(Political) To the Left wing of the Democratic party
 

Do you realize how much like 13 year olds you sound right now. How "everything is ruined forever" because you didn't get the progressives dream in a national health care system.

Look, I'm thinking it was a good idea too.. but here's the thing. There's sixty of you. That is a high water mark that the democrats DREAMED about, a decade ago, or even 6 years ago. So you didn't get everything you wanted. Get what you can, and call it good.

If you can't get it now, you ain't gonna get it. And what you're doing right now is wasting an advantage you may never have again. Not just in numbers, but in grasping the center. The rival political party is split between the orthodox and the fringe.

But you're doing the same thing. A lot of the Democratic party are in the progressive side.. understandable. However, by demanding orthodoxy over practical concerns, by demanding the "Big Leap" instead of small, practical steps you are handing the momentum right back to the Republican party.

You got where you were (60 senators, and a sizable lead in the house), by the strategy of moving to the center, playing to all 50 states.Now that you've been granted this amazing difference in party size and potential power, you're playing back to your bases and forgot what got you to the dance, so to speak. The right lost the center a while ago to you.

Now you're trying to give it back.

(sorry for the ranty ravey, I think I've been exposed to one too many "Everything is ruined forever" rants from people who expected this great fundamental shift in America)

Two things. One, nobody should have expected Obama to be anything more than a center-left pragmatist. He isn't a radical and is always going to look for a consensus position. That's the guy I thought I was voting for, so I'm cool with that.

However, that doesn't excuse the incompetence around HCR. There's no reason why Reid and Obama should have defaulted to a position where every single moderate can be in charge of writing the bill. I know they need sixty votes to beat the GOP filibuster, but why did they take reconciliation off the table before they started negotiating? Why are there no consequences for committee chairs to vote against closure? Why hasn't a single Dem been screaming on TV every day about the principle of an "up or down vote"? Where's the ghost of Lyndon Johnson when you need him?

I'm not in favor of scrapping the bill, but I'm not far from that position. As it moves more and more to be little other than forcing thirty million people to buy insurance, what's the point?

i'm at the point where scrapping the bill (unless you remove the mandate to purchase insurance) is what i want to see.

in its current state it's essentially a fucking handout to he health insurance companies. and frankly the "tougher rules" on denying coverage for preexisting conditions just give the insurance companies a built-in excuse to say "ohhh our costs are going up...time to jack your premiums even more!"

reforming the industry through the private sector is a fucking joke. the system here in Massachusetts isn't really all that great, but at least there's a semblance of cost-control in it - now you want to remove even that?

the health insurance companies bought and paid for a gazillion lobbyists, and they've won.

so why not pass this bill to at least (as I heard some senators say) "lay the foundation?"

because that simply gives opponents ammunition to say "oh we tried healthcare reform...it didn't work." or "oh we still need to give the last reforms time to really work."

:rant:

+1, pretty much

Nate Silver over at 538 has been talking about this all week- mostly the same idea as Foz: there's a lot of good in this bill, quit griping because the most liberal stuff wasn't going to get done. I love Nate, but I think he also missed the big picture here.

-At this point, the bill is basically that you force everyone to buy insurance, you get rid of the pre-existing condition clause, and give a bunch of subsidies to lower income families people to get insurance and *that's it*. Not to go all fiscally conservative, but if we're spending close to $1T- I want more than that for my money.

-But what did we give up to get that? We're forcing people who can't really afford it to buy into the system and having everyone else pay for it. I'm ok with that idea in theory- we're in a social contract and I think we need to look out for the less fortunate, both as its the right thing to do and as it's in the national interest- that's why I'm one of those dirty liberals. But if we're giving the insurance industry more than 30M new customers and a giant share of $100B per year in cold, hard cash- I want something back, more than just bargaining away pre-existing conditions. You could have just made a law outlawing it in Februrary to near unanimous bi-partisan support before this even got started and then start from a new negotiating point, if you had really wanted to.

-Where are the cost savings? I know it's crazy, but even those of us on the left care about these sorts of things. How does this bill do anything but push this issue down the road? The insurance exchange is going to be just like employer based health care: strangely, everyone is going to have almost identical prices for the same coverage despite a 15% profit margin per year and grossly inflated operating costs (like most companies in this country). We're going to see some smaller companies get bought up as they might actually have tried to be price competitive to grow their share and it's going to look like every other industry here- 3~5 big players and oligopoly-controlled prices.

-And we've handed pharmaceuticals a crapload more of cash. And for what? To still get gouged as we can't negotiate as a group and can't get their "international" drug rates? Any increased regulation so we stop fast-tracking stuff that will kill people? Any requirements to provide drugs to the poor or require research on something actually beneficial to society other than helping make sure aging baby boomers can sit around in bathtubs outside as some weird euphemism for sex?

So, at the end of the day, the political capital was pretty much pissed away and there's not much to show for it in this bill. Not only did the Dems fail to actually pass something substantial by trying to head towards the middle, they also now are perceived as having done nothing as, well, they did nothing. Rather than getting a big electoral victory, they've endangered their majority for next year. And for what? To water a bill down to make it more palatable to the middle who hates it all that much more.

