There is a sneaky sleight of hand here: by talking about annual household income, you get a continual rise of income from the 1970s onward because you are moving from single income to dual income households as "typical." The news is really even worse than is portrayed.

Miguelito - As someone who offered informative commentary on my recent post on proposed reform, you know that we agree on the need for more aggressive cost control. I expect you also realize that we disagree about the value of a plan without a public option in the sense originally proposed. I support a public option, but I've offered evidence to support my contention that even without it, the proposed legislation would mark a transformative leap for the better in offering Americans high quality affordable healthcare.

Rather than repeat the extensive evidence and commentary from that post and the ensuing thread, I hope readers will visit it as a complement to this post. The link is

http://tpmcafe.talkingpointsmemo.com/talk/blogs/fredmoolten/2009/09/is-the-public-option-important.php#comments

As a practical matter, I now see the chance of a government-run public option in what eventually passes as close to zero, the chance that it would be open to everyone as zero, and the prospect of starting over as almost equally low. I certainly rejoice that we won't start over, given my conviction that we are about to transform healthcare for the better. I would not discourage public option proponents from maintaining the pressure on Congress - first because the public option is a good idea, and second because it will frame the debate more favorably in terms of what eventually emerges. I would strongly discourage any attempt to sabotage the process so as to kill passage of proposed legislation.

I also support efforts to push Congress to maintain adequate subsidies for low income earners. Unlike Obama, I would not oppose taxes on employer-provided health insurance even down to middle income levels, although I doubt that's feasible politically.

Finally, in terms of visceral reactions to what is happening, I believe disappointment that we may not achieve everything we might wish should nor blind us to the major achievements that still await us, not blunt our enthusiasm to advocate for them. I also don't believe that antipathy toward private insurers should blind us to the reality that insuring 46 million more Americans is good for them as well as the insurers, and the fact that the latter will benefit does not negate the benefits to the former.

I could go on and on, but I would prefer readers to visit the post I linked to, where they will find many more details explaining the basis for my conclusions. I will certainly be glad to elaborate further for those who want to take it beyond that point.

Bi-partisanship at its finest.

Health care reform = forcing people who can't afford insurance to pay for it

Not really what I envisioned. Again the conservatives and centrists get their way and they are smiling all the way to the bank with the checks from Big Pharma, Health Insurers, Trial Atty's, ect all who will make a killing from this mandate. Why did I ever think things would change in DC? This is like a bad acid trip that never ends...what a fucking nightmare.

Goodness peeg! You've devolved into a newt (or something).

PS -- is that a newt or a fetal pig? In either case, the creature is appealing but alarmingly vulnerable.

If you really want to have a system where you can show some genuine savings then we have to get the 29% admin costs down to a single digit number. That percentage is about the industry living high on the hog. It puts money in the pockets of executives, it's money the industry uses to lobby our congress, it's money that goes to various industry junkets and just plain waste. I don't want corporations to have the ability to be soaking me on costs and then using the proceeds to fund a PAC that seeks legislation which is also focused on screwing me. This is exactly why corporations should not be able to participate in the political process. Not only are they not citizens but they will that citizen status to screw real citizens. This is exactly what corporate America has been doing for three decades or so.

I was intrigued by a NYT piece yesterday suggesting something that seems self-evident in retrospect - the Obama Administration never envisioned the public option as a centerpiece of reform, and was surprised that it assumed that status in the eyes of proponents and opponents. Obama judged that option attractive, but not essential. In my recent post, I offered detailed evidence indicating why I subscribe to that position, and I hope those interested will visit the post to review that information.

http://tpmcafe.talkingpointsmemo.com/talk/blogs/fredmoolten/2009/09/is-the-public-option-important.php#comments

Current reform discussions at times refer to the possibility that coming reforms will be "incremental". The term is ambiguous. If it signifies that proposed legislation purports to reform mainly insurance, with less attention to the larger problem of healthcare tself, "incremental" is an appropriate designation. On the other hand, if it implies that the step forward would be minor, "incremental" is surely wrong. Indeed, in my view, we are poised to witness an advance that will be judged historic in moving us toward universal or near universal healthcare coverage for all that is equitable, and as affordable as insurance reform alone can reasonably accomplish. This will be true with a public option, without one, or with some variant thereof - the differences any of these portend is likely to be marginal.

