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As you all know, Jacob Hacker, a professor of political science at Yale and fellow at the New America Foundation, is widely credited with coming up with the idea for a public option. He is also an expert on the politics of U.S. health and social policy, he is author, coauthor, or editor of numerous books and articles, both scholarly and popular, including The Great Risk Shift: The New Economic Insecurity and the Decline of the American Dream (2006; paperback, January 2008) and Health At Risk: America’s Ailing Health System and How to Heal It (2008).

Today, Jacob Hacker, on New Republic, wrote a piece in "shy" support of the Senate Health Care Bill. For the past two days, progressives and other are debating whether the Bill should be killed or not. Some argue that without a strong public option, there is no Health Care Reform. While other are pledging pragmatism over idealism and are hoping that the bill can be fix in the future.

Jacob Hacker said that while he is tempted to side with Howard Dean in his call to kill the Bill, he also thinks that any delay on Health Care Reform can hurt millions of americans. I agree myself with Hacker. In my humble opinion, I think it always easy to fix something that exists than starting a new reform from scratch. Even Ted Kennedy said that one of his biggest regrets was his opposition to President Nixon's health reform proposal.

As I said before, I think the senate should pass the bill, and make some improvements in the conference. Then if it's still possible go nuclear by using reconciliation in adding the Public Option in the next bugdet.

Is Killing the Bill a solution ? If so what next ? Do you really think that killing the bill will help more Dems in 2010 ? Or Could "Saving The Bill" be helpful for Dems in the next election ?

Here some highlights of Jacob Hacker's article and you can found it at The New Republic

(...)

For me, the question is particularly difficult. I have been the thinker most associated with the public option, which I’ve long argued is essential to ensuring accountability from private insurers and long-term cost control. I was devastated when it was killed at the hands of Senator Joe Lieberman, not least because of what it said about our democracy -- that a policy consistently supported by a strong majority of Americans could be brought down by a recalcitrant Senate minority.

It would therefore be tempting for me to side with Howard Dean and other progressive critics who say that health care reform should now be killed.

It would be tempting, but it would be wrong.

Since the first campaign for publicly guaranteed health insurance in the early twentieth century, opportunities for serious health reform have come only rarely and fleetingly. If this opportunity passes, it will be very long before the chance arrives again. Many Americans will be gravely hurt by the delay. The most progressive president of my generation--the generation that came of age in the anti-government shadow of Ronald Reagan--will be handed a crippling loss. The party he leads will be branded as unable to govern.

The public option was always a means to an end: real competition for insurers, an alternative for consumers to existing private plans that does not deny needed care or shift risks onto the vulnerable, the ability to provide affordable coverage over time. I thought it was the best means within our political grasp. It lay just beyond that grasp. Yet its demise--in this round--does not diminish the immediate necessity of those larger aims. And even without the public option, the bill that Congress passes and the President signs could move us substantially toward those goals.

As weak as it is in numerous areas, the Senate bill contains three vital reforms.  First, it creates a new framework, the "exchange," through which people who lack secure workplace coverage can obtain the same kind of group health insurance that workers in large companies take for granted.  Second, it makes available hundreds of billions in federal help to allow people to buy coverage through the exchanges and through an expanded Medicaid program. Third, it places new regulations on private insurers that, if properly enforced, will reduce insurers’ ability to discriminate against the sick and to undermine the health security of Americans.

(...)

Originally posted to LaurenMonica on Sun Dec 20, 2009 at 10:01 AM PST.

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Comment Preferences

  •  Tip Jar (136+ / 0-)
    Recommended by:
    JekyllnHyde, chrississippi, Bailey, skyesNYC, ORDem, askew, mem from somerville, LynChi, kpardue, dkistner, x, SallyCat, bumblebums, jeremyb, mll, deaniac83, bronte17, missLotus, understandinglife, sja, dvogel001, twcollier, itskevin, Cedwyn, lirtydies, wader, missliberties, leevank, grannyhelen, Nina, Catte Nappe, betson08, beachmom, riverlover, Sybil Liberty, sebastianguy99, Gowrie Gal, Julie Gulden, rapala, Elise, Lying eyes, Gary Norton, devadatta, Viceroy, LNK, LABobsterofAnaheim, Inland, begone, Crestingwave, trentinca, fou, doinaheckuvanutjob, gratis4, DBunn, Mithridates, lordcopper, yowsta, Matt Z, GMFORD, second gen, chicago jeff, millwood, OIL GUY, willb48, kafkananda, dotster, scooter in brooklyn, Rich in PA, Mannabass, smartdemmg, bluesheep, meldroc, Blogvirgin, a night owl, Irixsh, LaFeminista, 1BQ, MTmarilyn, aufklaerer, snackdoodle, RandomActsOfReason, velvet blasphemy, cultural worker, Tax problems, virginwoolf, zbbrox, elziax, zizi, NWTerriD, Hope Monger, sanglug, allep10, kevinpdx, PoliticalJunkessa, Little Flower, D Wreck, sherijr, lompe, Lazar, sulthernao, jamtown, Tx LIberal, bullyness, breathe67, gramofsam1, amk for obama, DemInRedville, indepenocrat, juturna, Egalitare, pateTX, nickrud, ericlewis0, indubitably, Onomastic, Front Toward Enemy, jtown, Inkin, BlueJessamine, BldrJanet, princesspat, Escamillo, theone718, StringTheory, earljellicoe, SoCalSal, moonpal, Huginn and Muninn, MichaelNY, modwen, New Horizon, sciphile, ridemybike, SaintC, Gay CA Democrat, PTF

    Republicans secret dream = the impeachment of Bo the Dog LOL

    by LaurenMonica on Sun Dec 20, 2009 at 10:01:51 AM PST

    •  Thanks for the well written diary, but (35+ / 0-)

      the problem we have with the bill isn't simply that it was stripped off the public option and Medicare expansion.  It's more than that.  It hardly has ANY cost controls in place - how do you live with the subsidies covering people only up to 300% of poverty when an insurance company can charge older people 3 times as much as they charge young, healthy ones?  Yes, you can get insurance if you have pre-existing conditions under the bill.  But your insurance company is allowed to squeeze you by making you pay three times as much in premiums.

      I mean, in practical terms, a family of 4 making $70,000 in San Diego, California will not get any subsidies (above 300% of poverty), and if Dad has a heart condition and one of the kids have a football injury he needs pain medication for long term, they can be priced the hell out of the market.

      That's not right.

      •  I see your point. I agree with you but (14+ / 0-)

        Should we let Perfectbe the enemy of the Good ?
        The bill isn't perfect but it's a pretty good start as Senator Harkin said.

        Republicans secret dream = the impeachment of Bo the Dog LOL

        by LaurenMonica on Sun Dec 20, 2009 at 10:23:39 AM PST

        [ Parent ]

        •  No, we shouldn't (28+ / 0-)

          But I am not convinced yet that this bill is actually good.  There are some good things in the bill, but I am not at all sure that this is a good bill overall.

          I respect Sen. Harkin and everyone else that wants to get it passed.  I don't like the bill, I'm not proud of it, but I damn sure as hell won't stand by and let anyone call them sellouts.  That's just as wrong as anyone who wants the bill to pass to question the motives of people like Howard Dean.

          •  Hacker Isn't Convinced Either (22+ / 0-)
            But I am not convinced yet that this bill is actually good.  There are some good things in the bill, but I am not at all sure that this is a good bill overall.

            Jacob Hacker agrees with you.

            So a bill must pass. Yet it must be a better bill that passes.

            Hacker supports the House bill, not the corrupt little bargain working its way through the Senate.

            The diarist badly misunderstands what Hacker wrote.

            •  Yeah (11+ / 0-)

              This is major distortion; Hacker says a bill must pass, not this bill. Which is basically what the alleged progressive bill-killers are saying.

              Either the diarist misread Hacker, or she's lying.

              I'll assume it's the former.

              •  David, please top-level your comment. (3+ / 0-)

                If this a factual problem with the diary, it needs greater readership.

                This diary as it reads now implies Hacker is willing to support the Senate bill as it is today.

                ♥ Medicare For All. ♥
                "Our health care system is like a casino. The insurance industry is the House... The House always wins." -- UnaSpenser

                by Chi on Sun Dec 20, 2009 at 11:22:16 AM PST

                [ Parent ]

                •  better advice: read the linked article (7+ / 0-)

                  as this diary's title is taken straight from it.

                  mizner's comment is misleading and irresponsible.

                  The problem with people who need to follow leaders is that they need to follow leaders.

                  by Cedwyn on Sun Dec 20, 2009 at 11:53:51 AM PST

                  [ Parent ]

                  •  It's the headline that misleading (5+ / 0-)

                    no surprise coming the NRepublic, a neoliberal, pro-corporate organ.

                    •  This is the part that reinforces my misgivings... (5+ / 0-)

                      Third, it places new regulations on private insurers that, if properly enforced, will reduce insurers’ ability to discriminate against the sick and to undermine the health security of Americans.

                      Three cheers for properly enforced regulations! Unless the administration doesn't want to enforce them!

                      I sure wish my government gave me as much privacy as they demand I give them.

                      by Daddy Bartholomew on Sun Dec 20, 2009 at 12:41:34 PM PST

                      [ Parent ]

                      •  I like this bit too... (7+ / 0-)

                        The lack of a public option also makes even more imperative tough requirements on insurers to make them live up to their stated commitment to change their business model and slow the spiraling cost of coverage. The most important way to do this is to move away from the Senate bill’s state exchanges and toward a national exchange such as that contained in the House bill....

                        The federal government is the only entity big enough and powerful enough to ensure a highly consolidated private insurance industry follows the law. ...

                        So a bill must pass. Yet it must be a better bill that passes. And  it must be understood by the President, the Congress and every American as only a step--an important but ultimately incomplete step--toward the vital goal that the campaign for the public option embodied: good affordable health care for every American.

                        Sounds an awful lot like what many of us have been saying, doesn't it? He's not really coming out in support of this particular bill; he's saying that even though it's a shit sandwich, it's better than not eating at all -- and that's no reason to shut up and like it.

                        I sure wish my government gave me as much privacy as they demand I give them.

                        by Daddy Bartholomew on Sun Dec 20, 2009 at 12:50:43 PM PST

                        [ Parent ]

                        •  and more than that (6+ / 0-)

                          he's saying the kill-the-billers are essentially correct in their reading of the current bill:

                          If it does not deliver--if the new options offered through the exchange do not attract broad enrollment, if insurers continue to undermine health security with impunity--then the worst fears of progressives will come true.

                          His argument is that it needs to be improved in conference and more so after it passes.

                      •  REQUIRING people to buy private insurance (2+ / 0-)
                        Recommended by:
                        Gorestro, rsie

                        is a loser concept for the public.  

                        It's not too cynical to guess that the only real "enforcement" will be the fines on the poor people who don't send in their payments on time to private, for profit, insurance companies.  It is quite likely that insurance companies will be getting away with the same old shameful policies and shenanigans that most American corporations do now.  

                        And there's no way to make that palatable to people who already can't or don't want to pay the high cost of health insurance.  Helping them out a little, even with "subsidies," is STILL going to cost them money.  It would essentially be a massive new tax on "lower income" Americans.  

                      •  or the next admin doesn't want to. (0+ / 0-)

                        we all know, for instance, how much Bush loved to ignore regulations and write new ones with no teeth.

                        866-338-1015 toll-free to Congress in D.C. USE it!

                        by cany on Sun Dec 20, 2009 at 02:35:32 PM PST

                        [ Parent ]

                  •  Did you read the linked article? (2+ / 0-)
                    Recommended by:
                    Chi, Onomastic

                    It's your comment that is misleading and irresponsible.

              •  Did you read it? (2+ / 0-)
                Recommended by:
                twcollier, Onomastic

                It would therefore be tempting for me to side with Howard Dean and other progressive critics who say that health care reform should now be killed.

                It would be tempting, but it would be wrong.

                Which bill was the one Howard Dean referred to?

                Earns no money here for blogging, commenting, or driving traffic to any web site.

                by mem from somerville on Sun Dec 20, 2009 at 11:55:32 AM PST

                [ Parent ]

                •  to be slightly more nuanced (5+ / 0-)

                  Hacker also wrote:

                  The lack of a public option also makes even more imperative tough requirements on insurers to make them live up to their stated commitment to change their business model and slow the spiraling cost of coverage. The most important way to do this is to move away from the Senate bill’s state exchanges and toward a national exchange such as that contained in the House bill. The federal government needs to be directly involved in implementing and enforcing strong national regulations of insurers and creating the new exchange. Otherwise, the effort for reform might fail at the hands of hostile governors.

                  So Hacker is not saying "Senate Bill no, House bill yes," but he's also not supporting the Senate bill as it stands.

                •  It feeds on the misconception (8+ / 0-)

                  that Dean and company want to kill health care reform, period, They merely want a better bill to pass, as does Hacker.

                  So a bill must pass. Yet it must be a better bill that passes.

                  My guess is Hacker isn't pleased with the headline the New Republic editors have his piece.

            •  I think we all can agree that if it was the house (4+ / 0-)
              Recommended by:
              ovals49, Bronxist, rsie, Onomastic

              bill that on the table, there would not even be a conversation but the Senate is holding the entire nation hostage.  We have to suck up their arcane bullshit and we cannot make a move to stop them...the deal they are giving us is simple...your money or your life.  This bill goes to conference and if the house change it a hair, it will not pass the Senate.  That is what they have told us....when someone holds you hostage..it is because they are not doing good things, they are usually criminals.  They have usually done something REALLY, REALLY bad that they want people to suck up....so I believe it is with this bill.  We have been given the broadstrokes but this bill is thousands and thousands of pages...and the devil is in the details.  The insurance lobbyists have been working on this bill for a year...and we need to pass it in two days...no thanks.

              "When fascism comes to America, it'll be wrapped in a flag and carrying a cross." Sinclair Lewis

              by lakehillsliberal on Sun Dec 20, 2009 at 11:20:08 AM PST

              [ Parent ]

            •  I want to know ONE THING. (2+ / 0-)
              Recommended by:
              Daddy Bartholomew, Onomastic

              I want to know what the employer's contribution is.

              This matters when you add consideration of income.

              You could have two identical plans both costing $200 per month, but one could provide you a raise while the other will not. Because perhaps plan A has a $500/month Employer Contribution, while plan B does not. If you don't know what that employer contribution is, you do not know how to achieve that extra income.

              If you include the "Self Insured" option a corp has, to keep that employer contribution in their pocket until, you have yet another way an employer can keep your income low while enjoying all the benefits of your labor. Not to mention that "Self Insured" provides a strong reward to a corp to keep you from getting needed medical care.

              Now, all that is needed is a way to get the people themselves to choose the plan the corp wants. That's almost too easy - you manipulate the premiums.
              If plan A actually keeps medical care costs down while still performing as intended, but plan B is really just a way to redistribute your share of the corporate wealth into the pockets and bank accounts of the CEO, then the answer is to make Plan A's premium really high and Plan B's premium super low.

              Here's a real world example. My monthly premiums are below $100, but the Chairman of the company decided his 7 bedroom mansion wasn't large enough so has been constructing a 14 bedroom compound (spa, bowling alley, all the trimmings) to replace it.

              We don't get sick days, but my premiums are really low. I'll give you three guesses where the real wealth earned by this company is going, and how it is getting there, and the first two guesses won't count.

            •  FLUBBER ARE YOU PURPOSELY MISLEADING US (0+ / 0-)

              or are you just lazy?

              GO TO THE LINK.

              THIS IS THE FIRST PARAGRAPH IN THE ARTICLE THIS DIARY COMES FROM:

              Now that the core demand of progressives has been removed from the Senate health care bill--namely, the public health insurance option--should progressives continue to support the effort?

              Your comment creates doubt and suspicion quite needlessly.

              READ before you jump to conclusions, will ya?

          •  It pains me to say this... (8+ / 0-)

            ... but perhaps 3 times the rate is better than being denied completely.  In addition, the required 85% medical costs provision should be 90%... but it is an improvement from as high as 30%, as we've currently seen.
            I hate this bill, and I am also quite saddened that candidate Obama seemed to fight tirelessly for a public option with no mandate about as equal to how listlessly President Obama fought a bill with a mandate and no public option.
            However, due to some thought provoking diaries on Dkos (yes, they still exist), I did a little reading about the legislative process in historical perspective and all I can say is, in this country it appears to be FAR easier to improve a law after it's been passed than to pass a law in the first place.
            I think this law should be passed.  Then I think, perhaps next year, perhaps next term, a public option should be passed or put through reconciliation.  
            Then I think the lifetime cap and preexisting conditions provisions should be strengthened.  A voila, a better healthcare system, fought for and improved over a generation.  That appears to be comparable to any other law we like and take for granted.
            I fear that many younger contributors on this site are experiencing their first political win followed by their first political disappointments.  Believe me, Bill Clinton's first campaign was motivational and promised to change the paradigm completely.  However, change is slow and frustrating in reality and we should all be thankful that it is...
            Otherwise, Social Security would have been handed over to Wall St, we would be at war with Iran and Medicare would be gone...