Where's the major victory on any fronts?

SI

This is a fun little game. When a fiscal conservative points out the numerous flaws in this bill and where the money is going, it's called 'hoping the bill will fail'. When a liberal points out the same issues at a later date, it's called constructive criticism from supporters.

I like this game.

well said sir. particuarly on the costs - i hadn't mentioned that. it's essentially just shifting the costs down the line onto us in a few more years and leaving it for another Congress to deal with. Something that our legislators are really great at.

but we don't get anything as far as actual reforms to keep costs down - like I said it's a handout to the insurance industry (which really does not need it AT ALL).

it's also going to demoralize a ton of those first-time or younger voters that they had turn out for them in such large numbers in the last election. shit, it's demoralizing to me, and i'm neither. so you run the risk of lowering your turnout in the midterm elections and losing a bunch of seats by people who are so pissed off that they just decide to stay home and not vote.

lose lose lose. lost all-around. it's a magnificent clusterfuck.

i may disagree with the Republicans ideas (particularly socially, since as has been noted i am at least fiscally responsible), but i can damn sure be a pragmatist and admire the fact that when they have legislation they want to get passed as a majority they twist arms and get their house in order and got something passed that at least somewhat resembles what they want.

can you provide links to posts where you have pointed out flaws in where the money in this bill is going and then where people chided you for "hoping the bill will fail?"

I'm not speaking solely of my opinion. While I certainly understand that you put a high value in what I say, there are others that have pointed out the fiscal irresponsibility of this bill and the president has certainly pointed the finger to the opposition on numerous occasions both publicly and privately that he thought they wanted the bill to fail.

As Fozzie correctly states, the ball still lies in the Democrat court with everyone staring at the ball and no one wanting to pick it up and do the best thing for their constituents rather than what is best for their political future. If they continue doing this, they may end up irritating their constituents AND jeopardizing their political future.

Hear Hear on the OP (and Nate Silver). There is a lot of good in the bill, but if you are going to scrap it because you can't get everything you want, then forget about ever having a national health care system. Pass a bill that extends coverage to everyone (through mandates and support for low income people) and eliminate pre-existing conditions and insurance to drop you for no reason (well, the reason is you get too expensive) and go with that. Maybe later you can get other things you want after seeing how this works. It may be done in stages, but AT LEAST get the first stage off the ground.

After all, it took 11 Apollo's to get to the moon (yes, I know, not the best analogy..)

Anyone who took the pushback against the Republicans and election of Obama to mean America's liberal again probably deserves their frustrations.

But the difference is the CBO and many experts think a public option will reduce the deficit and overall spending on healthcare. Just shoveling money from the treasury to the insurance companies without means in place to reduce costs is a far worse option.

The fiscal part of the bill is a joke. All it does is create huge deficits in the future.

Much of the way they go ten years without creating a bigger deficit is just a ridiculous shell game.

The bill includes a public long term care plan. This plan would cost something like $175 a month to join and there would be no government subsidy. When you needed long term care it would pay $75 a day towards it. Here is the shell game: You have to pay premiums for 5 years before you can collect the benefits. So they will collect premiums for 5 years before they pay a claim, of course you can make the 10 year financial picture make sense.

This ignores a couple of problems:
A. $75 a day is a worthless benefit today, nevermind 15-20 years from now. That won't pay to get your ass wiped once.
B. They will take an absolute bath in the long term based on underestimating how long the average person will live and how upside down our demographics are. As soon as the writing is on the wall and the plan is a disaster who is going to join, because there is provisions that allow the premiums to be raised, but the benefit seems to be set at $75 a day.

Yes, it sounds great in sound bites to talk about taking care of the elderly and the disabled and how it will change lives. It is a noble cause. It's an impossible bill that is going to come due in the future and can't be paid.

There is one political party. They go by different names but they do the exact same things in power, spend your money. They both love the state, they both believe that government benefits they will provide outweigh their costs even though this is proven over and over to not be true. There used to be a saying that one party believes in welfare and the other in warfare but now both parties believe in both. One party will deflect blame by talking about George W Bush and blatantly doing exactly what Bush did. The other party will talk about fiscal responsibility while spending out their ass when they are in power. Continue your partisan bickering if you like but if you can't see this then you truly are disillusioned. The Republicans will bring change in 2010, the Democrats will bring change in 2012, the Republicans will bring change in 2014, etc...

2024: US President "We must win this war in India. People may have doubts about our wars in Iraq, Afghanistan, Pakistan, Egypt, Yemen, Turkey... But the security of the United States has never been more at risk. We must also fix health care it is broken and we can’t keep spending tax money to get us out of this mess."

2024 FOFC poster: "He's right. I know I doubted the previous president in 2020 with their war in Algeria, but he must be right since he is on our side! Now let’s go argue some unimportant side issue!"

