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What Obama Must Demand from Congress on Health Care
Congress returns next week to one of the fiercest and most important debates in recent memory -- whether and to what extent the nation will provide health care to all Americans, and how we will reign in the soaring costs of health care overall. But do not expect unusual courage from this Congress in standing up to demagogic lies and money-toting lobbyists. An unusually large portion is facing close races in 2010, both in primaries and in the general election. Republicans have many primary challenges from the right. A record number of Democrats, who took over Congress in 2006, hail from traditionally Republican or swing states and districts.
In order to get anything meaningful through this session of Congress, then, the President will have to give congressional Democrats far more leadership and more cover. Doing so is harder now than before the recess, when he was still basking in the afterglow of a honeymoon and 60 percent favorabilities.Yet it's not too late. Addressing a joint session of Congress next Wednesday is a good idea but Obama can't rely solely on his exceptional rhetorical skills. He'll need to twist arms, cajole, force recalcitrant members to join him, threaten retribution if they don't come along.
Most importantly, he'll need to be specific about what he wants -- especially about three things. I hope says the following next Wednesday, and makes clear to individual members that he means business.
1. I will not stand for a bill that leaves millions of Americans without health care. It's vitally important to cover all Americans, not only for their and their childrens' sakes and not only because it's a moral imperitive, but because doing so will be good for all of us. One out of three Americans will experience job loss and potential loss of health insurance for themselves and their families at some point. One out of four of us who have health insurance is underinsured --unable to afford the preventive care we and our kids need on an ongoing basis. And those of us who don't get preventive care can get walloped with diabetes, heart disease, and other major illnesses that wipe us out financially, or force us into emergency rooms that all of us end up paying for.
2. The only way to cover all Americans without causing deficits to rise is to require that the wealthiest Americans pay a bit extra. The wealthy can afford to make sure all Americans are healthy. The top 1 percent of earners now take home 23 percent of total national income, the highest percentage since 1928. Their tax burden is not excessive. Even as income and wealth have become more concentrated than at any time in the past 80 years, those at the top are now taxed at lower rates than rich Americans have been taxed since before the start of World War II. Indeed, many managers of hedge funds, private-equity partners, and investment bankers -- including those who have been bailed out by taxpayers over the last year -- are paying 15 percent of their income in taxes because their earnings are, absurdly, treated as capital gains. We should eliminate this loophole as well, and use it to guarantee the health of all.
3. Finally, I want a true public insurance option -- not a "cooperative," and not something that's triggered if certain goals aren't met. A public option is critical for lowering health-care costs. Today, private insurers don't face enough competition to guarantee low prices and high service. In 36 states, three or fewer insurers account for 65 percent of the insurance market. A public insurance option would also have the scale and authority needed to negotiate low drug prices and low prices from medical providers. Commercial insurers now pay about 30 higher rates to providers than the government pays through Medicare, because Medicare has the scale to get those lower rates. A nationwide public option could get similar savings. And those savings would mean lower premiums, deductibles and co-payments for Americans who can barely afford health insurance right now.
We'll see.
In order to get anything meaningful through this session of Congress, then, the President will have to give congressional Democrats far more leadership and more cover. Doing so is harder now than before the recess, when he was still basking in the afterglow of a honeymoon and 60 percent favorabilities.Yet it's not too late. Addressing a joint session of Congress next Wednesday is a good idea but Obama can't rely solely on his exceptional rhetorical skills. He'll need to twist arms, cajole, force recalcitrant members to join him, threaten retribution if they don't come along.
Most importantly, he'll need to be specific about what he wants -- especially about three things. I hope says the following next Wednesday, and makes clear to individual members that he means business.
1. I will not stand for a bill that leaves millions of Americans without health care. It's vitally important to cover all Americans, not only for their and their childrens' sakes and not only because it's a moral imperitive, but because doing so will be good for all of us. One out of three Americans will experience job loss and potential loss of health insurance for themselves and their families at some point. One out of four of us who have health insurance is underinsured --unable to afford the preventive care we and our kids need on an ongoing basis. And those of us who don't get preventive care can get walloped with diabetes, heart disease, and other major illnesses that wipe us out financially, or force us into emergency rooms that all of us end up paying for.
2. The only way to cover all Americans without causing deficits to rise is to require that the wealthiest Americans pay a bit extra. The wealthy can afford to make sure all Americans are healthy. The top 1 percent of earners now take home 23 percent of total national income, the highest percentage since 1928. Their tax burden is not excessive. Even as income and wealth have become more concentrated than at any time in the past 80 years, those at the top are now taxed at lower rates than rich Americans have been taxed since before the start of World War II. Indeed, many managers of hedge funds, private-equity partners, and investment bankers -- including those who have been bailed out by taxpayers over the last year -- are paying 15 percent of their income in taxes because their earnings are, absurdly, treated as capital gains. We should eliminate this loophole as well, and use it to guarantee the health of all.
3. Finally, I want a true public insurance option -- not a "cooperative," and not something that's triggered if certain goals aren't met. A public option is critical for lowering health-care costs. Today, private insurers don't face enough competition to guarantee low prices and high service. In 36 states, three or fewer insurers account for 65 percent of the insurance market. A public insurance option would also have the scale and authority needed to negotiate low drug prices and low prices from medical providers. Commercial insurers now pay about 30 higher rates to providers than the government pays through Medicare, because Medicare has the scale to get those lower rates. A nationwide public option could get similar savings. And those savings would mean lower premiums, deductibles and co-payments for Americans who can barely afford health insurance right now.
We'll see.
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Robert,
I agree, this is what I'd also like to see him do. It will be interesting to see what he actually does. This speech he will make is like a fork in the road for him, he could crash his presidency and the party if he takes the wrong path.
September 3, 2009 2:16 PM | Reply | Permalink
Good comment.
September 3, 2009 2:20 PM | Reply | Permalink
Congress JUST TURNED OFF the MEDICARE TRIGGER:
The House on Tuesday voted 242-181 to approve an operating rules package (H Res 5) that eliminates the Medicare trigger, which requires the president to submit a plan to contain Medicare costs if they reach a certain level, CQ Today reports. The trigger was approved as part of the 2003 Medicare law. Under the law, if 45% or more of the program's funding comes from general tax revenues for two consecutive years, the president must submit to Congress legislation that would slow spending over a seven-year period and make the program financially stable. The trigger went into effect for the first time last year
September 3, 2009 4:33 PM | Reply | Permalink
But not in the larger scheme of things. Because we all know the Republican offer nothing. Nothing on the environment, nothing on health care, nothing on the economy...except the failed policies of the past 8 years. They got us into this economic wreck and Americans know going back to the Republicans will lead to disaster.
September 3, 2009 2:54 PM | Reply | Permalink
Unfortunately, I worry that if Obama abandons the fight for real health care reform, he won't fight hard for anything substantial in any other area.
All the folks who worked so hard to get him elected, to push back against the birthers, and the teabaggers, and the deathers - why should we fight so hard if he won't?
That is the danger - that he will de-activise his own base, while energizing his opponents. And as much as I want to blame Rahm, it will ultimately be Obama's decision to fail at this. IF he does not see that now, he never will.