            Montesquieu and Locke are rolling in their graves right now...

            by Mannabass on Sun Dec 20, 2009 at 11:17:38 AM PST

            [ Parent ]

          •  If this was the last move, I would be pissed. (6+ / 0-)

            But this won't be the last move.

            Consider this like a long war.  You take back territory, country by country, bit by bit, taking strategic strongholds in a sequence that redefines the situation, part by part, in more favorable terms.

            Reject the drama like Barack Obama!

            by Stephen Daugherty on Sun Dec 20, 2009 at 11:54:02 AM PST

            [ Parent ]

        •  This bill is not good.... (17+ / 0-)

          and therefore that tired slogan doesn't even apply.

          I am so sick and tired of that stupid slogan that I may need to seek medical help (oh wait, my insurance won't cover that).

          "Don't let the perfect be the enemy of the good" is just an excuse for weakness.  For this slogan to apply, the bill actually has to be good.  This bill is not good.  Perfect isn't even a question here.

          And in the end the love you take is equal to the love you make. Lennon/McCartney

          by landrew on Sun Dec 20, 2009 at 10:41:53 AM PST

          [ Parent ]

        •  Show me good, and I won't let perfect oppose it. (22+ / 0-)

          I have $0 dollars left over to spend on health care, despite not being at poverty level.  I'd need 100% subsidization, and I'm not low enough to get it, which means I either give up on 15 years of paying a mortgage that costs me less than the cost of a single room efficiency apartment, or somehow manage to pay water, gas, electric, internet/phone, food, clothes, transportation and miscellaneous things like cleaning products and add some amount for healthcare on $250 a month.

          And I'm not alone.  Millions of Americans are skating along on a knife-edge, desperately trying not to fall off, and unless they get 100% subsidization, over they go into the abyss.  And they're not all at the poverty level.  Saying they'll get 'some amount of subsidization' up to 300% or whatever just doesn't cut it.

          So you'll hurt millions in the name of helping millions, some of them the very same people.  I'd far rather keep what I've got than be homeless in the name of having insurance.

          And that doesn't even begin to touch on the 51% or so of Americans for whom the odious abortion rights language is a major step backwards in time.

          Those who labour in the earth are the chosen people of God. - Thomas Jefferson

          by Ezekial 23 20 on Sun Dec 20, 2009 at 10:47:38 AM PST

          [ Parent ]

          •  I feel you (4+ / 0-)

            I am in the exact same position. Just barely squeaking by, but paying all my bills.

            Adding health care would kill me right now.

            The mandate won't begin until 2014 though right? Business will be much better then.

          •  A question (0+ / 0-)

            How much extra taxes would you be paying in Canada to cover your health care? Your argument is purely about costs, so please explain how you could afford that.

            •  If you want a hypothetical (3+ / 0-)
              Recommended by:
              Chi, tikkun, allergywoman

              answer, more.  But Canada is a crappy choice, since they're also only a bit better than us on healthcare, aren't they?

              What's their unemployment or underemployment rate comparatively too?

              I imagine I wouldn't be on a knife edge financially in Canada either, so could certainly afford to pay higher taxes.

              Those who labour in the earth are the chosen people of God. - Thomas Jefferson

              by Ezekial 23 20 on Sun Dec 20, 2009 at 10:57:16 AM PST

              [ Parent ]

              •  you might very well be. The point is (3+ / 0-)
                Recommended by:
                Lying eyes, satanicpanic, allep10

                you haven't had health care in your budget, whereas other countries have forced their citizens to include it. I don't necessarily think this is a bad idea for us in the long run. There may be pain in the short, but anything that forces us to deal with the actual cost will create space for further reform down the road.

                •  Oh I certainly feel it needs to be (9+ / 0-)

                  addressed, and urgently so.

                  Ignoring the tacked on odious parts that bought the last few votes, and continuing to focus on the central ideas, though, I'm fine with any and all additional regulation on the insurance industry.  But the industry is driving itself to financial ruin, pricing its products so high as to drive off customers, and has to, thanks to the profit motive.

                  The main problem here is enshrining the notion that there need to be people between you and healthcare who have any incentive to deny you healthcare for their own financial gain.

                  Sure, you can cavalierly say 'some people won't pay, taxpayer subsidies will pick up the bill'.  But those are tax dollars that could otherwise be going to education, public safety, or actual healthcare.  Why on earth would you claim (you in the generic sense, not you personally) that is fiscally responsible to spend gov't money on an added layer of healthcare execs who don't actually provide any healthcare, rather than providing more healthcare with the exact same number of dollars?

                  Is it sound and good to provide healthcare for 30 million when you could provide healthcare to 40 million if you merely cut out the middlemen?

                  We can see the problem, but this bill doesn't address it directly.  Instead, it provides an overly complicate Rube Goldberg approach to address the problem while diverting resources better used to directly address the problem.

                  Those who labour in the earth are the chosen people of God. - Thomas Jefferson

                  by Ezekial 23 20 on Sun Dec 20, 2009 at 11:16:24 AM PST

                  [ Parent ]

                  •  Enshrining? (3+ / 0-)
                    Recommended by:
                    Lying eyes, Matt Z, allep10

                    I disagree with this totally - this is the first time that there's been any motion on reining in the idea that the private market is the only proper place for health care for other than the indigent and elderly. To me it's the absolute opposite - it's telling the insurance companies that someone's actually watching over their shoulder. For the very first time. The requirement that they meet minimum standards (including medical loss ratios that are draconian compared to current state levels) gives space for further improvement.

                    I never expected the PO to pass; if you go back to June you'll find me saying the the exact people who killed it were going to kill it. I'm a true blue incrementalist. The modern civil rights movement started in the '30's in harlem, got it's first real success with Truman in '47, got over the hump in the '60's, and won't be completed (integration on the level of the Irish) in my lifetime. Same with sufferage. This will take as long. I'm not willing to wish a societal collapse, as some here do, to make it happen sooner.

                    •  Hmmm. (2+ / 0-)
                      Recommended by:
                      nickrud, allergywoman

                      The problem is that we're speaking about different parts of the bill.  As I said, I'm thrilled at the parts about regulating the industry.  But we're tying those to other parts that, without a gov't run alternative, force money to be given either from the people directly, or the gov't from tax dollars in their name, to a small pool of specific companies that are floundering.

                      It would be similar to passing a bill that all citizens are required to own cars, and subsidizing them if they can't afford it, simply to sustain the automobile industry, and not allowing people to choose not to own a car, but to use public transportation instead. (unless, they meet some extremely limited set of exemptions, such as becoming or being Amish.)

                      So I agree totally about the parts of the bill you cite, and would be happy enough to see this bill passed if it were stripped down to just those parts.

                      Those who labour in the earth are the chosen people of God. - Thomas Jefferson

                      by Ezekial 23 20 on Sun Dec 20, 2009 at 11:37:27 AM PST

                      [ Parent ]

                    •  Oh yes, some slight tweaks to the market (1+ / 0-)
                      Recommended by:
                      output

                      along with millions of new coerced customers - that's a huge victory for social justice.

                      "The work goes on, the cause endures, the hope still lives, and the dream shall never die." - Ted Kennedy

                      by Lazar on Sun Dec 20, 2009 at 01:23:47 PM PST

                      [ Parent ]

                •  It's easy for them (1+ / 0-)
                  Recommended by:
                  allergywoman

                  to force their citizens to pay for health care because health care is massively cheaper in every other developed country.

                  "The work goes on, the cause endures, the hope still lives, and the dream shall never die." - Ted Kennedy

                  by Lazar on Sun Dec 20, 2009 at 01:19:30 PM PST

                  [ Parent ]

              •  Canada has single payer (6+ / 0-)

                I don't think anybody here has been talking about going further than single payer - in the DKos discussion, Single Payer has always been treated as the ideal that we wish we could get to. So by the standards of the DKos discussion Canada is pretty much the promised land.

                England goes even further and has the government actually run the hospitals - I grew up there and generally never had to think about healthcare - you just got it if you needed it.

                The thing about changing the world... Once you do it, the world's all different. (Joss Whedon, BtVS Season 8 "The long way home")

                by sab39 on Sun Dec 20, 2009 at 11:16:58 AM PST

                [ Parent ]

                •  I was referring (0+ / 0-)

                  to the choice of Canada in reference to the delivery of healthcare, not the degree of socialization, which may well be a side issue.

                  Healthcare can be provided in many ways, and the payment issues don't necessarily reflect the number of infant mortalities, and so on.

                  Those who labour in the earth are the chosen people of God. - Thomas Jefferson

                  by Ezekial 23 20 on Sun Dec 20, 2009 at 11:19:18 AM PST

                  [ Parent ]

            •  In Australia it's 1.5% for basic single payer (12+ / 0-)

              (up to 2.5% for higher income brackets).

              Pretty good deal considering Americans could now be taxed 2% as a penalty and receive nothing.

              The US system is a laughing stock worldwide, and people watching this debate liken it to deciding between lettuce or arugala on a shit sandwich.

              •  You're telling me that total cost for Australia's (0+ / 0-)

                health care is 1.5% to 2.5% of the total government's budget?

                Actually, a large percentage of the costs come from general revenue. And over 30% of health care is paid by private health insurance for things like hospitalization. An Australian pays far more than 2.5% yearly for their health care.

                •  Misreading. (1+ / 0-)
                  Recommended by:
                  allergywoman

                  "You're telling me that total cost for Australia's health care is 1.5% to 2.5% of the total government's budget?"

                  No, I'm saying any Australian citizen can have health insurance for 1.5-2.5% of their income. And it covers all hospital care in public hospitals, except elective surgery (cosmetic, non-emergency dental, etc).

          •  And if I honestly believed that this bill would (7+ / 0-)

            get you relief, I would hold my nose and support it but I believe with all my heart this is a bait and switch.  The insurance industry does not spend hundreds of millions of dollars so they can be forced to change their practices.  They have loaded this thing with loopholes and the average American will see no relief.  This is an insurance industry scam and they are good at scams.

            "When fascism comes to America, it'll be wrapped in a flag and carrying a cross." Sinclair Lewis

            by lakehillsliberal on Sun Dec 20, 2009 at 11:25:33 AM PST

            [ Parent ]

          •  Hear dat. (2+ / 0-)
            Recommended by:
            cany, allergywoman

            So THERE with you on that one.

            I am self employed. My bare bones plan for myself and my wife costs over $700 a month. My older son is uninsured, is Special Needs and our plan does not cover his needed services or meds. He is currently uninsured. We make just past the medicaid line doe to having some investments.

            We are slowly but surely burning through our retirement and our son's college money. I will likely have to work till they peel the dataglove off my cold dead claw.

            What th' heck do I know, I work for a living...

            by SamuraiArtGuy on Sun Dec 20, 2009 at 01:16:57 PM PST

            [ Parent ]

        •  Should we let let the mediocre be a friend (4+ / 0-)
          Recommended by:
          Chi, SallyCat, Lazar, allergywoman

          of the bad?  That's what's going on.

          The trouble with the world is that the stupid are cocksure and the intelligent are full of doubt. Bertrand Russell

          by accumbens on Sun Dec 20, 2009 at 10:53:57 AM PST

          [ Parent ]

      •  I don't think your analysis is correct. (7+ / 0-)

        First, there are lots of other cost controls in the bill, here's a link to Ezra Klein discussing five.

        Second, the CBO's latest report said that removing the public option has no material effect on premiums.

        Third, the Dad's condition and the kids injuries wouldn't effect the size of the premiums (age, smoking and certain other limited factors are allowed to a limited extent).  The bill would put limits on annual and lifetime expenses which I'm guessing would help out a lot.  Also, the kids could stay on the parents coverage until their mid-20s.

        Finally, merely going on the exchange will mean that they will get more bang for their buck on their coverage (i.e., they'll get better plans).

        This of course all presuming he doesn't have employer coverage...

        •  When did they remove annual limits? (3+ / 0-)
          Recommended by:
          Chi, SallyCat, CarolynC967

          I thought they were allowed in the latest incarnation, though lifetime limits were not.

          Those who labour in the earth are the chosen people of God. - Thomas Jefferson

          by Ezekial 23 20 on Sun Dec 20, 2009 at 10:49:57 AM PST

          [ Parent ]

        •  Hmm, where are you getting this? (5+ / 0-)
          Recommended by:
          Chi, SallyCat, CarolynC967, cany, allergywoman

          this stuff about how pre-existing conditions other than age and smoking aren't allowed to affect the premiums?  Any proof of that?

          Yes, there are annual caps on out of pocket expenses.  But they are essentially a joke.  For the family I discussed, the cap is around $15,000-$20,000.  A family with a gross income of $70K with a mortgage to pay can't really afford that.

          I disagree with Ezra Klein that costs are not rising because insurance is expensive but because health care is.  If costs were simply rising because health care is expensive, then the big health insurance companies would not be taking 26-30% of your premium dollars for executive salaries and profits.  And secondly, if it's health care that's so expensive, please tell us why hospitals are exempt from the cost control commission that IS in this bill.  If controlling cost is there, then why is one of the largest drivers of cost exempt from future regulatory watch?

          •  there have always been only 3 things (5+ / 0-)
            Recommended by:
            Cedwyn, Elise, Mannabass, allep10, Theston

            that could affect premiums in the Senate bill, and two in the House: family size, age (1:3), smoking and family size and age (1:2) respectively.

            •  I'd like to see a link to this (0+ / 0-)

              that makes those factors exclusive, i.e. doesn't say "and other reasonable factors" or some such crap like that.

              •  Thomas.loc.gov HR3590 with Manager's Amendments (2+ / 0-)
                Recommended by:
                Cedwyn, allep10

                sadly, Thomas uses totally dynamic links. You'll have to go to http://thomas.loc.gov/... and click on Section 2701. Hopefully the link above will exist for a while. I'll quote it below:

                SEC. 2701. FAIR HEALTH INSURANCE PREMIUMS.

                     `(a) Prohibiting Discriminatory Premium Rates-

                           `(1) IN GENERAL- With respect to the premium rate charged by a health insurance issuer for health insurance coverage offered in the individual or small group market--

                                 `(A) such rate shall vary with respect to the particular plan or coverage involved only by--

                                       `(i) whether such plan or coverage covers an individual or family;

                                       `(ii) rating area, as established in accordance with paragraph (2);

                                       `(iii) age, except that such rate shall not vary by more than 3 to 1 for adults (consistent with section 2707(c)); and

                                       `(iv) tobacco use, except that such rate shall not vary by more than 1.5 to 1; and

                                 `(B) such rate shall not vary with respect to the particular plan or coverage involved by any other factor not described in subparagraph (A).

                            `(2) RATING AREA-

                                 `(A) IN GENERAL- Each State shall establish 1 or more rating areas within that State for purposes of applying the requirements of this title.

                                 `(B) SECRETARIAL REVIEW- The Secretary shall review the rating areas established by each State under subparagraph (A) to ensure the adequacy of such areas for purposes of carrying out the requirements of this title. If the Secretary determines a State's rating areas are not adequate, or that a State does not establish such areas, the Secretary may establish rating areas for that State.

                           `(3) PERMISSIBLE AGE BANDS- The Secretary, in consultation with the National Association of Insurance Commissioners, shall define the permissible age bands for rating purposes under paragraph (1)(A)(iii).

                           `(4) APPLICATION OF VARIATIONS BASED ON AGE OR TOBACCO USE- With respect to family coverage under a group health plan or health insurance coverage, the rating variations permitted under clauses (iii) and (iv) of paragraph (1)(A) shall be applied based on the portion of the premium that is attributable to each family member covered under the plan or coverage.

                           `(5) SPECIAL RULE FOR LARGE GROUP MARKET- If a State permits health insurance issuers that offer coverage in the large group market in the State to offer such coverage through the State Exchange (as provided for under section 1312(f)(2)(B) of the Patient Protection and Affordable Care Act), the provisions of this subsection shall apply to all coverage offered in such market in the State.

                •  Big Loophole (0+ / 0-)

                  `(B) such rate shall not vary with respect to the particular plan or coverage involved by any other factor not described in subparagraph (A).

                  This means that the rate of that specific plan may not vary by any other factor than age or smoking (and family size).  But insurers are free to offer completely different plans for those with a serious health condition and those without.  For this to actually be effective, the bill will have to explicitly state that insurers must offer the same plans to everybody.

                  •  you missed the first paragraph (1+ / 0-)
                    Recommended by:
                    allep10

                    IN GENERAL- With respect to the premium rate charged by a health insurance issuer for health insurance coverage offered in the individual or small group market--

                    That means every single policy on the Exchange.

                    •  YES, BUT (0+ / 0-)

                      every single policy does not have to be offered to every single person in the exchange.  That's the loophole.  There is nothing keeping insurance companies from offering some policies only to healthy people and some policies only to sick ones.

                      •  Nice try (2+ / 0-)
                        Recommended by:
                        deaniac83, Lying eyes

                        but yes, if a policy is on the exchange it's available to everyone. Offering a policy only to healthy people is discriminating due to a pre-existing condition, which is also prohibited.

                        `SEC. 2704. PROHIBITION OF PREEXISTING CONDITION EXCLUSIONS OR OTHER DISCRIMINATION BASED ON HEALTH STATUS.

