It is clear that there are power structures including the pseudo-christian mafia running things in this country. They clearly have for some time. I don't know how we managed to get President Obama elected but it's clear that our democratic majority is fairly meaningless. Representatives are not representing the people from what I can see.

We have only the semblance of democracy here. The elite have plundered and robbed us blind stealing our democracy out from underneath us.

And the reality is that without some real leadership, some plan to save or restore our democracy... it is already gone. The insurance companies and big pharma will buy the republicans back into power. All of the money that has already been stolen from us and the weakened economy working against us... what have we left to fight back with. It is a sick story of power hungry, demented, religious thieves doing their utmost to ruin a country.

I am curious why you have no objection to anti-democratic corruption of the constitutionally defined democratic institution (congress), but consider it a threat to democracy when those seeking self-interest influence the never-very-democratic-in-the-first place executive branch?

He sold us out? Oh I see the bill has been passed by both houses of congress and he's ready to sign it into law. That was quicker than I expected.

Seeing as the CBO says under the House bill 96% of all Americans will be covered by private insurance and 4% by the public plan you can look for private insurance companies, forced to compete like they ought to, drive those drug prices down through negotiation, the same way the UAW gets the same deals from Ford, Chrysler and GM. WellPoint: "Why should I pay you that kind of price for Lipitor when BCBS is only paying X?"

They're going to have to because under the new bill they won't be able to just deny drugs to their policy holders or dump the really sick ones onto the public plan. Now if you don't think that'll work then why the fuck did you vote for the clowns who passed the same kind of legislation in the Medicare Part D drug bill?

You're criticizing Obama for playing winning politics by pitting stakeholders like insurance and drug companies, as they try to preserve their own personal fiefdoms against each other, for the benefit of the rest of the country.

And frankly I'm not worried about any of these negotiations. The sausage isn't seasoned yet let alone in the tube. House leaders aren't going to let the likes of Baucus and Enzi decide the fate of this bill.

“Politicians are a set of men who have interests aside from the interests of the people and who, to say the most of them, are, taken as a mass, at least one long step removed from honest men”

Abraham Lincoln

Thank you very much for saying this and for saying it so well.

Guess I'm not a puritan

I take the 150 million in adversting - actually 300 million because they'd run the ads against you - and run

Deal with the problem in separate legislation...Lotsa time to fine tune

What dream world have you been in? Democracy?
Democracy is and has always been an illusion in order to make the common people believe it had control.
We live in a Republic, where the rich property owner, where the wealthy elite are the kingmakers.

In the event the peasants should somehow bring up, from its grass roots someone unlettered, the elites will always have the final say with the Electoral College procedure.

The American Revolution was going to happen, in response to Englands atrocities.
Who would eventually control in the aftermath, was essential. Lo and behold monied interests eventually got a hold of the reigns; again.

1905 Fellow workers, this is the continental congress of the working class. We are here to confederate the workers of this country into a working-class movement that shall have for its purpose the emancipation of the working class from the slave bondage of capitalism. “Big Bill” Hayward, at the founding meeting of the Industrial Workers of the World (IWW).

1908 Competition was natural enough at one time, but do you think you are competing today?.... Against whom? Against Rockefeller? About as I would if I had a wheelbarrow and competed with the Santa Fe (Railroad) from here to Kansas City. Eugene V. Debs, Socialist Party candidate for president in 1908.

Big pharma or big insurance

1906 The greatest single hold of “the interest” is the fact that they are the “campaign contributors.”... Who pays the big election expenses of your congressman, of the men you send to the legislature to elect senators? Do you imagine those who foot those huge bills are fools? Don’t you know that they will make sure of getting their money back, with interest? David Graham Phillips, in his article, “The Treason of the Senate”

Politics or sausage making?
1906 There was never the least attention paid to what was cut up for sausage.... There would be meat that had tumbled out on the floor, in the dirt and sawdust.... There would be meat stored in great piles in rooms; and the water from leaky roofs would drip over it, and thousands of rats would race about on it.... These rats were nuisances, and the packers would put out poisoned bread for them, they would die, and then rats, bread, and meat would go into the hoppers together. Upton Sinclair, description of sausage-making in his muckraking novel, The Jungle.

