The Public Option's Last Stand, and the Public's
I would have preferred a single payer system like Medicare, but became convinced earlier this year that a public, Medicare-like optional plan was just about as much as was politically possible. Now the White House is stepping back even from the public option, with the President saying it's "not the entirety of health care reform," the White House spokesman saying the President could be "satisfied" without it, and Health and Human Services Secretary Kathleen Sebelius saying that a public insurance plan is "not the essential element."
Without a public, Medicare-like option, health care reform is a bandaid for a system in critical condition. There's no way to push private insurers to become more efficient and provide better value to Americans without being forced to compete with a public option. And there's no way to get overall health-care costs down without a public option that has the authority and scale to negotiate lower costs with pharmaceutical companies, doctors, hospitals, and other providers -- thereby opening the way for private insurers to do the same.
It's been clear from the start that the private insurers and other parts of the medical-industrial complex have hated the idea of the public option, for precisely these reasons. A public option would cut deeply into their current profits. That's why they've been willing to spend a fortune on lobbyists, threaten and intimidate legislators and ordinary Americans, and even rattle Obama's cage to the point where the Administration is about to give up on it.
The White House wonders why there hasn't been more support for universal health care coming from progressives, grass-roots Democrats, and Independents. I'll tell you why. It's because the White House has never made an explicit commitment to a public option.
Senator Kent Conrad's ersatz public option -- his regional "cooperatives" -- won't have the scale or authority to do what a public option would do. That's why some Republicans say they could buy it. What's Conrad's response? "The fact of the matter is there are not the votes in the United States Senate for a public option. There never have been," he tells "FOX News Sunday." Conrad is wrong. If Obama tells Senate Democrats he will not sign a healthcare reform bill without a public option, there will be enough votes in the United States Senate for a public option.
I urge you to make it absolutely clear to everyone you know, everyone who cares about universal health care and what it will mean to our country, that the bill must contain a real public option. Tell that to your representatives in Congress. Tell that to the White House. If you are receiving piles of emails from the Obama email system asking you to click in favor of health care, do not do so unless or until you know it has a clear public option. Do not send money unless or until the White House makes clear its support for a public option.
This isn't just Obama's test. It's our test.
"...regional "cooperatives" -- won't have the scale or authority to do what a public option would do."
- I wish someone would explain clearly why not.
My understanding is that the co-ops would get such a giant infusion of tax-payer start-up money that they would be a public option in everything but the name.
August 17, 2009 12:48 PM | Reply | Permalink
Apparently, the man never heard of Fannie or Sallie or Freddie. Odd, given what he does for a living.
August 17, 2009 1:41 PM | Reply | Permalink
I wonder if we could get to the real heart of the matter. How can we get corporate money out of politics? Until we can do this, we won't be able to reform anything in any meaningful way.
Who says corporations are people? Who says money is speech?
How can a system now dependent on corporate money wean itself off?
If we don't tackle these questions, our Republic is doomed.
-- ARG
August 17, 2009 3:48 PM | Reply | Permalink
Vote in primary elections in higher numbers than the pathetic 16% average we have today. The only thing louder than the sweet tinkle of corporate coins is the woosh of air when an incumbent is sucked out of Congress.
We will see just what lessons we have learned these last decade or so by how many people turnout for primaries this year. What comes next? The "almost record" primary turnout of the 2008 election or the dismal 15% of the 2006 primaries? Or something totally unexpected perhaps.
Whatever the case, until the majority of voters in both parties wake up, the Republic remains doomed to Celebrity Death Match by its fringes because they are the only ones interested enough to turn out more than once in an election season.
August 17, 2009 4:19 PM | Reply | Permalink
Brevity is the soul of eloquence. Congratulations on getting to the heart of the matter in so few words. Sorry about the blather that follows.
The speech=money fallacy as law has been in place for over thirty years. Most of the politicians holding elective office have been elected in the interim. They and the remaining holdovers are all people who excel at raising funds for re-election in this system. As such they are poor candidates to reform it from within.
Bush was allowed to appoint two Supreme Court Justices whom I would call reactionary dogs if I didn't have such respect for canines. So unless Scalia and Kennedy retire and/or die in the next 42 months, the Supremes will never reverse the rulings that created the mess. It's a terrible act to pray for another human being's death.
Structurally, the situation looks almost hopeless.
I once read an essay by Robert Graves, who attributed Rome's expansion and subsequent decadence to an analogous incurable structural
flaw:the institution of the Triumph and competition among the noble families to accumulate Triumphs. If they realized the situation, they couldn't find a way out of it.
Lastly, you'll notice that none of the bloviation which follows your cri de cour (sp?) addresses it in any meaningful or penetrating fashion. Conflict and argumentation over minutiae is much more entertaining. The reward for penetrating underneath the surface to the heart of a matter is, often, to be ignored.
On the other hand, if the power elite is alert, ruthless, and unrestrained by a framework of laws, the penalty can be imprisonment, torture, and death.
August 17, 2009 10:57 PM | Reply | Permalink
I don't think we know exactly how the cooperatives are going to look, but I believe it's clear that there would be many small ones, as opposed to a single, larger, public plan. I also believe I've heard that they would be barred from bargaining collectively.
August 17, 2009 1:46 PM | Reply | Permalink
I don't understand why Obama doesn't just sign an executive order allowing Medicare to sell, at cost, insurance to the unisured as a "temporary emergency" measure for American's without health insurance.
Call it, "Medicare-for-sale."
He'd be stealing a page from Bush's 'unitary executive' doctrine, to do it. Bush did a lot of awful things using executive orders.
Since it's revenue neutral it won't need congressional authorization, Liberals can stop any attempt by conservatives to thwart it legislatively, and the supreme court won't get involved because its a political question.
This would alter the bargaining power by which Obama is trying to get health reformed passed. If it never passes, then the 'temporary emergency' measure stays in place, indefinitely.
If liberals can muster larger majorities, they can provide incentives to get employers to pay for half, and subsidies for the poor.
At that point, Obama will have won by crook what he couldn't get by hook.
August 17, 2009 2:52 PM | Reply | Permalink
Because something like this has never been offered by the democrats. It would have worked beautifully as a way to "reform" Medicare and likely would have had bipartisan support. I have been suggesting this for weeks, but it doesn't change the need to have the rest of the suggested reforms passed as well.
August 17, 2009 3:07 PM | Reply | Permalink
Well, that and the small matter of its being ILLEGAL.
August 17, 2009 4:23 PM | Reply | Permalink
It's not illegal. It's a public program managed by the executive branch that can be changed via legislation crafted in Congress.
August 17, 2009 4:30 PM | Reply | Permalink
The Federal government can't simply start offering Medicare to everybody any more than they can just offer VA coverage or federal employee coverage to everybody. The age cutoff is part of the Medicare law.