                             `(a) In General- A group health plan and a health insurance issuer offering group or individual health insurance coverage may not impose any preexisting condition exclusion with respect to such plan or coverage.';

                        A plan on the exchange may not discriminate due to health, nor may it vary costs based on anything but age, family status, or smoking. (thank god I quit 11 months ago, after a 34 year habit).

                        •  You're right (0+ / 0-)

                          Alright, you're right when you're right.  But the bill says senate Amendment, is that the actual Senate version?

                          Still, the 1:3 difference based on age is pretty stark (although I would personally fall on the lower end of it).  Secondly, could this not just be an excuse to jack up everyone's rates?  "We want to charge this 55 year old man with a heart condition 3,000 a month, so we have to charge you, the 29 year old guy with no problematic health history, 1,000 a month.  See, we're in compliance!"

                          •  Sure, they could do that (0+ / 0-)

                            but then they'll have to do one of two things: actually spend that extra money on providing health care or refund the difference between what they spend and 85% of the premiums (The medical loss ratio that Rockefeller and Franken helped get added). So, say they radically overcharged as you suggest, and end up only spending 75% of the premiums? You'll get a 1200 refund (less any amount the feds had subsidized) and I'd get a $3600 refund.

                            Your numbers are awfully high in the first place; a decent individual plan for this 53 year old here in california can be had for a bit more than $500 per month, with a 75% Medical loss ratio. With 85% it'd actually be lower. $20 doctor copays, $2000 deductible, $1million lifetime cap.

                          •  Well, no, not really (0+ / 0-)

                            They will claim that they paid $500 for one pill of your prescription aspirin!  Or how about that $2700 they paid for your one hour of inpatient care at the hospital?  Ergo, they spent it on "care."  Of course, Pharmaceutical CEOs, Hospital CEOs and health insurance CEOs would never be friends or anything.  No possibility of  collusion there.

                            Remember they gutted the Dorgan amendment for drug re-importation and even the anti-trust exemption stays in place.

                            What I'm saying is without some sort of a stringent, public-utility style enforcement mechanism (or a public option), insurance companies and their friends would find their way around the regulations.

                          •  This MDL ratio (0+ / 0-)

                            works in controlling insurance companies. http://www.actuary.org/... is a very good overview of them, how to read and apply and why they have worked historically.

                            Why would a public option force them to follow the law? Especially if PO premiums would be higher than private, according to the CBO? (Anti-trust exemptions doesn't extend to hospitals and their ceo's.)

                            The problem with hospital costs is another ball of wax and it's own cost control mechanisms. The Bills do address that. I'd suggest going to thomas.loc.gov and clicking on the 3950 link. The second half of the bill is nearly entirely about how to hold down the actual cost of care. It has nothing to do with insurance companies and everything to do with health delivery and savings.

                          •  Loss ratios won't work without (0+ / 0-)

                            stringent enforcement mechanisms.  And I mean the way public utilities are regulated.  You are quoting studies that are done in a system in which people are not mandated to buy coverage - so insurance companies at least have the incentive to try to lure healthy people to their plans.  Now, everyone will be forced to buy their product by law, so they have no incentive whatsoever to lower premiums unless forced by law and by law enforcement to do so.

                          •  and for people making $14K/year, your (0+ / 0-)

                            "decent policy for about $500.00/month" can't be had.

                            Plain and simple.  And, essentially, in the bill under discussion, those very same people will have a greater % of their income now dedicated to healthcare than before.

                            THAT is the rub.

                            866-338-1015 toll-free to Congress in D.C. USE it!

                            by cany on Sun Dec 20, 2009 at 02:57:54 PM PST

                            [ Parent ]

                          •  Now don't get me wrong (0+ / 0-)

                            there's some real problems with the bill - mostly for people in the 300%-500% FPL area. They have no subsidies at all, and aren't in the habit of allowing for medical costs. There will be some horror stories there in the 2014-2016 area I'm betting. But not nearly as many are in the 100%-300% range right this minute.

        •  CBO report did not say removing PO had no effect (5+ / 0-)
          Recommended by:
          Cedwyn, wsexson, allep10, cany, allergywoman

          CBO of 12/19

          Effects on Health Insurance Premiums
          On November 30, CBO released an analysis prepared by CBO and JCT of the expected impact on average premiums for health insurance in different markets of the legislation as originally proposed.10 Although CBO and JCT have not updated the estimates provided in that letter, the effects on premiums of the legislation incorporating the manager’s amendment would probably be quite similar. Replacing the provisions for a public plan run by HHS with provisions for a multi-state plan under contract with OPM is unlikely to
          have much effect on average insurance premiums because the existence of that public plan would not substantially change the average premiums that would be paid in the exchanges.
          11 The provisions contained in the manager’s amendment to regulate the share of premiums devoted to administrative costs would tend to lower premiums slightly, and the provisions prohibiting the imposition of annual limits on coverage would tend to raise premiums slightly.

          The average premiums are not subsidized. The Public Option lowered subsidized plan primarily - non-group individuals.

          Then the footnote:

          11 The presence of the public plan had a more noticeable effect on CBO’s estimates of federal subsidies because it was expected to exert some downward pressure on the premiums of the lower-cost plans to which those subsidies would be tied.

          HR 676 - Health care reform we can believe in - national single-payer NOW.

          by kck on Sun Dec 20, 2009 at 11:37:55 AM PST

          [ Parent ]

        •  Read it, but here's part of the problem: (0+ / 0-)

          In a world without a universal health-care structure and an individual mandate, premium increases are a shame, but not much of a political problem. In a world with an individual mandate, large premium increases are Congress' problem.

          So what's the problem?  Congress IS the problem, specifically the Senate, and more specifically those who sprint along on insurance industry largess.  

          We wouldn't even have the problems we are seeing today if NOT for certain members of Congress.

          So I sure as hell hope that line from Klein doesn't assuage anyone's fears.  It should amplify them!  

          866-338-1015 toll-free to Congress in D.C. USE it!

          by cany on Sun Dec 20, 2009 at 02:51:13 PM PST

          [ Parent ]

      •  85% of premiums must go to pay claims (4+ / 0-)
        Recommended by:
        Cedwyn, Elise, satanicpanic, allep10

        compared to 30% (or more) currently.  Now that's cost control at the source.

        "Nothing is more powerful than an idea whose time has come." Victor Hugo

        by lordcopper on Sun Dec 20, 2009 at 11:23:06 AM PST

        [ Parent ]

        •  Yes, indeed (1+ / 0-)
          Recommended by:
          Pete Rock

          But how are utilities managed wrt publicly held companies? I believe this MCR limit may be illegal without a restructuring of the company. Anybody know?

          I suspect that's why it has remained in the bill - because it won't pass legal scrutiny.

          HR 676 - Health care reform we can believe in - national single-payer NOW.

          by kck on Sun Dec 20, 2009 at 11:40:57 AM PST

          [ Parent ]

          •  States have mandatory MCR's and have for years (0+ / 0-)

            it's legal.

            •  For non-profits and mutuals (0+ / 0-)

              The exchange will include only one non profit.

              I'm not an expert in finance laws but I'm not aware of a publicly held company (i.e, for-profit) with a mandated MLR at any level.

              HR 676 - Health care reform we can believe in - national single-payer NOW.

              by kck on Sun Dec 20, 2009 at 11:51:04 AM PST

              [ Parent ]

              •  this says otherwise (and includes two state's (1+ / 0-)
                Recommended by:
                allep10

                actual law: http://www.familiesusa.org/... . They make no differentiation between types of companies that I see.

                •  Well, some of the entries do specify non-profits (0+ / 0-)

                  ...which leads me to believe it supports your contention. I like Cal's law:

                  Managed care plans:
                  Administrative costs not to be
                  "excessive," limited to 15% to
                  25% based on developmental
                  phase of plan. Administrative
                  costs do no include some factors
                  such as salaries, stock options,
                  etc.

                  All MLR's (again, I'm no legal expert but I am an industry expert...) exclude investment expenses so if the MLR doesn't cover salaries and stock options out of operational costs then it's a formality. I can say that I have worked in Ca for two insurance cos, one a non-profit, and neither ever crossed the MLR nor did they ever even contemplate it. An accounting shift would have "fixed" it by reallocating from one bucket to another. The Ca DMHC does not have the legal funds or staff to enforce much.

                  I'm very supportive of the 80%/85% but remain suspicious about it's survivability.

                  Thanks for the info, I agree it supports your point.

                  HR 676 - Health care reform we can believe in - national single-payer NOW.

                  by kck on Sun Dec 20, 2009 at 12:36:02 PM PST

                  [ Parent ]

          •  How are utilities (energy companies) capped (1+ / 0-)
            Recommended by:
            kck

            at 8% in many states for cost increases,rate of return, and insurers are allowed 15%??????

            8% good enough for Exxon Mobil subsidiaries why not insurers?

            OK. 15%.  For now. ENFORCE IT!!!!!

            cast away illusions, prepare for struggle

            by Pete Rock on Sun Dec 20, 2009 at 01:00:08 PM PST

            [ Parent ]

        •  What is much more relevant (0+ / 0-)

          is what percentage of income is expected to go to premiums (and associated costs, such as co-pays). I heard on average 17% and it could go much higher. This is simply not sustainable.

          Don't let the awful be the enemy of the horrifically bad.

          by virtual0 on Sun Dec 20, 2009 at 11:41:55 AM PST

          [ Parent ]

      •  Actually, there are cost control measures (7+ / 0-)

        in the bill...

        See my comment here.

        And something I didn't mention there in a lot of detail - the 85% Medical Loss Ratio - requiring insurance companies to keep their administrative costs and profit to 15% of each dollar - is a big cost control measure. It would be better if it was 90%, but 85% is great considering that right now there are insurance companies who spend 30% of every dollar on admin costs and profit.

        And I finished this letter with unshakable faith that the dream will be fulfilled for this generation, and preserved and enlarged for generations to come.

        by Elise on Sun Dec 20, 2009 at 11:23:33 AM PST

        [ Parent ]

      •  You need to change the diary title (2+ / 0-)
        Recommended by:
        hester, cany
        - you're completely misrepresented what Hacker said.

        Don't let the awful be the enemy of the horrifically bad.

        by virtual0 on Sun Dec 20, 2009 at 11:34:34 AM PST

        [ Parent ]

      •  And Your Point Is? ------------ (1+ / 0-)
        Recommended by:
        masterp23

         

        in practical terms, a family of 4 making $70,000 in San Diego, California will not get any subsidies (above 300% of poverty), and if Dad has a heart condition and one of the kids have a football injury he needs pain medication for long term, they can be priced the hell out of the market

        What are their options then if this bill doesn't pass? Better? Worse? No different?

        "There's no sense in being precise when you don't even know what you're talking about." --John von Neumann

        by earljellicoe on Sun Dec 20, 2009 at 02:20:50 PM PST

        [ Parent ]

    •  Jacob Hacker - HERETIC! (19+ / 0-)

      Burn him at the stake!

      See if he floats on water or sinks! Maybe he's a witch, A WITCH I SAY!

    •  Pass it now fix it later (6+ / 0-)

      The same thing was said about Medicare and 40 years later we're STILL waiting for it to get better for the rest of us.  If anything the GOoPers have punched holes the size of Texas into Medicare to make it worse.

      I and many others cannot wait another 40 years for healthcare to be fixed cause a handful of Dems were too fucking cowardly to do the right thing from the get go.

      This is your world These are your people You can live for yourself today Or help build tomorrow for everyone -8.75, -8.00

      by DisNoir36 on Sun Dec 20, 2009 at 10:22:50 AM PST

      [ Parent ]

    •  Wonderful post! (5+ / 0-)

      Wholeheartedly recommended.  Whew!  Just when I thought the last vestige of sanity had left.  

      Oba-MA bumaye! Oba-MA bumaye!

      by fou on Sun Dec 20, 2009 at 10:23:11 AM PST

      [ Parent ]

    •  Excellent find Lauren. He makes some great points (3+ / 0-)
      Recommended by:
      Cedwyn, LaurenMonica, Gay CA Democrat

      Hope this would help cool down things here, but I doubt it.

      Rec'd.

      Between birthers, deathers and mouth-breathers, the gop has got 'teh crazy' and 'teh stoopid' covered.

      by amk for obama on Sun Dec 20, 2009 at 10:35:05 AM PST

      [ Parent ]

    •  Hacker AND Franken (6+ / 0-)

      in on day?

      Yes. Please.

      "Show up. Pay attention. Tell the truth. And don't be attached to the results." -- Angeles Arrien

      by Sybil Liberty on Sun Dec 20, 2009 at 10:49:22 AM PST

      [ Parent ]

    •  During comm to reconcile House & Senate bills (0+ / 0-)

      ...there are many changes that are left to make to improve this bill.

      After that milestone is passed, if the bill is not worse, then I'll also call for its signing. If the bill is worse, I will call for a veto.

      I agree completely with Jacob Hacker. But while elements are still in flux it's my role to call for a better bill.

      If I was a Senator, I would have an opinion appropriate to my role.

      Improvements:
      ...community rating - eliminate age rating increases for unsubsidized non-group individual plans
      ...reduce the ratio of age rated increases
      ...increase the minimum wage for the excise tax to kick in
      ...drug price negotiation, reimportation
      ...require annual updates
      ...reduce the 12 years for data exclusivity for biologics/biosimilars to 7 or less
      ...reduce or eliminiate the shift of Medicaid costs to the states
      ...reduce the time before adult pre-exist etc.  kicks in
      ...reduce the time before ins subsidies & exchange starts
      ...only non-profits in the national exchange
      ...cap the adult nongroup nonsubsidized premiums
      ...federalize emergency costs for undocumented adults
      ...no Medicare Advantage - this will be hotly challenged in the remaining days
      ...no increases to mandate non-compliance fines - another ins co demand for high prices that will fall on the House/Senate committee
      ...move foster children from Medicaid to Medicare

      HR 676 - Health care reform we can believe in - national single-payer NOW.

      by kck on Sun Dec 20, 2009 at 11:29:52 AM PST

      [ Parent ]

    •  you can't strip the PO and leave mandates in (0+ / 0-)

      they have to be tied to each other.

      and what examples in the past do we have to harbor the fantasy that this will get 'fixed' at any time in the future.

  •  My God, they got to him too! (38+ / 0-)

    Just like they got to Franken.  Or maybe the good ethical and political sense that has won them our respect and admiration is on display here as well.

    Al que no le guste el caldo, le dan dos tazas.

    by Rich in PA on Sun Dec 20, 2009 at 10:05:18 AM PST

  •  Just noticed that Nataline Sarkisian died... (2+ / 0-)
    Recommended by:
    mattman, landrew

    ...two years ago today.

    Does this reform fix what sealed her fate?

    There is no planet B

    by Minerva on Sun Dec 20, 2009 at 10:07:52 AM PST

    •  Yes - there are no annual limits (1+ / 0-)
      Recommended by:
      Cedwyn

      or lifetime limits in the bill.

      And I finished this letter with unshakable faith that the dream will be fulfilled for this generation, and preserved and enlarged for generations to come.

      by Elise on Sun Dec 20, 2009 at 11:27:31 AM PST

      [ Parent ]

      •  I have a question (1+ / 0-)
        Recommended by:
        Elise

        that I asked in another thread and maybe you can help me. I'll just quote myself, if that's ok.

        My crap insurance only pays for 5 doctor visits a year-- whether they be to specialists or my PCP. Recently I had a biopsy (to rule out cancer) and in the course of testing used up 3 of those visits. My 5th visit (I'll be seeing another specialist for my chronic condition on Tuesday) will actually be on New Year's eve (that's to get the results of said biopsy) and then I'll have to wait until April for a new year (according to my insurance).

        According to the Kaiser Family Foundation Subsidy Calculator, were the House or Senate bills pass I would qualify for Medicaid without that crappy insurance. To check that I'm not bullshitting, enter Family of 4 and $28,136.

        If this bill doesn't end that sort of annual limit (and if you say it doesn't, please provide a link), would I be penalized for dropping the insurance and picking up the subsidies instead? And, if not, would I be able to do that immediately?

        I'm asking you because you seem to know what you're talking about and you (hopefully) know on which side of this debate I fall.

        Thanks.

        •  I think you would ultimately (1+ / 0-)
          Recommended by:
          gratis4

          just qualify for Medicaid because you would be under the 133% of the FPL. More on that here.

          Basically, anyone who is 133% below Federal Poverty Level is automatically eligible for Medicaid under this new bill.

          But let's say you didn't automatically qualify for Medicaid because your income went up just a bit. If you look at the calculator...to the right it gives you a note:

          Note: In general, full-time employees with employer coverage available that meets specified requirements are not eligible for premium subsidies, unless the employee would have to pay more than 9.8% of income for the employer-provided coverage.

          If you would have to pay more than 9.8% of your income for your health care, then you would be able to get out of your employer insurance and opt into the exchange - where you'd get a voucher for the amount your employer would have otherwise had to pay for your insurance to help you pay for a plan there. You would also probably qualify for subsidies in that case. This is where the Wyden Amendment fits in:

          Sen. Ron Wyden scored a small win with vouchers that workers can use to buy insurance in the exchange if their employer's offerings are not affordable. The voucher will be for the amount the employer would otherwise have contributed to the insurance plan, and CBO expects 100,000 people to use it. Link.