I simply know that I will not go out on a limb for him if he won't go out there for himself.
September 3, 2009 3:19 PM | Reply | Permalink
Thucy said:
Excellent point. Poor performance by Obama compounded by a weak Harry Reid = low voter turnout for Democrats in next election.
September 3, 2009 5:44 PM | Reply | Permalink
THUCY, YOU HAVE SOME SPLAININ TO DO!!!!
HAHAHAHAH
September 3, 2009 10:30 PM | Reply | Permalink
Baba-loooo
September 4, 2009 1:19 PM | Reply | Permalink
He hasn't stood strong on anything and he's getting us into a quagmire in Afghanistan. The Republicans have totally intimidated the party and you can see why (snark) - with their 12% approval in Congress no wonder they have Democrats capitulating on every issue from labor, to health, to war, to gay rights, to civil to rights, ...
We have a lunatic party and a right-wing party.
I'm going to have to move to Vermont so I can vote for Bernie.
September 3, 2009 5:55 PM | Reply | Permalink
If you define real health care reform as only including the public option (which is a stretch), then using a short-term strategy (4 years or more) to get the public option is still fighting for real health care reform. Good fighting is smart fighting and smart fighting is not just running out into the open and getting your head blown off, which is what demanding a public option would be at this point. It's not good to confuse smart fighting with not fighting.
We should fight so hard, not only in support of the President's smart fighting and realistic fighting (which is the best kind of fighting) because we're intelligent people who understand that sometimes other things like a bad economy and massive government spending to prevent a depression, can limit the speed with which we can accomplish our goals.
Some people in the base may be de-activised by smart fighting and pragmatic fighting, but even more of the base, moderate democrats and independents will not only be de-activised, but disgusted, if Obama engages in reckless fighting and is defeated on healthcare.
I will go out on a limb for the President because he will not recklessly go out on a limb and play craps with health care reform. I support progress and results more than a political roulette player any day.
September 3, 2009 6:16 PM | Reply | Permalink
smart fighting - pragmatic fighting - these are the traits of an oposition party. well that is what democrats are goodat - but when they are in power - go on fighting - ridiculous
September 3, 2009 6:50 PM | Reply | Permalink
Smart fighting and pragmatic fighting are the traits of all good parties. The Democrats should go on fighting: smart fighting and pragmatic fighting, not reckless fighting. - Idiotic
September 3, 2009 6:58 PM | Reply | Permalink
I don't think Obama is practicing pragmatic fighting I think he is practicing pragmatic surrender.
In the end it will not be so pragmatic at all, and will destroy him, and his Presidency.
If real health reform fails and there is no check on the for-profit insurance industry which is the major cause of the problem, it will be because Obama wants it to. He wants it to in order to get millions of dollars for his campaign from the corporate interests that stand to profit from fake reform. No other explanation makes sense, except gross political incompetence, which I still don't think is Obama's problem.
September 4, 2009 3:33 AM | Reply | Permalink
You have Obama's strategy confused with those of hardline liberals. Obama has a short term strategy to get the public option. Get half of it done now, get half of it done later, when the economy is stronger. Hardline liberals who want to torpedo the Senate plan and the President's plan are practicing pragmatic surrender.
The only thing that would destroy Obama is just that, not being able to get a bill at all, mostly likely because hardline liberals put a gun to their head and held themselves hostage like that scene from Blazing Saddles.
Obama is not interested in any corporate donations to his own campaign. That's psycho talk. Obama is interested in passing legislation, and he rightly thinks it a mistake to ask for all you want and get nothing. Wisely, he chooses to take what he can get and use that to build upon for what he wants.
September 4, 2009 3:53 PM | Reply | Permalink
Smooth,
To me, health care reform is not just the public option, there's more, but the public option is
like the big box anchor store in a mall. Without it there is no mall or "reform."
Why anyone believes the public option will be passable four years, or even two years from now is a mystery to me.
September 4, 2009 9:13 AM | Reply | Permalink
Smooth,
To me, health care reform is not just the public option, there's more, but the public option is
like the big box anchor store in a mall. Without it there is no mall or "reform."
Why anyone believes the public option will be passable four years, or even two years from now is a mystery to me.
Eliminating the ban on exclusions for pre-existing conditions is huge. Tell someone who is thrown off their health plan because they have cancer, heart disease or diabetes that stopping health care coverage from discriminating against them is "no mall or reform." Tell people who cannot afford health care coverage, that you oppose the government helping them to pay their premiums because it's "no mall or reform." Try that out and let me know if you still think those measures are "no mall or reform."
Really, you can't see why a public option would be passable in 4 years? You didn't notice all the media coverage on the stimulus as a drag on the health care reform? You didn't notice Obama defending the stimulus while defending health care reform? You didn't notice the mild depression we went through and the massive toll its taken on government coffers, and you didn't notice that those government coffers are the same ones that would fund a public option? You didn't notice economic projections that the economy will have recovered in 4 years? It's a mystery to me that you didn't notice that.
September 4, 2009 4:12 PM | Reply | Permalink
Smooth,
yes, in 4 years the economy will be better....and the insurance companies, PHARMA and the Republicans will be altruistic. Why, we might even see Grassley leading the charge for the public option.
Without the public option you have insurance reform, not health care reform. And I suggest you read the fine print in the insurance reform bill.
People with pre existing conditions will be able to get insurance? Good, how much per month?
September 4, 2009 5:37 PM | Reply | Permalink
Ah, so because you have no plan to pass health care reform your resort to dishonesty and sarcastically attacking a position that I never said that I believe in. Doesn't the fact that you can think of no plan to pass health care reform make you doubt your opposition to a compromise? If you actually had any good ideas on how to pass health reform, wouldn't you have proposed them by now?
Health insurance reform is health care reform. Also, subsidies for poor folks, an employer mandate, and lower co-pays are also health care reform.
Thanks for the advice on reading the fine print on the insurance reform bill. Since you're giving that advice to me, I assume you've read the fine print and you know something about the reform bill that I don't. By all means, please share it.
I don't know, how much is it?
September 4, 2009 7:07 PM | Reply | Permalink
"If you define real health care reform as only including the public option (which is a stretch)"
Not in NY. Here, everything else proposed already exists -- except individual mandates (RomneyCare), which are an obscenity if there's no public option.
The public option is the only real health insurance reform for the residents of the third-largest state in the Union. That should matter.
OK, OK, there is *one* possible alternative plan which would work: outright caps on total out-of-pocket payments, set at $5000/year or less for everyone and lower for the lower-income, combined with allowing states to enact single-payer. The caps would drive all the private insurers out of the NY market and NY would then enact single-payer.
September 4, 2009 3:46 PM | Reply | Permalink
September 4, 2009 4:26 PM | Reply | Permalink
[[then using a short-term strategy (4 years or more) to get the public option is still fighting for real health care reform.]]
You're kidding yourself. If it doesn't pass this year, Dems will be wiped out in 2010 and it will be another generation, with thousands of people dying unnecessarily every year, before it has another shot.
And if the Supreme Court legalizes unlimited corporate campaign contributions later this year, which seems likely, there may never be another chance.
