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The Divisions in the White House Over Health-Care Reform

PH2009082003377.jpg

This is health-care reform's endgame, or close to it. Next Wednesday, Barack Obama will give a prime-time address before both houses of Congress. But that's not all he's giving Congress. The administration is going to put a plan down on paper. The question is what it will say.

Conversations with a number of White House officials make it clear that, at this point, even they don't know. The argument was raging as recently as last night, and appears to have hardened into two main camps. Both camps agree that the cost of the bill has to come down. The question is how much, and what can be sacrificed.

The first camp could be called "universal-lite." They're focused on preserving the basic shape of the bill. They think a universal plan is necessary for a number of reasons: For one thing, the insurance market regulations don't work without universality, as you can't really ask insurers to offer standard prices if the healthy and the young don't have to enter the system. For another, it will be easier to change subsidies or improve the benefit package down the road if the initial offerings prove inadequate. New numbers are easier than new features. Creating a robust structure is the most important thing. This camp seems to be largely headed by the policy people.

The second camp is not universal at all. This camp believes the bill needs to be scaled back sharply in order to ensure passage. Covering 20 million people isn't as good as covering 40 million people, but it's a whole lot better than letting the bill fall apart and covering no one at all. It's also a success of some sort, and it gives you something to build on. What that sacrifices in terms of structure it gains in terms of political appeal. This camp is largely headed by members of the political team.

Both camps accept that the administration's proposal will be less generous than what has emerged from either the HELP or House Committees. The question, it seems, is how much less generous.

The answer appears to hinge on Sen. Olympia Snowe. "I'm a Snowe-ite," joked one official. Her instincts on health care have proven quite a bit more liberal than those of many Democrats. In the Gang of Six meetings, she joined Sen. Jeff Bingaman in focusing on affordability and coverage — putting her, in practice, somewhat to the left of Conrad and Baucus. The problem is that Snowe is scared to be the sole Republican supporting this bill, not to mention the Republican who ensures the passage of this bill. The reprisals within her caucus could be tremendous.

If Snowe drops off the bill, using the budget reconciliation process will probably be a necessity. The bill then goes through Sen. Kent Conrad's Budget Committee, giving him much more power over the product. The absence of any Republicans repels at least a couple of conservative Democrats. Passage becomes much less certain, which means a scaled-back bill becomes much more likely. This is the irony of the health-care endgame: The bill becomes much more conservative if it loses its final Republican.

Photo credit: By Alex Brandon — Associated Press

By Ezra Klein  |  September 2, 2009; 4:48 PM ET
Categories:  Health Reform  
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Comments

Sounds like 100% political nightmare. The progressives will not accept massive scaling back with no public option.

Posted by: JonWa | September 2, 2009 5:12 PM | Report abuse

"The progressives will not accept massive scaling back with no public option."

Sure they will. What choice do they have?

Posted by: ostap666 | September 2, 2009 5:34 PM | Report abuse

I will be surprised if these kinds of issues are resolved by the President's speech. He is likely to increase the focus of the discussion and get it pointed toward achievable options. But, he is also likely to leave room for the Senate to find its way to a bill with as much content as possible. The final negotiation will not happen until it is time to count the votes. If the Senate Democrats can get to a bill that they all support, there is likely to be more than one Republican who does not want to be responsible for its failure.

Posted by: dnjake | September 2, 2009 5:39 PM | Report abuse

No one gives a damn what the progressives will accept. They can be flexible and have a bill, or they can be militant and be the cause of having no bill. The liberals aren't driving this bus.

Posted by: FreeMas | September 2, 2009 5:41 PM | Report abuse

Have fun losing 60 seats in the house. The base will stay home, labor will stay home. All money and time normally spend on general elections will be spent on primary challenges.

Posted by: JonWa | September 2, 2009 5:43 PM | Report abuse

"you can't really ask insurers to offer standard prices if the healthy and the young don't have to enter the system."

"For another, it will be easier to change subsidies or improve the benefit package down the road if the initial offerings prove inadequate. New numbers are easier than new features."
********

1. what are "standard" prices? can someone, anyone, tell me what that means? and dems wonder why people throw around the word socialism...

2. it seems the administration realizes its easier to commit the country to a new health care system, underfund it at first in order to disguise the true cost, and knowing that when the true costs become apparent, we will have little choice but surrender ourselves to the extra cost.

and democrats wonder why people are concerned about things that, technically, "arent in the bill". not surprisingly, people are most focused on the likely consequences and outcome of the bill, not simply the bare language of the document itself.

Posted by: dummypants | September 2, 2009 5:45 PM | Report abuse

I think for the White House to put all their eggs in getting the OK from Olympia Snow and lose some Blue Dogs on the way would be a mistake and I think they know that.

The compromise will be done between Blue Dogs and other Democrats in both houses. I think once they find a way to lower the price of the bill to $600-700 billion over 10 years and bring down the inflation rates of Medicare/Medicaid, most Blue Dogs would come around having a public option because that's something they can sell to their constituents. But it will not be sold as a "public option" but as creating true "market place" of health insurance where people can have real choice and competition.

Posted by: ovwong | September 2, 2009 5:48 PM | Report abuse

The question should be: Who, other than the "captives" in both Houses, invited "captives" and his 34 "Czars", will actually waste time listening to this propraganda? If the writers of this egregious bill, whoever they might be and I suspect it was not one member of Congress, cannot explain 1300 pages of gobblededook, don't expect the president to be able to explain it either. Without his teleprompter he can barely get out a cogent sentence. Oh, I forgot - he will have his teleprompter.

Posted by: marine2211 | September 2, 2009 5:49 PM | Report abuse

The liberals aren't driving this bus.

Posted by: FreeMas | September 2, 2009 5:41 PM |

_________________

If not them, then who?

Posted by: lostinthemiddle | September 2, 2009 5:49 PM | Report abuse

"What choice do they have?"

A House that is spared the yelping of Blue Cross Dogs in 2011?

Posted by: pseudonymousinnc | September 2, 2009 5:52 PM | Report abuse

Please give us the tort reform for medical malpractice which will reduce health care cost by
twenty percent. The fear of malpractice is ruining the way the physicians are practicing medicine.
Kenneth J. Wooh, M.D.

Posted by: kenjanewoohgmailcom | September 2, 2009 5:54 PM | Report abuse

In the Supreme Court, it doesn't much matter what Justice Stevens or Justice Thomas thinks. They're sure things. What Justice Kennedy thinks - now, that matters.

In the Senate, it doesn't much matter what Senator DeMint or Feingold or Senator Sanders thinks. What Senator Baucus thinks - now, that matters.

In the elections, it doesn't much matter what "progressives" or wingnuts think. What I think - now, that matters. It's a nice position to be in. If we could just get some rational Republicans ...

Posted by: ostap666 | September 2, 2009 5:54 PM | Report abuse

To schedule a presidential address to congress without first doing weeks of analysis of the final proposal is a disaster waiting to happen. It reeks of 'do something' action that deserves ridicule.

I'm coming to the conclusion that Obama lacks executive leadership abilities. He belongs in a law school classroom teaching social justice law or something.

I don't speak for the progressives and liberals, but if this is only half as bad as it appears to be, my ballot will remain unmarked in 2010 and 12. I don't think I'm going to be lonely with that response.

Posted by: JimPortlandOR | September 2, 2009 5:59 PM | Report abuse

@Dummypants ~ Let me try to explain this...

1. Currently, there is no health insurance mandate a la car insurance -- if you have a car, you get the insurance. The benefits of having a mandate is that "standard" prices are lowered because you would be spreading "risk" among many more participants.

2. The administration is NOT commiting the country to a new healthcare system. Because they're not creating something new at all, unless you're only focusing on the health insurance exchange market place where you would be able to go online, look at "X" amount of health insurance options, costs and select a plan that fits your budget. But this only applies to folks who don't have insurance already through their employees or small business with 10 employees who want but can't afford to provide health coverage.

The current system that you have right now will not change to a brand new system. The only thing that the Administration and Congress are doing is to find ways to cover the 45 million or whatever number you're OK with (20 million?) who don't have insurance or can't afford it.

