Heathcare News: Public option hangs in the balance, Is reform without it even a good idea?
September 8, 2009 7:12 PM Subscribe
"Employer Requirement in Baucus Health Package Would Have Unintended Effect of Discouraging Hiring of Low-Income and Minority Workers." Robert Reich channels his inner Don Draper to sell the public option, while Josh Marshall wonders if the current plans are even a good idea. Rep. Raul Grijalva claims that progressives in the house arn't Prepared to Surrender on the public option, and Obama's Speech before congress is tomorrow.
Grijalva is one of the leader of the Congressional Progressive Caucus, who wrote to the president claiming that that they wouldn't support a bill without a public option on September 3rd (after the whitehouse started signaling that they wanted to drop the public option) On September 4th, Pelosi said that without a public option wouldn't pass the house, but today she moderated that somewhat, saying that the public option was the best option "For the moment". and People are talking a lot about so-called "triggers".
Also, a lot of people are pointing out that the "Baccus Plan" from the senate finance committee would yield a health-care system Much like Switzerland's system but in fact, while Switzerland has no public option, it also has no private health insurance companies participating in the mandatory market (and it's still one of the most expensive)
Grijalva is one of the leader of the Congressional Progressive Caucus, who wrote to the president claiming that that they wouldn't support a bill without a public option on September 3rd (after the whitehouse started signaling that they wanted to drop the public option) On September 4th, Pelosi said that without a public option wouldn't pass the house, but today she moderated that somewhat, saying that the public option was the best option "For the moment". and People are talking a lot about so-called "triggers".
Also, a lot of people are pointing out that the "Baccus Plan" from the senate finance committee would yield a health-care system Much like Switzerland's system but in fact, while Switzerland has no public option, it also has no private health insurance companies participating in the mandatory market (and it's still one of the most expensive)
If you think Max Baucus is doing anything other than trying to delay, distort, or deny healthcare reform at the behest of his insurance industry patrons, you haven't been paying attention.
posted by orthogonality at 7:33 PM on September 8, 2009 [5 favorites]
posted by orthogonality at 7:33 PM on September 8, 2009 [5 favorites]
Has this Matt Taibbi article from Rolling Stone been posted yet?
posted by dilettante at 7:41 PM on September 8, 2009 [4 favorites]
posted by dilettante at 7:41 PM on September 8, 2009 [4 favorites]
Helpfully, Baccus filled in the lobbyists about his plan before the White House.
posted by shothotbot at 7:41 PM on September 8, 2009
posted by shothotbot at 7:41 PM on September 8, 2009
FiveThirtyEight suggests that the public option has been watered down enough that a trigger tied to a more robust option in the future may be the better alternative.
Personally, I'm frustrated by this deathless narrative that "people just don't want the public option." The (very little) polling done on the issue has shown healthy support in the early summer eroding to slight-majority opposition on the issue; however, the details of such polls usually show that the opposition is rooted in misinformation about what the plan involves. For instance, according to this August 18th MSNBC poll:
I have slim hope that Obama's address will garner a boost in the polls and help turn the narrative around if he's incisive enough (I mean, shouldn't the media have tired of this defeatist "storyline" by now?). But realistically any bill should take several weeks to produce, which is of course a lifetime in Washington. Here's hoping Obama can nail it into the fence-sitters' heads that they have much more to fear from failing to pass a bill than from angering the vocal minority that dogged them the last month.
Lastly:
Heathcare
ballance
arn't
whitehouse
Baccus Plan
Might want to get a mod to clean up these typos.
posted by Rhaomi at 7:46 PM on September 8, 2009
Personally, I'm frustrated by this deathless narrative that "people just don't want the public option." The (very little) polling done on the issue has shown healthy support in the early summer eroding to slight-majority opposition on the issue; however, the details of such polls usually show that the opposition is rooted in misinformation about what the plan involves. For instance, according to this August 18th MSNBC poll:
"Majorities in the poll believe the plans would give health insurance coverage to illegal immigrants; would lead to a government takeover of the health system; and would use taxpayer dollars to pay for women to have abortions — all claims that nonpartisan fact-checkers say are untrue about the legislation that has emerged so far from Congress. [...] Forty-five percent think the reform proposals would allow the government to make decisions about when to stop providing medical care for the elderly. That also is untrue: The provision in the House legislation that critics have seized on — raising the specter of 'death panels' or euthanasia — would simply allow Medicare to pay doctors for end-of-life counseling, if the patient wishes.Crucially:
while just 36 percent believe Obama’s efforts to reform the health system are a good idea, that number increases to 53 percent when respondents were read a paragraph describing Obama’s plans."So the popular rejection Blue Dogs cite as their reason for opposing a public plan is mostly based on lies and slippery comparisons to British-style socialized medicine, which no one is advocating. And that's not even counting the very real effect insurance industry lobbying is having on the proceedings, which Nate Silver pegs at nine lost votes in the Senate alone.
I have slim hope that Obama's address will garner a boost in the polls and help turn the narrative around if he's incisive enough (I mean, shouldn't the media have tired of this defeatist "storyline" by now?). But realistically any bill should take several weeks to produce, which is of course a lifetime in Washington. Here's hoping Obama can nail it into the fence-sitters' heads that they have much more to fear from failing to pass a bill than from angering the vocal minority that dogged them the last month.
Lastly:
Heathcare
ballance
arn't
whitehouse
Baccus Plan
Might want to get a mod to clean up these typos.
posted by Rhaomi at 7:46 PM on September 8, 2009
Dear conservatives: remember when giving women the vote was gonna destroy the fabric of the nation? Remember when the Clean Air Act was gonna cripple industry? Remember when the Americans with Disabilities Act was gonna create enormous financial burdens on small businesses?
Remember how none of that ever even came close to happening? Yeah, health care reform is like that.
Love,
Most Americans
posted by BitterOldPunk at 7:53 PM on September 8, 2009 [31 favorites]
Remember how none of that ever even came close to happening? Yeah, health care reform is like that.
Love,
Most Americans
posted by BitterOldPunk at 7:53 PM on September 8, 2009 [31 favorites]
Speaking of the Baccus plan, and this isn't a big deal, but if you look at the metadata in the PDF He actually released, it shows the Author as being Liz Fowler, who had actually been the VP of Public and External Affairs at Wellpoint before Joining Baccus's staff at the senate. "Public Affairs" generally means lobbying.
