How Progressives Should Weigh Compromises
The 2009 battle over health care reform is soon going to come to a head in national debates and legislative specifics. President Obama will re-set the agenda when he speaks to Congress, and in all likelihood sheer survival instincts will prompt Democrats in both House and Senate to generate some legislation that can be taken to conference and finally signed by the President. For progressives, it is already clear that the final result, if anything at all, will be much less than we hoped -- and perhaps much less than might have been possible if this battle had been better waged from the grass roots to the White House.
But that is the way it always is: there are compromises and half-measures in the end. The issue for progressives right now is how can we push for compromises that open doors politically, that promise to get all Americans covered somehow and spur interest groups in the future to work for shared arrangements that can manage costs.
Rather than remain fixated on one mechanism -- the "public option," make or break -- progressives need to be clear about principles for weighing trade-offs and compromises. And we need to think about how future developments might unfold from half-steps taken now. This kind of over-time thinking is tough in a 24-hour news/blog cycle and in an atmosphere where ephemeral polls are given too much weight. But it is vital,
For the sake of spurring this discussion, here is my personal take on it:
-- a weak and marginalized "public option" is not worth fighting for to the bitter end. If the House and Senate gut this option and force it to be underfunded, unable to bargain for low costs, and available only to marginalized groups, it could do more harm than good. We need to keep in mind the PURPOSES of the Hacker public option idea: to give citizens and businesses choices and create an entity with clout to go head to head with private insurers. This may already be out of reach, and a public option that is really symbolic welfarism, with no means to bargain, could easily be underfunded and denigrated down the road.
-- public option or not, we need supple and strong federal regulators who can create new rules of the road for private insurance companies, making them more like public utilities than cowboy capitalists. The rules should make it hard to profit by denying coverage or cherrypicking the healthy. So progressives should support a regulatory body and system that is focused, simple,not too tied down by congressional bargains. And prod Obama to make it effective by putting fearless people in charge and giving them a lot of data analysis capability.
-- above all, we need to get ALL Americans into the private or public parts of the system somehow, and give generous subsidies well into the working middle class. The allocation of sufficient resources for everyone to have decent insurance should be the key thing we insist upon. And it is pretty dumb for Democrats to do anything else.
-- a broad employer mandate is also vital, even if generously counterbalanced for smaller businesses with public subsidies. The Senate Finance idea of having no employer mandate may be the worst compromise some Democrats are contemplatiing. This is NOT because we progressives like the employer-funded health insurance system. It is the root of a lot of America's problems. But starting from where we are, we need to force ALL businesses to "play or pay" in that system. That will give all employers going forward an interest somewhat parallel to Medicare and Medicaid: an interest in keeping health costs under control and trimming private insurance profits. Indeed, within a few years it may be possible to attract broad business support for expanding Medicare to, say, age 50. But ONLY if all businesses have to weigh health care costs. If they do, they will be looking for a road toward single-payer, whatever it is called. And it will be called "opting into early Medicare."
-- Finally, Medicare needs to be consoldiated and given full powers to bargain for the best prices. This is a critical step in keeping federal costs down and unifying elder interests going forward. Even if Medicaid, not Medicare, is expanded this time to cover many of the working-aged uninsured, anything we can do to reinforce the unity and bargaining power of Medicare -- and repeal the privatizations Republicans passed some years ago -- will set the stage for a better future, Medicare needs to thrive, and be cost effective, in order to serve as an attraction for employers and citizens in the future.
Democrats should years ago have gone for step by step expansions of Medicare -- because politics requires that citizens think they understand what is being proposed. People like and think they understand Medicare; they have no idea what a "public option" is! Who can blame them? And doctors rightly dislike the idea of yet another set of bureaucracies to deal with.
Too late this time to preclude the mau-mauing of the Right on the latest incarnation of incomprehensible Democratic policy-speak gobbledegook. But not to late to think ahead, and settle this time only for changes that will set up better battles next time,
Optimistically, "next time" might even arrive before Obama leaves office in a second term.
Progressives should push for compromises that pool citizen fates, inject new resources for the middle class along with the less privileged, and prod businesses to turn against costly health insurers over time. These should be our goals -- and we should support Congressional Representatives who go in these directions, and prepare to punish those who do not.
--
You write "But that is the way it always is: there are compromises and half-measures in the end."
That's not true. When the Republicans come to power it's always
MY WAY OR THE HIGHWAY.
Only the Kumbya Democrats, compromise away the farm.
Democrats, a lot like Chamberlain. Who'd have YOU convinced just give them Poland and Hitler will stop.
On September 30th after some rest, Chamberlain went to Hitler and asked him to sign a peace treaty between the United Kingdom and Germany.
http://en.wikipedia.org/wiki/Munich_Agreement
Either you stand your ground and push back, or when the Republicans come back into power, we'll be that much more behind. Never having reconquered lost ground, always compromising losing more ground.
September 2, 2009 6:09 PM | Reply | Permalink
Of course we should push back. For a ROBUST public option and all the other things I listed. My post is arguing that we should not push only on just-any-weak public option. A weak one is worth less than other reforms.
It is not accurate to say that Republicans in power did not compromise. As extreme as their rhetoric is, and as much as they get/got, they did not get all they wanted in Congress -- for example, tax cuts for the rich without sunset clauses. The fact that they had to settle for some sunsets allows Obama to let some of these boondoggles "expire."
I agree with your frustration about the Democrats. But the fact is this battle has been mishandled in the past four months, and the blame for that is widespread. Now we have to deal with where we are.
September 2, 2009 6:18 PM | Reply | Permalink
You are incorrect on this. For starters, the Republicans were not creating programs, they were cutting taxes. The Bush tax cuts were not permanent either. Thus, they were able to use reconciliation. The public option is a permanent program and thus not suitable for reconciliation. That is a structural obstacle and has nothing to do with kumbaya.
Then there's also the economy, which is still in the crapper and massive debts being run up, which makes reform harder as well. Lastly, it's very likely that Democrats are just more philosophically diverse than Republicans and thus don't all want the same thing. You've ignored the key reasons that stopped the public option in your tantrum against the Democrats.
September 2, 2009 8:51 PM | Reply | Permalink
You are incorrect, sir. There is nothing in Senate procedure concerning the permanence of a program as consideration of reconciliation.