Posted by: ovwong | September 2, 2009 6:00 PM | Report abuse

*A House that is spared the yelping of Blue Cross Dogs in 2011?*

This is really an important point. The Iron Law of Institutions will be in play here: the factions of Democrats in the House will care more about their power within the structure of the Democratic caucus rather than the power of the Democratic caucus itself. That means that the Blue Dogs are doing to be willing to play the House leadership off against the white house to make themselves power brokers even if this weakens the position of the Democrats, but at the same time the liberals (with secure seats) will be fine with a bunch of outrage from the base and the right wing that causes the blue dogs to lose their seats at the cost of the caucus's large seat margins.

In this case, it ultimately means that the Blue Dogs are the ones who need to compromise. If they don't, then they lose their position as power brokers in the midterms, when they lose their seats in a sweep of base apathy and conservative activism.

Posted by: constans | September 2, 2009 6:01 PM | Report abuse

Thanks for nothing, Mr. Wimp President.

Posted by: kmblue | September 2, 2009 6:04 PM | Report abuse

Listen very carefully to Obama and do not take him at his word. Check the facts and "his" facts.

Posted by: um1967 | September 2, 2009 6:06 PM | Report abuse

Health care is dead. Put a fork in it and you will see. It died in August from the disgust in townhall meetings. There is not going to be a conservative bill, but no bill.
Why? They went way too far.
The target was supposed to be the 10 million of relatively well-off Americans who don't take health insurance because they want the money instead. But instead of writing a bill that just orders them to join in, the House bill threatened Medicare beneficiaries with $500 billion in program cuts, and also brought fresh worries from those with health care insurance that their employers would drop their expensive plans if a public option was adopted. No one knows what the public plan means, but what we do know is that members of Congress refused to vote to scrap their personal plans to join it.
So now there is no political solution. The House bill won't come to the floor, and the Senate bill hasn't come close to emerging. Moderate Democrats, looking over those crowds of angry middle-aged and older voters, are going to vote their reelection and tell the leadership to stop any further talk of health care reform. There currently isn't 60 votes to jam it through the Senate, and senators will not abandon their collegial ways to do that because they fear it means all-out war.

Posted by: edwardallen54 | September 2, 2009 6:09 PM | Report abuse

The insurance companies also agreed to stop rescission and non-coverage of pre-existing conditions for verfied mandatory health insurance. So that part of the bill isn't really contraversial.

There will be a new public option that doesn't exist now, that is a very big difference.

There will also be all kinds of new mandates on coverage, how much it costs, taxes and lots of things like that.

So yes, it is a new system.

Posted by: ovwong
1. Currently, there is no health insurance mandate a la car insurance -- if you have a car, you get the insurance. The benefits of having a mandate is that "standard" prices are lowered because you would be spreading "risk" among many more participants.

2. The administration is NOT commiting the country to a new healthcare system. Because they're not creating something new at all, unless you're only focusing on the health insurance exchange market place where you would be able to go online, look at "X" amount of health insurance options, costs and select a plan that fits your budget. But this only applies to folks who don't have insurance already through their employees or small business with 10 employees who want but can't afford to provide health coverage.

The current system that you have right now will not change to a brand new system. The only thing that the Administration and Congress are doing is to find ways to cover the 45 million or whatever number you're OK with (20 million?) who don't have insurance or can't afford it.
Posted by: ovwong

Posted by: win1 | September 2, 2009 6:09 PM | Report abuse

"The liberals aren't driving this bus."

But they're not willing to accept being thrown under it, again, either.

We gave them 60 votes in the senate and the presidency to get this done. If they can't pass even the weak tea version of universality they promised, what good are they to us?

Posted by: adamiani | September 2, 2009 6:14 PM | Report abuse

Reform is in critical condition because of the president's desire to push something through congress without real leadership in the work. All factions began pushing their own agendas while the president kept saying "I want this done by September 1."

Dare I suggest that bipartisan committees be formed in the house ala the gang of 6 with a mandate to do no harm, a means of paying for the plan, and a reasonable time frame for completion of the work?

Posted by: sandiego1969 | September 2, 2009 6:14 PM | Report abuse

"No one knows what the public plan means, but what we do know is that members of Congress refused to vote to scrap their personal plans to join it."

It's amazing how many people who read this blog have no idea what they're talking about when it comes to health care.

Posted by: praxis22 | September 2, 2009 6:15 PM | Report abuse

ovwong - I think you should pay for the health insurance of the uninsured. And Congress should have to get the exact same insurance. You are already paying for the sub-prime loans to the folks who can not afford to own a house and must rent, and paying for the car insurance that they do not have in spite of the law requiring it and not paying the taxes that support all the Federal programs.

Posted by: um1967 | September 2, 2009 6:16 PM | Report abuse

President Obama, Please review our www.sophiasangels.org, under "Amend the Law of Children's Services" The current guidelines are set for the very poor, or for people of another country. We, the hard working Americans, who own a home, car and/or business and are in crisis. We make over $17,000.00 per year and for that, if our child experiences a sudden onset of Cancer, like Leukemia, like my Daughter Sophia Hartman, then we are denied all help, especially because other organization abide by the same requirements. Because of this, my daughter died at age 12, as we hoped for further care at Children's hospital, but they would not move her from UCLA until the insurance okayed it. Without work, cause I was her caretaker, I had no money for Cobra, and because I was the hard working American, I was denied Medi-cal for her, even if she was already in the hospital for months. She was already in the system, but denied life because, she was born to me. What if this was your daughter? Would you change the policy then? Please contact us. She is an angel, speaking greatness to be. HOPE is what you preach. It's to late for my daughter, but not to late for those along side me, and in front of me in this situation. CNN headline news did a story on how they believe Sophia's Angels could inspire the world. Check it out. www.sophiasangels.org. It would be great if we could meet. I have a lot to say with love.
Vivian Hartman of Sylmar CA who still believes that miracles can happen. It's all about love. Knowledge is powerful, and Love is the power of the world. www.sophiasangels.org. We need your attention.

Posted by: sophiasangels | September 2, 2009 6:28 PM | Report abuse

Obama is not going to do anything that would endanger the public option or alienate his base, i.e. the progressive left.

At most he will make it look like he is being flexible while he puts his machine against any of the Democrats that do not go with his real plan.

Obama sees the public option as a way to single payer, and he has always been for single payer. He was for single payer in Illinois and the main reason it didn't pass was because it would have costs to much and taken away to many jobs. Obama was more willing to negotiate then because he was still looking forward the the Senate and Presidency. A second term isn't important to him, as long as he passes enough of his agenda so that the progressives can stay in power, why should he care.

He is more concerned about the progressives staying in power and his agenda then anything else. He feels that if the compromises on health care the progressives will lose power, not gain it.

Posted by: win1 | September 2, 2009 6:31 PM | Report abuse

Obama has kissed the public option good bye.

And without a public option, costs will not fall. Way to wimp out.

Posted by: kmblue | September 2, 2009 6:38 PM | Report abuse

The dream scenario for Republicans is a scaled back version that actually passes, but with little or no Republican support. Then they can't be accused of defeating it, but can snipe away at it for all it's worth.

They stand to lose a LOT more if the bill fails altogether.

That's why smart thinking progressives believe it's a public option or nothing at all.

The Negative Nelly Republicans are going to be hyper-critical of any reform, so why not give them something of substance to sink their ugly fangs into.

Posted by: kkord1 | September 2, 2009 6:43 PM | Report abuse

The crucial question is how Howard Dean reacts to the plan. He has said that if there is no public option, the $600 billion is a waste of money. If he basically sticks to that, he is planning to run candidates in 2010 in Congress like Teddy Roosevelt did in 1912.

It may well be that the most likely option is that which the Wall Street Journal predicted--a division of a bill into insurance reform, which enjoys broad subject among the public and even many Republicans, which will pass, and the money bill with universal coverage and the public option which will fail.

Posted by: jhough1 | September 2, 2009 6:58 PM | Report abuse

So what are the odds that the cost-cutting will be on the backs of the poor as usual. I have seen no info on any restrictions/enforcement measures to preclude premium hikes by the insurance companies after the bill passes. Just like the credit card companies, they will just adjust their rates to make their profits stable. Moreover, currently the govt isn't properly enforcing the illegality of purging and rescission, so how's all this new "regulation" going to be enforced??