This isn't really a big deal, after all Baccus hired Fowler as a legislative aide, so it's not surprising that she would be involved in the process. but it illustrates just how deeply connected he is to the insurance industry.
posted by delmoi at 7:56 PM on September 8, 2009 [7 favorites]
This isn't really a big deal, after all Baccus hired Fowler as a legislative aide, so it's not surprising that she would be involved in the process. but it illustrates just how deeply connected he is to the insurance industry.
posted by delmoi at 7:56 PM on September 8, 2009 [7 favorites]
BitterOldPunk: "Dear conservatives: remember when giving women the vote was gonna destroy the fabric of the nation? Remember when the Clean Air Act was gonna cripple industry? Remember when the Americans with Disabilities Act was gonna create enormous financial burdens on small businesses?"
Remember when Communism was the watchword used to oppose everything decent? Oh, wait, nevermind.
posted by Rhaomi at 8:09 PM on September 8, 2009 [6 favorites]
Remember when Communism was the watchword used to oppose everything decent? Oh, wait, nevermind.
posted by Rhaomi at 8:09 PM on September 8, 2009 [6 favorites]
So Massachusetts Mefites, how is the health care plan there working out? It seems like it is very similar to the public optionless plan in the senate now.
posted by afu at 8:20 PM on September 8, 2009
posted by afu at 8:20 PM on September 8, 2009
"Dear conservatives: remember when giving women the vote was gonna destroy the fabric of the nation? Remember when the Clean Air Act was gonna cripple industry? Remember when the Americans with Disabilities Act was gonna create enormous financial burdens on small businesses?"
Don't forget those pesky child labor laws--people were screaming that they were just thinking of the welfare of the families which would fall apart without the income that the kiddies brought in from the sweatshops.
posted by leftcoastbob at 8:27 PM on September 8, 2009
Don't forget those pesky child labor laws--people were screaming that they were just thinking of the welfare of the families which would fall apart without the income that the kiddies brought in from the sweatshops.
posted by leftcoastbob at 8:27 PM on September 8, 2009
Dear conservatives: remember when giving women the vote was gonna destroy the fabric of the nation? Remember when the Clean Air Act was gonna cripple industry? Remember when the Americans with Disabilities Act was gonna create enormous financial burdens on small businesses?Ann Coulter: "I think [women] should be armed but should not [be allowed to] vote. No, they all have to give up their vote, not just, you know, the lady clapping and me. The problem with women voting — and your Communists will back me up on this — is that, you know, women have no capacity to understand how money is earned."
Remember how none of that ever even came close to happening?
Lew Rockwell: "The ADA has erected, not torn down, barriers to employment and the proper exercise of charity. There’s something fundamentally evil about a law that would do that. A president who cared about freedom and the status of the disabled in society would repeal the ADA, and defend the economics of liberty, not central planning by the central state, as enacted by Republicans."
And they're all for whittling away at the Clean Air Act.
posted by Flunkie at 8:30 PM on September 8, 2009
Don't forget those pesky child labor laws"Repeal Child Labor Laws", by the editorial vice president of the Mises Institute, linking to his article "The Trouble with Child Labor Laws":
"In every way, the opponents [of child labor laws] were right. Child-labor laws were and are a blow against the freedom to work and a boost in government authority over the family."
posted by Flunkie at 8:37 PM on September 8, 2009 [2 favorites]
Sick And Wrong by Matt Tabbi: When they all sat down in Washington to tackle the problem, it amounted to a referendum on whether or not we actually have a functioning government.
posted by The Whelk at 8:39 PM on September 8, 2009 [1 favorite]
posted by The Whelk at 8:39 PM on September 8, 2009 [1 favorite]
Baucus, God of fucking insurance company assholes.
posted by dirigibleman at 8:39 PM on September 8, 2009 [1 favorite]
posted by dirigibleman at 8:39 PM on September 8, 2009 [1 favorite]
Baucus, God of fucking insurance company assholes.
They would never use such a crude word to describe what they do in the hidden corners of the senate office building at four thirty in the morning. It's not fucking, it's making love.
posted by delmoi at 8:48 PM on September 8, 2009 [1 favorite]
They would never use such a crude word to describe what they do in the hidden corners of the senate office building at four thirty in the morning. It's not fucking, it's making love.
posted by delmoi at 8:48 PM on September 8, 2009 [1 favorite]
Good Lord. I'm going to have to abandon my cheap house after all and flee to Europe. Well, my wife will be happy; she's been wanting to move home to Budapest for years.
posted by Michael Roberts at 8:53 PM on September 8, 2009
posted by Michael Roberts at 8:53 PM on September 8, 2009
Here's the thing about people like the blue dogs. If they really believed in reform and weren't just paying lip service, at some point they'd have to say "I'm convinced that you've written a pretty great bill, let's just work to pass it and buff out the blemishes later."
Obviously, not everyone's going to think it's a pretty great bill. But it increasingly feels to me that those people overlap nearly 100% with those who will never believe government can do this properly. It's not that they're wrong (though I personally believe they are). It's that the gulf between me and them is so wide that it's pointless to argue over compromises.
Should the bridge over a hundred-foot chasm be forty feet long or sixty?
posted by Riki tiki at 8:57 PM on September 8, 2009 [2 favorites]
Obviously, not everyone's going to think it's a pretty great bill. But it increasingly feels to me that those people overlap nearly 100% with those who will never believe government can do this properly. It's not that they're wrong (though I personally believe they are). It's that the gulf between me and them is so wide that it's pointless to argue over compromises.