I don't disagree with your second point. But as Fozzie stated so well, the weak stances from the Democrat party are causing disappointment on both sides of the issue from a constiuent standpoint. If you're a Democrat supporter, you're disappointed that the large majority that your party has received hasn't reinforced to them that they should put a policy in place that does what's needed rather than a watered-down bill that does nothing. If you're a GOP supporter, you're wishing the Democrats would have enough balls to push their agenda full-bore and define their policy stances come hell or high water. Instead, you're left with a majority that isn't really sure what they're doing and don't even act like a majority should.

+1

I expected Obama to be a center-left pragmatist, and a realist, and he hasn't disappointed me on that front so far.


+2

I know life in the Senate is difficult, but to come out of an electoral cycle with good majorities in both the House and the Senate, and ownership of the White House, and then give up as much ground as they have, is somewhat ridiculous.

Everything isn't "ruined forever", but Reid and Pelosi (Reid especially) have squandered the kind of golden chance that doesn't come around very often. I mean, they couldn't even use Ted Kennedy's death to shame some people into voting for the bill. :D


I always wanted Universal Healthcare, but never figured I'd get it, even with the Democrats in this kind of strong political position (or at least the strong political position they had about a year ago). I did not, however, figure that I'd get as little as this bill is going to give us, especially considering all the crap that's also going to go into this bill that I'd rather not have.

The less Congress 'accomplishes' the better off we all are.

Ah, the Curry Powder Invasion of 2024.

On pre-existing conditions. You can't require companies to drop pre-existing condition requirements and not require everyone to buy insurance. There would be no individual market within 3 years if you didn't. The rates would get so highly so quickly that anyone who wasn't chronically ill could even consider insurance.

If you could purchase collision insurance AFTER you totaled your car how would anyone afford car insurance?

Exactly. The best situations are years where the Democrats control one part of Congress and the Republicans the other, both with weak majorities. Or when the president is a different party than Congress. A lot of bickering and theatrics and fortunately not a whole lot gets done.

Conservatives never wanted this bill to pass so yes, they've been hoping the bill would fail.

Liberals wanted some sort of reform bill to pass, but now that it's a clusterfuck, they're pointing out the many elements (including fiscal ones) that make it a clusterfuck.

It's a difference of starting context.

Really, this isn't a difficult concept, MBBF.

I agree, and this is a big part of the problem with the half-measures made in the name of Health Care Reform, like this bill - the whole thing isn't thought through.

Of course, my answer would be to just go to a UHC system, in which case this particular issue of "having to insure" pre-existing conditions goes away.

Further, in light of the money we're going to spend on the dubious benefits of this particular bill, one really has to wonder if, in the end, it would have been cheaper to go to UHC and just cover everything in one fell swoop. Economies of scale and all that....

Fixed.

Republicans don't inherently have a problem with health care reform. They just differ on how they'd do it. A small clarification, but a very important one. While the tactic is used to villianize the minority party, there's nothing wrong with wanting a bill to fail if you don't believe that it's the best way to structure a policy. It just depends on where you stand as you correctly state.

what's your point though? we should all wake up and vote libertarian? the problem with the libertarian party (well okay there are several) from my viewpoint:

1 - in national elections they put up candidates who are not comitted libertarians, but rather as LINO's

2 - i just think you have a fundamental problem trying to get the vast majority of Americans to buy into a political philosophy that embraces
a) minimally regulated markets (especially today - we've seen how well that worked out)
b) minimal border controls (yay terrorism...scary...oooh!!! muslims!!! 9/11!!! 9/11!!!!)
c) non-interventionism (see (b) )

3) the vast majority of Americans, while frustrated with inaction on the "pet issues" of the day clearly like their tax-supported government programs (from public education to medicare)

4) there isn't a working country in the world that is "Libertarian" that Libertarians can point to as a model and say "See...we can throw out everything we've got and it'll still be okay. We won't go to hell in a handbasket and totally fuck everything up." That's a massive risk to ask people to take, particularly when there are incremental steps that could be taken instead (100% public financing with caps for all elections, term limits, etc).

That would be a more effective argument if the GOP and/or fiscal conservatives actually put together an alternate plan that was anything but a cipher, but as we've pointed out to you again and again, they did no such thing, despite how many of Huckabee's or Jindal's "10 point plans" you care to post.

the fact that you're posting that from Hartford doesn't escape me.

I totally agree. They're playing the same game at some level by not offering up a real alternative outside of the talking points which is frustrating to people like me who support their ideas on health care. With that said, the onus here is on the majority party to make something positive happen. The current bill they'd like to pass just so they can say they reformed health care could hurt them much worse than taking a stand with a true reform bill that actually puts forth what the Dems believe is the best way to change the system, even if it means not passing a bill.

Stop the world - I want to get off. I AGREE WITH YOU MBBF!

I think there are a few points to be made:

1) I think the Dems erred in believing that they had a mandate from the last election. Rather than a mandate, I believe it was a voter revolt from the Republican party.

Using myself as an example, I voted for Bush, not because I liked him, but because he was better than Gore and Kerry. Bush used the term conservative, but he was not. The only conservative things that Bush did was in the social arena, but even that was limited, and I really do not worry about those items.

The result was an alienated party after 8 years and it cost them in the elections.

