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Senate Bill Used As Framework Of White House Health Care Plan
House Speaker Nancy Pelosi (D-CA), President Obama, and Sen. Harry Reid (D-NV)
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President Obama took the Senate health care bill and stripped special deals and added his preferred compromise for taxing high-end insurance plans, detailing for the first time his preferred approach for finishing the long battle for reform.
The White House just released the Obama plan in advance of Thursday's health care summit, framing it as an improvement to the Senate bill and an ultimate compromise.
The administration is signaling they are prepared to push the plan through reconciliation, talking about the need for an "up or down" vote, and wants the American people to see the negotiations play out on television among Democrats and Republicans.
Obama aides described what they are posting today at WhiteHouse.gov as the president's "take" on bridging the differences between the House and Senate bills passed last year. It's largely been crafted based on negotiations Democratic leaders had with Obama in the Cabinet room before the Jan. 19 election in Massachusetts.
Communications director Dan Pfeiffer framed the 11-page plan as what Obama will bring to the table at the health care summit Thursday, calling it "the opening bid for the health meeting."
"The president expects and believes the American people deserve an up or down vote on health care reform," Pfeiffer said, calling the potential of a blockage from Republicans an "extraordinary step of filibustering health care reform."
Pfeiffer said Obama wants an "honest, open, substantive discussion where both parties will get off their talking points."
Among the highlights, which Brian goes over in more detail here:
* A delayed start to a new tax on high-end insurance plans. It would go into effect in 2018, not the 2013 as initially proposed.
* Ends the Nebraska deal giving a federal government subsidy for Medicaid.
* It has no public option but creates an exchange system.
* Was crafted to be in line with using reconciliation as a tactic for final passage.
* As we reported earlier, the measure proposes giving the government new power to block insurance rate hikes.
Pfeiffer said the fact the summit will be on television and that the legislation is posted online "help take away a little of the concern of this being something hatched behind closed doors." That's a charge the Republicans have been making for several weeks.
White House health care "czar" Nancy-Ann DeParle told reporters the administration believes the plan will be deficit neutral, though it will still need to be scored by the Congressional Budget Office. They also did not disclose a price tag.
Obama feels the Republican calls for "starting from scratch doesn't make sense," Pfeiffer said, but the president will come to the summit with an "open mind."
Read the entire plan here.
The White House will allow comments on the plan on their Web site.
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superking
February 22, 2010 10:11 AM
1.Sebelius: If Senate Leadership Wants A Public Option, Obama Will 'Absolutely' Fight For It (VIDEO)
2.Reid Will Back Public Option If Dems Can Get Around GOP
3.White House Health Care Plan crafted to be in line with using reconciliation as a tactic for final passage.
Who wants to take bets on whether or not Obama is going to "fight for a Public Option." Oh wait, he already sold out for 'exchanges' on the "opening bid." Yet more disappointment to come. Dems really do want to lose their majority in 2010 so they no longer have the responsibility to govern.
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Mateo123
February 22, 2010 11:09 AM in reply to superking
I know, we should just surrender to the GOP. Would that make you happy?
Please. This is a complicated issue on so many fronts. Obama is trying to deal with these different areas in a way that produces a great health care plan and that attracts enough votes to pass it. We heard about how great the public option was -- until it became apparent that a majority of senators oppose it.
Now, I think the public option would work. But, I also think that subsidizing premiums and capping premiums could work, too, provided that we bar discrimination on p/e conditions and we compel policies to cover certain conditions.
What won't work is when the so called progressives, who insist on government-run program to solve everything, mislead the public and drive down voter turnout in 2010.
So, if you want to help elect the GOP, go somewhere else. There are plenty of blogs, from Powerline to Redstate, that would happily accept you.
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EastWest
February 22, 2010 11:46 AM in reply to Mateo123
"...drive down voter turnout in 2010."
Can you seriously believe that pissing on the liberal base is going to increase voter turnout? Seriously? Have you so completely bought into Rahm Emmanuel's breathtakingly stupid thinking?
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Mateo123
February 22, 2010 12:16 PM in reply to EastWest
Yes, you're right. It would be so much better for liberals if they just stayed home in 2010! I mean, hey, if the liberals won't provide a public option, let's make sure we put conservatives in charge! For sure, they will solve the health care problem.
You must not have had your coffee yet.
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NR
February 22, 2010 12:33 PM in reply to Mateo123
Yeah, we sure wouldn't want Republicans to get back into power, because they'd do things like sell us out to the private insurance companies, block meaningful reform of the banks, and get us stuck in an endless war in Afghanistan. We have to vote for Democrats to make sure things like that don't happen!
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elkins
February 22, 2010 12:42 PM in reply to NR
Are you seriously equating a Democratic administration with a Republican one? I understand you are pissed off, I think a lot of people are... But the "i'm taking my toys and going home" approach is a little narrow sighted don't you think?
I understand how frustrating political pragmatism can be, but for goodness sakes we can't have another 4 or eight years of moving backwards, or at least making no forward progress at all.
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EastWest
February 22, 2010 2:12 PM in reply to elkins
What I am not advocating, and which all of you clearly are advocating, is rewarding bad behavior. "They're good because they're Democrats" is flat out irresponsible.
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elkins
February 23, 2010 1:17 AM in reply to EastWest
It really all depends on how you frame the issue.
What are my choices? Am i rewarding failure by continuing to support the democrats even though they don't go as far as I want them to go with the policies they put forth? Yes. But what is the alternative? Voting for the republican party in its current state is unfathomable. One thing I could do would be to stay at home. That will simply remove me from the political process altogether and make it more likely that my views won't be represented. I can perhaps support bolder candidates in various primaries. But what if they don't win? Am i supposed to stay away from the ballot box?
Until more people (who vote) agree with me enough to get the more progressive candidates through the primaries and into office my only choice is to support those candidates whose views are most closely aligned with mine.
I think this is pretty rational. Don't you?
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Mateo123
February 22, 2010 5:51 PM in reply to NR
Although to your public option-obsessed eyes (or single-payer-obsessed-eyes), Obama may not have accomplished a lot, but ask whether the mines, coal plants, auto companies and polluters think Obama has been a friend.
Could he be more progressive? Sure. But, it's nearly always very difficult to raise taxes and doing so mid-recession is practically suicidal. Without the revenue, it's tough to advocate for the public option and/or the single-payer plan (not to mention that it would raise some other issues, such as consumer availability and provider reimbursement rates).
Subsidizing premiums and making sure they're capped in a meaningful way would be a good and progressive step in the right direction.
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madmatt
February 22, 2010 1:50 PM in reply to Mateo123
we already surrendered to em, thats why skipping the bill is better than passing it!
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AhTrini1
February 22, 2010 2:25 PM in reply to Mateo123
Yup, yup, just like those bright MA Democrats and Independents who "wanted change" and voted for #41 - you betcha **wink, wink**.
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madmatt
February 22, 2010 2:43 PM in reply to AhTrini1
how much shit should dems eat before they realize the bill is a corporate giveaway and helps NOBODY!
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Dorn76
February 22, 2010 11:40 AM in reply to superking
Inspiring.
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Andy K
February 22, 2010 1:34 PM in reply to superking
"Oh wait, he already sold out for 'exchanges' on the "opening bid.""
When, exactly, did he sell out? If you read the Obama/Biden campaign literature- Bluprint For Change (pdf here: http://www.barackobama.com/pdf/ObamaBlueprintForChange.pdf )- you'll see that the focus was always on a National Health Insurance Exchange. Here, I'll make it easy:
Guarantee Affordable, Accessible Health Coverage for Every American
"Barack Obama and Joe Biden’s health care plan both builds on and improves the current insurance system, and leaves Medicare intact for seniors. For all Americans who like their health insurance, nothing changes except that they will have lower costs — $2,500 for a typical family. For those who do not have health insurance, they will have a range of private insurance options — accessible through a new National Health Insurance Exchange that is similar to what Members of Congress have — as well as a public plan.
The National Health Insurance Exchange will feature:
• Guaranteed Eligibility: No American will be turned away from any insurance plan because of illness or pre-existing conditions.
• Comprehensive Benefits: The benefit package will be similar to that offered through Federal Employees Health Benefits Program, the plan members of Congress have. The plan will cover all essential medical services, including preventive, maternity, and mental health care.
• Affordable Premiums, Co-Pays and Deductibles
• Tax Credits: Individuals and families who do not qualify for Medicaid or SCHIP but still need financial assistance will receive a tax credit to purchase health insurance.
• Simplified Paperwork and Reined in Health Costs
• Easy Enrollment: The National Health Insurance Exchange will be simple to enroll in and provide ready access to coverage.
• Portability and Choice: Participants will be able to move from job to job without changing or
jeopardizing their health care coverage.
• Quality and Efficiency: Participating insurance companies will be required to report data to ensure that standards for quality, health information technology and administration are being met."
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Indie Pro
February 22, 2010 2:06 PM in reply to Andy K
When, exactly, did he sell out? If you read the Obama/Biden campaign literature...you'll see that the focus was always on a National Health Insurance Exchange.
Obama is proposing "State Based" Exchanges here. That is the sell out, I assume.
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philogratis
February 22, 2010 2:24 PM in reply to Indie Pro
State exchanges are a betrayal of every progressive principle. We must have a national exchange so insurance policies can be sold freely across state lines.
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gharlane
February 23, 2010 3:09 AM in reply to Andy K
If you read the Obama/Biden campaign literature- Bluprint For Change ... you'll see that the focus was always on a National Health Insurance Exchange.
Actually, if you read the literature that was up on the Obama site at the time of the campaign but now has been mysteriously scrubbed -- Now with more transparency! -- and thankfully is still available to us thanks to the Wayback Machine (until such time as they succeed in getting it scrubbed from there as well). Here -- I'll make it easy.
Blockquoting isn't working. Everything between "quote" and "end quote" is from the campaign document.
Quote.
QUALITY, AFFORDABLE & PORTABLE HEALTH COVERAGE FOR ALL
The Obama plan both builds upon and improves our current insurance system, upon which most Americans continue to rely, and leaves Medicare intact for older and disabled Americans. The Obama plan also addresses the large gaps in coverage that leave 45 million Americans uninsured. Specifically, the Obama plan will: (1) establish a new public insurance program available to Americans who neither qualify for Medicaid or SCHIP nor have access to insurance through their employers, as well as to small businesses that want to offer insurance to their employees; (2) make available the National Health Insurance Exchange to help Americans and businesses that want to purchase private health insurance directly; (3) require all employers to contribute towards health coverage for their employees; (4) mandate all children have health care coverage; (5) expand Medicaid and SCHIP to cover more of the least well-off among us; and (6) allow state flexibility for state health reform plans.