For the most part, the rules are arbitrary if not byzantine: there is no "real" burden that must be met for a reconciliation process because the Parliamentarian is the ultimate arbiter. That said, the "Byrd Rule" can strip certain things out that don't effect the budget. Theoretically, the public option is supposed to be budget neutral, so it could be ruled out. But it can just as easily be argued that it will cost money (to start up and run) or could save money (i.e. through cost savings).
So it depends on the strategy and the Parliamentarian. But it has nothing to to with short term programs - which there is real no such thing: legislation can be amended or struck.
September 2, 2009 9:37 PM | Reply | Permalink
No, I'm correct. The public option passed through reconciliation would only last 5 years.
Source: http://www.huffingtonpost.com/2009/08/21/budget-buster-kent-conrad_n_264123.html
Lawrence O'Donnell (who worked on the Finance Committee) also said the same thing while he was guest hosting on MSNBC.
The creation of this particular budget may have been done in an arbitrary fashion, but it's nonetheless setup only to provide for the existence of the public option for 5 years.
As far as repealing the Byrd Amendment, that kind of seems like dropping a 4,000lb bomb on a parking lot to destroy a car, when dropping a 250lb bomb on the car will do. If you're going to marshal 60 votes to do something, you may as well marshal it to break a filibuster and then let each member vote up or down on the bill as they see fit. Under such a scenario you could get someone like Nelson who opposes the bill vote to break the filibuster, then vote against the actual bill, but possibly still get 51 votes for it. That's just one possibility, and I don't think it will happen as it still will result in something that Blue Dogs don't want: an increase in the budget deficit.
September 2, 2009 10:36 PM | Reply | Permalink
Right on the mark . . .Resistance . . .
I fully agree with this point:
And in addition to that, I do believe I read this in Professor Skocpol's original post:
I guess the "old warriors" and the so-called "looking glass left" should have thought that a weak and marginalized voting rights act was not worth fighting for to the bitter end.And then there was this one:
Sounds great, but I swear that was the same basic sales pitch for Medicare back during LBJ's reign. Now look what has transpired with that over the past 45 years. Stripped down, raided and now gutted to the point of financial ruin so the whole thing can be re-regulated under the terms of the investor class lobbying those idiots on the hill
Progressive?
Incremental change?
Mandatory coverage?
Provide Exchanges as the sales outlets for the for-profit insurance providers?
No safety outlet provided by a not-for-profit public option?
Ya' ... That's progress ... But not very liberal progress.
~OGD~
September 2, 2009 10:46 PM | Reply | Permalink
LBJ was everything but a member of the Looking Glass Left. Here is the support he was able to gain for his "radical" voting agenda.
LBJ would have laughed his ass off at the tactics today's "progressives" have mastered and would have been quite happy with the compromises being floated to pass this initial round of health care reform.
Unlike today's democratic faithful, those of yesteryear understood the notion of incremental gains leading to exponential change over time.
September 3, 2009 5:09 PM | Reply | Permalink
Well frickin . . . Duh . . .
LBJ was everything but a member of the Looking Glass Left? Do tell . . .
That's due to the reality that the "Looking Glass Left" is nothing but Mister Bluster's one-note divisive rhetorical device and a figment of his single compartment mind.
Sensing sarcasm is not Mister Bluster's specialty.
~OGD~
September 3, 2009 5:56 PM | Reply | Permalink
Now ... With the Blustery One dealt with . . .
Let's go back again and take a look at what that particular portion of my statement said without removing the substance of the statement by using selective choice of a minute portion designed to sidetrack from the overall intent of the statement. (Something I'm constantly accused of doing by a certain someone)
Here is the section where I was responding to a point made by author of the blog:
To further clarify and expand: We have had incremental changes to the health care systems off and on over the past 40+ years. Some that moved the best interests of the people forward and some of those changes were revisited that took hard won legislation and changed it to benefit the insurance industry to the detriment of the interests to the citizens. (think Medicare Advantage as but one of too many to mention).
Now if we look at removing the public option in this current mark-up as a progressive move to win a partial victory for positive incremental change only to end up with a mandate of mandatory coverage offering only insurance plans offered by for-profit insurance providers in the stated Exchanges, without the outlet provided by a not-for-profit public option to compete, it places the whole scenario in a regressive mode of incremental change with no guarantees to future exponential changes.
And in this day and age what with the current balance of power what it is and the past month of irrational discord, LBJ would leave no prisoners that got in his way, neither leftists, liberals, progressives, moderates, centrists, right-leaning blue dogs, and especially not the obstructionists of the current party-of-no. If anyone bucked it Johnson would filet 'em like a largemouth bass pulled from Lake LBJ.
But ... In today's political climate it takes the art form of ju-jitsu . . .
~OGD~
September 4, 2009 1:37 AM | Reply | Permalink
Agree 'resistance'..The republican bully is always present when they have the power..now the dem's are whimping out to them!
but we need to have sharp talking points---using the words that will get reactions--not lengthy explanations that cause people to turn off.
A trigger would give Insurances Cos FREE REIN FOR 3 YEARS!
A trigger would NOT CONTROL COSTS!
A trigger would NOT PROVIDE COMPETITION Till the Companies are proved to be abusive in court!
A trigger is a financial windfall to the Insurance Co's, Hmo's and Big Pharma! 46 million new custumors and NO negotiations on drugs!
A trigger is the republican DO NOTHING SOLUTION!
A trigger is a copout by Blue Dogs and repubs to their Corporate donors!
September 3, 2009 9:34 AM | Reply | Permalink
I didn't even have to get to the jump to recommend this blog. I think you are exactly right in that incremental change today can lead to exponential changes tomorrow.
September 2, 2009 6:26 PM | Reply | Permalink
The battle has been mishandled the last 30 years.
This is the absolute last straw for me.
You have some good ideas and I could see simplifying your agenda and making it a manifesto but unless that is tied to a new party or a take no prisoners faction within the party, it's just fodder to be compromised away.
The public option is really not more than a sign post to tell us whether the Democrats are advancing or just retreating again. Answer: retreating.
The public option is only the NEXT sell-out. It is not the LAST sell-out and the Blue Dogs and the faux progressives who enable them will not take any point you list any more seriously than the public option they sell out.
September 2, 2009 6:29 PM | Reply | Permalink
The public option is not necessary to achieve universal access, nor to lower costs and improve quality, so why on earth would this be your biggest issue in the world for you.
It's fine to be for it, but to pretend that it is somehow the best measure of whether Democrats are going to achieve the goals of quality affordable permanent health care for all is juvenile.