2) Due to this misjudgement, the Dems felt they needed to push through their agenda. They did this without shoring up any support from those who put them in office. Rather than starting small, building consensus, and then going for the big enchilada, they followed the South Park model of 1) Get Elected 2)????? 3) PROFIT!

Oh I work in the industry, I don't hide that. It doesn't change the fact that you can't force carriers to cover people but not require everyone to participate if you want any chance for success. You don't need to be a genius to see how quickly a few sick people can drive the healthy people out of a risk pool. It happens in employer groups and it creates issues, in the individual market it's unsustainable.

There certainly needs to be coverage for everyone and to do that the government is going to have to get somewhat involved. This bill is a total shitshow though and makes things much much worse not better.

So what did it mean when I was posting from the Medicare IT offices in Baltimore in 2005?

I don't understand why the democrats aren't stripping Lieberman of everything including his parking spot at this point.

It means you were wasting taxpayer's dollars.

The GOP acted much less like a party in control then the Dems are currently.

Regarding Libertarians, the response regarding market regulation is that with the regulations that were being enforced, you wound up with a bigger screw up than you did otherwise. You have to be willing to let those who screw up fail. It sucks short term, but in the long term you are in a much healthier situation. As it stands now, you are going to have the banks continue to run risks. The problem is, they feel if they are big enough the government will bail them out.

Would it be a better bill if he wasn't opposed to it?

They wouldn't have had to neuter it so much, so yes.

Atta boy! Actually, it was allowed during breaks. I just wanted to find out if creating a system to handle government payouts made me a big-government liberal since living in Hartford makes Jim a GOP shill.

He's not forcing them to neuter it in any way. If the bill is good enough and you believe it is what's best for the people, you should stick to your guns. He's a senator who has the right to voice his approval or opposition just as much as any other. He's just villianized because he's the one the Dems can often sway. When he doesn't, he's an easy political football to toss around as an excuse.

I am certainly no GOP shill and support health care reform in baby steps to see what works and what doesn't work. I am against bills that just increase future deficits and think that as important as health care is, the economy needs to be a higher priority since without the economy working there is no way to make anything else work. If you 'fix' health insurance but break the economy further, then shortly health insurance will be broken again.

Thanks for the clarification. :D

Agreed. And nice post, by the way.


Yep. As I argued from the beginning (in the other threads), better to state clearly what you believe in and (ironically) put it to an "up-or-down" vote, going down in flames if necessary, than compromising the bill to the point that it's little more than a complicated way to shovel public money at insurance companies to cover people who could be covered for less via another method.

Heck, I wonder, at this point, if simply having people who earn below some threshold submit their insurance premium bills to the government for reimbursement might be cheaper.


And this is why we need UHC. Public health is a public good. Forcing private entities (even non-profit ones, such as BCBS) to compromise their financial operating models in pursuit of a public good almost never works, and certainly doesn't work on a long-term basis.

Heck, even companies who supplied military equipment for WWII didn't do so at a loss or with unacceptable financial risk, and that was a finite endeavor.

Does this make you a Jesse Ewiak shill?

Ok, you a shill for the socialists? Anyone can call someone names and not deal with the issues. I'm sorry that I have been immersed in the subject for a decade and understand it much better then you do.

Might need it, but there is no way to pay for it and would need an immense shift in the behavior of our culture. You'll see over the next decade how quickly many of the European models that are held up as a standard begin to fall apart. Some are already starting to show the strain.

He's not a democrat in any sense at this point, so why treat him like he is? Take away everything you can, and kick him out of the democrat caucus. He is forcing them to neuter it so that they can actually get to the magical 60 number, since no clearly republican's dare break the ranks of the Waterloo plan.

Yeah, the difference is- the more we like the bill, the more you hate it. If there were a strong public option to reign in costs, some import cost control measures to reign in pharma, and a chunk of money taken out of all parties in fees and taxes to keep them from charging more- I'd be happy with it and you'd be talking about it as if it were the end of days.

So, yeah, you are just hoping the bill will fail whereas this is constructive criticism.

SI

sorry, i wasn't trying to attack you on that or anything, or even point it out, i just kinda thought it was worth a little chuckle.

i agree that you can't force carriers to cover people but not require everyone to participate. we are on agreement there.

but i think in order to ensure that insurance companies don't take the "oh we have to cover all these sicker people now so everyone's rates are going to go up even more" tack you have to have some method for keeping prices competitive - hence a public option. even if limited in size+scope at first.

i found your last couple sentences to be interesting and somewhat...refreshing i guess you'd say? that you think the bill is a total shitshow and you agree there needs to be government involvement.

i just thought it was worthy of a chuckle that's all. i wasn't trying to attack him or point it out with huge flashing neon lights or anything.

wasn't really calling him a shill (as i said). just thought it was kinda...worth a chuckle.

does anyone else still chuckle, or just me?

BTW, the lack of a firm GOP bill option is because it could easily strengthen the Democrats. A bill option by the GOP would allow the Democrats to say "See, I told you they were full of crap. This bill is a mess." At this point, the Democrats don't have an opposition bill to argue against, leaving the full target and scrutiny on the Dems bill. .

