Here's my thoughts. If the republicans refuse to play ball on the bill, which I'm assuming, will include the Schumer public option, then they'll have another bill waiting for reconciliation. I've heard that Congress is prepping another bill behind the scenes. Expect that to be powerfully liberal if this plan fails due to republicans/insurance industry.

UUUUUGGGGGGGGHHHHHHHHH.

That's the only appropriate response.

Reich is right in saying that without heavy pressure from the White House and public the public option will not succeed. Right now, the signals from the WH are less than encouraging. But Emanual, Axelrod, and Obama may be overestimating their continuing support from their base and the 60+% of Americans now favorably inclined toward him. As a campaign worker for Obama and avid backer of Obama's changes so far, I can say categorically that if he doesn't support a public option (or something better), he will lose my vote, not only in 2012, but in the congressional elections of 2010.

Yes, its a litmus test. And its such an important issue, that I would rather vote for a Republican if she or he promised true health care reform after another failed Democratic effort. Some Republican politician somewhere might figure out that it will take a Republican (aka Nixon goes to China) to take on the corporate health care and insurance industry and achieve true change. Whats truly discouraging is that all of Obama's personal tales of the broken health care system may have been campaign rhetoric. I see no sign of a President's realistic understanding of how insurance companies, health care system game the system and will continue to do so unless confronted by true competition.

It's all image.

The reform amy be worse than the problem. Obama won't fight for real reform.

So change means going from chronic pessimism under Republican rule to chronic disappointment under Democratic rule?

I am not a politician, so maybe I'm not qualified to second-guess our leaders, but I don't see how sheep-like behavior in the face of corporate interests is going to help us here.

It used to be that corporations could simply be dissolved by the government when they stepped out of line. Lincoln ended that by giving them the same rights as a person, forgetting the little detail that the only individuals with the resources approaching those of a corporation are the owners of the biggest corporations.

I was kinda hoping Obama and the Dems would be a little more aggressive with their power. Not Bush/DeLay aggressive, but not Pelosi/Reid meek either. The Republicans simply steamrolled through the last 8 years with their agenda, I think giving them one chance to compromise on each issue is enough. It is change, it is fair, and it does not need to be followed up with a complete cave-in.

If the Republican party manages to make itself irrelevant, hopefully the party that replaces them will have both a tolerable agenda and the actual backbone to see it through. I'd happily vote for them.

I'd appreciate it, Dems, if you could make it possible for the non-rich to afford health care before my mother dies of heart failure while still in debt from the previous surgery, mmkay?

Yawn. Just another example of politicians (of both parties) promising big "change" and really not changing a damn thing, except perhaps on the outermost margins.

They tell us what we want to hear every two, four or six years. But in the end they sell out to whoever shoves the most money in their pocket. And that sure as hell isn't rank-and-file Americans.

McMia, I agree that we need another political party in this country that isn't entrenched and actually has the guts and fortitude to follow through on solutions. Unfortunately, the financial realities of American politics will likely prevent such a party from becoming viable; it costs too much money to advertise and get a message out to all parts of the country.

Hey - you folks are aware that the President can't just dictate a new health system, right? You have heard about Congress and committees and votes and all that stuff, haven't you?

Anyone who would actually contemplate voting for a "Republican who promises real health reform" if we don't get exactly what we want from Obama should have his head examined. No republican will ever give us anything remotely close to single-payer or a public option.

Instead of carping, write your congressman.

Totally agree with Señor Seaton, disagree with Virginia re contacting corrupt idiots in Congress. Won't work. Obviously voting didn't, either.

Obama is the best face possible for the old order and will go down with the ship. Too bad, 'cause I love him, but he has no balls. Sigh.

I get Medicare next year, better than nothing, so I'm not investing any more emotion in this critical issue. The rest of you are going to have to RIOT, though. (This doesn't get fixed by calling Congress. What a cruel joke that is.)

If we really wanted to follow a good plan for universal healthcare, there are at least twently in place to choose from, every other industrialized nation on earth except the US has one. Copy one of theirs. Or,,,keep HMO's and outlaw the following:
Denial of any service, no matter how "experimental", recommended by personal physicians/specialists.
Denial of either claims or coverage due to pre existing conditions.
Cap medical malpractice awards to lifetime potential earnings with lawyers contingencies fees capped at 5%. Wrongful, fraudulent, or frivolous suit expenses to be borne by the law firm with a 6 month license suspension to the offending attorney.
Cap pharmaceutical profits to 20% over the life of the patent, coupled with tax depreciatiion for r&d over the patent life. No drug developed in US or by US based pharmaceuticals can be sold at a lower price in any other country without that price taking effect immediately in US market. Cosmetic drugs and otc medicines to be excluded from this rule.