Should the bridge over a hundred-foot chasm be forty feet long or sixty?
posted by Riki tiki at 8:57 PM on September 8, 2009 [2 favorites]
Here's Paul Krugman's take on what he thinks Obama should say tomorrow.
posted by delmoi at 8:57 PM on September 8, 2009 [1 favorite]
posted by delmoi at 8:57 PM on September 8, 2009 [1 favorite]
MSNBC.com has a new section about the healthcare debate called Dose of Reality.
posted by netbros at 9:12 PM on September 8, 2009
posted by netbros at 9:12 PM on September 8, 2009
Too bad the Dems can't stand together and just blow universal care through. Like, pass a law that allows the President to make anyone an honorary federal employee, with the restriction that if they're only honorary federal employees, then the only benefit they get is the array of choices for health care that all federal employees get. Then have Obama make every citizen of the country an honorary federal employee. Boom, affordable health insurance for everyone. And have an opt-out too, so if you just hate having those extra choices, okie dokie, check a box and poof, they're gone, no extra choices for you.
posted by jamstigator at 9:32 PM on September 8, 2009 [1 favorite]
posted by jamstigator at 9:32 PM on September 8, 2009 [1 favorite]
Good reality-based article from the washington post: eight questions about health care reform
posted by shothotbot at 9:37 PM on September 8, 2009 [1 favorite]
posted by shothotbot at 9:37 PM on September 8, 2009 [1 favorite]
Too bad the Dems can't stand together and just blow universal care through. Like, pass a law that allows the President to make anyone an honorary federal employee, with the restriction that if they're only honorary federal employees, then the only benefit they get is the array of choices for health care that all federal employees get.
A simpler method would be to drop the medicare age restriction.
posted by delmoi at 9:40 PM on September 8, 2009 [1 favorite]
A simpler method would be to drop the medicare age restriction.
posted by delmoi at 9:40 PM on September 8, 2009 [1 favorite]
Should the bridge over a hundred-foot chasm be forty feet long or sixty?
Good meme. Do you want to build only half a bridge? Then how could you want to build half a medicare system?
posted by five fresh fish at 10:01 PM on September 8, 2009
Good meme. Do you want to build only half a bridge? Then how could you want to build half a medicare system?
posted by five fresh fish at 10:01 PM on September 8, 2009
Robert Reich is the conscience of American progressivism.
Then we are so fucked.
posted by eriko at 10:06 PM on September 8, 2009
Then we are so fucked.
posted by eriko at 10:06 PM on September 8, 2009
A simpler method would be to drop the medicare age restriction.
Rep. Anthony Weiner has suggested this, among other things. Rather than doing it all at once, he suggests we lower the Medicare age from 65 to 55. A few years later, lower it to 45, and so on. Could have universal/commie/single-paye/ whatever in a decade with that plan.
It's eminently sensible. So it'll not happen in my lifetime.
posted by zardoz at 10:28 PM on September 8, 2009 [2 favorites]
Rep. Anthony Weiner has suggested this, among other things. Rather than doing it all at once, he suggests we lower the Medicare age from 65 to 55. A few years later, lower it to 45, and so on. Could have universal/commie/single-paye/ whatever in a decade with that plan.
It's eminently sensible. So it'll not happen in my lifetime.
posted by zardoz at 10:28 PM on September 8, 2009 [2 favorites]
There will be no public option. There was never going to be a public option. It was a bargaining chip, a carrot to keep progressives in line while behind the scenes it was traded away for support from the health care industry. Did you really think that Obama was going to allow a few hotheads in Congress to bite the hands that elected him?
The result will be a corporatist's dream -- compulsory purchase of an industry's product, with many of us forced to buy policies we can't afford with deductibles so high we'll never be able to use them, and the poor given bare-bones policies subsidized with taxpayers' money.
And no matter how pointless and unworkable and unfair it is, Obama will claim victory and the newsmonkeys will trumpet this historic occasion.
And real reform of health care in the US will be dead for another 50 years. Game over.
posted by words1 at 10:46 PM on September 8, 2009 [5 favorites]
The result will be a corporatist's dream -- compulsory purchase of an industry's product, with many of us forced to buy policies we can't afford with deductibles so high we'll never be able to use them, and the poor given bare-bones policies subsidized with taxpayers' money.
And no matter how pointless and unworkable and unfair it is, Obama will claim victory and the newsmonkeys will trumpet this historic occasion.
And real reform of health care in the US will be dead for another 50 years. Game over.
posted by words1 at 10:46 PM on September 8, 2009 [5 favorites]
Check out this strange comment from white house press secretary Robert Gibbs:
posted by delmoi at 10:57 PM on September 8, 2009
QUESTION: I’m sorry. What did you just mean by it’s bouncing around K Street ?Sounds like even the Obama white house is saying the baucus plan is too to tilted towards the insurance companies? Seems strange, it could mean nothing
GIBBS: I was told that — that K Street had a copy of the Baucus plan, meaning, not surprisingly, the special interests have gotten a copy of the plan that I understand was given to committee members today.
posted by delmoi at 10:57 PM on September 8, 2009
If does that "Fired Up" routine, without properly addressing where he'd like reform to go, I will feel the cold knife of cynicism run up and stab my heart. Please knock this one out, Obama, pretty please?
posted by cavalier at 2:22 AM on September 9, 2009
posted by cavalier at 2:22 AM on September 9, 2009
Taibbi's article that dilettante linked to is good, as Taibbi usually is.
It's a situation that one would have thought would be sobering enough to snap Congress into real action for once. Instead, they did the exact opposite, doubling down on the same-old, same-old and laboring day and night in the halls of the Capitol to deliver us a tour de force of old thinking and legislative trickery, as if that's what we really wanted. Almost every single one of the main players — from House Speaker Nancy Pelosi to Blue Dog turncoat Max Baucus — found some unforeseeable, unique-to-them way to fuck this thing up. Even Ted Kennedy, for whom successful health care reform was to be the great vindicating achievement of his career, and Barack Obama, whose entire presidency will likely be judged by this bill, managed to come up small when the lights came on.posted by Kirth Gerson at 4:15 AM on September 9, 2009
And real reform of health care in the US will be dead for another 50 years. Game over.
ftfy
It is dead. It's been dead for months now. All that's left is the arguing over what casket to put the body in. And even that argument is as partisan as hell. Oak? Cherry? Maybe just cremate the body?
Whatever gets enacted as "reform" will be largely worthless to consumers. It'll probably be a big windfall for insurers, though. FoxNews will trumpet the glorious, patriotic defeat of socialism, and declare Obama's presidency dead.
Fear the mid-terms, kids. Fear more, though, 2012, as the Supreme Court gets set to overturn campaign finance regulation.
posted by Thorzdad at 4:53 AM on September 9, 2009
ftfy
It is dead. It's been dead for months now. All that's left is the arguing over what casket to put the body in. And even that argument is as partisan as hell. Oak? Cherry? Maybe just cremate the body?