September 4, 2009 4:23 PM | Reply | Permalink
No, you're in a state of delusion. Got any evidence to show that if the public option "doesn't pass this year, Dems will be wiped out in 2010" or is that just a scare tactic to get people to point the gun to their heads and hold themselves hostage for the public option?
WRT thousands of people dying unnecessarily every year, the number will be millions if you have your way, and the Progressive Caucus mounts their final defense of the public option at Little Big Horn, lose the bill, lose any credibility for governing among the American public at large and among the Democratic base.
Let's accept your hyperbolic claim that thousands will die my way and my equally hyperbolic claim that millions will die your way. Those are the only two ways. What's the rational thing to do?
Right, because if the SC passes some law on campaign finance reform the Democrats will never ever gain control of Washington again. The wheels of history will permanently come to a grinding halt due to a law on campaign finances. We've gone through Revolution, Civil War, Civil Rights, the Southern Strategy, the permanent Republican majority, but this campaign finance thing, yeah that's going to stop history once and for all. Right.
September 4, 2009 4:49 PM | Reply | Permalink
[[if the SC passes some law on campaign finance reform the Democrats anti-corporatists will never ever gain control of Washington again.]]
Fixed.
Hey, mock me if you like, but if you think things are bad now, you wait until the top ten Fortune 500 companies start spending 5% of their $330B annual profits to make things even more to their liking.
September 4, 2009 6:34 PM | Reply | Permalink
Bingo.
Axelrod's questions about Obama's toughness were much on his mind when he was encouraging Obama to run. Now is Obama's supreme test. It may not be his basic nature to fight. But he will have to prove that he can do so when he needs to. And now is that time, or else he will suffer a disastrous and potentially permanent loss of respect and good will.
I don't mean toughness as bellicose or overstated public language, of course, but rather as rock solid firmness of purpose, visible determination and a willingness to twist arms and pull out all the stops for what he believes the country needs.
September 3, 2009 10:07 PM | Reply | Permalink
I think you're right that now is the time, but frankly, I don't think he's got it in him. We'll have confimation of that (unfortunately) on Wednesday.
September 4, 2009 3:56 AM | Reply | Permalink
Perhaps so. We can both hope that isn't what happens. If the President reads DanK's September 4 PM "The Defining Moment" post he might feel as though he can skip the coffee in the hours leading up to his speech.
September 5, 2009 5:05 PM | Reply | Permalink
I concur. Including fork in the road.
And if this is blown for us it was mainly because of the senate so no matter what we think of the president we should be focusing on an even bigger majority in the senate. And we should push for a new Senate majority leader.
September 3, 2009 6:00 PM | Reply | Permalink
Obama seems to have become a wuss, when it really matters. Playing the consensus road, Clinton's "famous" triangulation, leads to inaction on the issues that affect the common person. If the Financial i-want-my-bonus but-no-resposibility thugs and the i-want-my-afgan-war armchair radicals are getting their way so why not the Insurance i-stand-for-capitalism swindlers?
September 3, 2009 6:43 PM | Reply | Permalink
Unfortunately, I wouldn't hold my breathe.
September 3, 2009 11:00 PM | Reply | Permalink
I wish the White House had the wisdom and common sense to have you inside the Oval Office, taking these arguments to your old adversaries like Larry Summers and Rahm Emanuel and making your case directly to President Obama.
September 3, 2009 2:30 PM | Reply | Permalink
I couldn't agree more.
September 3, 2009 2:32 PM | Reply | Permalink
Second.
September 3, 2009 2:38 PM | Reply | Permalink
This is why Reich is not there. The same reason Dean is not.
Obama chose Rahm and the capitulation path.
Mr. Reich would have been a problem because he would have opposed the path.
September 3, 2009 2:46 PM | Reply | Permalink
Robert, I like what you've said, reasonable, clear, sane, understandable, even compassionate - but, the opposition out here (not inside the Belt) are unreasonable, fogged up with Rep. fiction, insane, and apparently not compassionate.
A good speaker knows his audience and writes his speech for them. Let's hope Obama remembers this, otherwise he'll speak in vain because his 'audience' won't hear him.
September 3, 2009 2:35 PM | Reply | Permalink
You don't need compassion to sell health care and the public option. You need to pitch to self-interest and build up hatred and distrust of the insurance companies. The far right can't understand a world without evil in it. Obama fairly enough sees all in shades of gray. But it's time to speak to the nuts in way that looks true through their polarized glasses - which primarily polarize not along left-right but along good-evil.
Obama needs to highlight the true evil in the current system, and launch a crusade against it. The hard left - which also like a polarized view - will rejoice. And the hard right, which includes many who have life experiences that make it easy to hate the insurance firms, will join in.
Without portraying the insurers as evil (which in large part they are), there's no "bipartisan" way to promote the alternative, which is a public option.
September 3, 2009 4:12 PM | Reply | Permalink
Absolutely. The Right has spent years demonizing the government (remember Harry and Louise do-you-want-the-government-in-your-medicine-cabinet.)
The fact that the Left refuses to demonize the insurance consortia, which people will get - like do-you-want-the-insurance-business-in-your-medicine-cabinet, or in your hospital room, or in your doctor's office - tells me that the Left cares more about money and reelection than it ever cared about health-care for the people.
I've yet to hear a self-identified backer of the public option say anything that just might get them in trouble with big insurance. And people wonder why for too many years this issue has come to the table of government and for the same number of years it's died before it was ever born.
September 3, 2009 4:53 PM | Reply | Permalink
Excellent point. I offer myself to create several anti-insurance ads based on absolutely true stories (myself and many patients). I could put it all together in a week or two.
But you are right -- where is the outrage?
Oh! And where are the bumper stickers?
I'm thinking.........
Here are some:
HEALTH INSURANCE -- It's there for you -- UNTIL YOU GET SICK!
INSURANCE EXECUTIVES -- At lest THEY are financially HEALTHY!
THE PUBLIC OPTION -- IT'S FOR U.S!
September 3, 2009 6:47 PM | Reply | Permalink
How about HEALTH INSURANCE: MURDER BY SPREADSHEET?
September 4, 2009 3:47 PM | Reply | Permalink
Good strategy!
September 4, 2009 1:32 AM | Reply | Permalink
does anyone else feel that its to late no matter what he says?
Obama never wanted real reform with a true public option.
thats the point people wont admit to themselves.
show me one piece of evidence, one action that he did.
words are cheap.
people now are responding to Obamas actions.
how is that going??
September 3, 2009 2:36 PM | Reply | Permalink
Obama never wanted real reform with a true public option.
thats the point people wont admit to themselves
So he went into this whole debate "just because". Nonsense. He has consistently advocated reform and placed much of his prestige on the line with it. I don't know what a "true" public option is but a reform bill even with a trigger public option provision would be an improvement over the current state of affairs.
September 3, 2009 3:04 PM | Reply | Permalink
no, thats not what i said.
of course he wanted a bill and wanted to call it reform.
but he wanted something that the insurance and the drug companioes would go along with.
if you dont know what a real public option is by now, I dont understand how you can take issue with my point.
September 3, 2009 4:42 PM | Reply | Permalink
You are right... people have been fooling themselves.
