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The Finance Committee's "Comprehensive Incrementalism"

ARCHIVEPH-WHITEHOUSE.jpg

The outline I was given today isn't the Finance Committee's final bill. It's not even necessarily the Chairman's Mark (the bill that will go to the rest of the committee for debate, changes, and modifications). But it's the clearest look at what Finance -- the key committee for health-care reform -- is currently considering.

You could write this story a couple of different ways. The first is to note is the Finance Committee has substantially retreated in the face of the $1.6 trillion price tag the Congressional Budget Office affixed to its original submission. This version of the plan is, comparatively, quite diminished.

The numbers tell the story. In that plan, subsidies reached 400 percent of poverty. In this plan, they've been cut to 300 percent. In that plan, Medicaid eligibility was as high as 150 percent of the poverty line. In this plan, it's 133 percent for pregnant women and children, and 100 percent for childless adults. In that plan, the "gold" coverage was 93 percent of a person's estimated expenses, and "bronze" coverage was 68 percent. In this plan, those numbers are 90 percent and 65 percent, respectively. That means people with a low-cost plan might be covered for only 65 percent of what they're likely to need.

Another way of looking at the plan is that it remains a significant step forward. Subsidies to 400 percent of poverty would be nice, but subsidies to 300 percent of poverty are far beyond anything we offer now. Coverage that protects against 65 percent of anticipated costs is better than no coverage at all. The co-op idea isn't a public plan, but with federal seed money to start new co-ops, it's a good idea on its own merits. There's an individual mandate, state-based health insurance exchanges, and a substantial health and wellness initiative. Insurers are barred from discriminating based on health history and Medicaid is sharply expanded.

People frequently refer to the goal of health-care reform as "comprehensive reform." But this is what I'd term "comprehensive incrementalism." It makes everything a bit better. It is not radical. It is not root-and-branch reform. For all the concerns about cost, there is no strong public plan able to negotiate low rates and implement aggressive reforms. The health insurance exchanges are a step forward, but they're state-based, and there's even room for multiple competing exchanges in a single state. They could be made substantially stronger. Revenue sources are not discussed in this draft, but it's clear that the employer tax exclusion -- which is to say, the employer-based system -- is preserved, and there's even an attempt to "grandfather" existing insurance arrangements from the individual market.

It is one of the paradoxes of the legislative process that something that is substantively quite timid can also be quite bold. This version of health reform is far from what the country needs. It is far from what any health-care experts would develop left to their own devices. But it is still a monumental initiative and, if passed, it would be the most significant step forward since the creation of Medicare and Medicaid.

It is also worth remembering, however, that this bill has not been merged with the more liberal legislation being considered by Sen. Ted Kennedy's HELP Committee. Nor has it been reconciled with the legislation being driven through the House of Representatives, which Speaker Pelosi promises will feature a strong public plan. And most importantly, the White House has not forcefully stepped in with its priorities and preferences. Health care reform still has a long road to travel. This is just one snapshot that helps to illustrate how the landscape is changing along the way.

Photo credit: Marvin Joseph, The Washington Post

By Ezra Klein  |  June 18, 2009; 7:01 PM ET
Categories:  Health Reform  
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Next: Listen to the Polls

Comments

This is quite a plan. At least 1.6 trillion more in debt and fewer people covered. Great Plan! Then, we get taxed into poverty while the government and leftist extremists use our money to destroy health care providers under the lie of creating competition. Great plan!

Posted by: hkimcraig | June 18, 2009 7:21 PM | Report abuse

The plan as outlined would be a very hard sell politically. Requiring an individual mandate unless premium costs (not total out of pocket if I'm reading it right) exceed 15 percent of income while subsidies are only available to people under 300 percent of the federal poverty level will leave a lot of people howling.

This is starting to look a lot like what happened in California. In order to move to guaranteed issue and community rating you need something close to an individual mandate. In order to make an individual mandate palatable, you need to subsidize coverage. That takes money, and a lot of it. A strong employer requirement helps significantly.

Massachusetts already had guaranteed issue
and community rating, so could leave a loophole for hardship without increasing premium costs. Mass also has a relatively small low-wage workforce, they started from a higher base of public health care subsidies, and they had a large outside source of funding, namely the federal government.

It's hard to see how something passes that the public will accept without the administration stepping in in a much stronger way than they have to date.

Posted by: kjacobs9 | June 18, 2009 7:24 PM | Report abuse

Come on Klein it is terrible. state exchanges = terrible. "bronze plans" = terrible. At some point this could be reform, but if Dem bring this back to their base and voters all proud they "reformed" health care they are going to suffer terrible loses.

if you make $31500 you wil get no subsidies and be forced to buy coverage. Your premiums alone run about 6000 (19% income), Add in co-pays, deductables, and an unfortunate out of network emergency room visit you could easily be spending over 25% of your income on health care.

Posted by: JonWa | June 18, 2009 7:33 PM | Report abuse

Ezra, I've tried to ask this in a hundred ways, but can't seem to get a response. I wish you would address this issue:

What the hell does "Insurers are barred from discriminating based on health history" mean?

If it means insurers can't deny insurance based on health status, but can charge whatever premium they want it is meaningless. And if they can't base premiums on health status, but can base them on age or other factors, it is equally meaningless.

One more thing here really sticks in my craw. People who are barely making ends meet and have coverage that only covers 65% of their health care costs might as well not have any coverage at all if they get seriously ill. To say that it is better than no coverage at all is preposterous.

Posted by: adagio847 | June 18, 2009 8:21 PM | Report abuse

I'm a big supporter of Obama, but he's pissing it away. The key is to trade insurance premiums, copays, deductibles, the 20% insurance doesn't pay, the amount OVER "usual, customary and reasonable" (whatever that is), bankruptcy, and Medicare payroll tax ----> for an income based tax (on Form 1040)plus a small national sales tax. That takes care of revenue. Note that it is not on the backs of business.

Then have a single-payer system. Cut the paperwork, dividends, 1,300 bureaucracies, executive salaries and bonuses, Lear jets, cherry-picking, etc. and cover everyone, from cradle to grave. That solves Medicare/Medicaid. Create a system.

It really isn't so hard.

All these hoops are unnecessary and a waste of time and resources.

Posted by: michael4 | June 18, 2009 8:41 PM | Report abuse

Obama's health reform is a new tax on the middle-class without benefit to them. Whatever happened to Obama's promise to make the rich pay their "fair share"? Oh yea, the rich don't pay income taxes only high wage earners do. Populist promises bamboozled a lot of middle-class Americans to support Obama's pie in the sky. All they've received is more debt to payoff Obama's big donators, and more taxes to payoff the most liberal base of the Democratic party.

Posted by: rpatoh | June 18, 2009 8:43 PM | Report abuse

The public should refuse to fund health care for the congress and senator, saying that only its too expensive to do so but these are corrupt institutions and are not entitled to this public largess.

Posted by: kevin1231 | June 18, 2009 8:49 PM | Report abuse

I don't think I could ever bring myself to vote for a Repulican, but is the DEMs offer a health care plan without a public plan, I will never again vote period.

Posted by: xargaw | June 18, 2009 9:00 PM | Report abuse

So, the status quo basically remains and the health care middlemen get richer by the day!! Ain't lobbyist great........

A Disgusted Independent

Posted by: aeaustin | June 18, 2009 9:00 PM | Report abuse

The American people need to do away with being controlled by industry lobbyists as bad as the Iranians need to ditch the Mullah's!

Both parties have sold out the American people.......

A Disgusted Independent

Posted by: aeaustin | June 18, 2009 9:06 PM | Report abuse

This is non-comprehensive incrementalism that whistles past the graveyard of healthcare reform, and is really just government acceptance of corporate dominance and control of our lives.

Obama's team badly miscalculated: setting a one trillion cost limit over 10 years; leaving the Congress to work its weak will; refusal to use hard words to describe the massive failure that the private insurers have brought us; throwing out those with incomes below some riduclous limit to fend for themselves; compromising in advance with GOPers who will end up opposing any plan.

So, we'll spend $100 billion a year (less than we spend on Iraq/Afghanistan) and still have a system that denies healthcare to millions of citizens that can't afford 15% of their low income to be spent on a plan that will be filled with exceptions, co-pays, denials of coverage, and other horrors. Dying of or being disabled by an untreated disease because we were kow-towing to a political group that has opposed every attempt at better solutions for every American is the ultimate in torture. Even a animal receives at least a humane death, but our citizens must suffer to a very bitter end because the corporate dictators must have their multi-million bonuses, salaries above any conscionable, and vacation houses, yachts, and luxuries of every kind.