Whatever gets enacted as "reform" will be largely worthless to consumers. It'll probably be a big windfall for insurers, though. FoxNews will trumpet the glorious, patriotic defeat of socialism, and declare Obama's presidency dead.
Fear the mid-terms, kids. Fear more, though, 2012, as the Supreme Court gets set to overturn campaign finance regulation.
posted by Thorzdad at 4:53 AM on September 9, 2009
Americans have the attention span of a gnat. The public option was the fucking compromise.
Who needs enemies when we have Congress?
posted by Benny Andajetz at 5:15 AM on September 9, 2009 [3 favorites]
Who needs enemies when we have Congress?
posted by Benny Andajetz at 5:15 AM on September 9, 2009 [3 favorites]
I am amazed by the incompetence of the health care "reform" process.
A good bill would have garnered huge support by reducing the crushing burden on job creation and entrepreneurship embedded in the present system. Instead, every active proposal increases that burden in one or more ways.
A good bill would have had a broad-based, benefit-level-linked funding system, similar to Social Security or Unemployment Insurance. Instead, the drafts all fund themselves by soaking the "rich," many of whom (in their capacity as job creators) are already going to be suffering because of the "reform."
A good bill would have tackled the inherent problems with using "insurance" with low deductibles and co-payments to provide primary and routine care, and would instead have recognized the need to bifurcate the system between primary and routine care, which is an uninsurable cost of living, and true insurance against catastrophic events. Instead, the proposals all extend and complicate the broken low deductible / low co-payment "insurance" model.
posted by MattD at 5:26 AM on September 9, 2009 [1 favorite]
A good bill would have garnered huge support by reducing the crushing burden on job creation and entrepreneurship embedded in the present system. Instead, every active proposal increases that burden in one or more ways.
A good bill would have had a broad-based, benefit-level-linked funding system, similar to Social Security or Unemployment Insurance. Instead, the drafts all fund themselves by soaking the "rich," many of whom (in their capacity as job creators) are already going to be suffering because of the "reform."
A good bill would have tackled the inherent problems with using "insurance" with low deductibles and co-payments to provide primary and routine care, and would instead have recognized the need to bifurcate the system between primary and routine care, which is an uninsurable cost of living, and true insurance against catastrophic events. Instead, the proposals all extend and complicate the broken low deductible / low co-payment "insurance" model.
posted by MattD at 5:26 AM on September 9, 2009 [1 favorite]
If there isn't a public option, I will be contacting my represntatives to tell them to vote no. Fuck this, I don't care. Setting up a bill that requires coverage and kills off pre-existing conditions means crazy-high premiums. The insurance companies are rentiers already, a health care bill without the public option will just be obscene free money for them.
I will be royally pissed if my congressional representatives vote in a garbage bill — no bill is better. If it passes that way, I will be buying a shitton of stock in insurance companies, it's free government-mandated money.
posted by amuseDetachment at 5:42 AM on September 9, 2009
I will be royally pissed if my congressional representatives vote in a garbage bill — no bill is better. If it passes that way, I will be buying a shitton of stock in insurance companies, it's free government-mandated money.
posted by amuseDetachment at 5:42 AM on September 9, 2009
A good bill would have garnered huge support by reducing the crushing burden on job creation and entrepreneurship embedded in the present system.
This is worth pointing out to your small-business-is-the-engine-of-economic-growth, according to an OECD report on entrepreneurship, the US has a fairly low rate of entrepreneurship and small businesses compared to other developed countries. I would guess that part of the reason is if you start a hot dog stand you are betting your kids' health on the success of your wiener cart.
posted by shothotbot at 6:32 AM on September 9, 2009 [1 favorite]
This is worth pointing out to your small-business-is-the-engine-of-economic-growth, according to an OECD report on entrepreneurship, the US has a fairly low rate of entrepreneurship and small businesses compared to other developed countries. I would guess that part of the reason is if you start a hot dog stand you are betting your kids' health on the success of your wiener cart.
posted by shothotbot at 6:32 AM on September 9, 2009 [1 favorite]
"rich," many of whom (in their capacity as job creators) are already going to be suffering because of the "reform."
Let's nip this one in the bud right here. The contemporary threshold for "rich" (scare quotes and all) was set at $250,000/year during the 2008 Presidential campaign. That is a LOT of money, to the tune of 8x what the "average" (mean, not median!) person makes in the USA.
A lot of job creators are large corporations, run by CEOs making a lot of money, but the corps themselves aren't going anywhere if the CEO gets hit slightly by a tax increase. The other job creators? Small businesses, many of whom have an owner that's just not making even close to that threshold of 250K. When the business starts up, the owners will pay themselves just enough to live on, and even later on, they'll still be struggling to push 6 digits. You see, they're still going to be putting most of the business's income back into the business, hiring more people, expanding, improving, etc.
So who's really making so much money and being "hurt" by this? The stock brokers, the lobbyists, the movers and shakers who see people as anthropomorphized sacks of cash rather than real people. It's so easy to live on even a fraction of "rich" that I can't feel any sympathy for people who whine about being taxed a little more. The notion that rich folks would hire fewer people rather than take a cut in pay is sickening, complete truth, and a compelling rationale for public health care, as employers clearly can't be relied upon to take care of their employees these days.
posted by explosion at 7:15 AM on September 9, 2009 [2 favorites]
Let's nip this one in the bud right here. The contemporary threshold for "rich" (scare quotes and all) was set at $250,000/year during the 2008 Presidential campaign. That is a LOT of money, to the tune of 8x what the "average" (mean, not median!) person makes in the USA.
A lot of job creators are large corporations, run by CEOs making a lot of money, but the corps themselves aren't going anywhere if the CEO gets hit slightly by a tax increase. The other job creators? Small businesses, many of whom have an owner that's just not making even close to that threshold of 250K. When the business starts up, the owners will pay themselves just enough to live on, and even later on, they'll still be struggling to push 6 digits. You see, they're still going to be putting most of the business's income back into the business, hiring more people, expanding, improving, etc.
