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Beware Authoritative "Inside Washington" Sources Who Say The Public Option is Dead
Washington, D.C. is an echo chamber in which anyone who sounds authoritative repeats the conventional authoritative wisdom about the "consensus" of inside opinion, which they've heard from someone else who sounds equally authoritative, who of course has heard it from another authoritative source. Follow the trail to its start and you often find an obscure congressional or White House staffer who has seen some half-assed poll number or briefing memo, but seeking to feel important hypes it a media personality or lobbyist who, desperate to sound authoritative, pronounces it as truth. In any other place on the planet it would be called rumor, gossip, or drivel. In our nation's capital it's called "inside information." The process would be harmless except that it creates self-fulfilling prophesies. Since most of our elected representatives would rather not stick their necks out lest they lose their heads, they tend to rush toward whatever consensus seems to be emerging -- which, of course, is based on authoritative reports about the emerging consensus.
In the last few days authoritative sources have repeatedly told me that the public option is dead, that the President won't be able to get a comprehensive health care bill, and that the White House and congressional leadership already know the best they'll be able to do now is move incrementally -- starting with insurance reforms such as barring insurers from using someone's preexisting health conditions to deny coverage -- with the hope of more reforms in the years ahead. The rightwing media fearmongers and demagogues have won. Don't believe it. The other thing about Washington is how quickly conventional authoritative wisdom changes, especially when the public is still in flux over some large matter. Rightwing fearmongers and demagogues thrive only to the extent the mainstream media believes they're thriving. Although polls continue to show that while most Americans like the health care they're getting, they also dislike their insurance companies, worry that they or their families will be denied coverage, and are anxious about the increasing co-payments, deductibles, and premiums they're facing. Most are still eager for reform.
In addition, we've come to the point where health-care incrementalism won't work. To be sure, the health-insurance industry is powerful and will fight reforms that threaten their profits. But they won't fight if they know their profits will be restored when everyone is required to have health insurance. (This isn't just conventional authoritative wisdom; it's political fact.) Obviously, in order to require everyone to have health insurance, tens of millions of Americans will need help affording it. The only way the government can possibly pay that tab is to raise taxes on the rich while also getting long-term health-insurance costs under control. And one of the surest ways to get long-term costs under control is to force private insurers -- which in most states and under most employer-provided plans face very little competition -- to compete with a public insurance option that can use its bargaining clout with drug companies and medical providers to negotiate lower prices.
When you go through the logic, it starts to look a lot like comprehensive reform.
Years ago, as the story goes, Britain's Parliament faced a difficult choice. On the European continent drivers use the right lanes, while the English remained on the left. But tunnels and fast ferries were bringing cars and drivers back and forth ever more frequently. Liberals in Parliament thought it time to change lanes. Conservatives resisted; after all, Brits had been driving on the left since William the Conquerer's charriot. Parliament's compromise was to move from the left to right lanes -- but incrementally, on a voluntary basis. Truckers first.
Lest anyone in Washington repeat this story authoritatively, it's a joke -- but with a kernel of truth. Sometimes reform has to occur in a big way, everything or nothing, if it's to happen at all. That's the way it is with health care reform at this stage. Every moving piece is related to every other one. That's also why a public option is necessary.
So forget the authoritative sources. Mobilize and organize. We can get comprehensive, meaningful health care reform if we push hard enough. And we must.
In the last few days authoritative sources have repeatedly told me that the public option is dead, that the President won't be able to get a comprehensive health care bill, and that the White House and congressional leadership already know the best they'll be able to do now is move incrementally -- starting with insurance reforms such as barring insurers from using someone's preexisting health conditions to deny coverage -- with the hope of more reforms in the years ahead. The rightwing media fearmongers and demagogues have won. Don't believe it. The other thing about Washington is how quickly conventional authoritative wisdom changes, especially when the public is still in flux over some large matter. Rightwing fearmongers and demagogues thrive only to the extent the mainstream media believes they're thriving. Although polls continue to show that while most Americans like the health care they're getting, they also dislike their insurance companies, worry that they or their families will be denied coverage, and are anxious about the increasing co-payments, deductibles, and premiums they're facing. Most are still eager for reform.