We are a very sick society, and not just of medical illness.

Posted by: JimPortlandOR | June 18, 2009 9:09 PM | Report abuse

By getting healthcare insurance off the backs of business, prices could be reduced with no loss of profit (in general). That would make us more competitive with the rest of the world.

Posted by: michael4 | June 18, 2009 9:13 PM | Report abuse

I believe that the White House is muddling with something they know little to nothing about, and trying to rush a bad policy through before the public knows what hit them!

A survey by the Physicians' Foundation has uncovered what it calls widespread frustration and concern among primary care physicians nationwide, which could lead to a dramatic decrease in practicing doctors in the near future. The survey examined the causes behind the doctors' dissatisfaction, the state of their practices and the future of care.

The resulting findings show the possibility of significantly decreased access for Americans in the years ahead, as many doctors are forced to reduce the number of patients they see or quit the practice of medicine outright.

An overwhelming majority -- 78 percent -- of physicians believe that there is an existing shortage of primary care doctors in the United States today. Additionally, nearly half of them -- 49 percent, or more than 150,000 practicing doctors-- say that over the next three years they plan to reduce the number of patients they see or stop practicing entirely.

"Going into this project we generally knew about the shortage of physicians; what we didn't know is how much worse it could get over the next few years," said Lou Goodman, PhD, President of The Physicians' Foundation. "The bottom line is that the person you've known as your family doctor could be getting ready to disappear -- and there might not be a replacement."

To test the above, I have asked my local physicians their plans. The answers were shocking: one is planning on leaving practice and start operating equipment for other physicians -- to rid himself of mal practice insurance, and bureaucratic paper work from the government. Another one is looking into leaving his medical practice for 'moral reasons' if 'Obama Care' comes about. He reminded me that a physician's first obligation is "to do no harm'. None that I spoke to are recommending the medical profession to young students due to government interference; bureaucracy; possible use of a board of bureaucrats to determine cost effective treatment; and the lack of TORT reform from the politicians -- many of whom are lawyers.

My sensing is that Obama is already having an 'unintended consequence' on our health care system: A SHORTAGE OF PHYSICIANS!! Now that is change we will believe in within a few years!!


ASK YOUR OWN PHYSICIANS THEIR PLANS, AND THEIR MOTIVATIONS!! YOU ARE GOING TO BE SHOCKED AT WHAT YOU FIND!!

Look at our medical schools!! Are they filled? If not, why not???

What is shocking to me is the TOTAL LACK OF HOMEWORK BY OUR ELECTED OFFICIALS -- FROM THE WHITE HOUSE TO THE CONGRESS!! PATHETIC!

Concerned? Call Sen Baucus’ office:

Committee On Finance
219 Dirksen Senate Office Building
Washington, DC 20510-6200
(202) 224-4515

Posted by: wheeljc | June 18, 2009 9:18 PM | Report abuse

Three trillion in tax cuts for the wealthiest top one percent of Americans, trillions spent on a war for profit, trillions more to bailout Wall Street.

Heck, Dick Cheney told Americans deficits don’t matter. However, the truth is that deficits don’t matter when it profits the top one percent of Americans who own all the wealth, but when it comes to spending any money to benefit the public, deficits matter.

The American public must not be too big to fail.

If the Democratic majority can’t end profit driven private insurance that manages to pay hundreds of millions to CEOs while denying health care to those who need it the most, or at least offer a nonprofit national public health insurance, they are useless and need to get tossed out. Who does this to their people? I know --corrupt governments.


Posted by: sandyfeet | June 18, 2009 9:19 PM | Report abuse

This represents a monumental failure by elected officials to understand what they are supposed to be doing. We don't need more for-profit insurance for anyone.

These people are have so much invested in their own gold-plated insurance plan, they are blind to the fact the escalating costs they want to control are in fact a product of the for-profit model they insist on perpetuating.

What they present to the full committee or elsewhere is largely irrelevant because it has nothing to do with what the public wants. No mater how much they talk among themselves, they will be no public support and they will have to start over.

We've had 50+ years of incrementalism down the wrong road. What we need now is *reform*...Single Payer

Posted by: Athena_news | June 18, 2009 9:24 PM | Report abuse

Of course the richest Americans and greedy glutenous corporations don't pay taxes.

Only the unwashed masses pay taxes. You know, the bottom ninety percent of American wage earners whose incomes have been stagnate for decades. Soon enough, the bottom ninety percent will no longer be able to pay the premiums to the for profit health insurance firms, and, I suppose, those firms will be looking for a taxpayer bailout

Posted by: sandyfeet | June 18, 2009 9:34 PM | Report abuse

Contact your congressman and ask where the heck the public plan is!!!

Posted by: griffpen | June 18, 2009 9:46 PM | Report abuse

I don't usually comment, but when the Washington Post puts an analysis on its homepage, I expect it to be credible. This however, isn't.

I don't mean to be rude, but what credentials does this author have to analyze "Economic and Domestic Policy, and lots of it" aside from being a political junkie like most of DC? He's been a pundit, and somehow that makes him qualified?

This blog demonstrates no understanding of economic policy, whatsoever. I actually agree with with the author that healthcare reform is important. But what intelligent commentary does this blog actually bringing to this debate? Where is a cost benefit analysis? Where is a discussion of the fiscal implications of this? What are going to be the effects on the insurance markets? Is this legislation actually going reform the health care market and stem the rising costs of healthcare?

At the very least, the author could point to other authorities who have written on the subject and synthesize their views. Instead, he gives us "his own take," which is no more valuable than watercooler commentary.

In a nutshell, not only does the author not understand the economics of what he writes about, he's too lazy to actually put in the work to learn -- and to help his readers learn -- from other credible sources out there.

If the Washington Post is going to put a link to an analysis on its homepage, shouldn't it be substantive? Shouldn't it add something to the debate? Shouldn't it educate readers, and not waste their time?

How about the Washington Post gets someone with some actual economic credentials and know-how to write their blog titled "Economic and Domestic Policy, and Lots of It", and have Mr. Klein stick to his reporting on food?

Posted by: postreader35 | June 18, 2009 10:01 PM | Report abuse

JimPortlandOR has it exactly right and griffpen suggests the correct strategy to win. If the 75% of Americans who support a public health insurance plan option took a little bit of time to get active on that point, then we'd probably get what we need to really start to reform the system. If they don't, then we will not. It's a very simple calculus. A million people got to D.C. to have a party when Obama was elected. If we can't get numbers similar to that to make calls, march on cities and talk to their neighbors about getting a strong public health insurance plan option, it's game over. And we'll have deserved what we get.

Posted by: eRobin1 | June 18, 2009 10:05 PM | Report abuse

I read the proposal and the AHIP proposal and they are nearly indentical. In fact besides the Co-op, the AHIP is in fact slightly better. The AHIP is more generous with subsidies and Medicaid Eligibility.

To say this bill was written by industry lobbyist would be an insult to lobbyist. Even they are not this cruel.

http://jwalkerreport.blogspot.com/2009/06/baucuss-health-care-plan-is-worse-than.html

Posted by: JonWa | June 18, 2009 10:11 PM | Report abuse

Obama, despite his frequent recent talk about the need for health care reform is not showing strong leadership on this issue. He should be stating, true to his principles as enunciated as a candidate, what is acceptable and unacceptable to him in an ultimate health care bill.

Many Democrats in the Senate seem as determined to sell-out to the private health insurance companies at the expense of the people of this country, as Republicans. For Obama to abandon his support for a government run health care plan and/or renege on campaign promises not to raise taxes on people making less than $250,000, allow an individual mandate with inadequate subsidies, indexed to inflation,
would demonstrate not only weak leadership skills, but a health care bill, that is regressive in financing and quite inadequate.

Pelosi and progressives in the House need to stand their ground, insisting upon true health care reform, not a surrender to the greed of corporate interests and conservatives seeking universal health care on the backs of older people and the middle class.

Posted by: Aprogressiveindependent | June 18, 2009 10:16 PM | Report abuse

http://www.cnsnews.com/public/content/article.aspx?RsrcID=49625

Posted by: EdRuff | June 18, 2009 10:17 PM | Report abuse

postreader 35, you are way off base. Ezra Klein IS an authority on health care issues. He has the credentials and he's done his homework. He is the best example I know of a blogger who does real reporting - actually reading reports, talking to policy makers and going to hearings. To call him lazy is completely ignorant. I don't always agree with everything he says, but I've learned more about health care reform from reading this blog than anywhere else. He has often addressed at length every single aspect of the issue that you specifically mentioned. YOU need to do your homework before you write an attack like that.