So who's really making so much money and being "hurt" by this? The stock brokers, the lobbyists, the movers and shakers who see people as anthropomorphized sacks of cash rather than real people. It's so easy to live on even a fraction of "rich" that I can't feel any sympathy for people who whine about being taxed a little more. The notion that rich folks would hire fewer people rather than take a cut in pay is sickening, complete truth, and a compelling rationale for public health care, as employers clearly can't be relied upon to take care of their employees these days.
posted by explosion at 7:15 AM on September 9, 2009 [2 favorites]
Meanwhile, in a remote corner of NC, "Blue Dog" and Family man Heath Shuler makes a spurious claim and gets called on it. Never could read a defense....
posted by halcyon_daze at 7:40 AM on September 9, 2009
posted by halcyon_daze at 7:40 AM on September 9, 2009
Too bad the Dems can't stand together and just blow universal care through. Like, pass a law that allows the President to make anyone an honorary federal employee, with the restriction that if they're only honorary federal employees, then the only benefit they get is the array of choices for health care that all federal employees get.
This isn't a bad description of the current proposals languishing in Congress, including the Baucus plan, except that instead of "everyone" becoming an honorary federal employee, only those who don't currently get offered insurance through their employer will become honorary federal employees. The new insurance market they're creating is basically the same thing as FEHBP, just with a different risk pool and subsidies only for those under 300 percent of poverty (maybe 400 percent if Olympia Snowe gets her way, let's cross our fingers).
Obviously it's going to be a separate risk pool from federal employees, which is a good idea since federal employees are a LOT older on average than the population in general (read: quite a bit more expensive). Interestingly the Senate Finance Committee seems to be leaning towards separate risk pools for individuals and small employers, which is strange--pushing all the young 20-year-olds into the individual market is going to pull down premiums, and you'd think it'd be politically popular to let the small employers tap into that younger-and-healthier-than-average risk pool.
If there isn't a public option, I will be contacting my represntatives to tell them to vote no. Fuck this, I don't care. Setting up a bill that requires coverage and kills off pre-existing conditions means crazy-high premiums.
Not necessarily--it all depends on who will now have access to insurance that didn't before. The rates of uninsurance are highest among people in their 20s and people in their 50s. It's entirely possibly that adding in a bunch of under-employed people in their 20s will actually lower premiums. (It's also possible that adding in a bunch of uninsurable people in their 50s will raise premiums. Since it's looking like this might be done on the state level, which directions premiums go will probably depend heavily on how well the state's current high-risk pool is operating; states with shitty programs that leave out very sick people will see worse increases than states with well-functioning high risk pools.)
I'm not saying that you have to support the Finance Committee version of this, but honestly? There's some hugely progressive stuff in there. Expanding Medicaid to 133% of poverty regardless of your disability or family status is huge. That's really just fucking huge, probably the largest expansion of a federal health program since Medicaid was created. Right now there are a lot of very, very low-wage workers who are totally shut out of any public program because you have to be pregnant, disabled, or have a kid under 6 years old in order to even start qualifying for Medicaid, no matter how poor you are. Also, the Finance Committee bill provides significant consumer protections against some of the nastiest business practices, most notably things like recissions.
In my mind, the expansion of Medicaid and consumer protections in even the most conservative proposal in the Senate make the bill worth supporting; it's not like a public plan couldn't be added later once the health insurance exchange is set up. My one big, big concern with this bill is that they're setting up 51 separate state exchanges, rather than one federal exchange (in my opinion, the best option) or a series of regional exchanges (still better than a state exchange). I think it's pretty clear from the current state of affairs that kicking insurance regulation to the state level doesn't necessarily work; plus, if a public option is "triggered" later, you're significantly reducing its effectness by limiting its size from the get-go.
posted by iminurmefi at 7:42 AM on September 9, 2009
This isn't a bad description of the current proposals languishing in Congress, including the Baucus plan, except that instead of "everyone" becoming an honorary federal employee, only those who don't currently get offered insurance through their employer will become honorary federal employees. The new insurance market they're creating is basically the same thing as FEHBP, just with a different risk pool and subsidies only for those under 300 percent of poverty (maybe 400 percent if Olympia Snowe gets her way, let's cross our fingers).
Obviously it's going to be a separate risk pool from federal employees, which is a good idea since federal employees are a LOT older on average than the population in general (read: quite a bit more expensive). Interestingly the Senate Finance Committee seems to be leaning towards separate risk pools for individuals and small employers, which is strange--pushing all the young 20-year-olds into the individual market is going to pull down premiums, and you'd think it'd be politically popular to let the small employers tap into that younger-and-healthier-than-average risk pool.
If there isn't a public option, I will be contacting my represntatives to tell them to vote no. Fuck this, I don't care. Setting up a bill that requires coverage and kills off pre-existing conditions means crazy-high premiums.
Not necessarily--it all depends on who will now have access to insurance that didn't before. The rates of uninsurance are highest among people in their 20s and people in their 50s. It's entirely possibly that adding in a bunch of under-employed people in their 20s will actually lower premiums. (It's also possible that adding in a bunch of uninsurable people in their 50s will raise premiums. Since it's looking like this might be done on the state level, which directions premiums go will probably depend heavily on how well the state's current high-risk pool is operating; states with shitty programs that leave out very sick people will see worse increases than states with well-functioning high risk pools.)
I'm not saying that you have to support the Finance Committee version of this, but honestly? There's some hugely progressive stuff in there. Expanding Medicaid to 133% of poverty regardless of your disability or family status is huge. That's really just fucking huge, probably the largest expansion of a federal health program since Medicaid was created. Right now there are a lot of very, very low-wage workers who are totally shut out of any public program because you have to be pregnant, disabled, or have a kid under 6 years old in order to even start qualifying for Medicaid, no matter how poor you are. Also, the Finance Committee bill provides significant consumer protections against some of the nastiest business practices, most notably things like recissions.
In my mind, the expansion of Medicaid and consumer protections in even the most conservative proposal in the Senate make the bill worth supporting; it's not like a public plan couldn't be added later once the health insurance exchange is set up. My one big, big concern with this bill is that they're setting up 51 separate state exchanges, rather than one federal exchange (in my opinion, the best option) or a series of regional exchanges (still better than a state exchange). I think it's pretty clear from the current state of affairs that kicking insurance regulation to the state level doesn't necessarily work; plus, if a public option is "triggered" later, you're significantly reducing its effectness by limiting its size from the get-go.
posted by iminurmefi at 7:42 AM on September 9, 2009
It is dead. It's been dead for months now. All that's left is the arguing over what casket to put the body in. And even that argument is as partisan as hell. Oak? Cherry? Maybe just cremate the body?