August 17, 2009 4:42 PM | Reply | Permalink
Did you bother to read what I actually wrote? I said Congress could offer legislation to amend Medicare as part of reforming the system by bringing in younger plan participants and making the overall population much less expensive to insure.
House democrats offered Medicare-for-All as the basis for single payer system that would replace the existing system rather than putting forth Medicare-for-More to reform the existing public option that needs the help and already enjoys wide-spread grassroots support in both parties.
That is the difference between playing checkers and chess when it comes to politics.
August 17, 2009 4:52 PM | Reply | Permalink
So the remaining question is: Who is in the "More" group in the "Medicare for More" program, and how do we decide? In other words, who is eligible?
Obviously, if it truly would have bipartisan support, then no exec order is needed and it's a really simple fix, accomplished in a few pages at most.
Somehow, though, I don't share Jason's faith that it would have bipartisan support. Two reasons: (1) it would improve the lives of Americans under a Democratic administration, which, as demonstrated by recent history, is more than enough reason for Republicans to oppose it (in that it would improve future Democratic electoral odds); and (2) it could threaten insurance industry profits -- which probably would lead to bipartisan opposition.
August 20, 2009 12:17 AM | Reply | Permalink
Medicare-for-More is all those people the insurance companies won't insure now, so it will hardly eat into their profits.
The problem is and remains wanting to institute new programs when the existing ones can be modified to provide the same benefits while at the same time fixing a program that everyone loves and is quickly on its way to insolvency.
Forgive me if I think that more partisan warfare is not the way to get this legislation passed, let alone having it be successful. A smarter strategy that would have flanked the GOP idiots in Congress and went right to the grassroots would have been effective.
Instead, the message has been so muddled and misinterpreted that you have people at townhalls telling them to keep their hands off Medicare with one breath while they rail against "socialized medicine" with the next. Rather than modify the messaging or the solutions, democrats insist it is the audience who is to blame and go even more partisan as if that has ever solved anything.
I am not a fan of doing more of the same shit that hasn't worked in decades as if this time will be the one that finally works. Time for some new strategies.
August 23, 2009 6:25 PM | Reply | Permalink
mans_best_friend is probably correct that this sort of thing can't be accomplished by executive order, although there might be some wiggle room if the order wasn't directly contrary to statute.
It would, otoh, be simplicity incarnate for Congress to do it.
Simple, yes. Easy -- hardly.
Even leaving aside the political hurdles, I think the particular devil in these particular details would be figuring out what "at cost" would mean.
But it would be far and away better than the Byzantine bills currently plodding through Congress.
Or we could, perhaps, just take a fresh look at this approach. Which might not be all that different.
August 19, 2009 1:38 AM | Reply | Permalink
Because they end up being too small when broken up regionally in proportion to the competing interests in those regional markets. It's been tried. Check out California's attempt for an example of how this approach fails to appreciably impact the market.
August 17, 2009 1:53 PM | Reply | Permalink
I'm a member of a credit union, owned by several hundred members. It's very small, but my mortgage interest is the envy of everyone I know, without a single exception. So is my interest on the savings account. And credit cards.
I would fight republicans tooth-and-nail if they wanted to eliminate credit unions but I don't see why they would even object to them.
An advantage of coops could be their ability to organize based on conditions (I'm not sure if it's possible though). For example, a coop for non-smokers would be able to extract significantly lower rates than smokers.
Plus, the rules would be written by the government.
Plus, the startup money comes from the government.
I seriously don't understand the problem here, apart from "public option or death" slogans.
August 17, 2009 2:01 PM | Reply | Permalink
Here is the nub: The reason why there may not be a public option is that Blue Dogs and Repubs do not want the government competing against the for-profit health care companies. Cooperatives will be offered BECAUSE they won't work. That is the whole point of eliminating the public option: To ensure that the U.S. health care system remains a for-profit system controlled by Big Money.
August 17, 2009 2:38 PM | Reply | Permalink
OK. Why do the coops not work? What's preventing them from working well?
August 17, 2009 2:42 PM | Reply | Permalink
How 'bout you first explain why coops will work well? Until someone makes a good case for why coops will work, I don't see why we need to prove they won't work . . .
As far as I can tell, Conrad and Grassley don't even understand how a coop will work, never mind whether it will work well.
August 18, 2009 12:02 AM | Reply | Permalink
It is semantics as far as I can tell. The "public health exchanges run by the government" will become "nonprofit coops regulated by the government" and both party's fringes should be happy because the same foundation will be used for both.
The only difference is in how the programs are administered. Sort of how Sallie Mae manages all the various and sundry private lenders who fulfill Uncle Sam's guaranteed loans for students or Fannie Mae does the same with mortgages.
That's why it seems self-defeating to me to get too pessimistic before the particulars of the "new" programs coming out of committee are known.
August 18, 2009 10:25 AM | Reply | Permalink
Good heavens. What a ridiculous comparison. A credit union loans you the money directly. It's not negotiating rates with someone else.
If you want a good example of why coops won't work, just take a look at insurance companies themselves. They negotiate lower reimbursement rates with doctors and other providers within their network. Just look at the statement you get when they pay the bill. The paid amount is less (sometimes considerably less) than the billed amount. Larger insurance companies have the most leverage and negotiate the best rates. Small insurance companies have no leverage and can't negotiate discounts (which is why most small insurance companies are out of business). Coops will be like small insurance companies - too little leverage to negotiate better rates and doomed to fail. Which is the whole point.
August 17, 2009 2:54 PM | Reply | Permalink
"A credit union loans you the money directly."
- That's not true, at least in my case. My credit union negotiates and my loan was financed by a different bank.
Secondly, your idea about leverage seems a little bit exaggerated to me. I'm sure there is significant leverage that can be obtained through size.
But I think your expectations of how far this leverage could go are a little bit ouside of reality. There is only so much the doctors would be able to give up - and most of that would probably be built-in "cushion" meant to be given up anyway.
August 17, 2009 3:08 PM | Reply | Permalink
For a recent operation, the bill was $30,000. My insurance company paid $10,000. The bill was paid in full.
That is the leverage of a large medical insurance company.
It also points out how inflated the prices are for uninsured medical services and explains why people without medical insurance are going bankrupt.
.
August 18, 2009 9:05 AM | Reply | Permalink
It's because the largest and most expensive population to insure - all 98 million of them - negotiate bargain rates and only pay 80% of the billed amount.
Most providers know that will never be paid without some sort of supplemental plan which most Medicare/Medicaid patients can't afford, so they pass the delta on to the private insurers, who negotiate downward while the provider rights off the difference as a loss.
It's really quite simple when one takes a 10,000 foot view. Too many people are allowing too many problems to go unaddressed, both in the public and private health sectors.
August 18, 2009 10:30 AM | Reply | Permalink
Hey now . . .
Welcome to the world of the Black Cat in the Hat's pretzel logic.
And be forewarned: If the Black Cat in the Hat says it, it follows that that's the only reality there is.