This would shake things up real quick, but good luck, lawyers make up congress and they are owned out right by big pharm and HMO's. Dream on if you think anyone will ever get universal healthcare established in US.

Thanks for asking so nicely. I was trying to say from the standpoint of those of us who want serious health care reform (like those of us who would like to see a serious change in foreign policy or accountability for illegal government acts (torture, misuse of power, illegal wiretaps) and like those of us desiring a serious restructuring of the current financial system that benefits the banking and Wall Street elites at the expense of the middle and working class) the election of a Democratic president and Congress seems not to have made a significant "change" from the previous (Bush/Cheney/GOP) rule. Previously we were assured that if we wanted these serious changes, the best route was to elect a Democratic president and Congress. Now it would seem we are as close to a change in the situation as we were before the recent elections. I find this deeply disturbing.

Robert,
You rock ...and for the life of me, I can't understand why I never run into you around Berkeley.

Here in California, though, regardless of the mishugass going on re this healthcare cowardice at the federal level, we again have SB810 moving along through the legislature (aka in previous year as SB840). THIS time, most of us are pretty confident that we WILL get it passed. After all, the ONLY thing that stood in its way was Arnold. The thing had passed both sides of the state legislature TWICE (unPRECEDENTED). If Arnold vetos it again, we will re-submit it to the new governor (and put all of our efforts into finally getting a Dem into power who is PRO-single payer).

I was a bit shocked at Schumer. Usually, the guy seems to be sensible and very supportive of real people but with that bit about the govt. having to adhere to private insur type rules, he just lost me as any potential supporter.

I would note that THIS is the type of cowardice (the unwillingness that now EVEN with a majority seated & the economy and unemployment rate being so vastly different than when this whole public/private strategy was formed) that was my tipping point in leaving the Democratic party and becoming an "independent/decline to state".

Does an elected official exist who actually is more interested in the common welfare than their own interests? Please name one 'cause from my POV, I ain't 'feelin' it.

Until we deal with the imbalance of talk radio that is quite effectively reaching 10's of millions a day and framing this important debate we will never progress on ANY issue.
The real power in America is in the five companies that own the media and are supported by
1. Insurance and Pharma
2.Oil, gas and Coal
3.Banks and finace
4. Military Industrial complex
These masters at propaganda repeat and repeat and saturate the country with these Corporate talking points. This powerful infrastructure has to be addressed ASAP.How else can you explain why even with the Dems in the WH and Majority Congress we still can't beat the banks,Healthcare and energy reform. The power is in too few hands, not the people or the WH. This is why they can't even disagree with Rush....how pathetic

Real Healthcare Reform:
Changing Priorities, Incentives and the Rules of the Game; Creating an Electronic Health Record for Every Citizen Who Wants One

If you have the financial resources of Bill Gates or Warren Buffett you needn’t pay money to a health plan each month, since if you get sick or injured – even very seriously - you have more than enough money to pay all your medical bills yourself.

But those of us who have significantly less financial resources must find some other means of dealing with the thousands or even hundreds of thousands of dollars or more of medical expenses that we might incur should a serious illness or injury be our fate.

Enter the concept of “health insurance”.

Large numbers of individuals and/or their employers pay some money each month into one or another big pot called a “health plan”. Those individuals who remain essentially very healthy for many years and then suddenly die or perhaps leave a particular health plan for some other reason – if they have put more money into the pot than was taken out to pay all their medical expenses - wind up helping to pay the medical bills of those members of the health plan who become seriously ill or injured and incur a lot of medical expenses.

Many Americans covered by some form of health insurance don’t seem to fully understand or perhaps choose to ignore the fact that if they become seriously ill or injured, for the most part their medical bills will be paid by the members of their health plan who have remained healthy. Keeping members of a health plan healthy by preventing illness and injury is critically important, but is something not currently given the high priority and attention it deserves.

Some Americans believe that healthcare should become a “right” of every American citizen. If a nationalized single payer health plan were enacted, every American citizen who became ill or injured - for any reason whatsoever - and incurred significant medical expenses would for the most part have his or her medical bills paid by U.S. taxpayers. Many Americans oppose such a system for America recognizing that significant difficulties such as long waiting periods and rationing of care exist in such types of all inclusive government healthcare systems that currently operate in other countries such as Canada and the United Kingdom.