What the hell are you talking about? All the relevant congressional committees have finished writing their bills, except for the finance committee, and it looks like Baucus is finally getting off his ass. So we will probably see the reconcilation process start within a month and have a final bill in another month or so. Now that bill could be defeated, but reform is far from "dead".
If you were expecting something like single payer, you weren't paying attention to the Dem primaries. Kucinich was the only one advocating for that and it turned out he didn't do to well.
posted by afu at 8:01 AM on September 9, 2009
What the hell are you talking about? All the relevant congressional committees have finished writing their bills, except for the finance committee, and it looks like Baucus is finally getting off his ass. So we will probably see the reconcilation process start within a month and have a final bill in another month or so. Now that bill could be defeated, but reform is far from "dead".
If you were expecting something like single payer, you weren't paying attention to the Dem primaries. Kucinich was the only one advocating for that and it turned out he didn't do to well.
posted by afu at 8:01 AM on September 9, 2009
I know delmoi linked to this above, but I'll link again in case anyone is still following this thread:
The preliminary Senate Finance Committee plan
It's surprisingly readable (not written in legalese) and only about 20 pages long. There's some interesting nuggets in there, if you make it through the first couple of pages.
*$600 million per year to a nonprofit institute to study comparative effectiveness of different medical/surgical treatments (p 15)
*It would require drug, device and biologic manufacturers to report any payments or transfers of value made to a physician or teaching hospital, and would publish the information in an easily-searchable format (p 16)
*It would require all employers to disclose the value of health benefits that the employer subsidizes on the employee's W-2 (page 17)
posted by iminurmefi at 8:49 AM on September 9, 2009
The preliminary Senate Finance Committee plan
It's surprisingly readable (not written in legalese) and only about 20 pages long. There's some interesting nuggets in there, if you make it through the first couple of pages.
*$600 million per year to a nonprofit institute to study comparative effectiveness of different medical/surgical treatments (p 15)
*It would require drug, device and biologic manufacturers to report any payments or transfers of value made to a physician or teaching hospital, and would publish the information in an easily-searchable format (p 16)
*It would require all employers to disclose the value of health benefits that the employer subsidizes on the employee's W-2 (page 17)
posted by iminurmefi at 8:49 AM on September 9, 2009
What the hell are you talking about? All the relevant congressional committees...blahblahblah...but reform is far from "dead".
Horseshit. Have you actually looked at what's coming out of the committees? Evaluated what actually stands a chance in hell of being passed? There is nothing...nothing...coming out that passes any reasonable smell test as meaningful reform for common citizens and consumers. Nothing that will lower the cost to the consumer in a way that will stem the financial disasters hitting middle-class families. All we are sure to get is some form of mandatory insurance (the giveaway to that industry) coupled with, maybe, some minor cost assistance aimed at the poorest of the poor, and nothing for the middle-class. By all estimates that I've seen, costs are probably going to go up for middle-class consumers...the ones already getting hammered by costly premiums and high deductibles.
This shit isn't reform. It's putting pretty slipcovers on the Titanic's deckchairs.
I'm not looking for single payer...I'm looking for something that actually helps consumers. It's not there.
posted by Thorzdad at 9:36 AM on September 9, 2009
Horseshit. Have you actually looked at what's coming out of the committees? Evaluated what actually stands a chance in hell of being passed? There is nothing...nothing...coming out that passes any reasonable smell test as meaningful reform for common citizens and consumers. Nothing that will lower the cost to the consumer in a way that will stem the financial disasters hitting middle-class families. All we are sure to get is some form of mandatory insurance (the giveaway to that industry) coupled with, maybe, some minor cost assistance aimed at the poorest of the poor, and nothing for the middle-class. By all estimates that I've seen, costs are probably going to go up for middle-class consumers...the ones already getting hammered by costly premiums and high deductibles.
This shit isn't reform. It's putting pretty slipcovers on the Titanic's deckchairs.
I'm not looking for single payer...I'm looking for something that actually helps consumers. It's not there.
posted by Thorzdad at 9:36 AM on September 9, 2009
Thorzdad, you really think that none of the bills will help the middle class? (What do you define as the middle class, by the way?)
On balance, I think this bill definitely does a LOT more for the very poor than it does for the middle class. I'm not sure that's a bad thing, though, since the poor who are unlucky enough to not qualify for Medicaid (mostly young adults with no children) are the ones that are literally dying for lack of any access to care.
In terms of what the middle class is getting, I'd say the following are pretty major:
*Subsidies up to 400% of poverty to ensure no one spends more than 13% of their income on health insurance
*Standardized benefit packages (this one is HUGE) in the exchange, and a similar "floor" for employer-based insurance that ensures no one is wasting money on crappy coverage that has so many holes it leaves you medically bankrupt after a serious injury or illness
*Disallows insurance companies from denying coverage or imposing exclusion riders for pre-existing conditions, and disallows companies from rescinding insurance
Maybe subsidies won't actually go up to 400%, but there's no way that it will go below 300%, and I'd say that includes a fair number of the middle class. Even people who aren't getting help with premiums are going to end up with a lot more protections than they had before, particularly in the individual market.
I dunno. It's not perfect, there's definitely some things that I'd prefer to see improved in the Finance bill (the biggie would be a cap on total out-of-pocket spending as a percent of income, which I didn't see), but I'm honestly surprised that so many people are calling this nothing or worthless or not real reform. This is incredibly similar to what Obama (and Clinton) proposed in the primaries, and it has the potential to help millions and millions of people. It seems a bit like people are letting perfect become the enemy of the good.
posted by iminurmefi at 9:53 AM on September 9, 2009 [1 favorite]
On balance, I think this bill definitely does a LOT more for the very poor than it does for the middle class. I'm not sure that's a bad thing, though, since the poor who are unlucky enough to not qualify for Medicaid (mostly young adults with no children) are the ones that are literally dying for lack of any access to care.