Drop that percentage paid by insurance companies to 65% rather than 75%, so the consumer will get raised premiums (based on the company's having to pay for insuring those with pre-existing conditions, no doubt--never mind the millions of healthy young people added with the individual mandate) and we will also have to pay almost a third of the cost of any claim. In addition, no doubt the subsidy line will be dropped down to 250% of the poverty line, so once again all the people who make too little to be able to afford premiums/deductibles but too much to qualify for aid will end up bearing the brunt of the cost increases AND a fine if they decline the privilege. Meanwhile, the health insurance companies who RIGHT NOW are making record profits will still have blocked negotiated drug prices and the choice to buy drugs from Canada.

Once again, the insurance companies are being subsidized at the expense of taxpayers because the Dems are too scared to do a Bush and ram through a liberal bill. Damn right they're in trouble in 2010 elections. I didn't expect to get my choice, single payer, but I damn well expected a strong public option.

Posted by: aka3000 | September 2, 2009 6:58 PM | Report abuse

I have a question for those who think that the Government has to solve the problem for the millions that do not have or do not want health insurance: Do you think that it is the Government’s responsibility to feed, house and cloth all the needy?

Posted by: pilgrim1211 | September 2, 2009 7:10 PM | Report abuse

If the president is speaking about reform, I assume that fixing liability is on the agenda. Otherwise it will be a repeat of the old baloney again. The middleclass and seniors want to hear that he is seriously offering true corrections and not another pork boondoggle.


Posted by: rich15 | September 2, 2009 7:18 PM | Report abuse

Obama dealt the public option out of his plan a long time ago. He & Rahm (along with Baucus) have given away the whole store to the health insurers and big pharma.
It will be much better if the progressives DO kill the horrendous industry giveaway that's snaking its way through Senate Finance, otherwise we'll all be forced BY LAW to purchase crappy, expensive private insurance with unaffordable co-pays (35% !!) and huge deductibles.
Unless there is a strong public option, this monstrosity will bankrupt the entire middle class.

Posted by: pointy | September 2, 2009 7:28 PM | Report abuse

Olympia Snowe should be invited to the Democratic caucus and receive a prized committee chairmanship, of the Senate Banking Committee. That way, you solve 2 problems, you dont have Tim Johnson of South Dakota (Senator Pay Day Lenders) leading that committee and you have 61 seats when Ted Kennedy's seat is filled
by another Democrat.

Posted by: asja | September 2, 2009 7:29 PM | Report abuse

If we don't end up getting good healthcare out of this process, we probably won't see an other attempt for many years to come. No Democrat will have the political courage in the future if President Obama, with majorities in both houses, can't prevail in post Bush America. It's now or never for any of us older then 30.

In the immediate aftermath of healthcare reform, progressives will once again find themselves having been abandoned by Democrats. Democrats can't get elected without the Progressive wing of the party. Once elected, they turn their backs on progressives with talk about "The real world".

Just as Democrats had this opportunity to show us how important our healthcare needs really are to them, we progressive Democrats and independents are also once again at the put up or shut up point.

We can come together as progressives and vote as a block, the way Bluedog Democrats do. We're a bigger part of the party than they are, but the Bluedogs get a whole lot more of their agenda dealt with than we do.

All that's necessary is for some representative of progressives to emerge. That and us standing up to be counted. If there was a web site where progressives could sign up, we'd be able to get some idea of our numbers. My bet is that the numbers are very big. Big enough that we'll feel ridiculous for not getting more attention from those we help elect.

The progressive agenda is the morally right path for society to follow and we ought to be a bit more insistant that our votes be appreciated.

I've seen the phrase Aggressive Progressives but don't know if that's the name of a political group. It ought to describe the Democratic party.

Posted by: fredfawcett | September 2, 2009 7:32 PM | Report abuse

"The progressives will not accept massive scaling back with no public option."

Sure they will. What choice do they have?

--
Oh yes we do have a choice - We as progressives can stop giving money to President Obama and the DNC until they find a candidate who has some spine! Good luck to these people getting re-elected in 2010 or 2012!

Posted by: dre7861 | September 2, 2009 7:34 PM | Report abuse

Pilgrim 1211 - so what would you suggest we do with the poor and the needy? Let me guess - water the tree of Liberty with their blood I suppose?

Posted by: kiranand | September 2, 2009 7:34 PM | Report abuse

Let's see the final bill, I will withhold judgement until then.
If it achieves cost-cutting measures that help more people be able to afford coverage and put regulations on insurance companies so they cannot continue to gouge the public then I will be satisfied.

Posted by: JRM2 | September 2, 2009 7:40 PM | Report abuse

I may have missed it somewhere, but I would really like to know what category the potential 20 million that will not be covered are in. Are they the ones that will still not be able to afford insurance, or the ones that have a pre-existing condition that the insurance companies still can reject? Does anyone know?

Posted by: politicaljunkie4 | September 2, 2009 7:41 PM | Report abuse

I'd have little hope that Obama could be different from the two party monopoly establishment. Not anymore. So far he showed all the signs that he is in no way will change how business is done. He is part of the oligarchy. We know he, like his predecessors, after leaving the White House will get immensely rich working for the very corporations he and the rest of our corrupted politicos are protecting. Big Pharma, sounds familiar. He already and secretively promised not to touch the way they overcharge medicare.

Posted by: bluelagoon21 | September 2, 2009 7:46 PM | Report abuse

I may have missed it somewhere, but I would really like to know what category the potential 20 million that will not be covered are in. Are they the ones that will still not be able to afford insurance, or the ones that have a pre-existing condition that the insurance companies still can reject? Does anyone know?

Posted by: politicaljunkie4 | September 2, 2009 7:47 PM | Report abuse

Patients with terminal illnesses are being made to die prematurely under an NHS scheme to help end their lives, leading doctors warn today.

http://www.telegraph.co.uk/health/healthnews/6127514/Sentenced-to-death-on-the-NHS.html

Posted by: tommyk63 | September 2, 2009 7:49 PM | Report abuse

I have a question for those who think that the Government has to solve the problem for the millions that do not have or do not want health insurance: Do you think that it is the Government’s responsibility to feed, house and cloth all the needy?

Posted by: pilgrim1211 | September 2, 2009 7:10 PM


In a country as wealthy as ours, the answer to that question is YES. (Although what I'd describe as the "government's responsibility" is to be a last resort for those that fall through the cracks by not being aided sufficiently by their families and communities. If you want the gov't out of aiding the poor, be more charitable!)

Posted by: SheGeek | September 2, 2009 7:52 PM | Report abuse

If the president does not begin with "insurance companies out" and "single payer," he might as well stay home. He won't be doing anyone, including himself, any good.

Posted by: michaelaldridge | September 2, 2009 7:53 PM | Report abuse

The fear of losing "fee for service" for the physicians and the fear of losing big profits in the private insurance industry is what is fueling this, to refute a poster here.

I am exhausted with this. I am tired of all the fear, shouting, ugly threats, the seditious behavior, the insults, the "jokes", the slander, the lies, the distortion, the attacks on people at end of life, on Granma, on people with cancer, and of seeing the stupidity of the American people.

None of it was necessary. We are going to end up with certain regulations for the insurance industry that should have been in place by Congress long, long ago and with a Medicare prescription plan that should have not even had a "gimmick gap" and a "donut hole" in it and should not have been a new product for private insurance with govt subsidies to them. This is a clear example of what a Republican, kicking and screaming, does with "Socialized" programs and how Democrats, willingly, "comprimise" to because "anything is better than nothing".

The entire problem/crisis in healthcare is because the working middle class can no longer be counted upon to subsidize everyone else's healthcare in their Public Options of Medicare, Medicaid, VA, TriCare, Indian Health, Congress, the WH, retired Presidents and Vice Presidents, and the indigent who do not qualify for an entitlement, AND pay our own way, too, to private insurance and neither can employers. The only people who have one or a combo of Single Payor, Public Option, Universal Care, are those listed in the above groups. Provided by us. We are left with private insurance plans, compounded by subsidies from the govt from taxes we pay.....What a deal.

I am through with expecting anything from politics or candidates or parties. I sure do not want to see any more money put into any bail outs, mortgage deals, car deals, or wars. It's over. Every man for himself.

Posted by: nana4 | September 2, 2009 8:02 PM | Report abuse

Contrary to the last paragraph in this article, if reconciliation is used, the bill will have to become more liberal, not more conservative. The key element of the reconciliation is that cost savings must be demonstrated. The only way that's going to happen is if there is a public option that sets low rates and implements cost controls.