(1) OBAMA’S PLAN TO COVER THE UNINSURED. Obama will make available a new national health plan which will give individuals the choice to buy affordable health coverage that is similar to the plan available to federal employees. The new public plan will be open to individuals without access to group coverage through their workplace or current public programs. It will also be available to people who are self-employed and small businesses that want to offer insurance to their employees. The plan will have the following features:
* Guaranteed eligibility. No American will be turned away because of illness or pre-existing conditions.
* Comprehensive benefits. The benefit package will be similar to that offered through the Federal Employees Health Benefits Program (FEHBP), the program through which Members of Congress get their own health care. The new public plan will include coverage of all essential medical services, including preventive, maternity and mental health care. Coverage will include disease management programs, self management training and care coordination for appropriate individuals.
* Affordable premiums, co-pays and deductibles. Participants will be charged fair premiums and minimal co-pays for deductibles for preventive services.
* Subsidies. Individuals and families who do not qualify for Medicaid or SCHIP but still need assistance will receive income-related federal subsidies to keep health insurance premiums affordable. They can use the subsidy to buy into the new public plan or purchase a private health care plan.
* Simplifying paperwork and reining in health costs. The plan will simplify paperwork for providers and will increase savings to the system overall.
* Easy enrollment. The new public plan will be simple to enroll in and provide ready access to coverage.
* Portability and choice. Participants in the new public plan and the National Health Insurance Exchange (see below) will be able to move from job to job without changing or jeopardizing their health care coverage.
* Quality and efficiency. Participating hospitals and providers that participate in the new public plan will be required to collect and report data to ensure that standards for health care quality, health information technology and administration are being met.
(2) NATIONAL HEALTH INSURANCE EXCHANGE. To provide Americans with additional options, the Obama plan will make available a National Health Insurance Exchange to help individuals who wish to purchase a private insurance plan. The Exchange will act as a watchdog and help reform the private insurance market by creating rules and standards for participating insurance plans to ensure fairness and to make individual coverage more affordable and accessible. Through the Exchange, any American will have the opportunity to enroll in the new public plan or purchase an approved private plan, and income-based sliding scale subsidies will be provided for people and families who need it. Insurers would have to issue every applicant a policy, and charge fair and stable premiums that will not depend upon health status. The Exchange will require that all the plans offered are at least as generous as the new public plan and meet the same standards for quality and efficiency. Insurers would be required to justify an above-average premium increase to the Exchange. The Exchange would evaluate plans and make the differences among the plans, including cost of services, transparent.
End quote.
I "made this easy" at TPM back on Dec. 23, btw.
Also in PDF at http://fdlaction.firedoglake.com/files/30/files//2009/09/5996811583d82a33cd_6muomvq5x.pdf
The bolding at the beginning of each paragraph is as in the original. The remaining bolding is mine, serving to emphasize the number of times the public option (then called the "new public plan" is mentioned, and the detail in which it is discussed. Likewise, italics are mine, and emphasize the same points.
And that is "what the focus was always on" -- until the WH decided it no longer was.
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LNAB
February 22, 2010 5:37 PM in reply to superking
ain't it the truth... Obama has delivered JUST LIKE SOME OF US PREDICTED in 2008
let's see, guy COMES OUT OF NOWHERE, has the nomination handed to him via the DNC and uninvestigated caucus fraud and were wondering who he's going to side with?
I was sure hoping he would have disappointed my original estimation of him and his probable leadership... but he hasn't
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Mateo123
February 22, 2010 5:55 PM in reply to LNAB
Handed to him? Right. Good one. He really just had it handed to him, while getting beaten down through Iowa (for most of 2007), New Hampshire, Ohio, Pennsylvania, and etc.
No one worked harder and organized harder than the Obama campaign. Of course, campaigning isn't governing and working hard and giving some folks a shot at participating in reform doesn't translate into support.
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lousgirl84
February 22, 2010 10:12 AM
http://www.dailykos.com/story/2010/2/21/223631/076?detail=f
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jdb316
February 22, 2010 10:15 AM
It's disappointing, to be sure. But Josh Marshall is right that doing nothing and letting this initiative die again will be worse this November. And if they are successfully able to jam this through with reconciliation, maybe it will convince some that the Dems have the you-know-whats to play hardball afterall.
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madmatt
February 22, 2010 1:54 PM in reply to jdb316
By all means, let them walk all over us so they can continue to do that for the foreseeable future...god forbid a progressive idea is advanced!! At least with rethugs in office we know we are getting shafted, with dems its a surprise each and every day!
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jdb316
February 22, 2010 3:41 PM in reply to madmatt
If America as a whole (not just the NE, West Coast and Chicago) wanted a hard core progressive agenda, why didn't Howard Dean win the Democratic nomination in 2004? And why is Dennis Kucinich still considered a crackpot Congressman and not a major player in the Democratic Party?
The votes aren't there. And Obama does not need a legislative failure. Go with the best thing that you know can get passed by both chambers and go back to it later once you have a new benchmark. But if you let this thing die now, the Republicans will take control of Congress this November and it will be another 15-20 years, if not longer, before you get another shot.
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Thornhill
February 22, 2010 10:16 AM
Had he just done this last year, a bill, with a public option, could have been passed 6 months ago and he could have then spent all of that time explaining to the American people how fantastic it is.
Instead, he let Max Bacaus play footsie with the Republicans all summer and now we're going to take a major lashing in the 2010 general election.
Bravo. Bra-vo.
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brillobreaks
February 22, 2010 10:23 AM in reply to Thornhill
All summer? And uh, what then? We had this bill in our hands for nearly 8 months after negotiations with the Republicans evaporated, and nothing got done. Progressives just couldn't deal with the fact that the Blue Dogs weren't gonna go along with everything. Instead of passing that shitty watered-down bill then, we're trying to do it now... having spent all those months doing absolutely nothing.
Stop blaming Baucus, and Obama, and the GOP, and the Teabaggers, and everyone else but yourselves. This was failure of progressives to deal with political reality. Should have said 'OK' and passed this thing back in September, instead of spending the next half a year stomping your feet and whining and trying to 'negotiate' with the Bluedogs for something better that they were never going to give.
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mophan
February 22, 2010 11:09 AM in reply to brillobreaks
Brillo, you are right. It made absolutely no sense to fight for something that 70% of the American public supported. Keep sucking on that nipple.
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brillobreaks
February 22, 2010 11:13 AM in reply to mophan
Hate to break it to you, but this isn't a direct Democracy. It doesn't mean jack shit that 70% of the public supports something, if we don't have 60 senators who don't. And we don't have 60 senators who support the PO.
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mophan
February 22, 2010 11:20 AM in reply to brillobreaks
Right again. Just continue to screw the average worker while redistributing the wealth. Who cares about democracy?
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mophan
February 22, 2010 11:26 AM in reply to mophan
In all seriousness, Brillo, I support this bill. I prefer getting anything that will help millions of Americans that need health care, but currently can't get it. It's not perfect, but it is something, and a step in the right direction.
I don't agree with the condescending attitude many on here have towards the people that have probably done the most to get us where we are today.
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brillobreaks
February 22, 2010 11:29 AM in reply to mophan
Please do feel free to scream a bit in your bedroom or whatever if that's a new revelation for you. Once you've got it out of your system, get to work fixing things. But don't sit here and refuse to deal with the reality of how things work.
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Indie Pro
February 22, 2010 10:18 AM
a sad opening bid
I have little confidence in leadership
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Indie Pro
February 22, 2010 12:35 PM in reply to Indie Pro
http://theplumline.whorunsgov.com/senate-republicans/polls-in-key-states-public-option-far-more-popular-than-senate-plan/
* In Nevada, only 34% support the Senate bill, while 56% support the public option.
* In Illinois, only 37% support the Senate bill, while 68% support the public option.
* In Washington State, only 38% support the Senate bill, while 65% support the public option.
* In Missouri, only 33% support the Senate bill, while 57% support the public option.
* In Virginia, only 36% support the Senate bill, while 61% support the public option.
* In Iowa, only 35% support the Senate bill, while 62% support the public option.
*In Minnesota, only 35% support the Senate bill, while 62% support the public option.
* In Colorado, only 32% support the Senate bill, while 58% support the public option.
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Economides
February 22, 2010 2:00 PM in reply to Indie Pro
1. You know full well that the constituent elements of the bill poll much better than the whole thing. Nate Silver did this analysis just a little while ago. There are even provisions that poll more favorably than a "public option".
2. Do you really think most people have any idea what a "public option" is? They would have to know what a health exchange is first, right? Seventy precent of the people can explain that? We know there are members of congress who had no idea what it was--wasn't Mary Landrieu yapping about how she she thought the public option meant free health care provided by the government?
Policy making by polling is a very, very bad idea since what you call things has far more to do with the results than what they actually do.
So who can tell me what the insurance policy offered by a public option would actually be?
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Indie Pro
February 22, 2010 2:43 PM in reply to Economides
I admit it. I am not as cynical as you about people.
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Economides
February 22, 2010 2:45 PM in reply to Indie Pro
I used to do survey research as a profession.
You drive Indy cars.
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Indie Pro
February 22, 2010 3:34 PM in reply to Economides
assumption fail
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Economides
February 22, 2010 3:43 PM in reply to Indie Pro
You don't race cars? damn.
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LNAB
February 22, 2010 5:43 PM in reply to Economides
I'll answer you....MEDICARE which is a FAR BETTER and affordable plan than ANY offered by private insurance
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gharlane
February 23, 2010 3:23 AM in reply to Economides
Policy making by polling is a very, very bad idea since what you call things has far more to do with the results than what they actually do.
Policy making by polling is a bad idea when the policy under consideration can be independently demonstrated to be bad policy. If you want to make that argument about the public option -- however it's phrased in various poll questions -- go right ahead. That would be fun to watch.
I expect most polls on this issue more or less track Quinnipiac's language, e.g. from its latest (14 January 2010) poll: "Do you support or oppose giving people the option of being covered by a government health insurance plan that would compete with private plans?"
That's Question 28 and you are welcome to look at the poll questions and answers online.