Just ask the Cat . . .
~OGD~
August 17, 2009 5:44 PM | Reply | Permalink
Does your credit union accept new members with FICO scores below 800? Just curious, as you suggest a coop for smokers and a coop for nonsmokers. How about a coop for obese people and another for slim people? A coop for people with high blood pressure and another for those with excellent blood pressure? Your system sounds just like the very fine health insurance system we have now.
August 17, 2009 4:43 PM | Reply | Permalink
"Just curious, as you suggest a coop for smokers and a coop for nonsmokers."
- Oooh, I didn't realize that you were against sin taxes on cigarettes and other wonderful measures to alter human behavoir. My bad.
August 17, 2009 4:59 PM | Reply | Permalink
Don't let your hatred of smokers make you miss the point of universal health insurance. The point is: We should insure everybody, not just the people we like, or the people who are virtuous and healthy. There are reasonable ways to alter bad behavior, but gouging the unapproved for health insurance is not a moral means of doing it. That's Aetna's way.
August 17, 2009 5:33 PM | Reply | Permalink
LOL. I am a smoker and I don't hate myself at all.
August 17, 2009 5:40 PM | Reply | Permalink
Well, dammit, then don't suggest a "coop" to discriminate against you.
August 17, 2009 6:17 PM | Reply | Permalink
You're missing my point completely, but perhaps this is the wrong thread.
August 17, 2009 6:27 PM | Reply | Permalink
I'm starting to think your icon is an homage instead of a slam.
August 17, 2009 6:35 PM | Reply | Permalink
Well, I gave you a real world example that doesn't work. You gave me an apples/oranges anecdote about your credit union. Look at my example if you want, but cut the crap with the "I just don't understand, why won't someone explain it better" nonsense.
In other words, you asked why co-operatives won't work so I tried to show you why. You responded by talking about balogna sandwiches. You either don't really care about or aren't willing to believe the salient facts.
August 17, 2009 6:53 PM | Reply | Permalink
No, you just dismissed my question with a missive to "check out" California.
So I'm doing that now.
Back soon. Ta ta.
August 17, 2009 7:10 PM | Reply | Permalink
I assume you can research the failure of California's health insurance cooperatives on your own, but gave you the explanation for why they failed in a nutshell. Feel free to look it up or don't. Unless, that is, you need me to spoon-feed you links in another tawdry missive.
August 17, 2009 8:37 PM | Reply | Permalink
If you have them handy, it would save time. Otherwise, I'll look them up on my own. No biggie. Thanks for heads-up anyway.
August 17, 2009 9:46 PM | Reply | Permalink
You wouldn't 'understand' it unless you heard it reported and repeated umpteen times on Fox News Lalo.
August 17, 2009 1:57 PM | Reply | Permalink
Insurance-company shares jumped on news that there might be no public option, Lalo.
That's the free market speaking. It's saying it believes the industry's obscene gouging will continue unabated under co-op-based "reform."
August 17, 2009 2:55 PM | Reply | Permalink
The entire idea -- which Obama has stated a million times -- is to get the public sector (with all its advantages and disadvantages) to compete against the private sector. Republicans and Blue Dogs are unalterably opposed to that on an ideological basis. If cooperatives worked, Republicans and Blue Dogs would oppose them. Simple as that. We know where the Blue Dogs and Republicans stand? What about our president? And exactly who is the boss anyway? You mean to tell me that a newly and decisively elected Democratic president cannot command fealty from his own party's senators on the signature issue of his administration? If that is so, then Obama is finished. And the Democratic party is finished, too.
August 17, 2009 2:47 PM | Reply | Permalink
"get the public sector (with all its advantages and disadvantages) to compete against the private sector. Republicans and Blue Dogs are unalterably opposed to that on an ideological basis.
Bullshit - Republicans and Blue Dog Democrats are opposed to it in order to keep getting massive campaign donations (bribes) from the medical insurance industry. That is their ideology.
.
August 18, 2009 9:11 AM | Reply | Permalink
Well, that too.
August 19, 2009 7:50 AM | Reply | Permalink
I thnk this is a fair, though quick, take on why co-ops won't have any impact (and an historical look at them bears this out). Huge insurance cos. have divided up the country and only a national competitor will break Goliath's stranglehold.
As Dr. Shriver points out, Medicare provides an existing infrastructure to build on. Everything is in place. If we are going to fork over taxpayer money to build non-profit insurance, why not use what we've already spent $billions building up? Both efficiency and economy of scale are built into Medicare.
The Dr. also feels that a public option would not eventually lead to a single payer system (or national insurance cos. going non-profit), which is disappointing to me. My hope is that, if a public option were enacted (someday), it would be a Trojan horse to national health care.
As Obama has pointed out, it's been almost a century since Teddy Roosevelt (1912 campaign) first proposed national health care (along with his other progressive reforms including social security). Just think, that was at a time when going to a doctor was just as risky as staying in your filthy slum!
When it came up again a few years later the AMA turned against it and has, together with the other medical industries, successfully killed it for most of a century under the likes of T.R's cousin, FDR, Truman, Ted Kennedy, Carter, Clinton (Wellstone), etc.
August 17, 2009 8:03 PM | Reply | Permalink
Thanks Don, it's very interesting.
Having read this:
http://prescriptions.blogs.nytimes.com/local-cooperatives-will-not-work-in-rural-america/
i get a pretty good idea why Republicans are already on the record opposing cooperatives (a national cooperative as a version of the public option).
August 17, 2009 9:44 PM | Reply | Permalink
Yes, the differences between urban and ultra-rural scenarios is an important point concerning co-ops. But so much of this depends on not just how they would be set up, but how they would evolve (or devolve). Co-op is an amorphous term. You could even have a public option, one based on Medicare infrastructure, but divided up into regional 'co-ops' (the difference being that there would be some reliance on direct revenues, beyond the start-up funds, to the co-ops as opposed to taxes funding a public option (if that makes any sense).
My company went to BCBS last year (the original non-profit insurer) and our coverage went down , deductibles and co-pays up, and many prescription prices skyrocketed). 30% of health care costs are administrative. This is ridiculous.
To me, it still comes down to what we are going to do about Big Pharma and Big Insurance that are praying on the misery of American workers (particularly low-income workers). How can we justify subsidizing them with plans like this while pharmaceutical cos., for instance, sell their drugs cheaper to other countries? Are they too big too fail?
August 17, 2009 10:25 PM | Reply | Permalink
I'm going to learn more about this. In fairness, though, the paragraph you cite can be read both ways:
- profit motive doesn't seem to be the cause of all evil
- regulatory barriers to entry
- difficulty of building provider networks in the face of most-favored nations clauses
- other barriers to competition
Perhaps an adjustment to the overall field of health insurance regulation, putting coops and private insurers into a level playing field could address some of this.