Robert, You are both too cynical and not nearly cynical enough.

That our democracy is in serious trouble should be a given. The table, chairs and meeting room are owned by the insurers and pharma. You of all people know this.

Given that, it seems to me that Obama needed to divide the opposition, and between big insurance and big drugs, he surely made a better choice in allying with pharma.

The Presidency and Congress have little power against the industries of America, including in healthcare. Can they really do more than back one of them against the other? Just where do you think Congress, and Democrats in particular, will get the money they need for re-election. If you look at patterns of donation I think it is safe to say that big insurance is the Republican/Blue Dog industry, and the core Democrats are more big pharma types anyway. So Big Pharma is a logical ally.

Now this means that Obama has decided to go for coverage first, and cost control ... later, or someday. Given the state of our economy that's not a bad stimulus policy. Once we do get near universal coverage, both in practice and established institutionally as a principle and political expectation, that will be time to start squeezing. The deal with Pharma isn't forever.

Now I'm surprised to find myself justifying Obama's choice here... I consider myself a hard core leftist, favoring single payer. But I'm also a hard core realist, and I've learned how pathetic the political establishment is in relationship to the power of the medical industrial complex. It literally lacks any serious domestic political power without some kind of industry support.

So this is the sellout, and it seems like it is almost how it would have to be. I'm way beyond disappointment in Obama, or disappointment in the failure of any kind of progressive single payer plan. I'm trying to figure out if there is any way that Obama could possibly salvage anything good for my family, which can barely afford our insurance.

I can easily see how selling out to Pharma is the only way the Obama administration would stand a chance against the Insurance industry.

When will it become standard practice that such deals come with hundreds of millions of dollars of industry-sponsored TV advertising designed to persuade the public that the legislation is in the public's interest?

It's a close call I have to admit

1) levitra ads
2) health care ads
3) Avodart

At my age, I vote for #3

Anyone who thought Obama wouldn't be making these kinds of deals is either illusional or delusional. This *is* American capitalism, after all, and he is its political leader. In the absence of a major labor uprising that raises the issue, the chance of getting universal health care in or about the current context is about the same as Reich becoming Pope.

Most of the problems people have with Obama's actions is based on a misreading of Obama. If you studied his position papers leading up to his election nothing that has happened would be a surprise to you. Obama is a middle of the road, compromising, politician, who favors incremental improvements, and making the smallest changes possible to show some progress. He is not anti-war, is not against the bloated munitions industry, does not oppose pork barrel politics, is friends with lobbyists, etc. He did not promise to reduce the size of the military establishment, but to increase it! He didn't promise to shut down the Afghanistan conflict, but to escalate it. He didn't promise universal health care, and especially not single payer health care, but a group of small changes, the biggest of which is mandatory purchase of commercial insurance by everyone.

Perhaps more people should have read his position papers. Then again, when you have a President like Bush, and a Repub candidate like the old timer, with a choice between centrist Clinton and centrist Obama, it isn't like we could try to elect a real liberal. We probably got the best deal that was available when we elected Obama, just as we will get the best deal available when we are all forced to buy private health insurance in return for everyone being covered.

Secy Reich - I am not happy about this deal but as a then staff member to a junior Democratic member of Congress I also had a front row seat to the Clinton Health Reform effort as both a member of the Health care Task Force and the chief health aide to my boss who was on a House committee with jurisdiction and reported a bill.

In 1994, both Big Pharma and Big Insurance worked to defeat health reform. They were basically the trojan horse that the rest of the health care industry used to defeat those efforts.

Changing health care is tough not just because of the campaign contributions but also because of the jobs involved (tens of millions nationwide). For example, you may hate pharma companies but if you represent NJ you have to listen to them b/c they employ close to a hundred thousand people. The biggest employer in our district was a hospital system with 11,000 employees. Imagine how powerful it was when they came in and told us that if health reform in this form it will result in a 10% jobs loss. We listened and agreed to help change parts of the bill to help them but not to oppose them.

I am disgusted by details of the deal but it is smart politics. Obama has succeeded in basically isolating Big Insurance which is quite a feat politically and why he is likely to succeed where Harry Truman, Richard Nixon and Bill Clinton all failed.