Posted by: greguva | September 2, 2009 8:06 PM | Report abuse

Suggesting that liberals are being militant is absurd. They have said no mandate without a public option. That is all. We refuse to to see tax dollars subsidize a massive give-away to insurance companies. If you must give up the public option, remove the mandate.

Posted by: FalstaffsMind | September 2, 2009 8:12 PM | Report abuse

Ezra ...
You say ...
For one thing, the insurance market regulations don't work without universality, as you can't really ask insurers to offer standard prices if the healthy and the young don't have to enter the system.

Problem is ...
First, mandates will not pass via reconciliation. Competitiveness of the INSURANCE companies is not directly tied to the budget.

Second, Mandates are probably unconstitutional. The commerce powers are not that elastic.

As pointed out in http://www.washingtonpost.com/wp-dyn/content/article/2009/08/21/AR2009082103033.html

The otherwise uninsured would be required to buy coverage, not because they were even tangentially engaged in the "production, distribution or consumption of commodities," but for no other reason than that people without health insurance exist.
The federal government does not have the power to regulate Americans simply because they are there.
Significantly, in two key cases, United States v. Lopez (1995) and United States v. Morrison (2000), the Supreme Court specifically rejected the proposition that the commerce clause allowed Congress to regulate noneconomic activities merely because, through a chain of causal effects, they might have an economic impact.
These decisions reflect judicial recognition that the commerce clause is not infinitely elastic and that, by enumerating its powers, the framers denied Congress the type of general police power that is freely exercised by the states.

So, they mandate to me I must purchase insurance. I now have standing and sue. The supreme court follows the decision of Lopez and Morrison, and POOF goes the mandate.

One thing to understand is a STATE can make a mandate, because the commerce does not cross the state line. It is bound by the State Constitution. But the Federal Government cannot because it crosses state lines.

The way around this of course is to require every state to pass a mandate for the bill to take effect. Good luck on that one.

Posted by: chromenhawk | September 2, 2009 8:17 PM | Report abuse

Fred Fawcett, eighteen months ago Obama was pretty much everything progressives were looking for "to emerge." The problem is how messy governance is. It would be helpful if we had a stronger a stronger majority in Congress from a progressive perspective. But frankly, I don't see that happening. This is nirvana my friend for the near future, for our lifetime, and we will long for it if Congress fails to deliver some kind of health care. Get the best plan we can get and move on. This debate is killing us and wasting time which is what the Republicans desperately want. We need to plant the flag and declare victory wherever we can. Then we can hit replay on Cap and Trade and Employee Free Choice Act reforms. We need to get bills passed. That is the real world where people who are keeping ideological score do not really live.

Posted by: Juliasdad | September 2, 2009 8:20 PM | Report abuse

"The liberals aren't driving this bus."

Then the liberals need their own bus.

Posted by: motodude | September 2, 2009 8:27 PM | Report abuse

The "Universal Lites" have it. You just wait and see.

The strategy has been brilliant. Now that all the cards are on the table - including the Old Maid cards played played by the lightweights in this high stakes game.
This president will nail down the bottom line and put 4 aces on the table.

You can't have real reform without some version of a public option.

You'd better believe that Obama will call.

He loses nothing even if Republicans win this hand.

Why? Because the problem still demands action. If the GOP stalls on health care it only cements their failure to act. Obama gets to point fingers at the specific lawmakers who failed to pass reform.

This is really gonna suck for the GOP - no matter what happens!

Posted by: JohnQuimby | September 2, 2009 8:29 PM | Report abuse

So what happened to the legendary legislative skills of former Rep. Rahm Emmanuel?

Posted by: edwardallen54 | September 2, 2009 8:32 PM | Report abuse

If she were alive, Frances Perkins would be appalled at President Obama's utter lack of courage to stand up for the promised health insurance public option. She'd be calling him the names I dare not write here.

Obama, and his Corporate Democratic WH team, have never fought to have the vitally important public option in this bill.

Look at what Rahm et all did for Big Pharma.

Teddy Kennedy, FDR and the genius of the New Deal: Frances Perkins are all watching this Obama disaster unfold.

This is Obama's profile with no courage.

I , for one, will not be voting for, contributing to, or volunteering weeks of my time for this crew of Corporate Vichy Democrats ever again.

Posted by: kirby2 | September 2, 2009 8:32 PM | Report abuse

The liberals have 60+ votes in the house to kill a bill with no public option. If the Blue Dogs had got on board early on this debate wouldn't be taking place. It is too early to say if or how many blue dogs will go down in 2010 as a result of not passing a health care bill. In any case, though, the liberals are at the wheel. If there is no public option there will be no health care bill.

Posted by: theonlytexaschainsaw | September 2, 2009 8:33 PM | Report abuse

The reason that 40 million people are not currently insured is that there is no market for them. They lie beyond the bounds of Capitalism, an unprofitable risk either due to age, pre-existing condition or penury. Each and every one of us, if we live long enough, eventual reaches a point when the market turns it's back on us. For older people, and the very very poor, we have put programs in place to sustain them. But for those with pre-existing conditions or the working poor that simply can't afford the premiums, there is nothing. They face financial ruin and death if medical problems arise. For those who cry socialism when Progressives try to help those people, I say show me the market for them? What you are really saying is there is no profit in keeping those people alive.

Posted by: FalstaffsMind | September 2, 2009 8:34 PM | Report abuse

If the Democrats grow a spine and force through some version of universal healthcare for all (which is what they were elected to do) they will forever be remembered as the party that finally brought the USA into the modern era - like the rest of the civilized world.

Eventually even those Americans currently believing the right wing lies will come to realize what a wonderful thing universal healthcare will be for all.

The Republicans will be remembered as the hypocritical "christian" party that wanted to help no one except the rich and those who don't even need help.

This is the deciding moment. Will America be seduced by the GOP hate, lies, bigotry, greed and corporate whoring? Or will we take an enlightened step into the future and realize that helping EVERYONE is really to the benefit of "WE the people".

To continue with the status quo is not only despicable, it is evil.

Posted by: scoobydubious | September 2, 2009 8:39 PM | Report abuse

Anything less than a bill with a public option and he will be seen as a loser and weak. Republicans will say Sarah's one Facebook page killed health care reform. They will gloat. Obama will be neutered. Just the thought makes me sick.

Posted by: ikea1 | September 2, 2009 8:43 PM | Report abuse

Anyone against a "public option" because it is "socialism" must also be against Medicare and Social Security. All three programs are one in the same. If you can stand there and say you' be willing to give up and social security payments, and any help from the government once you get older, then that's fine. The people yelling "keep government out of my Medicare" and "I'm not going to let socialism take my social security" are very sad, and hypocrites even though they don't realize it....which is doubly sad.
Stay consistent, argue for the abolishment of social security and Medicare, or come to terms with the fact that you are ok with socialism when the money comes to you, but against it when it goes to other Americans

Posted by: maurban | September 2, 2009 8:45 PM | Report abuse

You are assuming that Olympia Snowe from blue Maine is solidly behind her increasing hard-right Republican Party. Check out her unhappy comments after the Stimulus battle. She is a very popular Senator in a state where her party is poison. Considering how far she has been sticking her neck out on Health Care, I'd say she sounds like the perfect candidate to pull a Jeffords/Specter.

Posted by: DuaneW | September 2, 2009 8:53 PM | Report abuse

Anyone against a "public option" because it is "socialism" must also be against Medicare and Social Security.
--- maurban

Misinformation.

Medicare is actually pretty damn close to the concept of Co-ops.
Canada by the way IS state ( province in their case ) run co-ops.

Social Security is a plan that is closer to WHOLE life insurance ... you get as much out of it as you put in to it.
Don't pay anything into it and you get very little back.

Posted by: chromenhawk | September 2, 2009 8:55 PM | Report abuse

"The progressives will not accept massive scaling back with no public option."

Sure they will. What choice do they have?

Posted by: ostap666 | September 2, 2009 5:34 PM

What choice do they have? They have a choice between standing up for the majority of citizens in this country by only supporting a bill with a robust public option or they can throw the citizens of this country under the bus in order to kowtow to the political aristocracy in this country. If they choose the latter this voter will get a second job in order to donate every last dime of my 2nd paycheck to defeat every last one of them.

Posted by: pmorlan1 | September 2, 2009 9:09 PM | Report abuse

If Obama abandons his base on this most critical issue, after having let them non-stop since taking office, they will abandon him on everything, especially in 2012. Republicans will despise him no matter what he does.