For you this is about ideology not people's lives. How is that any different from the attitude of people like Gary Bauer?
September 2, 2009 7:09 PM | Reply | Permalink
I didn't say it was the best measure, I said it was a sign post. Do you seriously believe that the Blue Dogs are selling out because of the public option alone? Do you think if we give in on that they will fight for the people and not for the corporate lobbies?
Sure, it is about ideology with me because you may not be fighting an ideological fight but they sure the hell are! They know it is an ideological fight. They're fighting to keep their piece of the pie as big as it can be and to do that they will make your slice as small as it can be. The centrists traded away the poor long ago. They won't battle on the premise that it is a moral imperative that the United States join the civilized world and make universal healthcare a right for all of its people because they have agreed with the Republicans that the poor don't count. No, they have incrementally given ground and now only really represent the upper regions of the middle class.
The working poor are the ones who are totally going to get the shaft in this bill. They're going to be ordered to buy a crappy policy that they cannot afford and which will not guarantee them healthcare.
As to lives, I recommend that you count how many times Obama says "cost" in his speech and how many times he says "lives". The messaging on this has never been about lives. Some centrist sold Obama on the idea that it would sell in suburbia to talk cost instead. That's one reason the Republicans have done so well with their fear campaign. What Democrat is telling them this bill is about their life? Instead, they've been convinced they are the cost that is going to be cut.
September 2, 2009 8:32 PM | Reply | Permalink
The poorest poor as you know get medicaid. many who are eligible are not enrolled but should be. These bills have exapnsion of medicaid built in.
Under all these bills the working poor get some subisdies to buy insurance. You cannot have mandates without subsidies. You cannot have any kind of universal coverage without subsidies.
You say it will be crap insurance. Why is that? And what determines how good the insurance will be? Does it have anything to do with cost? If you lower the cost of care then a subsidy of a given value buys you better insurance. Asked another way, if we have no control over cost then how do you afford keeping everyone insured.
My point is smart policy gets us universality, it gets us lower costs and it gets us better quality. Instead we have a mostly thoughtless food fight.
September 2, 2009 9:04 PM | Reply | Permalink
Here's how I see it . . .
Actually we improve Medicaid by enrolling those under 133% of poverty into a private insurance plan offered in the Exchange and subsidize those individuals and or/families on a sliding scale so by January 1, 2016 the following section of the bill takes affect.
~OGD~
September 3, 2009 12:10 AM | Reply | Permalink
Right on, bluebell.
You've never been better.
September 2, 2009 11:56 PM | Reply | Permalink
Hear Hear Bluebell! Excellent points all!
Ya know it all sorta boils down to the old phrase: "No guts, no glorly!"
If the Democrats want anything but rasberries and Bronx cheers from the nation then it's time to man up, show some guts and just for one time do the right thing by the American people.
September 3, 2009 3:09 AM | Reply | Permalink
I didn't say it was the best measure, I said it was a sign post. Do you seriously believe that the Blue Dogs are selling out because of the public option alone? Do you think if we give in on that they will fight for the people and not for the corporate lobbies?
I tend to agree with this. A robust public option is important not just on the policy merits, but also as a signal victory for progressives. In any struggle, one's enemies are encouraged by victories and demoralized by losses. The public option has become the key policy hill that everyone is paying attention to, and one of the chief measures that observers will use to measure the strength of the progressive movement. Republicans are trying to take that hill and progressives are trying to defend it. If Republicans get a moral-boosting win here, they will become more zealous, and attract more media attention and money to their cause. But if they fail, the moderating voices in the Republican party - Powell, Frum, etc. - will have more evidence to make their case that the Limbaugh, Beck, teabagger faction is a an albatross around Republican necks. For the sake of the country, the most zealous enemies of progressive change need to be dealt some harsh, stinging blows.
September 3, 2009 11:18 AM | Reply | Permalink
The public option is absolutely necessary to lower health care costs. All you have to do is look back over the past thirty years without a Public Health Service to see that.
ex animo
davidfarrar
September 2, 2009 9:48 PM | Reply | Permalink
You're a puzzling guy.
September 3, 2009 12:58 PM | Reply | Permalink
Nah, just a birther.
September 3, 2009 5:11 PM | Reply | Permalink
Recommended as a constructive comment that can stimulate useful discussion going forward.
Criticizing what has been done and not been done up until now--which some at this site have been doing very well and many more are entirely capable of doing well if they so choose--is not helpful and probably counter-productive at the moment. There's plenty of time to critique and hopefully learn some useful lessons once this current push has run its course. But it is not close to that point now.
If what Theda suggests should be the focus going forward ends up getting done, that should be treated as a major step forward, however ugly and messy the process has been, and however substantively unsatisfying it would be in important respects.
I despise the private, for-profit aspects of our approach to health insurance as much as anyone around here and really, really wanted a robust public option this time around. Heck, we might still be able to get it.
But in any case, even if that can't be, or simply is not, done this time, I think Theda makes a good case that getting changes of the sort she identifies would be worth fighting for.
September 2, 2009 6:29 PM | Reply | Permalink
The problem is the Democratic Party is surrendering not fighting and there is zero reason to think they are going to start fighting tomorrow if they aren't fighting today.
September 2, 2009 6:38 PM | Reply | Permalink
Both right and left resorting to metaphors of violence. Seems a funny way to approach health and well-being.
September 2, 2009 7:11 PM | Reply | Permalink
I assume you're at least half joking. I'd say it's about 95% on one side and 5% on the other. I know I don't have to write which is which...
September 2, 2009 9:04 PM | Reply | Permalink
Yep!
September 3, 2009 3:10 AM | Reply | Permalink
Democrats and especially progressives already compromised by allowing for a public option vs. a single payer plan. This is nothing short of a Republican win and a complete failure on the part of our President if he eliminates a public option without ever having done anything to fight for it in the first place.
Let's face it, these so called reforms without a public option are nothing short of the plans Republicans like Giuliani and McCain asked for throughout the 2008 Presidential Election process. Why don't we add Torte Reform and make it an EXACT replica of their primary plans.
Progressives like me opened our doors to the community, trained hundreds of volunteers to work to get Obama elected, and we have continued to work to fight for an aggressive health care reform package that includes the compromise of a public option. To date we have not seen our President do anything to stand with us.
It is NOT compromising to give the Republican minority and insurance companies everything they want while offering absolutely nothing that will significantly or noticeably help any of us real folks out here who have been working for change.