          And I finished this letter with unshakable faith that the dream will be fulfilled for this generation, and preserved and enlarged for generations to come.

          by Elise on Sun Dec 20, 2009 at 01:35:38 PM PST

          [ Parent ]

          •  I'm wondering (1+ / 0-)
            Recommended by:
            Elise

            if I would be allowed to just discontinue my employer plan and go to subsidies without penalty, though.  

            It would be better if my employer's insurance were improved, but I don't see that happening.  

            Thanks for taking the time to respond.

            •  Yeah, if you didn't qualify for Medicaid (0+ / 0-)

              but you were able to get out of the employer plan because of the high cost, you'd get subsidies and there would be no penalty. The plan would have to be high cost though - 9.8% of your income and then you can opt out and go to the exchange.

              And I finished this letter with unshakable faith that the dream will be fulfilled for this generation, and preserved and enlarged for generations to come.

              by Elise on Sun Dec 20, 2009 at 10:57:08 PM PST

              [ Parent ]

  •  Exactly. Have to keep this in mind: (10+ / 0-)

    As weak as it is in numerous areas, the Senate bill contains three vital reforms.  First, it creates a new framework, the "exchange," through which people who lack secure workplace coverage can obtain the same kind of group health insurance that workers in large companies take for granted.  Second, it makes available hundreds of billions in federal help to allow people to buy coverage through the exchanges and through an expanded Medicaid program. Third, it places new regulations on private insurers that, if properly enforced, will reduce insurers’ ability to discriminate against the sick and to undermine the health security of Americans.

    The people complaining this bill does nothing need to get their heads on straight. Maybe you have some reason for believing it does more bad than good, but claim there's nothing here for progressives is flatly false.

    •  "If properly enforced" is a big if. (3+ / 0-)
      Recommended by:
      CarolynC967, glockw0rk, Mind That

      Just look at our drug laws.

      Silvio Levy

    •  Haven't we been over this ground before? (0+ / 0-)
      1. Exchanges don't work to control costs.  Voting down the antitrust legislation didn't help either.  Nor did exclusion of a strong public option.  Nor did exclusion of Medicare expansion.  The medical loss ratio of 80-85% being labelled as restrictive in this legislation?  Lower than the present loss ratio of 86%.  Blocking reimportation of drugs from Canada?  How does that square with cost containment?  The Eshoo Amendment?  Same story.  The bill is a give away to corporate interests.  All the exchanges do is make people choose between healthcare and watching their budgets get killed until they reach the subsidy threshold.
      1. Expansion of coverage via subsidy will not benefit those with complex medical problems or chronic illness.  Why?  a) Medicaid has been historically underfunded.  Just how persistent will the 'expansion' be with the GOP set to gain next year in 2010, not least because this legislation forces people to buy crappy policies from the ever so popular insurance companies.  b) Few doctors take medicaid patients because of lower reimbursement and those that do are either overwhelmingly idealist (very, very few) or marginal, ie, likely to inflict bad care and worse prevention.  c) The focus on premiums overlooks the far more pertinent out of pocket expenses, which this bill doesn't cover.  I can't do justice to this argument, so I'll invite you over to look at DWG's analysis: http://www.dailykos.com/...  d) As with every mandate, a significant fraction of the population will not comply.  Taking auto insurance as an example, about 25% of California and Alabama drivers, despite mandates, drive without.   Translation: between self-exclusion and recision (see below) the burden on Medicaid's budget is likely to climb.
      1. Regulations on insurers?  A few days ago, someone in the Senate inserted language in the bill allowing the insurers to deny care based on fraud, the same excuse they have used to deny 10s of thousands of Californians healthcare coverage.  So what if the insurers are required to take all comers at the outset of the policy?  Frankly they don't care about that as long as they can deny care when matters get expensive down the road.  In fact, from the insurance company perspective, this arrangement is ideal.  After all, they collect the premiums in the interim and then deny coverage.  Bigger profits.  And if you're relying on the government to adequately regulate insurers, then pop on over to Slinkerwink's diary and review the section on California's success in enforcing a $1M fine against the insurance company.  The state gave up.
      •  Wow. (0+ / 0-)

        Virtually none of that actually applies to what I quoted.

        1. This bill established dozens of different programs for controlling costs. The exchange is there to help individuals buy into group plans, which won't control overall healthcare spending but will make it easier for many individuals to find coverage.
        1. What does Medicaid have to do with the subsidies? The subsidies can be used to purchase any qualifying insurance. And that means you can gasp use them to buy a plan with lower out of pocket expenses. These aren't just subsidies for the poor, fer cryin' out loud, they go up to 400% of the poverty line. And yes, many people will opt out, that's why the bill is projected to over 30 million people not 40 million...
        1. Do insurance companies fuck with their customers? Obviously. But they way you people talk, you'd think no one in the entire country ever gets their medical bills paid for. It's a horrendous, awful leap of logic from "insurance companies do awful things" to "health insurance isn't worth having". Expanding coverage is a good thing. There's a reason people still pay hundreds a month for insurance.
  •  They will pass the bill. Just know when Obama (4+ / 0-)
    Recommended by:
    mattman, wsexson, CarolynC967, limpidglass

    and other Dems (including Baucus and Reid who have made the same claim recently) that the Senate Bill will lower premiums and costs for the American people.

    They are lying.

  •  Sadly this is unrealistic (5+ / 0-)

    If and when legislation passes, progressives should demand immediate concrete actions to make the promise of a reform a reality more quickly and more effectively.

    Yes, because the WH really cares what progressives want. This whole idea of fixing the bill later, it simply is unrealistic.

    There is no reason for Obama to try to fix it, this seems to be what he wanted. So who is going to fix it? The next President?How many senators is it going to take, 80?90?

    But if Hacker believes in this bill, then why did he say this:

    So a bill must pass. Yet it must be a better bill that passes

    So the bill isn't good enough?

    "Hey Joe, could you check his bearings. Again!"

    by allmost liberal european on Sun Dec 20, 2009 at 10:14:11 AM PST

    •  House/Senate conference (1+ / 0-)
      Recommended by:
      bullyness

      And someone cares what progressives want, or the lifetime limits prohibition that had been quietly taken out wouldn't have been put back in.

      The thing about changing the world... Once you do it, the world's all different. (Joss Whedon, BtVS Season 8 "The long way home")

      by sab39 on Sun Dec 20, 2009 at 10:21:24 AM PST

      [ Parent ]

  •  I'm still feeling so unsure.... (6+ / 0-)

    ...but, Jacob Hacker's article helped.

    at this point, I'll listen the experts; as many as possible.

    one thing is certain, they understand this better than I.

    "When I see an adult on a bicycle, I do not despair for the future of the human race." ~H.G. Wells

    by ridemybike on Sun Dec 20, 2009 at 10:18:50 AM PST

    •  Every wonk, (8+ / 0-)

      Cohn, Klien,Volgsky(I always say his name wrong), Hacker. They ALL say to pass it. Why? Because we cannot start from scratch ALL over again. We set this as a marker and when the time comes we do this all over again, but instead of starting from the endzone, we start from the 30 yard line(sorry for the football analogy).

      "I don't want a line in the Sand lines can be moved. They can be blown away. I want a six foot trench carved into granite."

      by theone718 on Sun Dec 20, 2009 at 10:34:32 AM PST

      [ Parent ]

      •  I'm inclined to listen to the wonks ~eom (0+ / 0-)

        "When I see an adult on a bicycle, I do not despair for the future of the human race." ~H.G. Wells

        by ridemybike on Sun Dec 20, 2009 at 10:41:07 AM PST

        [ Parent ]

      •  When is then? (0+ / 0-)

        What I don't get is when these wonks think the time for progressive reform will be?  I agree it isn't now, but when?

        After this bill passes, for having to fund the insurance companies, the American public will be so irate with the Dems, the Repubs are going to gain power and its going to stay that way for a while.  Translation: the future amendments that will emerge from Congress will weaken the public protections and strengthen the looting.

        So when will the progressive change come?  2014?  2016?

        And by then with the insurance industry even more powerful than now, what do you think 'reform' will look like?

        •  I don't know why you think (0+ / 0-)

          20 years from now it will be easier. If you don't realize it 30 YEARS AGO Nixon's health care plan was WAYY more far reaching then any version of the House bill.

          "I don't want a line in the Sand lines can be moved. They can be blown away. I want a six foot trench carved into granite."

          by theone718 on Sun Dec 20, 2009 at 05:29:17 PM PST

          [ Parent ]

          •  Actually (0+ / 0-)

            I'm hardly advocating a 20-30 year delay, and re-reading my paragraphs above, I don't know where you got that idea.

            What I was trying to say was this: The wonks think that we can get progressive reform by serial amendment.  When will that be?

  •  And Mr. Hacker will not need to buy (9+ / 0-)

    TWO health plans:  a separate one to cover basic legal reproductive services, like women will have to.

    This bill sucks.  It sucked before the new abortion language and it sucks now.

    People who say otherwise are desperate for attention or will get something out of the deal.

    "Most fools don't understand my worldview." - Ignatius J. Reilly

    by impygirl on Sun Dec 20, 2009 at 10:20:55 AM PST

  •  Thanks, LaurenMonica...this is helpful ~eom (1+ / 0-)
    Recommended by:
    LaurenMonica

    "When I see an adult on a bicycle, I do not despair for the future of the human race." ~H.G. Wells

    by ridemybike on Sun Dec 20, 2009 at 10:21:03 AM PST

  •  His support is rightfully tepid (6+ / 0-)

    because there is no guarantee that the regulations will be at all effective. However, if we can secure an agreement that keeps something that the health insurance companies want in check (e.g., sunset the mandates), we should pass this and hold on to the ability to revisit the issue.

    Ok, so I read the polls.

    by andgarden on Sun Dec 20, 2009 at 10:21:06 AM PST

    •  Absolutely. n/t (1+ / 0-)
      Recommended by:
      LaurenMonica

      Oba-MA bumaye! Oba-MA bumaye!

      by fou on Sun Dec 20, 2009 at 10:23:58 AM PST

      [ Parent ]

    •  The mandates serve a purpose (2+ / 0-)
      Recommended by:
      fou, bullyness

      They serve the same purpose as a tax - "there's no such thing as a free lunch". If everyone's going to actually get the health care they need, then it has to be paid for. Yes, this is a tax that goes to private companies rather than to the government and I hate that. But the whole point of government services in general is that some people pay more than they will use, so that people in direst need can get what they need for less than what it would cost. That's a progressive policy, even if channeling it through private companies is not.

      If policies must cover people with preexisting conditions and not have any annual or lifetime limits on what is covered, then there HAVE to be healthy people paying premiums to ensure that enough money is coming in to pay for what is going out.

      In other words - much as this is heresy on DK apparently - the mandate is cost control. That plus the '85% of premiums must be spent on care' limit puts a cap on insurance company profits, and insures that policies for people with preexisting conditions or older people can actually pay for all the care they'll need.

      It's an article of faith around here that the mandate serves no purpose except a giant giveaway to insurance companies. But it's not true, even if it might be true without the 85% in there. It's necessary; otherwise premiums for anyone who actually needs care would be insane.

      The thing about changing the world... Once you do it, the world's all different. (Joss Whedon, BtVS Season 8 "The long way home")

      by sab39 on Sun Dec 20, 2009 at 10:30:28 AM PST

      [ Parent ]

      •  You have misunderstood me (1+ / 0-)
        Recommended by:
        wsexson

        In the context of an overall scheme that works, I can accept the mandate (though I do not agree that it constitutes cost control in any meaningful sense--nothing in this package does).

        What I am sure of, however, is that the insurers really want a mandate above almost anything else. So we're going to give it to them. But I do not want that to be a blank check. I want to have the ability to revisit this "compromise" in a few years so we can actually improve what doesn't work. ANd the only way to get the political pressure to do that is if the insurance companies also have incentive to revisit the issue. The only way that will happen is if they don't get everything they want, in perpetuity, right now.

        Ok, so I read the polls.

        by andgarden on Sun Dec 20, 2009 at 10:33:55 AM PST

        [ Parent ]

        •  Can't we always do that? (0+ / 0-)

          The point is whether we are in a better position in a few years to "revisit" whatever.  I'm thinking not.

          Subsidies without cost controls, regulatory reform means that citizens get a little more awful insurance at a huge cost to taxpayers. Like Part D but worse.

          by Inland on Sun Dec 20, 2009 at 10:45:57 AM PST

          [ Parent ]

          •  That's why I want the Insurance companies (2+ / 0-)
            Recommended by:
            Inland, cany

            to have something on the line later, not us.

            Ok, so I read the polls.

            by andgarden on Sun Dec 20, 2009 at 10:49:14 AM PST

            [ Parent ]

            •  Have a default position that (0+ / 0-)

              removes the mandate and doesn't require getting sixty senators.  Got it.

              Subsidies without cost controls, regulatory reform means that citizens get a little more awful insurance at a huge cost to taxpayers. Like Part D but worse.

              by Inland on Sun Dec 20, 2009 at 10:55:26 AM PST

              [ Parent ]

              •  No, have a default position (2+ / 0-)
                Recommended by:
                wsexson, Inland

                that sunsets the mandate on date certain. You can drop it in in conference.

                Ok, so I read the polls.

                by andgarden on Sun Dec 20, 2009 at 11:02:58 AM PST

                [ Parent ]

                •  I still say it's a red herring (0+ / 0-)

                  Dropping the mandate doesn't hurt the insurance companies all that much - they're guaranteed 15% profits and they're forbidden from any higher numbers.

                  If you want to put something on the line for them later, then instead of a sunset provision have the 85% rise to 95% on date certain. Cutting their allowed profit margin by two-thirds would be far more harmful to them than dropping the mandate.

                  The human cost of dropping the mandate - in terms of people who thought they were invincible but turned out not to be, in terms of higher premiums for everyone else, in terms of the entire system collapsing in slow motion the exact same way it's collapsing now - would be horrific. Telling the insurers 'give us what we want or 5 years from now we shoot the entire healthcare system in the head' isn't a win for the people who have to live in that healthcare system - EVEN IF you're right that the insurers wouldn't like it much either.

                  The thing about changing the world... Once you do it, the world's all different. (Joss Whedon, BtVS Season 8 "The long way home")

                  by sab39 on Sun Dec 20, 2009 at 11:56:00 AM PST

                  [ Parent ]

                  •  I do not believe that the percentage reqs (0+ / 0-)

                    are at all enforceable. It has to be something that the insurance companies cannot paper over without legislation.

                    And I do not understand why, after having a mandates regime for some number of years, a lapse in the mandates would suddenly create higher premiums for the rest of us. How many people do you expect to suddenly drop insurance? Presumably people who aren't getting subsidies, or who aren't getting sufficient subsidies. Indeed, it seems to me that the mandate is a convoluted fix for the fact that subsidies are insufficient.

                    Ok, so I read the polls.

                    by andgarden on Sun Dec 20, 2009 at 12:25:45 PM PST

                    [ Parent ]

                    •  Quite a lot of people (1+ / 0-)
                      Recommended by:
                      cany

                      Particularly the young - the exact sort of people who are railing against mandates now, because they don't want to have to buy insurance that they feel is an unnecessary expense because if they get sick they can just pay out of pocket (and without a mandate, they're right). All the people who are newly unable to be covered under their parent's insurance - who with a mandate would sign up for insurance but without a mandate won't bother.

                      I didn't say "suddenly", because I don't think it would be sudden, any more than the collapse of our healthcare system over the past century was sudden. It'd just restore the slow-motion train wreck that is the status quo.

                      The subsidies are only insufficient because the costs of actual CARE are too high in this country. Look at the cost of an MRI (or anything else) in this country versus anywhere else in the world. Medicare pays about double what other countries pay; private insurers pay about double what Medicare pays.

                      The problem is that everyone is insulated from how much they're paying for care - except the people in the individual market, and even they aren't actually able to get real comprehensive coverage at any cost. Employees think they're paying X dollars but actually they're paying 2X+Y dollars because the employer pays more than half the cost and just reduces their pay level accordingly. Up the subsidies further and all that does is make more people get 'free' care and insulate them from the cost even further.

                      Actually, if I could fight for one single change in the bill, it'd be that paychecks have to include the employer contribution to health insurance, and the 'total' compensation, ie, the sum of the gross pay plus the employer healthcare contribution. That'd open people's eyes quite a lot, I think.

                      The thing about changing the world... Once you do it, the world's all different. (Joss Whedon, BtVS Season 8 "The long way home")

                      by sab39 on Sun Dec 20, 2009 at 12:43:02 PM PST

                      [ Parent ]

                      •  This is what we're dealing with that infuriates (0+ / 0-)

                        me. I know not a single young person who would prefer not to have health insurance. But I know many who could not afford a plan on the individual market. If, even with the subsidies, they still can't afford such a plan, what in the world is the mandate going to accomplish? It will raise their taxes a little.

                        If you want to cover such people, you essentially do have to make it free. In most other countries, such coverage is almost free.

                        Ok, so I read the polls.