September 4, 2009 1:34 AM | Reply | Permalink
I hope he will stare directly at the Republicans, who will neither be standing nor applauding, and really ticks them off with broadsides on their obstruction, corporate and party loyalty over the nation's welfare, and lack of participation.
The Democrats will go it alone, as we have from the beginning a century ago on this issue, to serve the needs of our citizens rather than the craven money and political gain that this particular group of Republicans, you, represent.
And by the way, we are the Democratic Party, not the Democrat Party that leads a diverse nation that includes Christians. We are not, nor ever have been, a Christian nation.
September 3, 2009 2:44 PM | Reply | Permalink
To date, I have seen nothing to think Obama has the courage to do what you suggest.
Change is ending; hope is dead.
September 3, 2009 2:45 PM | Reply | Permalink
What, Obama gave some great speeches and you got all tingly last Fall, and now the World isn't the utopia you dreamed it would be?
Grow up. For goodness sakes.
September 3, 2009 3:08 PM | Reply | Permalink
Well, I have every reason to believe he will ask for number 1 and 2. In fact, I think universal coverage and paying for it with some taxes on the wealthy are things he has been consistent, and somewhat passionate amount.
It really comes down to the public option, I think.
What he says about that could make or break the Democratic Party for a decade.
I know that we've all heard that this is Obama's biggest speech of his lifetime, and we heard it starting with the Wright controversy, and seemingly every third month since. And it was true every time.
But seriously. This is Obama's biggest speech of his Presidency.
September 3, 2009 2:51 PM | Reply | Permalink
I typically agree with you.
But on this: What he says about that could make or break the Democratic Party for a decade.
The Democratic Party itself will be assisting in this making or breaking, as it has all summer long.
And while Obama may be severely damaged by what he says, or doesn't say, and the reaction to it, I also tend to think that if the economy improves (a big if, certainly) the damage may be lessened.
September 3, 2009 3:09 PM | Reply | Permalink
Shorter: Best possible care, for most people, at cheapest cost.
Oh, and it would be nice if he stands up, literally and figuratively and puts a stake through the Reagan myth: "Government isn't the problem, BAD government is the problem."
But it ain't gonna happen. I agree that Obama's plans have too closely tracked Emmanuel's preferences, which is politics as usual, don't offend the health industry - make them your friend and get their money, instead of making them your enemy so they fund the Rs.
September 3, 2009 2:51 PM | Reply | Permalink
Mr. E, it will never be put any better than that.
September 3, 2009 3:21 PM | Reply | Permalink
Well ... actually ... it should be stated . . .
Take your best shot ... Paddlin' back into the tall reeds of the pond...
Quack! Quack! Quack!
~OGD~
September 4, 2009 2:13 AM | Reply | Permalink
Politically, I don't think it behooves the President to make this a populist issue (#2 - tax the rich).
I think it's understood that the tax burden will need to shift in order to pay for the plan, but highlighting it will not help him politically. If he does, every pundit in the world will be screeching "YOU SEEEEEE!!! HE WANTS TO RAISE TAXES!!! *snarf snarf*!!!"
Standing firm on coverage for all Americans and insisting on a public option will show leadership and allow the President to firmly claim the moral high ground as his own.
September 3, 2009 2:59 PM | Reply | Permalink
You should hear Mara Liasson's screeching on NPR, arguing in favor of all the rightwing talking points. She's terrified that insurance companies will have to be regulated in order to lower costs.
There is no media presence arguing for a transation to a European-style health system, in spite of the fact that they get comparable (even slightly better) outcomes for half our cost.
September 3, 2009 3:01 PM | Reply | Permalink
I'm SO surprised ... NOT!
A corporate shill and FauxNews twit?
How many times did she repeat the right's latest mantra, "It's better to have incremental compromises to achieve exponential change over a series of years."
Somebody ... quick. Stick a pickle in that pie-hole of hers.
~OGD~
September 4, 2009 2:28 AM | Reply | Permalink
And add that 18% of our GDP goes toward health care while GDP cost to France and Canada is 12%. (So where the hell does our one-third more go, since it doesn't go to delivering health care that even comes close to the quality, or quantity, delivered by France or Canada.)
September 5, 2009 2:07 PM | Reply | Permalink
Mr. Reich's advise would be perfect . . . if the President shared the same goals as Mr. Reich.
I don't believe he does.
The past few months have made clear that the President is not firmly committed to health care reform -- only winning a legislative battle. It has been this strategy, politics over agenda, that has guided the White House since January. This explains his decision to "close" Gitmo, but fail to follow through on policy; to criticize past White House behavior on the stump, but continue Bush's policies in the White House; to rail against the war on the middle class, but protect Wall Street at every turn.
In short, the White House does not want health care reform, they want a health care reform bill.
It is not the same thing.
September 3, 2009 3:01 PM | Reply | Permalink
I think that you are bang on target. A very shrewd appraisal.
September 3, 2009 3:24 PM | Reply | Permalink
We may not like "politics over agenda," but "agenda over politics" is what gave us such golden oldies as the McGovern and Carter administrations.
I realize I must sound like some kind of DLC "centrist" triangulator, but I'm not. I just think the politics is a prerequisite to our actually doing anything in office.
Now, I would much prefer that Obama played the FDR political game to the Clinton political game. But he has to play one of them -- principles be damned -- or we might as well take our ball and go home.
September 3, 2009 4:24 PM | Reply | Permalink
Politics over agenda has been the party strategy for about 30 years and that's why the party only wins when the Republicans screw up so badly that people vote them out. How can you vote the Democrats in? They stand for nothing. They are about nothing. And those who remember the time they stood for something all have grey hair.
September 3, 2009 5:59 PM | Reply | Permalink
Yes Bluebell... There are the "Old Warriors" . . .
. . . with silver-gray hair, beards down to their belly-buttons standing at a freeway off-ramp with a sign reading, "Spare Some Health Care?" and constantly being mis-labeled, denigrated, and vilified as the "Looking Glass Left" to counter-balance those of the "Rapture Right."
QUACK! QUACK!
~OGD~
September 4, 2009 2:43 AM | Reply | Permalink
September 4, 2009 3:40 AM | Reply | Permalink
numed,
you summed it up; sometimes it seems Obama is a closet Republican.
September 4, 2009 9:23 AM | Reply | Permalink
However, if he does that he's misread the public, which is a fatal error.
Progressives are not going to take it any more. And we have the power to destroy Democratic control of the federal government. We will do it if we have to.
It's a bit like Mutually Assured Destruction. Don't try to take us down, Obama, or we take you down with us...
September 4, 2009 3:53 PM | Reply | Permalink
Thank you Bob.
Medicare for all: simple, effective.
September 3, 2009 3:03 PM | Reply | Permalink
I've always been mercilessly skeptical of Barack Obama, thinking that he was taking progressives for a ride, and when he addresses congress next week I'll definitely know if I was right or wrong.
If he comes out strongly for a public option I will happily eat plate after plate of humble pie. If he dumps the public option, which at this moment seems very likely, I will feel that all my skepticism has been vindicated.
Eliminating the public option would be a tragic prevarication, a travesty and a betrayal of all those who have placed their faith in this man and who worked tirelessly to get him elected.