Posted by: ssfs20007 | September 2, 2009 9:12 PM | Report abuse

Lefties on this board need to reboot with the BHO criticism, for just another couple of weeks.

Has anyone ever counted 50 senate votes for the public option? I think 43-44 has been the high mark to date. Thus, BHO has never been in a position to push for the public option to go through on reconciliation.

If lefties want to blame anyone, blame congressional dems. This whole argument is D vs. D - the R's are powerless and their town hall squawks mean zip if there are 50 votes for the public option.

As we get to the end game, BHO must make his choice. If he chooses a weak bill and declares "victory" then criticism is warranted. If he chooses a strong bill and loses, then criticism belongs with congressional dems for not putting together the right bill, and the votes. He tried and Congress didn't deliver.

If he chooses to fight and wins, then his poll numbers damn well better go back up, because this is the single hardest domestic problem to fix in the country.

Posted by: SimpleAnswer | September 2, 2009 9:13 PM | Report abuse

Here's an idea. Let's all stand up for what we believe and let the chips fall where they may. Radical. I consider Maine my home and I've never been a big fan of Sen. Snowe, but I have admired her conduct in the past year. If the Obama administration can't get 1 other Republican to support her, or even get the members of their own party to support their plan (is there one?), then who can blame her for not wanted to twist in the wind. I wouldn't trust the Obama White House to back me up either. If Obama thinks he can trust the Repubs or tosses the progressives over the side, might as well stick a fork in him. Let's make smores!

Posted by: riano | September 2, 2009 9:13 PM | Report abuse

So the Dems have the WH, a 10 (9 at the moment) seat Senate majority and a 79 seat majority in the House. And what are they doing on the one signature issue they've been waiting to tackle again? Decide how much "less generous" they should make their already watered down proposals.

This is exactly what I'm not a registered Dem. No balls at all.

Posted by: mikebythesun | September 2, 2009 9:27 PM | Report abuse

"might as well stick a fork in him. let's make smores!"
"this is obama's profile with no courage."

you think president obama lacks courage?
i think he has shown nothing but courage, facing millions of faces in a crowd, taking on virtually unbeatable opponents, and causes that the best politicians of our generation have failed miserably at....and it takes a lot of patience and courage to put up with the barrages of criticism.
i wonder how he keeps his faith at all, these days.


i just wonder, commenters....
do the people in your lives give up on you this quickly when you cant fulfill all of their needs and wishes in a couple of months?
or are you just so magical and dynamic, that moving from A to B is just a seamless,straight line for you?
i am glad that the people who put their faith in me dont give up on me this quickly.

the timetable for busy americans.....fix the world in six months.
do you ever make allowances for being human?
take the planks out of your own eyes.

Posted by: jkaren | September 2, 2009 9:42 PM | Report abuse

Designed to fail healthcare -- Keeps us insecure, fearful and in submission to authority.

Many reasons are there for Empire USA to keep our sick healthcare system in place, such as:

(1) The average American diet is 50% fat, and this not only causes 90% of illness, but doubles the profits in both the processed food and medical industries. So a healthy medical industry that promoted a 10% fat diet to keep us healthy, coupled with a steep tax on high-fat food plus a cash reward at the end of each year for those with no medical expenses, surely this would reduce our Gross National Product by 20% and increase unemployment by 15% to 25%,

(2) A great fear of the rich is the intelligent middleclass acquiring wealth and real estate, ownership of which rules the world. So most of the wealth that should pass from father to son among the middleclass, this is passed up to the rich by way of their get-rich-quick medicine.

(3) People in power who strive to reduce over population, surely this is the numer one cause of death on planit earth, just above deadly Empire USA, and allowing the rich to own our healthcare system is my idea of self-suicide.

(4) There has to be some logical reason why we in America are so submissive to authority. Especially when it forces us into wars unending, creates a bubble-burst economy that every 20 years shifts most wealth up to the top, creates a law enforcement system that houses 25% of all prisoners on earth, and now adds trillions to our national debt for generations to come. Now could it be that our medical industry keeps us so apprehensive, insecure and fearful that our stress reaches the sever depression onset level just thinking about defying the deadly force of government? For it does have a manopoly on the use of force and violence.

Posted by: Alabama_John | September 2, 2009 9:56 PM | Report abuse

Based on the sampling of comments I have read, there is one glaringly clear point about the opinions of most of the commentors: none of you has the foggiest idea what's going to happen. It's all (I mean 100%) conjecture at this point. All the pontificating from "The public option is dead" to "he is fooling you. he's going for single payer." are straight out of each person's backsides. How about *listening* to his speech, seeing the *actual bills* then *making a *rational judgment* for a change? That's Change I Can Believe In.

Posted by: williambentley2 | September 2, 2009 10:05 PM | Report abuse

We know now that Government by organized money is just as dangerous as Government by organized mob.

Never before in all our history have these forces been so united against one candidate as they stand today. They are unanimous in their hate for me‹and I welcome their hatred.

http://history.sandiego.edu/gen/text/us/fdr1936.html

Posted by: johnmacneille | September 2, 2009 10:12 PM | Report abuse

Republicians are not needed, just 51 Democrates will do nicely thank you. And if the majority of Democrates vote for it, pity any Democrate who fails to support it.

And so, as real healthcare reform the rich would never approve, profit killer that it be, surely it will a worthless bill that only a capitalist could love.

Posted by: Alabama_John | September 2, 2009 10:13 PM | Report abuse

As a long-term commenter here: Where did all these right-wing commenters come from? What swamp linked to this post?

Also: Ezra, can you explain the political logic behind why the White House plan has to be so far to the right of all the other plans out there? And why the reconciliation process -- which had recently been described as pushing the bill left-ward -- now is considered pushing even farther rightwards?

Posted by: Ulium | September 2, 2009 10:13 PM | Report abuse

Just remember what Teddie so famously said: "If we are a pale reflection od the opposition, we will lose, and will will have deserved to lose."
I have already told the callers from the variuos Democratic organizations that I will no longer give to general Demo fund raising because I do not want any of my contributions going to Pseudo_demos like the Congressman in Montana who only votes with the President 40% of the time. From now on I donate directly to the candidates who are True Blue--not Yellow. I urge others to do the same.

Posted by: atp2007 | September 2, 2009 10:16 PM | Report abuse

This is a no-brainer, politically. Make the right bill, get it to the floor of the Senate, and let the Republicans defeat it. Paint the Republicans as obstructionist and move on.

Ultimately we can get the reform that we want, as the current system can't last. But there aren't enough people hurting yet.

Let things go further downhill and try again in 5-10 years.

Posted by: jscott5 | September 2, 2009 10:16 PM | Report abuse

For those who say the 60 progressives have no where else to go and therefore have to submit to 50 Blue Dog have got it all wrong. It's the Blue Dogs that are being attacked by constituents and have no where to go. They're running scared. The Progressives are safer in their districts. Progressives know the healthcare bill is really about the heart and soul of the Democratic Party. They should not cave in. I have already decided not to donate anymore to Obama, the DNC, the DCCC, the DSCC because they share the funds with Blue Dogs. I will sit out the 2010 and 2012 elections. I will not vote for Obama. You think I have no where else to go. Hmmm, I can stay home. This former life long Democrat will wait until there's a third party as a GOP Lite and the real GOP isn't a choice anymore.

Posted by: d-seid | September 2, 2009 10:21 PM | Report abuse

So what are the odds that the cost-cutting will be on the backs of the poor as usual. I have seen no info on any restrictions/enforcement measures to preclude premium hikes by the insurance companies after the bill passes. Just like the credit card companies, they will just adjust their rates to make their profits stable. Moreover, currently the govt isn't properly enforcing the illegality of purging and rescission, so how's all this new "regulation" going to be enforced??

Drop that percentage paid by insurance companies to 65% rather than 75%, so the consumer will get raised premiums (based on the company's having to pay for insuring those with pre-existing conditions, no doubt--never mind the millions of healthy young people added with the individual mandate) and we will also have to pay almost a third of the cost of any claim. In addition, no doubt the subsidy line will be dropped down to 250% of the poverty line, so once again all the people who make too little to be able to afford premiums/deductibles but too much to qualify for aid will end up bearing the brunt of the cost increases AND a fine if they decline the privilege. Meanwhile, the health insurance companies who RIGHT NOW are making record profits will still have blocked negotiated drug prices and the choice to buy drugs from Canada.