August 18, 2009 8:06 AM | Reply | Permalink
You're right, Lalo, you could come to completely different conclusions from looking at this. I think health care is a different animal from any normal business. Phizer can charge whatever it wants for a certain drug because the patient has to have it to live without pain or to live, period. There are no governors on the system. The profits (much of which is hidden) that insurers, pharma, HMO's, etc. are reaping on people's misfortune are obscene. It seems to me that anything less than a Federally-run program that has a mandate to lower costs all around (especially administrative costs, hence the need for a national economy of scale) is going to be the only way to force change, MHO.
August 18, 2009 4:50 PM | Reply | Permalink
Is there a cure for political cowardice of the kind we see in Washington on healthcare Prof. Reich? Is there any issue that the Democrats in DC won't sell out on?
August 17, 2009 12:55 PM | Reply | Permalink
rhetorical question, unfortunately.
The way career politicians look at it, the only constituency that Washington is willing to sell out is average Americans.
Otherwise, they have an excellent record.
August 17, 2009 1:03 PM | Reply | Permalink
I don't know where else to ask this question, so I'll have to ask it here and hope that someone can answer it.
When Republicans say that Obama wants to cut Medicare by 500 million, what precisely are they talking about?
August 17, 2009 1:06 PM | Reply | Permalink
Efficiency improvements. NOT benefit cuts. And 500 million is just a big number for Republicans to throw around. It's a fraction of a percent of the total expenditure.
August 17, 2009 1:44 PM | Reply | Permalink
could you explain that a little more?
August 17, 2009 2:36 PM | Reply | Permalink
I'll defer to The Man himself:
http://bulletin.aarp.org/yourhealth/policy/articles/obama_fields_tough_questions_on_health_care_reforms_at_aarp_tele_town_hall.1.html
August 17, 2009 3:09 PM | Reply | Permalink
Here's the phrase that pays.
"Right now we’re paying about $177 billion over 10 years to insurance companies to subsidize them for participating in Medicare Advantage [private health plans, such as HMOs, offered as an alternative to the traditional Medicare program]. “Now, insurance companies are already really profitable. So what we said is, let’s at least have some sort of competitive bidding process where these insurance companies who are participating [in Medicare] are not being subsidized on the taxpayer dime.”
Democrats call them cuts to insurance company subsidies.
Republicans bend that truth beyond recognition by calling it cuts to Medicare.
Dishonest F---S!
August 17, 2009 3:49 PM | Reply | Permalink
The Republic of Corporations - no longer "of citizens".
August 17, 2009 1:07 PM | Reply | Permalink
When was it ever?
August 17, 2009 1:42 PM | Reply | Permalink
When?
Apparently, sometime previous to Mister Bluster being squeezed out his mother's birth canal.
I'm sure he remembers that.
~OGD~
August 17, 2009 5:36 PM | Reply | Permalink
Apparently sometime previous to the Revolutionary War, a time the duck remembers well.
August 17, 2009 5:46 PM | Reply | Permalink
Thank you for this.
The progressive Caucus in the House must defeat a bill without a real public option.
Yesterday was the death of hope and trust.
August 17, 2009 1:21 PM | Reply | Permalink
"death of hope and trust" ?
Wow, that's truly elevating Obama to mythical proportions.
Obama is one person, working in a hornets nest.
It's disingenuous to suppose that the extent of our President's influence is representative of his intentions. He's not omnipotent.
The death of hope and trust takes place in your own heart. Overcome that cynicism you become an agent of hope and trust, and you move the ball one step closer to the goal.
August 17, 2009 1:32 PM | Reply | Permalink
ghaon, I agree with some of what you have to say except that Obama has the bully pulpit and he can certainly influence if not sway some power over the evening news cycle and he is not at all forcefully out there advocating for a strong public option. He has handed this off to Congress without leadership. That is a recipe for sellouts like Baucus and Conrad to hand healthcare over to the healthcare industry. Any reform without a strong public option with be a cash cow for the industry and worse than the same for the consumer. I spoke with my "good" Senator's office this morning. Please, everyone, call your Senator's and reps and implore them to demand a public option. I am still trying to reach my lousy Senator.
August 17, 2009 2:35 PM | Reply | Permalink
Absolutely correct. I have also called my senators and my representative but, you know what, there is only one president. Where the HELL is he?
August 17, 2009 2:40 PM | Reply | Permalink
Simple answer . . .
Fax the President at the White House
202-456-2461
~OGD~
August 17, 2009 5:50 PM | Reply | Permalink
Thanks, ghaon. The United States Senate, one of the Founding Fathers' worst ideas ever, has defeated progressive presidents at least since the Civil War. To blame Obama for the existence of well-fed hacks like Chuck Grassley and Max Baucus is more than a tad unfair. All we can do --- and we're the only ones who can do it --- is work to defeat the Repub douchebags, primary the Dem douchebags, and harass all of them in the meantime.
August 17, 2009 4:54 PM | Reply | Permalink
Correct. It is our test. Not only Obama's.
The fact that we're even talking about Health Care and the public option is proof that Obama has come good on his end on the deal.
He's pushing for it, but his capacity to negotiate for the public option is completely proportional to the ruckus being stirred up by Obama's supporters.
Citizens make themselves such.
August 17, 2009 1:24 PM | Reply | Permalink
One of the ways was to reduce fraud in Medicare. It is huge, apparently. One stated was that if hospitals screwed up a surgery, they paid for the do-overs, not Medicaid. Small help, but it's all i have.
August 17, 2009 1:30 PM | Reply | Permalink
Excellent comment and analysis. Would that these words came from the man I busted my butt for to get elected president. Unfortunately, President Obama is acting as though he is a spectator who will simply sign whatever alleged "reform" package his own party deigns to give him. Time for President Obama to declare himself: Will he or will he not insist that health care reform include a public option?
August 17, 2009 1:30 PM | Reply | Permalink
I agree he needs to draw a line in the sand.
But who's the real spectator here?
Is it the President who's traveling across the country on his vacation?
Or perhaps, it's the endless melodramatic blog post and response echo-chamber.
Get out and organize.
August 17, 2009 1:40 PM | Reply | Permalink
Listen, Bro. I have a job and so does President Obama. His job is to . . . be president! That means leading, not following around and picking up crumbs from HIS OWN PARTY. You want people fighting for health care reform: Let the president show some guts and declare that he will not sign a bill without the public option. Then people -- including me -- will fight like hell for it. It's very difficult to fight for a leader who isn't leading. Have Obama declare and dare the Democratic senators to betray him. He isn't a spectator, he's the president. Time he acted like it on one of the two crucial issues facing the country. BTW: Once Obama rolls on health care, how far do you think he's going to get against the oil companies when he tried to tackle the other major initiative, coming right behind this one. Time to stand up and be counted, Pres. Obama. If you don't, your administration is toast.
August 17, 2009 2:18 PM | Reply | Permalink
Last point is crucial.