September 3, 2009 3:07 PM | Reply | Permalink
A public option is critical for lowering health-care costs.
If there is one message above all others that I hope Obama gets across in the speech, this is the one. He needs not just to say that this is true, but explain why it is true, in words simple enough to be grasped by millions of ordinary listeners, but detailed enough to make the case solid and irresistible.
And he needs to make it 100% clear to ordinary Americans that preserving the stake in the existing system held by insurance companies is no part of his agenda, but that the goal is delivering the best and most universal health care possible to health care consumers, for the lowest national cost. In other words, he needs to speak to that great, ponderous majority of Americans whose only "stake" in the health care system is as consumers of health care, and leave no doubt that he is on their side. If he does that he will have them all on his side, and the Blue Dogs will be left panting to get on board.
September 3, 2009 3:12 PM | Reply | Permalink
Obama needs a Tommy Douglas transplant so his speech sounds like this.
September 3, 2009 3:12 PM | Reply | Permalink
AMEN!
September 3, 2009 3:21 PM | Reply | Permalink
Agree 100% on Robert's points. This is the big one. Obama's already got two strikes (going to bed with the megabankers, propping up the war & torture machine) and I'm kinda doubting progressives and others are going to do the rah-rah for another at-bat.
September 3, 2009 3:26 PM | Reply | Permalink
HR 3200 only requires $239 billion of the expiring Bush tax breaks for the rich over 10 years. That doesn't even roll them all back. There's no need to emphasize it but if he does I'd surely put the onus on Republican for defending those tax breaks they all promised would expire and defending the status quo on health care.
There's not gonna be any groundswell electing Republicans next year. Democratic congressmen may not be very popular but Republicans are at 12%.
September 3, 2009 3:29 PM | Reply | Permalink
Very good point ... Mark . . .
And the Democratic congressmen who may not be (or even may be) very popular should seriously think long and hard about what I posted in my Cafe blog back on August 4, 2009:
~OGD~
September 4, 2009 3:10 AM | Reply | Permalink
Well put OGD. Oh sure there might be a few fence straddling blue dogs, probably freshman who can be picked off by a pretty face with a nice haircut and a line of patter. But the problem Republicans have is they're still selling the same old "kill the government" or Taliban like religious nonsense that got us into this mess in the first place. And even pretty new faces usually have a history of supporting those crazy policies and the con men who sold them so I think the losses will be minimal and may even be gains if we pass health care reform and Cap and Trade.
September 4, 2009 9:47 AM | Reply | Permalink
Would you take two out of three? Cuz, I don't think you will get the last one.
September 3, 2009 3:34 PM | Reply | Permalink
I am surprised, given the current disparity of health care coverage between the 'haves' and 'have nots', that in the following excerpt (from the first paragraph):
"how we will reign in the soaring costs of health care overall."
the incorrect word 'reign' was used, instead of 'rein', by Mr. Reich. I assumed he was smarter, and more sensitive than that.
September 3, 2009 3:36 PM | Reply | Permalink
Seriously?
September 3, 2009 4:09 PM | Reply | Permalink
At the end of the day, it appears to me that we have squandered the opportunity to frame the debate. Reich's frame is a good one. To shore up the public option, we need to make two points:
1) Government health insurance works like private health insurance, only cheaper.
2) The cost for this insurance will be distributed up for this type of insurance, while lots of other government insurance distributes costs down.
To prove point number one, President Obama should point out how many federally supported or financed health insurance plans we already have, how well they function, how happy their consumers are and how normal their care is for their patients:
Medicare
Medicaid
State Children's Health Insurance Program
Veteran's Health Administration
TriCare
Federal Employee's Health Benefits Program
To prove point two, we can point out plenty of other federal insurance that takes tax money from all of us to pay for insurance benefits to the wealthy, such as:
Federal Deposit Insurance
Crop Insurance
Flood Insurance
And even though they are not called insurance, let's not forget:
Under Bush Sr., Bailouts for S&L "Crisis"($124B)
and
Under Bush Jr., TARP ($388B)
These two insurance schemes paid for risky behavior after the fact to actors who had not insured their risk, a true moral hazard if ever there were examples.
September 3, 2009 4:09 PM | Reply | Permalink
Here's in part what Obama should say during his address to Congress next week:
"If you do not reform the healthcare system, Americans will keep on dying younger than citizens of other countries. So, the death panels are not in the healthcare reform bill, they are in the Congress. You are the death panels. I'm talking to you, Senator Grassley.
If you do not reform the healthcare system, the cost of healthcare will continue to bankrupt ordinary Americans and their employers, and eventually their government. It is not healthcare reform doing this, but the lack of it. I'm talking to you, Senator McCain.
If you do not reform healthcare for Americans, it will not affect me or my family or, no doubt, you or your families. It will not be my or your Waterloo, but it will certainly be the American people's Waterloo. I'm talking to you, Senator DeMint.
If you do not reform healthcare for Americans, then more and more Americans will take themselves elsewhere to find the competent, affordable, readily available healthcare that they envy when they stay at home. I'm talking to you, Representative Boehner."
September 3, 2009 4:10 PM | Reply | Permalink
Why mention the Republicans at all? We have the votes in the House and the Senate. To blame this on Republicans shows weakness. Take the bull by the horns and handle this business!
September 3, 2009 4:24 PM | Reply | Permalink
Whoa there young nihilist...
Don't let go the reins of hope BEFORE the steed has fled the barn.
Keep in mind Barack is a poker player.
Keep in mind he plays his cards close to the chest.
Keep in mind Americans are desperate for leadership, clarity, and education on this issue.
Keep in mind if he was throwing in his hand he wouldn't be giving this speech at all.
Keep in mind that this speech will be watched by a massive audience.
Keep in mind that if he didn't wait this long the audience wouldn't be nearly as massive...
When you start putting all that together you start to get the feeling Barack set this up not to fold, but to bet and raise...
Hang in there young fella.
Give it another week.
Don't underestimate our guy just yet...
September 3, 2009 4:33 PM | Reply | Permalink
Spoken like a ... true "Old Warrior" . . .
In the journey of the hero-- the struggle is not in a day, a month, a year or a decade.
The struggle is continuous and eternally internal.
We are all heros in our own struggles.
The Monomyth
~OGD~
September 4, 2009 3:40 AM | Reply | Permalink
Can I bring a little dash of cold-water reality? If Congress is going to enact a public option, the reason is going to have to be better/different than that proposed by Mr. Reich. NOT that he is wrong - he isn't. But what he proposes as the reason FOR a public option is precisely the fear motivating so many who are AGAINST the possibility ...... so many people who will be voting next Nov, and therefore so many in Congress for whom they will vote, or not.
At a very, simple (simplistic) level the fear is that the public option will 1) run private insurers out of business because it can, like the example given, get breaks private insurers can't and 2) it will then, when it's the only game in town, suddenly morph into the Department of Defense paying for $800 hammers.
And there's no way to prove that that's an impossible outcome -- in fact, to be honest, it IS a possible outcome. (Think about this wonderful public option we all want so much being operated by a future Bush and Cheney, whose buddies are the ones selling the equivalent of gold-plated hammers.)