                        by andgarden on Sun Dec 20, 2009 at 12:51:02 PM PST

                        [ Parent ]

                        •  It's the illusion of free (0+ / 0-)

                          What you're effectively proposing is that you make the mandate stronger (larger fines), so that the tax increase is as large as the cost of insurance would be. Because that's what other countries do - raise the tax enough to cover the cost of care, and then pay for care out of the tax dollars.

                          Because yeah, everyone wants to have healthcare if it's free. Duh. Similarly, virtually NOBODY wants care if they have to pay the amount that it actually costs, in this country, since the costs in this country are so ridiculously high. I suppose the ridiculously rich who don't have to worry about the price of anything can be excluded from that but that's a miniscule minority.

                          The single-payer or nationalized approach, where it's "free" because the price is part of the taxes you're paying anyway, is one way to handle that, but politically that's impossible here, unfortunately.

                          The idea of the mandate is to provide some counterbalance to the people who want it but aren't willing to pay even a small amount for it. The subsidies are for the people who really can't afford it; the mandate is for the people who really can, but don't consider it worth what they'd have to cut. You need both to make the system work.

                          The thing about changing the world... Once you do it, the world's all different. (Joss Whedon, BtVS Season 8 "The long way home")

                          by sab39 on Sun Dec 20, 2009 at 01:04:03 PM PST

                          [ Parent ]

                          •  You didn't read what I wrote (1+ / 0-)
                            Recommended by:
                            cany

                            the young people who can't afford it now will likely still not be able to afford it with insufficient subsidies. Having a bigger fine will not give these people money that they don't otherwise have.

                            If you wanted to try and talk me out of supporting this "compromise," you couldn't have found a better argument.

                            If you believe that the number of people who intentionally go without insurance for reasons other than inability to pay is anything other than a rounding error, you are simply  disingenuous or an idiot.

                            Ok, so I read the polls.

                            by andgarden on Sun Dec 20, 2009 at 01:08:38 PM PST

                            [ Parent ]

                          •  Can't have it both ways (0+ / 0-)

                            If the number of people who intentionally go without insurance for reasons other than inability to pay is miniscule, then the number of people affected by the mandate is miniscule.

                            I guess you could be quibbling with the bill's definitions of affordability and the subsidy levels. And yeah I take your point that both those things could probably use improvement - but there's tradeoffs all over the place. That's what you get, unfortunately, for a bill that's trying to take into account the political reality that you can't just tax people and pay for their care out of the taxes.

                            But the bill has definitions of what's considered an acceptable percentage of your income to be an affordable plan; if you don't have access to an affordable plan you are either subsidized or exempt from the mandate. The definition of affordable is too high; that sucks. It should be lower. But if you make it too much lower then nobody has access to an affordable plan, so everybody is getting subsidies and nobody is paying for them. And you have the situation that we have today in reverse.

                            The mandate does two things: alters the tradeoff a bit for people who say "I can't afford it" - because they're going to have to find some way to afford something, so it gives them an incentive to see if they can afford a bit more and get healthcare too - and for those who still can't, raises some money, which is part of what pays for the subsidies for those who are MORE badly in need than they are.

                            Ultimately, we have to solve the problem by getting the costs of the medical services themselves down. That means taking on not the insurers but the hospitals and the doctors. Both of whom are harder to attack because they're politically popular. Expand Medicare to everyone and doctors and hospitals scream bloody murder - and the bill dies. But costs go way down because Medicare pays doctors and hospitals less. And people can afford stuff.

                            The only way to do that is to get everyone covered, otherwise the problem "solves itself" in good old free market fashion by prices continuing to go up and less and less people buying.

                            The real point I'm making is that "can't afford" is an illusion. Unless you're living in an apartment in a crappy neighborhood with no TV or phone or internet and subsisting on water and ramen noodles, there are things you could do to cut your expenses (and if you are living that way, then you're eligible for subsidies). I'm lucky - I don't have to choose between health care and internet access and cellphone and tv or using my car instead of public transit. I'd hate to have to make that choice. But if I did have to make that choice it wouldn't be a matter of "can't afford" healthcare, it'd be a matter of what I was willing to trade off in quality of life to get it.

                            Anyone who needs to trade off healthcare vs essentials like food and shelter and heat should be getting subsidies, no question. If you're trading off against nonessentials, the mandate changes the tradeoff. If you're in a country that does healthcare right, you don't get to make that tradeoff at all; you pay regardless. That's how it should be - we all pay taxes to get essential services, and healthcare is an essential service.

                            The bill basically decrees that the appropriate tax level for essential healthcare services is N% of your income (the affordability level for premiums) and then directs you that you must pay it or be fined. The nonsensical part is the idea that instead of being charged for nonpayment of taxes, you get fined a much lower amount and don't get healthcare. That's dumb. The existence of the mandate isn't dumb; the lowness of it is.

                            The thing about changing the world... Once you do it, the world's all different. (Joss Whedon, BtVS Season 8 "The long way home")

                            by sab39 on Sun Dec 20, 2009 at 01:37:58 PM PST

                            [ Parent ]

                          •  The affordability definitions (1+ / 0-)
                            Recommended by:
                            cany

                            are exactly what I quibble with. If you're going to create a situation where people have to give up their housing for a cheaper situation, and perhaps drop out of school, just so they can pay for insurance (that still has a huge deductible that they also can't afford), then you aren't really reforming anything.

                            What you're proposing, then, is a hugely regressive tax. And it's only because we don't have the political will for real cost control (i.e., replacing the insurance companies) that we're stuck where we are. I think we've already proven that insurance is a broken and unworkable model for healthcare. But apparently the country needs more evidence of that. To provide that evidence, I all willing to support this monstrosity of a package, but only if the House funding mechanism is used instead of the excise tax, and only if the mandate sunsets.

                            Ok, so I read the polls.

                            by andgarden on Sun Dec 20, 2009 at 01:47:13 PM PST

                            [ Parent ]

                          •  You nailed it, and this is exactly what I have (1+ / 0-)
                            Recommended by:
                            andgarden

                            been saying:

                            What you're proposing, then, is a hugely regressive tax.

                            This is exactly what is going on.  The working poor are going to get banged but good.  But those not fitting that definition just don't seem to give a shit.

                            866-338-1015 toll-free to Congress in D.C. USE it!

                            by cany on Sun Dec 20, 2009 at 03:30:42 PM PST

                            [ Parent ]

                          •  The working poor get subsidies. (0+ / 0-)

                            The middle class get fucked. I'm middle class, by the way.

                            And I support the bill.

                            The thing about changing the world... Once you do it, the world's all different. (Joss Whedon, BtVS Season 8 "The long way home")

                            by sab39 on Sun Dec 20, 2009 at 03:45:54 PM PST

                            [ Parent ]

                          •  Let me try this again. (2+ / 0-)
                            Recommended by:
                            andgarden, sab39

                            Here's the reality.

                            A poor family doesn't have insurance because they cannot afford it.  They go to doctors and pay directly.

                            For those 134%-200%, the increase in their MANDATED spending on this will increase significantly even WITH subsidies.  Subsidies don't pay the bill.  It pays PART of the bill for insurance. Money out, no health care.

                            They will NOT be able to afford quality plans, therefore deductibles and co-pays will HAVE to be met prior to their already paid for insurance to kick in.  More money out, no health care.

                            What you don't understand is that for the working poor, their money will often STOP at the mandated insurance company fees and go no farther.

                            They can't grow more money.  So yes, it is a regressive tax.

                            Shame on us.

                            866-338-1015 toll-free to Congress in D.C. USE it!

                            by cany on Sun Dec 20, 2009 at 03:55:44 PM PST

                            [ Parent ]

                          •  I don't disagree (0+ / 0-)

                            Do you have evidence of the subsidies not covering everything for the first level outside of medicaid? I hadn't heard that.

                            I know the House bill does better on subsidies, I believe that improving those is something that CAN be done in conference while still getting around the Nelson-Lieberman roadblock after conference, and I hope it will be and I expect it will be improved somewhat (although probably still not enough).

                            But even if you're right and even if the subsidies don't get fixed at all:

                            Suppose someone in that poor family gets an cancer - something treatable, but expensive. Today, they die - they have NO recourse. They have no coverage, they've been paying dr bills as they've come up, and they could sell everything they own and not have a hope of covering a fraction of this particular bill. They're a walking dead person.

                            If this bill passes, that coverage that they've hated paying for all this time kicks in. They still have to pay a big deductible and a copay and it hurts like hell financially. The financial costs are crippling. Everything sucks. But the cancer can get treated and the person can live.

                            We could and should do more in this bill. The holes that it leaves are shameful and I could write for pages about them. But a world in which people have the option to live is better, in my opinion, than a world in which they don't.

                            The thing about changing the world... Once you do it, the world's all different. (Joss Whedon, BtVS Season 8 "The long way home")

                            by sab39 on Sun Dec 20, 2009 at 04:07:51 PM PST

                            [ Parent ]

                          •  Also, (0+ / 0-)

                            The status quo is a hugely regressive tax. The bill in front of us now doesn't go nearly far enough in making it less regressive. Not even close.

                            But it does make it less regressive.

                            Because the status quo is "as long as you're healthy, if you're too poor to get insurance, you can pay nothing - but if you get sick you have to pay everything you have and more and if you can't afford it then you just die".

                            A hugely regressive tax is still better than an effectively infinite regressive tax, especially given that the poorest who are mostly completely fucked now are fully subsidized.

                            The thing about changing the world... Once you do it, the world's all different. (Joss Whedon, BtVS Season 8 "The long way home")

                            by sab39 on Sun Dec 20, 2009 at 03:52:13 PM PST

                            [ Parent ]

                          •  Yes it is. And this bill won't change that for (0+ / 0-)

                            a lot of the working poor.  It seems clear that once again, we just don't see them.

                            866-338-1015 toll-free to Congress in D.C. USE it!

                            by cany on Sun Dec 20, 2009 at 03:56:44 PM PST

                            [ Parent ]

                          •  People much smarter than me, and who I trust (0+ / 0-)

                            say that the excise tax and the mandate ARE two of the most significant cost controls in this legislation. Even the CBO, known for being ridiculously conservative about anything that might save money, says that the excise tax saves a crapload of money.

                            People like Ezra Klein and Jon Cohn talk to experts who spend their lives trying to figure out ways to save money in the healthcare system, seem to be hearing the same thing from all their experts: we don't know for sure what will save money, in a system this big and complex, but almost all the things we CAN think of are in this bill. Sometimes not strong enough or on too small a scale or with loopholes, but they're in there.

                            Part of the reason we're talking past each other, I suspect, is because you're focused on the cost of premiums, and I'm focused on the cost of, say, an MRI. But if an insurer - or the government! - in this country has to pay 4-10 times as much for an MRI as the going rate in other countries, it's impossible for that insurer to charge a reasonable premium even if they take no profits at all, and the tax increases necessary to do it by the government would be unsustainable. I'm not sold on the idea that insurance company profits is where all the excess money is going - in fact I think that's objectively disprovable.

                            I don't claim to know how this will play out - and I'm sorry if I implied that I know any of this for certain. Everything I think I know comes from reading a lot about the policies that are in the bill and that aren't and what experts think about them.

                            A lot of the reason why I have faith in the excise tax and mandates as being legitimate policy measures is because they make no sense as a way to buy someone off. If you're trying to buy off the insurance industry you don't set a cap on their profits or add an extra tax on their most profitable products. Every populist group hates them. There's no constituency to fight for them. If you're right that "can't afford it" is the only reason people don't buy insurance, then the mandate does nothing for the insurance companies - their product doesn't get bought, anyway, people just pay a fine to the government. Unions are dead set against the excise tax and fighting it with everything they have and they're a powerful lobbying constituency especially on a bill that requires every single democratic vote!

                            The constituencies left fighting for these unpopular measures seem to be uniformly the policy wonks, the ones who spend their lives thinking about the obscure details of the effects of legislation and analyzing them. Perhaps I'm unduly biased in favor of people who give complex, nuanced arguments with no good answers, and against people who are sure for simple reasons that complicated things are all good or all bad. But that's where I'm coming from.

                            The thing about changing the world... Once you do it, the world's all different. (Joss Whedon, BtVS Season 8 "The long way home")

                            by sab39 on Sun Dec 20, 2009 at 03:44:45 PM PST

                            [ Parent ]

                          •  The cost of an MRI is irrelevant (0+ / 0-)

                            because nobody can ever hope to pay for one out of pocket. But lots of people try and fail to buy health insurance. And when they get insurance, it often proves worthless because it won't pay out. And that's the other problem with this bill: the enforcement end. My feeling is that unless we structure this to make the healthcare insurance model uneconomical (as it is for old people, which is why we got Medicare), we'll never solve the problem.

                            In any case, insurance is clearly the wrong model for healthcare in the first place. You simply cannot insure against certainties (i.e., I will need to see a doctor for checkups periodically).

                            Ok, so I read the polls.

                            by andgarden on Sun Dec 20, 2009 at 04:16:04 PM PST

                            [ Parent ]

                          •  I agree with the last paragraph (0+ / 0-)

                            But you almost lost me entirely with the first sentence.

                            The cost of an MRI isn't irrelevant at all because someone has to pay for it. Go single payer, and your taxes are directly proportional to the out-of-pocket cost of an MRI (and of a primary care visit, and of chemo, and of a blood test, etc). Go with a regulated insurance model, and your premiums are.

                            You're right that you can't insure against a certainty, but any healthcare system (well, except the disaster of a healthcare system we have today) involves spreading out the costs of healthcare across a large population and a large amount of time. Everyone will need to visit the doctor from time to time. Everyone will eventually die; most will need expensive end of life care. Most will have at least one expensive medical treatment needed during their lifetime to fix something. A few will have crippling conditions that will require expensive lifelong care.

                            The goal of any healthcare system is to add up the cost of all those things over the lifetimes of all those people and then distribute the cost between all of them. Ideally in such a way that the distribution is based more on what they can afford than on what care they need. But one way or another, the total price that needs to be paid is the amount of treatments people get multiplied by the cost of each treatment.

                            We could cut every healthcare premium in the country by easily a factor of 4 tomorrow if we made every MRI, every primary care visit, every kind of medical treatment, cost only as much as it costs in other countries. Even if we picked the most expensive other country!

                            Insurance is one of the problems with healthcare in this country and certainly an important one. But to suggest that the underlying costs are irrelevant is horrifically false! Single payer, nationalized medicine, or some bastardized agglomeration of the current system like this bill gives us, we HAVE to get those costs down or we're fucked.

                            The thing about changing the world... Once you do it, the world's all different. (Joss Whedon, BtVS Season 8 "The long way home")

                            by sab39 on Sun Dec 20, 2009 at 04:33:51 PM PST

                            [ Parent ]

                          •  Here's the problem with what you're saying (1+ / 0-)
                            Recommended by:
                            sab39

                            Our costs are the direct result of the structure of our system.

                            I do not personally believe that the proposed package will reduce costs one cent. Because I am a big liberal, I don't really care about that. But what really concerns me is that we're going to ask a lot of people living paycheck-to-paycheck, or worse, to pay out money that they don't have.

                            Ok, so I read the polls.

                            by andgarden on Sun Dec 20, 2009 at 04:37:03 PM PST

                            [ Parent ]

                          •  Yes they are, but not the way you're saying (0+ / 0-)

                            The drivers of costs within our system are not to do with insurance. Insurance deals with costs easily by raising premiums and denying care. They pass on the costs, but they don't set them.

                            The drivers of costs, rather, are a million little things in the current system.

                            The fact that doctors and hospitals get paid per treatment given rather than per patient cared for.

                            The amount of pay that doctors expect to receive.

                            The fact that most people get coverage through their employer, with the employer bearing the brunt of the cost and docking it from your salary level before you even see the dollar figure.

                            The decision to deal with malpractice lawsuits by insuring against it (!) instead of reducing malpractice. (The right wing is completely correct that the malpractice system is a problem, but completely wrong about why it is, and how to fix it).

                            The lack of electronic medical records.

                            The lack of any incentive whatsoever for anyone involved in the system at any level to reduce costs (in fact, at most levels they get rewarded for raising them!).

                            The crazy billing systems.

                            The amount of paperwork.

                            All this is off the top of my head and most of it is probably, in one way or another, not strictly accurate because I'm not an expert on this stuff. But people who are experts on this stuff say that there are a hell of a lot of provisions in the bill that make some attempt or other to tackle just about every one of these cost-driving factors.

                            And if you're such a big liberal that you don't care about costs, why do you care about raising taxes on people? I'm a liberal too in that I believe it's the government's job to help people. I don't believe it's helping people to take their tax money and waste it on a product that's four times as expensive as it could be.

                            The thing about changing the world... Once you do it, the world's all different. (Joss Whedon, BtVS Season 8 "The long way home")

                            by sab39 on Sun Dec 20, 2009 at 04:48:42 PM PST

                            [ Parent ]

                          •  Sigh. . . (1+ / 0-)
                            Recommended by:
                            sab39

                            Contra the conservative bogeyman, liberals do not like to raise taxes on everyone. We like to raise taxes on people who have and make a lot of money (i.e., "progressive" taxation).