You can give up on change if you like, but I refuse to carry the water for you or any Democrat who is willing to ignore the desperate situation as it exists.
In my state, 800,000 people are uninsured. We only have about 3.7 million people in our state! That is 25 percent of our population. We have seen our unemployment numbers steady around 12 percent for months now and I have personally watched people I care about suffer the consequences. The luxury of security may allow some like you to tell everybody else to hang on to the edge for several more years because you don't have the stomach to fight for true change, but I am not with you on this.
I'm not with you on this because I have the strength and the courage to fight for those who do not, and I am unwilling to give tyrants and bullies exactly what they want because it is easier than giving the people what we truly need.
September 2, 2009 6:47 PM | Reply | Permalink
Theda,
Let me start with some decorum: I appreciate that your posts are serious and well developed. You take the time to treat a subject properly.
That said, I totally disagree with some of your characterizations of health reform and the nuances of the process. (Full disclosure: I am a lobbyist - the dread - for an organization of the left).
The public option which you deride, much in the fashion of "adult" progressives (e.g. Yglesias, Ezra Klein etc.), is nowhere gutted nor should it categorized as "out of reach." Quite simply, in accordance with parliamentary rules, an option can and should be passed through reconciliation, where its cost saving value will only strengthen the option's merit (i.e. its deficit reduction capabilities are more stringent). Using reconciliation is not "out of reach" only if the white house determines it does not want true competition.
Possibly more laughable is the line of argumentation about adopting strong regulators. While this would be perfectly reasonable and necessary, it is a bit utopian in today's Washington. Spend a few nights hanging around the Capitol, especially Patton Boggs on-campus building, and you will see how far regulation will go - nowhere. The idea that the insurance industry (just like the financial industry) will allow stringent regulation over its enterprise will be fought tooth and nail - and effectively. (See financial reform). Moreover, it is really not clear that the two most significant issues: premiums and fees will be under consideration. And lest we forget, regulatory apparatus can, and has, been undone at the whims of political expediency; recent history provides ample evidence.
With a mandate (which is necessary under proper conditions) to purchase insurance with no control over premium costs (subsidies can be gutted and are, at present, inadequate) you will essentially create a class of captive healthcare customers. A much more egregious and personal manifestation of the experience of modern freight rail.
Finally, the idea that concessions must be made and "always" are, to push this bill through conference is silly. Unless the democratic President is negotiating against himself, he can pass the bill.
September 2, 2009 6:50 PM | Reply | Permalink
This is a very thoughtful post and I do not disagree with much of it. I agree, or at least hope, that a robust public option may still within reach, especially if they fall back on reconciliation.
Still, you will have to admit, won't you, that neither the Dem leaders nor the Obama administration really want to go the reconciliation route (and they do not explain it well to regular Americans, either; they should call it "majority rule"!) They may think they cannot fashion a reconcliliation approach that gets enough Democrats. So my post is about how progressives should think about trade-offs if we do not get the ROBUST public option we want.
I believe that fixating on a weaker and weaker public option figleaf at the expense of the other goals would be a mistake.
As to regulation, I am a political scientist and I know all you say about DC ways. It remains the case that, historically, there HAVE been instances of strong rather than weak/interest-riddled federal regulation. That is why I said we should push for a focused, simple regulatory regime with strong powers of data collection in the hands of the regulators. It might evolve in better than usual directions, because the idea here, going forward, is to DIVIDE THE ELITES, to get business and government interested in cost containment after all Americans are somehow included, so that private insurance companies can be reined in. That is not at all impossible -- and there is no scenario in any of the reforms now on the table where it would not be necessary from a progressive point of view.
Robust public option or no, the private insurance giants must be regulated. Competition alone will not do it. They should also gradually be nibbled away by an expanding Medicare program (single payer).
September 2, 2009 7:01 PM | Reply | Permalink
I know folks like to call Medicare "single payer," but as implemented it is no such thing. Even before the implementation of various HMO-like options, Medicare used regional and state intermediaries who effectively ran separate programs. Medicare is old style Blue Cross for the elderly and disabled, and only an insane person would call that "single payer."
In any event, one of the worst characteristics of Medicare (as with Medicaid) is that it uses the same sort of aggressive pre- and post-authorization process and utilization review process as the privates, in some ways its processes are more aggressive. While not strictly a matter of the "single payer" language, any public program going forward has to REVERSE this trend. Medical care providers should not have to justify professional medical judgment to ANY payer, public, private, single, competitive, whatever.
September 2, 2009 7:11 PM | Reply | Permalink
Not following you on the single payer part. Who else is paying beside the federal government?
Totally agree that we need fundamental reform of the payment system. I think docs have to be accountable to someone for their medical decisions this seems to be a major advantage of multi-specialty group practices and integrated hospital systems such a Mayo or Intermountain.
I think if you have a system that uses someone else's dollars, especially compulsory taxes, that there has to be accountability for not wasting resources and pursuing the highest possible quality. It's doctors and hospitals that are driving up the cost of health care. In some ways they are just responding to the incentives in front of them. But ultimately they control utilizations decisions.
September 2, 2009 7:28 PM | Reply | Permalink
Go back to 1960, you have a Blue Cross-Blue Shield in each state (maybe some of the less populous states had regional BC/BS). That WAS health insurance, except for crappy individual policies that reimbursed the patient (not the doctor), small amounts. I am sure the big employers had other plans, and there was something else somewhere, but THAT was the environment.
When Medicare was established, it replicated this process by HIRING the BC/BS companies to operate as "intermediaries" for Medicare. What Medicare IS is BC/BS (often the remnants of the same companies), paying bills for Medicare. The reimbursement practices were officially set by Medicare, but actually set by the intermediaries. Practitioners with patients served by different intermediaries got (probably still get) different reimbursement depending on who the intermediary was.
How is that single payer?
As to second guessing medical care professionals, the federal government (treasury) stopped pre-audit of its own bill payment system (for the WHOLE GOVERNMENT) sometime in the middle of WWII, because, it is said, such pre-audit saved little and was clogging up the whole process to the point that we might lose the war. What the whole UR system in health care is is that same pre-audit process, except much more intensive. It also clogs up the process. The only reason health payers haven't long ago stopped it is that they have no particular desire to make sure that individuals do not lose their individual wars with bad health outcomes.
September 2, 2009 7:41 PM | Reply | Permalink
So BC/BS process payments from the federal program. How is that NOT single payer?
