« Sex, Oil, and Misogyny: McCain at Buffalo Chip | madvilletimes's Blog | Caroline Kennedy -- Best NY Can Do? »
Memo to Daschle: Public Single-Payer Is Health Insurance Done Right
What do my wife and I do on New Year's Eve? Think up e-mails on the
need for universal health coverage to send to our fellow South Dakotan Tom Daschle and the Obama
Administration. Here's a message I submitted this morning through Change.gov. Mr. Daschle, pay attention!
To Secretary-Nominee Tom Daschle:
A friend of ours told us about the hard times her sister and brother-in-law have hit. She is recovering from breast cancer and still undergoing some treatments. Her husband just received a heart transplant Christmas Eve. He has lost his job, because, of course, he missed a lot of work. He has thus also lost his health insurance. Chances of finding an affordable policy that won't exclude either him or his wife are slim to none. His employer-based health plan covered the transplant, but how they'll pay for the follow-up medicines and treatments is anyone's guess.
It occurred to us that if insurance worked the way it was supposed to--a bunch of us pool our money to take care of the few of us each year who will need health care, in return for the promise that if something bad happens to us, we'll be covered--these folks wouldn't have to worry. If they were in my insurance pool, I'd never deny them coverage. I'd say, "You can't work right now? No problem, neighbor. Come in the pool, we'll cover you, and then when you and your wife are better and can contribute to the pool, we'll expect you to help us if we're in a bind."
Why can't we do that? Because we, the insurance purchasers who provide private insurance companies with their capital, aren't the real stakeholders. Private investors buy stocks in health insurance companies, creating a distinct and conflicting interest group. We join the insurance pool for it to function; private investors buy stock in hopes that it won't function (i.e., won't pay out for health care).
I want my health care dollars to go toward health care, toward helping my neighbors, not toward profit. Health insurance should be one giant public pool in which every American pledges to help protect every other American (and anyone else who happens to be our guest).
Single-payer not-for-profit health care: it's decent, it's practical, and it's how insurance is supposed to work.
As we see from the case of of the couple paying bills for breast cancer and a heart transplant, it doesn't make sense to tie health insurance to jobs. You don't deserve health care because you are a good employee. You deserve health care because you are human.
Similar conversation about both the morality and practicality of universal health coverage was on MPR's Midmorning with Kerri Miller yesterday. Give it a listen, then get hold of Tom Daschle yourself and tell him to do health care reform right.
Advertisement
"I want my health care dollars to go toward health care" Bingo.
January 1, 2009 11:50 PM | Reply | Permalink
There is only on reason to have a business, for profit. Having someone pretend they are in business for my personal health is absurd.
If the US automakers were not responsible for healthcare, would they be more competitive. Ubetcha!!! Even Sarah palin knows that!
January 2, 2009 12:10 AM | Reply | Permalink
Exactly. And the Health Insurance companies provide absolutely no service for their money. They are gatekeepers and depend on insuring as few sick people as they can get away with to make their profits.
Therefore, it is a "business" that is only in business to make money without providing any service. Therefore they should be eliminated and thrown on the scapheap of bad ideas. Good riddance!
If you can tell me how they earn one penny of what they rake in, I'm all ears.
January 2, 2009 12:24 PM | Reply | Permalink
Doesn't this relate to the "Money " post below? Why are we paying bankers to use our own money? Why do we need bankers? Usury used to be a sin. All major religions condemned it. Shouldn't making a profit on disease be condemned too? I remember when you paid the doctor for his time when he came to the house to give you a dose of medicine. In the older days, you gave him a chicken and some eggs. It was an even exchange. In the Great Depression people exchanged work hours for stuff. You had something like Feral Cat hours. You exchanged it for a haircut or something.
Is everything a lot more basic than we think?
Anyway we should all sit down with our neighbors and dictate letters and send them to Daschle. Being from Montana, my neighbors and I will send them to Baucus with a note saying how glad we are that our county finally voted for him. We were one of only two counties in Montana that did not vote for him six years ago. Maybe that will have some sway. It's worth a shot.
January 2, 2009 8:56 PM | Reply | Permalink
If only it were simple.
There is no such thing as single payer, every taxpayer or contributor to the pool, would be a different payer with different interests and values. The term Single Payer is a handy fiction for "Government Pays". Let's stop lying. I don't want to pay for your elective surgery, and you might argue that it's not elective. Without common values and interests, there is no "single" in the pool notion.
To change the real status quo, it helps to know the status quo for what it really is. Fixing the wrong problem is like going in for a flu shot and getting a smallpox inoculation, and sometimes vice-versa; both can be deadly but both are incompetent if not criminal.
It's clear that massive "competition" in the health care "insurance" industry has not been all that effective at keeping costs down. Single Payer proponents say that excess costs of 25-40% or so compare to overhead of some programs running at around 5%. Let's accept that.
If a dictator suddenly took over the US and by fiat got rid of the health care "insurance" industry in favor of Government Payer, how many jobs would be lost? How many revenue streams would be destroyed? How many Government or other jobs would be created? How would the new revenue stream look?
Other than by such gross fiat, how to change the status quo both effectively and with optimization for ?
Another problem: Health care is just damn expensive. Messing with the "insurance" industry isn't going to change the fundamentals even if it frees up some formerly "wasted" revenue streams by stealing wages and jobs from the industry. Any reform needs to look at fundamentals too.
January 2, 2009 2:09 AM | Reply | Permalink
Part of a sentence got lost near the end:
"Other than by such gross fiat, how to change the status quo both effectively and with optimization for important values and minimal disruption?"
January 2, 2009 2:20 AM | Reply | Permalink
The only possible answer is: by everyone, with decisions made by some sort of medical board answerable (probably indirectly) to voters. The process will inevitably be politicized, in the same way that supposedly-independent groups and individuals (such as justice appointments or the chairman of the Federal Reserve) are politicized. But those systems do work, however sputteringly. This one will, too.
January 2, 2009 6:10 AM | Reply | Permalink
I would hope it will work, but I'm quite skeptical.
January 2, 2009 4:11 PM | Reply | Permalink
We can't afford to not change the current health care paradigm in the US to single payer for both financial and moral reasons.
January 2, 2009 7:24 AM | Reply | Permalink
Great job, miguelitoh2o. You pretty much disassembled that argument point for point, and leave little doubt that single payer makes as much sense as it seems. Keep it up, and we'll get this job done.