Quinninpiac's numbers are quite consistent with those shown here.
Do you have a problem with Quinnipiac's phrasing of the question? Here's your big chance. Have at it.
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gharlane
February 23, 2010 3:29 AM in reply to Economides
So who can tell me what the insurance policy offered by a public option would actually be?
Oh, I don't know... how about the Obama campaign?
Just a thought.
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EastWest
February 22, 2010 10:18 AM
And just when Obama was showing signs of actual leadership, he folds. Useless, one-term chump.
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brillobreaks
February 22, 2010 10:25 AM in reply to EastWest
What leadership is he going to provide that would magically make the necessary votes appear? He's a charming motherfucker, but he's not that charming of a motherfucker.
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Alixman984
February 22, 2010 10:30 AM in reply to EastWest
Well maybe you should run for the office in couple of years time!!
We (liberals) are our own worst enemies, think president has the magic power to produce votes!!!
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Lok52
February 22, 2010 10:45 AM in reply to Alixman984
That is the problem with being a big tent party. Everybody in the tent thinks their cause is the most important. It is one of the weaknesses of the American political system when compared to a parliamentary system.
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Viva!America!
February 22, 2010 10:44 AM in reply to EastWest
Who's folding? Looks like you are the one that's folded. It's a proposal and the summit hasn't happened yet and the votes for the PO aren't there yet. I've been watching the Left for a couple of years and if anyone knows how to fold it's you guys.
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EastWest
February 22, 2010 10:57 AM in reply to Viva!America!
Who's folding? Obama is folding. Is this what he means by fighting for the public option? Pulling it from his proposal? You call that leadership?
And for those of you making excuses for Obama's lack of leadership, let me ask you: If the President is such a weak and powerless figurehead, why didn't you just vote for McCain? By your reasoning, McCain couldn't do any sort of substantive harm to the nation, and it would have been a nice parting gift for the old guy.
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brillobreaks
February 22, 2010 11:01 AM in reply to EastWest
Leadership has become a magical word. Stop using it.
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EastWest
February 22, 2010 11:02 AM in reply to brillobreaks
Leadership is a magical quality. Obama should start using it.
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Alixman984
February 22, 2010 11:02 AM in reply to EastWest
Dude you live in your very own dreamland.
Who said president is a weak position? What I ment is he can't produce votes when there isn't any. PO? so far only 20 senator have signed it!
If you rather have NO bill at all then that's another discussion.
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EastWest
February 22, 2010 11:05 AM in reply to Alixman984
There "aren't any" votes, so Obama shouldn't push for any. Weakling.
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FreeRider
February 22, 2010 11:04 AM in reply to EastWest
You're here every single day but it's clear that the only thing you read is the headlines.
The Obama proposal contains what was agreed to by the House and Senate in the conference talks, which did not contain a public option. So there never was a public option to remove.
The Senate is talking about putting in the public option if they make the fixes through reconciliation. Obama said "If you got the votes, I'm with you."
Right now the Senate is 30 votes short of the votes necessary for a public option. But you want Obama to put one in, dick around with it for the next 3 months, only to have go nowhere like last fall?
You are a huge idiot.
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EastWest
February 22, 2010 11:16 AM in reply to FreeRider
Obama and his mouthpieces have repeatedly said they support a strong public option. That is, when they're not busy denying they ever heard of it. The Obama plan takes it off the table.
The Obama plan contains the Ben Nelson abortion language as a starting point. It's never going away.
Those are facts, not headlines.
An idiot is one who refuses to see that his emporer is buck-naked. "What a wonderful outfit that is, Mr. President! What strong leadership you're showing, Mr. President! We love you, Mr. President! Can we wash your backside, Mr. President? Ooh, what manly buttocks you have, Mr. President!"
I said it above: If POTUS is such a toothless, weak, ceremonial position that Obama has no power to get some of those missing votes, why were all of you in such an all-fired rush to get him elected?
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anna am
February 22, 2010 11:23 AM in reply to EastWest
Because he's a helluva lot better than one foot in the grave McCain with Sarah Palin waiting in the wings.
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EastWest
February 22, 2010 11:36 AM in reply to anna am
Why? He's a figure-head! By your own reasoning, he's only a figure-head.
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anna am
February 22, 2010 12:30 PM in reply to anna am
Your reasoning. Not mine. What I said is that is he was a helluva lost better choice than McCain.
But as for your reasoning, and I use the term loosely, I believe I heard a lot of those figure-head type comments back when the Supreme Court handed Bush the presidency.
How'd that work out for you?
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EastWest
February 22, 2010 2:14 PM in reply to anna am
If Obama is more than a figurhead, where's the leadership? Either he should lead and isn't leading, or his position is only ceremonial - in which case no leadership is possible or needed. You people are tying yourselves into knots apologizing for his weakness.
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philogratis
February 22, 2010 12:56 PM in reply to EastWest
Actually, while presidents have pretty limited influence over legislation, they can bomb anything they want.
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Mateo123
February 22, 2010 12:21 PM in reply to FreeRider
thank you. exact-a-mundo.
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madmatt
February 22, 2010 1:58 PM in reply to Viva!America!
Folding is the only practical thing to do, better that than a bailout for the Ins Ind...let the bill fail, in a decade or so the Ins Co's will of priced themselves out of existance and we can try again....if we pass the bill the ins co's get stronger every year and will never let go of the system.
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philogratis
February 22, 2010 10:52 AM in reply to EastWest
You are right, I got all excited for five minutes, but now I am going to start drinking whiskey and crying to old Bobby Kennedy speeches
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EastWest
February 22, 2010 11:02 AM in reply to philogratis
Better you start crying to old Obama speeches - you and the other DLC weaklings who want to drag this country further down the road to wing-nuttia. "Make the bad man stop, mommie! He's being confrontational! We want bipartisanship! He's a meanie, that... that... Liberal! Sniffle...."
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brillobreaks
February 22, 2010 11:08 AM in reply to EastWest
Dude. We need x votes. We don't have x votes. Nothing you've suggested will get us x votes. If you can't suggest something REAL (not magical amorphous bullshit like leadership) that will get us x votes, then you need to stop claiming Obama's missing the boat on this, and accept the fact that we're not going to get the bill we'd like.
PS. The DLC? Is this 1996 or something? You might as well try insulting us by calling us Mugwumps.
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EastWest
February 22, 2010 11:20 AM in reply to brillobreaks
I keep forgetting that many of you are still in middle school. Bad habit. I was referring to the Rahm Emmanuel wing of weaklings.
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FreeRider
February 22, 2010 11:47 AM in reply to EastWest
I was in middle school the last time the DLC had any sway in the party. But folks like you keep throwing them up as this all-powerful, controlling force.
Another example of how out-of-touch you are. Do you have an Atari, too?
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EastWest
February 22, 2010 11:56 AM in reply to FreeRider
Oohhh... I'm impressed. A historical reference. I'll bet you even read a chapter once about Viet Nam, didn't you? You know, the war where the Chinese came across the Yellow River and the Marines fought so valiantly at Dien Bien Phu before their Death March along the Chosin Reservoir? (We'll pause now while you look up the actual facts for your next self-congratulatory reply.)
The simple fact is, the DLC is alive and well in the Obama White House. You may not like it, and you may prefer to call it by its current moniker of OFA, but it's the same weakness and why-can't-we-all-just-get-along-with-Republicans garbage.
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FreeRider
February 22, 2010 11:59 AM in reply to EastWest
Make yourself some Jiffy Pop on the stove and go play with your Atari.
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EastWest
February 22, 2010 12:06 PM in reply to FreeRider
I guess I was wrong. You thought all that stuff I said about Viet Nam was historically correct, didn't you? No wonder you guys are so willing to settle. You have no perspective, and your lack of a proper education combined with atrophied critical thinking skills makes you think doing so is okay-fine.
Sad.
Come the '10 elections, you're going to get what you deserve. And God help this country when you do.
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FreeRider
February 22, 2010 12:08 PM in reply to EastWest
Is your Atari broken?
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gharlane
February 23, 2010 3:36 AM in reply to FreeRider
What FreepRuder does when bested in an argument: put an inane sound bite on repeat-forever.
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madmatt
February 22, 2010 2:49 PM in reply to brillobreaks
at least fighting for popular dem ideals will bring the base out...I have no reason to give a damn about the "bipartisan" bs barack is feeding us. Better a unifying loss then a fragmenting victory!
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Dorn76
February 22, 2010 11:43 AM in reply to EastWest
So 1 year in, that's your conclusion?
Sorry, but that's just unbelievable, Championship Level bitching.
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EastWest
February 22, 2010 11:48 AM in reply to Dorn76
Obama wasted this entire year. He's already 25% through his (guaranteed) time in office. If he's going to do something, shouldn't he start?
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FreeRider
February 22, 2010 12:02 PM in reply to Dorn76
Olympic Gold Medal Level Bitching with absolutely no basis in reality.
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philogratis
February 22, 2010 12:22 PM in reply to Dorn76
If you look back at posts, EastWest didn't vote for Obama. Probably voted for Nader, or just sat it out.
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lousgirl84
February 22, 2010 2:24 PM in reply to EastWest
What irrelevant bullshit.
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LNAB
February 22, 2010 5:40 PM in reply to EastWest
***gag**** Cheney was right... if Obama and the Senate pass a mandate without a true public option... it is ALL OVER for Democrats...Bambi in particular
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Theda Skocpol
February 22, 2010 10:41 AM
Folks on the left -- it is time to get behind the President's plan and talk it up. This is really the only chance to get a new framework in place in health insurance, including subsidies for millions who need help. If this framework is in place, it will be possible -- indeed more than possible -- to get either a public plan or Medicare extenstions down the road, because these will be cost-saving for public budgets, and hence something that can be enacted with 51 votes.
I keep getting emails asking me to "push" for the public option. This is just posturing by elected Reps and advocacy groups trying to raise money. Dems and would-be reformers MUST speak with one voice now, supporting Obama, period, and getting this stuff through Congress ASAP. The alternative is not something better. It is the status quo and a Democratic rout in November.
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Homefries
February 22, 2010 10:46 AM in reply to Theda Skocpol
Co-sign this. Life is good these days for the shills advocating public option or nothing.