You aren't going to talk the American people out of this fear, not even with Obama's oratorical skills. And he has to get that fear out of people's minds before their representatives will vote for a public option. Maybe he can do it -- but I don't know what he could say that would reach the people for whom this scenario is the real horror hiding in the closet, but maybe he can find something. It won't be the argument that Mr. Reich makes above. While, to us, the BEST thing you can say about the public option is that it's a first step to a single-payer system .... to someone who deeply fears that outcome, it is the very WORST thing you can say. How do you convince them that their 'fear' is unfounded, when you believe the same thing yourself ... but just don't consider it something to fear???
I don't have an answer that will accomplish the job; I haven't heard one; and I don't really think Pres. Obama will be able to pull one out of the magic top hat on Wednesday. And unless that fear can be put to rest, we will not have a public option.
So, barring a miracle I can't quite imagine, I don't think the President has any choice but to pull back from making that an absolute requirement, or even an expected requirement. I can hear the howls of real pain if/when he does that, but I'm realistic enough not to insist that he do something that be impossible to achieve and that, with his failure, will surely cripple him for all the other things he has to face and handle.
Instead of fighting a fear that can't be defeated, I would like to see him make use of it. Get legislation that recognizes the existence of a public option, that establishes the framework for one (maybe having leeway to make it even more what we would like to see since it isn't going to be implemented right away), and set a trigger for implementing it if the private providers can't do the job. You know they will most likely blow it. (And if they don't, if they actually meet the goals, then we've got what we want without putting that additional responsibility on the government. Unlikely but I guess possible.)
In the meantime, the public option (or maybe it will be the single-payer-waiting-to-be-born by that point) is recognized; it's framework is being built; it's perhaps being implemented in small sections of the country (as I understand the 'trigger' provision) and thereby becoming less frightening; and it's not dead. It wasn't ignominiously killed off and the carcass hung around our President's neck.
For those of you who will definitely and for all time lose faith in Obama if he doesn't "produce" a public option, that's certainly your right. But I believe that all you can ask of anyone is the best they can do, and if it's simply impossible for him to get legislation passed to implement a public option now, then the best thing is for him to accept that and get everything that is *possible* now while, while leaving a pathway open for more advancement down the road. You know, the Civil Rights Act originally was to contain all the provisions that were eventually broken apart and enacted over the period of several years (basic rights, voting, housing). We couldn't get everything we wanted up front --- but we did get what was possible and in the end, we got it all. In hindsight, the wait was very worthwhile.
The way I see it, we're fortunate enough to have a president who is intelligent and hard-working and in my opinion) has the right priorities. (And when you compare it to what we had from 2000-2008 that's quite a miracle.) I'm not giving up on him if he "settles" for the best that he can get.
Because it's not just up to him, you know. Ultimately the American people say what happens in this country ... and we're still dealing with a 'people' that re-elected George Bush. That pretty much says it all. And they might well have elected John McCain if he hadn't shot himself in the foot with a certain Alaskan Governor. And a lot of those people -- quite possibly enough of them to motivate them at the polls when they next vote for Representatives and Senators (or at least so those Representatives and Senators believe) -- are simply terrified of a public option.
The question isn't "what is the best outcome for this health care reform effort?" .... it's "what is the best POSSIBLE outcome?" As long as President Obama aims for and works for and largely achieves that, he will have my support.
September 3, 2009 4:55 PM | Reply | Permalink
Hello ... Elizabeth . . .
Overall, a very well stated comment.
I am actually a strong proponent of the single-payer plan, and have already seen the light on the wall that the public option is as good as one can expect in light of the current weak-kneed in the environs on the hill in Washington. And with that said, I specifically take note and commend you on your point in this graph:
Your use of the voting rights act is a very good example. I was personally quite involved in that struggle back in the day.
But I do have a small point to raise with this one small part that you wrote here ...
I won't deny the first part of that sentence. I can't deny it. There's no way to prove a negative. But I must point out that the second part of the sentence cannot be based on "fact" and is just as unprovable as the first.
To be totally honest: Any situation may be possible. Some situations may be probable. But until something becomes concrete, based on a observable action, it only then becomes fact.
So yes. It is a possible outcome. Is it probable outcome? Possibly. Is there any action as of yet to base a factual determination of an outcome. No.
For me, it comes down to being aware of the past mistakes and actions and staying vigilant to the possible future actions that are yet to come.
Thanks for taking the time to post your thoughts.
~OGD~
September 4, 2009 4:29 AM | Reply | Permalink
Thanks - appreciate your thoughts and nice words. I should have stated my thought more clearly: "Even someone like me who wants single-payer or, failing that, a public option and tend to more or less trust government has to admit that it's possible --- and to someone who is already afraid and distrustful, it may well seem to be probable."
Supporting facts? 1) History - or at least perceived history - of DOD, Post Office, Medicare, etc., all of which are believed to have morphed into money-guzzling entities that can't be sustained and some perceived as giving very poor value for the many dollars. 2) History - perceived and I think real - of the White House and the sheer incompetence if not downright veneality (sp?) of some of the past administrations,one of them of very recent memory.
Yes, there are other examples and historical truths that could lead to the opposite conclusion -- but if you're already afraid, and the people you talk to daily are afraid, and some people pretty high up in power are telling you to be afraid ... then I doubt it takes much to be convinced.
My point is that I just don't know if the real (not crazy tea-bagger) fear out there, among not-unreasonable people who VOTE, can be reduced enough to convince these people to let their legislators know it's safe to vote for a public option. In fact, I don't know that there is *anything* Obama could have done to overcome this fear in so short a time, at least with the way the opponents are willing to act. Mr. Reich's argument that the pubic alternative will have so many, many advantages over its private competitors is not going to reduce that fear.
I'm just glad that those involved in the long, slow, hard struggle for civil rights didn't get indignant and wash their hands from leaders who were trying to make headway as readily as some of the people posting here seem prepared to do. Eyes on the prize.
September 4, 2009 8:56 AM | Reply | Permalink
The fictitious fear of a government plan must be replaced by the provable fear of the existing health-scam corporations.
Case in point, GIGNA.
"CIGNA, a global health service company, takes its corporate social responsibility (CSR) very seriously. We embrace it as an opportunity to reflect and extend our mission to improve health, well-being and security for all those we serve.. . .CIGNA is the only National Health Service company to offer 24/7 service for all of its medical, dental and pharmacy plans."
http://www.cigna.com/
Really?
from the LA Times: For the first half of 2009 Cigna denied 33% of its medical claims in California.
http://www.latimes.com/news/nationworld/nation/healthcare/la-fi-insure-denials3-2009sep03,0,1423324.story
repeat as necessary:
Cigna denied 33% of its medical claims.
Cigna denied 33% of its medical claims.
Cigna denied 33% of its medical claims.
September 4, 2009 12:10 PM | Reply | Permalink
Preaching to the choir here! Nothing terrifies me more than insurance companies run amok!!!! But I'm not one of those who believes that capitalism/competition is ultimately good and will ultimately right all wrongs. To them, if CIGNA is that bad, then someone else will come along and do it better and that company will prosper because they have created a better product. And to them, if the government plan should get that bad, there would be no one to stop it and no way for a better product to be developed to compete with it.
