Enh. A healthcare reform bill will pass. It won’t have everything the progressives want, but the Republicans really can’t stop it either. And then down the road it’ll be tweaked. A lot of Americans without insurance will have it. A year from now this will be seen as a fairly clear win for Obama. A lot of the commentary that’s wrapped up in how ugly things have been the past few months are really missing the forest for the trees.
In 1994 after the bill didn’t pass the moderate Democrats got slaughtered. What’s your evidence that their position will be improved be holding off popular things like the public option?
This.
With the emphasis that * = all Americans. The mandate will be in play, and even Olympia Snowe, a Republican, is pushing for subsidies to cover 400% above the poverty line, which is 100% more than even Baucus’ plan calls for. Which means we’ll get the mandate and universal coverage (the absolute most important parts of the bill), and low income people won’t be completely screwed by the mandate (people are saying that subsidies may end up being a compromise of 350% above poverty). The public option probably won’t exist, or will exist as a trigger, or the pretty much useless compromise of co-ops, but that’s a neglible omission outside the hyper-partisan world of 24-hour news cycles.
Universal coverage, the end of recission, regulation that restricts insurance companies from rejecting sick customers and only accepting healthy people that never access medical care… these things look very, very achievable right now. But the right will fight to destroy health care reform purely as a political tactic, so it’s definitely not over yet.
I’m guessing there is no evidence other than their fears. Are you asking me to defend them? I refuse to do that!
In other news, Baucus has caved on the public option, so it’s dead now.
Errrrrr…okay. So? That’s still a large segment of reforms that they simply cannot get through the reconciliation process without changing the rules. Reconciliation only lets you circumvent the filibuster with 51 votes for issues related to money and funding - it’s kind of a stretch from there to creating a new bureaucratic office, which is what they’d need to do a public option. Given the fact that it’s only about halfway effective for what they want and it makes them fully accountable for pretty much every budget deficit for the next ever, I still feel comfortable suggesting that any practical politician would regard that approach as the worst kind of bad idea.
I’ve only been following this as much as discussion of it has popped up in this forum, and some of the terms being thrown around confuse me.
This ‘public option’ that people are saying isn’t going to happen - What is that? Is that referring to free healthcare without insurance? If so, what the hell? If you’re not getting that, what is it that’s getting reformed?
The public option would be the option to have the government as your insurer instead of a private insurer. There are a great many ways that could be implemented - doesn’t necessarily mean free for a given user.
If you put that aside, there’s rewriting the regulations that govern the industry.
If you remove public options it basically looks like this so far:
- lowering medicare (old people) payments to doctors
- increasing medicaid coverage (state-based coverage, half of bill goes to federal government so states love it.)
- increasing coverage
- mandating insurance coverage by employers (possibly with exceptions for small businesses.) Unknown what would qualify as insurance, probably going to have a lot of ‘plans’ with maximum benefits of $2000 yearly or something…
- mandating individual coverage, or pay fines for people with incomes from $20k-$60k roughly $1000 a year. A bit more if you earn more.
- a bit more taxes to medical device makers, drug companies, labs, all of which should expect nice fat profits next year. I should go see if I can have some money to invest.
OH YEAH, and they remove any talk of death-panels whatsoever. Medicare will no longer reimburse a doctor for discussing end-of-care options with a patient.
I love CAP’s argument. Shouldn’t they note that Republicans removed ANWR from Reconciliation protection b/c it was so contentious? That the end result was ANWR was filibustered successfully? So what they’re saying is that some R’s tried to use reconcilation in 2005. But it failed b/c it was such a hostile move. Dems then successfully filibustered ANWR drilling under Senate rules. So CAP can call Gregg a hypocrite if they want. But the ANWR comparison just shows how damaging trying to pass anything under reconciliation rules is.