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brillobreaks
February 22, 2010 10:55 AM in reply to Homefries
Gotta get paid somehow, right? What better way than declaring yourself a Health Care expert, start blogging about it, and spend the next year working to sink the biggest piece of progressive legislation in several decades because it's not quite as good as the theoretical solution you've attached yourself to?
Sounds crazy, but we've got a whole lot of people getting paid as we speak to do just that.
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hewhohasnoname
February 22, 2010 10:51 AM in reply to Theda Skocpol
Agreed. Now's the time to get this done.
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Indie Pro
February 22, 2010 10:56 AM in reply to Theda Skocpol
I'm sorry. There was an opportunity here for leadership to ignite the base and the cause and come out strong. Instead it's limped out with this, Senate bill lite as a starting point.
Your hope now is that the blue dogs sign on, or something unforeseen pops up. Good luck.
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precisioncontrol
February 22, 2010 11:02 AM in reply to Indie Pro
What in the world are you talking about?
My understanding is that this proposal tracks very closely with the compromise that the House and the Senate were already negotiating before Scott Brown was elected. In addition, it's been clear since then that the endgame for healthcare reform would be for the House to pass the Senate bill and to run said compromises through the reconciliation process in the Senate.
How, exactly, did you think Obama was going to "come out strong" on this?
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Indie Pro
February 22, 2010 11:10 AM in reply to precisioncontrol
national exchanges, talking about the need to bring the industry under anti-trust laws, etc.
the abortion language, the tax on insurance plans etc may be no big deal to you, but it is to me.
plus, he could start talking about how the CBO scored the PO has a significant cost control and deficit reducer, you know, in order to help that effort. But let's be honest, they have no intention of doing any of these things.
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precisioncontrol
February 22, 2010 1:14 PM in reply to Indie Pro
Thanks for replying to "What in the world are you talking about?" with a measured response...my tone should've been more respectful, and I appreciate your restraint!
I agree that there should be national exchanges. I'm not clear on why that element wasn't included in the compromise. It doesn't seem right that there wouldn't be votes for it under reconciliation, and it was in the House legislation. From my understanding, bringing the insurance companies under anti-trust laws wouldn't do much to make insurance more affordable, though.
I'm still not really understanding people's opposition to the excise tax. I think the unions have gotten some pretty healthy exemptions from it for their members, but at root, I believe economists when they say that reducing expensive health plans will result in higher wages; that tying health insurance to employment is counterproductive; and that it's an important step to "bend the cost curve."
Isn't the Senate's abortion language weaker than in the House version?
Yea, the robust public option that wasn't even in the final House bill.
They may or may not. Nonetheless, this legislation is very good, and the House and Senate should pass it into law.
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Indie Pro
February 22, 2010 1:39 PM in reply to precisioncontrol
there is a PO in the House bill. Plus, it fits under recon sidecar.
as far as the excise tax bringing about larger wages, I laugh. The CBO views it as a way to get employers to drop those plans, and buy cheaper ones. It's a way to raise revenue, that's all. I prefer the House's methods.
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precisioncontrol
February 22, 2010 1:59 PM in reply to Indie Pro
I didn't say there wasn't a public option in the House bill. I said there wasn't a ROBUST public option in the House bill, i.e., one tied to Medicare payment rates. Instead, it was to have negotiated payment rates. And since it was limited to people in the non-group market who didn't have access to the exchanges, it was expected to (a) be available to less than 5% of Americans and (b) have slightly HIGHER insurance premiums than average.
As such, I'm not even clear why this option -- other than its name -- is even really worth fighting for.
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Economides
February 22, 2010 2:24 PM in reply to Indie Pro
Your salary or wage is only about 75% or so of the amount your firm has to spend to employ you. So you are saying there is no tradeoff between the 25% spent on benefits and taxes and what you are paid in wages? If that is true why did labor unions actually trade wage increases for better health care benefits?
CBO views the tax as a way to get firms to buy cheaper plans.
Are you suggesting that more expensive plans are better?
Are you suggesting that shopping for a better price necessarily results in buying something of lesser quality or value? Bulk purchasers have no market power?
What happens if giant firm X loses 10% of their tax exclusion. Then tells insurer Y that they want a 10% discount on exactly what they bought last year or they are switching insurers?
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Indie Pro
February 22, 2010 2:42 PM in reply to Economides
I'm saying that the excise tax does not equal greater wages
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Economides
February 22, 2010 2:47 PM in reply to Indie Pro
Cheaper health plans = greater wages
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Indie Pro
February 22, 2010 3:36 PM in reply to Economides
false
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philogratis
February 22, 2010 7:08 PM in reply to Indie Pro
I think Economix has a point. The argument as far as I can tell is that corporations want to make big profits, and they would make more profits if they cut health care benefits and replace them with nothing.
Corporations would also make more profits if they fired all their workers and brought in 6 year old Bangladeshi kids to run their factories for a dollar a day. They don't this because factories are technological these days and they need skilled workers to get it done.
Some of these skilled workers belong to unions and get their wage and benefits packages through collective bargaining. Others don't belong to unions but have such valuable skill sets that the corporations offer them attractive benefits. Suppose they get hit with this new excise tax. The corporation could cut their benefits and offer nothing... but why don't they do that now? In the case of collective bargaining agreements, they can't. They just have to renegotiate. In the case of highly skilled workers, if the corporations offer a crappy deal, the employee can walk.
It seems like your argument is that corporations would rip off workers because they are evil like that, but almost by definition the excise tax effects skilled workers with pretty good job security. If they weren't valued by their companies, they wouldn't be getting such good health care benefits to start with.
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philogratis
February 22, 2010 1:43 PM in reply to Indie Pro
Basically you want Obama to abandon a 50 vote strategy (reconciliation) for a 60 vote strategy, because abortion language, national exchanges, and all that other stuff won't fit into reconciliation. The PO could, but probably doesn't have 50 votes. Only 20 co-signers so far.
A 60 vote strategy empowers Republicans and Blue Dogs.
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lousgirl84
February 22, 2010 2:26 PM in reply to philogratis
Indie Pro and EastWest. A match made in heaven.
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Overreach THIS!
February 22, 2010 11:09 AM in reply to Theda Skocpol
Thank you for this. Much needed.
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EastWest
February 22, 2010 11:31 AM in reply to Theda Skocpol
Sounds good if you don't dig too deep, but it's the HCR (aka HIR) equivalent of telling everybody to go and vote for Democrats no matter what. Who cares if they're showing weak leadership and plain old cowardice? Reward that bad behavior!
The waffling and wimpiness of the entire Dem leadership on this issue has been and continues to be disgusting. There is some hope that the House and at least 20 Dem Senators can make something positive happen. If so, it will be in spite of Obama, not because of him.
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Economides
February 22, 2010 11:42 AM in reply to EastWest
Your sense that the only positive outcome is the inclusion of a public option on the exchange is narrow indeed and short sided. Millions of sick people will get coverage and care where they could not get any before. Millions more will get desperately needed financial assistance. Most will get increased security. All will have a vested interest in making the "system" work even better.
Sadly, you don;t have a deep understanding of the true problem so you just shout as loud as you can about the one thing you think you know.
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EastWest
February 22, 2010 12:00 PM in reply to Economides
LEADERSHIP! We need LEADERSHIP! You can't make progress without trying! You people keep whining that the Republican majority won't let you do anything!
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FreeRider
February 22, 2010 12:07 PM in reply to EastWest
Platitudes.
Get back to us when you have solutions.
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EastWest
February 22, 2010 2:38 PM in reply to FreeRider
So Obama's apologists think leadership is a platitude. Adults think it's a quality. One seriously lacking in the Dem leadership these days - including in the White House.
Your President is a weak figurehead. Sort of like the governor of Texas. And you think that's just dandy. It doesn't occur to you that maybe Obama should be giving some of that "Unitary Executive" action Bush was so good at. Nope, not at all. You prefer your executives to be mild-mannered milquetoasts praying at the altar of bipartisanship. How's that working out, by the way?
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philogratis
February 22, 2010 7:13 PM in reply to EastWest
Unitary executive mainly good for invading foreign countries and torturing people. Not so good for passing sweeping social legislation. Bush got shot down twice by his own party: once on privatizing Social Security and once on immigration reform.
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Economides
February 22, 2010 1:28 PM in reply to EastWest
This impending reform is what results from trying. It is a massive improvement on the status quo. I credit the President's leadership putting this on the agenda from the very beginning of his term and sticking with it despite the incompetence of the legislative branch. When you can come up with another president who was able to accomplish this I'll be more sympathetic to your interpretation of leadership as "getting me what I want".
A public option won't provide health care to any more chronically ill peopel who cannot get insurance today than will the bill on the table. I'd prefer to alleviate that suffering as soon as possible.
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lousgirl84
February 22, 2010 2:22 PM in reply to Theda Skocpol
Amen!!! Stop the fricking whining and bitching.
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madmatt
February 22, 2010 2:57 PM in reply to Theda Skocpol
Only in your opinion is a openended bailout of the insurance industry a good idea. Let me guess you work for anthem or one of the other scumbag companies that want to sell us useless shit at the point of an IRS gun.
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Politor
February 22, 2010 10:42 AM
I think it was pretty obvious that the "president's plan" was going to be the compromise between the House and the Senate bills. He needs to argue for the bills that have already been pass to circumvent the "start from scratch" argument.
I don't think it undercut the seemingly renewed effort for a public option. If it can be passed through reconciliation, I am sure the White House will be game. Unfortunately, for all the attention the Senate has received, I think when it comes to adding the public option into the bill, the House is the place that I am most skeptical about.
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jim43
February 22, 2010 10:45 AM
The problem for the White House is that this is a plan that will not gain any new Republican support. The GOP will simply read this and walk away tomorrow. Obama needs to make a concerted effort to woo Republicans, no matter that they won't bite. Ir's all about seizing the most politically advantageous position.
http://www.political-buzz.com/
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Lok52
February 22, 2010 10:48 AM in reply to jim43
That is where the "Up or down vote" message comes in. It is the message that the Republicans pounded on during the first 6 years of Bush, but the Dems have not used it at all effectively yet. But the circumstances are basically the same politically, and the Dems should be hammering the Republicans with that message.
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philogratis
February 22, 2010 10:55 AM in reply to jim43
What does this even mean? The problem is that the Republicans won't like this plan... but you admit that there is no plan that they would like.