September 2, 2009 9:31 PM | Reply | Permalink
You clearly do not understand health finance from the inside. If your practitioner notices that your intermediary will pay $150 for a procedure that the next person in the room (also "Medicare") will be reimbursed $200, you may find that your service isn't quite the same, especially if there are differing UR practices that are more bureaucratic in YOUR instance.
September 2, 2009 10:29 PM | Reply | Permalink
can you explain this: "The reimbursement practices were officially set by Medicare, but actually set by the intermediaries. Practitioners with patients served by different intermediaries got (probably still get) different reimbursement depending on who the intermediary was."
You are saying same procedure and in one location it is reimbursed but in another it is not due to the discretion of a local BC/BS person?
September 2, 2009 9:35 PM | Reply | Permalink
They both got paid (unless there was differing approaches to UR), but the AMOUNT paid differed.
September 2, 2009 10:27 PM | Reply | Permalink
If it is impossible to regulate the insurance industry because the normal political process is vulnerable to lobbyists then how do propose to insulate a government public option from the exact same forces?
Do you understand why Medicare cannot negotiate drug prices? Or why they pay absurd prices for durable medical equipment? Do you understand why Medicare has not implemented so many of the excellent recommendations of the Medicare payment Advisory Commission (MedPAC)?
If you think strict and effective regulation is not possible (the basic rules on things like guaranteed issue would be statutory I guess) then how is effective administration of a public option possible?
September 2, 2009 7:17 PM | Reply | Permalink
Well, some are fighting and other are surrendering. We need to push and support the fighters and perceive intelligently the full range of things they need to weigh. We should not box the fighters into symbolic rather than substantive gains for progressives. "The Democratic Party" is not a unified actor.
Just to be clear: I think, and have thought all along, that Obama as President should make a compelling case for a Medicare-like choice to be available to all Americans. To be fair, he often has, and maybe he will again. I wish he would explain it vividly and clearly in ways regular folks can understand.
September 2, 2009 6:51 PM | Reply | Permalink
"regular folks" = people dumber than Theda Skocpol, of course!
September 3, 2009 9:52 AM | Reply | Permalink
Another Obama apologist. I forgot to drink the koolaid, myself.
The fact is, without public competition, the mandate based program is a privatized tax program giving monopoly power to the already demonstrably greedy insurance industry. Why is this a good idea?
September 2, 2009 6:54 PM | Reply | Permalink
Come on, read my post. I did not say a universal mandate to unregulated buy private insurance was a good idea, did I? In fact, if I were advising progressive Dems in Congress, I would say do not give insurers the individual mandate if they do not agree to a robust public option. That ought to be the bargain.
I am critical of Obama to a considerable degree -- I wrote in the NY
Times blog last week that he should have taken this forward himself many weeks ago. But there is more to this overall battle than just-any-kind-of-public-option -- which was never as good an approach in my view as expanding Medicare would be (single payer expansion in other words).
September 2, 2009 7:08 PM | Reply | Permalink
No, you recommended regulations. Perhaps we could use the SEC?
September 2, 2009 7:13 PM | Reply | Permalink
And, you haven't said why it is a good idea, yet.
September 2, 2009 7:20 PM | Reply | Permalink
Under the thrall of private health insurance is what is driving up costs? Too bad this is wrong.
Why are Medicare and Medicaid costs going up so fast?
Why does McAllen spend so much more per Medicare enrollee than El Paso? Same public insurance scheme, 50 percent difference in costs/ What does that have to do with private insurance.
September 2, 2009 7:34 PM | Reply | Permalink
Since you know so much, can you guess which company in the US makes the most money off of health care?
September 2, 2009 7:45 PM | Reply | Permalink
You have to answer a question before you get to ask one. That's basic courtesy.
Who cares what company makes the most money? Why does that even matter?
September 2, 2009 9:41 PM | Reply | Permalink
Because the answer is General Electric.
September 2, 2009 10:31 PM | Reply | Permalink
Which is also the answer to your question, why are health costs going up so much? Because the cost of technology in the US is unreasonable.
September 2, 2009 10:32 PM | Reply | Permalink
I agree in part. There are other factors, of course. We know it;s complicated.
First, I would say it is more the rate of diffusion of technology that drives costs--we use the technology in many cases where it is not necessary--rather than the high price of individual innovations.
Second, we clearly over use technology that has no proven benefit. Lots of new drugs are no better than the old ones, for instance. High prices are not an issue when there is an even more valuable benefit.
But technology does not explain what the difference is between El Paso and McAllen (the reference is to Atul Gawande's June 1 New Yorker article by the way). They have access to exactly the same technology. But the folks in McAllen just use way more resources per patient. They over test, they over refer to specialists, etc....
Public option won;t change technology. Comparative effectiveness research will show us what technology actually has value. And better delivery of care a la Mayo, Cleveland, Intermountain, Billings, Geisinger, Scott and White, etc... will make a huge difference to cost and quality. We need better incentives in payments to drive that change.
September 3, 2009 12:24 AM | Reply | Permalink
We don't use way too much technology. The technology we use is way too expensive.
There is nothing wrong with comparative effectiveness studies that lead to updating professional judgments of health care providers. I favor it. If you think that is what UR is about, you have never seen the inside of a health payer.
UR, as a profession, is the same form of clogging up of the payment system as ANY pre-audit. Do you get reimbursed for your travel by your employer? If so, is there a pre-audit of your travel voucher? If so, do you get your money back before you get your credit card bills?
September 3, 2009 11:30 AM | Reply | Permalink
The Republicans and their mob have spent the last 6 weeks using intimidation and threats of violence to achieve this victory. Jason cheers for incrementalism while they pack heat and joke about assassination at public meetings. Regardless of the merits of the bill, if Obama caves on this he is toast because they will know exactly what to do to get what they want next time -- and the last strategy they will use is incrementalism.
September 2, 2009 7:00 PM | Reply | Permalink
Bingo. The Republicans declared war when they obstructed the stimulus package, and then organized a party line vote against it. Obama didn't ask for this war, but now he has to fight it. Now, much of the right is using anti-democratic intimidation tactics and "direct action", with open contempt for any political civility or decency. If these efforts are seen to succeed, they will be redoubled. The stench of defeat and the blood in the water around Democrats, along with weak-kneed defections from demoralized progressives, will seriously damage the prospects of future victories for the progressive agenda.