I think they are wrong. I believe a gov't plan would assure everyone in the country of basic health care ..... and the folks with lots of money would probably still pay extra and get posh private plans from insurers. The best analogy I've come up with is USPS v FedEx and UPS: they exist side by side and the US Postal Service is slower, clunkier, less efficient, produces less income (to put it mildly) but, by gum, EVERYONE gets mail, wherever they are. FedEx and UPS go where it pays them to go and the rest of us can go hang. I think I'm going to start asking these "NO PUBLIC OPTION" people if they would really agree to dismantle the USPS. Do you really want to take the risk that you would be unable to get ANY mail, no matter how slowly it might arrive? I don't think a lot of people would agree to go without that guaranteed-for-all vital service.
September 4, 2009 4:59 PM | Reply | Permalink
Nice ideas, but BHO is desperate for any deal he can get in order to claim so as not to appeared as having failed.
Most of what is rattling around Congress will be a big fat wet kiss to the insurance lobby and medical providers with little or no substantial cost savings. Yes they may make strides toward universal coverage, at least in the short run.
But nothing is being proposed to help rein in costs and those who have been so fearful that reform will negatively effect them can look forward their employers increasing shifting the cost of health insurance to them.
The incompetence of Obama and the Democrats during this process has been staggering.
September 3, 2009 5:18 PM | Reply | Permalink
Frex,
if you're right the Democrats will pay the price.
September 3, 2009 5:47 PM | Reply | Permalink
So what happens when you call the White House these days? Do they even bother to hang up on you?
September 3, 2009 5:21 PM | Reply | Permalink
September 3, 2009 6:21 PM | Reply | Permalink
Oh, I think it is too late.
September 3, 2009 7:53 PM | Reply | Permalink
If he was going to say anything like this, he would have said it long ago.
September 3, 2009 7:55 PM | Reply | Permalink
Reich mistakenly believes public policy is principally the province of the president. Apparently he and Cheney have been reading the same Constitution, but it isn't the one you will find printed inside your political science textbook.
September 3, 2009 9:01 PM | Reply | Permalink
Government Option = Governhment Care
Take a look at the Obama Czars and you will see who the President will pick to run the Obama health care system.
September 3, 2009 9:55 PM | Reply | Permalink
What on Earth are you talking about?
Don't answer that. I don't care.
September 3, 2009 10:44 PM | Reply | Permalink
You think it can be any worse than the Corporate Health Insurance Czars now? The ones who already have their death panels in place deciding who lives and dies. You aren't going to lose your freedom to BIG GOVERNMENT because you have already lost it to the obscenely wealthy oligarchs in corporate America who have been enslaving you for quite some time...just so they can make a fistful of $$ while you break your back. Then they will lay you off, tell you that they will not honor your pension and send your job to India...wake up.
September 3, 2009 11:48 PM | Reply | Permalink
Please be nice to the obscenely wealthy oligarchs in corporate America and hope that they will continue to be obscenely wealthy. According Obama, they will pay for your health care. If they stop being obscenely wealthy. who is going to pay for your health care?
September 3, 2009 11:55 PM | Reply | Permalink
Nawwww...they could give a rats a$$ about my kindness or any kindness. They just want money...cold hard cash. To them the sentimentality crap is for saps and losers. So I will not be nice because the meaning would be lost on them anyways.
September 4, 2009 12:08 AM | Reply | Permalink
Be nice to people who send hired goons out to ridicule the handicapped who are seeking a tiny bit of compaasion and dignity at town halls? Maybe in my next life...in this one all they are gonna get from me is scorn and contempt. They are the Bastards of the Universe...
September 4, 2009 12:23 AM | Reply | Permalink
I am a staunch supporter of a single payer system. I was willing to compromise with the public option. If there is neither I do not see how I can in good faith support a party that passes legisaltion that is de facto Republican. It'll finally be time for me to stop being a registered Independent who votes only for Democrats and become a loyal member of the Green Party.
September 3, 2009 11:39 PM | Reply | Permalink
Now hold on just a second. I'll be as disappointed as the next person if we don't get a public option, but to call the resulting health care package "de facto Republican" is simply not reality-based. The Republicans would have done NOTHING. A "de facto Republican" health care reform package would have been no policy change whatsoever.
I understand the argument that a mandate without a public option would be a bonanza for insurance companies, but don't forget that this package also has a lot of features no Republican would have included in there. Things like forbidding recission and denial of coverage for pre-existing conditions. Or mandating that insurance companies institute best practices. Whether you think that's good enough or not is certainly open to debate, but it's NOT in any sense similar to what Republicans would have done.
September 4, 2009 9:47 AM | Reply | Permalink
Yes it is reality based. Without a public option it will amount to another in a long line of corporate giveaways, and maybe the biggest one of all, in the history of our country.
And helping out downtrodden and oppressed rich oligarchs is what the Republican Party is all about...
September 4, 2009 11:40 AM | Reply | Permalink
Obama has to make clear (if it's true) that health reform won't be financed in part by any cuts in Medicare benefits. That's a hot button issue for seniors.
Also, what about tort reform? John Edwards, and other trial lawyers who financially support Dems, wouldn't like it but a lot of Repubs would, and it would dampen health care costs through lower insurance premiums for docs and medical institutions.
September 3, 2009 11:41 PM | Reply | Permalink
Before you can have any financially large program, you have to get your financial house in order.
A must read article.
Insight: A matter of retribution
Financial Times
03-Sep-2009
By Gillian Tett
How many financiers do you think ended up in jail after America's Savings and Loans scandals? The answer can be found in a fascinating, old report from the US Department of Justice*.
According to some of its records, between 1990 and 1995 no less than 1,852 S&L officials were prosecuted, and 1,072 placed behind bars. Another 2,558 bankers were also jailed, often for offenses which were S&L-linked too.
Those are thought-provoking numbers. These days the Western world is reeling from another massive financial crisis, that eclipses the S&L debacle in terms of wealth destruction.
Yet, thus far, very few prison terms have been handed out. For sure, there have been a few high-profile dramas. Bernie Madoff is one, obvious, example.
But one reason why the Madoff drama has grabbed so much attention and already sparked a slew of books this month, is precisely because there are precious few other financiers behind bars, or facing momentous fines. Compared to the S&L days, the level of retribution so far seems almost non existent.
http://us.ft.com/ftgateway/superpage.ft?news_id=fto090320091244573891
September 3, 2009 11:55 PM | Reply | Permalink
Me, I think they have the "public option" sewn up.
Me, I also think that apathy and anger are useful emotions to evoke if trying to suppress a popular demand. Might even have written a post about it during the primaries.
September 4, 2009 5:04 AM | Reply | Permalink
The good is ALWAYS the enemy of the perfect.
But the status quo is the enemy of both.
Comprehensive health insurance reform is a victory for the good.
But it is a defeat for the status quo.
Just like Medicare and Medicaid, and SCHIP.
His supporters(like me) need a victory (even if partial) on this and then another one on carbon (same caveat).
September 4, 2009 8:28 AM | Reply | Permalink
I don't have a problem scuttling the public option. So long as we get health insurance reform and virtually universal coverage, the fact that there is not a public option is beside the point. The only reason to demand a public option is because it is the only way to get universal coverage and cost control, but judging by some European countries (notably Germany and the Netherlands - and France may be this way as well) you can cover everyone affordably with private insurance.