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HCTexas
February 22, 2010 10:56 AM in reply to jim43
I couldn't disagree more. I'm as PO'd at the Republicans as I am at the purity liberals. Both are being obstructionist here. The Republicans wants nothing that will really make a difference, and too many liberals want nothing if it's not "pure" enough. The plan on the table is far, far better than the system in place right now. Pass it and then continue working to improve it. (If there are enough votes in the Senate to pass a public option through reconciliation, then good. But I'm so sick of seeing this issue boil down -- for some -- to a public option when these reforms include so many other vital measures.)
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EastWest
February 22, 2010 11:41 AM in reply to HCTexas
"Purity liberals". Cute. I guess you're one of those who'll take anything offered and declare, "Mission accomplished!" Those evil purity liberals - you know, the folks who actually want something substantive rather than settle for fluff - will only mock you when you do.
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The Commenter Formerly Known as NCSteve
February 22, 2010 12:48 PM in reply to EastWest
But it's okay for you to label those who have substantive policy differences with you "DLCers?"
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HCTexas
February 22, 2010 12:59 PM in reply to EastWest
I'll take what is politically possible if it improves the system as much as this plan would. I'm somehow settling for "fluff"? You mean, "fluff" is finally ending exclusions for pre-existing conditions, expanding insurance to more than 30 million people, providing subsidies to make health insurance more affordable for families (Obama's suggestion today takes the more generous House approach), putting measures in place to rein in skyrocketing health care costs, and creating a national board that could stop excessive rate increases by insurance companies. Sorry -- those are all substantive things that I want, and I'm not willing to throw them out simply because I can't get a "pure" bill with a public option (or single payer or any other liberal "promised land" item).
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concerned parent
February 22, 2010 11:00 AM in reply to jim43
Frankly who cares about the republicans, They have decided the best thing is to do nothing, which of course is the conservative motto. The gop has had ample time and opportunity to work with dems and they only wish to play political games. The party of NO should be told to GO until they stop acting like little babies. They can come and sit at the big kids table when they grow up and decide that they actually want to help their fellow Americans. Otherwise STFU, move to alaska or texas and start your own little pathetic country.
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DownriverDem
February 22, 2010 10:54 AM
Where is the public option????????????
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brillobreaks
February 22, 2010 10:58 AM in reply to DownriverDem
Cutting room floor? Same place as single-payer. There aren't enough votes for it, so including it is stupid. People gotta learn to deal with that reality.
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NR
February 22, 2010 12:44 PM in reply to brillobreaks
And the reason there aren't enough votes for it is because DEMOCRATS won't vote for it and Obama refused to fight for it.
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twanger
February 22, 2010 10:56 AM
People, people, people…why is this so hard for you to understand. I’ll try to make it as simple as I can. Our health care predicament is a Crisis of Cost. We are a at 16% of GDP. Compare that to Britain at 8% with universal coverage via their National Health Service. That should tell anyone - anyone with intelligence, that is - that we are already paying enough!!! Already paying enough for universal coverage and more! The question is – oh please hear me – Where’s the money going! We should start with an item-by-item, line-by-line comparison to our national peers, who provide universal coverage for 8% to 11% of GDP, in order to find out why ours is so out of whack. Now, I can already give you the answer – it is simple, honest, good ol’ fashioned profiteering. We have a business culture where only mega-profits will do, and that seeps and creeps throughout the entire system – a systemic infection, if you will - which has so many thousands of individual chargeable items that are all nicely fattened for profit. Throw into that mix the insurance companies fat profits, and you’ve got double the cost of health care, easily. And growing ever fatter. I maintain that the profit motive is not a fix-all, and is not appropriate for dominating health care. We need something that leads the way, and that would be a National Health Service of our own. You tell me, what else can you think of that would be strong enough to knock our health care costs back down to a reasonable 10% of GDP? For all you free-marketers (I am a small businessman, got no personal problem with a free marketplace), just where is that competition gonna come from that could do that? Huh, huh, huh? I say, allow us to compete. I think there are enough people that would indeed support a National Health Service, and we should be allowed to come together through the mechanism of government to provide that service to ourselves, and compete with the profiteers. And what is holding us back from doing that - conservative ideology. Wait a minute, aren’t conservatives supposed to be big on “freedom”. It’s a free country, and we should be allowed to compete by forming a National Health Service. Don’t force your worship of the “marketplace” on me.
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Economides
February 22, 2010 11:38 AM in reply to twanger
Here's a good summary of comparative health care costs:
http://www.academyhealth.org/files/2009/monday/Jensene.pdf
(You can get to the whole MGI study here, most is behind a registration wall):
http://www.mckinsey.com/mgi/publications/US_healthcare/Executive_Summary.asp
1. Health insurance profits are a small share of our excess costs. Most of it goes to doctors and hospitals who just happen to be the same people the insurance companies and the government have to pay. Please provide some proposed language for a speech that tells them they are all going to employees of the government with salaries at 50 percent of what they are getting today.
2. Nationalized health care such as in the UK is only one model. Perhaps you gravitate to it because you are an English speaker and you have little knowledge of systems that combine private and public payments such as in Germany, Holland, japan, Switzerland. These countries also pay much less per person than we do. Moreover, you should know that about 50 percent of health care spending in the US is already paid for by the government through Medicare, Medicaid, VA, SCHIP, DoD.
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twanger
February 22, 2010 12:11 PM in reply to Economides
Nice study, thanks. But I believe it supports my position.
1. "Profits" are diffused throughout the system and under-reported (though what is reported is often healthy enough.) Everyone in the chain gets their cut, which show up in expenses as salaries, wages, commissions, bonuses,etc. So the "profits" don't all come out on the bottom line of a financial statement. And that's just health care profits. Eliminate the insurance industry, and we'll immediately save 20% or more right off the bat.
2. There are indeed other systems, but argue with 8% - Britain has the lowest with their NHS. Case closed. So far as recruiting doctors into the system - how 'bout we put doctors through school and they contract to work a number of years, like our military does now. No school debt!!! Then we offer them a work environment where they can practice medicine and not business management, limit the number of patients they see, etc. Many doctors are being driven miserable in the current environment. Let's give 'em a nice place to work. Couple that with a good salary, and I don't think there'd be a problem, do you?
Overall, we need a different culture. One not driven by a lust for fame and fortune. We are sick with that. I think our own NHS would help redefine who we are.
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Economides
February 22, 2010 1:50 PM in reply to twanger
The vast majority of the drivers of increasing cost are coming from the delivery of care not from private insurance. Your 20% figure is way off. Yes, the the fragmented insurance market is wasteful, and there exploitation of the pathetic level of regulation often has obscene results. But most of the excess is currently in the hands of doctors, hospital, device and drug makers. It will not be easy, absent a massive change in the culture of practicing medicine and in organizing the delivery of care.
Almost all the health care delivery institutions in the US (Intermountain, Mayo, Cleveland Clinic, etc...) that have low costs and high quality care employ doctors on salary. This removes a huge incentive for doctors to enrich themselves by providing more care. There are big advantages for doctors. I doubt most will take up the offer to work for the the American Health Service rather than the Cleveland Clinic.
I think the solution lies primarily in the types of institutions I mentioned above. they are doing the right thing and expanding their influence would be hugely significant. I think the best thing the government could do is to put in place payment incentives that encourage the rest of the country to follow that example. The government already pays for 50% of care. Switching from fee for service to paying for episodes of care and quality would profoundly change the way health care is delivered without creating the mother of all bureaucracies.
Please stop fetishizing the UK's NHS. There are lot's of workable models. I'll bet the French are pretty convinced their health care system is better than the UK's and it costs practically the same.
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twanger
February 22, 2010 2:36 PM in reply to Economides
Sorry, have to disagree, 20% is underestimating the insurance industries take of the cash flow. And I dont have UK NHS fetish. I'll take the French system, or the Canadian, etc. Let me see if I can summarize my position - Our current system is not tweakable in any form or fashion. Trying to do so condemns us to more of the same, for decades to come. It will take some drastic measure to bring our costs in line (and we do need this otherwise our economy will be crippled as discretionary income goes to health care instead of restaurants, etc.) My fear is that we wont have the will to make such a change. We need a leader like Teddy R. or Franklin D. R. to force the changes, and unfortunately, Obama has failed in this leadership. The change we need may come when that catastrophic pandemic finally hits, at which time you will hear the sound of our private health care system vacuuming the money straight out of our millions of our wallets. Talk about a massive transfer of wealth. Just wait and see. And then listen for my "I told you so."
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Economides
February 22, 2010 3:05 PM in reply to twanger
Your previous posts are all about why we should have an American NHS, so that's your fetish. France and Canada do not run their health care systems. They pay for universal coverage, but they do not employ the doctors and own the hospitals. Germany and Holland and Switzerland have to some extent or another a highly regulated exchange with the government guaranteeing affordability.
You say it is impossible to get to an efficient system from where we are and yet we already have very efficient, high quality operations scattered throughtout the country (and also in the government sector with t he VA). They are organized better and they have a different ethic than most places people get care, but they exist and are highly workable models. They exist despite perverse incentives. Change the incentives, provide support for the institutional transition and I think you could see massive improvements. You should read Gwande's new book.
As for the 20 percent figure, this is pie in the sky. Private insurance pays for less than 40% of health care in this country, so to save 20% off our total bill you are arguing that 40% of their revenue us just pure waste. That's hard to swallow given that we know that a much larger share of the higher level of costs, and cost growth has to do with aspects of the health care delivery system (what those insurance companies have to pay for)--you know the things that make private AND public insurance grow much faster than inflation.
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twanger
February 22, 2010 4:34 PM in reply to Economides
I stand corrected regarding the percentage of health costs paid by private insurance. Good to know. Perhaps to say 20% of the cash flow is an exaggeration.
Nevertheless, I say again, the system is not tweakable. In any form or fashion. Not unless you mean we'll tweak it for 3 or 4 decades, maybe long enough for one of the pandemics to hit and force a change on us. And whether or not the pandemic does hit, 30 years of tweaking simply makes for a slow percolating major transformation. So, we'd be both right. Cheers.
This country is being crippled by the surging cost of health care. And this will fester for decades unless we have the will to do something about it. You seem to be suggesting tweaking here and tweaking there and we will tweak our way out of this hole. I have to disagree. We are so greed driven that the corporates will continue to outmaneuver any attempts to contain costs, and the costs will continue to escalate, from 16% to 20% to 24% of GDP. I say that our health care has a systemic infection, and much like the financial crisis, no one will do anything about it, and it will continue until something breaks.