Posted by: adagio847 | June 18, 2009 10:22 PM | Report abuse

No, Ezra, something "timid cannot be quite bold". They are contradictions in terms and contradictions in reality.

What is being described adds complexity upon complexity with no real relief. "Health Insurance Exchanges" especially on a state level sounds like a recipe for disaster and chaos. Navigating through the chaos of insurance is already difficult. Why add more complexity. The "regulations" requiring insurers to comply with laws regarding pre-existing conditions are toothless and farcical.

BTW, why not get a real progressive blogger with life experience and economic creds rather than Klein who graduated from UCLA summer school in '05; unless you are only seeking a faux progressive voice.

Posted by: ophelia3 | June 18, 2009 10:31 PM | Report abuse

Ezra, you've lost your usual good sense in these matters.

The COOPs are doomed to fail in the plan powerpoint you linked to - borrowed risk cap, but must meet mutual insurer standards, with no network and no brand in the market?? And all their business plans must be approved by HHS? That's the worst placeholder for a public plan ever.

Just ask around and see if anyone really wants that start up job, and whether anyone thinks it will gain market share. AHIP will crush them slowly.

Why not allow the COOPs to use the Medicare network at 110% of Medicare rates?

Posted by: eunomia | June 18, 2009 10:33 PM | Report abuse

Welcome to the corporate state and senate. Hey, I think there is word for that.

Obama was not my first choice amongts a number of choices. Most of what I feared about him, and many of his critics said , proves to be true. He has little spine. The senate is courrupt and should relinguish their healthcare. I never will vote for another senator for president unless they have shown real leadership and courage and accomplishment somewhere before.

He is not a leader and refuses to truly use his bully pulpit! With the exception of Wall Street baliouts, we will see little bold out of this guy if it is a heavy lift. GM was done by Wall Street no nothing types.

His tax and student financing plans are somewhat bold but we have not heard anything more about that because I am sure Wall Street told him we do not want that and you do what we want. Ok,I will screw the people instead.

He wants to have everyone get along to the expense of effective or meaningul policy. The only time he acts tough or is unswayed is when he is protecting Wall Street from real reform or having them be meaningful and useful to a real economy. He beats back the popular will everytime without batting an eye.

He appears to be a corporatist out of the Milton Friedman school but played at being a populist to get votes. Even more cynically, he appears to have used his mama's suffering and death to show a fake committment to health care reform.

He does not want to offend his friends in the Senate. He rather offend Americans than do a heavy lift and go against anybody that he actually has to see more than once or twice.

Mr. compromise and middle of the road. Often that is ineffective but it makes us feel good. Our congress lives in an ivory tower.

Mr. President, you could have all opponents to a real good and affordable public plan to cover everyone running for cover if you chose too, but you rather get along.

Posted by: labear | June 18, 2009 10:51 PM | Report abuse

Come on folks, save the hysteria for when you know a lot more about the details. This is a trial balloon in many ways. There are many hurdles to overcome before a final bill is passed. And as one commenter pointed out, there must be resolution among the House and Senate HELP plans which are much more generous.

However, no matter what we end up with, it does have to get CBO scoring that makes it financially feasible. So there will be sacrifices and compromises by everyone. Health care reform has failed before because people insisted on having everything at once. People are desperate out there and we need to push to get the best thing we can, but not freak out if it isn't exactly what we thought was best. I am very worried by the tenor of these comments. A lot of wringing of hands, not much discussion of alternatives. So, big shots -- what would YOU do if you knew what these guys know about the cost of this? How would you balance all the competing demands?

Posted by: LindaB1 | June 18, 2009 10:52 PM | Report abuse

Let's stop wasting money on health care. Geez, since the Iraq War has only cost a trillion bucks, why not another war? Death, not health! This message has been brought to you by the American Corporate Party, proud owners of the Dems & the GOP.

Posted by: allen11 | June 18, 2009 11:03 PM | Report abuse

Ezra, please give up your healthcare coverage if you think 65% coverage is anything. BTW, I am still awaiting the Post's analysis of single payer or any other countries health systems compare to the US.

The plan 20% of your salary to healtcare is a a boondoggle for private insurance and a rip off of people. This plan does nothing to help Americans or make the country healtheir, care more affordable, or more competitive with countries with national healthcare plans.

I guess the US people are just weak sheep now. The senate knows who matters and it is not the US people and they know the people will not protest, march, or do anything but pretend.

Posted by: labear | June 18, 2009 11:03 PM | Report abuse

Pay for it by pulling out of Iraq and Afghanistan. Take half of that money and do what the BRIG nations are smartly doing, offering resources andd building something in Afghanistan. Guess who will look like the bad guys while they look good.

Most of our far flung military prescense and spending could be scaled back. Have an industrial policy and business bank instead of making Wall Street gamblers 100% whole on their most speculative and gambling instruments.


Posted by: labear | June 18, 2009 11:09 PM | Report abuse

Its DOA : Dead On Arrival.

There is no middle ground. Get behind HR 676 or get out of the way.

As in "in 2012" - get out of the way.
We are Legion.

Posted by: redbeard | June 18, 2009 11:11 PM | Report abuse

In Canada, I heard a women saying her health care plan from the government was not free. She was middle class but had to spend $ 48 ,Canadian, a month never to receive a medical bill for any medical treament.

Wow, that amount of money must be crippling. Our industries have to compete against that. Worker's comp is lower as is medical liability coverage.

Posted by: labear | June 18, 2009 11:15 PM | Report abuse

Why would we want to spend trillions of dollars to make insurance companies richer. This is ridiculous. I lived in the UK for six years and loved their National Health System. When are we going to stop pandering to special interests and do what is right for Americans. Insurance companies are not in business to make people well, they are in business to make money -- period. One's health should not be dependent on profit margins and bonuses for CEOs.

Posted by: dzinn1 | June 18, 2009 11:39 PM | Report abuse

The proposed "plan" is a joke, the co-op idea is the same, it's all to throw us under the bus in favor of their sugar daddies.

Polls show that at least 2/3 of the people want single payer but Washington no longer reflects what we as citizens want and need. Boss Tweed would be proud.

I'd like one of them to, with a straight face, tell me that for profit gatekeepers, the insurance companies, have our best interests as patients in mind.

If they pass this woefully inadequate bill they had better batten down the hatches, I think they all are still way underestimating the anger and/or desperation out here.It's not just poor people who are getting hurt badly, even fairly well off people might struggle with a $40,000 medical bill.

Also, do they not realize the burden our employer based care puts on companies here, since companies in other countries don't have to do that? Our system is insane and they just want to tinker with it? Please.

In a nutshell, the people are mad as Hell and they aren't going to take it much longer, they've been sold down the river too many times - and more and more of them are connecting the dots.

How to pay for it - raise the top tax rate back to 50% - nobody needs a gazillion dollars while other people are unnecessarily suffering and dying because of our ridiculous health care mess.

Posted by: Libgal239 | June 19, 2009 12:33 AM | Report abuse

Health care is a basic right. It's not like you can decide to never get sick. Congress needs to find a way to get everyone covered. Everyone at the table will have to give up a little. http://www.BenefitStudio.com

Posted by: BenefitStudio | June 19, 2009 12:34 AM | Report abuse

Well it looks like we are getting real health care reform all right. The kind that the health insurance industry loves. Everyone will be required to purchase health insurance even if they couldn't afford to. From what I read about this, it seems as if the Republicans are the majority party and not the Dems. It just seems like the Dems have no stomach for the fight. I understand why the Republicans are for this. They have their head up the arses of the health care lobbyist. It seems that the Dems have the same problem. Obama has got to get into the trenches to fight for us. He has to install a backbone into the Senate Dems. We all voted for "Change You Can believe In.". Now We want change. If the Dems and Obama give in to the Republicans on this matter,we all may just stay home when it's election time. It would prove that there is no difference between parties. I know I won't vote again.

Posted by: rankin_edward | June 19, 2009 12:49 AM | Report abuse

Ezra - The above comments raise a lot of good questions. Why doesn't the CBO score HR676? What do the for profit insurers give us for their hundreds of Billions in overhead and physician and patient compliance? Why hasn't the Post or any other newspaper examined why "single payer is not on the table" when the public supports it by 2 to 1?