In addition, we've come to the point where health-care incrementalism won't work. To be sure, the health-insurance industry is powerful and will fight reforms that threaten their profits. But they won't fight if they know their profits will be restored when everyone is required to have health insurance. (This isn't just conventional authoritative wisdom; it's political fact.) Obviously, in order to require everyone to have health insurance, tens of millions of Americans will need help affording it. The only way the government can possibly pay that tab is to raise taxes on the rich while also getting long-term health-insurance costs under control. And one of the surest ways to get long-term costs under control is to force private insurers -- which in most states and under most employer-provided plans face very little competition -- to compete with a public insurance option that can use its bargaining clout with drug companies and medical providers to negotiate lower prices.
When you go through the logic, it starts to look a lot like comprehensive reform.
Years ago, as the story goes, Britain's Parliament faced a difficult choice. On the European continent drivers use the right lanes, while the English remained on the left. But tunnels and fast ferries were bringing cars and drivers back and forth ever more frequently. Liberals in Parliament thought it time to change lanes. Conservatives resisted; after all, Brits had been driving on the left since William the Conquerer's charriot. Parliament's compromise was to move from the left to right lanes -- but incrementally, on a voluntary basis. Truckers first.
Lest anyone in Washington repeat this story authoritatively, it's a joke -- but with a kernel of truth. Sometimes reform has to occur in a big way, everything or nothing, if it's to happen at all. That's the way it is with health care reform at this stage. Every moving piece is related to every other one. That's also why a public option is necessary.
So forget the authoritative sources. Mobilize and organize. We can get comprehensive, meaningful health care reform if we push hard enough. And we must.
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Yes. Yes. Yes.
I've shuffled off the DC consensus coil a long time ago.
We need to get our attention on the facts of the health care debate, and not what's being filtered through the press (which is hostile to reform, and bloodthirsty to hype setbacks).
September is when it happens, folks.
August 28, 2009 1:29 PM | Reply | Permalink
Thanks, Professor, for issuing a clarion call of common sense, and not the doom and gloom dinner bell I have been hearing all month.
August 28, 2009 1:30 PM | Reply | Permalink
It's a mystery to me why Chuck Schumer, Nancy Pelosi, Howard Dean and others can go on TV and say they are working on getting a bill passed with a public option and they think it will happen, and then there's nothing but crickets.
But Stephanopoulos goes on O'Reilly (!), or Kent Conrad goes on Fox News Sunday and asserts that the votes aren't there, and suddenly we've got news.
Oh, wait, it's not a mystery.
August 28, 2009 2:28 PM | Reply | Permalink
I'm going to guess the reasons are similar to why 1 million people in the street trying to stop a march to war gets scant media attention, while 25 whack-nuts screaming like tired children outside a town-hall meeting get non-stop coverage for months on end.
I still don't know what that reason is, but I have a suspicion that there is a connection.
August 28, 2009 3:42 PM | Reply | Permalink
Oh yes you do know the reason, you just don't want to be labeled a conspriracy theorist.
August 28, 2009 5:47 PM | Reply | Permalink
It's a conspiracy of silence!
August 28, 2009 6:32 PM | Reply | Permalink
It is naive to believe there are no major conspiracies plaguing us endlessly.
Study up on how the slavers bought up the media over the decades preceding the civil war, and it is easy to believe the media can be owned by pernicious people with greedy motives. They actually had the southern public brainwashed to believe that both the Constitution and the Bible not only approved of, but protected slavery as an institution.
Also, two simple thoughts;
... the conspiracy of greed needs no meeting house.
...it only takes two to make a conspiracy.
Anyone who seriously dismisses conspiracy is much more naive than those who see conspiracy in every issue.
But in truth, most of those who adamantly and consistently dismiss conspiracy theories and label conspiracy theorists as nuts, are probably part of the conspiracy.
August 31, 2009 10:10 AM | Reply | Permalink
I think mediamatters.org might give you an explanation.
Or, actually, they're too polite: they'll just give you 10,000 pages of more evidence pointing to one and only one explanation.
September 4, 2009 3:56 PM | Reply | Permalink
The media are pushing the repub agenda because it draws out the crazies...Thank God Reich has a clear head and a venue to express it!
The media viewership is dropping like a stone...Most people under the age of 60 are getting their news from foreign press and the internet! No one believes them, MSM, anymore!
August 29, 2009 10:44 AM | Reply | Permalink
Democrats really, really, really need to figure out that failing to pass a strong health care bill will kill the party.
Expectations are high because we have 60 seats and a supposedly progressive president and a real mandate for change. Screw this up and you tell me what is the purpose of electing Democrats?