In terms of what the middle class is getting, I'd say the following are pretty major:
*Subsidies up to 400% of poverty to ensure no one spends more than 13% of their income on health insurance
*Standardized benefit packages (this one is HUGE) in the exchange, and a similar "floor" for employer-based insurance that ensures no one is wasting money on crappy coverage that has so many holes it leaves you medically bankrupt after a serious injury or illness
*Disallows insurance companies from denying coverage or imposing exclusion riders for pre-existing conditions, and disallows companies from rescinding insurance
Maybe subsidies won't actually go up to 400%, but there's no way that it will go below 300%, and I'd say that includes a fair number of the middle class. Even people who aren't getting help with premiums are going to end up with a lot more protections than they had before, particularly in the individual market.
I dunno. It's not perfect, there's definitely some things that I'd prefer to see improved in the Finance bill (the biggie would be a cap on total out-of-pocket spending as a percent of income, which I didn't see), but I'm honestly surprised that so many people are calling this nothing or worthless or not real reform. This is incredibly similar to what Obama (and Clinton) proposed in the primaries, and it has the potential to help millions and millions of people. It seems a bit like people are letting perfect become the enemy of the good.
posted by iminurmefi at 9:53 AM on September 9, 2009 [1 favorite]
It would require all employers to disclose the value of health benefits that the employer subsidizes on the employee's W-2
So the government can tax me on my crappy sky-high deductible, low-coverage plan as part of my income? Gosh, that sounds just super. I can't afford to use my non-existent medical insurance now, just imagine how little I can use it when I'm getting taxed on it!
Seriously, could someone explain how this benefits the consumer?
posted by winna at 10:21 AM on September 9, 2009
So the government can tax me on my crappy sky-high deductible, low-coverage plan as part of my income? Gosh, that sounds just super. I can't afford to use my non-existent medical insurance now, just imagine how little I can use it when I'm getting taxed on it!
Seriously, could someone explain how this benefits the consumer?
posted by winna at 10:21 AM on September 9, 2009
The purpose of publishing the value of your health benefits isn't to tax them (that's pretty much radioactive politically--Obama wanted to tax health benefits that exceeded a certain value, like anything in excess of $10,000 per year, but even that was a no-go with Congress). Workers are paying for that coverage, whether they know it or not. If your employer is contributing $500 per month towards the cost of your coverage, then it's coming straight out of your wages. Part of the reason why you see poll after poll show that more than 80% of Americans are "satisfied" with their health coverage is because very few people realize exactly how much it's costing them (in lost wages if nothing else).
Making employers disclose the total premium cost for health insurance means that the entire thing is transparent to workers--which has the potential to really gather support for more aggressive measures to tamp healthcare inflation down. (Like, say, instituting a public option that has the authority to use Medicare payment rates.) Maybe people will start clamoring for a chance to join the exchanges (where any public option would be housed) once they see how much more expensive it is to buy insurance through their employer.
More information is pretty much always consumer-friendly.
posted by iminurmefi at 10:52 AM on September 9, 2009 [1 favorite]
Making employers disclose the total premium cost for health insurance means that the entire thing is transparent to workers--which has the potential to really gather support for more aggressive measures to tamp healthcare inflation down. (Like, say, instituting a public option that has the authority to use Medicare payment rates.) Maybe people will start clamoring for a chance to join the exchanges (where any public option would be housed) once they see how much more expensive it is to buy insurance through their employer.
More information is pretty much always consumer-friendly.
posted by iminurmefi at 10:52 AM on September 9, 2009 [1 favorite]
The result will be a corporatist's dream -- compulsory purchase of an industry's product, with many of us forced to buy policies we can't afford with deductibles so high we'll never be able to use them, and the poor given bare-bones policies subsidized with taxpayers' money.
I agree that this is, sadly, the most likely outcome, but I don't think, like words1, that real reform will never happen because of it. At some point, rising health care costs and insurance costs will get so bad that it will cross the threshold that causes enough people to panic that the lies and distortions of the insurance companies and their puppets in Congress won't be powerful enough to push back against a true popular uprising.
Right now, most members of the middle class have not faced a personal calamity due to the state of the nation's healthcare. Some have--see Sicko--but not that critical amount. Most middle class Americans still have decent health coverage through their employer. The poor aren't doing so well, but the middle class in America doesn't care about the poor. The unemployed aren't doing so well, but even in this recession over 90% of the workforce is employed. Few people actually care about someone who has gone bankrupt or worse due to the state of the healthcare system.
And so most people just aren't invested in it enough to look hard at the issue and think out a good solution. They're willing to eat up the insurance industry's lies, because they're what have been in the media lately, and frankly it doesn't really matter to them one way or the other, materially.
But as the situation gets worse and worse over the coming decade, more and more people will have had bad--really bad--encounters with the healthcare system. One of the main drivers of this, I think, will be that benefitted jobs will become harder and harder to find. Last recession had a 'jobless recovery.' This one will have a 'benefit-less' recovery. Jobs that were eliminated during the recession will return, but maybe as two part-time positions without benefits. So people will have to buy individual policies more and more, and when they realize how expensive they are, and how easy it is for insurance companies to find loopholes in them if an illness actually does happen, more and more people--middle class people--will get angry. Once enough are angry, all it will take is a president who can play to their feelings of outrage, helplessness, and isolation and really get a movement going. I don't think the current president has the temperament to do that, but maybe the next Democratic president will.
People say the rich and powerful really run the country, and to a large extent that is true. But just by demographics alone, the middle class in America has ultimate veto power. It's just that usually they are apathetic about most issues, and so the rich (who have the most to lose) just get to do whatever. Arguments from logic or morality cannot break this apathy--that's just human nature, really--but when the middle class really starts to experience raw suffering on a widespread scale, that will start the democracy up and running again. Just look at what happened during the 1930's--you think the big businesses wanted the New Deal? The hell they didn't--but the middle class was falling into brutal suffering, they demanded it, and they got it. That's what it'll take this time. It's just unfortunate that it seems to be human nature that potential problems, even ones that will almost definitely become real problems in the future, don't get addressed until that future has already arrived.
posted by notswedish at 11:04 AM on September 9, 2009
I agree that this is, sadly, the most likely outcome, but I don't think, like words1, that real reform will never happen because of it. At some point, rising health care costs and insurance costs will get so bad that it will cross the threshold that causes enough people to panic that the lies and distortions of the insurance companies and their puppets in Congress won't be powerful enough to push back against a true popular uprising.