Once again, the insurance companies are being subsidized at the expense of taxpayers because the Dems are too scared to do a Bush and ram through a liberal bill. Damn right they're in trouble in 2010 elections. I didn't expect to get my choice, single payer, but I damn well expected a strong public option.

Posted by: aka3000 | September 2, 2009 6:58 PM | Report abuse


--------------------------------------

85% loss ratio people. a bill without a public option is not a sell out to an insurance industry that has 3% profit and will be forced to tighten their belts more than even before in an industry that is more regulated that any other. They're also getting their golden egg of Medicare Advantage taken away (which they should) so don't go acting like Big Insurance is making tons of profits on this deal. They're not.

Posted by: visionbrkr | September 2, 2009 10:22 PM | Report abuse

Ezra ...
You say ...
For one thing, the insurance market regulations don't work without universality, as you can't really ask insurers to offer standard prices if the healthy and the young don't have to enter the system.

Problem is ...
First, mandates will not pass via reconciliation. Competitiveness of the INSURANCE companies is not directly tied to the budget.

Posted by: chromenhawk | September 2, 2009 8:17 PM | Report abuse


-----------------------------------

people really need to pay attention. Mandates will not have to go through reconcilation. They will have enough Republican support (along with an end to pre-ex) to get through. I don't get what people don't understand about those two things being tied together. If you have a mandate and no end to pre-ex its a complete sell-out to insurance. If you have an end to pre-ex and no mandates you have a system that can't work because almost no healthy people will go into the system until the day they get diagnosed with Stage 4 cancer.

Posted by: visionbrkr | September 2, 2009 10:25 PM | Report abuse

Suggesting that liberals are being militant is absurd. They have said no mandate without a public option. That is all. We refuse to to see tax dollars subsidize a massive give-away to insurance companies. If you must give up the public option, remove the mandate.

Posted by: FalstaffsMind | September 2, 2009 8:12 PM | Report abuse


you really need to get an idea of how risk works. The trade-off for a mandate is not the public option its the end to pre-ex. Its about EVERYONE being accountable. What about that don't you get?? SO basically you'll forgo coverage until you get sick, right? And what money will be in the system to pay for that if we all did that? Ya i thought so, NONE.

Posted by: visionbrkr | September 2, 2009 10:30 PM | Report abuse

don't go acting like Big Insurance is making tons of profits on this deal. They're not.

Posted by: visionbrkr

question then, who is making all the money in health care?
we pay twice the average of industrial nations

Posted by: johnmacneille | September 2, 2009 10:36 PM | Report abuse

As a long-term commenter here: Where did all these right-wing commenters come from? What swamp linked to this post?

Also: Ezra, can you explain the political logic behind why the White House plan has to be so far to the right of all the other plans out there? And why the reconciliation process -- which had recently been described as pushing the bill left-ward -- now is considered pushing even farther rightwards?

Posted by: Ulium | September 2, 2009 10:13 PM | Report abuse


I'm sorry do i need my SEIU card to join in a conversation? Maybe we came from the fact that we've been around but we've been the silent majority (yes majority as polls earlier this year said that a majority of 40% of americans considered themselves conservative). Now when Obama over-reaches on healthcare, cap and trade and immigration reform (coming down the pike) we can't stand idly by.

Posted by: visionbrkr | September 2, 2009 10:37 PM | Report abuse

Obama's base is sick and tired of all of his compromising. Their line in the sand is a public option. If he does not address the public option and take a specific stand during his address, he will seriously erode his already flagging support with his base. It's time for Obama to man up.

Posted by: TripLBee | September 2, 2009 10:39 PM | Report abuse

If the insurance companies agreed to insure those with pre-existing conditions, stop canceling polices and reduce rate increases, what are they waiting for? Nothing is stopping them from doing any of this now. It appears to be all talk. No public option will be the end of Obama's base. It won't matter if the base has no where else to go. They won't show up for the Dems or Obama from now on. Obama's base are the grassroots, the activists, the worker bees. These kind of voters don't stick around when they have been sold out. They are counting on the public option. If they don't get it, their gone.

Posted by: xargaw | September 2, 2009 10:41 PM | Report abuse

don't go acting like Big Insurance is making tons of profits on this deal. They're not.

Posted by: visionbrkr

question then, who is making all the money in health care?
we pay twice the average of industrial nations

Posted by: johnmacneille | September 2, 2009 10:36 PM | Report abuse


---------------------------------------

AFL-CIO had a report in 2006 that had insurers profits at 15.3 Billion dollars. A lot I agree but its gone down since then. The profit margin then 7.1%. now its 3.5%.

Medicare and Medical Fraud as mentioned by the Inspector General of the HHS is upwards of 10% of the system annually. At this point that would be about $220 billion dollars. (2.2 Trillion x 10%)

Who's greedy now?

Posted by: visionbrkr | September 2, 2009 10:46 PM | Report abuse

If the insurance companies agreed to insure those with pre-existing conditions, stop canceling polices and reduce rate increases, what are they waiting for? Nothing is stopping them from doing any of this now. It appears to be all talk. No public option will be the end of Obama's base. It won't matter if the base has no where else to go. They won't show up for the Dems or Obama from now on. Obama's base are the grassroots, the activists, the worker bees. These kind of voters don't stick around when they have been sold out. They are counting on the public option. If they don't get it, their gone.

Posted by: xargaw | September 2, 2009 10:41 PM | Report abuse


---------------------------------------

they don't do it because people would game the system. no one would be covered UNTIL they needed to be covered and costs would skyrocket farther past their current unsustainable level. I can't get how people can't see that??? You need to stop drinking the kool-aid of the left and pay attention to simple econonic facts. Big Insurance CAME TO OBAMA with this last year as the reform process started. Most every insurer has stayed on the sideline. They haven't campaigned against reform but for what they know is true reform because unlike anyone else they're entrenched within the system. Doctors aren't, they're only part. Hospitals aren't, they're only part. Pharma isn't, they're only part. Insurers are the only ones that are in every aspect of the healthcare sector from payer, to consumer to everything. Look to Ezra's posts of conversations with Karen Ignani of AHIP. He's spoken very highly of her.

Posted by: visionbrkr | September 2, 2009 10:49 PM | Report abuse

Senator Snow's heart is in the right place, though she needs to watch her back. She should follow her conscience and vote for the bill, then switch her party affiliation before the long knives come out. She'll be a lot more effective as a Democrat than as a Republican, where she's largely a pariah anyway.

Posted by: jpdonovan | September 2, 2009 11:01 PM | Report abuse

So, you think those supporting a public option have no choice in the matter if it is thrown under the bus. Really? If President Obama fails to support a public option, which actually is the only way real reform will work and which he promised during the campaign, then the choice of supporters is to simply throw up their hands in despair and opt out -- totally. I think the Republicans understand this and are acting accordingly. Too bad the White House and the Congress do not understand.

Posted by: ram9478 | September 2, 2009 11:01 PM | Report abuse

""a majority of 40% of americans considered themselves conservative""

I really don't think you understand what "majority" mean.

""they don't do it because people would game the system. ""

The insurance companies are gaming the system NOW which is the problem. Ask any small employer.

Posted by: tyromania | September 2, 2009 11:02 PM | Report abuse

""Senator Snow's heart is in the right place, though she needs to watch her back. She should follow her conscience and vote for the bill, then switch her party affiliation before the long knives come out.""

Snowe is actually pretty safe in her seat. There aren't any knife-wielders in Maine willing to come out against her. Her position is much safer than Specter's was.

Posted by: tyromania | September 2, 2009 11:04 PM | Report abuse

tyromania,

actually I DO. Majority doesn't mean over 50% if there are more than two options there pal.

http://www.gallup.com/poll/120857/conservatives-single-largest-ideological-group.aspx

40% conservative, 35% moderate and 21% liberal. And it wasn't 1000 people polled either it was 160,000+.

And insurers aren't gaming the system they're living in the system they're given. Employers costs are going up because THEIR CLAIMS WARRANT IT. give them a system with no pre-ex and everyone covered and costs would come down (well as long as you have a credible loss ratio which 85% is more than credible.)

Posted by: visionbrkr | September 2, 2009 11:09 PM | Report abuse

Amateur hour in the White House. It shows time and time again. If they are running national security like they are this health plan the amateurs are dangerous.