                            I think some of the problems you identify are real, but none of them will really be fixed by this package.

                            And this idea that people don't see the real costs of healthcare, I think that's wrong too. Premiums keep going up, as do co-pays. Everyone knows, for example, that brand name drugs cost a fortune. And you cannot explain that away by claiming it's because our system is fractured. Moreover, I think you discount the degree to which people consider the quality of their health insurance package when comparing employers and negotiating a salary.

                            Ok, so I read the polls.

                            by andgarden on Sun Dec 20, 2009 at 04:55:51 PM PST

                            [ Parent ]

                          •  I don't like to raise taxes on anyone (0+ / 0-)

                            ... but I believe you get what you pay for and that people who have a lot of money don't pay anything like their fair share and yes that should be fixed. But not by a healthcare bill!

                            Have you looked into the areas of the bill that attempt to fix the issues I mentioned? Like I said, I haven't either, but at least I'm citing people who have looked into those things and think there's stuff in there that helps. What's your basis for believing that those experts are wrong?

                            Do you know how much your employer's contribution to your healthcare is? I don't. I am aware of my own contribution, and yes it was totally a part of negotiations of my compensation with my employer, but I have no idea how much THEY are contributing. Not a clue. Bet it's more than my contribution is. I'd love to know how much higher a salary I could be receiving without it!

                            I also am aware that my contribution to my healthcare hasn't gone up in several years - but neither has my salary. I can make an educated guess that those facts aren't unrelated, but I can't prove it. Wages correlate more closely - negatively - to healthcare premiums, than they do to GDP growth which is what economists say they ought to correlate to!

                            Which is to say, I am one of the lucky ones - I get good healthcare through my employer. But I still get screwed by the system because I'm paying some ridiculous amount for it and I can't even know what that amount IS!

                            The thing about changing the world... Once you do it, the world's all different. (Joss Whedon, BtVS Season 8 "The long way home")

                            by sab39 on Sun Dec 20, 2009 at 05:05:25 PM PST

                            [ Parent ]

                          •  Yes, I do think this is the problem (1+ / 0-)
                            Recommended by:
                            sab39

                            Many people, especially those working for smaller companies, often hear from their employers how expensive it is, and why their plans can't cover the rest of their families.

                            I have scanned the rest of the bill, but nothing makes a bigger difference to cost than the structure of the payment system.

                            Ok, so I read the polls.

                            by andgarden on Sun Dec 20, 2009 at 05:12:14 PM PST

                            [ Parent ]

                          •  Exactly (0+ / 0-)

                            (I work for a small employer, I do know it's expensive but not HOW expensive).

                            So if employer-based-ness is part of the problem (which I think we both agree it is) then the parts of the bill that create exchanges for individuals and small employers, and Wyden's vouchers for people whose employer-based coverage is too expensive, are good things, right?

                            The thing about changing the world... Once you do it, the world's all different. (Joss Whedon, BtVS Season 8 "The long way home")

                            by sab39 on Sun Dec 20, 2009 at 05:27:48 PM PST

                            [ Parent ]

                          •  Depends on how worthwhile you think (0+ / 0-)

                            the exchanges are. Personally, I don't think the employer-based-ness is the biggest problem (though it's big). Rather, I think the problem is in pretending that insurance makes sense as a model for providing healthcare. I can insure against having a car crash, but that doesn't mean that it makes sense to insure against routine car maintenance.

                            Ok, so I read the polls.

                            by andgarden on Sun Dec 20, 2009 at 05:32:15 PM PST

                            [ Parent ]

                          •  Hmm (0+ / 0-)

                            That sounds like you're advocating having cheap insurance with high copays and deductibles that's intended only for catastrophic medical needs.

                            Which I thought was roughly what the minimum mandated insurance in the bill actually was, but I could be wrong.

                            But, it also sounds like you're saying "the bill doesn't solve the biggest and most intractable problem, therefore any progress it makes towards solving any of the other big problems is irrelevant".

                            Personally I do prefer having an insurance plan that keeps my costs small and predictable even for routine care. And I'm willing and able to pay a higher premium for that luxury. But that's just me.

                            The thing about changing the world... Once you do it, the world's all different. (Joss Whedon, BtVS Season 8 "The long way home")

                            by sab39 on Sun Dec 20, 2009 at 05:42:14 PM PST

                            [ Parent ]

                          •  No, not exactly (1+ / 0-)
                            Recommended by:
                            sab39

                            Other countries have models for national healthcare that make sense. Just look north to Canada and you'll see one.

                            I'm not saying "reject this bill," but I do think it's being way oversold.

                            Ok, so I read the polls.

                            by andgarden on Sun Dec 20, 2009 at 05:44:53 PM PST

                            [ Parent ]

                          •  Ok, I misunderstood then (0+ / 0-)

                            I thought you wanted to reject it outright unless the mandate and excise tax were dropped.

                            I'm not trying to oversell it, at all, frankly I'm entirely underwhelmed by it. It seems to do all the big stuff wrong (or at least NOT) while doing lots of little stuff right.

                            But the little stuff it does right, when applied to such an epically godawful mess we have today, adds up to a whole lot of human beings being on the right side of a whole lot of life or death situations where they would be on the wrong side today. For that reason alone I think it's simply essential that it pass. Even with all its massive flaws and omissions, killing it would be a disaster, IMO.

                            The thing about changing the world... Once you do it, the world's all different. (Joss Whedon, BtVS Season 8 "The long way home")

                            by sab39 on Sun Dec 20, 2009 at 05:49:17 PM PST

                            [ Parent ]

                          •  I don't think the mandate is so terrible, (1+ / 0-)
                            Recommended by:
                            sab39

                            but I don't think the way it's implemented is very fair. I've always objected to mandating the impossible (or the infeasible). This is a complicated problem, but during the campaign Obama seemed to have a problem with the mandate.

                            Ok, so I read the polls.

                            by andgarden on Sun Dec 20, 2009 at 05:56:18 PM PST

                            [ Parent ]

                          •  "It sucks but we should pass it"? (1+ / 0-)
                            Recommended by:
                            andgarden

                            If we're in agreement on that much, I can live with disagreeing about which parts of the suckage are worst ;)

                            The thing about changing the world... Once you do it, the world's all different. (Joss Whedon, BtVS Season 8 "The long way home")

                            by sab39 on Sun Dec 20, 2009 at 05:58:30 PM PST

                            [ Parent ]

                          •  Well, I'm not at "we should pass it" yet (1+ / 0-)
                            Recommended by:
                            sab39

                            I want to see the subsidies improved and the House funding source adopted.

                            Ok, so I read the polls.

                            by andgarden on Sun Dec 20, 2009 at 06:01:49 PM PST

                            [ Parent ]

                          •  I'm with you on 1 out of 2 (1+ / 0-)
                            Recommended by:
                            andgarden

                            but I guess that's something :)

                            The thing about changing the world... Once you do it, the world's all different. (Joss Whedon, BtVS Season 8 "The long way home")

                            by sab39 on Sun Dec 20, 2009 at 06:03:26 PM PST

                            [ Parent ]

                          •  If you want my list (0+ / 0-)

                            I want the subsidies improved and the House's national exchange instead of the Senate's state-based one.

                            If I got one more freebie it'd be requiring disclosure of employer contribution to healthcare on every paycheck. But I don't think either bill has that so I don't think the conference can introduce it out of thin air.

                            The thing about changing the world... Once you do it, the world's all different. (Joss Whedon, BtVS Season 8 "The long way home")

                            by sab39 on Sun Dec 20, 2009 at 06:09:47 PM PST

                            [ Parent ]

                    •  There are a lot of poor people who won't be (0+ / 0-)

                      participating, that is certain.  Now, their dollars go directly to the doctors (when needed) v. to ins. companies.

                      The woman up the street with two kids just had this discussion with me today.  She's just going to go underground completely.  She's barely making it now, and cannot afford insurance even WITH subsidies.

                      866-338-1015 toll-free to Congress in D.C. USE it!

                      by cany on Sun Dec 20, 2009 at 03:26:10 PM PST

                      [ Parent ]

      •  For the life of me. (0+ / 0-)

        I do not understand why this is so hard for people to comprehend.  Also, I understand that the bill taxes insurance companies to pay for subsidies to low income people.  They way I see it, that tax has two benefits:

        1.  It pays for subsidies for regular people.
        1.  It keeps insurance companies from raising their premiums too high.

        Why aren't those benefits progressive?

        Oba-MA bumaye! Oba-MA bumaye!

        by fou on Sun Dec 20, 2009 at 10:37:33 AM PST

        [ Parent ]

        •  The excise tax is not so simple (1+ / 0-)
          Recommended by:
          codairem

          What it will likely do is cause the insurance companies to reduce the quality of all of their plans. The right funding mechanism is that proposed by the House: raise taxes on the wealthy.

          Ok, so I read the polls.

          by andgarden on Sun Dec 20, 2009 at 10:40:16 AM PST

          [ Parent ]

          •  Fair enough. (0+ / 0-)

            And given that the tax is not so simple, indeed given that the world is not so simple, why don't we pass an imperfect bill that we can change.  I think Jay Rockefeller is absolutely right when he says that passage of the bill will spur meaningful reform efforts every election cycle.  That's a good thing that we should encourage by passing this bill.

            Oba-MA bumaye! Oba-MA bumaye!

            by fou on Sun Dec 20, 2009 at 10:45:42 AM PST

            [ Parent ]

          •  I know smart people who disagree (0+ / 0-)

            Which isn't to say that you're wrong, just that it's a point that smart, sincere people can disagree on.

            Personally I'd rather do something that might help keep costs down and fix it later if it turns out to suck, than do something (a tax on the wealthy) that intentionally has no effect on health care costs at all.

            Can you explain why you think the exise tax will cause insurance companies to reduce the quality of all their plans? My understanding is that the bill sets a pretty well-defined floor of what services MUST be in every plan and what fees MUST NOT be applied or must be limited - which is to say that even if you're right that they reduce them, the lowest possible level of insurance is still orders of magnitude better than the junk insurance sold to individuals today which covers everything except anything that involves you getting sick or otherwise needing healthcare.

            The thing about changing the world... Once you do it, the world's all different. (Joss Whedon, BtVS Season 8 "The long way home")

            by sab39 on Sun Dec 20, 2009 at 10:53:19 AM PST

            [ Parent ]

            •  The price of "cadilac" plans will go through (0+ / 0-)

              the roof, and nobody will be able to afford them anymore. But such plans are often the cornerstone of union contract negotiations.

              Ok, so I read the polls.

              by andgarden on Sun Dec 20, 2009 at 10:59:03 AM PST

              [ Parent ]

              •  Union-type jobs that really NEED cadillac plans (0+ / 0-)

                (where the job specifically entails lots of physical risk, like mining) are exempt, if I understand rightly.

                And frankly if I were in a union I'd MUCH rather my union were trying to get me decent pay, and be able to take that pay and go to the exchanges and get my own healthcare, than have them needing to make concessions on my pay to get me healthcare.

                The employer-based nature of our current system is the biggest problem with it, not the insurers (although I freely admit they're a problem too, but that's largely because all their incentives are to be evil; the bill does make some meaningful steps to turn around the worst incentives).

                The most important parts of this bill are the baby steps it takes in moving us away from employer coverage - the exchanges, the regulations on individual insurance plans to make the market for individual insurance not quite so dysfunctional, the Wyden amendment which gives a tiny sliver of employed people access to the exchanges using pre-tax company-provided vouchers, etc. Those are all things that can - and must! - grow, but they're the key to real reform. NOT doing them would get us nowhere, even with a public option.

                The thing about changing the world... Once you do it, the world's all different. (Joss Whedon, BtVS Season 8 "The long way home")

                by sab39 on Sun Dec 20, 2009 at 11:24:26 AM PST

                [ Parent ]

    •  like the strong financial regulations the (2+ / 0-)
      Recommended by:
      arlene, codairem

      Dems have passed on the financial industry? <snark>

      Not towards you, but what a joke!  

      The Dems are bought and paid for by Wall St and by the health insurance industry. They have already paid back their Wall St. buddies with pathetic "reform"s.

      What in god's name makes anyone believe that the Dems will put any teeth into the regulations governing the insurers? What????  They are all set for life now, living in their comfortable tax-payer provided bubble.

      If they think some of us under the $70,000 income mark can afford 20% of income towards this crap -- they are insane, and should gear up for a coming revolt.

  •  The list of corporatist (16+ / 0-)

    sellouts is getting longer. Add Jacob Hacker to the list.

    Barck Obama, Joe Biden, John Kerry, Vicki Kennedy, Nate Silver, Paul Krugman, Bill Clinton, Al franken etc and my humble self. we are all damn sellouts.

    "This union may never be perfect, but generation after generation has shown that it can always be perfected". -Barack Obama

    by indepenocrat on Sun Dec 20, 2009 at 10:23:38 AM PST

  •  The three most important words (11+ / 0-)

    if properly enforced,

    There would be no housing crisis, or financial crisis, or Bernie Madoff...if regulations were properly enforced.

    After all of this was given away, why would anyone believe this time will be different.

    At some point Democrats will cease being so gullible.

    I am not against all health care reform, I am just against dumb health care reform!

    by justmy2 on Sun Dec 20, 2009 at 10:24:22 AM PST

  •  Fair use issue? (4+ / 0-)

    I love your post, but I just thought I flag this as a potential issue.  I think you're allowed to cite no more than three paragraphs from an article to be in keeping with fair use laws.

    Oba-MA bumaye! Oba-MA bumaye!

    by fou on Sun Dec 20, 2009 at 10:25:56 AM PST

    •  It's not a law (4+ / 0-)
      Recommended by:
      Phoenix Woman, fou, codairem, LaurenMonica

      it's a site rule. The law on fair use (and the broader ideology surronding intellectual property) is debatable even if one is taken to court (very unlikely in this case or most cases).

      Not a law, site rule, and a rule that has and is repeatedly bent as necessity allows.

      In every cry of every man, In every infant's cry of fear, In every voice, in every ban, The mind-forged manacles I hear

      by Areopagitica on Sun Dec 20, 2009 at 10:40:30 AM PST

      [ Parent ]

  •  When Max Baucus ... (6+ / 0-)

    ... hired Liz Fowler in 2008 to advise him on health insurance matters and to eventually write his bill, his official announcement left out that she was coming to him from WellPoint, a massive insurer.

    That was her most recent experience, from 2006-2008, yet there was no mention of it.

    Why do you suppose that is?

    While you're at it, ask Blanche Lincoln about Elizabeth Barnett.

  •  Thanks for sharing this POV. (1+ / 0-)
    Recommended by:
    Gay CA Democrat

    It's worth arguing about. My take is summed up in the "keep working" section of this article. I just don't believe we should sit this one out for fear of having to keep working on it in future years. Of course we'll have to keep working on it. If people really want to fight for single payer, they'd better be prepared to come back to this again and again, for generations if it takes that long. That's just what you do to achieve a goal you really value.

    Republican "party": Party like it's 1929.

    by noabsolutes on Sun Dec 20, 2009 at 10:31:22 AM PST

  •  Watered Down Exchange Mechanism (1+ / 0-)
    Recommended by:
    IndianaDemocrat

    Engineered by Insurance Lobbyists so the government cannot effectively regulate the insurance industry and American's won't really have an effective choice in plans.

    They will have a pseudo choice through a watered down Exchange that is designed by insurance company lobbyists and NOT government regulators.

    That was by design - the watered down weak exchange system.  This is one of the 'features' of the bill - a sham exchange system that doesn't allow real choices and makes meaningful regulation impossible.

    Thanks Sell Out Democrat's - my family needed somebody to stand up for us - and you took the money AND RAN.

    COWARDS!!!!!

    •  With $518.5 Billion In Tax Increases (0+ / 0-)

      After running on "No Tax Increases on those making under $250,000!!", and running commercials that said vote for Obama, because McCain was going to tax your healthcare insurance!!!

      We DESERVE to have our asses handed to us next year, when the Repubs FIRST move of 2011 will be to repal this nightmare...

      Way to go, folks....

  •  Two real optoins in the poll (1+ / 0-)
    Recommended by:
    LaurenMonica

    Kill or not kill. what about Reconciliation...  or Modify in the confrence.. This is what I want.

  •  I was ready to support the bill until the Manager (3+ / 0-)
    Recommended by:
    arlene, priceman, cany

    Amendment was put in. Taking away a national protection for women's reproductive health care will never get my support.

    So...they kill the anti-abortion amendments and I'll support the bill as a temporary step towards public option then single payer. Not until then.

    The only thing you get from sitting on the fence is splinters in your ass. My Granddaddy!

    by SallyCat on Sun Dec 20, 2009 at 10:33:01 AM PST

    •  I'm not going into the substantive value of this (3+ / 0-)
      Recommended by:
      Phoenix Woman, Crestingwave, raf

      post because we'll agree to disagree strongly on the fact that no rights are taking away since the people going into these exchanges are the uninsured, who would already have to pay out of pocket currently for this procedure, so no bill is the same as this bill for that issue. But i will say your post history is readily available, and you were not a supporter of this bill in the Senate previously and made that quite clear on many occasions so why include you were ready to support this?