I make my living getting Democrats elected and the purpose is supposedly to get good things done to help those without a voice. If we can't do that with 60 seats, what is the point? Why should progressives work so hard, spend so much to get those last seats if having a 60 seat Senate gets us what having 53 seat Senate would?
I have spoken to a lot of folks in a lot of states and they are telling me the same thing: screw this up and I'm gone because there is no point of electing Democrats. They don't do what they say they'll do.
Republicans with a 60 seat Senate would mean the actual implementation of those things on which they campaign. For Democrats, it simply means, getting (maybe) a 1/4 loaf instead of 1/16.
I'm done with this party if we screw this up.
August 28, 2009 1:37 PM | Reply | Permalink
We will get this done.
August 28, 2009 1:51 PM | Reply | Permalink
I wholeheartedly agree. But "WE" need to find a point of reference to gather that "we" together in some sort of unified body, not just as obscure percentages mentioned in passing.
Our Democratic party leaders (now that Ted's gone, someone need to take this opportunity to at least partially fill his shoes) need to organize a group and a forum with which these ideas might be chewed over, without including the propagandizing insurance industry mindbenders.
We need a "public option" panel of experts who are FOR the option, that can counter the industry's big money media blitz with some simple truth.
I know there are many organizations working together, but as yet I've seen nothing akin to a fulcrum or focal point specifically for those of us who WANT single-payer and/or a public option.
The industry has it's power in smoke-filled back rooms, we need a front-room, clear-aired organization, consisting of a body of medical and economic experts to counter that greedy power.
August 31, 2009 9:59 AM | Reply | Permalink
Every assertion that anything has been taken away from the people in the health care reform requires an immediate and sharp retort from the people. Shake the walls of Washington, nothing less. Congressmen need to know they cannot waver on this important bit of public policy. Our generation sees this as part of Social Security delayed by 70 years.
August 28, 2009 1:55 PM | Reply | Permalink
Yes, yes, yes, yes ,yes.
Thank you.
These "sources" are inevitably Blue dogs, GOP, or insurance people who are offering their wishes, not some inside scoop.
Yet, every time, the MSM falls for it:
Grassley says PO is dead.
Conrad says its dead.
etc. etc.
Sorry, but Grasshole (as we affectionately call him) doesn't decide. A vote decides. And I think we in fact have the numbers if we can only put if for a vote.
Screw the Senate Finance Committee. they failed.
Go with HELP. We can get to 50 votes with certainty. And we can muscle out 60 votes for cloture.
This is doable. This will get done.
Go ahead and call, and share this contact list, and keep the pressure on.
http://tpmcafe.talkingpointsmemo.com/talk/blogs/observer2/2009/08/public-option-senate-contact-l.php
August 28, 2009 2:17 PM | Reply | Permalink
Obama will never get the Edwards endorsement. Palin will win over independents. Hillary supporters won't vote for Obama. McCain won the debates. We're turning a corner in Iraq. Obama should not use Greek columns.
All of this is great news for John McCain.
August 28, 2009 2:24 PM | Reply | Permalink
LOL. Good one.
Why can't Obama close the deal??
I revised this list, and by my count, we likely have at least 51 votes for the Public Option, and potential for 60 votes of cloture. If we can get a replacement for Kennedy, it increases our margin of safety.
http://tpmcafe.talkingpointsmemo.com/talk/blogs/observer2/2009/08/public-option-senate-contact-l.php
August 28, 2009 2:48 PM | Reply | Permalink
From where I sit in the Bay State, it's looking like an appointed placeholder for Kennedy's seat between now and Jan. 19th is highly likely. I know Gov. Patrick is quite keen to do it.
August 31, 2009 5:29 PM | Reply | Permalink
It's long been clear that Summers and Geithner froze you out. I'd like to see some evidence that they'll even ALLOW the government to negotiate prices.
August 28, 2009 2:19 PM | Reply | Permalink
I'd like to see some evidence of that too. My guess is that they'll pass legislation with a public option, but not allow it to negotiate lower rates, let alone pay medicare rates, (the key to reigning in healthcare costs in the private insurance market as well). Meaning we get to revisit this reform again and again.
August 28, 2009 2:34 PM | Reply | Permalink
You speak of the dreaded emerging consensus dynamic with an... er... authoritative voice.
Thank you, Mr. Reich, for telling it like it is.
Let's end the hand-wringing and get this done.