January 2, 2009 9:46 AM | Reply | Permalink
Amen. To the post. And to miguelito. And SJ too.
January 2, 2009 10:58 AM | Reply | Permalink
Slice and dice seldom adds up well.
m -"We can't afford to not change the current health care paradigm in the US to single payer for both financial and moral reasons."
I understand that is your bias. But it's one thing to say that we need to change the current paradigm (I'm fine with that), and another thing to insist on a particular falsely labeled method (single payer) as the only option. It would also help to know the specific reasons you have. Comparing health care to the GM problem is silly, unless you merely meant to agree that the GM problem at a few tens of billions is much smaller than health care at many hundreds of billions.
m - "... You may disagree with what constitutes 'elective' but a set of guidelines/impartial medical review board will determine the eligibility for medical procedures."
Like HMOs have "guidelines" now? That's not an improvement, it's excess uniformity where some diversity is needed. It's government bureaucracy getting in the way of patient-doctor decisions. The point again is that the situation is not as simple as some want it to be.
m - "An electoral concensus on this as opposed to the common values and interests, (profit motive), of the insurers/pharmas we currently live with would be a great improvement."
There will never be a consensus. There might not even be a majority vote by the electorate. I'm not arguing in favor of "insurance" profits, I'm arguing for sanity in change.
m - "There has been no incentive to contain costs in our privatized health care system, where the insurers costs are simply passed on to the consumer after at most a cursory review by a public insurance regulatory commission."
That is not true as stated, but maybe we agree that the "free market" competition notion supposedly in place now doesn't seem to be holding down "insurance" costs. The question is - what to do about it?
I'm generally opposed to demonizing in serious discussion (blaming pharma et al). When I see it, I have to ask if you're serious or kidding around! But thanks for the reply.
January 2, 2009 4:36 PM | Reply | Permalink
Slice and dice works for me so I don't have to paraphrase your comments.
I should have a post up within 24 hours that addresses your concerns.
January 2, 2009 5:44 PM | Reply | Permalink
Please to not slice and dice any peegalitos.
I get kinda squeamish.
January 2, 2009 7:56 PM | Reply | Permalink
Despite any difficulties inherent with fixing the health care system in this country, we are far past the time that the status quo is sustainable. In fact, health insurance companies have just about wrecked what was once the finest medical system in the world.
Medicare for All is the best solution simply due to economies of scale, but even a plan that is privately managed such as the congressional plan and offered to all 300 million plus will keep costs low for everyone involved. We save even more money over the long run as we begin to focus on disease prevention instead of disease management.
Health insurance companies, competing against a public plan that is much more affordable and sustainable, will either find a new line of business or go out of business.
January 2, 2009 9:38 AM | Reply | Permalink
"No such thing as single payer"? Don't you think I know that single-payer would be paid for by my taxes (and yours, etc.)? I'm all for that. Right now I pay $2700 a year for crummy coverage from the individual market. I'd rather see Obama raise my taxes $2700 (our 2008 income: $42K) and provide my family (and yours, etc.) with reliable health coverage no calamity or twist of genetics will take away.
January 2, 2009 4:38 PM | Reply | Permalink
You agree that "Single Payer" is a misnomer. Wouldn't you be happier if your health care costs were cut by 30%, so that you could buy better coverage in a well-functioning open market?
January 2, 2009 4:55 PM | Reply | Permalink
Health care markets aren't well functioning. If they were the best and brightest wouldn't be choosing dermatology while there are shortages of primary care physicians, pediatricians, and ER's. The market rewards the doc giving the botox injection not the doc saving your kid's life.
January 2, 2009 5:45 PM | Reply | Permalink
Well, health care as we are discussing it here is not the be-all or end-all. So, noting that some bright people choose to work in another field is a bit odd. If there is money in another field, and demand for the services, what's the problem? That's not a sign of the health care system (or non-system) not being well functioning.
I'm not saying "insurance" is functioning optimally.
January 3, 2009 6:22 AM | Reply | Permalink
I have thought about this issue for forty years.
Single payer is the only way to go. Too many programs attempting to attach a problem to too many programs.
January 2, 2009 2:31 AM | Reply | Permalink
I am losing hope that the Obama team will even try to do "anything" right, instead go for lowest common denominator to keep everyone happy. That is a course that will prove self-destructive if taken.
January 2, 2009 8:25 AM | Reply | Permalink
Have you read his plan? He hasn't changed his tune one single bit, so if you like Obama's plan during the campaign then you'll like the plan that comes out of his efforts as president.
I think it is a great first step that will fix many of the problems mentioned in this post (unaffordable insurance without an employer, preexisting conditions exclusions, lack of information technology advances, etc.) while avoiding a direct fight that won't advance our common goals.
Congress will be responsible, ultimately, for the bill comes to Barack's desk for signing, so any lack of progress on this issue will land squarely at their feet. I am sure Obama would sign Mecidare for All if Congressional democrats could get that sort of bill through Congress.
January 2, 2009 9:21 AM | Reply | Permalink
Mr. Miller, I think our difference is policy. You seem to like the center. Good for you. But I disagree with your politics.I know Obama hasn't changed on some matters where I always thought he was too cautious and wrong for the times. The times are changing rapidly. What was promising even two months ago is not as promising now that more radical steps are needed.
Here is what Josh said earlier today:
"Thinking Too Small?
Noam Scheiber asks whether, in an effort to attract substantial Republican support, Obama is aiming for too low a dollar amount ($675-$775 billion over 24 months) in his upcoming fiscal stimulus package.
I'm torn on this. As Noam points out, that looks to be a starting point at the low end of what most economists think is necessary, leaving treacherously little safe room to negotiate down. And everything about our recent history and current predicament tells me we have to be bold and aggressive, on policy and politics. But I've always had a weakness for One Nation politics; so I'm not willing to discount the possibility that Obama reshuffle the deck politically, operate under a different calculus."
If you want to applaud everything Obama does, as long as he does not go against what he said earlier, go ahead. That is not how I see things.
January 2, 2009 11:47 AM | Reply | Permalink
I laugh when I read articles about Obama aiming too low. I don't believe for one second that that is the final figure nor the actual figure. The bailout was supposed to be $750B and look at what happened there. Obama's been saying over and over that things will get worse - once they get worse that amount will get higher. Besides, when has anything the gov't done cost exactly what they said it would?