That's part of being the majority party. You have to take that spotlight and bask in it like you want it. Right now, it just feels like the Democrats are withering under the intense heat of that spotlight. I think that this would be going well for the Obama administration if they had good majority leaders in Congress. Reid and Pelosi are doing Obama and his supporters an extreme disservice.

Disagreed on the former (I've seen models that indicate not only can we pay for it, but in the long-term it would be cheaper than our current model), agreed on the latter (I believe that U.S. culture is much less inclined to pay for "public good" programs than most other first world countries).


Strain due typically to egregious financial mismanagement and/or bungled attempts at partial privatization by (typically) conservative governments. The model itself isn't bad, it's the management of the model in certain specific instances that leaves much to be desired.

Now, if you want to argue that the U.S. government couldn't possibly manage a big UHC system, then you may have a point. But I ask you:

What better? U.S. government trying to administer a simple "You get sick, we pay for it" system, or trying to work with the extraordinarily complex system we get as a result of this bill?

Btw, I come from the other side of lynchjim. I work for the US government enforcing ERISA, making sure companies follow health care regulations for the group health plans, and I completely agree with lynchjim's observations on pre-ex and mandates. I wonder who that makes a shill for? ;)

The issue with pre-existing conditions and mandates is common sense. Why in the world would private entities agree to "insure" (read: pay for) people with known expensive conditions? Even if these entities are non-profit? Even with the "greedy profit motive" aside, it still makes no sense.

If we force insurance companies to pay for people with pre-existing conditions, the result will be insurance companies needing to offset these costs with higher premiums on healthy (or at least currently healthy) people. To me, the eventual outcome of this is that healthy people don't pay insurance premiums until they develop a costly condition, at which point they get "insurance". Of course, you can force them to own insurance, which is basically forcing them (or their employer) to pay into, in effect, a national system of "health care cost distribution".

So, if you're going to do all this, through a complex system involving 50 states and hundreds of insurance companies, might it not be better, simpler, and easier simply have the government pay for everything, and distribute the cost to all taxpayers evenly?

Oh wait, but then we get death panels. My bad.

Oh, insurance companies are killing people. Well when you put it like that I'm convinced.

I think most people agree there should be coverage for everyone. I really don't know many (any) who don't agree with that.

This bill is a fiscal boondoggle though. Even if it truly was deficit neutral for a decade (if it is it's only because they tax for 3 years before they spend any money), in the decades after it would make the bank bailouts look like chump change.

quite the well-reasoned and simple explanation.

Why don't you do some research on how things really are tracking going forward in Europe and we'll catch up after that. The demographics don't work in the future. There are too many old people and not enough workers. Some of the countries are starting to fray and when the demos catch up with them it will turn south quickly.

Raise taxes? Are you a senator or just a lowly member of the House?

There is no way to construct a healthcare reform bill that would gain GOP support. They've decided, rightly I think, that Obama losing offers greater political gain than any other option. Now I think it's a cynical game to play with people who are dying due to lack of insurance, but it is what it is.

This is why the Dems don't have to accomplish anything - they can just blame others for their failures.

To even ask the question you've got a lot more faith in government then I do. It could potentially be simpler, but I don't see any way in the world that it could be better.

This isn't with respect to your post but I'm not in the mood to hear about Europe and Canada. Give me a call when:

A. The US doesn't have to play defender of freedom to the world and can move spending from the military to health care.

B: Americans are willing to be treated like patients in those countries. Chicago has more MRI machines then Canada. Let me know when Americans are willing to stop having expensive tests like that.

C: The sort of medical providers you'd want treating you are willing to work for what medical professionals in those countries make. My wife has a cousin who is a brain surgeon in a European country with socialized medicine and has a standard of living about 4 levels below us.

Oooooohhh.. our system is so much better then you Americans... but if someone tries to invade us please stand up to them.

Arguably the demographics work worse for our private/public (don't forget Medicare) system.

Future workers will be paying more in taxes to pay for Medicare (because more people will be on Medicare than even before, just due to aging, not even the increased costs due to this bill) while also paying more in health care premiums because of the ever-rising cost of health care itself.

At least a fully-public system can:

1. Use huge economies of scale to aggregate and manage cost inflation.

2. Adjust based on demographic trends by tapping sources of funding not available to private entities.

I'm not sure I mentioned this here- but I've been fairly impressed with what Pelosi has done in the House with rounding up the troops and getting votes done. A much better health care bill, cap and trade, financial regulation, card check, and more are already signed, sealed, and delivered. I never liked her, but I've been impressed by how things have gone in the past 3 years in the House so I've had to change my opinion.

So, here's the big "but". It turns out Reid is as bad as we thought he was. He has a much more difficult situation to deal with but he's unwilling to do anything even with his job in jeopardy. A lot of this lies at his feet because you know if, say, Tom DeLay were running things on the Democratic side and, mercifully, he's not as they don't tend to employ lesser demons, Lieberman wouldn't just be threatened with losing his seat but the life of his firstborn and his firstborn's firstborn.