August 28, 2009 2:35 PM | Reply | Permalink
If the phrase "public option" raises so much anxiety about socialized medicine why can't our Democratic wordsmiths come up with a more favorable formulation? Seems to me there's potential to talk about it as a "not for profit" option analogous to hospital administration; at least this would open the option of highlighting greed and inefficiency as primary drivers of cost in the health insurance industry. More needs to be said also about making health care worker compensation results-driven more than a function of number of procedures performed and providing more incentives for coordination of medical care in keeping with the Mayo model, but shifting the focus of insurance from making a profit to providing comprehensive cost-effective service needs to be the first step.
August 28, 2009 3:51 PM | Reply | Permalink
the Mayo model
Let's backdoor the public option. Apparently, The Mayo Clinic is allowed to cut costs without drawing down the wrath of the Heritagistas.
soit
The National Medical Licensure Bill will federalize previously fragmented state by state ccntrol of medical care providers.
One feature will be the nationally franchised health care deliver corporation.
Like the Natinal Mayo Clinic, which having gone national, will negotiate to become a *favored provider for medicaid and medicare.
*another feature of the NMLB, the possibility for a national franchise to become the exclusive medicaid provider in it's territory, and to get an extra payment of vigorish over its total billing in recognition of the medicaid cooperation.
August 28, 2009 4:42 PM | Reply | Permalink
How about...
Everybody gets Medicare if they want to buy into it, but Grandma gets hers for free.
The public option in a nutshell. Don't even have to come up with a new name for it. Just ask people if they would like to buy Medicare instead of Blue Cross or Humana or Aetna.
August 28, 2009 5:51 PM | Reply | Permalink
Why not
Because Medicare needs to be reformed because it is on track to go bankrupt soon. And it also needs to be reformed away from the fee-for-service model that is one of the main drivers of "money-driven medicine," because with fee-for-service the consumer is in the driver seat and many consumers have this habit of buying certain kinds of medicine that they don't need from providers that are out to make money, sometimes even to their own detriment. The money-driven medicine that is the cause of our health care costs being such a higher percentage of GDP than other coutnries.
At the same time, saying this is still verboten for politicians, because Medicare is still a "third rail" for politicians.
(I don't believe so many seniors are stupidly falling for the "death panels" thing, but what raising that issue is doing is reminding them of other fears; they know Medicare has to change to more managed care and they don't want it to happen on their time on it.)
This is why both of the main Dem presidential candidates health insurance plans, Obama's and Hillary's, were plotted the way they were, to this reality--you can't put more people in Medicare, because if you do so, it will be even harder to do the reforms that are necessary and looming.
If you put more people into Medicare besides the boomers entering it, and then try to reform it, you will be booted out of office and the result will also be an epic fail on behalf of the country. But if we don't reform it, we might as well just get used to the idea of having medical care being like 50% of our GDP.
The health care reform proposals by the candidates were about incremental change, getting people used to the idea of managed care and away from the fee-for-service model, so that the Medicare problem can eventually be fixed without rioting in the streets.
I'm not defending it, I'm simply trying to explain why "they" don't want to do that, including Obama. "They" don't want more people in Medicare, because they really must change Medicare.
BTW, re:
Grandma gets hers for free.
A reminder that grandma doesn't currently get it "for free." She or her husband pays for it during their whole working careers with specific tax deductions for that purpose. Then when they reach Medicare age, under Part A, they get a certain limited number of days of inpatient hospitalization coverage "for free," after they pay a $1,000 deductible. But they do pay a monthly premimum for Part B coverage (non-hospital services,) which is usually deducted from their Social Security check. I won't even go into Part D, the relatively new drug coverage, it's too complex.
August 28, 2009 6:52 PM | Reply | Permalink
I should add that some saw a public option in a plan as hopefully furnishing a positive road map for reform of Medicare, one that wouldn't have voters reacting with "don't you dare touch my Medicare," but one that would suggest instead to people: Medicare should be probably be doing it that way, too.
August 28, 2009 7:04 PM | Reply | Permalink
P.S. Here's some guess-estimate work using Medicare-furnished numbers that puts current actual value of Medicare fee-for-service coverage at about $800-$900 a month for one individual.
It's often argued that widening the pool to more healthy and under 65 would lower that cost. But the more I read on the damage of fee-for-service to our system, the more I doubt that, and the more it seems as cost would stay about the same.