January 2, 2009 5:44 PM | Reply | Permalink
Once they get worse it may well be too late.
January 3, 2009 11:39 AM | Reply | Permalink
I simply cited his plan as being one that is likely to get passed. I don't think any single solution is the "right" one independent of execution and acceptance, so it is difficult to say where the center lies.
It's not until we implement a solution that we can actually judge whether it was the right one or not. "Medicare for All" is just as likely to fail as transitioning our current system to something more like Germany or Japan with a mixture of public and private health care dollars being spent. There are a lot of smart people who have offered many plans, each basically the same as the other in getting universal access to health care.
No country has yet to design a system that is perfect in all respects or one they don't have to run at a huge loss, so simply shouting "Single Payer!" and calling me a centrist for not agreeing isn't thinking the problem through.
January 2, 2009 6:39 PM | Reply | Permalink
PS: All we can really judge him on is what he promised to do and how. As long as he is doing his level best to deliver that agenda, then I will have mostly applause for him and not quibble too hard over tactics.
I understand that the left tends to complain about stuff just for the sake of offering a critique. Seems a waste of time and energy to me that could better spent actually achieving Obama's progressive center agenda, which is way better than getting nothing by trying to swing the country harder left than it's ready for and thus polarizing it further.
Mostly we are talking semantics, but by all means, please feel free to tilt at windmills and I will feel free to call you idealistically naive.
Thus it ever is around this place.
January 2, 2009 6:47 PM | Reply | Permalink
This is probably true, and depressing, but we are so far seeing them at least offer lip service to the idea that input is needed and welcomed. We need to provide the push from the bottom up.
Call your representatives and senators.
Use change.gov and change.org
Keep writing, here, and elsewhere (does anyone know of a conservative site which has blogs such as these on TPM and those on Daily Kos?).....
January 2, 2009 11:06 AM | Reply | Permalink
I agree with the single payer solution and I don't really care if 'single payer' is secret code for 'Government Pays' or not. I need health coverage and I need it to be portable. I need to know it's gonna be there if I have to move to find work. Why should health insurance be awarded only to those who can afford it and healthy enough not to need it?
And, I wouldn't even expect tax dollars spent on universal health coverage to pay for my boob job anyway. The elective surgery conundrum is just roar in the ears.
A while back, Donna Shalala was interviewed and asked for her input on health coverage reform. She suggested letting individual states sort of 'try out' the various methods of providing health coverage in order to make an intelligent decision as to which coverage would provide the best results nationally.
Since she was Clinton's Sec. of Health and Human Services, I would reckon that Obama has given ear to her comments. As I recall , she wasn't too enthused about universal health coverage way back then, but perhaps she has changed her mind. Her comments lead me to believe she has.
Personally, I don't believe the health insurance issue will be lost in the shuffle when Obama takes office. I really believe it's an integral part of the economic solution, which is the foremost concern as things stand at this moment.
Also, why can't we look at the solutions other countries have come up with? Do we really have to reinvent the wheel here?
January 2, 2009 10:07 AM | Reply | Permalink
A related letter, which I wrote, was published in the NYT on December 22 (see below).
On Wednesday, before New Year's Eve, I met in my office with 17 participants discussing health care reform as part of the incoming administration's "Health Care Discusssions" program. The conclusion: Single Payer is the only way..
To the Editor:
Necessary Medicine? (December 14, 2008)
Re “Necessary Medicine?” (Week in Review, Dec. 14):
The problem with President-elect Barack Obama’s supposed emphasis on the costs of health care is that his proposals fail to deal with the biggest source of wasteful expenditures, our dependence upon private health insurance.
Mr. Obama’s plans, by continuing to embrace a role for private health insurance in our system, wed us to the waste, profiteering and venality of an industry that exists only to take our money and spend as little of it as possible on the objective.
The private insurance industry seeks to increase the proportion of its revenue reserved for profits by spending as little as possible on health care, instead directing its expenditures to marketing, underwriting, “product development” and executive compensation.
I’d prefer my health care dollars to be spent — surprise! — on health care. Only a move toward “Medicare for all” can do that.
Aaron M. Roland
San Francisco, Dec.
14, 2008
The writer is a practicing family physician and clinical associate professor of medicine at the University of California San Francisco.
January 2, 2009 11:01 AM | Reply | Permalink
We spend more per capita on health care than England, France, Germany, Switzerland, Canada, and Australia. They all have some form of universal health care. Their medications are cheaper. Oh! And we are below all of them in longevity and quality of care.
I don't hear people wanting to opt out of the Fire Department's services, or the Police Dept; both of which are paid for by taxes -- only a few Scrooges who don't have young kids want to hold back taxes that are used to fund schools. Why is health care such a boogy-man?
One reason is that Congress has a wonderful, gold-plated insurance policy that they would probably have to forfeit if we truly went to single-payer. Think about it. Why else has this stayed an unsolvable problem for so long with the whole rest of the world beating us in this field?
Well, that, and the fact that many campaigns are funded by the very insurance companies and big pharma that have so much to lose if our citizens are allowed to win.
January 2, 2009 12:36 PM | Reply | Permalink
Bingo! And the insurers have the most to lose.
They are, in reality, not in the business of providing "coverage" for anything. That is what they consider an unavoidable part of the cost of doing business.
That business is the generation of investment capital. Since their portfolios - much like everyone's - are not doing so well lately, look for significant rate increases coming soon to a policy near you.
January 2, 2009 7:06 PM | Reply | Permalink
Single payer is the only way to escape the stranglehold the insurance companies and big pharma/big medicine have on the entire economy let alone every American family.
Those who favor the current system of theft and denial of services claimt that competition is the key to keeping costs down. Great! Let's set up a not-for-profit, government run, single payer program that everyone belongs to and let those fuckers compete with it. Whadya say? I hope this is what Obama comes out of the blocks with but we all know it won't be. And more's the pity.
January 2, 2009 6:38 PM | Reply | Permalink
This is something Congress would have to do. Obama can't just sign an executive order and create a huge non-profit single payer health insurer.
Given the dynamics at play, if he can get some of the existing programs expanded and get costs down to make the numbers work on a publicly-funded single-payer plan, that is moving in the right direction and could lead to Medicare for All.
Having said that, I am sure he wouldn't veto Medicare for All if it hit his desk. We need to start holding the right people accountable for this stuff.