Frankly, at this point, I hope that nothing gets done. What you talk about today is worse than nothing and will be harder to fix. Let's just sit back and let conditions deteriorate until public pressure is strong enough for something like HR676. I don't care; I have Medicare. (See I'm a poet and didn't know it.)

Posted by: lensch | June 19, 2009 12:51 AM | Report abuse

This is just a shell game - cowtowing to the insurance industry and to the "no new taxes" crowd. There are 350 million people in the country and if we don't have affordable insurance, there will be a country of uneducated, sick citizens, unable to work and unable to find work. This is the "sickest" plan I have ever seen. You have to pay 15% of your salary if you earn $32m. How much does that leave, after taxes for rent, food, etc. Working class people will be homeless and without health insurance. This is a farce.
I was 100% behind Obama but now realize the Democrats don't now or never have had the guts to stand up to the Republicans. I thought we won the election, yet the Republican's and the Corporations are still running the show.

Posted by: nualak | June 19, 2009 12:54 AM | Report abuse

AMERICA’S NATIONAL HEALTHCARE EMERGENCY!

It’s official. America and the World are now in a GLOBAL PANDEMIC. A World EPIDEMIC with potential catastrophic consequences for ALL of the American people. The first PANDEMIC in 41 years. And WE THE PEOPLE OF THE UNITED STATES will have to face this PANDEMIC with the 37th worst quality of healthcare in the developed World.

STAND READY AMERICA TO SEIZE CONTROL OF YOUR NATIONAL HEALTHCARE SYSTEM.

We spend over twice as much of our GDP on healthcare as any other country in the World. And Individual American spend about ten times as much out of pocket on healthcare as any other people in the World. All because of GREED! And the PRIVATE FOR PROFIT healthcare system in America.

And while all this is going on, some members of congress seem mostly concern about how to protect the corporate PROFITS! of our GREED DRIVEN, PRIVATE FOR PROFIT NATIONAL DISGRACE. A PRIVATE FOR PROFIT DISGRACE that is in fact, totally valueless to the public health. And a detriment to national security, public safety, and the public health.

Progressive democrats and others should stand firm in their demand for a robust public option for all Americans, with all of the minimum requirements progressive democrats demanded. If congress can not pass a robust public option with at least 51 votes and all robust minimum requirements, congress should immediately move to scrap healthcare reform and demand that President Obama declare a state of NATIONAL HEALTHCARE EMERGENCY! Seizing and replacing all PRIVATE FOR PROFIT health insurance plans with the immediate implementation of National Healthcare for all Americans under the provisions of HR676 (A Single-payer National Healthcare Plan For All).

Coverage can begin immediately through our current medicare system. With immediate expansion through recruitment of displaced workers from the canceled private sector insurance industry. Funding can also begin immediately by substitution of payroll deductions for private insurance plans with payroll deductions for the national healthcare plan. This is what the vast majority of the American people want. And this is what all objective experts unanimously agree would be the best, and most cost effective for the American people and our economy.

In Mexico on average people who received medical care for A-H1N1 (Swine Flu) with in 3 days survived. People who did not receive medical care until 7 days or more died. This has been the same results in the US. But 50 million Americans don’t even have any healthcare coverage. And at least 200 million of you with insurance could not get in to see your private insurance plans doctors in 2 or 3 days, even if your life depended on it. WHICH IT DOES!

Contact congress and your representatives NOW! AND SPREAD THE WORD!

God Bless You

Jacksmith – WORKING CLASS

Posted by: JackSmith1 | June 19, 2009 1:12 AM | Report abuse

Health care in this country is a mess. Public health expenditures within the U.S. government budget are roughly 7 percent of GDP. The tax financed expenditure to subsidize private insurance is 60 percent of the total expenditure, roughly 9% of GDP; however, the U.S. system leaves millions uninsured and under insured while the government spends more per person and has the worst health outcomes than other developed countries with national health insurance.

How do we pay for health care? Easy –remove profit driven private health insurance. Insurance is risk management and doesn’t respond to market forces like electronics and shoes. Insurance firms earn profits by limiting and eliminating risk. It is counterintuitive to have a private health insurance industry that doesn’t want to insure sick people or pay for care. It is cheaper for insurance firms to deny care and pay an attorney to argue its case than it is to pay for chemotherapy.

A national nonprofit health insurance plan that everyone pays into would spread risk, eliminate expensive administrative costs, remove profit, and give taxpayers leverage to negotiate pharmaceutical costs. It is the most economically sound choice, and it is the moral choice.

Posted by: sandyfeet | June 19, 2009 1:30 AM | Report abuse

There is a solution:

A new study shows that SINGLE-PAYER HEALTHCARE REFORM WOULD BE A MAJOR STIMULUS FOR THE US ECONOMY and would provide:

** 2.6 Million New Jobs,
** $317 Billion in Business Revenue,
** $100 Billion in Wages, and
** $44 Billion New Tax Revenues

The press release is here: http://www.calnurses.org/media-center/press-releases/2009/january/nurses-to-congress-expanding-medicare-could-reverse-job-losses-and-repair-our-broken-healthcare-system-and-safety-net.html

Here’s the study: http://www.calnurses.org/research/pdfs/ihsp_sp_economic_study_2009.pdf

See the YouTube clip (5 minutes) about how to pay for healthcare reform “HR676 - The Single Payer Solution, Part 4 of 4: http://www.youtube.com/watch?v=Nxi7DnCH3zk It’s about public financing and private delivery.

It’s clear that single-payer is the solution, not only in terms of providing quality care for all, but also economically!

Posted by: 4progress | June 19, 2009 1:38 AM | Report abuse

"In that plan, subsidies reached 400 percent of poverty. In this plan, they've been cut to 300 percent. In that plan, Medicaid eligibility was as high as 150 percent of the poverty line. In this plan, it's 133 percent for pregnant women and children, and 100 percent for childless adults. In that plan, the "gold" coverage was 93 percent of a person's estimated expenses, and "bronze" coverage was 68 percent. In this plan, those numbers are 90 percent and 65 percent, respectively. That means people with a low-cost plan might be covered for only 65 percent of what they're likely to need.

Another way of looking at the plan is that it remains a significant step forward. Subsidies to 400 percent of poverty would be nice, but subsidies to 300 percent of poverty are far beyond anything we offer now. Coverage that protects against 65 percent of anticipated costs is better than no coverage at all."


Kindly stop sucking up to your sources.

Fact: 97% of the uninsured have incomes below 400% of Federal Poverty Level

Fact: 90% of the uninsured have incomes below 300% Federal Poverty Level.

Fact: 299% Federal Poverty Level for a couple is $43,564 a year.

Fact: ONE (1) night in the cardiac ICU is $35,000. A broken leg wit surgery and 2-3 days in the hospital will blow past $60,000.

Fact: 35% of $35,000 is $12,250 which is 28.12% of the couple's income. 10% of $60,000 is $6000 or 13.7% of the couple's income.

Fact: Over 60% of the uninsured or under-insured skip filling prescriptions, do not see a doctor when they need care, do not get follow up care or skip tests that have been ordered because of the COST.

Fact: When deductibles exceed $500-1000, even those with coverage skip care at the same rate as the uninsured.

Fact: Unpaid medical bills get reported to credit agencies.

Fact: 59% of those who are uninsured or underinsured with unpaid medical bills have problems getting housing or employment because of credit checks.

Fact: No coverage or 65% coverage or even 90% coverage for those in the lower income groups have exactly the same result if they need medical care or have a chronic illness or a serious illness. All those options lead to BANKRUPTCY COURT!


Posted by: eabpmn | June 19, 2009 2:03 AM | Report abuse

I find it distressing that, as a nation, we're even considering forcing people to buy insurance from private companies. Since when did the constitution grant corporations the power of taxation? That's essentially what this is. If the "individual mandate" is part of this law, we'll (ultimately) be sending people to jail for refusing to give the insurance companies their pound of flesh.

Insurance is the problem, not the solution. Mandating insurance will undercut innovative strategies to deal with the health care problem that don't involve corporate insurance - which is, I suspect, the point.

Posted by: dblack2 | June 19, 2009 2:33 AM | Report abuse

Put Single Payer on the table and push everything else off. Seriously. You will feel our wrath come 2012 if you don't make this happen with the cherry set up we've given you with majorities in both houses of Congress.