      There are only 2 things in life I believe about religion: There could be a God and I'm sure as heck not him.

      by Irixsh on Sun Dec 20, 2009 at 10:40:49 AM PST

      [ Parent ]

      •  So...I can't move to the "tepidly support" (2+ / 0-)
        Recommended by:
        arlene, cany

        My posting history...yep and I've been pretty quiet about this topic for a number of weeks. I was adamant about the public option but was willing to accept that at this point we were not going to get better. I really believed that Stupak would come out in committee. It helped that the Nelson amendment died. THEN the manager's amendment went back in.

        So...now I am adamantly opposed. Women's reproductive rights is an issue I have fought for since pre-Roe v Wade.

        Attack on the merits
        ...defend taking away women's reproductive rights at the state level...pre Brown v Board of Education and Roe. If you can.

        The only thing you get from sitting on the fence is splinters in your ass. My Granddaddy!

        by SallyCat on Sun Dec 20, 2009 at 10:44:56 AM PST

        [ Parent ]

        •  As i said, these exchanges are for those who have (2+ / 0-)
          Recommended by:
          Phoenix Woman, Onomastic

          insurance, so no rights are being "taking away" so I can't attack the merits of something with no merits. It's an impossibility. Insurance options on the exchange for those who do not have insurance (IE do not have an insurance company covering abortion currently) will now be able to get access to other types of care but abortion in some states. So that means more women (in states who do not ban this right) will actually GAIN the right to a covered abortion. It's really quite straightforward thinking, even if it is an awful part of the bill.

          There are only 2 things in life I believe about religion: There could be a God and I'm sure as heck not him.

          by Irixsh on Sun Dec 20, 2009 at 11:02:53 AM PST

          [ Parent ]

          •  Going back to states control instead of national? (1+ / 0-)
            Recommended by:
            cany

            This is okay with you...to penalize women that live in states that treat women as non-entities?

            Sorry...stupid and wrong and illegal. See Brown v Board of Education on State v National or Roe v Wade. You're willing to send women's reproductive rights back to a conservative Supreme Court. No thanks.

            The only thing you get from sitting on the fence is splinters in your ass. My Granddaddy!

            by SallyCat on Sun Dec 20, 2009 at 11:05:36 AM PST

            [ Parent ]

            •  It's not OK with me, and if a Supreme challenge (2+ / 0-)
              Recommended by:
              Phoenix Woman, Onomastic

              happens, I am all for it. But again, you are not responding to my key point, which is unfortunate. The people who will be governed by the exchange, which will be state run, are currently not able to get abortion covered based on NO insurance. So by passing this bill, they gain access to subsidies in the insurance market, they gain coverage for a multitude of other health concerns, and in most states, they GAIN access to abortion coverage by gaining coverage.

              There are only 2 things in life I believe about religion: There could be a God and I'm sure as heck not him.

              by Irixsh on Sun Dec 20, 2009 at 11:13:01 AM PST

              [ Parent ]

    •  SallyCat, maybe you'll know (4+ / 0-)
      Recommended by:
      Elise, Crestingwave, gratis4, indubitably

      what are the top priority health care issues for the impoverished in the US?  

      If you can find me any survey from a reputable source, or an academic study, that puts abortion first--I'll join you on this.

      Otherwise I'm going to listen to what the poor actually need.

      Earns no money here for blogging, commenting, or driving traffic to any web site.

      by mem from somerville on Sun Dec 20, 2009 at 10:43:17 AM PST

      [ Parent ]

  •  I foresee dark clouds ahead on this one (0+ / 0-)

    and for those poor souls in New England today:

    I got so much honey, the bees envy me.

    by tazz on Sun Dec 20, 2009 at 10:33:50 AM PST

  •  Does ACORN or NAACP say "pass the bill"? (2+ / 0-)
    Recommended by:
    SallyCat, Kentucky DeanDemocrat

    I've been on the sidelines, conflicted, since it was clear that the Insurance enforcers wouldn't let anything happen that didn't give them a percentage. It's not right that they should demand a percentage any more than the bankers, but I don't see a way to make that not happen.

    I'm in a state AFSCME job where there's a lot of union jobs. I have, I think, good insurance. If there was bad "murder by spreadsheet" behavior by the companies our state entity buys coverage for it would have been a topic for contract negotiations. I don't think it has been. So I'm not directly affected.

    If legitimate advocates for the uninsured (I think the ACORN and NAACP constituiency has a lot of uninsured) is saying "it's not perfect but better than nothing" I'm not going to go against their judgement: they've got more at stake than I do.

    PS: I am a woman, pissed off at being pushed to the back of the bus again. I'm still conflicted.

    I'm for single payer universal health care

    by stargaze on Sun Dec 20, 2009 at 10:38:43 AM PST

  •  Totally agree (2+ / 0-)
    Recommended by:
    Elise, LaurenMonica

    As I said before, I think the senate should pass the bill, and make some improvements in the conference. Then if it's still possible go nuclear by using reconciliation in adding the Public Option in the next bugdet.

    I couldn't agree more.

    Thanks for this great diary, Lauren!

    Voted proudly for Obama in spite of all the primary flame wars! Let's move on and support him!

    by GregNYC on Sun Dec 20, 2009 at 10:39:01 AM PST

  •  Thanks for bringing this (3+ / 0-)
    Recommended by:
    Elise, LaurenMonica, Gay CA Democrat

    I wouldn't have seen it otherwise.  

    Earns no money here for blogging, commenting, or driving traffic to any web site.

    by mem from somerville on Sun Dec 20, 2009 at 10:39:11 AM PST

  •  I wish you had foregone the snark in the poll (1+ / 0-)
    Recommended by:
    LaurenMonica

    I think people are allowed to flat-out disagree even with the architect of the public option -- no conspiracy theory required. (I think he's probably right.)

  •  Ds shouldn't frame the battle as over. (2+ / 0-)
    Recommended by:
    cany, LaurenMonica

    It will keep any frustrations over bill from turning into lower D turnout.  Base turnout will be strongest if the 2010 election is framed as needing D votes to keep going forward, that cynical Republican obstruction is working to block popular initiatives like public option.  If the economy shows any life and the messaging is right, 2010 doesn't need to be as ugly as people fear.

    •  The Ds are going to have a hard time (0+ / 0-)

      explaining to women, after the Manager's abortion addition, why I should bother and I am a life-long dem.

      They screwed 1/2 the population of this country, so yeah, I'm in a real foul mood about dems right now.  I can't see myself becoming an indy, but maybe.

      But if they don't get off their asses and get rid of that I cannot see WHY I should support them.

      866-338-1015 toll-free to Congress in D.C. USE it!

      by cany on Sun Dec 20, 2009 at 03:47:20 PM PST

      [ Parent ]

  •  Medicare part D (1+ / 0-)
    Recommended by:
    cany

    don't allow another one with this bill.  Fix it or kill it.

    •  This bill actually fixes a lot of the problems (0+ / 0-)

      within Part D...

      And I finished this letter with unshakable faith that the dream will be fulfilled for this generation, and preserved and enlarged for generations to come.

      by Elise on Sun Dec 20, 2009 at 11:31:37 AM PST

      [ Parent ]

      •  fix people with multi million dollar lobby jobs (0+ / 0-)

        that got them as soon as medicare part D was passed?  How many multi-million dollar lobby jobs will this current bad bill enable if it is not fixed?

        •  I don't give a shit about lobbying jobs. (1+ / 0-)
          Recommended by:
          gratis4

          The purpose of health care reform was to get people insured and ensure access to care. This bill does both of those things for 94% of Americans.

          And I finished this letter with unshakable faith that the dream will be fulfilled for this generation, and preserved and enlarged for generations to come.

          by Elise on Sun Dec 20, 2009 at 12:52:18 PM PST

          [ Parent ]

          •  You will care (0+ / 0-)

            when you have health care insurance, but you cannot afford to use it because treatment costs to much.  This bill accelerates this curve upward.
            http://en.wikipedia.org/...
            Then you will have to ask yourself if those people who you don't think should be held accountable now still deserve those multi-million dollar lobby jobs while your family suffers.

            •  I have health insurance... (0+ / 0-)

              and this bill contains cost controls. And I'm sick to death of people suggesting otherwise. Either educate yourself about the bill and comment fairly about it, or just stop commenting all together. It just makes you look uninformed.

              And I finished this letter with unshakable faith that the dream will be fulfilled for this generation, and preserved and enlarged for generations to come.

              by Elise on Sun Dec 20, 2009 at 01:22:48 PM PST

              [ Parent ]

              •  i am educated about this bill (0+ / 0-)

                the fact that your ignored to link to the graph is telling about how informed you are.

                •  That graph doesn't tell me anything (0+ / 0-)

                  about the projected costs of health care in the future. It's irrelevant. It doesn't take into account how this bill will change health care in this country.

                  And I finished this letter with unshakable faith that the dream will be fulfilled for this generation, and preserved and enlarged for generations to come.

                  by Elise on Sun Dec 20, 2009 at 01:43:53 PM PST

                  [ Parent ]

                  •  irrelevant (1+ / 0-)
                    Recommended by:
                    cany

                    health care costs are skyrocketing and this bill only accelerates it is irrelevant?  You do realize that you pay subsidies so whether you pay taxes or the private health insurance companies directly it is contributing to skyrocketing health costs.  And the 85% rule actually encourages private health insurance to drive up costs to make their 15% larger.  In fact nothing in this bill does anything to discourage increasing health care costs and many will suffer as a result of it unless it is fixed.

  •  Remember the gushing around here when (5+ / 0-)

    Alan Grayson made his apology to the dead and to those that would die until healthcare reform was passed?

    Pure ecstasy came from many here at kos as Grayson dismantled the right wing bs and put it back in their face.

    And yet, those who cheered Grayson are the very one's that are now saying "kill the bill" like spoiled little children.

    How many MORE people will die if the bill is killed?

    I guess crybabies just LOVE hyperbole when it suits them!

  •  "Yet it must be a better bill that passes." (1+ / 0-)
    Recommended by:
    Lazar

    So a bill must pass. Yet it must be a better bill that passes.

    He does exhort to improve it. Why not do that now, when there's the leverage for Democrats of having nothing and getting creamed if they don't?

    Don't get it.

    "Rove's job, and by extension McCain's job, is to basically nuke reality and leave everything open to question." - dday

    by itswhatson on Sun Dec 20, 2009 at 11:06:50 AM PST

  •  obama strived to weaken this legislation (0+ / 0-)

    from the start and he has succeeded

    giving away single payer as a starting point was a clue, but since he is the president we tried to get elected we tried to get him to take a stand on a compromise, the public option

    but he did not  want that, or any other serious threat to the insurance companies

    all that talk of ' not this time,'  that this time the democrats were not going to get the corporations through a softer facade than the republicans present to reach the same goal, that was the big lie

    he has said, this is not an abortion bill, but he willingly let it become one, a great betrayal of the people of the united states

    this whole mode of getting his Great Achievement is what he will be using for everything else he does.  he will cater to the Liebermans and the Nelsons and the Stupaks, he will not try to rally the public behind a coherent vision of what our country can be - the only way to counter those forces.  eventually some of the people vigorously defending him will become vocal critics. in fact, that is starting to happen.  in the next elections, democrats will try to run on ' we re not george bush'  again, but the public has moved on. many, many democrats will be feeling as i do now - that Team Obama  is not Barack Obama, not the one he pretended to be.

    Obama will continue his march to the right

    Politics is not arithmetic. It's chemistry.

    by tamandua on Sun Dec 20, 2009 at 11:07:30 AM PST

    •  That is bullshit. (2+ / 0-)
      Recommended by:
      Matt Z, Hawkjt

      Obama knew he had a tough sell in the House and Senate.  He wanted a public option.  He just couldn't get it.  He can't force these fucking whores to do anything.

      He's doing the best he can with what he has to work with.

      You reform health care with the Congress you have, not the Congress you wish you had.

      To love America is to hate the GOP.

      by HawkRock33 on Sun Dec 20, 2009 at 12:40:59 PM PST

      [ Parent ]

      •  Exactly (1+ / 0-)
        Recommended by:
        Matt Z

        HawkRock is 100% right. Obama may or may not have cared about the public option (I personally think he couldn't care less about it) but he knew it had no chance in this Congress. And don't lose sight of the fact that this is the most Democratic Congress we'll ever see in our lifetimes. If it couldn't make it into this bill, it'll never make it into ANY bill.

      •  the president has great power to influence public (0+ / 0-)

        opinion

        the reagan administration knew that. they faced big democratic majorities. but they pushed for what they wanted, and it changed the political climate. then, as now, the democratic party was a mixture of some sincerity and a lot of sellout. reagan sold his pack of lies and the dems hardly countered at all.

        obama did not lift a finger for the people of this country.  people who pretend he is serving us help continue the lie.

        Politics is not arithmetic. It's chemistry.

        by tamandua on Sun Dec 20, 2009 at 01:54:12 PM PST

        [ Parent ]

  •  The PO was concocted to avoid Single Payer (3+ / 0-)

    Come on people think.

    We got the Public Option architected to avoid the obvious and better solution -- Single Payer

    So why is it affecting people that the "architect" say oh gosh this health care bill that shackles us to private insurance system that costs about twice as much as what the rest of the world pays is ok?

    If the architect was for real people in the first place we would have had single payer and the Public Option would not have reared it's head in the firs place

  •  Are state co-ops still in the bill? (0+ / 0-)

    Or has that been removed too?

  •  "Perception" is the huges problem: public opinion (1+ / 0-)
    Recommended by:
    HawkRock33

    Republicans own most American media and shape public opinion.

    Until we have better ways to communicate, like more diversity in media ownership, more well-groomed, well-prepared spokespeople, we face an awful uphill struggle.

    Meanwhile, 'consider only the consistent effort'..........

    I'm glad for this diary. Thanks.

    Media Reform Action Link http://stopbigmedia.com/

    by LNK on Sun Dec 20, 2009 at 11:15:39 AM PST

  •  Actually Howard Dean's position as expressed on (6+ / 0-)

    MTP is far more nuanced than arbitrarily 'KILL THE BILL'. In fact a great deal of his objections come down to the fact that it is NOT universal health care, which he strongly advocates, and he went into great detail over how it wasn't what Stizerland and the Netherlands have. He is also for expandsed medicare ebcause bvasically that is his baby too, and what he has achived for Vermont when he was Governor. In fact I think a state by state  approach is probably  the way it will be implemented as time goes by.  Exaxctly as same sex amrriage is graduiallu being implemented.

    In fact he was merely pleading to make it better and more like Europe's socialised medicine systems, which is NOT going to happen right now in America where 85 percent of the population get their helth coiverage through employment, than the all out no hold barred, take no prisoners attitide still held by many progressives who are more keen to overturn 'corporate welfare' than they are to see a foundation put in place NOW to build on in the future.

    I think Progressives argument if they are going to rely on Dean to help them KILL THE BILL has lost a lot of steam. He repeated several times that he supports the President and the Democrats.

    •  Employer-provided HC is a problem (0+ / 0-)

      But it's been around so long, no one wants to touch it.  The Unions don't, of course, and neither do democrats.  And of course, people are very comfortable with it, because it's all they know. I wish the Wyden/Bennett plan had gotten more of a look, because it really transformed the health care system.

      •  Well, as i see it that is why an incremental (0+ / 0-)

        approach is the only way that makes sense in allowing the American public to understand what it really means to them, first higher health care coverage results in lower wages, Second, in a total global economic world two things make America less competitive, esepcially in the manufactuirng sector on which a great deal of worker faith is pinned to restore prosperity, the first of course is the edge Europe has in terms of its national health and welfare systems and the second is the lower costs of labour in China, India, and Asia.

        This will seriously start impacting American businesses and the first thing they will jettison is employer based health care or move to Europe and Asia.

        That is the time Americans will start screaming for universal government  funded taxpayer based affordable health care.

        I give it about a year frankly.  So get smart and build the foundation NOW and then start immediatly putting up the walls, finishing the roof and figure out how to replace all those jobs that will be LOST when the insurance companies are forced to give up health coverage because their profits will be cut. Then the next job for government will be to persuade the medical industry complex that if they want government business they are going to have to cut costs drastically and/or accept price fixing exactly like Europe and Japan and others have to to provide universal health.

        Be patient people, be smart. PASS THIS BILL NOW and comre back for more tomorrow.

        Part of the CHANGE you said you wanted has to come from the people themselves. You can't have both change and keep things the same at the same time. Doesn't compute.  To get you gotta give.

  •  Theory. (0+ / 0-)

    Dems pass this bitter bill now. 2012, they campaign on more HC reform, promising a public option, Medicare expansion, etc.

    If the Repubs manage a challenger who is not a moron or lunatic, however, the mandate will give them the biggest weapon to romp in a victory.

  •  OT OMG Actress Brittany Murphy is dead from (0+ / 0-)

    a heart attack

    Republicans secret dream = the impeachment of Bo the Dog LOL

    by LaurenMonica on Sun Dec 20, 2009 at 11:22:50 AM PST

    •  Whoa...that's crazy. (0+ / 0-)

      And I finished this letter with unshakable faith that the dream will be fulfilled for this generation, and preserved and enlarged for generations to come.

      by Elise on Sun Dec 20, 2009 at 11:30:13 AM PST

      [ Parent ]

    •  seriously? (0+ / 0-)

      I can't find anything...where do you see that?