If Obama rolls over over on this crucial issue, to the detriment of all citizens, there's little hope he can rally majorities for the rest of his agenda -- unless it's all equally watered down.
As I wrote elsewhere, this crisis is setting the template for the remainder of his administration.
The Republicans sure know that; it's time Team Obama clued in too.
August 17, 2009 3:06 PM | Reply | Permalink
Hear, hear!
I'm not convinced writing letters to my congressmen does a damned bit of good. All I ever get is a form letter in response, saying "Thank you for your communication with _________." Do they read the letters they get? Who the hell knows? Where do they stand on any given issue? Once again, who the hell knows? All they ever say is that they are studying it.
August 17, 2009 3:15 PM | Reply | Permalink
I have volunteered for President Obama's campaign and have made over 2,000 phone calls over a 2 month period. I, like many progressives, doctors, nurses, etc., strongly believe a single payer system to be the easiest, most effective way to deal with the health care crisis.
With the understanding that we live in a world of compromise, progressive have settle on the compromised position of a public option in order to accommodate the interests of the much too powerful insurance industry and its representatives in Congress, the Republican party.
The elimination of the public option would be an unacceptable capitulation to the will of the minority (70% of Americans have consistently supported single payer over many years) and for this reason, it will not be something that I, and many other progressives would support.
The President, and the Democratic party should better pay attention to the following: any health care bill that shall pass without a strong public option will simply be seen by progressives like myself as a mandate to deliver more customers to private health insurance companies; and if that is what comes to pass you will have lost my support for the foreseeable future.
If the Democratic party capitulates to the pressures of big business and deny the people the choice of a strong public option, it will be the final nail in the coffin of the party as the representative of working people. I, for one, will actively begin working to build a truly progressive party to the left of the apparently centrist, corporate driven Democratic party.
August 17, 2009 1:31 PM | Reply | Permalink
I am 100% with you. If the Democrats can't get it done -- with a decisively and newly elected president, in conjunction with overwhelming majorities in both houses of Congress -- then the Democratic Party is worthless. Absolutely worthless. Time to look elsewhere for political leadership.
August 17, 2009 2:35 PM | Reply | Permalink
Medicare isn't a single payer system. How can we take anything that follows seriously?
August 17, 2009 1:40 PM | Reply | Permalink
Cite your source. Or do you belong to the Humpty Dumpty school of semantics?
Here's mine
http://www.pnhp.org/news/2007/september/major_health_care_pr.php
August 17, 2009 1:47 PM | Reply | Permalink
A number of countries have strict single payer systems, but the dominant paradigm appears to be a public-private hybrid like we currently have. A single payer plan covers every single person in the country and is the only way to lower costs enough to make government-managed health insurance viable.
Medicare, on the other hand, is a government-run insurance plan that covers perhaps 43 million Americans, many of them seniors and disabled, and among the most expensive to insure. That being the case, they are forced to pay only 80% of the costs of care at drastically reduced rates.
If Medicare was an actual single payer plan, it wouldn't be in such desperate need of repair.
August 17, 2009 2:09 PM | Reply | Permalink
Let me amend one thing: The dominant paradigm is a public-private hybrid like ours, but one that actually has and enforces the right regulatory environment to make it work. I am a fan of systemic reforms that are focused on the current system first.
If we need to toss the baby and the bathwater aside at some point, I may consider that as well.
I just don't think that should be our first choice. Evolution is always much more cost effective and sustainable than revolution, with the possible exception of our nation's birth and even that society wasn't sustainable in most respects.
August 17, 2009 2:12 PM | Reply | Permalink
So, in short, you refuse to take Reich seriously, because you don't like his use of the conventional tag of 'single-payer' for the system we know as Medicare.
That's your right... hurrah for seriousness!
August 17, 2009 2:33 PM | Reply | Permalink
I don't take him seriously because he is a hypocrite on too many issues to list.
I don't take him seriously because all of a sudden he is an ideological purist when he was never any such thing when he had the power to do something. I don't take him seriously because he is unable to see how this legislation is a great first step down the road to sustainable health care reform.
That is doesn't know the difference between Medicare and single payer is just funny.
August 17, 2009 2:53 PM | Reply | Permalink
Ditto.
August 17, 2009 2:55 PM | Reply | Permalink
BUT MOOOOOM, JASON STARTED IT!!!!!
August 17, 2009 2:59 PM | Reply | Permalink
That where things invariably go when we want to get to the same place via different routes.
August 17, 2009 3:05 PM | Reply | Permalink
Seriously, at some point I'd be interested in your arguments about the non-centrality of the public option. do you think
1. No competitive pressure is necessary to keep premiums down, given a mandate and anti-discrimination rules?
2. there exist other ways of keeping premiums down through regulation, co-ops, insurance exchanges, etc, and these are in the bill?
3. It is not important to keep premiums down?
I'm not interested in surreptitiously getting to single-payer by means of an ever expanding public option, but this bill will be a catastrophe without some way to keep premiums from going through the roof.
August 17, 2009 3:22 PM | Reply | Permalink
Sorry if I have been unclear in that regard. To answer your questions in order:
1) With a federal mandate, subsidized coverage and anti-discrimination rules, many of the worst practices of the health insurance industry will be addressed. Add to that, number two:
2a) The non-profit exchanges provides a group benefits package to anyone who meets certain qualifications such as small business owner with under 20 employees and the self employed. It also becomes the place for the scaled subsidy programs based on income, with Medicaid and Medicare taking the rest much as they do now.
2b) This could be a combined bargaining population of as many as 100 million Americans, exerting the same pressure as a public plan alone. Additionally, technology improvements that go along with most of the proposals will help lower costs from duplication of efforts and medical mistakes from poor record keeping.
3) Like other countries with a public mandate that is filled via private means in some, way, shape or form, the insurance companies compete on price by way of innovation. It is the only way one can compete in a mandated benefits environment.
Insurance companies are willing to be regulated in exchange for mandates. They think they will be able to avoid regulations like other industries before them. I say we use that mistaken impression to get our regulations passed right out of the gate. We can make them submit to the common good. Put an Elliot (Spitzer) Ness on their ass if that is what it takes.
We can change the paradigm via incremental tactics aimed at strategy for exponential change. We can bring this system under control using smart, strategic fixes that have broad national support on both sides of the fence. What I see emerging is more than moderate enough to gain such support.
I think the legislation that should hit Obama's desk not long after the recess will be a serious democratic party touchdown by any measuring stick except single payer.
August 17, 2009 3:37 PM | Reply | Permalink
Obey's right, Jason. Cut the ad-hominem crap and address the issues.
August 17, 2009 3:26 PM | Reply | Permalink
I respond to ad hominem in kind even as I address the issues. Multitasking is a must in my career.
August 17, 2009 3:40 PM | Reply | Permalink
Robert Reich didn't call you a hypocrite.