We are already at 16% of GDP, and its climbing fast. And what are they talking about - "containing" cost growth. NOW, here is my fetish!!! We need to bring it down, down, down...I like 8%, but I will settle for 10%. So Mr. Tweaker, how you gonna get us there. I'm waitin'.
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artappraiser
February 22, 2010 4:33 PM in reply to twanger
It's 4.5%:
Health Care Spending: The Basics--
JUST HOW MUCH DO PRIVATE INSURERS ADD TO THE NATION'S HEALTH CARE BILL?
And savings by getting rid of them would not even be that much because you have to add back in the administrative costs of whatever would be replacing them. It would also be a one-time savings only and then the rising cost curve would continue.
You are on the right track by seeing money-driven medicine as the problem, you're getting there (I was once at the stage you are,) but you need to inform yourself more, about how fee-for-service (like Medicare) is the main thing driving our costs.
NHS is salaried, not fee for service. We need to eventually get to managed care of some kind, and if you don't understand that, you are bound to be disappointed with any reform, including getting rid of for-profit insurance. The for-profit insurers manage care to make profits, that's certainly not what most of us want, most everyone hates that, but it is not the main problem, because they are at least managing care, which is one major thing that needs to be done.
To get away from money-driven medicine, consumers cannot be driving what is being done, that is the main thing that puts the profit motive in our system which you rightly see as wrong. Fee for service, like Medicare currently is, is the main thing driving the rise in costs over that of other countries. You will not see much improvement merely by getting rid of for-profit insurance, it's virtually guaranteed, it would only be a one-time savings and only like 3% at most--read Maggie Mahar's post in my first link.
I actually wish they could put a public option in ASAP so that people would finally learn this reality--that getting non-profit insurance without other reform is not where the savings or bending the curve of the cost thing are going to come from. It would be nice to get rid of their bullshit of rationing for profit, recissions etc., but it is not going to solve our main problem. The form of current Medicare is a much larger part of the problem, because it allows for consumer-drive medicine.
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artappraiser
February 22, 2010 4:52 PM in reply to artappraiser
Those that want to read more on what is actually behind our "money-driven medicine" problem, and solutions, I compiled a thread of some of the best recent stories here.
You can go on believing that simply getting rid of for-profit insurers is a magic pill that has solved everything in other countries, but that's simply not true and you are bound to be disappointed in the future, as big change is coming to Medicare. folks, it has to. The reforms we are talking about passing now are like a big guinea pig trial to see what model is going to be acceptable. I always thought that was evident in the incremental health reform proposals put out by Presidential candidates Obama and Clinton as well as the work done by Kennedy before the election, and didn't understand why more people didn't see that as well. It's also, clearly now, why Obama left it mainly up to Congress until now--because the details of the actual reforms put in place weren't that important to fight for, just change of any kind to get a process moving.
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twanger
February 22, 2010 5:17 PM in reply to artappraiser
I appreciate the info. Allow me to say eliminating the insurance companies is not central to my original proposition here, but thanks again. Good stuff.
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twanger
February 22, 2010 5:51 PM in reply to twanger
Allow me to restate my original proposition. 1. At 16% of GDP (going on 24% ?) we are already paying enough for universal healthcare and more! The question should NOT be how do we pay for it. The question is Where is the money going? 2. Our healthcare system is not tweakable, such as you find in any of the health care reform proposals. It is a bit disheartening to read all the tweaks suggested by well-intentioned people, precisely because the system is NOT tweakable, and the tweaking just prolongs the agony and plays right into the hands of the corporate types who are gonna outmaneuver you for the foreseeable future, meaning decades. Let me say again, we are at 16% of GDP, which is outrageous and crippling to the economy. If we as a country were thinking straight, we'd be trying to get it down to something realistic like 10%. Of course, it looks like that is not gonna happen, for whatever political or pragmatic reasons. So, sad to stay, we're stuck with 16% and climbing, YEA!!! And wont have universal coverage for some time either. Another YEA!
To make a long story short - For all those who want both universal coverage and health care reform for the financial well-being of themselves and the country, it would be ever so nice if we had one voice...shout it loud - We need a National Health Service Now, Now, Now!!!
And for those you who want the reform but think we tweak our way there, I say thanks for several more decades of 16% and growing. YEA! (And dont hold your breath waiting for universal coverage. )
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ru4862
February 22, 2010 10:57 AM
I'm still waiting for the GOP HC proposal? oh, that's right...'kill grandma' and jack up premium rates.
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concerned parent
February 22, 2010 11:04 AM in reply to ru4862
No, apparently it is to fly an airplane into a building.
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Moose49
February 22, 2010 10:58 AM
I can't tell if he's keeping the Senate bill's state-based exchanges or preferring the House bill's national exchange. Seems to me like a very important question to settle. Am I missing something or does the proposal not address this?
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Indie Pro
February 22, 2010 11:02 AM in reply to Moose49
White House proposal preserves the Senate bill's abortion language, and state-based exchanges...
from Brian's other article
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Moose49
February 22, 2010 11:06 AM in reply to Indie Pro
That sucks.
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Theda Skocpol
February 22, 2010 11:09 AM in reply to Moose49
The White House would prefer a national exchange, but that cannot be done with a 51 vote margin in the Senate right now. That is why, instead, the President is calling for national regulation of insurance price hikes. That may not be possible with 51 votes either, but it would be good -- perhaps in a separate bill -- to force Republicans to vote to shield the private insurance industry. Get them on record.
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Indie Pro
February 22, 2010 11:11 AM in reply to Theda Skocpol
the sun'll come out tomorrow...pie in the sky later on...
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Moose49
February 22, 2010 11:36 AM in reply to Theda Skocpol
Thanks -- that explains why.
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Indie Pro
February 22, 2010 12:15 PM in reply to Moose49
again, look at what she is saying:
That is why, instead, the President is calling for national regulation of insurance price hikes. That may not be possible with 51 votes either
so both may not be possible, but which is he going with?
The national regulation will likely be flagged and stricken from recon. Still, why not the national plans then? For that matter, if 51 may not be had, why not the PO. Atleast it can be part of a recon bill since it does effect the budget by the CBO numbers.
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The Commenter Formerly Known as NCSteve
February 22, 2010 12:47 PM in reply to Indie Pro
You realize that making predictions about things that will "likely" happen in order to justify your positions is totally bogus, right?
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Indie Pro
February 22, 2010 1:05 PM in reply to The Commenter Formerly Known as NCSteve
The "not likely" predictions are Theda's. I then offer others.
But, I don't understand how predictions aren't good for arguments anyway. Are not CBO reports full of predictions?
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Economides
February 22, 2010 2:13 PM in reply to Indie Pro
Projections aren't actually the same thing as predictions.
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Indie Pro
February 22, 2010 2:46 PM in reply to Economides
I agree. I'd say a projection is a type of prediction.
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philogratis
February 22, 2010 2:22 PM in reply to Indie Pro
The insurance regulatory board will likely be flagged by parliamentarian and then require a 60 vote super-majority to waive the Byrd rule. This is a trap for Republican Senators, who will be forced to vote to protect the insurance companies from rate controls. It might pass if Snowe, Collins, and Brown defect.
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philogratis
February 22, 2010 12:26 PM in reply to Theda Skocpol
So exchange rules can't changed with reconciliation? That seemed reasonable to me.
For people carping about Obama loving Republicans, this bill is specifically designed so he won't need them: He can pass it with 50 votes.
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philogratis
February 22, 2010 12:27 PM in reply to Theda Skocpol
So exchange rules can't changed with reconciliation? That seemed reasonable to me.
For people carping about Obama loving Republicans, this bill is specifically designed so he won't need them: He can pass it with 50 votes.
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madmatt
February 22, 2010 3:04 PM in reply to Theda Skocpol
The white house cares about what wellpoint tells it to care about...and that is not the citizens of this useless country!
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HCTexas
February 22, 2010 11:10 AM in reply to Moose49
As I understand it (early reading), the Administration thought the Senate wouldn't be able to use reconciliation rules to change the current Senate bill from state exchanges to a national exchange. So they left it as a state exchange.
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SocialJusticeForAll
February 22, 2010 12:45 PM in reply to Moose49
Didn't President Obama state in September 2009, while addressing the country on national television:
"One more misunderstanding I want to clear up -- under our plan, no federal dollars will be used to fund abortions."
http://www.lifenews.com/nat6028.html
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tommyo
February 22, 2010 10:59 AM
Lets see, no public option and the terrible Senate plan, not any midway point between the House and Senate plans, used as the template.
Face it Obama apologists, he's a loser.
"Pfeiffer said Obama wants an "honest, open, substantive discussion where both parties will get off their talking points."
Translation: Please, please Mr. GOP, may I be allowed to appease you some more by selling out my supporters for your total non-support? Please?
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Alixman984
February 22, 2010 11:08 AM in reply to tommyo
Thanks god you have the opportunity to vote him out of office in3 years time - maybe you should already put up a petition for kucinich to primary him - he is a single payer advocate maybe he can magically produce votes!!
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mophan
February 22, 2010 11:18 AM in reply to Alixman984
Right, continue to antagonize and deride the left. Sure proven method for winning elections!
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brillobreaks
February 22, 2010 11:25 AM in reply to mophan
I suspect that commenter is a member of the left too. One can be on the left, and still have some vague sense of how our political system works.
I want single payer. It would be better, cheaper, and easier to implement than this monstrosity. That makes me a member of the left. I understand that we're not going to get single payer though, and that sinking any bill that comes up short of it is stupid. That makes me sane.
Those of you who are not just pushing for, but actively working against any bill that isn't optimal, are not sane.
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mophan
February 22, 2010 11:28 AM in reply to brillobreaks
Brillo... read my post further up... it appears that we agree.
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madmatt
February 22, 2010 3:18 PM in reply to brillobreaks
So I should work for a bill that actively HURTS ME! Fuck you and barack, I refuse to pay for corporate jets and exec salaries when I get stuck paying for a policy that doesn't cover me!
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Alixman984
February 22, 2010 11:28 AM in reply to mophan
I'm left too!
I worked as hard as anybody else to get this president elected, but Im not going around shouting and expecting him to produce 60 votes and bring us all peace and love (and single payer). I live in real world
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mophan
February 22, 2010 12:37 PM in reply to Alixman984
And blame the ones that would like a better bill because the 60 votes required to pass it aren't there makes sense, how?