But here is still a progressive giant out there. It is not at all sleeping, but it is also not fully aroused. Obama's numbers have fallen because of progressive and centrist concerns about his leadership, and dissatisfaction so far with his ability to push forward the agenda that truly has majority support. If Obama gives a firm, rallying speech next week, and backs it up with determined and forceful leadership, the giant will be fully roused into action and the teabaggers can be trampled underfoot.
September 3, 2009 11:42 AM | Reply | Permalink
The republicans you point to are toothless in the way of political power and represent a shrinking part of the conservatives in this country. I have said the ONLY way to beat that sort of attack is to face it with innovative solutions rather than more insanity.
Obama could graciously "kill" the public option tomorrow and support for the plan would go to 70% or more. He could then "resurrect" the idea of a public option as the only possible way to save Medicare. That way, inside of his first year in office, he gets a regulated insurance industry, a national mandate for health insurance and a more robust public plan that will survive its coming implosion.
I am saying that facing idiotic tactics from the far right with idiotic tactics of your own is counterproductive if progressive change is your long-term goal.
September 3, 2009 5:18 PM | Reply | Permalink
Obama is turning out to be such a huge disappointment. He and the Dems are so into the same old same old and they really DON'T GET IT that the people did NOT vote for that! So we have our first black (or African-American if you prefer) president--big whoop! Who even cares if nothing changes? For what he has managed so far it could really have been anyone. I will NOT be forced to pay exorbatent rates for insurance so that I can partake of the crappy US health care system.
September 2, 2009 7:57 PM | Reply | Permalink
JEM:
This is the astroturf I was talking about. You want links, and call me paranoid, but if you google this statement or paraphrases thereof, you will find SCADS of this across the internet.
I am not stupid or crazy. The internet is an ideal place for information warfare because of relative anonymity. In the days of strictly printed media, this was called flak. The intended result is still the same: manufacturing consent and setting the scene for a scapegoat.
September 2, 2009 8:37 PM | Reply | Permalink
Huh? People can't be unhappy with a president of their own free will and bitch about it with similar phrases? Someone has to influence them to do that?
Sorry, that sure sounds crazy and paranoid to me.
It's pretty standard for elected leaders anywhere for a substantial proportion of the electorate to be disappointed, and to be disappointed for similar reasons. What has gone on since the invention of democracy is not a conspiracy, it's just part and parcel of it. One guy says I'm unhappy with him, the other guy says "me, too, that's exactly how I feel" and it's a conspiracy?
BTW I've seen this commenter posting here for quite some time, virtually always expressing quite left sentiments. I doubt very much that he/she is in on any astroturf campaign, and I also doubt very much he/she has been influenced by one. Seems to very much have a mind of his or her own.
September 3, 2009 4:06 AM | Reply | Permalink
Thanks AA-You are right, I am very liberal (much more so than Obama) and I have been around since the beginning of TPM. But I think that the comment was actually directed at Jason (JEM-Jason Everett Miller) and not at me (even though tit SAYS it is in reply to me). Oh well. My comment stands. This is NOT a time for incremental "go along to get along" sidling up to the corporate interests. And again, I think that a mandate without a public option is immoral!
September 4, 2009 12:24 PM | Reply | Permalink
Gotta go with AA on this one. I have seen similar sentiments from mostly liberal democrats as well as some moderate conservatives who think he is being too liberal (or too conservative) by letting Congress legislate.
September 3, 2009 5:20 PM | Reply | Permalink
At the end of the day, public option or whatever it's called, it has to be big enough and strong enough to spell the beginning og the end of for-profit healthcare insurance. If it's of insufficient critical mass (buying power) and doesn't have protections from opponents it will wither and die.
Adequate healthcare is either a birthright or a business, that's the crux.
September 2, 2009 8:56 PM | Reply | Permalink
"We should not box the fighters into symbolic rather than substantive gains for progressives."
Theda, I thought about pasting that about ten times just to see if anyone would read it. Seems to me it's the most important concept of your original post.
September 2, 2009 9:44 PM | Reply | Permalink
What fighters?
September 2, 2009 9:50 PM | Reply | Permalink
Because the answer is General Electric.
September 2, 2009 10:30 PM | Reply | Permalink
sorry, wrong place.
September 2, 2009 10:33 PM | Reply | Permalink
The health care issue before us is just like cover-all BINGO - you have to cover all the squares on your card to win. And that's the problem; there's too many single issues that need to be addressed. So I gather you're suggesting we cover as many as we can, in a helter-skelter manner and hope for the best we get something upon which we can build a firmer foundation in the future. Perhaps there needs to be some consensus as to what are the primary building blocks necessary to pass first that will ensure future success. As far as I can tell, single payer/public option is the best solution to cover all those squares. The only problem with it is the repuglicans are hell bent on destroying any possible chance of it succeeding. And anyone who balks at moving forward with the option is surrendering to the repuglicans disruptive tactics. We either go all the way or stay at home. If the repuglicans want to destroy this initiative then let them. In a very short time,health insurance and medical services will so overpriced, the average citizen will not be able to afford their co-payments for services received. Only then will the public be ready to rethink their opposition to single payer/public option.
September 2, 2009 10:39 PM | Reply | Permalink
I am intrigued by this argument that the robust public option is the one that will best pass through the parliamentary limitations of the reconciliation bill approach--if this is true, then who needs the Senate Finance Committee sellout version?
We need Obama to put the fairest, truly competitive version of a public option out there and make people vote: are you with the people, or the insurance companies? I'll live with the results--if it falls, we'll know who to separate from the Dem flock in 2010 or their next re-election run. I don't see it failing.
As for the rest of it, it comes down to pay-or-play for employers, the proper level of subsidies for the poor, and no use of pre-existing conditions to deny or overcharge. Eliminate the question, "Have you ever been denied coverage?" If those are present, I can support the reform bill, even if the public option falls. It just has to be out there and voted upon--this is a political issue of the highest importance.
September 3, 2009 12:24 AM | Reply | Permalink
I usually agree with your strategic suggestions. Can't agree to this design for surrender.
I'll concede you want to at least negotiate terms with the enemy and come out of the surrender with something like some regulations and such. But frankly, the time has long passed for such half measures. And please quit arguing that some kind of bill with some paltry reforms is needed. No, it isn't. It's either real, substantive, sweeping, permanent and irreversible reform or nothing.
At this point it is better to do nothing than to pass yet another shoddy piece of legislation that only extends the life of the rotten system we have and delays real reform longer than would otherwise be the case. Better to let the system fester and get worse on it's own and thus force a political uprising from the middle class and the business owners who are getting raped by the insurance parasites and who, in a couple of years, will not be able to afford the insurance the parasites offer because their unbridled greed will not allow them to moderate their exhorbitant rates and their ongoing thievery of more and more of the premiums to increase their quarterly profits.