August 17, 2009 9:34 PM | Reply | Permalink
I wasn't responding to Reich, I was answering the question of why I find him to be an unreliable source at best when it comes to this debate. Why? Because he doesn't appear to know the difference between single payer and Medicare.
August 18, 2009 6:32 AM | Reply | Permalink
We don't have a national health care system. A national health care system would be controlled by professionals with the goal of providing the lowest cost and most effective service possible. Our "system" is controlled by politicians and the market. The politicians starve and handicap our public system and subsidize or allow the private insurers, pharmaceuticals and providers of care to make the rules. We have no set of goals, standards and regulations that cover all the participants nationwide.
If the public option is removed from the bill, so should mandates. An IMAC or other permanent non-political commission, insulated from the health care market players, with real clout, would be sufficient to make this law a success. They could craft and maintain a national system.
August 17, 2009 10:32 PM | Reply | Permalink
Strict insurance regulation will never work without mandates. It's been proved in every country in the world who seeks to use public regulations to control private health insurance interests.
Not sure what you are talking about with regards to the health care system not actually being a health care system. As if only Washington and the insurance companies were part of this debate. As if the problems with Medicare aren't all their own based on the very way the legislation was written and its existing mandate.
Don't know how it ever made any sort of fiscal sense to design a plan that was supposed to cater to the sickest among us without a corresponding population of healthy people to offset the expense with premiums of their own. That is usually what happens when democrats get a hold of a good idea.
At least they have them, though, if we could just get the republican part to help with implementation we might have a chance at a complete country.
August 18, 2009 6:37 AM | Reply | Permalink
Paul Krugman, if you read the Swiss Menace carefully is also caving on the public option. Between the lines in the column you'll notice that he likens the US reform efforts as aiming toward a Swiss system, which when you read his blog, you discover does not have a public option
Yglesias accurately describes the stakes
He also provides a link to this excellent Reform Flow Chart
http://3.bp.blogspot.com/_BTt4cJQj7GI/Sol7S9NA7QI/AAAAAAAAACo/YIwN-rOQCRQ/s1600-h/hayes_flowchart.PNG
My sole concern at this point is process - shut Circus Baucus down and get to conference as soon as possible.
Make no mistake - 'Bagger led, the GOP's objective is to defeat any form of health care reform.
August 17, 2009 1:41 PM | Reply | Permalink
Thanks for bring up Krugman's latest column.
I would also like to know why this issue is concentrating on the funding of health care and not much on the providers. The outrageous fees and the hospitals themselves. That for a vast majority of the time - in many areas - we have hospitals and physicians coming out the kazoo. But in other areas a dearth of medical facilities.
That despite all the money poured in the health care we wind up with either far too much or not enough. That for the majority of the people a trip to a GP is all that is necessary and yet if there were any kind of large crisis out heath care system is vastly lacking.
To me the entire system needs a re-working.
C
August 17, 2009 2:22 PM | Reply | Permalink
So now the Administration is saying, "Public option? We don't need no stinkin' public option!"
Okay, kiddies - pop quiz.
Q: What's the difference between Barack Obama and Sarah Palin?
A: Nothing. They're both quitters.
August 17, 2009 1:42 PM | Reply | Permalink
That should be what's the difference between the Left and Sarah Palin.
August 17, 2009 3:20 PM | Reply | Permalink
Please, no more talk from pundits about co-ops being the way to get a reform bill passed. I seem to recall that Blue Cross/Blue Shield started out as a regional co-op, and we know how that story ended.
August 17, 2009 1:56 PM | Reply | Permalink
You mean the story by an entirely different author with an entirely different plot and a different cast of characters? That story ended the way it was written to end. This is a different story by any objective definition. Totally different if you bothered to read the book rather than the Cliff Notes.
August 17, 2009 4:35 PM | Reply | Permalink
The Administration and the Democrats have compromised to a ridiculous extent on this whole issue. I've written my Senators, Representative, the White House, and both majority leaders (Senate and House) to urge retention of a public option. If they don't show some backbone on this issue, the Democrats no longer get my money or my vote. I won't vote Republican either.
The corporations and their legislative lackeys (Repub and Demo) count their billions and laugh at the taxpayers.
August 17, 2009 1:57 PM | Reply | Permalink
I need some help here:
We're not going to get HCR with a public option. That's obvious. And HCR is not reform w/o a public option. So could the Pres change/modify existing laws w/o Congressional approval?
Meaning ... is there a way for the Pres to make Medicare coverage start at age 55 instead of 65 w/o Congressional approval? And then continue to lower it every year - two years, whatever?
I remember Bush doing this with coal emissions, changing the caps and backdating the laws so that the coal industry would not have to pay any penalties incurred under the laws of Clinton's EPA administration.
So one set me straight - i'm desperate.
August 17, 2009 2:04 PM | Reply | Permalink
Were you around in 1994 when Bill Clinton threatened to veto legislation that did not guarantee universal coverage?
Wait, you were in his administration, that's right. The cooperatives have potential if they're structured right.
1.) Health care insurance must be a requirement for everyone
2.) We have to eliminate lifetime/yearly caps
3.) We have to structure the bill so that it's subsidized enough to make families be able to afford to insure themselves.
4.) We have to make sure that insurers/cooperatives do not reject applicants on the basis of preexisting conditions;
5.) We have to ensure that individuals have a fixed out-of-pocket cap for any year (i.e. no more than $5,000-$10,000 out of pocket). Anything over that, the government pays, using Medicare reimbursement rates.
These reforms would help reduce the cost of insurance premiums for everyone. This, in turn, will stimulate coverage.
August 17, 2009 2:06 PM | Reply | Permalink
$10,000 out of pocket/year over a period of even 3 years would likely be ruinous for a good many families. What good is lowering premiums at the cost of bankrupting people who get seriously ill?
August 17, 2009 3:26 PM | Reply | Permalink
The logic of your position, Dr Reich, is that it is the OBAMA ADMINISTRATION we should be pressuring, and not just with letters and telephone calls but with a unified national progressive voice
And that's EXACTLY what needs to be done -- and hopefully this would set the groundwork for a unified progressive economic platform overall, of which healthcare is necessarily a huge part, and so is eco-industrialization and green energy
But it seems that just isn't "beshet" (meant to be) i.e. getting with the program, which includes complete environmental destruction
August 17, 2009 2:22 PM | Reply | Permalink
Art Brodsky, Huffington Post:
"Democrats talk a good game. Obama talked the best game of all during the campaign. Remember that night in Denver: "Change should not come from Washington, change must come to Washington." Well, Obama and his team came to Washington, but change didn't. Obama won because people believed his call for change. Whether that was the real Barack Obama or whether the real Obama is a deal-making, practical politician doesn't really matter. People believed. And now he's letting everyone down, in a big and disappointing way. Those big ideas are falling by the wayside, and it's a shame, because people support them."
http://www.huffingtonpost.com/art-brodsky/the-politics-of-destructi_b_260653.html
August 17, 2009 2:35 PM | Reply | Permalink
That change comes to Washington comment refers to YOU, the people. He's referring to legislation passed because YOU the people stood up in great numbers and demanded it. The Civil Rights Movement is a great example of that. The President didn't lead on that, the people did.