The ones that need to be blamed are those legislators that call themselves Democrats but undermine the democratic agenda at every opportunity. Stop blaming progressives and liberals for calling a spade a spade.
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tommyo
February 22, 2010 11:01 AM
For the Conservatives Obama is the gift that keeps on giving.
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Viva!America!
February 22, 2010 11:04 AM
If anyone is interested:
http://yglesias.thinkprogress.org/archives/2010/02/how-the-white-house-health-plan-compares.php
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Derek Stodghill
February 22, 2010 11:06 AM
It seems Obama is willing to give up the public option for one last chance at bi-partisanship. The question then is, what will the administration do once the GOP predictably objects to it? I don't think you get the exchanges through reconciliation so at that point the plan should (hopefully) be to add back in the PO and push it through with a majority vote without the national exchange.
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brillobreaks
February 22, 2010 11:11 AM in reply to Derek Stodghill
Huh?
We don't have a PO, or any reasonable shot at getting one. And I think everyone here understands that there is no actual expectation of Republican support of this or any other bill. The bipartisan shtick is theatre, and we all know it.
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anna am
February 22, 2010 11:40 AM in reply to brillobreaks
Seconded.
Not that it wouldn't be a nice thing, but I think our PO diehards here also must believe the moon is made of green cheese.
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Economides
February 22, 2010 11:55 AM in reply to Derek Stodghill
How hard is it to understand that it is conservative democrats who refuse to vote for a "public option"?
But if you really understood stuff, you wouldn't be so fixated on a public option anyway.
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Derek Stodghill
February 22, 2010 12:09 PM in reply to Economides
If the PO has no chance, why is there a letter circulating amongst Senators to pass a PO via reconciliation? It's a) popular with the public at large specifically independents and b) will energize the base to vote in November and c) will reduce the deficit according to the CBO. Even if it's watered down it can be strengthened later to be more effective.
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brillobreaks
February 22, 2010 12:19 PM in reply to Derek Stodghill
Because it's being used to score points with people like you.
Getting twenty or thirty senators to sign such a letter is pretty easy. They get to be on record as having done all they could to get the PO passed, and it earns them some goodwill from that segment of the base which has seized upon the PO as the be all and end all of this bill.
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Economides
February 22, 2010 12:31 PM in reply to Derek Stodghill
1. Call me when your 20 turns into 51. Until then you'll have to convince me that those 20 aren't merely posturing for their own constituents.
2. Arguments that the public option is popular are truly unconvincing. 70% of the public can't even name the vice president let alone what a health exchange is, who is eligible for the exchange and what unsubsidized insurance publicly provided even means (the public option is not like medicare which is massively subsidized by all workers). And how many die hard public option supporters who are in favor of "medicare rates" have any idea how much of a problem the way Medicare pays for health care is? And how many know that virtually all Medicare recipients find it necessary to buy (or get through former employers or medicaid) supplemental insurance policies to cover all the things that Medicare does not--like lack of catastrophic coverage?
The base will be energized by a policy that is neither necessary nor sufficient to get us to universal, affordable, quality health care. That's my biggest worry.
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Derek Stodghill
February 22, 2010 1:24 PM in reply to Economides
I think you are projecting other people's opinions on myself. I never said the PO would be the panacea to cure everything nor did I promote the Medicare version. I am more than willing to accept the watered down version of the PO that passed the House.
I simply believe the Democrats need to concentrate on policies that fire up their base to GOTV AND win independents back to their coalition. Legislation focusing on jobs, financial reform and yes the PO would all fall into that category. That's how the Democrats stay in control of Congress. In these cases, good policies are good politics.
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precisioncontrol
February 22, 2010 11:09 AM
Reading the majority of the responses to this article on TPM is disappointing. This bill lays the foundation for universal coverage, bans recissions and non-coverage of pre-existing conditions, prohibits unreasonable premium increases, and gets health coverage to 31 MILLION people who don't currently have it.
Don't let the perfect be the enemy of the good. This bill is an incredible progressive accomplishment. No, it's not single-payer, and it never was going to be. But it's monumental. If we don't do it now, it'll be another 15-20 years before someone tries again, and more people will die and go bankrupt in the meantime. I'm thrilled that we're this close to the finish line!
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HCTexas
February 22, 2010 11:11 AM in reply to precisioncontrol
What he says.
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brillobreaks
February 22, 2010 11:16 AM in reply to precisioncontrol
Yep.
And I just gotta say fuck all the armchair political idiots who worked to sink this in the first place. If we get what Obama's proposing, it's going to be an absolutely massive win for us politically and morally.
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Dorn76
February 22, 2010 11:49 AM in reply to precisioncontrol
I'm cheered that there doesn't seem to be a coherent criticism of your comment.
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NR
February 22, 2010 12:41 PM in reply to precisioncontrol
Wrong. Read the actual text of the legislation. The bill does not ban rescission. It bans rescission except in the case of fraud. So the insurance company will just claim fraud, you will have to go to court to challenge the decision, and the entire process will take years to resolve, during which time you will be going without potentially critical medical care. I hope you manage to survive long enough to see a verdict in your case.
The fact is that the insurance companies already cite fraud as the #1 reason behind rescissions, so this bill changes absolutely nothing in that regard.
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precisioncontrol
February 22, 2010 1:01 PM in reply to NR
The bill also mandates that insurance companies have a stronger appeals process. And surely, if insurance companies get even more aggressive about recissions in the wake of healthcare reform, legislation should be passed to stop abuses of the fraud exemption.
Good catch though! That's an important point that I think legislators should be aware of.
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NR
February 22, 2010 1:15 PM in reply to precisioncontrol
Just like legislation was going to be passed to end rescission in the first place?
Anything that is predicated on a future Congress taking action is doomed to failure. The insurance companies were able to block meaningful reform this year; in the future, it'll be even easier for them to block reform because we're about to make them a lot more powerful by handing them 50 million new customers who will be required by law to buy their shitty product.
Expecting anything meaningful regarding health care from a future Congress is just incredibly naive.
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philogratis
February 22, 2010 1:47 PM in reply to NR
Shouldn't recission be an option in the case of fraud? There is such a thing as actual fraud.
They won't be able to boot people for lying about pre-existing conditions because pre-existing conditions no longer relevant.
If somebody did get booted, for some reason, they could sign up with another insurance company right away, so your whole point is bogus.
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precisioncontrol
February 22, 2010 2:03 PM in reply to philogratis
Thanks for picking up on that. That type of thing was actually the only malicious form of recission that I could find in my cursory Google scan. I definitely agree that you can't exactly say companies can't rescind policies due to fraud.
I understand that some on the left simply won't be satisfied with anything less than Medicare for All, but really, in reading some of these responses, it seems that the left blogosphere is engaging in a lot of anti-healthcare demagoguery and misinformation of its own.
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slightly_peeved
February 22, 2010 5:29 PM in reply to NR
Wrong.
The frauds that are currently used to deny coverage are frauds related to pre-existing conditions; because a single checkup or pimple wasn't mentioned in the application form, the insurance company claims fraud and denies coverage.
As the legislation also bans discrimination due to pre-existing conditions, not mentioning a pre-existing condition can no longer be claimed as fraud. The fraud claims currently used have no basis in the new system, and would get thrown out immediately by any review system (such as the one being implemented).
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The Commenter Formerly Known as NCSteve
February 22, 2010 11:12 AM
Have any of you moaners actually read the damn thing? Not the whole bill, just the eleven page summary? If you have, then please explain us which parts of it you're against and tell us why you're against them.
If your only gripe is that it doesn't have the Holy of Holies, the Public Option--or worse yet has a requirement that healthy people who choose not enrich evil private insurers pay a few hundred bucks a year in return for the right to sign up with an evil private insurer after they get sick--then please do explain to us how those objections justify opposition to passing all the other stuff in the proposal that you can't find a reason to object to.
If you can't, do that, it seems to me it's morally, yes and politically, incumbent upon you to support the proposal on the table now and direct your energy into the positive activity of getting a public option implemented through a stand-alone bill later rather than the negative activity of bitching and griping and generally demoralizing yourself and and everyone around you like a bunch of Livia Sopranos.
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Scott in PacNW
February 22, 2010 12:14 PM in reply to The Commenter Formerly Known as NCSteve
The pattern of comments here is clear. Supporters support it for political reasons. Detractors oppose it for policy reasons.
That said, why read 11 pages when it's basically the Senate bill? It's a Rube Goldberg monstrocity lacking key cost control methods such as the public option (God forbid single payer), retains the anti-trust exemption, no reimportation of drugs, etc., etc. All while mandating individuals to buy insurance from the anti-trust exemptees.
Do I support the bill? Yeah sure. But please don't tell me it's quality policy or a foundation for universal care. It's not. It cements the special interests into place by design.
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FreeRider
February 22, 2010 12:24 PM in reply to Scott in PacNW
Supporters support it because it's this or nothing.
Detractors oppose it because that's what they do.
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Scott in PacNW
February 22, 2010 4:11 PM in reply to FreeRider
'This or nothing' = a very political reason, which I support without enthusiasm.
But long term, I think the policy shortcomings cited above will crush the political value.
I hope I'm wrong.
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FreeRider
February 22, 2010 4:14 PM in reply to Scott in PacNW
I disagree. I support it because of what it will mean to my family. I wish we had a bill that would be even better for my family but it's this or nothing. That's not political; that's personal.
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Scott in PacNW
February 22, 2010 4:27 PM in reply to FreeRider
I hope you're right. The exchanges don't start until 2013, correct? That's a long lead time for the insurance companies to undermine the bill's provisions & exploit its loopholes.
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FreeRider
February 22, 2010 4:43 PM in reply to Scott in PacNW
My family needs an end to annual and lifetime caps. My family needs the security of knowing we won't be dropped from my individual insurance policy if someone gets cancer. Those are just two of the things that go into effect as soon as the bill is signed.
That's why I want this bill.
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Mateo123
February 22, 2010 12:31 PM in reply to Scott in PacNW
I don't even agree with this -- that detractors oppose it for "policy" reasons.
They cannot point to one study or expert who has concluded that the only way to lower the number of uninsured individuals is through a so called "strong" public option. It's just that in their view, this is the only way to achieve universal coverage because the Europeans have accomplished it in this way.