Incrementalism in the case of health care is capitulation and there's no two ways about it. We may as well wait for the second coming as follow the incremental approach for health care reform because the former is a lot more likely to happen before the latter. I am 51. The course you describe means I'll be long dead before any real change occurs assuming I've got another 20-30 years left. That is unacceptable. Totally and completely unacceptable. That would mean my as yet unborn grandchildren would be the first to see real change. If we wait that long the country will be in tatters but more importantly I'm completely unwilling to put the yoke of keeping a for profit system going that benefits so few and the expense of my children and their generation. That's immoral and just as immoral as delaying healthcare reform in the name of getting something passed this year. People are literally dying for lack of health care. Thousnads and thousands more will die if adopt the wimpocrat approach of capitulation and a few crumbs for the people while the parasites gorge themselves on the economic lifeblood of our families and our businesses.
No, sometime you have to say I'm just not going to put up with this bullshit anymore, this time we must stand and fight for what is right. At least if you fight and lose you know you took your best shot. Following the same weak, cowardly route of capitulation the DC Dems love so very much is absolutely out of the question for me and, I do believe, most actual Democrats. I agree a weak public option is not worth fighting for, but neither is a package of "reforms" that are more illusory than real and establishing fake regulations and regulators that won't have any teeth. You can't honestly believe the people running the show in DC would actually regulate those insurance swine do you? Of course they wouldn't! They would appoint a bunch of industry hacks to run whatever farce of a regulatory agency was set up and the only thing that would change is that insurance company profits would grow even faster.
September 3, 2009 3:33 AM | Reply | Permalink
I'm sorry but I can't get behind this: "above all, we need to get ALL Americans into the private or public parts of the system somehow, and give generous subsidies well into the working middle class."
Without a public option, private insurers become the only mechanism for this. Yes, we can regulate them but we should be regulating them already not giving them captive customers in exchange for regulations that should have been in place years ago.
Any sort of mandate that leaves the insurance industry in the hands of the private insurer is a subsidy, pure and simple.
September 3, 2009 9:44 AM | Reply | Permalink
"Any sort of mandate that leaves the insurance industry in the hands of the private insurer is a subsidy, pure and simple."
Right on--and it is immoral besides!
September 4, 2009 12:39 PM | Reply | Permalink
Defeatist drivel.
September 3, 2009 9:49 AM | Reply | Permalink
I’ve taken excerpts of quotes from an early organizer for workers rights, who in his day, recognized the corruption of the Parties.
http://en.wikiquote.org/wiki/Eugene_V._Debs
“The very moment a workingman begins to do his own thinking he understands the paramount issue, parts company with the capitalist politician and falls in line with his own class on the political battlefield.”
WHAT? Did you expect a Capitalist Politician lackey, who derives his financial gain from the likes of insurance Companies to fight for the people, if it should cost his benefactor money?
“Deny it as may the cunning capitalists who are clear-sighted enough to perceive it, or ignore it as may the torpid workers who are too blind and unthinking to see it, the struggle in which we are engaged today is a class struggle, and as the toiling millions come to see and understand it and rally to the political standard of their class, they will drive all capitalist parties of whatever name into the same party, and the class struggle will then be so clearly revealed that the hosts of labor will find their true place in the conflict and strike the united and decisive blow that will destroy slavery and achieve their full and final emancipation.”
WHEN WILL THE WORKING CLASS DO THIS?
“, they will drive all capitalist parties of whatever name into the same party, and the class struggle will then be so clearly revealed that the hosts of labor will find their true place in the conflict….Ignorance alone stands in the way …… The capitalist parties understand this and use their resources to prevent the workers from seeing the light.
WHO CONTROLS THE NEWS, WHO CONTROLS THE PRESS, WHO PURPOSELY KEEPS YOU BLINDED
Who made sure third party candidates are not heard? Destroying Ross, Ron, and Dennis; viable candidates all, but not liked by the Capitalists.
“The Republican and Democratic parties are alike capitalist parties — differing only in being committed to different sets of capitalist interests — they have the same principles under varying colors, are equally corrupt and are one in their subservience to capital and their hostility to labor…..The Republican and Democratic parties, or, to be more exact, the Republican-Democratic party, represent the capitalist class in the class struggle. They are the political wings of the capitalist system and
such differences as arise between them relate to SPOILS and not to principles.
WHAT SPOILS? INSURANCE LOBBY MONEY?
NO PRINCIPALS
Do you really think the Capitalist will allow a Reconcilaition Bill, that limits their ability to make money?
Now is not the time to capitulate, or to compromise. YOU’VE PISSED US OFF, SHOULD BE THE RALLYING CRY. Not; can’t we just all, get along.
No we can’t get along, if your intent is to enslave me.
The choice is theirs, Do the right thing or face the prospect of WE THE PEOPLE, REIGNING IN THE ABUSES. THE AMERICAN WAY
Would they prefer another rewrite of the Declaration of Independence?
WE THE PEOPLE, ARE SICK OF THE GREED AND IT’S INFLUENCE
If your idea of compromise is what I think you mean; No I will not bend. Over; .In hopes tomorrow will be better.
Whats wrong wih fixing the problem today, before it gets worse? Fixing the problem today would avert an untimely reexamination of What and whose interest are served by our Government, that derives it's power from the people.
I suppose they’ll throw another RED ALERT. That usually chills dissent. Keeping the satus quo in Power.
Maybe Bernanke can tell the President and Congress, a thing or two about worker discontent during the Depression.
Unless you think we better compromise with the opponent, because WE THE PEOPLE have already lost?
September 3, 2009 2:21 PM | Reply | Permalink
Looks like someone got her marching orders. Theda Skocpol in June:
http://tpmcafe.talkingpointsmemo.com/2009/06/24/robust_health_care_reform_is_the_moment_of_truth_f/
And now you post this? Wow. If David Axelrod is going to grace TPM with his talking points, he should at least have the decency to do so under his own name.
September 3, 2009 2:25 PM | Reply | Permalink
Nice Dijamo. This struck me too.
September 3, 2009 2:38 PM | Reply | Permalink
“And those of us who wrote big checks last time will tell the Democrats -- especially in the Senate -- to hold pharmaceutical fundraisers instead.”