For any health plan to work which has a large number of people pooling their money to essentially pay the medical bills of whichever members of the plan become seriously ill or injured, rules must be established as to when and how much money may be taken out of the pot e.g. “legitimate” doctor bills and hospital bills. Equally important is keeping track of the amount of money that is being put into the pot each month in premiums paid by health plan members or their employers. If too much is being paid out in expenses as compared with the amount being received in premiums, the pot will soon become empty and the health plan will go broke.

As previously mentioned, the monthly premiums paid by individuals or their employers go into a health plan’s big pot from which “covered” healthcare expenses are paid. But also from this pot are paid all the health plan’s administrative expenses including what may be big salaries and golden parachutes for CEO’s and other “healthcare executives” – individuals who may be paid to find technicalities of one sort or another in the health plan’s agreements so the health plan can deny or reduce payments, raise premiums, cancel insurance, or in one way or another minimize or exclude “bad risks” from the health plan. All such questionable business practices are done to enable the health plan to make a profit and remain in business.

Currently we are experiencing continual increases in healthcare costs that are unsustainable and which, if unchecked, will soon seriously threaten the future of the entire American economy. Healthcare costs must be controlled, but how? If a healthcare system made up of health plans is going to have a chance of both meeting the needs of health plan members and simultaneously develop the ability to keep costs under control, priorities, incentives, and the rules by which the game is played all must be changed.

The good news is that a lot of illnesses and many injuries are actually preventable. But how will prevention ever become a top medical priority when doctors, hospitals, and other providers get paid largely for diagnosing and treating illness and injury, not for preventing it?

Although health promotion and disease and injury prevention receive fashionable and socially acceptable lip service, the fact is that most of the participants in what should be more appropriately called our “sickness and injury care system” actually have no significant financial incentive whatsoever to spend any significant time and energy in genuinely promoting health and helping to prevent disease and injury.

Much to the contrary. Other than the actual members of a health plan – patients and potential patients - and their employers and perhaps the employees of some health plans, most participants in our sickness and injury care system - because of the way they are paid - have an enormous (if unspoken) financial incentive for massive amounts of disease and injury – much of which is preventable – to continue to occur in America. Strictly from a financial point of view, for those whose incomes come solely from the treatment – not the prevention - of illness and injury, the more illness and injury that occurs, the better. And if the illness or injury is serious and requires perhaps many expensive tests, multiple surgical procedures, and other very complicated prolonged treatment in an intensive care unit, so much the better; just as long as those unfortunate individuals who happen to be ill or injured are “covered” by “good insurance”, i.e. health plans that are reliable bill payers.

This is not to say that there are not some excellent very dedicated and hardworking doctors and other health professionals - although they are paid on a fee for service basis to care for illness and injury – who nevertheless attempt to essentially work themselves out of a job by making health promotion and disease and injury prevention a top priority with their patients.

It should also be recognized that some existing health plans – e.g. Kaiser and Group Health - combine insurance, doctors, and hospitals into a single entity in such a way that provides everyone - including all the health plan’s doctors - a real incentive to spend time and effort with patients on health promotion and disease and injury prevention as well as on early diagnosis and treatment. But unfortunately the above examples represent only a small part of the sickness and injury care system that currently exists throughout America.

For the most part - because of the way they are compensated – the majority of doctors and other professional providers, acute care hospitals and long term care facilities, pharmaceutical manufactures and pharmacists, medical and surgical equipment manufacturers and personal injury and malpractice attorneys - among others - depend mightily on massive amounts of disease and injury occurring in America; and these participants in our sickness and injury care system would be significantly negatively impacted if a lot of the preventable illnesses and injuries were actually prevented. This must be changed.

Unless the incentives and rules are changed to give as many participants as possible a real financial stake in health promotion and disease and injury prevention, in early diagnosis and treatment, and in maximizing health and minimizing disease and injury, healthcare costs in America will never be brought under control. Making appropriate changes in the incentives and the rules of the game is the real task and challenge of “healthcare reform”.

What about financial incentives for individual health plan members? Should individuals receive a financial incentive to be healthy? It is well recognized that engaging in regular exercise, abstaining from tobacco, and eating moderately so as to maintain a reasonably normal body weight are all significant factors in helping to promote an individual’s health and wellness. These healthy behaviors can all be confirmed by simple tests performed or ordered in a doctor’s office. Why shouldn’t those individuals who practice these health promoting behaviors and comply with recommended immunization schedules and appropriate preventive screening examinations such as for colon cancer and breast cancer pay significantly less in premiums to their health plan each month than those who don’t?