Posted by: burp2 | June 19, 2009 4:13 AM | Report abuse

The "health care" industry (which profiteers on human sickness & misery by denying care to those who need it most) OWNS the key committee chairmen who are crafting this latest corporate giveaway.
Let me get this straight: I will be MANDATED, by law, to pay the profit-driven health insurance racket for their crappy product (which covers only 65% of my medical bills)?? These cretins in congress, along with their corporate sponsors, ought to be thrown to the dogs.
Despite the fact that a large majority of the population want a public option, and a slightly smaller majority favor single-payer, national health insurance, our voices are COMPLETELY ignored.
The Democrats are poised to blow this thing really badly, and they will deservedly lose power in 2010 and 2012. Democracy is dead... and as commenter aeaustin points out, we have our own mullahs right here in the good old USA, stifling the will of the people: industry lobbyists & their filthy money.

Posted by: pointy | June 19, 2009 4:16 AM | Report abuse

The finance committee has a once in a century chance to attack all of the insidious costs for healthcare and moving them into a national VAT. This would fund healthcare partially through taxes on imports and go a long way towards evening the playing field for international trade. US manufacturers could no longer avoid paying for healthcare by outsourcing jobs.

Here are some of those insidious costs per employee each year and rising rapidly:

Municipal hosital deficits due to uninsured or underinsured patients -- $1,000 in property and sales taxes. Medicaid -- $1,500 in state taxes and another $1,500 in Federal taxes. Cost of medical expenses for current and retired state and local government employees including teachers -- ? thousands of dollars.

Here are some of the results of this medical expense financial squeeze at the local and state level: The cost of in-state college tuition is being rapidly beyond the reach of the middle class and is expected to double over the next few years. Primary education is being cut to the bone with no funds available to increase teacher pay. Increased state and local taxes on businesses making them less competitive.

Then, of course we have the employer and employee costs for Medicare, workman's comp and health insurance which exceeds $15,000 per family. One result -- the tendency for businesses to lay off workers over 50 to minimize group health insurance costs. The average "retirement" age has dropped from 67 in 1950 to 62 in 2000. Those pushed out of the work place early will contribute less towards the health care system and will drag on it more and earlier.

Those who would rail against a VAT should consider the hidden costs of our existing system described above. By taxing imports with a VAT we would also reduce our balance of payments deficit and thereby divert more worker purchases back into our own economy.

We have both a medical and competitive economic problem and the Finance committee should address both.

Posted by: microsrfr | June 19, 2009 5:19 AM | Report abuse

Why is the White House using Charlie Gibson to sell Obama's health care proposal? Is it another ploy that Gibbs can use -- claiming that what Gibson pitches "is not the president's"? Is the teleprompter broken? Obama is showing VERY LITTLE LEADERSHIP on his centerpiece legislation, and it is probably a blessing for the population of the US!!

Posted by: wheeljc | June 19, 2009 5:42 AM | Report abuse

Yikes. This looks like a watered down version of the Baker-Daschle-Dole plan. That plan also is based on state exchanges, which would take years to implement. But it addresses the premium limit matter, not just guaranteed issue (allows a max 5:1 age band ratio), which this does not. It goes up to 400% of poverty for subsidy and provides much higher than 65% coverage for a lower tier plan. If what is described here is the best we can do, it may not be worth it. By the way, according the the Baker-Daschle-Dole narrative, administrative, underwriting, and marketing costs for non-group plans are 40%. In other words, only 60% goes for health care.

Posted by: Jaywalker2008 | June 19, 2009 5:55 AM | Report abuse

If you liked Medicare Part D, you'll love this plan.

Like the Medicare drug bill, this bill not only fails to control healthcare hyperinflation, it subsidizes it.

Like the Medicare drug bill, it expands coverage while acquiescing in the shameful denial of coverage to millions of Americans. Is healthcare a right or isn't it?

Like the Medicare drug bill, it the bill preferred by the very private interests that have corrupted our healthcare system to the point where insurance executives can tell Congress "we will continue to arbitrarily and unjustly rescind coverage" without fear of a legislative response.

I understand what Ezra is saying about incrementalism, but this bill would be a massive failure by any measure. If the Big Healthcare and Big Pharma can push through this bill, even in the face of overwhelming popular support for a public option, then this will be a very dark day in our democracy.

Posted by: cassidyt | June 19, 2009 6:27 AM | Report abuse

The problem that I most see about health care is that many of us have great insurance and are not motivated to help others without it. We have to get up off our butts and speak up, even if WE have good health care. Others are counting on us and it can be done. Wouldn't you rather see our country advance medicine and care of the individual; instead of weapons and death?? Cut the weapons budget and give people good health care! Most people would rather work in health care than to make death ray machines and bombs!

Posted by: maymet | June 19, 2009 6:36 AM | Report abuse

No meaningful health care reform will occur that actually meets the needs not only of those "uninsured" but those of us who are laughingly insured.
The ruling elite of whatever party are bought and sold by the lobbyists for the insurance and pharma "industries." That is not changing so neither with health insurance ripoffs. Subsidies for that industry are what will rule the day.
Until Americans are protesting in the streets, as in the civil rights march days, we'll only get the sops from the table.

Posted by: RBShea | June 19, 2009 6:50 AM | Report abuse

Has anyone seen Dick Cheney or Bush and Obama together at the same time in the same place? Are we sure the Obama we see before us now is not Bush wearing an Obama mask? Where is the Obama we voted for in November? Has that Obama been kidnapped and is he being held somewhere in an unknown location, like one of the black hole prisons the Bushies created? Is that the explanation for this tragic about face and betrayal of the poor who voted for him?

Posted by: skylark1 | June 19, 2009 7:13 AM | Report abuse

Let congress give us the opportunity to buy into the same health care they and their families have. Anything less is elitist, it is the privileged congress people saying to the little peons below them, we deserve more while you get less. Nothing less than a public option is true health care reform.

Posted by: tinyjab40 | June 19, 2009 7:30 AM | Report abuse

Where is the CBO calculation for Fraud- ?

2009-The Wall Street Journal reported that Richard Scott, "the former chief executive of HCA Inc," had formed the non-profit organization Conservatives for Patients' Rights as part of a "lobbying campaign to derail or modify" President Obama's health care proposals, but failed to note Scott was terminated from HCA in 1997 amid a federal investigation into the company's Medicare billing, physician recruiting, and home-care practices...

This is just what was settled- under BUSH by the way- not the true robbery of our HEALTHCARE.

Did CBO calculate this:

JUNE 26, 2003; WWW.USDOJ.GOV;
HCA Inc. (formerly known as Columbia/HCA and HCA - The Healthcare Company)
LARGEST HEALTH CARE FRAUD CASE IN U.S. HISTORY SETTLED

IF so, where and when?

CBO- calculate the cost for ignoring the largest cost to our healthcare system-Fraud!

Fraud - government ignores-turns a blind eye- over 20 years!

Senator Grassley has tried to prevent fraud- to no avail.

AG Holder addressed this at the hearing, but it was LTC / Medicare- Fraud.

AG should explain why a settlement is offered for thieves - Rick Scott and friends at HCA- a perfect example.

Maybe if Rick Scott was prosecuted for his fraud he would not be allowed on CNN as the expert for our healthcare. CNN should be ashamed

HCA Inc -LARGEST HEALTH CARE FRAUD CASE IN U.S. HISTORY SETTLED in 2003-

It did not end here either- the fraud continued - In 2002 FBI raided the offices of National Century Financial Enterprises in Dublin, Ohio

“This case is one of the largest corporate fraud investigations involving a privately held company headquartered in small town America,” said Assistant Director Kenneth W. Kaiser of the FBI Criminal Investigative Division.

Guess where ALL of those Columbia/HCA Healthcare Corp. - home-care units were?

National Century Financial Enterprises- the "...largest corporate fraud investigations involving a privately held company headquartered in small town America,”


Posted by: sasha2008 | June 19, 2009 7:57 AM | Report abuse

Explain why this is occurring?

Gallup poll
Have Ailments, Will Travel


Medical travel, categorized as inbound (from other countries to the U.S.) and outbound (to other countries from the U.S.), was originally a luxury afforded to the rich -- particularly those inbound to the United States and European countries for treatment at world-class facilities. Yet the increasing cost of medical care in the United States and large numbers of uninsured (at least 48 million people, according to the Kaiser Commission on Medicaid and the Uninsured) may be making outbound travel an option worth considering.