January 2, 2009 6:56 PM | Reply | Permalink
Jason, I agree. I want a single payer system for a hundred reasons. But I will take any progress right now. You are right that the President is not always THE DECIDER.
January 2, 2009 7:32 PM | Reply | Permalink
If the new President doesn't back it, it certainly won't happen with or without Congress. Right now, the critical person in the healthcare debate is the new President because he will set the agenda which establishes the parameters for debate. This most certainly makes him "the decider" on the crucial matter of what is and is not in play. If Obama compromises in advance and doesn't press for single payer we have no hope of any meaningful progress at all on health care for all in this country. Given his very health-insurer friendly campaign position on health care there is little prospect he will do the right thing here. This is all the more unfortunate because right now is precisely the moment in history that favors pushing single payer through.
January 3, 2009 2:36 AM | Reply | Permalink
This is just not historically accurate. If so, we would have had health care in 1993. The president is never the decider unless what you want is a repeat of the last 30+ years.
To design and develop a system that is going to account for all the moving parts of our economy as well as our short-term and long-term needs, Obama and this new Congress is going to have to juggle chainsaws and cut an ice sculpture at the same time to achieve many of his very progressive goals.
Even FDR didn't make the New Deal happen in a vacuum and by proclamation.
January 3, 2009 10:17 AM | Reply | Permalink
You really don't get it.
January 3, 2009 11:38 AM | Reply | Permalink
Yes, that is much more likely than the inverse being true.
January 3, 2009 4:12 PM | Reply | Permalink
PS: Barack's campaign promise on health care reform was Reality Friendly not Health Insurance Friendly. That is merely coincidental as we have an existing system that needs to be dismantled or transformed that at least includes insurance companies at the beginning of that conversation.
Obama understands it will take most of his first term to clean up the federal budget, end the war and replace recalcitrant members of Congress with democrats and republicans to really achieve a sustainable system. He has a huge task ahead that won't be accomplished using traditional liberal methods of putting forth "All or Nothing" proposals.
I respect your ideals and agree with most of the goals, I just don't think you are really accounting for complexities and subtleties involved in our country.
January 3, 2009 10:52 AM | Reply | Permalink
These are the excuses of a typical capitulationist Democrat: concede your position first and call it "realism". That's a posture that has failed repeatedly, yet you and many other Democrats insist on trying it over and over and over. I'm sick of failing in advance to do anything meaningful on health care and other issues. Such advance concessions are a sign of political weakness and a total lack of courage, not realism or pragmatism.
How to guarantee failure: surrender before the battle is joined.
January 3, 2009 11:36 AM | Reply | Permalink
Point to a single lasting progressive accomplishment in more than 40 years of screaming bloody murder about the issues we should all care about. Mass transit, national health care, living wage, conservative and preservation of our natural resources? None of those very worthy goals have been advanced one iota while remaining in the hands of zealots.
That's why we elected Obama and not Kucinich.
Perhaps I missed the point where we became country that a just cause convinces a majority of Americans to pester their representatives to get it done? Did I miss Dennis Kucinich and Russ Feingold and Barney Frank accomplishing all their goals with their incendiary methods?
Just because the DLC wasn't able to accomplish anything progressive doesn't make Barack's agenda synonymous with theirs. Hiring them to fix the things they broke and to accomplish the goals they abandoned in the 90s may be part of his strategy, but they will work on Obama's agenda. His goals and methods haven't changed no matter how much you imply the opposite.
Barack is just following a different script than trying to shove everything down the country's throat all at once as you and many "liberals" would have him do, a tactic that is rarely successful and never sustainable.
In case you missed it, I am not a democrat. I am a realist and a pragmatist and a progressive but certainly not a democrat.
January 3, 2009 4:11 PM | Reply | Permalink
Dennis Kucinich? Russ Feingold? Barney Frank? All with incendiary methods?
You overreach, as usual jason, in your attempt to square a circle in this game of "reinventing" political reality.
And a single accomplishment by the progressives that was achieved by those who "scream bloody murder?" You actually listed some of them.
The environmental movement, for example, would be pretty pathetic were it not for Gaylord Nelson and the activists pushing along with him. Left to you, I reckon Rachel Carson would have been discounted as an ideologue who would have been told that she should be satisfied to gain promise of a study on DDT and perhaps incremental reductions in its application, but only if that was deemed necessary by consensus.
It is interesting to note that Nelson was a Senator from Wisconsin in much the same mold as that rabble-rousing Feingold. He was in fact much more of an activist than Feingold, mainly due to the fact that he served in a period where progressive activism was practiced among our leaders. Please point out to me who among your DLC-types have accomplished more for the environment than Nelson? In fact, who among any other leaders we've had in the last 40 years?
This nonsense grows wearisome. Somehow, we are encouraged to believe that activism is totally ineffectual; that the DLC-type of "go-along-to-get-along, carry your hat in your hand and someone will surely notice you standing there" kind of milquetoast political "action" will somehow advance progressive causes. And it's incredible to believe that we are to simply know for a fact that this is somehow productive - all just because jason says so with such keen assurances backed up with no data and no examples.
As for examples, I list here just a few more advancements that were gained from political activists despite those who cautioned them to "be patient," and too often right up to and including blood running in our streets:
1.) FDA regulations
2.) OSHA regulations
3.) Child labor laws
4.) Right to Collective Bargaining
5.) Civil Rights (And quit trying to insist that somehow these would simply have "evolved" out of the wisdom and largesse of our White Congress. That is incredibly insulting to those who sacrificed their very lives in this struggle.)
6.) 40 hour work week
7.) etc......
Finally, I'd suggest you be a little more circumspect in making charges about intellectual dishonesty. I see little in this goofy construct of "ideology vs. pragmatism," after all, that comports with anything in the real world. Think about it. What is pragmatism without ideology but a rudderless ship. Your effort to somehow declare each as separate from the other finds your intellectual "experiment" to be foundering on the rocks.
Meanwhile, I suggest you keep your eyes peeled as you stand in the middle of the road lest you get run over by that "DLC Special" speeding its way from NAFTA to CAFTA and free trade with Columbia. THAT is the type of deal you get when you simply stand with your hand out inviting everyone to join with you in a resounding rendition of kumbaya.
January 3, 2009 5:29 PM | Reply | Permalink
Gotta say I think Jason's rhetoric there fit very nicely into what he was dealt by the other poster.
January 3, 2009 7:01 PM | Reply | Permalink
No argument here! I would agree that one should feel free to respond in the same manner to which he is addressed.