To really reform healthcare we must find ways – through changes in incentives and the rules of the game - to actually prevent what is preventable, to maximize early diagnosis and treatment, and minimize disease and injury with all its associated cost. We must find ways for participants to be part of our “healthcare system” and not just a part of our “sickness and injury care system”.

Significant changes in the rules of the game for our legal system – tort reform – is also critically important so that the gaming of the system now being done by personal injury and malpractice attorneys and their clients can be ended and so that the exorbitant costs to physicians and other professionals for malpractice insurance can be dramatically reduced.

Truly transforming our “sickness and injury care system” into a “healthcare system” by making significant changes in the incentives and the rules of the game may seem to be a formidable task and one that probably has never really been done before on a large scale anywhere in the world. But it is a worthy task and a critically important task for the future of America and its people.

One significant part of this process is developing the capability of creating an electronic health record for every American citizen who wants one. We need a standardized framework that will allow every American citizen to have an individual electronic health record – a computerized medical record - that can be accessed by all the doctors who care for a particular individual, regardless of wherever on the planet the doctors or the patients happen to be. It would be like having your own personal online banking account that only you have the password to, but which you can share with the doctors who are caring for you, wherever you or they may be.

I applaud those who are using their energy and expertise to upgrade our deplorable current paper medical records system and bring medical records in America into the 21st century. Developing a standardized framework for an electronic health record - for every citizen who wants one – created by your doctor with your assistance, with proper security and safeguards - is something that our national government can and should do as a part of healthcare reform.

If done well, electronic health records will be transformational in helping doctors efficiently and effectively care for patients and will save an enormous amount of time, effort, and money which is currently wasted on needless and frequently inaccurate duplication. And having an accurate electronic health record for an individual will also facilitate appropriate health promotion and disease and injury prevention for that individual. Like the telephone and the computer, someday we will all wonder how we ever got along without individual electronic health records.

But all this requires action, not just words. Now is the time for Americans and their leaders and doctors and other health professionals to step up to the plate and begin the process of transforming our “American Sickness and Injury Care System” into an “American Healthcare System” that is worthy of our great country.

Robert Westafer M.D.

No public option = no meaningful reform.

Look for premiums to go up as industry insiders on the corporate airwaves tell the American people what a great deal they have. The only question is are the American people gonna buy the latest ad campaign brought to us by the same people responsible for the profitable ads run during the evening news?

"...significant difficulties such as long waiting periods and rationing of care exist in such types of all inclusive government healthcare systems that currently operate in other countries such as Canada and the United Kingdom."

Poppycock (spreading the above urban legend). I'm waiting several months, at least six I was told, to get a colonoscopy in the U.S.
And my insurance provider comes between me and my doctor all the time.
Another red herring is tort reform.

Sigh! So many on TPM are nothing but talk..or type. Don't you all get tired of just blogging about how Obama has betrayed or caved on another issue? How he's just another Bush, hope/change we can't believe in, or (add corny insulting spin on campaign slogan here). Aren't you tired of talking about the way things should be? I for one I'm sick of reading the same comments and complaints day after day. Seriously, with every new blog posted by a TPM blogger, it is always followed by the same arguments or comments. Yeah, yeah I know - debate is good for Democracy blah, blah, blah.

Here's my suggestion. If so many people are for single payer or the public option and if you all feel so passionate about it, why the hell are you blogging and not descending on Washington? Why aren't millions of Libs/Progressives setting up protests all over the country letting DC know what you want and that you want it now? You know, like the tea parties, except it wouldn't be an absolute joke.

Quit preaching to the choir and start getting the American people to be as passionate about this as you all seem to be.

I have much too much experience dealing with HMO reps and rules to believe that anything but a true public option will work. The best of these would be a single payer system; but what won't help at all is leaving the HMOs and pharmacare folk running the whole show like it does now.

.

Just in the nick of time . . .

The following announcement is perfectly timed for the flip-flopping dialog of some here at the Cafe
that has developed with the latest visits of Reich.

FDA Approves Risperidone as Maintenance Treatment for Bipolar I disorder...

~OGD~

"Many Americans oppose such a system for America recognizing that significant difficulties such as long waiting periods and rationing of care exist in such types of all inclusive government healthcare systems that currently operate in other countries such as Canada and the United Kingdom."

I live in Canada and I have not experienced LONG WAITING PERIODS or RATIONING. Stop with the anti-healthcare propaganda. It is actually an economic benefit to have universal health care for your citizens. The enormous burden of medical expense is the biggest cause of personal bankruptcy in the USA.