Both the Netherlands and Germany have heavily regulated health insurance that is privately provided. Subsidies for low income families is necessary, but those countries don't need a "public" option to cover everyone or keep costs reasonable. We should be looking at these systems as the most politically tenable way to get where we want to go - universal coverage. If we can get universal, high quality coverage without dealing with the political hot potato that is a public option then that would be the way to go.
No one is demagoging the German or Dutch health care systems (or France, for that matter) the way they carp on about the British and Canadian systems, because they are not "government run health care". I would agree with most readers here that both the Canadian and British systems are superior to our current system, but there are more politically tenable models out there that accomplish universal coverage. Why can't we focus on those systems as the way to go?
September 4, 2009 9:56 AM | Reply | Permalink
Germany has a public setup.
September 4, 2009 10:57 AM | Reply | Permalink
Not according to Uwe Reinhardt of the New York Times' Economix blog. He says the Neatherlands, Germany, and Switzerland all have universal care without a medicare like public option. Health insurance is run by private non-profits and/or for profits in those countries, but they are not government programs like the UK and Canada. The companies are heavily regulated.
Don - I haven't seen Sicko, but if we emulate the regulations in the Netherlands why would we expect a different outcome just because we're not them? I don't buy the argument that it can't work here because we're different. If we write effective regulations and enforce them on the industry it will work. Regulation is not socialism, at least not to the extent that an entire health care system run by the government is.
I have no problem with a single payer federal health care system - as I said Canada's works much better than ours - but it is not politically viable. Maybe heavy regulation of insurance isn't either, but it's a lot easier to sell than "socialized medicine" and if it works .
September 4, 2009 12:31 PM | Reply | Permalink
He is wrong. Not sure if there is a confusion with actual health care, which in the UK is also public.
Germany has a public-based insurance plan, with options to buy into private additional plans if you are above certain income levels.
September 4, 2009 12:36 PM | Reply | Permalink
The US isn't Netherlands or Germany. Tell us how the predatory US health-scam corporations would somehow become "heavily regulated." This would be by a new socialist US government, perhaps? You have seen "Sicko" haven't you?
September 4, 2009 10:59 AM | Reply | Permalink
Why cant we demand that health insurance policies be provided only on a non-profit basis? Profit motive is the reason that insurance company overhead for health coverage consumes 25% of every premium dollar, instead of a more reasonable 6% or so like in other industrial nations.
September 4, 2009 10:02 AM | Reply | Permalink
Health insurers ranked below many other industries, including other health sectors, in profitability, according to the latest Fortune magazine rankings. While pharmaceutical companies were the third-most-profitable industry last year, with a 19.3 percent profit margin, health insurers ranked 35th, with a 2.2 percent profit margin. Health insurers also ranked lower in profitability than medical products and equipment makers, pharmacies and medical facilities.
http://www.indystar.com/article/20090815/LOCAL/908150425/1083/LIVING01/Insurers++greedy+or+just+doing+their+job
September 4, 2009 11:11 AM | Reply | Permalink
That's not contradictory. The vast wads of cash the companies spend to deny care increase their profits relative to each other, but it's deadweight loss as far as the rest of us, and the economy, are concerned.
Those profit rates after that are *still* far higher than the profit rates of a true not-for-profit, one which isn't allowed to demutualize: namely, 0%.
September 4, 2009 3:49 PM | Reply | Permalink
"An unusually large portion is facing close races in 2010, both in primaries and in the general election. Republicans have many primary challenges from the right. A record number of Democrats, who took over Congress in 2006, hail from traditionally Republican or swing states and districts."
These Congresspeople don't need political "cover". They don't need Presidential rhetoric. They need a President who doesn't ask them to be lemmings for a "cause" they don't believe in and that their constituents reject as a matter of ideology or self interest.
If the President wants to keep Congress, he needs not only to drop the public option, but probably the individual mandate as well.
September 4, 2009 12:24 PM | Reply | Permalink
The Public Option was there to lower costs, which is what made the personal mandate palatable.
the subsidies are all ready being lowered, but even where they are, many American Families are gonna feel the brunt of Reform on their backs when they are forced to buy insurance.
Without a public option, a robust and good public option, the personal mandate will hurt families not covered by subsidies, and even some covered by subsidies. This could wreck the Democratic Party.
Obama campaigned against mandates when he was running against Hillary.
To me it seems, without the Public Option, there should be no mandates, or perhaps, a way to be exempted from the mandates. The subsidies need to be shored up, and perhaps increased. They should not be lowered as the Finance Committee is currently doing.
What do you think sir? Won't reform end up being a giveaway to the insurance industry (personal mandates) without a robust Public Option designed to offer competition and drive down costs?
September 4, 2009 3:19 PM | Reply | Permalink
Senate reconciliation is dead. Lawrence O'Donnell revealed on Hardball tonight that the 50 + 1 votes for reconciliation only counts for the FINAL vote on the bill in the Senate. It does not include that an infinite number of amendments may be raised about the bill and each one may be filibustered.
"Reconciliation requires 50 votes plus the Vice President for final passage only. During the process of reconciliation on the Senate floor there are countless votes that require 60 votes because it requires you to waive the rules of reconciliation - that's done constantly in every single reconciliation process that goes to the Senate floor. They can't think about going to the Senate floor without 60 votes whether they're doing it in reconciliation or outside of reconciliation."
- Lawrence O'Donnell
Former Democratic Chief of Staff of the Senate Committee on Finance and blogger at the Huffington Post
Source: http://www.msnbc.msn.com/id/3036697/#32696599
Time Index on Video 3:30
September 4, 2009 7:29 PM | Reply | Permalink
The question is -- why are costs going up so fast? advances in medicine are part of the equation...MRI machines, ultrasound, laproscopic procedures, cancer treatments, etc... all cost big bucks
There is another problem. Doctors have two incentives to perform more tests: fee-for-service and the avoidance of lawsuits. Answer this hypothetical: Say you have a condition and the doctor is 99% sure it is diagnosis "A" with treatment "A" proscribed. The test to determine if it is diagnosis "B" costs $10,000. If you turn out to actually have "B" and the test wasn't performed, will you sue the doctor for malpractice? Even if you answer "no", the doctor thinks you might...so he or she schedules the test and collects the fee for the "service."
Multiply this by millions of decisions every day, even if the test isn't $10,000 and you have a big cost problem due to the threat of malpractice suits and the fact that the doctor has no incentive to hold costs down if you are covered by insurance or the government plan.
Until this is addressed honestly by the administration, their talk of "reform" rings hollow, and instead sounds like just another government program that will spend more more money, lead to higher taxes and take us deeper in debt.
This is a difficult problem with no easy solutions. Solutions won't be found in a Nancy Pelosi-led drafting process; a public option doesn't solve this problem; nor does the mandate for all people to buy coverage. (even if those are good goals)
Candidate Obama promised to work for solutions by working in a bi-partisan manner and making hard choices. President Obama has done neither.
September 6, 2009 10:59 PM | Reply | Permalink