SI

we also have higher GDP than those other countries and thus can pay higher salaries to the medical professionals that we have and will have going forward.

we also already have all of those machines - not like they're all going to up and magically dissapear.

your point A is very well-taken and true though. wayyyyyyy too much spending going into the military-industrial complex in this country as a result of our playing unilateral defender of the free world.

What about the soldiers that die for unecessary wars? What about police officers that die fighting the war on drugs? Nah, government accountability is only needed for the private health care industry.

That's just flat-out wrong. A 'take it or leave it' stance by Democrats would put the crosshairs squarely on the GOP and result in much less backlash against the Dems. They could show that they really mean that they want true reform.

As it is, the Democrats look like a group looking to stay in office for 4-6 more years rather than anyone looking out for the interests of 'people dying due to a lack of insurance'. Once again, the Dems have the power and promised to do something. So do something already.

Uh, the Patriot Act passed the Senate with 98 yes votes. That is bi-partisan support, not the majority cramming something down the throat of the minority.

NCLB passed the Senate with 87 to 10. Again, this was a bi-partisan vote. Also, VT, MN, and NE both senators voted against it, 3 R and 7 D voted against the bill.

Tax cuts are arguably the one conservative item he passed.

My point is that the GOP was in a position to shove anything down the throats of the Dems. They did not do so. They split the committee chairs with the Dems, which frustrated many GOP members. You had Trent Lott removed from his leadership position, due in part to the way he handled the Dems.

Outside of the war and associated legislation, much of what Bush passed was not conservative. That was one of my problems with him, he ran as a conservative, and governed as a moderate.

Those machines cost a LOT to operate, though. It's not so much the fact that we have the machines -- it's that we're accustomed to having those tests performed more often.

Well, our solution of pricing the poorest 30% of the populace out of the market so they have no care is a much better model.

SI

Once you build a single payer system and there is no incentive whatsoever for the individual to control costs at a personal level you can forget any chance of managing cost inflation. All you need to see is how people utilize their employer plans once they reach their deductible and out of pocket limits. They get care just for the sake of getting care.

The only way to ever slow down the cost of health care growth is to force people to take care of themselves. If you've got a non-financial way to do that I'd love to hear it.

The demographics are an issue here as well as there, the difference is that no one here is pounding their chest about how great the system is. Many of those countries are about to watch their programs strangle their economy. We probably are as well, but running to their method that worked 15 years ago is no way to solve our problem.

If you really believe that you might want to start over. First of all you might want to be aware of Medicaid, secondly stop confusing 'health care' and 'health insurance'. Stop by your local emergency room for a crash course.

Uh.. they don't run themselves. They aren't cell phone towers, it takes well compensated people to run them.

But you can't compromise with a party that sees defeat as their primary goal. Bush ran up some big vote totals because Dems negotiated in good faith. On HCR the Gang of Six's Republicans made it very plain over the summer that any bill would be opposed. They're set to filibuster every major piece of legislation, which the Dems didn't do under Bush.

If the U.S. government administrates programs so much more poorly than private entities, then why are even the most vehement HCR opponents so attached to Medicare?

If the U.S. government administrates programs so much more poorly than private entities, why is the Veterans Health Administration such a success?


For someone who purports to be cost-conscious, I'm surprised that you're unwilling to look for cost savings in the vast military budget, especially with the many egregious examples that are ripe for the picking.


I lived in England and was a patient in that system. My quality of care was just as good as the quality of care I've received in the U.S., and I have excellent insurance.

Further, I'll bet that a resident of East London has far more equitable access to an MRI than a resident of the South Side of Chicago.


How do you define "4 levels"? Is he unhappy? Why doesn't he quit practicing or move to the States?

On the down side, he gets paid less. On the plus side, he probably doesn't have student loans to pay and almost certainly doesn't have to pay for a ridiculous level of malpractice insurance.

And anyway, how is the cause of "providing coverage for everyone", which you admit should be the goal, served by making every doctor a millionaire?

I'm not arguing the Dems have handled things well, but there was no way to garner GOP support. They haven't been negotiating in good faith, and, yes, the Dems should have had the sense to go it alone. However, the moderates don't roll that way and now we'll get a shit sandwich of a bill that won't be nearly as effective as it could have been.

I don't think the primary issue is insurance costs. The problem is the continuing increase in costs for providers and services. Regardless of whether it's a government program or private insurance the only solution is to reduce the rate of growth for expenditures. That means doctors and drug companies and medical service providers need to accept that they can't continue to have income rise well above inflation.

You're taking anecdotal evidence and trying to extrapolate it into data.

Due to having a toddler, my family blew through our deductible much earlier this year, and also our out-of-pocket maximum as well. So by your logic, I'm heading off to get a chest X-Ray whenever I feel a bit wheezy, or a CAT scan when I have a headache, and I always pick brand name drugs over generics, right?

If what you say were true, then everyone in my position would abuse the system, right? And all these insurance companies would be bankrupted by our egregious expenses, right?

But they're not, which means there's a flaw in your reasoning.