He also said, we're are the ones that we've been waiting for. That also means YOU, the people. I didn't see that in the article you cited.
I'd also like you to read this part of his Denver speech, because this was his warning to all of us about the next 4 years.
"The road ahead will be long. Our climb will be steep. We may not get there in one year or even one term, but America - I have never been more hopeful than I am tonight that we will get there. I promise you - we as a people will get there.
There will be setbacks and false starts. There are many who wont agree with every decision or policy I make as President, and we know that government cant solve every problem. But I will always be honest with you about the challenges we face. I will listen to you, especially when we disagree. And above all, I will ask you join in the work of remaking this nation the only way its been done in America for two-hundred and twenty-one years - block by block, brick by brick, calloused hand by calloused hand."
August 17, 2009 3:39 PM | Reply | Permalink
There are many things Obama said; many I agree with, even strongly. There are very few things he has DONE which reflect what he has said and which I think are good. He has, I have been told repeatedly, been conserving his political capital (not fighting with the right) so he could pass a meaningful Health care insurance reform. Ha. For a worse-than-worthless "reform" health insurance package we have seen the Big Giveaway to Wall Street, the flip-flop on torture and FISA, a major escalation in Afghanistan, a significant troop introduction into Colombia, continuation of Don't Ask Don't Tell, the singular continuation of Rove's US attorney appointments, a pro-corporate treasury Secretary, a refusal to restrain corporate pay, exclusion of the left from an y significant counsel, continuation of our Cuba policy, in short, he has continued the Bush-era politics albeit with a much lighter touch. We are on track, under Obama, to see the concentration of wealth in this country reach unheard-of Byzantine levels. Has there been foreclosure relief? Has the Obama administration lifted a finger in support of cram-down? No. Don't muddy the waters... the Big Surrender on health care reform has priority.
August 17, 2009 4:27 PM | Reply | Permalink
I do not understand why nobody is asking the conservative "Democrats" why they are opposed to the public option. I never heard any of them answer this question. Just saying there are not the votes in the Senate w.o any explication why is intelectually dishonest.
Let's take the important metrics of the reform everybody agrees on:
1. Univresality - No doubt a plan with public option will insure more people.
2. Choice - The public option only increases choice.
3. Affordability and 4. Cost - No doubt the price to insure a person or a family in the public option will be smaller than pay or subsidize the corresponding premium for the same coverage in a private plan.
So if more universal, more choices, more affordable, and will cost less why are these conservative "D" opposed (especially on cost how they square this with their deficit hawkiness)?
If asked the only remaining answer for them is ideological (the free market vs Big Gov, bla, bla, bla..).
If that were they go than we'll all know they are just GOP in disguise, enjoying all the perks of the majority and then stubbing their D colleagues in the back.
August 17, 2009 2:45 PM | Reply | Permalink
Great question. Why don't they own up to their votes? Somebody needs to ask them.
#1 reason for PO is reduce costs, by about $150 billion according to the CBO
August 17, 2009 4:44 PM | Reply | Permalink
I'm increasingly confused by a few things:
1.) This is August. Why would you say anything that alludes to an official position when there is no one in DC. Just because there are crazies at town halls doesn't mean that positions are changing. August is just a month of watching what Members say when they go home. NOT for changing or even hinting at changing your position.
2.) Where's the morality in this effort? Universal health care is a moral imperative. What civilized society, the envy of the world, can let uninsured children die simply because they were not born into wealth? Side question, is it worse to die young or to grow old and sick because of malnutrition, obesity, and lack of proper medical treatment (eventually becoming more expensive on the system anyway).
3.) Where's the money? I don't mean money for reform. I mean, where is the discussion about money? If today the average premium is 12k per person, 9k paid by employer and 3k by employee, and a public option reduces that cost to say just 6k (3k from both), how is that not better for every American? Including corporations? Take the 6k savings and give 4k to the worker and keep 2k profit. DUH. Where's the consistent quote that "If we pass health care reform it will put x dollars directly in your pocket!" ???
August 17, 2009 2:46 PM | Reply | Permalink
Hmmmm . . .
Referring to this little snippet of the comment here:
Why 50/50? What's wrong with 4.5k paid by the employer and 1.5k by the employee? Or even 3.6k employer/2.4k employee?
Our current plan, which is a non-profit co-op serving 5.1 million voluntarily enrolled members is 8.7k for the two of us ... I'd be tickled pink for a 50% reduction -- but a state-by-state co-op system won't bring that cost down any further.
~OGD~
August 17, 2009 8:07 PM | Reply | Permalink
What would "more support from progressives" et al. look like? We can't outspend the insurance lobby--that's one of the symptoms. After the broad (not just progressive) ground-level work to get Obama and many of these legislators elected, it's time for Congress to do the work they were sent by their constituents to do.
August 17, 2009 3:05 PM | Reply | Permalink
You can all get down off the ledge now:
http://www.cnn.com/2009/POLITICS/08/17/health.care/index.html
August 17, 2009 3:28 PM | Reply | Permalink
It is war and the best person ever to distill tactics was Sun Tzu. Here are just a few pertinent cuts from his text.
2. When you engage in actual fighting, if victory
is long in coming, then men's weapons will grow dull and
their ardor will be damped. If you lay siege to a town,
you will exhaust your strength.
3. Again, if the campaign is protracted, the resources
of the State will not be equal to the strain.
4. Now, when your weapons are dulled, your ardor damped,
your strength exhausted and your treasure spent,
other chieftains will spring up to take advantage
of your extremity. Then no man, however wise,
will be able to avert the consequences that must ensue.
5. Thus, though we have heard of stupid haste in war,
cleverness has never been seen associated with long delays.
6. There is no instance of a country having benefited
from prolonged warfare.
7. It is only one who is thoroughly acquainted
with the evils of war that can thoroughly understand
the profitable way of carrying it on.
August 17, 2009 3:29 PM | Reply | Permalink
Et tu, Brute?
August 17, 2009 3:33 PM | Reply | Permalink
Julius Caesar? My, how quickly the young king has advanced.
August 17, 2009 5:40 PM | Reply | Permalink
Rather, how fast he's been stabbed in the back by erstwhile friends.
August 17, 2009 6:44 PM | Reply | Permalink
Where did you go to pledge your awesome and unwavering loyalty? And are there bothersome cult rituals as well?
August 17, 2009 8:32 PM | Reply | Permalink
Actually let me stop with the clever repartee. Amike your comment really bothers me. I didn't know you viewed these great political issues as some sort of "club" activity. Reich doesn't agree with Obama's pathetic surrender and now he's Brutus abandoning his "friend". What is wrong with you? This sort of comment is pretty revealing. Loyalty to Obama, the man, seems to supersede your interest in seeing good and needed policy. A true Obamabot.