Posted by: neiman1 | September 2, 2009 11:11 PM | Report abuse

""Majority doesn't mean over 50% if there are more than two options there pal.""

Yes it does. Everyone here seems to give you a good ribbing for being a spokesperson for insurance industry. Now I realize that it's because you had a poor vocabulary, causing you to do poorly in school and the SATs, preventing you from getting a better, more productive job, leading you to become one of society's bottomfeeders. The word you were looking for is "plurality."

""Employers costs are going up because THEIR CLAIMS WARRANT IT.""

Well EXCUSE THEM for committing the crime of having an employee who contracted lymphoma, jerk. When insurance companies are playing divide-and-conquer with small business risk pools like that, it's called "gaming the system."

Posted by: tyromania | September 2, 2009 11:16 PM | Report abuse

James Buchanan as the 15th President also governed with and emphasis on compromise. His willingness to accommodate slave holders and secessionists set the stage for the civil war. He is often ranked as the worst President in US history.

Herbert Hoover also believed that half-a-loaf was better than none at all, and he lead humanitarian efforts which saved millions from starvation both here and abroad. But today he is reviled as the embodiment of elite indifference to the plight of the masses, not because he did nothing, but because he did not do enough when it mattered most.

Johnson and Carter both pissed off the base of their party in different ways, and both served only one term.

Clinton's willingness to "triangulate" and reach out to Republicans got him impeached.

The saddest thing about the mistakes being made by the Obama administration, is that anyone with half a brain and a decent knowledge of history can see exactly where they are leading. The lack of vision and perspective in the White House today is contemptible and inexcusable. Turns out Obama really is the empty suit his critics accused him of being.

Posted by: theo_mcc | September 2, 2009 11:27 PM | Report abuse

tyromania,

i am absolutely sorry. you are correct. plurality. See I can admit when I'm wrong. actually I did fine in school but thanks for showing how much a jerk you can be with your comments. I did very good on the SAT's but they were a long time ago. Conservatives have a PLURALITY. My job is plenty productive enough. Don't blame me because you're bitter with the system as it is. And its not gaming the system. Its living within the system as it is. They're most likely going to change it so pre-ex ends and insurers and I as well have welcomed it as long as everyone shares the risk. If you're an employer and your employees out out of coverage how is that fair to those still in when their costs go up? What's your answer? Single payer like in Oregon that now has a lottery to see who gets covered by Medicaid? TennCARE that exploded in cost?

Again I state that insurers profits 15.3 Billion and fraud and abuse of the Medicare system is many times more than that. So should we just hand the system over to those that have shown they can't manage it or to those that have shown in the 1990's that they can manage it?

Posted by: visionbrkr | September 2, 2009 11:29 PM | Report abuse

The dems have a majority in the House, a majority in the Senate, and 100% ownership of the WH. If all of the repubs do indeed vote nay on reform, and all of the dems vote yea, the bill passes and 'O will presumably sign it into law. What the he// is the problem here? We can complain about the "blue dogs" and the centrist dems but at the end of the day they are dems, voted into office as dems, and counted in the majority. Clearly, the problem here is with the dems, not with the minority party which has become irrelevant, right? Some folks want to blame the HC industry for the failures thus far in efforts to pass the reforms Main Street is looking for. But the truth is the industry and individual corporations would have no sway in this debate absent willing and greedy partners on the Hill, on both sides of the aisle, who wear price tags around their necks like Congressional bling bling. Sad to say, but that is the reality of the situation.

Posted by: realitysvoice | September 2, 2009 11:38 PM | Report abuse

My skepticism of Obama in the leadup to the primaries was always based in my perception that he wasn't selling solutions and goals so much as a giving supporters a chance to express their personal identity and selling a process that would make people feel good about themselves. He always seemed a little too unprepared to go toe-to-toe with an opponent. He figured he couldn't ever win the news cycle, so he never bothered to try. He always proved me wrong, of course, and ultimately I conceded that he, not I, had a strong perception of the state of the electorate and what was required to get things done.

But now I'm thinking he is good at recovering from mistakes but simply doesn't learn from them. He's given the Republican leadership a blank check to slander him and his ideas in the most dishonest way possible and allowed that to dominate the national dialog. With a strong base willing to work for him, he's basically let them stand on the sidelines while the Republicans went crazy with their bourgeois riots at townhalls.

Even if Obama pulls off good, comprehensive health-care reform, we're just going to face this same thing all over again. It's the Republicans who are channeling a lot of anger and activists, not Obama, and that bodes poorly for the future. One can't help but get the impression that his heart isn't in fighting the fights that need to be fought. He treats Republican tantrums and dishonesty as places to be negotiate from, not offenses to be punished. And his inner circle is publicly treating the left as a nuisance they wish would settle down rather than energy to be channeled.

Bush enjoyed playing the rancher/war president. I worry sometimes that Obama likes to see himself in the role of and play the "reconciliator president" and likes living this image of himself rather than doing what's required under the current circumstances.

Posted by: tyromania | September 3, 2009 12:02 AM | Report abuse

Just got home from a Republican Townhall with 1300 attending in a rural, red CA county. Guess what? There better be a public option because this crowd wants real reform. About 1/3 want private insurance but the rest want a real option that removes the huge profits from the whole equation in health care insurance.

Posted by: cordyc | September 3, 2009 12:16 AM | Report abuse

I really don't care who protest at the town hall meetings. These are the same type of people who protested against civil rights! Who stood on the steps with George McGoven blocking African Americans from entering a white school, who lynched blacks and would like to lynch Obama if they could! Screw them yes they can kissmyboot! The senior citizens protesting against government run healthcare is disgusting. I say kick them out of medicare, and see how that changes their tune. Here we have these people protesting against universal health with one foot in the grave! They themselves benefited from land mark legislation being passed in 1965! Granny get the hell out of the way! You have lived your life! Let your grandchildren live theirs with guaranteed healthcare!

Posted by: KissmyBoot | September 3, 2009 12:25 AM | Report abuse

While those who fear government offering a choice within public insurance are raising their voices, where are the voices opposing the government's forcing us to BUY something we don't really choose in the private market? There is NO other commodity that we are forced under government sanction to purchase. Yet. There is not even a term in economics for that. The public insurance option is smart and sensible, and if we are mandated to have insurance, that is an essential option. No one can ever be forced to buy what he or she cannot afford. Not EVER.

Posted by: Churchlady1 | September 3, 2009 3:23 AM | Report abuse

For those who think all we need is tort reform to fix everything, think again. In areas where it has been done, costs have not gone down. But if there is universal health care, if people don't have to worry about the costs of their medical care, there won't be nearly as many lawsuits anyway since they are mostly filed because people need to pay their medical bills. Also, lawsuits are much rarer when doctors apologize for mistakes. It's amazing what saying you're sorry can do to diffuse a situation.

I just hope we can get past all this political wrangling and fear-mongering and realize that Americans will be much happier if everyone can see a doctor when they need to and get any treatments when necessary without fear of costs driving them into bankruptcy. It's the right thing to do. People who are worried about cost, even a large tax increase would never come close to what most of us are paying in insurance premiums, not to mention our lack of raises because of their increasingly high cost.

This is right for the country. It's right for our families. It's right for us as individuals. It's just the right and compassionate thing to do. There's nothing to be afraid of. Just look at other countries that have a system in place. They wouldn't trade it for all our so-called "freedom" and their outcomes are better, too.

Posted by: WendyS9 | September 3, 2009 3:53 AM | Report abuse

I don't really understand the nature of a reform that allows you to "keep what you have today" if that's what you like.

The idea that junky reform is better than no reform may fly in DC but that is an inexplicable approach outside of the beltway.

If the "reform" is simply creating a bunch of regulations for docs to now follow (like the infamous section 1233 of HR 3200), and somehow adding the uninsured to a bloated and inefficient system without addressing how to pay for such an action - that's not much of a reform - and thus is hard to get people all fired up about its implementation.

Posted by: anne3 | September 3, 2009 6:57 AM | Report abuse

The compassionate thing to do! Since when did we become a compassionate country?

Health care is a commodity just like going to a mechanic to get your car fixed. If you can't afford to get it fixed, you'll have to either take up jogging, or ride a bike.