They don’t give a crap; they know there are too many stupid people out there.
They’ll come out and tell the electorate, you’ve got a choice, either you vote for a Capitalist Republican or you can vote for a Capitalist Democrat. The Capitalists would prefer a Republican, but if the groundswell is against Big Business interest, they’ll still have their man in place, to protect their self-interest. Someone to delay and pretend to fight.
Then someone like the Woman’s League of Voters will have a Dog and Pony show, putting up 5 or 6 Capitalist Candidates, shutting out any other party.
Same old, same old. Tactic.
Like a salesman and the sucker; Wave a flag and ask would you like that in Red or Blue, either way you’re buying his junk. Eventually some one named Adolph or Joseph S. will take the reigns, because the people, sick and tired of the same old tactics, will get angry enough, to throw all the bums out.
Oh I forgot, the Electoral College put in place by the Capitalist Class; along with their buddies at the Federal Reserve, will keep America safe for the Capitalist Class. Never to have a populist candidate to serve the working class, the Capitalist class will never permit it.
Gripe, to much about clean air and water and they’ll continue to move their operations oversees. To much cost in healthcare and they’ll hire foreigners. Then ship the crap back to the US, where the stupid working class worker buys cheap goods, never realizing they’ve cut their own throats.
Go after NAFTA and the other trade policies, then lets talk about compromising.
No more wars, for someone else’s coveting of other Nations resources, should start to interfere with Capitalist designs.
If the Capitalist class wants to whine about costs, then transfer the money from defense spending towards Social needs and then lets talk about compromising.
Where it hurts the most, is when it gets the attention.
September 3, 2009 4:49 PM | Reply | Permalink
Great catch Dijamo! My digital hat is off to you!
You're right on in noticing that they're now backpedaling to try and get us all to come along. Well, I ain't goin and I urge everyone else with an ounce of self respect and courage to join in tell them to go fuck themselves. Cheney did it and now they're bending over backwards to kiss his ass! It's worth a try!
September 3, 2009 10:02 PM | Reply | Permalink
Do NOT cross Dijamo.
September 4, 2009 10:17 PM | Reply | Permalink
"It might evolve in better than usual directions, because the idea here, going forward, is to DIVIDE THE ELITES, to get business and government interested in cost containment after all Americans are somehow included, so that private insurance companies can be reined in."
- So this is the best you have to offer? Regulation without a Public Option MIGHT evolve in a positive direction? And the reasoning seems to be:
1. We subsidize private insurance for all
2. Costs go through the roof
3. Businesses decide to stop demanding subsidies (???) and government ceases to be corrupt and stops providing it (???),
4. Everyone decides to push for cost-cutting instead of corporate subsidy.
There is an 'underpants gnome' kind of thinking going on here.
Theda, you or whoever is writing these talking points really needs to start giving a plausible explanation of
(a) how government regulatory agencies, which get captured by the industries they are regulating IN EVERY SIGNIFICANT MARKET, won't get captured this time
(b) why, with a public option, no one really needs to worry too much about regulation, because as long as the PO offers a better (i.e. more transparent, reliable and cheaper) product wo't force the private competitors to do the same out of self-preservation.
September 3, 2009 2:57 PM | Reply | Permalink
Thanks for calling this crap what it is...corporate crap.
September 3, 2009 5:57 PM | Reply | Permalink
Theda's the Goddess!
September 3, 2009 3:48 PM | Reply | Permalink
Some questions I am left with as a result of excellent points made in this thread:
1. Do any of the versions of the bill now in play in Congress have a public option which is robust?
How, exactly, to tell? Obviously, the strength, viability and effectiveness of a public option depends upon how the entire proposed reform would work in practice, not just on the language specifically laying out the public option.
2. In evaluating whether or not a public option is absolutely essential, I am forced to try to think concretely. For the hypothetical families of four with combined family income of, say, $15,000, $25,000, $35,000, and $45,000, what is the difference in total out-of-pocket costs they pay under a version Theda would say is worth fighting for that lacks a public option, versus what they would pay with a good public option?
This would include premiums, the tax side of the equation, copays and deductibles, and maybe other costs as well.
These are the working poor and working near-poor bluebell remains focused on like the proverbial laser beam. How they would fare is one of the principle criteria I use in trying to assess what are acceptable versus unacceptable alternatives.
If I don't know how different alternatives under discussion would affect people in these kinds of circumstances, I can't come to any sensible conclusions on where I think the lines should be drawn. The debate at that point becomes more about symbols than reality. And from there it quickly degenerates into just another version of the who-has-cajones versus who is the extremist, in-love-with death ideologue discussion which I find unhelpful, not to mention dull.
September 3, 2009 7:02 PM | Reply | Permalink
"Rather than remain fixated on one mechanism -- the "public option," make or break -- progressives need to be clear about principles for weighing trade-offs and compromises."
If only the energy waged on behalf of the public option was devoted to talking up the principles at stake, we might actually get through to people.
whp
September 4, 2009 1:28 PM | Reply | Permalink
I get what you and people like Paul Starr, Ezra Klein, Uwe Reinhard, etc. are saying. A bad public option is not worth the hassle, and a strongly regulated private insurance market COULD be better (a la the “Dutch option”). But as “K-town” above points out, that set of strong regulations is at least as unlikely (if not more so) as a strong public option. Moreover, the Dutch option has three additional disadvantages when played out in this country: first, it is more complicated than the public option, second it invites regulatory capture, and third it has no immediate progressive constituency in back of it. The advantage of a public option is that is easily understood (it’s kind of like Medicare) as opposed to your suggested regulations (it’s kind of like Holland?), over the long haul it resists capture by the industries being regulated because it has a point of leverage/comparison which IS efficient (again Medicare), and, most importantly, it has a significant number of progressives who support it right now. In your list of the advantages of the Hacker plan you leave out one that is very important: it could evolve into a single payer system. This is what scares the right, but it is also what mobilizes the left. The problem with your approach, as intelligent as it maybe, is that it turns off most progressives (see for example the long list of previous comments on this blog), and we need them enthusiastic and active. By keeping a public option in the mix, possibly with a phase in proposal to satisfy Senator Snowe, we keep the left mobilized. In the immortal words of a previous Secretary of Defense, we don’t go to war with the army we want, we go to war with the army we’ve got. We need to keep our little army of progressives mobilized now and in the future to get any decent kind of change. Going Dutch doesn’t do it.
September 6, 2009 12:36 PM | Reply | Permalink