CAP says “As ThinkProgress has noted, Gregg defended using the reconciliation procedure to open the Arctic National Wildlife Refuge for domestic drilling in 2005, arguing, “The president asked for it, and we’re trying to do what the president asked for.” Evidently, Gregg has lost the same sense of patriotic duty.”
Sure. Doesn’t mean it won’t work for lots of things.
Given the fact that it’s only about halfway effective for what they want and it makes them fully accountable for pretty much every budget deficit for the next ever, I still feel comfortable suggesting that any practical politician would regard that approach as the worst kind of bad idea.
There’s evidence the public makes voting decisions based on deficits? Do tell.
If you want a short argument that painfully and clearly makes the point on the need for changes, go download and listen to the most recent This American Life, entitled “The Fine Print” or something similar. Skip to the piece on the Congressional committee interviewing insurance officials and their victims. In particular, one woman who testified to being diagnosed with advanced breast cancer. The hospital demands a $35,000 deposit before they will do the required surgery, and the insurance company digs to find a reason to deny her claim, and they end up using a dermatologist’s report that said she had acne. They claimed it could be interpreted to mean she had some kind of pre-existing cancerous growths. The dermatologist called the insurance company, told them he wrote it, it was acne, that was he said it was, and begged them to pay for her surgery. They refused, and the woman was forced to wait months while this advanced cancer spread through her body.
At the end of the piece, the Congressional committee asked the three insurance CEO’s if they would pledge to never again deny claims from someone who they had accepted and had paid their premiums, purely for non-fraudulent mistakes in their application, and all three said they would not make that pledge.
I’m not sure anyone is arguing there is no need for change. And insurance reform seems like one of the most likely aspects of healthcare reform to end up on the president’s desk. It’s one of the reasons republicans are suggesting tackling healthcare reform in a series of smaller bills, instead of one 1,300 page omnibus. Being able to pass insurance reform on its own will make them look like winners to their core constituency, who already have insurance and will appreciate making it portable, non-revokable, etc.
Sounds like Obama heard the same show - he just cited that example in his speech. ;)
I’m curious why people who object to modeling our system on any of the other government-run or -supported systems do so. If we all agree, as NWJ says, that change is needed (and I’m not sure this is true - among the right-wing I’m sure there are some calling for status quo) why not adopt a proven model?
Because then those insurance company CEOs couldn’t afford another ivory back scratcher, do you want to deprive people of their hard earned ivory back scratchers? WON’T SOMEONE PLEASE THINK OF THE CEOs?!
In short, because solutions that work for other nations rarely, if ever translate to the United States. In general character, the nation distinguishes itself in being a lot more individualistic and generally conservative about policy than continental Europe, and our population is a lot more spread out, so just taking a model and trying to hammer it to fit the U.S. is arguably a worse solution than designing something from the ground up to be palatable to a broader majority of the population here. After all - those models are only proven to work for a social set with the same characteristics as those foreign nations that have implemented them. If folks in the United States behave differently, there’s no reason to expect equivalent levels of success.
Can you come up with some examples?
In general character, the nation distinguishes itself in being a lot more individualistic and generally conservative about policy than continental Europe, and our population is a lot more spread out,
What effect do you think these issues will have on the efficacy of other models?
so just taking a model and trying to hammer it to fit the U.S. is arguably a worse solution than designing something from the ground up to be palatable to a broader majority of the population here.
I’m unclear why “people won’t like it” translates to “it won’t work.”
After all - those models are only proven to work for a social set with the same characteristics as those foreign nations that have implemented them. If folks in the United States behave differently, there’s no reason to expect equivalent levels of success.
What would “behave differently” mean in this context? It seems awfully vague. Are there specific social behaviors that you can identify as having a potentially negative effect on a government run plan? Is there any particular reason to expect it’ll be worse than what’s happening now? Honestly, this argument just seems like misplaced nationalism to me. The US is somehow different, and therefore we shouldn’t even try anything that has worked for others.
I would like to believe that the poster behind her head says “HURR!!!”