My caution, however, is to be careful in the specifics to avoid becoming the pot calling the kettle "Black."
January 3, 2009 7:42 PM | Reply | Permalink
All of that was done generations ago. I said name one thing in the last 40 years. I can name SCHIP, but that is flawed and underfunded. Like most of the other lip service "accomplishments" the left has made on some very important items.
Yes, Kucinich and Beingold and Frank use incendiary methods else that would have been more successful. Obama, on the other hand, uses conciliatory methods, which is why he will actually get something done while the best the three I picked as representative of the far left continue to spin their wheels.
This is why we can't disuccs shit like rational adults int his country because the littlest criticism for anything "liberal" brings out the slings and arrows from the culture warriors who can't stand the idea that all their great ideas haven't moved a fucking inch on more than four decades.
Take a look in the mirror, SJ, to see one reason why the democrats haven't been more successful in all that time.
January 4, 2009 8:22 AM | Reply | Permalink
Gaylord Nelson, Senator from Wisconsin 88th- 96th Congresses (1963-1981) Democrat.
2008 minus 1963 = 45 years
2008 minus 1981 = 27 years
First Earth Day - April 22, 1970
2008 minus 1970 = 38 years.
As you see above, the example I chose does indeed fall within the "last 40 years" timeframe you enumerated.
I, of course, expected a response to this that would challenge reality with a misstatement that somehow the facts are bogus - rather than addressing the actual point of the example.
As to the other accomplishments, I insist that these were in fact accomplished precisely because we had activist legislators with sufficient integity to go to the mat in a fight for what they deemed to be right rather than always seeking to do what is politically expedient. Politically and strategically smart? Yes. But there was a time when leaders stood on principles, even recognizing in fact that we are endowed with certain inalienable rights that are sacred and not to be undermined; that there are principles that exist outside the give and take of political compromise that is often otherwise necessary.
An example? My guess is that if there were more Kucinichs, Feingolds, and Franks and Gaylord Nelsons and LBJs and JFKs and Saltonstalls, and Proxmires, etc., in the Congress instead of the milquetoast "pragmatists" we have had these last 40 years, we would not now be in Iraq and we would not EVER have even considered approving the terms of the Patriot Act.
Those two items alone (and there are so many other examples, unfortunately) recommend against the type of pragmatic "go-along-to-get-along" DLC-style BS that you promote.
And it is incredible that you should cite MLK, Ghandi, and Mandela as examples that would be equivalent to Clinton, Reid, Pelosi and the rest of the pandering "pragmatists" who sat on their hands as our Constitution was placed under assault. To even pretend that any one of these "non-ideologues" would have sanctioned the Patriot Act or this illegal war, or would have simply looked the other way as criminals in the Executive trashed human rights and our Constitution is a keen indication of just how bankrupt is your experiment in realigning political realities.
Please offer for me an example when anyone in Congress has recently "used reason and logic and persistence to change hearts and minds, which enabled change to be made." I suggest instead that we have a cesspool full of cowardly pragmatists who are more concerned about serving their campaign-contributing constituencies and winning that next election, regardless of how much they must compromise their soul in the process.
I have faith in Obama to be an able player in the political arena until proven otherwise. But he will not know success by failing to make substantial stands on principles in a hope that he will gain consensus and keep from alienating the opposition.
I honestly could give a rat's ass what Boehner and Mitchell and the rest of the Bush promoters think about the direction this country needs to go. I hope Obama leaves them at the station if need be as he actually assumes his role as an actual LEADER (What a concept!)and takes this country in a new direcion that is more closely aligned with the proud, progressive traditions that have so well-served this country in the past.
January 4, 2009 2:00 PM | Reply | Permalink
Whatever, SJ.
You still refuse to acknowledge that nothing of note has been done since at least 1980 and was beginning to head south when Nixon was elected, even though he signed OSHA and the EPA. You are just as incapable of self-reflection as the far right.
You pretend that resting on one's laurels, whether last year or last decade or further back makes no sense if "progress" is your stated goal. You use a whole lot of words to say nothing.
January 4, 2009 5:30 PM | Reply | Permalink
It ain't self-reflection that's missing here, jason. It's a response to my specific questions that goes lacking, even after granting you the courtesy of responding to your questions (quite effectively, I might add), which you then ignore while repeating the same questions wrapped in an ad hominum attack as though they remain unanswered simply because you refuse to address my response in particulars as requested. SHEESH!
My point, jason (I don't know why I even continue to try) is that during the days when real leaders walked the floors of Congress, progressives were pleased to gain advances in progressive causes. And you are ABSOLUTELY RIGHT in asserting that since '80 the progressives have been unable to accomplish much, but in so doing you simply prove my point.
Name for me one time since 1980 - or actually 1970, if you wish - that the activist leaders were allowed anywhere near the levers of power. Instead, we have had a run of Republicans and Repub wannabes whose sole recommendation for this job is their ability to sell their soul, if need be, to gain sufficient campaign contributions to win that next election. Inasmuch as the Dem Party has attempted to serve as an opposition party, it has been to follow the Clinton DLC lead of trying to make themselves saleable as "Republican lite." And so we get NAFTA, CAFTA, and finally a Dem Congressional Caucus that is so compromised that they can't even stand together against an assault on our Constitution and our Human Rights.
Say what you will about Feingold, Kucinich, Nelson, and the rest, but I'll cast my lot with a whole Congress full of such leaders long before I'll count on more of the same such as we've experienced these last 30 years as being able to accomplish anything even remotely progressive.
In the end, jason, I've engaged you here in a sincere atempt to try understanding what, exactly, it is you are proposing as your "new" way of playing politics. Unfortunately, all I get is the same empty rhetoric about "ideologues" and "pragmatists" and "reason" and "logic" and blah, blah, blah. I therefore quit the discussion here (God Willing!)unless you care to at last respond to the questions asked of you in my previous comments in at least somewhat the same manner I have responded to yours.
January 4, 2009 7:58 PM | Reply | Permalink
You're right. The fact that nothing has happened on the progressive front since the early 1970s is the fault of the system and not the leadership who failed to follow-up on the momentum gained in the 1960s. That isn't self reflection in my mind. That is shirking responsibility.
January 4, 2009 8:42 PM | Reply | Permalink
PS: I answered your question over and over in different ways: I think sending the same people in with the same tactics will mean the same lackluster. You disagree and point to things that people did a generation ago as proof that they can things done.