Gallup finds that sizable proportions of Americans would "consider traveling outside the United States for treatment in a foreign country" for a variety of procedures and medical treatments. Twenty-nine percent of respondents would consider traveling out of the U.S. for alternative medical treatments for a major medical problem, and 24% would seek cancer diagnosis and treatment abroad. Americans are less likely to say they would consider traveling abroad for orthopedic procedures (15%), heart treatment (14%), or elective cosmetic surgery (10%).


Can't Pass Up a Good Bargain


The poll of 5,050 U.S. adults involved a split-sample experiment, in which one random half-sample was asked the "direct" question, reported above, on whether they would consider treatment abroad. The second half was asked whether they would consider treatment abroad, assuming "the quality was the same and the costs significantly cheaper." Given this additional phrasing, the percentage saying they would consider medical treatment outside U.S. borders increased by 12 percentage points, on average.

Posted by: sasha2008 | June 19, 2009 8:01 AM | Report abuse

"If you liked Medicare Part D, you'll love this plan."

That was always my biggest fear from the start - that we'd end up Part D'ing the whole system.

Posted by: eRobin1 | June 19, 2009 8:16 AM | Report abuse

Remember Swift Boat- ?

How many of you really believed the Swift Boat Commercials?

Many believed John O'Neill and the swift boaters were ridiculous. But their attacks worked. And so will these if we take it for granted that Americans will automatically recognize a thief and a liar when they see one.
Five years later- enter Rick Scott

2009-The Wall Street Journal reported that Richard Scott, "the former chief executive of HCA Inc," had formed the non-profit organization Conservatives for Patients' Rights as part of a "lobbying campaign to derail or modify" President Obama's health care proposals, but failed to note Scott was terminated from HCA in 1997 amid a federal investigation into the company's Medicare billing, physician recruiting, and home-care practices...

JUNE 26, 2003; WWW.USDOJ.GOV;
HCA Inc. (formerly known as Columbia/HCA and HCA - The Healthcare Company)
LARGEST HEALTH CARE FRAUD CASE IN U.S. HISTORY SETTLED

Why was there a settlement and not prison? Funny- this was the TOO BIG TO FAIL company- largest healthcare company in our country!

What a joke the American People are!

Now- this same CEO who committed fraud-is on CNN speaking as a Health Expert. CNN- SHAME ON YOU !!! Payback for his advertising dollars?

Funny- we hear all about England and how bad England is....

Wonder why? HCA Inc-LARGEST HEALTH CARE FRAUD CASE IN U.S. HISTORY SETTLED

HCA International
2008- 242 Marylebone Road London, NW1 6JL
Welcome to London's leading private hospitals
We are recognised by all major medical insurance companies.
* The HCA Quality Report 2007
Why we are London's No. 1 private hospital group
• More than 3,000 top London and UK specialists in private practice
• Most comprehensive access to the very latest drugs and medical technology.
• Centres of Excellence in acute medical areas such as cancer, cardiac and neurology
• More clinics and hospitals in London - and more private intensive care beds
• We exceed national standards for cleanliness and treatment outcomes
• Award-winning partnerships with leading NHS hospital trusts
• More than 200,000 patients treated every year
• The hospitals of choice for acute and tertiary medical care in London


One of Scott's new enterprises is financially connected to FoxNetworks.
Scott now resides in Naples, Fla. In addition to his newfound public policy voice for Conservatives for Patient Rights, he is the founder of America’s Health Network (now a subsidiary of Fox Networks) and the chairman/CEO of Solantic, a chain of 23 freestanding urgent care facilities.

Posted by: sasha2008 | June 19, 2009 8:18 AM | Report abuse

RICK SCOTT: But, you know, we were the biggest company. If you go back and look at the hospital industry, and the whole health care industry since the mid-1990s, it was basically constantly going through investigations. Great institutions, like ours, paid fines. It was too bad.
http://washingtonindependent.com/36636/rick-scott-on-his-health-care-record

THURSDAY, JUNE 26, 2003; WWW.USDOJ.GOV;
HCA Inc. (formerly known as Columbia/HCA and HCA - The Healthcare Company)
LARGEST HEALTH CARE FRAUD CASE IN U.S. HISTORY SETTLED

July 26, 1997, Los Angeles Times article:
A controversial deal maker whose hard-nosed business tactics have reshaped the medical industry was terminated as scandal engulfed the vast hospital empire he had assembled over the last decade.
Richard Scott -

Remember GW Bush's Texas Rangers ex-partner Richard Rainwater?

Columbia/HCA is a partnership of financier Richard Rainwater of Ft. Worth and lawyer Richard Scott. Scott was recently terminated by Darla Moore, the wife of Richard Rainwater and according to Fortune Magazine, the "Toughest Babe in the Business".

In 2002 FBI raided the offices of National Century Financial Enterprises in Dublin, Ohio
“This case is one of the largest corporate fraud investigations involving a privately held company headquartered in small town America,” said Assistant Director Kenneth W. Kaiser of the FBI Criminal Investigative Division.
Guess where ALL of those Columbia/HCA Healthcare Corp. - home-care units were?
National Century Financial Enterprises- the "...largest corporate fraud investigations involving a privately held company headquartered in small town America,”


Posted by: sasha2008 | June 19, 2009 8:29 AM | Report abuse


people should start taking to the streets, demonstrating for health care, the way the iranian people are demonstrating.
a million people marching in the streets of washington might begin to change some minds in congress.
mobilize.
we have watched our money go to the war in iraq, the executives at aig and the banking industry, the auto industry...gas prices going to the roof again.
i think they just dont see us out here.

like everyone else, i just received an email from david plouffe, asking for a donation to fight for health care.
does he serioiusly think i have any money left now for donations?

Posted by: jkaren | June 19, 2009 8:49 AM | Report abuse

I love Ezra's wonderfully Orwellian use of the English language. Incremental change=sweeping reform; timid=bold. What happened to him? This is a guy who's quite knowledgable about health care, and he knows that some form of single payer or at least public option is necessary to get meaningful universal health coverage at tolerable cost. But apparently he now sees it a his role to justify a plan that doesn't even come within hailing distance of those goals and, as some comments have remarked, resembles very closely the health care industry's own pet plan. What happened to Ezra?

Posted by: redscott | June 19, 2009 8:54 AM | Report abuse

seriously,
we should pick a date,
and have a "health care we can believe in" day,
in washington and other cities, instead of wringing our hands and feeling incensed.
we managed to get out in massive throngs to help barack obama, canvassing and convening in the heat of the summer.
the will must be there for us to get out and mobilize for our own well-being.
i think it is fair now to say,
"ask not what you can do for your country,
ask what your country can do for you."

Posted by: jkaren | June 19, 2009 8:59 AM | Report abuse

Senate Dems have been marching around on their knees giving political head to the medical industrial complex in preparation for stabbing the American people in the back. It's not the republicans we have to worry about it's our own team. They should be ashamed of themselves. It is good however that they have finally revealed themselves for what they really are. And where the is the President?? No leadership on this issue.

Posted by: ssfs20007 | June 19, 2009 9:03 AM | Report abuse

If you want a straight news story on this bill rather than Ezra Klein's opinions, there is a straight news story on other pages by news reporters Lori Montgomery and Shailagh Murray. I don't pretend to understand this complex bill, but in spite of many protests by the Post that it does not blur the line between news and opinion, this Klein article talks about "steps forward" as if the whole universe agreed on what that means. At least, this time, the Post does offer a straight news sotry based on the same leaked commitee report. Again, for the NEWS version of what we once called a newspaper , see the article by reporters Lori Montgomery and Murray Shailagh. For opinions formed very hastily on the basis of one staffer's leaked draft, then go to what we used to call the op/ed page for the official Democratic Party line from its house publication in DC.

Posted by: MarkRhoads1 | June 19, 2009 9:05 AM | Report abuse

Maybe the WP had in mind all along that they were going to can Froomkin when they hired Ezra. It's a nice trade for them, unpredictable principled liberal who calls BS when he sees it for mildly progressive young man who knows not to make too many waves.

Posted by: redscott | June 19, 2009 9:12 AM | Report abuse

Nice job on O'Donnels' MSNBC show Ezra.

Posted by: par4 | June 19, 2009 9:27 AM | Report abuse

No single payer means no reform!

Does congress represent the people or the just those that contribute to political campaigns?

BTW, a law is needed that states only people eligible to vote should be allowed to contribute to political campaigns. No organizations or foreign entities should be allowed to contribute to political campaigns or elections.

Also, if this health care idiocy passes then Democrats are toast in 2010 and one term for Obama. They'll be in the wilderness just like the Republicans are now.