Sarah Palin chimes in, still believes in “Death Panels”
My favorite part
“Is it any wonder that many of the sick and elderly are concerned that the Democrats’ proposals will ultimately lead to rationing of their health care by – dare I say it – death panels?” she writes. “Establishment voices dismissed that phrase, but it rang true for many Americans.”
People believed my lie! Some people said my lie was untrue, but look at how many senior citizens I tricked into believing something that is untrue! That’s gotta be worth something right?
Most environmental proposals, as an example, fail to consider the breadth and scope of the United States economy. Mass transit proposals have routinely failed to take into account the general American preference for being in total control of your own movement.
I can’t speak with absolute certainty with respect to health care, since I wouldn’t consider myself any kind of a scholar on the subject (my exposure to this sort of thing comes from watching ten years of light rail debacle in Austin and Houston and the renewable energy topic my junior year of high school debate), but I’m just guessing that the demographic differences between your average European state and the United States are going to have some implications. Our nation probably has different endemic health risks than Sweden or Great Britain as well. While I wouldn’t reject a plan that has been implemented elsewhere offhand just because it’s foreign, I also wouldn’t assign it a lot of merit at the outset just because it worked for a group of people who are demographically distinct from the population for whom you’re trying to craft a plan - I would prefer to examine how well the model fits what it’s going to be trying to do in the United States. You also have the problem of entrenched industries in the United States that you can’t go disturbing if you don’t want to risk major economic upset. Europe has, for a long while now, evidenced a more controlled economy than the United States. Some of the assumptions that that situation allows you to make don’t necessarily hold across the pond.
A plan can only work for as long as it exists, and a plan can only exist for as long as people like it. Let’s say that a controversial plan gets rammed through with a big…ramming device or whatever would make the analogy sensical. Now you’ve got maybe forty percent of the United States cheesed off and actively rooting for the plan to fail. They’re not going to be treating it charitably, and you better damn well hope that the whole thing goes off without a hitch (this never happens; not ever - I may not have the longest history of project management, but every single thing that I’ve seen in the history I do have indicates to me that the only common thread you can be guaranteed to find between projects is unanticipated hardships and unexpected failures) or you’ll be out of a job and your new entitlement program will be shitcanned before you can say “midterm election.” Public buy-in to a program is incredibly important in that regard. The difference between a modern democracy and a dictatorship is that you can do that sort of thing in a dictatorship, but not a democracy. It’s also the reason why Aristotle eventually concluded that an enlightened dictatorship was the most superior form of government, but that’s not what you’re dealing with here, so you have to consider how accepting the population will be of the intervention you’re proposing when you try to figure out how effective a plan can possibly be. The United States is, in general, a lot more suspicious of government intrusion into any subject than any European state, which implies that selling any solution that worked over there may be simply impossible here.
What environmental proposals have we adopted from foreign countries? It seems to me that our track record is mostly filled with examples of rejecting foreign-led environmental proposals.
Mass transit proposals have routinely failed to take into account the general American preference for being in total control of your own movement.
Huh? Mass transit can and does work in this country - I take it every day. I’m not sure what this objection means. I also don’t think we’ve adopted foreign models here. The Boston T does fine, but I compare it to say, Madrid’s system and there’s no contest.
The rest of your objections I understand, but I again have to point out that they are very vague. I’m not sure why general demographic differences are going to have a significant effect on the nature of health care. Can we point out issues in our current health care system based on demographics? If so, we can probably make reasonable speculations about what would happen in a different system. If not, why are they going to make a difference in a different system if they don’t make a difference now?
In terms of the political issue - yeah, it could be unpopular. Unpopular proposals have been carried out to fruition before. I again don’t see that “people won’t like it, and the opposition will fight it” is a reason to not do anything. Democrats have tried that. It doesn’t work. I’m frankly of the opinion that the current GOP returning to power is going to be disastrous regardless of what happens in the meantime, so I say let’s attempt to make some progress anyway.