To use a hyperbolic example of the type of thing that could happen with more access to fee-for-service: you could just as easily end up with many doctors having a MRI in his office for every back pain complaint, and both doctors and patients encouraging more use, and MRI manufacturing being the next bubble industry, people getting rich off of that, and moving on to the next medical toys that are "must haves" to both doctor and patient and paid for under unmanaged fee-for-service. This type of thing already happens with Medicare, if you watch late night TV you will see ads for things like "personal mobility vehicles" that are advertised along the lines of "why struggle with that walker? free if we can't get Medicare to pay for it!" Here's the thing about allowing the consumer to make that choice by listening to ads: maybe a walker is better for your particular situation because your muscles won't atrophy.
You could also have doctor providers who chose to be "on assignment" and accept those payments now, because they consider it a form of pro-bono service to the elderly, but end up demanding more when it includes a much larger pool or just going "on strike"--it's not an automatic given that more youth in that pool will make it a more powerful bargainer than it was before, not unless it's a monopoly.
That's without bringing in the point that most are predicting a lot of those with acute illness and those of lower education levels, and the poor with more dangerous and less healthy living conditions to end up in "the public option". If it were Medicare, Without reforming Medicare first, you would have such people accessing a fee-for-service Medicare system without the direction of primary care/gatekeeping. They would be ripe for falling for clinics and treatments and providers of dubious quality, with Medicare unreformed, they would be able to chose those kinds of services, not to mention that reports about abuse of that type and policing that would add to administrative costs.
A public option that is different from Medicare is one way to get around the very difficult problem of necessary Medicare reform.
August 28, 2009 8:14 PM | Reply | Permalink
The reforms can certainly work with best practices boards determining what are reasonable procedures to take for specific problems. I think Medicare reform of this nature can work with an overall evolution of the way the health care industry works as a whole.
I think you call fee-for-outcome vice fee-for-service. That seems to me a perfect metric for the type of services we are talking about and the nature for which they must be paid. Lowering overall costs must be the main motivating factor for all involved because they share in the gains of a stable and predictable system.
This kind of model could be more broadly applied to other necessary services that straddle the public and private spheres.
August 28, 2009 9:18 PM | Reply | Permalink
Thank you for bringing this to our attention.
A few questions:
1. What does "bankrupt" really mean in the context of Medicare, a government program, as opposed to its usage in ordinary life (i.e., more debts than ability to pay) ?
2. What does "bankrupt" really mean in the context of the $1.7 TRILLION dollars of tax cuts for the upper 10% (well, come on, actually most of it went to the upper 1%)?
3. What does "bankrupt" really mean in the context of wars in Afghanistan and Iraq ($1 trillion plus?) ?
August 28, 2009 11:27 PM | Reply | Permalink
I used to use those same rhetoricals myself, until I learned more about the budget and the situation with Medicare and realized that those rhetoricals just looked silly to anyone who really had any power or knowledge to do anything. I'm not going to furnish you links because you can google for yourself if you want to move beyond tired rhetoricals that won't get you anything but an amen chorus. Suffice it to say that this country's budget is mainly Social Security, Medicare/Medicaid/Schip, and Defense (the amount differs so sppreciably little whether we are at war or not,) and then service on the debt. And all the rest, everything else, is relative peanuts. And that there is a CBO report on the Medicare situation you need to read before being able to form arguments that will resound with anyone that matters; the president and Congress have. It isn't just about taxes and government income, it's about our entire economy and whether it's mainly going to be about health care.
August 29, 2009 7:36 AM | Reply | Permalink
"Suffice it to say that this country's budget is mainly Social Security, Medicare/Medicaid/Schip, and Defense"
Considering that defense alone is more than 50% of that total, it seems it should get top billing instead of last place on the list.
Just wondered, anyone know what percentage of the bloated, no-bid military budget would cover the public option if it could be converted to that purpose?
August 31, 2009 10:17 AM | Reply | Permalink
This is all helpful in understanding that Medicare is under pressure, perhaps is sinking, but the fault is not specifically Medicare.
The problem is the Greed Gone Wild nature of for-profit hospitals, "insurers", and drug makers. Maybe we would be unable to get that for-profit genie back in the bottle (the horror -- socialism!), but these corporations should be regulated like public utilities.
There are some countries that provide universal health care while having the various providers still in private hands and even making some money in the process. The secret is regulating them so it is not possible to rob people blind when they are most vulnerable.
Well, okay. I guess we need to re-regulate those public utilities too while we're at it -- undo as much of this little 30-year-long Reagan Revolution that has been anything but a metaphoric "revolution."
The revolution is real and is being televised.