So, I agree that supporters like Obama's proposal for political reasons. We need at least 50 Senators and 218 Representatives. They also know that price controls, subsidized premiums and bans on pre-existing condition limits will lower costs and the mandate will bring universal coverage to fruition.
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Scott in PacNW
February 22, 2010 4:23 PM in reply to Mateo123
We know that Medicare has lower costs than private insurance. A vanilla public option would make Medicare available to a wider segment of the population. (Joe Lieberman backed out of this scenario.)
Making for-profit companies compete with Medicare-level costs is reasonable, non disruptive way to reduce costs.
As it is, this bill will maintain anti-trust exemption for insurance companies. I'm not an attorney, but I don't see price caps being upheld in that legal context.
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NR
February 22, 2010 12:37 PM in reply to Scott in PacNW
I'm quite familiar with the structure of this monstrosity, thanks.
Let's see: No public option. No drug reimportation. No significant employer mandate. No national exchange. No repeal of the insurance companies' antitrust exemption. No significant reduction in costs - the CMS projects premiums will go up by $1,000 per year for a family of four.
Add to this the most significant rollback in abortion rights since Roe (states will, under the Senate bill, be able to ban all plans on the exchange from covering any abortion, for any reason, ever. Not just plans that take federal dollars. ALL plans.)
Add to that an excise tax that will force tens of millions of people (21% by 2020!) to either pay a surcharge or get lousier insurance, with more affected every year because it's not indexed to health care inflation.
Other than that, though, it's a great bill! Gobama, rah rah rah.
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The Commenter Formerly Known as NCSteve
February 22, 2010 12:54 PM in reply to NR
So, the anser is "no?" You haven't actually read even the eleven page summary it but still feel fully qualified to oppose it on substantive policy grounds because you read this other thing one time on another site?
Thank you for your honesty in decertifying yourself.
Next.
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NR
February 22, 2010 1:12 PM in reply to The Commenter Formerly Known as NCSteve
Everything I wrote was factually correct. If you've chained yourself so tightly to supporting Obama and everything he does that you can't even bring yourself to argue the objective facts of a situation, I pity you.
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admiralmpj
February 22, 2010 12:47 PM in reply to Scott in PacNW
But, Scott...it is better than nothing.
If I've had a personal beef with the rhetoric about the Senate Bill is that the opponents feel that enacting the Senate Bill is worse than doing nothing. That never made sense, even rhetorically.
The Senate Bill does not suck...but it is worse than the House Bill.
The House Bill was good...but it is worse than Single Payer (my preferred option).
Since I do buy into the notion that nothing is not an option, the Senate Bill is better than nothing.
So I say (in case it's not patently obvious at this point), pass "Plan B" and let's see what else can pass via Reconciliation. (I think there's a strong possibility that the Public Option can pass via this route).
Senator Rockefeller observed not too long ago that after this Bill passes, Health Care goes from being an every-20 year debate, to an every year debate. People (like yourself) who don't like this Bill should not only have fixes they want this year, but have lists of fixes for next year and so on. This should be a continuing process for all of us. That will make both better policy and in the end, good politics.
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NR
February 22, 2010 1:20 PM in reply to admiralmpj
I hear this argument from bill supporters all the time. "Yes, this bill is awful, but we have to pass it now so we can improve it later."
How the Congress that couldn't get it right in the first place is going to improve upon it is never explained. Or, alternatively, how the next Congress, which will have a smaller Democratic majority, is going to improve upon it is never explained.
It's just a lot of pie-in-the-sky wishing.
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FreeRider
February 22, 2010 1:36 PM in reply to NR
Congress didn't get Social Security or Medicare or Civil Rights right in the first place but have improved them all over the years.
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admiralmpj
February 22, 2010 1:41 PM in reply to FreeRider
Acutally, "pie in the sky" thinking would be killing the bill to...well, do what exactly?
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Scott in PacNW
February 22, 2010 4:40 PM in reply to admiralmpj
The big things I see in this bill are (a) expanded coverage and (b) controls on rescission & premium gouging. Both noble things that I support 110%.
Again, I hope I'm wrong, but in this bill I see a very long wait for (a) and giant loopholes for (b).
The one part that makes me say the bill is 'worse than nothing' is the individual mandate to buy insurance from anti-trust exempt insurance companies. This is the alternative to a public option. This is how they're going to insure all those people.
We already know how the insurance companies operate, and this bill rewards them with 30 million new customers. It's 180 degrees in the wrong direction, because it reinforces a private insurance system proven to be unsustainable.
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philogratis
February 22, 2010 6:58 PM in reply to Scott in PacNW
Individual mandate was never a replacement for the public option. It's true that there was no mandate in Obama's campaign platform, but I'm afraid that was a rather shallow political ploy to attack Hillary's plan.
The point of the individual mandate is that it gets a lot more people insured, which was Hillary's argument during the campaign. It's sort of like how child car seat laws gets people to get child car seats by fining them if they don't. This is kind of a giveaway to the manufacturors, but it's better than dead babies all over the place.
I think this health care plan is better than sick people all over the place with no insurance.
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gharlane
February 23, 2010 5:22 AM in reply to The Commenter Formerly Known as NCSteve
Sorry, NCSteve, but my trust in this WH is not at the point where I'm willing to take their eleven-page (one page of "summary" for every 188 pages of bill text) word for it. Not any more.
And my trust in you, with your documented history of obfuscation, distortion, and outrageous strawmen posing as arguments -- which I've noted time and again and which you've ignored every single time (such as here, to cite but a single example) -- is even less.
I have an idea. Since the Senate bill is your own particular magic pony, you show us where specific language exists in the Senate bill that does all these magic things you and the WH say it will do. That's your burden -- not the other way around.
You can start with the actual provisions that prevent price gouging and cap premiums. And you can explain to us how the Senate bill does not further enrich and entrench an already extremely-powerful "industry" through mandated premium payments and taxpayer subsidies, enabling them both to game whatever regulatory system might finally make it into place, and giving them even more clout to thwart the magic over-the-rainbow additional reforms (like a public plan in competition with the private ones, to name one example) that will somehow magically happen later in this Congressional session or in subsequent Congresses. And you can tell us exactly which bill you are looking at, what number, when it passed the Senate, and where you can find it on thomas or govtrack.
We'll be waiting.
But I suspect that, as usual, you'll say nothing. Because there's a lot of foam in your posts, but very little beer. And when pushed for substance, or called out on your bogus, strawman arguments, you simply leave the room.
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Rick Jones
February 22, 2010 11:13 AM
It would seem that Obama sees himself as the President of all the citizens in the United States - not just the President of the Democrats and not just the President of those who voted for him (unlike a very recent occupant of the White House). Not everybody agrees on all of the most progressive health care reform proposals that have been made - not even all Dems. Let Obama do his job, try to get the best legislation passed now, then improve it over time as people see how it works in action.
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ericAZ
February 22, 2010 1:37 PM
Republicans want the insurance companies to be able to raise rates 39% like they are attempting in California;
Republicans want people with pre-existing conditions to die in the street without health care;
Republicans want to eliminate Medicare;
If we get on message, we can pass health care, defeat the Republicans in 2010, and pass even better health care legislation.
If the Democrats continue with confused infighting about obscure points, then the Republicans get to frame the debate and they will win, and people will needlessly die.
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madmatt
February 22, 2010 1:49 PM
Burn in hell barack...a higher mandate and still no public option...fu and the rest of the Ins industry bailout posse. They will never get a dime from me if I have to go steal a plane and fly it into wellpiont headquarters.
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philogratis
February 22, 2010 1:53 PM in reply to madmatt
Maybe this is snark but..
It's a lower mandate! The number is smaller. In fact, it is so small, it will be cheaper for a lot of people to pay the small fine (50 bucks a month), and not get insured until they get really sick.
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Economides
February 22, 2010 2:03 PM in reply to madmatt
The people you want to burn in hell are the chronically ill who can't get insurance. They are the ones suffering the most and yet the public option doesn't help them one bit more than the rules already in these bills.
Selfish bastard.
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madmatt
February 22, 2010 3:26 PM in reply to Economides
Yes I know as I am one of them and the bill won't do shit for helping me see a DR!
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madmatt
February 22, 2010 3:30 PM in reply to Economides
There is nothing in the bill that makes the ins co's offer anything affordable to sick people like me, they just have to offer something that has a huge dedectible and an unaffordable premium. If I can't afford it I still get fucked, but the company gets to keep on baracks good side.
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Economides
February 22, 2010 3:38 PM in reply to madmatt
You deeply misunderstand what the reform is.
Insurance companies have to offer you the exact same plan as they offer healthy people for the exact same price. And they won't be able to get rid of you when you start racking up bills far in excess of your premiums. If you can't afford the current group policy rate then you get a subsidy.
Now explain to me why you think the current bill does NOT help you. Please be specific.
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gharlane
February 23, 2010 2:38 PM in reply to Economides
Insurance companies have to offer you the exact same plan as they offer healthy people for the exact same price.
Show us where in the bill that is, please. Section and page. No more empty assertions.
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EastWest
February 22, 2010 2:27 PM
For all of the Obamapologists trying to pretend the Public Option is no big deal, here are some facts:
This comes from Greg Sargent (http://theplumline.whorunsgov.com/senate-republicans/polls-in-key-states-public-option-far-more-popular-than-senate-plan/) via Kos (http://www.dailykos.com/storyonly/2010/2/22/839544/-Public-Option-Much-More-Popular-than-Senate-Plan-in-Key-State).
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Derek Stodghill
February 22, 2010 2:46 PM in reply to EastWest
I agree about the PO, but I don't think the PO has to be in this bill. A separate PO only bill can be created that could be sent to reconciliation. I don't think the exclusion of the PO in the initial bill to the summit is the end of the PO.
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Economides
February 22, 2010 3:41 PM in reply to EastWest
Congratulations, you are the second person to post this exact same information on this exact same thread, only like 2 hours later.
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gharlane
February 23, 2010 3:40 AM in reply to Economides
Mm-hmmm, and your reply is as much of a crock here as was the last time you responded to the same information.
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artappraiser
February 22, 2010 7:52 PM
Here are the four "pillars" that the Obama administration said in November that they wanted above all else in a health care bill:
1) a proposed tax on high-cost insurance plans
2) a new commission to control Medicare spending
3) the legislation not add to the federal budget deficit
4) that it promote changes, known as "delivery system reforms," aimed at rewarding high-quality care rather than high-quantity care.
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