January 5, 2009 6:50 AM | Reply | Permalink
PS: I suggest you look a little deeper under the surface before you claim any sort progressive movement these last 40 years. Our skies and dirtier, our water unfit to drink in many places, species dying at records rates. I could on and on.
All of this was done under democratic and republican administrations.
Blame the "DLC" types all you want (and they are guilty of many trespasses) but the far left's tactics and rhetoric are at least as responsible for not convincing more Americans that they are right. It is divisive and accusatory and seeks to lay blame before we fix anything. It also allowed a democratic president to enact all those things you tell me to be wary of.
I am willing to think the Obama found a way to co-opt the DLC and its instituational ifluence as a way to make change. You'll forgive me I don't view the traditional American left as being the best people to emulate the tactics deployed in order to accomplish a lot of very important progressive changes.
Your side's track record isn't all that good given where we started when I was born.
January 4, 2009 8:33 AM | Reply | Permalink
PPS: I have never once claimed that Civil Rights evolved out of the largess of a White Congress. That is the type of shit I am talking about right there and is a prime reason I didn't join the democrats when I decided to get off the fence.
I have said (often) the Martin Luther King Jr. and his most influential followers were not ideologues and that is why they were successful. Same with Gandhi and Mandela and all the rest. They used reason and logic and persistence to change hearts and minds, which enabled change to be made.
That is a much more complex position than all your sputtering and fuming gives credit for.
January 4, 2009 8:39 AM | Reply | Permalink
None of those worthy goals have been advanced because people like you and your political fellow travelers have stood in the way and cautioned "go slow" and supported timid centrists when you should have supported liberals. When people take your position of being "realistic" that accomplishes exactly what our enemies wish: nothing progressive, half measures that don't work, and policies that favor the rich and corporations over the average person. It is the obstinancy of your position that has blocked progress for 40 years and stood in the doorway every single time the liberal wing of the Democratic Party attempted to do something progressive. Your position of surrendering in advance is what keeps America from moving forward.
January 6, 2009 10:59 AM | Reply | Permalink
This is exactly why "progressives" haven't accomplished anything in 40 years - an All or Nothing mentality that seeks to shut down debate and frame the issue as Us vs Them. The only reason "progressives" will finally make progress over the Obama administration is because "liberals" aren't the only ones involved with advocating progressive ideas anymore. Thank God for that!
January 6, 2009 11:08 AM | Reply | Permalink
Mr. Miller,
You simply don't know what you're talking about.
On the one hand you acknowledge that few progressive aims have been met over the past 40 years (a time when progressives have been shut out of power by conservative, centrist and capitulationist Democrats like yourself). Then you blame them for the failure of progressive aims when it has been the centrists and conservatives and the surrender in advance crowd that has repeatedly failed to accomplish anything of significance. It has nothing to do with "all or nothing" it has everything to do with simply supporting the things you claim to believe in. Centrists and conservaitve Democrats always claim they are for health care for all but the truth is they are not and that is why they have consistently sabotaged any meaningful measures in this regard.
You are like the media that still shuts out liberal voices and insists on filling the airwaves with the opinions and analysis of all the people who got it wrong on the war even though they and their positions have long ago been discredited. It's nonsense.
With an ounce of courage and one complete set of balls between them, the centrists and conservative Dems could actually show some guts for once and help the real Democrats get something done. But that might be too much like actually supporting the positions you say you are for.
January 7, 2009 12:32 AM | Reply | Permalink
You don't know a thing about me, so stop lumping me in with the DLC or the RNC or whatever label you are trying to affix to positions you clearly don't grasp.
I have been an independent for years. I supported Kucinich in the primary. I am further left than most of the people on this site. I am so far ledt I joined the republican party in the interests of joining the moderates in its rabks and helping transform it for the 21st Century. To stop it from getting in the way.
The same reason I come to TPM to help Raging Left ideologues such as yourself to stop getting in the way.
It is you who doesn't understand, because you closed your eyes before you started. It was the "progressive" movement's tactics that kept them out of the center of power, not centrists or republicans or conservatives or apathetic voters or anything else. Thankfully, Barack Obama was elected and will mitigate the influence of the democratic fringe with moderate, methodical and pragmatic leadership.
Stop blaming "center" for the Raging Left's failure to connect with the American people.
January 7, 2009 7:47 AM | Reply | Permalink
Actually, oleeb, you are spot on for making the connection between all of jem's intellectual flimflam and the same ol' DLC "conservative, centrist and capitulationist" nonsense that has so ill-served us these last decades.
jem makes a whole lotta' inconsistent arguments against the "Raging Left" in selling his snake oil political medicine, which when you examine it closely is nothing more than the same old DLC bullshit that has brought us NAFTA, CAFTA, The Patriot Act, and a Congress too fearful of their responsibilities to actually consider honoring their oath to uphold and defend our Constitution during the time GWB and Cheney placed it under the most egregious assault it has experienced in my lifetime.
I make this case against jason's intellectually dishonest, yet ongoing exercise in trying to sell a discredited DLC philosophy as something that is unique and "New and improved!" in greater depth in my most recent TPM post Sweet Jeezus! A Callout to the "New Politics" as Promoted by jem. I encourage you and jason both to check it out and I welcome any discussion on its merits.
January 7, 2009 8:12 AM | Reply | Permalink
Way to make my point for me, SJ! I really don't have to say a thing as you take up the banner recently thrown to the ground by American voters, still warm from the neocon's grubby, illogical hands.
January 7, 2009 9:18 AM | Reply | Permalink
A lefty who constantly cautions moderation and centrism is no lefty at all. It isn't smart to always play one's hand in a weak manner. Sometimes one needs to stand up for what they believe and fight for it. It is the centrists who always, always, always say that is the wrong thing to do. They have been undermining every progressive idea and effort with this strategy for decades. You are a centrist in all your statements and all your posts whether you supported Kucinich or anyone else. If you don't have the courage to support your real position then you are a centrist/capitulationist advocating more of the same defeat and appeasement of the Republican right, the wealthy and the powerful. Don't blame the lack of success of the very strategy you advocate on the left.
January 7, 2009 6:27 PM | Reply | Permalink
I never claimed to be a "lefty" just to support what would be considered progressive policies in the governing of our country. Mostly because they are based in common sense than that they happen to reside on the left. I would never advocate sacrificing progressive goals in the interest of "centrism" or any other ism. I simply agree with Obama that we must convince the "right" that our goals should be supported. That takes time and patience and pragmatism, but doesn't require capitulation or appeasement.