August 29, 2009 11:20 AM | Reply | Permalink
France has fee-for-service and its health plans are not going bankrupt.
Replacing fee-for-service with fee-for-results is therefore potentially useful (Britain's "capitation" payments work quite well), but not necessary.
What we have to do is to end this rather extreme form of "lemon socialism" where the government pays for all the expensive cases, while the private insurers rack in cash from everyone else and provide very little in return.
September 4, 2009 4:09 PM | Reply | Permalink
Lots and lots to think about, here -- Thanks.
Question: What about a Medicare Advantage-type program run inside Medicare (that is, managed by HHS's contractors)? With a reduction in the Part A deductible and the Part B premiums as an inducement to gain enrollees.
August 28, 2009 9:17 PM | Reply | Permalink
I only know enough to think that Medicare Advantage was an idea with potential that got royally fubar'ed by the insurance co. jerks that are participating in it.
Your suggestion would have the benefit of the bigger purchasing and negotiating power. I myself haven't thought through how much that would be for good and how much for ill.
One thing I really do believe strongly is that someone or something better get going on inspiring more doctors to go into primary care.
I don't just believe that on a political level, I've been through enough with elderly relatives and friends the last few years to see the harm that unmanaged care does. The elderly who have a good geriatrician overseeing their care (those are rare birds) are very very lucky. Many of those who are caught in a system of running around wily nily getting fee-for-service wherever they can for whatever ails them at the moment, are not being served well at all, and their younger family members are going through hell trying to figure out if they are getting the correct treatments or are suffering unnecessarily.
For instance, there are an awful lot of elderly on far too many prescriptions from far too many doctors, drugs that are contraindicting each other, causing them to loss their balance, or causing them more harm than good, or even getting diagnosed with senility when they haven't got it. When they go to to see the specialist about their arthritis, he gives them drugs that screw up their GI tract, then the GI specialist gives them supplements because they are not absorbing nutrition that screw up their magnesium balance or whatever so that they start having new problematic systems, meanwhile all of that is all for naught anyways as no one in any of the specialist offices they are going to is doing anything about a simple problem like the too long tube on that oxygen tank that is eventually going to kill them because they tripped on it and broke their hip.
August 29, 2009 8:14 AM | Reply | Permalink
I should probably add an explanation of how I have come to believe the dearth of primary care doctors is partly due to our fee-for-service Medicare system. The highly secretive Medicare RUC that sets physicians' payment rates bears a large responsibility for reinforcing primary care doctors as low status, low power in the system, and that they have much lower income relative to specialists. See this post by Maggie Mahar for more. It has been the case long enough where it is a vicious circle--if you have medical talent, you specialize; that leaves us with not only not enough primary care docs, but with a situation where too many of the ones we have are mediocre, burnt out, or even lousy.
August 29, 2009 8:29 AM | Reply | Permalink
Just keep in mind that "conventional wisdom" is an oxymoron uttered by morons intending to portray themselves as wise.
Wisdom, by nature and definition, is unconventional.
August 28, 2009 7:13 PM | Reply | Permalink
Ah, yes, conventional wisdom arrived at when people think they know the ending and then go back and find the evidence that fits their story and then you get group-think as people reinforce each other.
And then by way of established conventional wisdom we have a 'theory' which allows us to only ask the questions that our theory tells us to ask.
(And then the inevitably degenerating 'spin' takes over partially concealing our meanings from ourselves.)
August 31, 2009 12:22 PM | Reply | Permalink
I have to agree with Reich. I predict Obama will pass healthcare reform with Public Option. He will sign it into law around October, or however long it takes for these things to work. The GOP will sulk into a corner and lick their wounds.
I suppose their next move will be to attack Obama's energy policies. They will fail there too
August 28, 2009 8:01 PM | Reply | Permalink
Thank God for Robert Reich - a tiny breath of sanity and reason in a sea of drama queen bullsh_t and media-manipulated exaggeration.
August 28, 2009 9:50 PM | Reply | Permalink
I have already written you about my redneck friends here in West Virginia that want universal healthcare, not just the public option.
You are correct Mr. Reich. Furthermore, the media and Congress are lagging behind the public on this too.
August 28, 2009 10:46 PM | Reply | Permalink
I know a "conservative" who is liberal-radical on one issue and one issue only:
He's for universal health care.
It's a statistically insignificant lunatic fringe, rewarded by corporations for remaining agreeably stupid, and those corporations, which oppose it.