August 17, 2009 8:52 PM | Reply | Permalink
Let me be as clear as I can. There was a time I rather liked Robert Reich. I no longer like or trust him...not that he cares one iota. He strikes me as officious, tendentious, and a whole lot of other iouses I could go into if you wished.
Reich is incredibly long on advice incredibly short on actual assistance. And he would have the power to be of concrete assistance if he really wished to be. He's been in the corridors of power, he knows persons of power. Yet what he does is come in here and pontificate. Perhaps I shouldn't take offense when he feeds lines like "injures democracy" to the opposition, and then stands idly by when he gets quoted by them. But I do take offense to that kind of behavior.
So that's what's wrong with me Mr. Lazlo, sorry you don't approve. I shall refrain from returning the compliment by suggesting what's wrong with you.
August 17, 2009 9:14 PM | Reply | Permalink
OK, fair enough. I do not have that reaction to Reich. But I have a similar and growing unpleasant reaction to Obama. Perhaps you find Obama more agreeable and sincere; increasingly I do not. I think Reich was an advocate for working people who have been taking it on the chin for a very long time. "Pontificating" covers a pretty wide area in political life; many think Obama is guilty of saying a lot and doing little; if you could show me some actual dishonesty by Reich I would be grateful.
August 17, 2009 9:24 PM | Reply | Permalink
I wouldn't accuse him of outright dishonesty, and I don't think I have. If I have, I apologize to him and to you. What I might be tempted to accuse him of is the cynicism of blighted political hopes--and I don't mean philosophical hopes--I mean personal ambition hopes. Reich was part of the Great Triangulator's administration, and I don't think progressives of the 1990s were overjoyed with that approach to governance. I wonder why he refused a position on the council of economic advisors? Or was it that nobody asked him?
I should also clarify a little about my feelings about Barack Obama. I've been called an Obamabot and worse, but I don't worship the man. I have incredible sympathy for him and what he has to try to do. I think he's trying to preside in the original meaning of the word. I take my cue of what I can expect from John Winthrop, the Puritan. The last time I quoted him I was accused of supporting witch burning...(he didn't burn any). Anyhow... here's old John talking about the glories of governing.
http://www.constitution.org/bcp/winthlib.htm
We're probably going to disagree on what constitutes "faithfulness"--and I while I may err of the side of looking at how hard he works at his job and interpret trying as faithfulness, I think that's a humane and reasonable error on my part.
Thanks for reading what I have to say and reading it fairly--believe me I appreciate that.
August 17, 2009 10:16 PM | Reply | Permalink
Thanks much for your patience and for your explanation. I am sorry if I was caustic earlier; i have been pretty upset today with the emerging politics and it probably came out in my posts.
August 17, 2009 10:54 PM | Reply | Permalink
Hugs all around. I enjoyed this conversation a lot!
August 18, 2009 7:20 AM | Reply | Permalink
I hope Obama understands that mandating insurance isn't going to bring prices down. The insurance companies will simply pocket the profit. Prices may stabalize temporarily, like they did in the early 90s after the Democrats in Congress backstabbed Clinton (hint, hint), but they'll just go up again at some point in the future.
Also, I don't buy into this incremental change strategery. If we pass crappy healthcare reform now, it won't make it easier to pass better reform in the future, it will sap the will to fight for better reform. We had the numbers on this issue and they've squandered it, because the president won't pressure Congress. I've seen a number of people here say, he's only the president, he can't make Congress do what he wants. Lest we forget, Bush ROOLED like the little emperor who could with nothing more than 50+Dick Cheney. All it takes is the will to lead, to reward the faithful, and to crush the weak and headstrong.
Obama's problem, I think, is that he was a Senator for two years. He was inducted and indoctrinated, rode the billy goat naked through the Maryland woods, and became a gentleman. He finds it hard to quit that destructive lifestyle. He made a poor choice of friends and what he needs now is an intervention.
August 17, 2009 3:45 PM | Reply | Permalink
The simplest way to think about the public option is the CBO report on it:
Without a PO, it will cost $150 billion more, or about $1100 per person.
So Baucus & Co have just tried to raise your taxes by $1100.
Like it? Surely, even these "fiscally conservative" type can understand 1100 smackers is good to have, right?
Aahhh, what I would have done with those $1100.....
http://tpmcafe.talkingpointsmemo.com/talk/blogs/observer2/2009/08/baucusbucks-tm-1100-tax-increa.php
August 17, 2009 4:08 PM | Reply | Permalink
Ok, so tell me now HOW will this coop shtick saves ME as a provider $? If it's just MORE payers I have to bill and sit on the phone with and manage claims for, excuse me ...tell me precisely WHY, now - my ridiculously overweight clerical costs will go down as result of the coop thing?
Honestly, at this point, I am so fed up with yet again, another cave-in and essentially another administration allowing ignorant racist bullies to drive policy. Is it NOT possible to possess a spine in Washington?
August 17, 2009 4:12 PM | Reply | Permalink
The public option is not dead no matter what anyone says. It is still strongly supported by progressives, and wins majorities among the public.
Even if Baucus & Co. manage to strip it out of their bill, it can be put back in during the remaining several months of negotiation.
And even if they finally manage to kill it, since it's popular, there is nothing stopping us from having a separate bill later on adding the public option onto the completed health care system.
So let's fight for the PO now. If they kill it, we come back, primary the blue dog traitors, and have a bill just for the PO, perhaps after midterms. This thing will get done.
August 17, 2009 5:04 PM | Reply | Permalink
And here's why it won't go away:
$150 billion in savings
http://www.huffingtonpost.com/2009/08/17/compromise-co-op-proposal_n_261044.html
August 17, 2009 5:06 PM | Reply | Permalink
I support what Mr. Reich is saying here. What he doesn't say is the reasons for a robust public option are that the current system is both predatory and parasitical.
It's predatory because of the extra-high administrative costs, and because of recision. It's parasitical because it comes between doctors and patients and adds NO VALUE to the product.
If you were going to design a system of health care with the primary focus on patients, what we've got now is the opposite of an efficient and cost-effective system. Government-run health care keeps administrative costs to around 3%.
Robert Reich also talks about how capitalism has swamped Democracy. The fact that private industry exists with it's questionalbe ethical practices like recision is a perfect example.
Single-payer is the ultimate goal, but a robust Public Option that demands compliance from the private sector is what is best for the nation,in my opinion.
August 17, 2009 5:34 PM | Reply | Permalink
Why don't we scuttle the whole thing and just back Medicare for all.
August 17, 2009 5:57 PM | Reply | Permalink
Because . . .
. . . Mister Bluster says "Medicare isn't a single payer system" and it just won't work.
See his earlier sub-thread with Obey
~OGD~
August 17, 2009 8:20 PM | Reply | Permalink