It seems to me that our task at this point is to ensure that the proposed legislation encounters no last minute detours. Equally important, it must be viewed as only opening the door to system reform, via its demonstration projects, comparative effectiveness research, primary care incentives, and other steps toward system restructure. That restructuring will undoubtedly consume a decade or more, but its success or failure will determine our ability to emulate all other industrialized democracies in providing effective healthcare to all at affordable costs.

To reinforce the conclusion that system reform is central, while a public option or its absence is not, it's worth repeating that these other nations vary from those based almost exclusively on public insurance to those that deliver healthcare almost exclusively via private insurers. What these nations share in common is strong insurance regulation, and an organized healthcare system that avoids the chaos that prevails here.

Finally, if there are those here with a different perspective, I would appeal to them to revisit the post I linked to above, and if they wish, address each item cited there in some detail. What I hope to avoid is the circumstance in which any of us solidify our views to the point where evidence and data start to be ignored. At that point, the debate descends into dogmatism, and I don't want that to happen.

I make that appeal based on the evolution of my own perspective on healthcare reform, which has changed considerably since I began informing myself on tbe subject. Specifically, I have gradually, and somewhat grudgingly, been forced to admit that my earlier view judging insurance costs as a major villain and a public option or single payer alternative as an adequate solution has been forced to yield to the evidence about our own healthcare system mess, and evidence as to how other nations have successfully addressed similar challenges.

There is NOTHING in this bill that makes access to good health care any better for anyone! This is an unmitigated disaster!

This post is why I've been against health care reform all along. The individual mandate is just a tax increase on the middle class (and some of the poor, and not a few rich people) in return for which they get a product they could buy for that amount of money already if they wanted to.

The system now isn't perfect, but it's better than the alternative.

I second the Amendment!

Sixty four House members, enough to derail a bogus bill, have pledged to vote against any bill sans a strong PO. And I’ve been hoping that the House would hold to Pelosi’s promise of no reform without it. But that promise seems as resolute as the one opposing weakening FISA and gtanting telecom immunity. Steny Hoyer who does Pelosi’s dirty work is now backing off the PO.

We must forget -completely ignore- the corporate-sponsored “teabaggers.” Even those sincere people we know. This 20 to 30% does not represent anyone but the lobbies who back and exploit them or the corporate media who misleads them. How often have the truly poor and needy marched on Washington? Not often because they’re usually busy, you know, trying to survive. And the half of the middle class that's paying attention and actually wants real reform have sat on their hands because they thought they‘d already voted for it. All fools, myself included.

Maybe the answer is to do a little paltry tweaking around the edges (rewrite HIPAA) and call it a day, or to block this “reform” altogether. But let’s not pass another piece of crap legislation (like the Medicare Part D prescription drug program transferring extra taxpayer $billions to Big Pharma) just to say we did.

We can debate and discuss this ever so civilly; refuting each other's points detail by detail, thrust and parry. But what is on the line behind our polite talk? The system needs to be taken away from profiteers on human misery.

Approximately 2500 families filed for bankruptcy today because of medical debts. The same number will file tomorrow, losing most of what they have worked for all their lives- house, savings, and any credit-worthiness. Sixty or so people died today for lack of health care. That is just today! Sixty people died today and sixty will die tomorrow and the day after and every day until this system is fixed. Is it evil to believe that it would be better to let the uninsured continue to die in order to get real reform? I don’t really know, but in the end, I think less will die; less will be wiped out; less will be handicapped or partially disabled if we do it right- for once and all.