities, the poor)these ideas suddenly become liberal pandering.

Conservatives don't realize that what they fear most is change. The changing of American society and of the world. Thus their behavior is not much different from other conservative movements around the world, i.e. Taliban, Al Qaida, Likud, Abadgaran. These groups want to maintain the status quo and use fear and sometimes violence to achieve their means. These groups target the same type of people to believe in their ideology. These are usually the poor, rural denizens who feel that the rest of society is moving too fast and that they are being excluded because the city centers are thriving and they are not.

It is this simple mind trick that has allowed the military-industrial complex to roll along unabated for so long. The very thing president Dwight Eisenhower,a Republican, warned against. However, it was only recently that Republicans were up in arms against the slashing of the military budget and discontinuance of the F-22 and only a couple of days ago voted down the defense appropriations bill. This is just another example of how twisted and convoluted conservatism/republicanism is. It contradicts one of their venerated leaders and ideals.

Unfortunately, contradiction and hypocrisy have become the norm for conservatives, so much so that entire shows are based on it and have become very popular (The Colbert Report, Countdown, The Daily show etc.). When conservatives are confronted with this, the usual retort is that it’s the “main stream media” distortion, wholly ignoring that “main stream” = normal or average, non-fringe. Again this is just fear working on these people, fear that their ideology is being pushed to the fringe creating the us vs them mentality.

“No passion so effectually robs the mind of all its powers of acting and reasoning as fear.” Edmund Burke.


The recent tom-foolery in the Senate is further proof, that the jingoistic, uber-patriotic rhetoric by the republicans is just that, empty rhetoric. The republicans/conservatives don't care about human lives, concerning military operations nor domestic welfare. How can anyone support a party whose ultimate goal is political gamesmanship to keep the status quo? Democrats are not much better, being to spineless to hold up to their ideals. Negotiating like a bunch of dithering do-nothings.
People who support this type of buffoonary need to really look at what they are contributing too. This is the type of crap that makes government so inefficient, in particular the Senate. At least this debate on health care opens the eyes of the aveage lay person to realize how Senators have become the House of Lords and that this so-called aristocratic bunch believe they can play games while people are dying here and abroad. They have totally forgotten that they are supposed to be representatives of the people.

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December 22, 2009 7:15 PM   

Iron, right on the money. The Repubs got most of what they want and still get to attack us. Neville Obama Chamberlain strikes again.

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December 22, 2009 7:22 PM   

As I understand it, once Cloture is gotten past, the Blue Dogs' votes aren't needed anymore, because everything is majority rules. Why are they talking about the Blue Dogs? They only need 50 + Byden to pass it in the Senate, once they have gotten past Cloture, right? And once it goes to Conference Committee, isn't it majority rules? And when it goes back to vote on the final version in both houses, isn't it majority rules?

.

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December 23, 2009 8:29 AM    in reply to SteveGinIL

Um...no, one cloture is reached, the bill can't change and the conference report can be filibustered.

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