August 31, 2009 4:32 PM | Reply | Permalink
BRAVO!
BRAVO!
BRAVO!
August 28, 2009 11:08 PM | Reply | Permalink
I'm not as sanguine as Reich regarding prospects for a public option in the sense described in current proposals. However, to maximize the chance of getting it, or some reasonable facsimile, I believe one of the most important Senators to influence will be Olympia Snowe (R, Maine). She is not entirely unsympathetic, and if even a single Republican (e.g., Snowe) votes favorably, the bill becomes "bipartisan" and provides cover for reluctant Democrats to get on board.
I expect she would want some say in formulating the final product in exchange for her vote. Unfortunately, the one person most skilled at fashioning the kind of compromise that works in these circumstances is to be buried tomorrow at Arlington National Cemetery.
August 28, 2009 11:34 PM | Reply | Permalink
Reich's article has a lot of invective for some anonymous White House aide who hypothetically convinced everyone in the media that the public option is dead based on a "half-assed poll." A very fact-based and useful contribution indeed.
Nowhere does Reich layout at an actual political strategy for how the public option would be passed. "Mobilize and organize" is as much a political strategy as telling troops fight hard and tough is a military strategy.
Reich does not address the dead ends that the public option is facing. Less than 45 Senate Democrats have declared their support for it, making even the filibuster difficult. Even with the filibuster tactic, any legislation coming out of it is only valid for 5 years. Given that Democrats will probably lose more elections than they win within 5 years, that's a losing strategy as you have to re-fight the same battle with less strength.
The best bet for Democrats is to compromise. Get what we can out of this and get it on a permanent basis. See if we can get the employer mandate, and the subsidies for the poor who cannot afford insurance. Aside from the pre-existing conditions reform, those are the big issues still remaining. Get together your 59 Democratic/Democratic caucusing Senators, the seat warming senator that will likely come out of Massachusetts, the two senators from Maine, and make a compromise.
Get an employer mandate, the subsidies for the poor so they can get health insurance, the ban on dropping health insurance for pre-existing conditions, and reduce co-pays. Throw your victory flag up and move on to the next bloody fight (Cap and Trade). Be prepared to compromise on that one as well as it has already been dismissed by the Senate once.
You don't get any points for going down in a 1993 Clintonesque blaze of glory. Incremental reform is the Democrats only real option.
August 30, 2009 3:29 AM | Reply | Permalink
of course you are right.
the idea that Obama would take all these hits and allow the damage that has been done to him and the party because he really has some great plan working behind the scenes and will spring it...WHEN??, is fools gold.
August 30, 2009 10:36 AM | Reply | Permalink
It sounds like you are not able to read. Where did I say that this was all part of Obama's master plan? I addressed the shortcomings of Reich's article, and then proposed my own solution. Amazing that you dodged both and attacked a strawman instead. Of course you lacked the honesty to address what I said. You must be anxious to trade in that mountain of fool's gold you have.
August 30, 2009 11:57 AM | Reply | Permalink
"Be prepared to compromise on that one as well as it has already been dismissed by the Senate once."
But, if you (we) don't think 75% of the public should compromise for the profitability of 3% (the other 22% are blind lemmings), then start working to change the faces of your elected officials.
Democracy CAN work, we have seen proof of it quite recently. But we can't stop leaning into it every time an election ends.
If there is one thing we all need to learn from the Bush junta years, it is that we must remain vigilant and pro-active, and should not sit passively by, as they vote for their corporate contributors over their common constituents.
Cheney/Bush proved, all the way back to Bush V. Gore, that politics is a permanent, perpetual event, it doesn't disappear after the election.
August 31, 2009 10:45 AM | Reply | Permalink
Your claims on the profits being made by corporations in the energy sector is irrelevant. What's relevant is being able to pass legislation. You miss the point.
WRT changing the faces of your elected officials, well that poses two problems for you: go ahead and do that, but it would be extremely mistaken for Democrats to be voting down Democratic legislation until that happens and secondly, if you do bring Blue Dogs further left, who says they can still win in their districts?
WRT Democracy, the fact that Democrats representing red states are more conservative than you are does not mean that democracy is broken. Perhaps it means the opposite.
August 31, 2009 12:28 PM | Reply | Permalink
"Given that Democrats will probably lose more elections than they win within 5 years,"
To whom?
I agree, a lot of Democrats (specially the 'dogs) will get beaten in their primaries by more centrist, less rightwing Democrats.