Right now, most members of the middle class have not faced a personal calamity due to the state of the nation's healthcare. Some have--see Sicko--but not that critical amount. Most middle class Americans still have decent health coverage through their employer. The poor aren't doing so well, but the middle class in America doesn't care about the poor. The unemployed aren't doing so well, but even in this recession over 90% of the workforce is employed. Few people actually care about someone who has gone bankrupt or worse due to the state of the healthcare system.
And so most people just aren't invested in it enough to look hard at the issue and think out a good solution. They're willing to eat up the insurance industry's lies, because they're what have been in the media lately, and frankly it doesn't really matter to them one way or the other, materially.
But as the situation gets worse and worse over the coming decade, more and more people will have had bad--really bad--encounters with the healthcare system. One of the main drivers of this, I think, will be that benefitted jobs will become harder and harder to find. Last recession had a 'jobless recovery.' This one will have a 'benefit-less' recovery. Jobs that were eliminated during the recession will return, but maybe as two part-time positions without benefits. So people will have to buy individual policies more and more, and when they realize how expensive they are, and how easy it is for insurance companies to find loopholes in them if an illness actually does happen, more and more people--middle class people--will get angry. Once enough are angry, all it will take is a president who can play to their feelings of outrage, helplessness, and isolation and really get a movement going. I don't think the current president has the temperament to do that, but maybe the next Democratic president will.
People say the rich and powerful really run the country, and to a large extent that is true. But just by demographics alone, the middle class in America has ultimate veto power. It's just that usually they are apathetic about most issues, and so the rich (who have the most to lose) just get to do whatever. Arguments from logic or morality cannot break this apathy--that's just human nature, really--but when the middle class really starts to experience raw suffering on a widespread scale, that will start the democracy up and running again. Just look at what happened during the 1930's--you think the big businesses wanted the New Deal? The hell they didn't--but the middle class was falling into brutal suffering, they demanded it, and they got it. That's what it'll take this time. It's just unfortunate that it seems to be human nature that potential problems, even ones that will almost definitely become real problems in the future, don't get addressed until that future has already arrived.
posted by notswedish at 11:04 AM on September 9, 2009
And now the WH is signalling that even they have given up on Baucus. Baucus claims he is moving forward with the plan with or without the GOP support, presumably with or without Democrat support as well?
posted by mek at 1:17 PM on September 9, 2009
posted by mek at 1:17 PM on September 9, 2009
For me, the whole point of healthcare reform is the public option. I don't hold out much hope for it at this point, but if it doesn't happen, I don't see why they're even pushing for this.
posted by agregoli at 4:29 PM on September 9, 2009
posted by agregoli at 4:29 PM on September 9, 2009
So *thats* what it feels like to be thrown overboard. Huh.
posted by The Whelk at 6:06 PM on September 9, 2009
posted by The Whelk at 6:06 PM on September 9, 2009
I gotta say - President Obama's speech was pretty masterful. He put McCain and Grassley on the hot seat; I hope he's serious about calling out the obfuscators and obstructers going forward.
I hope it plays out well.
(Who was the dick that heckled the President? That's got to be a bit unprecedented.)
posted by Benny Andajetz at 6:21 PM on September 9, 2009
I hope it plays out well.
(Who was the dick that heckled the President? That's got to be a bit unprecedented.)
posted by Benny Andajetz at 6:21 PM on September 9, 2009
Joe Wilson (R, SC) is the dick that heckled the President.
posted by dirigibleman at 6:23 PM on September 9, 2009
posted by dirigibleman at 6:23 PM on September 9, 2009
My reaction was really strong to that. He should be ashamed of himself.
posted by agregoli at 6:27 PM on September 9, 2009
posted by agregoli at 6:27 PM on September 9, 2009
I think that Obama is putting his presidency on the line to try and improve American's health care. That is very brave.
posted by shothotbot at 6:41 PM on September 9, 2009
posted by shothotbot at 6:41 PM on September 9, 2009
The plan. Note that it is the "Obama plan", not the "National Health Care Initiative" or some crap.
posted by shothotbot at 6:50 PM on September 9, 2009
posted by shothotbot at 6:50 PM on September 9, 2009
Joe Wilson (R, SC) is the dick that heckled the President.
The Moment of Shame
posted by homunculus at 7:28 PM on September 9, 2009
The Moment of Shame
posted by homunculus at 7:28 PM on September 9, 2009
Joe Wilson (R, SC) is the dick that heckled the President.
The Moment of Shame
I really enjoyed how he (Joe Wilson) was quickly booed by his peers.
posted by [insert clever name here] at 7:40 PM on September 9, 2009
The Moment of Shame
I really enjoyed how he (Joe Wilson) was quickly booed by his peers.
posted by [insert clever name here] at 7:40 PM on September 9, 2009
Bah, I think your government could use a little more spirited heckling and debate, and a little less unopposed ridiculous speeches. That said, this was definitely not the occasion.
posted by Popular Ethics at 7:42 PM on September 9, 2009
posted by Popular Ethics at 7:42 PM on September 9, 2009
Apart from any political considerations (which are considerable), the reason for not fundin that one particular medical procedure is that it is illegal for the government to do so. The 1976 Hyde Amendment makes it illegal to use federal funds to pay for abortions.
I don't want the President to break the law, even if I would like the law to be repealed. I don't understand how someone could consider Obama following his oath of office to uphold the Constitution and laws of the United States to be "throwing women under the bus". Isn't that what he's supposed to do?
People wanting Obama to ignore this particular law no doubt were fine with Bush ignoring the laws he didn't like. Right?
posted by Justinian at 2:30 PM on September 10, 2009
I don't want the President to break the law, even if I would like the law to be repealed. I don't understand how someone could consider Obama following his oath of office to uphold the Constitution and laws of the United States to be "throwing women under the bus". Isn't that what he's supposed to do?
People wanting Obama to ignore this particular law no doubt were fine with Bush ignoring the laws he didn't like. Right?
posted by Justinian at 2:30 PM on September 10, 2009
Yeah, I hope I did not imply that you in particular wanted Obama to break the law, odinsdream. I was speaking of people in general.
posted by Justinian at 9:43 PM on September 10, 2009
posted by Justinian at 9:43 PM on September 10, 2009
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