January 7, 2009 6:34 PM | Reply | Permalink
Don't worry, I don't mistake you for a lefty, you misunderstand. You are a centrist, a capitulationist who believes in the myth that if you move incrementally (even when you have the votes to do the right thing) then it has some magical effect on the forces of reaction and so you advocate adopting a strategy that has discredited itself time and time again. How many more defeats will you accept before you see what is right in front of you? It isn't the left or progressives or liberals that have stood in the way of progress. It has been the Democrats like you who have stood in the way of progress in the name of what you perceive to be pragmatism but which amounts to appeasement. And as far as Obama is concerned, he too is advocating this losing strategy and I am hopeful that he quickly learns that it leads nowhere. It certainly does not lead to "change" in any positive sense of that word.
January 7, 2009 6:50 PM | Reply | Permalink
Namaste.
January 7, 2009 7:23 PM | Reply | Permalink
PS: These are the excuses of the intellectually dishonest who refuse to except reality when it gets in the way of ideology. I think you need to expand your reading list.
January 3, 2009 4:16 PM | Reply | Permalink
I, for one, do indeed refuse to "except reality," regardless of circumstance or my opinion/ideology. I'd rather keep my feet planted in the real world so I don't otherwise lose my bearings. ;O)
January 4, 2009 2:11 PM | Reply | Permalink
No, you seem to think that the ideal world you have created in your mind's eye is the real world and plays by the same rules. The real world requires more creative methods than "Storm the Bastille!" as the solution to every problem.
January 4, 2009 5:33 PM | Reply | Permalink
Does anyone know what plan Daschle promotes?
Although I think he is a great guy, he never seemed to have much fight in him, Bush frankly seemed to use him as a doormat. Perhaps Rahmbo will make up any lack of backbone at HHS on this issue.
January 2, 2009 7:37 PM | Reply | Permalink
As to those who are worried about job losses in the insurance companies, let me say this: There are plenty of places where insurance is important and will continue to be needed. But a reminder:
INSURANCE IS A HEDGE AGAINST SOMETHING YOU DON'T EXPECT TO HAPPEN TO YOU, BUT WOULD BE CATASTROPHIC IF IT DID!
Car insurance: No one EXPECTS to have a car accident. We all pay into the system (mandated by law, by the way, to protect insurance companies) so that when someone slams into my car, their insurance company pays for the repairs. If a deer runs into my car, my insurance company ponies up. But what is the take-home message here? Most people don't hit deers, and most people don't have accidents. Insurance companies (rightfully) make a profit by taking in more money than they pay out with the understanding that if every driver had an accident on the same day, they would have to pay up, and then THEY would lose (unlikely).
Homeowners insurance, including fire and theft: We all pay big bucks for this one, because if our house burns down, we get a new house! Insurance companies (rightfully) get to make a profit because usually, our houses don't burn down. But if they DO, we are so glad that our insurance company is there!
I'll skip on down to health "insurance:" Is there a living soul who doesn't expect to go to the doctor? Who never expects to have a prescription filled? For Christ sake! Everyone gets sick at some point, and we all even die at some point!
To call this absurd mess "insurance" is the biggest scam of all!
We need a health care system -- forget the term insurance, which is for things which are unlikely to happen! If someone wants insurance so badly, let them get a specific insurance, like "long-term care insurance." That is something all of us hope we will never need and many do not. We can pay extra in advance to ease the burden on our families. THAT IS INSURANCE!
Oh, I'll stop now, but I'm sure you get my drift.
January 2, 2009 7:52 PM | Reply | Permalink
Yes, thus my usage of the term in full quotes, "insurance", in this discussion! It's a euphemism now.
Health care has been sliced and diced in various ways. Preventive, emergency, elective, cosmetic, reactive, daily, routine, etc.
January 3, 2009 6:14 AM | Reply | Permalink
I, by a long shot, don't have any answers here.
I have been fortunate to have always had a good insurance plan, Blue Cross. I get sick, I go to the doctor, the insurance co. pays.
My daughter had Kaiser insurance...not so good. She gets sick, they drag their feet. They suggest she not pursue treatment we suggest. Their way is cheaper. She does what they say. She dies. Needless to say, we're massively pissed at Kaiser.
I don't like the Post office. I don't like DMV. My son's teeth are falling out as a result of the dental care he got in the Army. I'm afraid of government run health care.
I know we need to do something, but I don't know what.
January 2, 2009 10:16 PM | Reply | Permalink
stillidealistic: The Post Office delivers mail for eveybody more cheaply and efficiently than the private sector can. The Post Office has never delayed my important packages; FedEx has.
The government provides more education to more students in this country than the private sector ever will.
Do you like your police and fire departments and military? Would you trade them for private security firms that come to help you only if you can afford to pay?
Single-payer: you'll still have your doctor and hospital. All the government does (all we, your fellow citizens, will do) is write the check. We can do this.
January 3, 2009 10:54 AM | Reply | Permalink
.
For general info . . .
Knowledge reduces fear...
------------snippet------------
TITLE I--ELIGIBILITY AND BENEFITS
SEC. 101. ELIGIBILITY AND REGISTRATION.
(a) In General- All individuals residing in the United States (including any territory of the United States) are covered under the USNHI Program entitling them to a universal, best quality standard of care. Each such individual shall receive a card with a unique number in the mail. An individual's social security number shall not be used for purposes of registration under this section.
(b) Registration- Individuals and families shall receive a United States National Health Insurance Card in the mail, after filling out a United States National Health Insurance application form at a health care provider. Such application form shall be no more than 2 pages long.
(c) Presumption- Individuals who present themselves for covered services from a participating provider shall be presumed to be eligible for benefits under this Act, but shall complete an application for benefits in order to receive a United States National Health Insurance Card and have payment made for such benefits.
SEC. 102. BENEFITS AND PORTABILITY.
(a) In General- The health insurance benefits under this Act cover all medically necessary services, including--
(1) primary care and prevention;
(2) inpatient care;
(3) outpatient care;
(4) emergency care;
(5) prescription drugs;
(6) durable medical equipment;
(7) long term care;
(8) mental health services;
(9) the full scope of dental services (other than cosmetic dentistry);
(10) substance abuse treatment services;
(11) chiropractic services; and
(12) basic vision care and vision correction (other than laser vision correction for cosmetic purposes).