      You know someone named Arsenio Billingham? No.

      by Mikey on Sun Dec 20, 2009 at 11:31:45 AM PST

      [ Parent ]

    •  Not to nitpick but it was cardiac arrest (1+ / 0-)
      Recommended by:
      LaurenMonica

      which is not the same as a heart attack. I'm guessing the final cause will be SCA secondary to anorexia (but that is just my best guess).

      Cardiac arrest, (also known as cardiopulmonary arrest or circulatory arrest) is the cessation of normal circulation of the blood due to failure of the heart to contract effectively, and if this is unexpected can be termed a sudden cardiac arrest or SCA.
      A cardiac arrest is different from (but may be caused by) a heart attack, where blood flow to the heart is interrupted.

      Nonetheless, this is quite sad.

      There is an endless demand for people to speak, There is a limited supply of intelligent things to say--Jon Meacham

      by smartdemmg on Sun Dec 20, 2009 at 02:04:52 PM PST

      [ Parent ]

  •  Kill the mandate. (0+ / 0-)

    As long as there is no mandate, the bill does some good things.

    Democrats are the sleeping giant.

    by GMFORD on Sun Dec 20, 2009 at 11:28:17 AM PST

  •  From the article I see someone (0+ / 0-)

    desperately trying to make a silk purse from a sows ear and resigned to the fact.

    It will pass.

    Now lets see the results and keep working for something better.

    First strip out Nelson's garbage and make sure Stupak Pitts never see the light of day

    Oh no, the dead have risen and they're voting Republican. - Lisa Simpson

    by LaFeminista on Sun Dec 20, 2009 at 11:39:31 AM PST

  •  I say pass the bill and fight for the public (4+ / 0-)

    option in 2010, 2012, & 2014.

    One of these days it WILL be enacted.

    Obama 7/09: "Don't bet against us" (unless the Dems screw it up).

    by Drdemocrat on Sun Dec 20, 2009 at 11:39:32 AM PST

    •  It would have helped (0+ / 0-)

      if our president had made even the slightest effort to articulate a leftist policy vision.

      "The work goes on, the cause endures, the hope still lives, and the dream shall never die." - Ted Kennedy

      by Lazar on Sun Dec 20, 2009 at 01:31:09 PM PST

      [ Parent ]

  •  30 Million More Americans with Bad Insurance (5+ / 0-)
    Recommended by:
    SallyCat, dss, wsexson, Lazar, iBlue

    No wonder Wall Street is loving insurance stocks this week. Open up the Treasury doors for Blue Cross, Aetna, and Cigna! Pass this bill because Ivy League professors say so! Let the looting begin!

    The moral arc of the universe is long, but it bends towards justice. - Martin Luther King, Jr.

    by easong on Sun Dec 20, 2009 at 11:55:43 AM PST

  •  The Pacification Efforts Are (2+ / 0-)
    Recommended by:
    wsexson, Lazar

    pretty insulting.

    The truth about John McCain's Keating Cheating

    by tikkun on Sun Dec 20, 2009 at 11:58:11 AM PST

  •  strange (0+ / 0-)

    because the idea that HCR should be "killed" is not at all what Dean has been saying, at any point.

  •  Let the Patronizing Begin! (1+ / 0-)
    Recommended by:
    Lazar

    The truth about John McCain's Keating Cheating

    by tikkun on Sun Dec 20, 2009 at 12:01:48 PM PST

  •  There's a lot of "hoping this bill can be (2+ / 0-)
    Recommended by:
    SallyCat, wsexson

    fixed in the future" stuff going around in all of these threads.

    I don't know about you, but that's a pretty big red flag for me.

  •  The proof will be in the pudding (4+ / 0-)

    Discussing whether the bill should be "killed" or not, or, more accurately, "improved" or "replaced with the House version" is academic at this point. They are going to pass the stinking Senate version of the bill. There's no will whatsoever on the Hill to fight any longer. Al Franken posting his support is clear evidence that the game is over and all hands will now be shifted to selling it.

    How they sell it will tell us a lot. I don't think the sell job will impress us much more than the bill has, but we don't get to decide those things do we? We get to react to them.

    What's going to come down now will be a snowjob by the admin and lieutenants. That will be complicated by the republican hatchet job. And, unless "our guys" try something new or different, the public will remain as confused as they already are. Since much of the bill won't actually kick for awhile most won't feel much of anything but they'll hear a lot and it will be contradictory and abstract.

    I think what's clear, though, is that what should be an exciting victory has been turned into a "could have been worse" draw, and that's unfortunate. Because the next effort will be on the table. This effort was most notable for it's clear display of democratic weakness and corporate strength. Will the next battle reverse that perception or strengthen it?

  •  Thanks for bringing this to our attention. (1+ / 0-)
    Recommended by:
    Gay CA Democrat

    I love the perspective and the information.  This is exciting.

    President Barack Obama. 11.04.08.

    by PoliticalJunkessa on Sun Dec 20, 2009 at 12:26:20 PM PST

  •  There's a key phrase for you "If properly (2+ / 0-)
    Recommended by:
    SallyCat, iBlue

    enforced." Lots of ifs and lots of waiting for anything good...Just the fact that someone of Dr. Dean's stature would come out publicly and state that the bill should not be passed tells you quite a bit about it. The problem with accepting this crappy legislation is that we all know the Dems could have used reconciliation to pass a public option, even single payer (how about Medicare buy-in for everyone, phased in by age groups, with additional Federal funding to help out all states -- not just Nebraska). Then work on a bill with mandates and regulation -- that would have made sense.

  •  the fly in the optimist's ointment: (2+ / 0-)
    Recommended by:
    SallyCat, Daddy Bartholomew

    "Third, it places new regulations on private insurers that, if properly enforced....."

    Don't hold your breath, dude.

    Even if they're enforced during Democratic administrations, the Bush years have amply demonstrated what we can expect when the Rs reclaim the white house.

  •  All the self-proclaimed "true progressives"... (1+ / 0-)
    Recommended by:
    HawkRock33

    Must be quite busy today, what with labelling Franken, Krugman, Hacker, Nate, etc. all as traitors or whatever the sooperdooperpureprogressives are calling them.

    Quite the busy day for them indeed, I would imagine.

    •  they can be wrong (3+ / 0-)
      Recommended by:
      Daddy Bartholomew, wsexson, Lazar

      without being "traitors" etc etc.

      Unless the restrictions on insurers are made bulletproof, this thing is going to blow up in the face of the Democratic party.

      And what do you think is more likely, that we get meaningful protections, or that insurers keep on fucking people over like they always have leading to "stern words" but no regulatory action by Obama?

      I see us getting a replay of his performance with the banksters- "gee guys, you should show a little patriotism and not be so selfish!" while they laugh in his face.

    •  They're not traitors in the least - (0+ / 0-)

      but they've calculated that taking a nauseatingly incremental approach is better than doing nothing. When a dysfunctional political system tackles a dysfunctional industry, it's naturally going to produce a shit solution.

      "The work goes on, the cause endures, the hope still lives, and the dream shall never die." - Ted Kennedy

      by Lazar on Sun Dec 20, 2009 at 01:29:00 PM PST

      [ Parent ]

    •  Actually we aren't self proclaimed, you're (0+ / 0-)

      proclaiming us that. Apparently for you the label of true progressive has become something negative.

      Repent. The end is extremely f*cking nigh.--28 days later

      by voroki on Sun Dec 20, 2009 at 02:54:09 PM PST

      [ Parent ]

  •  And candidate Obama claimed we would pay for (1+ / 0-)
    Recommended by:
    SallyCat

    health care reform by repealing the Bush tax cuts for the rich (you know, those tax cuts the Republicans passed with reconciliation) -- when are that Dems going to start working on that repeal, anyway?

  •  Regarding single payer... (0+ / 0-)

    Yes, it is probably the most cost-effective, efficient method.

    But it scares the shit out of millions of Americans who have their insurance through their employment and are used to it and generally satisfied with it.

    The only route to single payer is with a robust public option which demonstrates the fear of single payer as unfounded.

    We don't have that.  So regulate the hell out of insurers and keep the heat up and if they screw over America, fight for a real public option open to anybody.

    This is he beginning.

    To love America is to hate the GOP.

    by HawkRock33 on Sun Dec 20, 2009 at 12:45:20 PM PST

  •  Must further down Compromise Road (0+ / 0-)

    from Universal Health Care

  •  it's unfortunate (3+ / 0-)
    Recommended by:
    Lazar, iBlue, standupguy

    that there isn't a public option, or, better yet, an expansion of Medicare, or, better yet, a single-payer system for all. Unfortunately, it appears that none of those will be in the final bill, according to all reports. So...as a reality based community, it seems incumbent upon us to look at the reality of the situation.

    As soon as this bill is enacted, however, we need to be begin the pressure toward a public option and expansion of Medicare. We need to find ways to attach those as amendments to bills not requiring cloture. And we need to replace opponents of the public option and Medicare expansion with supporters wherever possible, including in the Arkansas Senate race next year, for instance.

  •  They all said the same thing about Medicare: (0+ / 0-)
    "Let's pass it now, and we'll fix as we go on..."

    Nothing in all those years since its' inception has changed with improving Medicare, has it?

    Comments and opinions, please...

    "Try not to become a man of success, but rather to become a man of value." ~ Albert Einstein

    by LamontCranston on Sun Dec 20, 2009 at 01:04:22 PM PST

  •  "if properly enforced..." (3+ / 0-)
    Recommended by:
    Daddy Bartholomew, Big Tex, Lazar

    ay, there's the rub...

    "History is a tragedy, not a melodrama." - I.F.Stone

    by bigchin on Sun Dec 20, 2009 at 01:14:56 PM PST

  •  My choice would be......... (1+ / 0-)
    Recommended by:
    Lazar

    leaning toward holding my nose and passing it without enthusiasm and hoping we can make improvements down the road. But it does stink like kitty poop at this point.

    We have just begun to fight! We will not go away.

    I ask him if he was warm enough? "Warm," he growled, "I haven't been warm since Bastogne."

    by Unrepentant Liberal on Sun Dec 20, 2009 at 01:32:32 PM PST

    •  It's a choice between (0+ / 0-)

      disheartening mediocrity and total failure. Realistically, it's the best that we can expect right now from our pathetic political culture.

      "The work goes on, the cause endures, the hope still lives, and the dream shall never die." - Ted Kennedy

      by Lazar on Sun Dec 20, 2009 at 01:48:31 PM PST

      [ Parent ]

  •  Misleading. The support is conditional (1+ / 0-)
    Recommended by:
    wsexson

    It must be a better bill that passes and it must not be held captive by hostile governors and ONLY a NATIONAL exchange acknowledging what so many here do not, we have huge monopolies in every state. I repeat WE HAVE HUGE INSURANCE MONOPOLIES IN EVERY STATE.

    Not many kossacks here know history about monopolies and how they don't work and how state government are sometimes not big enough to enforce regulations. there was also the caveat about regulations if enforceable, which doesn't look like it's realistic to me. It seems Jacob Hacker wants to hope this bill an ideal bill with a national exchange and strong federal regulatory structure and those elements are in the house bill that he says must be included with the Senate bill in conference.

    Remember Jacob Hacker does not support ping ponging either so you can't hitch him onto Harry Reid's wagon just yet. Implying that is dishonest.

    I disagree with him politically and think this bill could be worse for us politically with the mandate and he acknowledges our point.

    I have to be thankful to Jacob Hacker even though I disagree with him(not by much but I do) for coming up with this idea. It probably should of been called the public choice, though, but even still I'm glad Edwards adopted it forcing Obama to make the broken promise.

    Pro Life??? Conservatives want live babies so they can raise them to be dead soldiers!- George Carlin

    by priceman on Sun Dec 20, 2009 at 01:56:31 PM PST

  •  Second Half: Senate bill not enough yet (1+ / 0-)
    Recommended by:
    wsexson

    You left out the second half where he makes it very clear he is not for THIS Senate bill but the House version with national regulation of the exchanges.  He is not urging adoption of this Senate bill, but a better bill....one that will be the result of conference.  So do we all...from me to Howard Dean.

    In his analysis what is needed to be delivered.....why, it is a significant change in the Senate version of the bill...He too is counting on the bill getting a necessary infusion of significant change NOW--not at some future date NOW.  What is need ed now he says

    The lack of a public option also makes even more imperative tough requirements on insurers to make them live up to their stated commitment to change their business model and slow the spiraling cost of coverage. The most important way to do this is to move away from the Senate bill’s state exchanges and toward a national exchange such as that contained in the House bill. The federal government needs to be directly involved in implementing and enforcing strong national regulations of insurers and creating the new exchange. Otherwise, the effort for reform might fail at the hands of hostile governors.

    The federal government is the only entity big enough and powerful enough to ensure a highly consolidated private insurance industry follows the law.  It can and must demand transparency and obedience to the new rules. Insurers must open their books, and subject their rates, administrative costs, and profits to federal review. These new rules must apply to all plans, not just those within the exchange. And states should have authority not only to enforce these rules, but to innovate beyond them as well.

    These are not politically unrealistic goals.(my addition. Are they? Will the presidient fight for tht?) Most are already embodied in the House bill. In bridging the differences between the two bills, Democratic leaders and the President must insist on a final bill that delivers on these fundamentals

    So he insisits they need to make a very significant change to the Senate bill.  This change would greatly strengthen the regulatory mechanism...because all we have left in his view at this time is regulation.  He thinks this is polticially realistic.  He thinks the president should fight for this change.  Will he? Those of us with more poltical involvement and history,  think the president won't unless he is forced to do so.

    So Jacob Hacker's support is also contingent on changing the Seante bill for the better, just like the rest of us progressives.  We would happily support a better bill, one written like the House bill. ....written through reconcilation.   He is not supporting this Senate bill, neither are we.

    The next time the leadership from the Senate to the White House doesn't fight for what he thinks is essential, will he still be ready to settle for scraps? Maybe.

    I don't want to be mean to Jacob Hacker....who is being strung along by hope...vain I think but hope.  Hope has a way of undoing you.

    Hacker thinks it's polticially realsitic to think the House's version of a national exchange will prevail in this bill.  Is it?  Will the president fight for it.

    Debra "But what I have concluded over the years is that talent is universal, but opportunity is not." SOS Clinton

    by debcoop on Sun Dec 20, 2009 at 02:13:07 PM PST

    •  I disagree with your analysis of this (0+ / 0-)

      He's talking about the bill that would come OUT of conference, not go into it.

      •  He wants a better bill out of conference we agree (0+ / 0-)

        But he makes it clear the bill in the Senate at present is not good enough.

        He thinks national regulation is needed not state as in the Senate bill.  So he's not for the Seant ebill as presently written.

        He does think we can get a better bill in conference.  

        I am beginning to think not.

        Will he still be for it without the changes he wants?  I don;t know and probably neither does he.

        Debra "But what I have concluded over the years is that talent is universal, but opportunity is not." SOS Clinton

        by debcoop on Sun Dec 20, 2009 at 04:49:05 PM PST

        [ Parent ]

  •  Sounds like Hacker (0+ / 0-)

    should remove the "e" and the "r" from his last name.

    I really don't care if killing the bill will "help more Dems in 2010".  Any pain they suffer at the ballot box is self-inflicted, and entirely deserved.  This bill should be killed because it WILL make things worse, and it WON'T be fixed - not in reconciliation, and not with subsequent legislation.  The Dems will be too timid to do anything that requires more than a modicum of political courage in 2010, and they won't have the votes to fix anything after next November.

    -7.12, -7.54 / "Health care reform will never take place until Rahm Emanuel is strangled with the entrails of Frank Luntz." - Diderot

    by Big Tex on Sun Dec 20, 2009 at 03:17:36 PM PST

  •  As we all know? (0+ / 0-)

    This is mind BS.

    Starting a diary like that.

    Go work for the Nazis.

  •  Kill the Bill - It's Not About HCR Anymore (0+ / 0-)

    It's about the arrogant attitudes of Obama, Rahm Emanuel, and a bunch of Senate Democrats like Mary Landrieu and Ben Nelson who believe that they can give the special interest - in this case the health insurance industry - 70% and the ordinary Americans 30% and brag that they did a major reform because the Republicans would not have given us even 20%.  

    This is a sheer arrogance and we should be treated with more respect and dignity than this.  We have to fight to be treated with dignity and respect so these DINOs give ordinary Americans much more than what they give to special interests.

    Otherwise, they will keep treat us with disrespect.  So for this reason, kill the bill and vote them out so they know later how to respect us.

  •  Please Add Another Choice To You Poll (0+ / 0-)

    My choice is not up there.  I think we make a mistake by portraying this as either accepting the Senate bill or try to kill the whole thing.  Here's my choice:

    Pass the Senate bill and then work to improve it in Conference.

    Let me cast the first vote for this option.

    "Some men see things as they are and ask, 'Why?' I dream of things that never were and ask, 'Why not?"

    by Doctor Who on Sun Dec 20, 2009 at 03:48:41 PM PST

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