But if you are suggesting the Republicans are somehow gaining new converts with their chaotic teabagging and micro-managed public disorder campaign, I have to disagree.
Maybe there's some hybrid Demopublican party waiting secretly in the wings to make an appearance? Or the Libertarians will suddenly grow exponentially?
Seriously, just WHO do you think Democrats will lose to, if not other Democrats?
August 31, 2009 9:46 AM | Reply | Permalink
"Seriously, just WHO do you think Democrats will lose to, if not other Democrats?"
Santa Clause and his band of elves. Who else?
August 31, 2009 12:22 PM | Reply | Permalink
Without a public option simply legislating a ban on recissions and denials, along with price controls, is not going to work.
We can go ahead and say "now you can't drop people for thus and so", but without some kind of vigorous enforcement and some serious penalties for getting caught the insurance industry giants will just laugh it off. I have seen nothing in the current bills about investing in that kind of enforcement and oversight. If they reason that they can violate the law and only get caught once out of every ten times, it will be in their best interests to continue behaving as they have.
Only if there is real competition from a federally-controlled insurer who will guarantee up front no recissions, no denials, and a reasonable deductible will private insurers be forced to do the same to remain competitive. This is why the Death By Spreadsheet industry is so keen to kill any kind of public option.
August 31, 2009 5:36 PM | Reply | Permalink
The "vigorous enforcement" for banning recisions is called lawsuits and jail time. No public option is needed to sue people civilly and criminally. Insurance CEO's are free to "laugh it off" in jail after paying out millions to each victim.
How do you figure that they only get caught 10% of the time? I'd love to have a law passed outlawing recisions and an insurance company withdrawing coverage for a pre-existing conditions. That's an easy payday for me with a lawsuit.
A combination of lawsuits from individuals as well as state and federal government are a deterrent to breaking any law on recisions, just as the law is a deterrent to any other crime.
August 31, 2009 6:56 PM | Reply | Permalink
If it's a criminal offense who will investigate and punish? If it's a civil matter, how is somebody with massive medical bills going to afford to bring suit?
August 31, 2009 7:21 PM | Reply | Permalink
[QUOTE]If it's a criminal offense who will investigate and punish?[/QUOTE]
The same people who investigate and punish in all other criminal cases: lawyers, judges and jurors.
[QUOTE]
If it's a civil matter, how is somebody with massive medical bills going to afford to bring suit?[/QUOTE]
The same way anyone else affords to bring suit. Attorney's fees are paid out of the proceeds of the lawsuit (typically 1/3 of the proceeds).
August 31, 2009 7:44 PM | Reply | Permalink
Just wondering, how hard would it be for some serious managers (maybe like our friend, Robert) to create a truly independent NON-PROFIT healthcare program that competes within the private sector, just long enough to prove that health insurance, not health care, is the real culprit in our system?
Seriously, if enough doctors and local/state politicians were to organize and promote the idea of a non-profit health insuror, that would drive the big, greedy companies out of business based on the basic model of market competition.
What I am suggesting is a privat sector entity that takes the profit out of health INSURANCE, not health CARE.
Take out the fat cats with a slimmed down kitten, make it economically ponderous for them to stay in business because they can't compete with a non-profit. Then without that greed factor, convert the non-profit into a single-payer, tax-supported system.
The health insurance creeps may be able to use legislation to prevent competition from the public sector, but they can't use it to prevent "us" from using the natural laws of free enterprise to weed out the profiteers.
Personally, I don't have a problem with the medical industry making a profit, as long as it is based on free enterprise and alternatives are allowed to compete in that market.
But the thought that such a huge percentage of the US healthcare dollar goes to insurance company profit, not medical industry profit, should give us pause to wonder at how the book-cookers took over the medical industry.
The other thought I had this AM is that there needs to be full disclosure about who owns HMO and health-insurance company stock, just to see who's playing both ends against the middle. The thought that doctors and/or public officials would be invested in either pharmy or HMO stock suggests a serious conflict of interest, that leads to dangerous results the likes of which we have seen in doctors investing in penicillin production.
Once invested, they prescribed it too often unnecessarily, obviously for no other reason than to increase their profits from their pharmy investments, at the expense of their hippocratic oath.
The results have been devastating, as superbugs had ample opportunity in that milieu to learn to resist the wonderdrugs those physicians were invested in..
Regulation is not a dirty word, it is a public duty.
August 31, 2009 9:38 AM | Reply | Permalink