That sounded a lot more impressive until I looked up populations. Chicago has almost 10M (9.52M in the MSA) versus 33.1M in Canada in 2007. Wow: Chicago has basically 1/3rd the population of Canada. Hell, NYC + LA are almost as populous as all of Canada (31.8M vs 22.1M). Never realized how few people lived in Canada.

That still means there are 1/3rd the MRI machines in Canada vs the US, at the minimum. But, who can afford to get an MRI? Hell, I know a lot of us are afraid to get basic blood tests because it's a fight to get back the $200+ that we get charged for preventative care. Lord knows if I were actually ever seriously hurt, I'd spend most of my time in the hospital bed worrying about how badly bankrupt I'm going to be, even tho I've been told I have good coverage.

And that a lot of people don't know how covered they actually are because they've never gotten seriously sick so they think their coverage is fine. I swear I need a lawyer just to go through my insurance renewals at work and we "streamline" stuff compared to a lot of companies.

It seems like we're trying really hard to protect the super high levels of care that only the wealthiest 2-10% of the population can afford at the expense of the other 90%.


What European country? We're not talking about Eastern Europe, right? And what is 4 levels below us? Can he only buy a BMW instead of a set of Porsches or is he having problems feeding his family and paying his student loans (which he probably doesn't have)?

Again, it's not like we only have the best and the brightest in that field right now. Just like any other field, there are good doctors and there are bad doctors. I've already been reading lots of stories about how we're badly short on primary care physicians in this country. Right now. Today. Not because off what we're talking about doing. But right now. Because of the system in place.

So what we have now is a really mercenary force that only goes into the fields that make the most money. I'm not sure how that really equals better care, just that you have a greedier bastard treating you.

SI

I thought chronic disease management and end of life care were the biggies in health costs. I don't think some extra office visits make much of a difference given the dollar amounts we're talking about.

Oh, I agree. I was just responding to the point I think Jim's trying to make that in a UHC system people will just take advantage of everything because it's free to them. It's demonstrably not the case, and even if they did (as you point out), it might not be the major cost factor anyway.

I would disagree that the Dems negotiated in good faith. The Dems fought GWB on every major piece of legislation from say summer of 03 on. They threatened fillibusters and other items. I'll say now what I said them, if you believe in what you are doing, force the other side to fillibuster.

Typically, a fillibuster makes the opposing side look like fools. Don't let them get away with a threat, call their bluff.

So the Democrats negotiated in good faith with the GOP and Bush for the first 2 1/2 years of his Presidency, by your metric (with which I agree, by the way). As opposed to the GOP now, which has negotiated in good faith with the Democrats and Obama since...?

Key legislation:

Economic Growth and Tax Relief Reconciliation Act (May, 2001) - 230/197, 62-38 (if I read the details correctly, elements of this were passed through the reconciliation process to avoid filibusters)

Authorization of Military Force (Sept, 2001) - 420-1, 98-0

USA PATRIOT Act (Oct, 2001) - 357-66, 98-1

No Child Left Behind (May/June, 2001) - 384-45, 91-8; (Dec, 2001 - after conference committees) - 381-41, 87-10

Iraq War Resolution (Oct, 2002) - 297-133, 77-23

Jobs and Growth Tax Relief Reconciliation Act (May, 2003) - 231-200, 50-50 (Cheney tiebreaker)

Partial-Birth Abortion Ban Act (Nov, 2003) - 281-142, 64-34

Medicare Modernization Act (June/July 2003) - 216-215, "unanimous"; (Dec, 2003 - after conference committees) - 220-215, 54-44


There was little in the way of major legislation passed in 2004.


Bankruptcy Abuse Prevention and Consumer Protection Act (April, 2005) - 302-126, 74-25

Energy Policy Act (July, 2005) - 275-156, 74-26

USA PATRIOT Act Reauthorization (July, 2005) - 257-171, "unanimous"; (Dec 2005/Mar 2006 - after conference committees) - 251-174, 89-10

Military Commissions Act (Sept/Oct 2006) - 250-170, 65-34



Also of note are that all of Bush's 12 vetoes came from 2006 onwards (the Democrats gained control of the House & Senate in the 2006 elections, but some vetos happened just before this).

Welcome to Washington DC everyone!!! Where a politicians only job is to do whatever it takes to get relected (since there's no term limits) and not what is best for their constituents, regardless of what party they align themselves with.

A filibuster doesn't make people look like fools. The procedures are such that it's much harder on the majority than the minority to force an old fashioned filibuster. It's gotten to the point where sixty votes in the Senate is seen as the norm when it was never meant to be used to such a degree.

HAHAHAHAHAHAHA! I really needed a good laugh with all the shit I've been going through lately. :lol:

If the system is such a success, then why did I wait nearly two months to get a MRI for a possibly debilitating neurological disorder (multiple scelorisis) or further degeneration of my cervical spine? The ONLY reason I even got in that early is because I requested a night appointment, or it would have been 3-4 months. Then, I get to wait another 3 weeks to find out what it is that I have. Yup, it's a great system alright! :rolleyes:

While I admit that the quality of care has improved significantly over the years, there are still too long of waits, overstressed overworked and undercompensated staff, and inefficency in the process of providing care to veterans. I attend several veterans organization meetings and as much as 75% of veterans are dissatisfied with the system. What makes it worst is that the VA don't even listen to us when we complain about the system! They brush us off in our surveys because they don't get adequate resources to carry out what they are here to do: treat veterans.