Posted by: phasor | June 19, 2009 9:48 AM | Report abuse

Thank you for this article. It is the first time I have seen an actualy analysis vs. the horse race of health care legislation. If only every outlet would do this, the public would better understand what is at stake and then could be more information to contact their representatives. As it stands now, the media has done a great job playing up to the fears of the cost. If only they played up to those fears of funding our defense and unlimited wars!

Posted by: ChicagoTodd | June 19, 2009 10:08 AM | Report abuse

With the CDC showing 7 out of 10 Americans as clinically Obese, of which I'm one ?

Why should I deserve health care to be paid for ?

I don't

Health reform is another way for big Coal and Big Oil to have you FORGET your POTENTIAL for health has been taken away.

Health care ?

I'll settle for Health.

Try a REAL FDA and REAL EPA to encourage health in the US.

Ever stop to ask why so many people NEED healthcare ?

Cigarette smoking may not be optimial - cigarette smoking when you are taking AUTO exhaust and incinerating those pollutants at the end of a cigarette ? Just asking for health problems-

no WONDER Lung cancer is the #1 killer in the US

Petro exhaust + Coal exhaust

but don't you worry about having your POTENTIAL for health robbed from you American's - you just keep letting coal and oil steal it from you - and then dangle a carrot in front of you saying 'lookey - health care assistantence'

I don't buy the misdirection going on here.

Right now Obama admin just PAVED the way for the nations largest coal facility to go online- AFTER changing 40% reductions in co2 to 4%.

No better than bush.

OWNED.

Health care is JUST A DISTRACTION from the BIG COAL changes going on right now

Don't be a sucker.

Posted by: GREEDOM | June 19, 2009 10:23 AM | Report abuse

The generous take: "The Rube Goldberg Healthcare Reform Act of 2009." But more likely: "The Sycophantic Bumblers Healthcare Reform Act of 2009." And the frosting on the cake? If the Democrats screw this up and go for high-cost, low-results "reform," we can say hello to a Republican resurgence. Painfully, dangerously pathetic.

Posted by: JonathanTE | June 19, 2009 10:28 AM | Report abuse

The reason that this Committee is weaving such a convoluted mess of a national health care system is as simple as.. well... the single payer system that is being ignored: Congress is protecting the insurance and pharmaceutical industries from the reality that there are limits to growth. By continuing with their plan, with no single payer system at most or no public option at least, they will inevitably be faced with a short term windfall while awaiting a catastrophic and massive slowdown in cash flow in the long term.

Anything but a single-payer plan, or an emerging and dominant public option will continue to bring about increasing health insurance premiums, increasing deductibles, AND decreasing coverage. It's the only way for private insurers to continue with their enormous profit margins.

In a market-driven economy, there is no desire to initiate a long-term plan. As always, quarterly dividend forecasts rule the day. And that's what's driving this Committee as they continue to receive a treasure-trove of lobby money from vested interests, none of which represent the economically endangered middle and working class.

You can see the handwriting on the wall. If allowed to continue with their "market-based" approach, with no public or single payer option, there will be no relief for the wage earner or middle class income earner. Health care costs will continue to rise as private insurers will bring out the "oh, we tried" excuse. Disposable incomes will continue to drop, and the consumer-based economy will be transformed into a "subsistence-based" economy-- which would turn out to be a euphemism for a third world country.

That's where we're headed, folks, if the lobbyists and the Finance Committee get their way.

Posted by: EyeballKid | June 19, 2009 10:30 AM | Report abuse

SELL OUT

Posted by: maurban | June 19, 2009 10:46 AM | Report abuse

I would ask every Senator no getting in the way of health care reform by blocking the public option if they voted in support of the Iraq war? The price tags are the same. If they see greater benefit to the average voter in the Iraq war than they are free to vote against honest health care reform. If , however, they are truly honest and now admit that the war was wrong than the very best apology they can make for their horrible mistake would be to ignore the financial interests pushing for the status quo and pass honest health care!
Why are we so quick to vote for death and destruction and so slow to do what might improve life for everyone?

Posted by: jfmeshna | June 19, 2009 10:52 AM | Report abuse

and to think that after WMD, torture, and your loss of jobs and pensions that you voted for these guys and their promise of
basic health care. Shame on you, sheepies................

Posted by: kennytal | June 19, 2009 11:13 AM | Report abuse


I don't think Ezra took as strong a side as some of you think.

And, parts of this reform do remain really, really bold. Those Medicaid expansions alone will save lives in places like Texas, Alabama and Mississippi. Yes, the bronze plan sucks at 65% (and note that coverage must be OFFERED at gold or silver, so if you want to gamble and pay less for premiums, it's your life, something for the libertarians), but that doesn't mean those expansions wouldn't be great.

I think the single-payer people got a little reinvigorated by this hiccup. And, sure, if we could start the system over we'd absolutely do it single payer but as there's no possible way we can migrate to single payer (nor have any of them offered a transition plan anyway) they run the risk of being the 04 Nader's of Health Reform.

Posted by: ThomasEN | June 19, 2009 11:34 AM | Report abuse

Sen. Baucus, Sen. Grassley, the insurance lobby, Big Pharma and virtually all of the Republican legislators who have been bought and paid for by the drug and insurance industry are bound and determined to sabotage any meaningful health care. The current status of health care is ruining our economy a crippling our businesses. These guys don’t care about their constituents! They are doing the bidding of the special interests that keep getting them elected to their well-paid sinecures. They are disgusting people. Americans should take a cue from the Iranians and rise up and push for change over these Senators who flaunt there “right” to impede what the country needs.

Posted by: jcadams1 | June 19, 2009 11:37 AM | Report abuse

Once again, the men and women of Congress are showing their true colors.

Congressional Republicans tend to be ruthless, while their counterparts in the Democratic Party tend to be gutless.

Posted by: labman57 | June 19, 2009 11:55 AM | Report abuse

A robust public option is an absolute must in any legislation that passes!

June 25 in DC - Rally for healthcare reform.

search HCAN on the web for details.

Let Congress (especially the Senate) know the you want meaningful "HEALTHCARE REFORM" and when you want it, "NOW!"

Posted by: tffletch | June 19, 2009 12:24 PM | Report abuse

You can't actually have a health care program that works, if you keep the insurance industry alive. DR. DAVID HIMMELSTEIN, co-founder of Physicians for a National Health Program.

Posted by: tidalcreek | June 19, 2009 12:56 PM | Report abuse

So: taxpayer subsidies for private insurance companies with no competition from a publicly-administered plan is the best that Baucus and Grassley think we can do?

"For all the concerns about cost, there is no strong public plan able to negotiate low rates and implement aggressive reforms."

No controls or even negotiating power against rising costs, with taxpayer subsidies flowing to insurers to cover their profitability is simply going to amplify the economic disaster that is already our health care delivery system.

The Senate Finance Committee needs to get serious and to listen to their constituents that aren't employed by the insurance industry.

Posted by: eztempo | June 19, 2009 2:15 PM | Report abuse

IF THE AMERICAN PEOPLE GET SCREWED AGAIN ON HEALTH CARE REFORM WITHOUT A STRAIGHT UP PUBLIC OPTION, WE SHOULD ALL TAKE TO THE STREETS IN PROTEST JUST LIKE THEY'RE DOING IN IRAN TODAY.

WE HAVE REACHED THE STAGE WHERE STREET DEMOCRACY IS ALL WE'VE GOT LEFT.

Posted by: Scruffyboo | June 19, 2009 3:21 PM | Report abuse

ThomasEN says, "there's no possible way we can migrate to single payer (nor have any of them offered a transition plan anyway)"

I'm 70 and I didn't notice a tranistion plan for Medicare. They just did it.

The President says we have to take incremental steps. Medicare for All IS an incremental step. Step one was Medicare for the highest risk pool, old fogies like me. Step 2 is Medicare for everybody else which is actually easier because it does not cost any more (see below). Step 3 would be more efficient medical practice as Dr Gewande wants.

The main reason that it is far better to extend Medicare to everyone is cost. Private insurance companies waste about $400 Billion each year in high overhead and physician & patient compliance cots. There is another $100 Billion wasted on high drug prices to companies that spend 3 times as much on "marketing" as on R & D. This $500 Billion each year can be used to pay for the extension of Medicare to everyone.If you simply add a public plan, you are leaving the $500 Billion on the table. You are simply adding cost. This is just stupid.