(b) Portability- Such benefits are available through any licensed health care clinician anywhere in the United States that is legally qualified to provide the benefits.
(c) No Cost-sharing- No deductibles, copayments, coinsurance, or other cost-sharing shall be imposed with respect to covered benefits.
SEC. 103. QUALIFICATION OF PARTICIPATING PROVIDERS.
(a) Requirement to Be Public or Non-profit-
(1) IN GENERAL- No institution may be a participating provider unless it is a public or not-for-profit institution.
(2) CONVERSION OF INVESTOR-OWNED PROVIDERS- Investor-owned providers of care opting to participate shall be required to convert to not-for-profit status.
(3) COMPENSATION FOR CONVERSION- The owners of such investor-owned providers shall be compensated for the actual appraised value of converted facilities used in the delivery of care.
(4) FUNDING- There are authorized to be appropriated from the Treasury such sums as are necessary to compensate investor-owned providers as provided for under paragraph (3).
(5) REQUIREMENTS- The conversion to a not-for-profit health care system shall take place over a 15-year period, through the sale of US Treasury Bonds. Payment for conversions under paragraph (3) shall not be made for loss of business profits, but may be made only for costs associated with the conversion of real property and equipment.
(b) Quality Standards-
(1) IN GENERAL- Health care delivery facilities must meet regional and State quality and licensing guidelines as a condition of participation under such program, including guidelines regarding safe staffing and quality of care.
(2) LICENSURE REQUIREMENTS- Participating clinicians must be licensed in their State of practice and meet the quality standards for their area of care. No clinician whose license is under suspension or who is under disciplinary action in any State may be a participating provider.
(c) Participation of Health Maintenance Organizations-
(1) IN GENERAL- Non-profit health maintenance organizations that actually deliver care in their own facilities and employ clinicians on a salaried basis may participate in the program and receive global budgets or capitation payments as specified in section 202.
(2) EXCLUSION OF CERTAIN HEALTH MAINTENANCE ORGANIZATIONS- Other health maintenance organizations, including those which principally contract to pay for services delivered by non-employees, shall be classified as insurance plans. Such organizations shall not be participating providers, and are subject to the regulations promulgated by reason of section 104(a) (relating to prohibition against duplicating coverage).
(d) Freedom of Choice- Patients shall have free choice of participating physicians and other clinicians, hospitals, and inpatient care facilities.
H.R.676 United States National Health Insurance Act
--------end snippet----------
Read that last line again... Where it says; "(d) Freedom of Choice"
~OGD~
January 3, 2009 12:22 PM | Reply | Permalink
I'm extremely glad to see the discussion here. I agree wholeheartedly that education reduces fear.
I still have not completely worked my way through this issue, but as I commented on another thread, I can see the merits of a government-run health care system, I just want it to be well thought out.
People having to be financially ruined in order to receive health care is unacceptable.
January 5, 2009 2:56 PM | Reply | Permalink
Ahem, I know this is a very knotty problem, CVille Dem, but I don't feel very comfortable with blithly separating end-of-life care from "health care." Let's see, health care/death care, hmmm. Methinks I do detect a connection here.
And I'm not talking about hospice. Hospice is already on the Medicare gravy train. You know, the hospice I've recently had experience with is 90% in the business of "taking care" of survivors, with precious little practical help with the actual caregiving at end of life. (See Denmark's "system.")
Will Mother Teresa and her nuns magically show up to staff your separate-but-equal nursing homes? I think not. And hospice organizations will never take the place of religion, especially not for atheists!
There are many, very valid reasons for self-respecting and honorable people at any given time to not have a job, and to not be "in-the-system" (current system). One of the reasons is in order to take care of an elderly parent, sibling, or even dear friend (not all of us have friends only from our own age group). Hillary Clinton, about the only politician ever to mention (and even in this case only during the PBS Primary Debate) the fact that caregivers (your wife or husband, for example) even forego paying into their own Social Security Accounts in order to spend months and years caring for someone they love. The operative word here is "love."
Fine, if you think you're never going to die! Fine if you've spent some time recently in the typical urban nursing home, public or private. Otherwise, I advise you to go and take a look, perhaps while you're still young enough to do something about it. Your average 85 or 90 year old is as helpless as your 2 to 5 year old. That's the facts, ma'am. Get used to it yourself.
Perhaps if you are really a progressive, you will want to live in a truly humanistic country. Many people in these United States are so accustomed to blaming the older generation for their own problems and shortcomings that they easily and shamelessly dismiss them later on. This is a non-denominational sin, IMHO. And it's a triple sin for those politicians and policy makers who enable it, regardless of party affiliation.
Take that to your mega church and make a sermon out of it! Christians, my b*tt.
January 2, 2009 10:45 PM | Reply | Permalink
Wow! I don't know where you got all that you said attached to me, but I'll give it a go. First of all, I am no christian! I am perfectly happy to let church-goers tend to their loved-ones, but I don't think they are any more likely to do so than those of us who were only born once.
When I gave the example on long-term care insurance as a form of "actual insurance" ie, something that many people don't need because they die more quickly. That is a fact. Heart attacks, and many forms of cancer, accidents, intracranial bleeds, for example do no lend themselves to lingering deaths. Acknowledging that is not the same as thinking that I'm never going to die. In fact, since I had breast cancer a few years ago, I might just have a more realistic understanding of that than you do.
If I were Queen of the World, there would be cradle-to-grave coverage for all, irrespective of a paycheck, but there would still be a market for a more up-scale type of care, and insurance
could answer that need for those who could afford it and want it.
As it stand right now, end-of-life care takes up about 26% of Medicare's $327 million budget. AND MEDICARE DOESN'T PAY FOR LONG TERM CARE! Think of all that money going for treatments to extend a life when a less expensive palliative care would be better for all concerned, including the dying patient.http://www.usatoday.com/money/industries/health/2006-10-18-end-of-life-costs_x.htm
To handle this the right way, people with nothing to gain, and with knowledge AND wisdom need to design it. In my opinion, if Barack Obama can't choose them well, then no one can. I don't care what Hillary said on TV; she had more of a chance than anyone in our country to fix this mess and she blew it for the very reason that she chose the wrong people and got mired in the insurance and drug companies' influences.
January 3, 2009 10:47 AM | Reply | Permalink