The opportunity to provide universal coverage comes along every 15-20 years and each time we let it pass without action the number of uninsured rises dramatically (it was 37 million in 1994 when Clinton Health Reform failed).

My number 1 goal is to provide coverage for the 50 million people who do have health insurance today and to provide a regulatory framework that protects people in private insurance. I'd love a single payer system or a public option but I am not willing to scuttle an imperfect bill in favor of a perfect one that will probably take another 15 years to come about.

I highly recommend today's NY Times editorial (link below) that shows that Massachusetts tackled the uninsured first and is now going to start addressing cost. I think they got it right.

http://www.nytimes.com/2009/08/09/opinion/09sun1.html?_r=1&ref=opinion

DeMint might be right. Healthcare may be Obama's Waterloo, not because healthcare isn't passed, but because it is passed. If he gives big pharma carte blanche to charge whatever they want and then gives the insurance industry 50 million new customers with no competition from a public plan, corporate America wins and the people are more shafted then before reform began. Frankly, beyond disgust does not even begin to describe my emotions. I am telling my kids to look to careers outside the U.S. as the quality of life, education and healthcare all surpass this country. I worked for Obama and have supported the Democrats, but only an idiot would continue to support a Party than continually caves.

"our democracy is in terrible shape".

Sad but true.

Obama should fire whoever sold him on this awful deal. Americans subsidize drug prices for the rest of the world. Pharmaceutical Companies got insurance against having to sell drugs at negotiated prices, just like Citigroup and AIG were rescued with government bailouts they won't have to pay back.
The Obama administration has only given us "reform" which corporate America signs off on. The banks got bailouts but avoided cram-downs, real regulation, and can still gouge credit card holders. The Democratic Party retreated without a fight for eight years, Obama hasn't shown us when he will stand up to corporate America.

We now regularly encounter this submissive behavior on the part of U.S. administrations. Is it possible that a group of large corporations, such as the pharmaceutical industry acting in concert, is actually more powerful, in certain respects, than the government of the United States?

It seems hard to believe that the pharmaceutical industry has quite that much power. Yet why else would the Obama administration give in to such an outlandish demand as "no price negotiation"?

Maybe Obama believes that such a commitment (not to negotiate prices) could not be enforced or even precisely defined. The government plan will inevitably maintain a list of drugs eligible for reimbursement, or at least a list of recommended drugs. In most situations, there are two or more choices between alternative drugs for a given medical problem. Take a drug off the recommended list, and the pharma company won't sell as much of the the stuff. So the government might be able to bargain about prices without actually saying or doing anything.

Just the implicit possibility of taking a drug off the recommended list might give a pharma company incentive to offer a lower price.

I appreciate the realistic comments here. I get the feeling that some people think Obama should accomplish everything in this one bill, and if he doesn't get it all then he's a failure. They don't want a president, they want a miracle worker.

I voted for Obama because he's a pragmatic strategist not an ideological egotist. He will get us competitive health insurance options, and that's what our family urgently needs to hold onto our insurance. And if that means he had to dance with one of the devils for a short time, than I am grateful he held his nose and did it.

Obama has managed to get almost every powerful interest group behind him on this huge, social-altering issue.

There is only one way to ensure Universal Health care for all.

Public financing of elections.

It is the only way to keep elected officials beholden to the people.
Otherwise, why would they listen to us ?

Drug makers are akin to doctors and hospitals -- people who make too much money in health care.

But they are different than insurers, who basically make money by bilking people with premiums and then denying coverage as much as legally possible. Insurers are killing people.

I still think Obama needs deals with key players, otherwise this will never pass. Reich has no plan for getting this passed either. So what are we left with? Do nothing and let's wait a few more decades??

"I've been dealing with the drug companies for many years. They have never lost. They're the Rocky Marciano of lobbyists. They never lose, never, zero. That is why they can double the price of your prescription drugs tomorrow. That is why they manage to get the Medicare Part D bill through that they wrote. That is why they pay their CEOs tens and tens of millions of dollars. That is why we don't negotiate prices with drug companies. They never lose. The insurance companies may occasionally lose, but they're also very, very powerful." - Senator Bernie Sanders