In addition, there are technical reasons just adding a public plan is foolish. If it has to take everyone while private companies can pick and choose , it will wind up with another high risk pool--the sick and the poor. While the idea of creating another pool is bad enough, if it is a high risk pool, it will be very expensive. The Republicans will seize on this and progress will halt.

Also if it covers preexisting conditions, then it will greatly expand the pool of the self insured which is terrible from an efficiency point of view. After all, why pay premiums when you are well?

Finally as to the attitudes of the public, Representative Anthony Weiner recently held a telephonic town meeting with 4,700 members of the public. He asked who preferred the public plan option and who preferred Medicare for All. Two thirds preferred Medicare for All. Then the Representative said the private insurance industry would never permit that option.

Who is running this country?

Posted by: lensch | June 19, 2009 3:49 PM | Report abuse

Since campaign money seems to be the yardstick by which any legislation gets passed ,those of us in favor of true health care reform can promise to donate to the Dems that have their heads up the health care lobbyist arses if they agree to look out for our interest. We could all say pledge maybe anywhere from a dollar up to 2% percent of our income per week. This way those Dems that are worried about having a war chest for their campaigns and "campaign expenses" would not have to depend on the lobbyist for funds to have fun. This could also be done if they agree to get the energy speculators out of the energy markets. This would all take some planning but it would be worth it. I am serious. Any other ideas?

Posted by: rankin_edward | June 19, 2009 3:53 PM | Report abuse

Of COURSE we "can't afford" health care. We have to fund 3 WARS, in Iraq, Afghanistan, and covertly in Pakistan, and our own president has stated there are 16 OTHER countries we may have to go to war with, including Iran and North Korea. We have to send OUR dollars to the IMF and the United Nations and billions in foreign aid, mostly to Israel who has NOTHING to give in return except to incite us to start more wars in the name of "protecting our ?interests?".

We have to pay billions of our dollars to "rebuild Iraq and Afghanistan" and more billions to destroy what we build and more to "rebuild it" again, over and over. We have to FUND the "torture programs" and the cost of "wiretapping ourselves" and CIA murders and executions and assassinations. And we have to pay the airlines, in cahoots with the CIA to fly our kidnapped victims to their torture chambers, and more millions to cover up their crimes.

We have to fund the "Space Station" at the cost of more than $80 BILLION dollars for each trip. We have to build TRILLIONS of dollars of obsolete war WEAPONS and defense against the WMD we have SOLD to the rest of the WORLD, or given away to Israel. We have to pay off the millionaire and billionaire BANKERS so they will tell us a few of the secrets of how they scammed the WORLD with worthless paper and maybe tell us where some of it is. We have to pay the WORLD restitution so the BANKERS don't lose anything while WE lose EVERYTHING we have.

Then, to add insult to injury, WE have to pay billions of dollars a YEAR to obscene salaries, perks, expense accounts and travel for a President, Vice President, 100 Senators, and over 400 Representatives who take the corporate pay offs and spit on us and tell us we are not worthy of a second thought. We are just the tools they use to get where they're at and the rest of the time we are NOTHING.

Even those who are supposed to ANSWER to CONGRESS hold nothing but CONTEMPT for congress and it doesn't matter which side. They are ALL bought and paid for. And they are paid to spit on the public, to throw us under the bus while they spend OUR health care dollars on themselves and tell us to stop bothering them until they need our votes again. Then the whole show will start all over again and too darn many of us will give them another chance or, continue to pay them half a million a year after they are defeated for the rest of their lives, in pensions, perks, lifetime free medical care, secret service protection and whatever else they want because if they don't already have it they will just write a new law giving themselves whatever they don't already have and giving the rest of us no way to stop it.

What a great racket they've got going for THEM!

Posted by: weslen1 | June 19, 2009 6:01 PM | Report abuse

Obama is rapidly turning out to be a massive disappointment. I contributed, worked hard and voted for the guy. He is going to turn out to be first American President who turned lame duck in the very first term.

Stimulus was a big flop. Nothing front loaded and everything into long term fixes and tax cuts. A neither here nor there plan. That's basically a dud thats costing us a ton of cash and nothing to show for it.

Compare it Chinese stimulus plan. Started after our great plan now firing up their economy and most of the Asian economies (don't believe it ? what is the gas price you paid and why do you think its going up ?? - their economies are getting back to scorching growth of over 5% again).

Obama's stimulus plan rates a F-. If they wanted bi-partisanship so bad and did not have what it takes to stick to their vision. They should have gone with republican plan. What they us instead is a perfect mis-mash of worst of both plans. Long term spending instead of instant spending and inadequate tax cuts (you receive any chq yet ?).

TARP is a super flop for main street (receive any credit card offer recently or more importantly any business loan ?). Its beyond me why government is allowing the banks to repay the funds back when the credit is not flowing to main street. Recycling TARP funds (if they can pull it off) will have nowhere as much effect as the leverage over banks TARP gave them and now its gone.

The whole stress gimmick has killed the lending by community banks to small business by fixing ratios for percent of each type of loan any community bank can finance. Setting stage for a massive commercial real estate deflation as the loans come up for refinancing (my nature unlike home mortgage, commercial mortgage are normally refinanced every 3 or 5 years). The local banks can not refinance because most are already at the ratios FDIC will allow them under new guidelines.

Now its the same deal with health care.

Basically Obama seems all for adoration at any cost.

Man, never thought I would regret not supporting Hillary. At least she has balls.

Posted by: kakatiya | June 19, 2009 7:15 PM | Report abuse

Obama is rapidly turning out to be a massive disappointment. I contributed, worked hard and voted for the guy. He is going to turn out to be first American President who turned lame duck in the very first term.

Stimulus was a big flop. Nothing front loaded and everything into long term fixes and tax cuts. A neither here nor there plan. That's basically a dud thats costing us a ton of cash and nothing to show for it.

Compare it Chinese stimulus plan. Started after our great plan now firing up their economy and most of the Asian economies (don't believe it ? what is the gas price you paid and why do you think its going up ?? - their economies are getting back to scorching growth of over 5% again).

Obama's stimulus plan rates a F-. If they wanted bi-partisanship so bad and did not have what it takes to stick to their vision. They should have gone with republican plan. What they us instead is a perfect mis-mash of worst of both plans. Long term spending instead of instant spending and inadequate tax cuts (you receive any chq yet ?).

TARP is a super flop for main street (receive any credit card offer recently or more importantly any business loan ?). Its beyond me why government is allowing the banks to repay the funds back when the credit is not flowing to main street. Recycling TARP funds (if they can pull it off) will have nowhere as much effect as the leverage over banks TARP gave them and now its gone.

The whole stress gimmick has killed the lending by community banks to small business by fixing ratios for percent of each type of loan any community bank can finance. Setting stage for a massive commercial real estate deflation as the loans come up for refinancing (my nature unlike home mortgage, commercial mortgage are normally refinanced every 3 or 5 years). The local banks can not refinance because most are already at the ratios FDIC will allow them under new guidelines.

Now its the same deal with health care.

Basically Obama seems all for adoration at any cost.

Man, never thought I would regret not supporting Hillary.

Posted by: kakatiya | June 19, 2009 7:16 PM | Report abuse

There is a way to get universal basic coverage, and preserve choice and private-insurance in a well-integrated way.

Consider this idea to send to your Congressman:


http://findingourdream.blogspot.com/2009/06/good-healthcare-ideas-help-think-up-new.html


Posted by: HalHorvath | June 20, 2009 4:51 PM | Report abuse

The world is a much safer place Since President Obama started his work. He is creating jobs, stabilizing world powers, and his speeches are motivating Mid-East youth into conducting "flower child" like protest.
He has cut over 1 million dollars of wasteful Government spending, and is adhering to the "Bush time table" in Iraq. He is also continuing to pave the way for the "road map to peace" started by Bush.
Anyone that thinks Pres. Obama isn't a cool guy is an idiot. He has maintained the Bush tax cuts and has greatly expanded Bush's spending policy.
About health care compromise: he is now willing to except proposals made by then candidate "McCain", (taxing HC), and will use the forced health care coverage to bolster support within the insurance industry, moreover, the mandatory HC data base will store your DNA, blood, and organ-donar info., along with you SSN, home address ect. You will need a card chip or mark to access HC. This is a brilliant two edge sword that will deny illegal immigrants a place to hide !

We have not seen a leader like this since WW2.
We urge you to forget about "common sense", just go with it, no time to think, "yes we can".

Posted by: newmail | June 20, 2009 5:41 PM | Report abuse

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