Posted by: MetalMD | September 3, 2009 7:13 AM | Report abuse

Look, visionbrk, we've been over this before. I don't care about insurance company profits. I get upset about the obscene compensation of their executives because that means they run their companies to increase their personal wealth, not to serve the good of the country. But even that's not the point. The point is WASTE. They waste enormous sums in their overhead. My God, you want them to get their loss ratios up to 85% when other countries have loss ratios 97% or 98%. In addition, they waste vast sums with paperwork aand making difficult to get what people need. Your job depends on the fact they have made the insurance situation so complicated we need another middle man to help us navigate through it. Compare that to France or any other weathly country.

You never answered the question of how other countries can provide better health outcomes as measured by all 16 of the bottom line public health statisics (OCED) and they do it at HALF the cost per person.

Our system is very inefficient.

Posted by: lensch | September 3, 2009 8:09 AM | Report abuse

I am a Democrat and desire a health care system that is fair and works for all. There is, however, a fundamental problem that isn't being discussed, and makes me fear that this round of reform will not solve the overall trend, where we see more of our GDP going into the health care bucket. I believe that this may be one the fundamental reasons that many citizens are so scared and acting irrationally - they see no end to the cost problem, in fact, see it as getting worse under this bill.

Please check out this thoughtful article in this month's Atlantic Monthly - http://www.theatlantic.com/doc/200909/health-care. It deserves to be read by serious people, especially those in Washington. Summarizing this article is very difficult in such a short space, but let me attempt to get to what I see as the real bottom line. With insurance covering the costs for nearly all health procedures, basic incentives are distorted and there is no mechanism for controlling costs. Additionally, doctors can essentially create their own demand by ordering more procedures, which the consumer accepts (why wouldn't we). The irony is that we end up with breathtakingly high costs that require insurance just to pay for basic services.

The author states that we must move toward a system that removes private insurance and Medicare from the center of the system and puts each of us, the individual, there. We would move toward a system, probably over a long period of time, where basic health care services are paid out of pocket, larger, expected costs are paid from individual's savings, and insurance is left to cover what it was originally meant to do, i.e. protect us from truly catastrophic situations, those that would bankrupt us.

The author points out that we see reduced costs due to improved technology in every industry except health care, and gives the following example to help elucidate his point: Lasik eye surgery is not covered by insurance, and the cost of the procedure has fallen drastically over the last 10 years. Since insurance is not funding this procedure, it is paid by the individual consumer directly, and they care about the price they have to pay. The providers have to respond to this and the prices tend to fall towards the marginal cost. MRI procedures, however, are covered by insurance, and he relates that his 20 minute procedure cost him $1200, where in fact the technology is old, and the marginal costs are low for this one procedure - a little electricity and a small bit of time for the doctors and technicians. Under the current system, these forces are never unleashed, and we end up consuming more and more of our GDP for health care each year.

Posted by: telluride1 | September 3, 2009 9:20 AM | Report abuse

Health care and my Mom

This blog is to follow the responses from the government and the media following a letter I sent on supporting healthcare reform. I plan to post all responses no matter what the content as the healthcare reform continues to struggle for life just as my Mom does.

http://reformformymom.blogspot.com/

Posted by: rogers_corey | September 3, 2009 9:37 AM | Report abuse

I'm divided over health care reform too. As a lifelong progressive who has always voted Democratic (since there is no other practical choice), I support what can only be described as a limp, watered-down, ghostly apparition of a rational health care system...the "public option".

Replace a very, very strong public option with nothing, or with some bad joke like 'cooperatives', and I will work for the rest of my life to elect the most insane rightwing crazies I can find, wherever I can find them.

Why will I do that? Because this nation will deserve nothing better. This is the defining issue, ranking above all others, including war and peace (which will come and go forever no matter what sensible people want).

This is it. Get it right or suffer the wrath of the supporters you have betrayed.

Posted by: Martel1 | September 3, 2009 12:48 PM | Report abuse

Since all people want access to affordable health care and since nearly all people will need health care at some point, health insurers exist not in anything like a 'free market' but instead in a market composed of free sellers and captive buyers. In point of fact, it is simply impossible to have anything like a 'free market' for health care insurance.

Insurance companies necessarily place one purpose above all others - profit. In order to generate profit, they have to find ways to eliminate expenses now that they have saturated the demand side of the market to the maximum profitable extent. In a market in which everyone wishes to buy their product, they quite obviously do that by eliminating those who might clearly need to generate company expense in the near future.

They also have no real interest in containing expenses for those who they permit to purchase their product, since they simply raise their 'premium' rates and include in those increased revenues enough to generate even more profit. There is a limit to that, of course, but enough people are desperate for the coverage that they continue to opt for paying rapidly increasing 'premiums' until it becomes an absolute impossibility. ('Premiums' being, obviously, that TAX we pay to private companies in order to receive health care and to avoid bankruptcy in the face of an imminent need for that health care.)

So the insurance companies earn profit by refusing to cover some people and raising rates to astronomical levels for others. They serve no other purpose. Why are they needed? More to the point, why are they tolerated, and why should American health care cost twice as much as better health care offered by government run health systems in all of the other industrialized nations of the world? Is it really necessary to continue to gut the American economic potential with a tax (almost equal to the entire amount paid to the federal government in taxes) collected by private companies which does nothing more than pay SOME of that money to health providers when we need care, while spending a large percentage of it to determine whose coverage they can deny? And if any 'reform' then prevents them from denying coverage to anyone, is there any point at all (even to themselves) for their existence?

Posted by: Martel1 | September 3, 2009 1:27 PM | Report abuse

If you watch cable news at all, you've seen the ads for “health care reform”, now being called “health insurance reform”. “It is an interesting subtle switch in language”. Mike Oliphant runs a small Utah health insurance website http://www.BenefitsManager.net and http://www.dentalinsuranceutah.net whom deals with people day to day struggling to find affordable coverage. “I think it’s important to not understate the huge difference in meaning between “health insurance reform” and “health care reform”. Let’s not lose focus on the need to reform a broken health care system which includes not only health insurance carriers but also billing practices of medical providers. Why isn’t TORT reform part of the national discussion? Studies show that alone could lower costs by 15% for both the medical professionals and health insurance carriers (Humana). Perhaps the federal government should take notice of what Utah has accomplished with first step of health insurance reform and promises for reform in the medical provider arena. Several interesting changes took place with the passage of H.B. 188. House Speaker Clark has championed the need for change while recognizing the experience of the private health insurance sector. To see more about this visit http://www.prweb.com/releases/utah_health_insurance/health_care_reform/prweb2614544.htm

Posted by: mikeoliphant1 | September 3, 2009 3:55 PM | Report abuse

*Why isn’t TORT reform part of the national discussion?*

It was. Republicans said that adding tort reform would not give them any reason to support the bill, so there was no point in adding that to it. In any case, states that have enacted tort reform do not have lower per patient costs.

Posted by: constans | September 3, 2009 4:50 PM | Report abuse

Whatever your feelings about the merits of any health care proposal, one thing is clear. This crowd in the White House can campaign but cannot govern. They wanted to make huge changes in the U.S. economy and way of life and they had not a clue what they were doing nor where they wanted to go. Scary.

Posted by: prosecutor1 | September 3, 2009 9:03 PM | Report abuse

Billions in giveaway to union VEBAs, billions to "community organizers", nothing about tort reform -- no one believes Obama anymore. The whole administration is acting stupidly. It is like Madonna expecting non-gay twenty year old men to be attracted to her -- eeewwww! The attraction is gone.

The non-koolaid drinker DO NOT BELIEVE OBAMA anymore! The stimulus pork, the handwritten cap-and-trade, the illegal UAW bailout that screwed bondholders, ACORN, Van Jones, etc.

This administration is a failure. We need a checks and balance on these radically lefties in DC. 2010 -- beware the wave!

Posted by: Cornell1984 | September 3, 2009 9:15 PM | Report abuse

All Mr. Obama has to do on Wednesday night is to display a chart with the names of each senator and representative and the amount next to that name received by each from 1.)"Health" insurance companies
2.)pharmaceutical companies.
At the bottom of that 2nd column, the total for 2008 should be shown, as well as the total for 2009 to end of July. Also, the grand total spent to influence legislation by these 2 should be shown. At least then, we'd know for whom our senators and reps are working...
Next, Mr. Obama should display the amounts spent year to date by "health" insurance companies and big pharma to kill any meaningful legislation. That would put his talk into meaningful context before saying a word about pending legislation.

Posted by: HonestPhil | September 4, 2009 7:34 PM | Report abuse

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