Here is Ezra Klein (no conservative):

http://voices.washingtonpost.com/ezr..._insurers.html

Hey, stupid question: USAA gives us money back at the end of the year on our auto insurance if we've been good (no accidents, tickets, etc.). I know above you talked about a non-financial solution, but would it be possible for health insurance companies to refund some money at the end of the year if you've undergone a physical and are healthy and have been healthy for the year?

Or would that just not work?

I'd be in favor of some sort of discount for getting a physical/check up, but being healthy is too much of a lottery. Many diseases have genetic components that can't be controlled no matter how healthy your lifestyle may be. It doesn't seem fair to punish people because they are predisposed to MS or breast cancer.

Ah, you're absolutely correct. Comparing auto insurance where you have control over tickets/accidents isn't the same as health insurance.

Standard of living 4 levels below us? What does that mean? He can't order useless crap from the Brookstone catalog?

And it's not like we don't ask other countries to stand with us when we go to war.

some of the limitations of this new legislation as far as ways insurance companies could still game the system?

so they're required to provide coverage for people with say kidney disease? Maybe they just won't have any nephrologists in their network. and maybe their out-of-network paperwork will be 10x as complicated as it is now.


also a worry with this new bill: because subsidies don't kick in until 2014, it's possible that in a nightmare scenario, they could be dramatically cut or even eliminated before seeing the light of day. In the absence of any systemic reform, then, we face the unpleasant possibility that with a realignment of power in Washington, DC, we could end up with a mandate -- and fewer, or even no, subsidies.

My brother's insurance gives him X% off per month for joining a health/fitness club. I forget the exact numbers, but the money he gets off per month more than makes up for the cost of membership.

pulling this out - wouldn't this just be a kick in the fucking balls. dream scenario for the insurance companies too - a government requirement to buy their product, no incentive to lower cost, and no help for those who can't afford it.

Angry liberals: Why didn't Obama fight? - - POLITICO.com

This sums up the situation well.

Especially this bit of wishful thinking:

Dean said there are some good elements in the bill, but lawmakers should pull the plug and revisit the issue in Obama’s second term, unless Democrats are willing to shortcut a GOP filibuster. “No one will think this is health care reform. This is not even insurance reform,” he said.

It's not a given Obama will have a second term! You take what you can get, because you will never come this far again!

Is that the same thing as those supporting the passage of the bill only because it will give brownie points to the Democrats in hoping that the Republicans don't realize any gain in 2010?

I swear, some of the comments I have read (not here, per se) is all about making their party look good at the expense of making the enemy party look bad. That's why it's funny to see the many partisans trying to debate this (when it doesn't really affect most of them) while trying not to say it's all about political power and self-esteem.

It's not anecdotal evidence. It's actuarial science.. you know the type of work that would be done to figure out what healthcare costs will be. Maybe everyone won't abuse the system, but if you don't think that people know how to utilize their health insurance to best serve them then you need to start over. It's not even worth debating, it's reality.

Sure if you want to qualify your statement with "everyone" it's not true. For someone as bright as you are, you are pretty out of touch with how people behave.

I'll be honest. I have no idea where the military can cut costs. I don't have any knowledge about how they spend the money or if it's appropriate. I assume that there are people (I'm guessing a small minority) who push for things to be handled correctly.

I also know nothing about the Veteran's Health Administration. I'm assuming they have something to do with Walter Reed, and if they do then they are a disgrace, not something that should be aspired to.

No, it means I've spent a week with them in WESTERN Europe and the standard of living pales in comparison to the people that live in my upper middle class neighborhood in eastern Connecticut. He's a brain surgeon, my neighbors are firemen and work on IT help desks.

Isn't that financial? Many employers are giving people money for taking part in wellness programs in the hope that this drives down their long term costs. The programs cost money though so it's mostly large employers.

I don't know many people in the insurance industry who wouldn't support preventative care being provided at no copay and no costs to members. The problem becomes that in the short term this drives costs UP and many employers aren't in a position to increase their costs in the short term especially since many industries experience enough turnover that it's a wasted investment.

This is the thing that gets me about this entire debate: The idea that the government will do a better job controlling costs then insurance companies is so wrong that it's painful. The human resources that the insurance companies are using to try and control costs are so much better then what the government would use they can't even be compared. Health care costs are out of control for a thousand reasons, the profits of insurance companies are a drop in the bucket.

The chart is impossible to make sense of, but it seems that in France the GPs make 1/3 what they make in the United States. Of course there are a ton of factors that come into play, but if you don't think that reducing what doctor's make will drive some talented people away from the field... I don't know what to tell you. Some people are motivated by the desire to help others and it won't matter, but plenty are motivated by material desires.