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20 questions

Nate Silver has 20 questions for liberals -- or anyone -- who want to kill the Senate bill. The first one is particularly good:

1. Over the medium term, how many other opportunities will exist to provide in excess of $100 billion per year in public subsidies to poor and sick people?

By Ezra Klein  |  December 16, 2009; 3:27 PM ET
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...$100 billion per year in public subsidies to insurance companies that are driven to maximize profit at all cost and will continue to screw people over at every chance.

There -- fixed for you.

Posted by: AZProgressive | December 16, 2009 3:33 PM | Report abuse

#15 on Nate's list is also important, particularly when it comes to choice, competition, and cost control:

"Are there any compromises or concessions not having to do with the provision of publicly-run health programs that could still be achieved through progressive pressure?"

And voila, we have Joe Lieberman, the scourge of Democrats everywhere, now throwing his support behind a strengthened Medicare commission.

Now, if we can only get the world's most deliberative body to support Wyden's ideas of opening up the exchanges...

Posted by: The_Doc1 | December 16, 2009 3:40 PM | Report abuse

His last question is pretty good too.

Posted by: Mimikatz | December 16, 2009 3:48 PM | Report abuse

Nate Silver has too much rationality for the leftist blogosphere to digest. They love the self righteous tirade and petulant rant too much.

Posted by: cmpnwtr | December 16, 2009 3:49 PM | Report abuse

How many opportunities Democrats have will depend upon them. If they slink away and moan about evil, obstructionist Republicans, they won't get many. If they do what they should have done over the past 15 years and go out to listen to their constituency and educate themselves about the possibilities, they could have many more opportunities.

This problem is much bigger than the [however many million uninsured] and I am tired of progressives whose bills are being paid by their employers telling me that I don't understand what it is at stake here.

The uninsured are not "the" problem; they are a symptom of a truly dysfunctional health financing model. Convoluted financing methods to extend that model may make you feel good but it does not do much for medium term financial and physical well being of the nation.

Posted by: Athena_news | December 16, 2009 3:58 PM | Report abuse

And before you get all arrogantly self-righteous -- "Oh, this is the best we can get, grow up hippie" -- you know the Dems could pass this bill, and once it is signed, put a public option and Med-buy-in through by reconciliation. But they will never do that, because they are more concerned with corporations than people.

Posted by: AZProgressive | December 16, 2009 3:59 PM | Report abuse

Joe did not write the rules, but he is smart enough to use them. I suspect most who dislike him are showing envy.

Posted by: gary4books | December 16, 2009 4:15 PM | Report abuse

For some time now, I have thought that people who said they had to have 60 votes to get the Conference bill past the Senate were just ignorant.

Silly me. Ignorance means money in the bank for those who want to sell out and look like they were outvoted.

But after Senate debate on the Conference bill begins, 51 votes (or 50 and Biden) will pass a bill.

That is the rule and it is not reconciliation - it is a straight up vote.

Posted by: gary4books | December 16, 2009 4:18 PM | Report abuse

I'm not interested in "experts" asking questions.

I'd rather have them answering questions.

I've posted a set of questions here several times. For example: How many people will fall thru the cracks on this latest plan? Will recision be illegal? What about rejection of new policy holders based on pre-existing conditions? How much savings will occur in each of the next two decades? Will premiums go up or down, and for whom? How high will coinsurance be? What about annual and lifetime maximums?

Without answers to those kinds of questions, it is preposterous to suggest the bill is good (or bad).

Posted by: Lomillialor | December 16, 2009 4:19 PM | Report abuse

Like you or Nate Silver have any real comprehension of being forced to buy prohibitivley expensive health insurance - way beyond your means? Get off that.

Stop singing your homolies concerns for the impovershed. Your and Nate's track records speak for themselves. Not buyin it.

Posted by: ctown1 | December 16, 2009 4:21 PM | Report abuse


Why, without the competition of a PO, will not premiums continue to sky rocket? Not all Americans will have a cap on their out of pocket or premium costs, so why wont insurance companies just grab all the subsidies up front via premiums and continue to charge those people who aren't covered by the out of pocket/premium caps more and more? Why wont they use the fraud exception to continue recision? Why wont they continue to deny treatments based on the same reasons they due today? If they are allowed 10-20% of American income will they not just take it immediately?

Honestly, you or John Cohn or someone need to do a fairly detailed post explaining why the anti-bill people are wrong. Because I can see the problems with the bill and they look like killers, both politically and in terms of policy. The only answer from the other side seems to be that the subsidies will get thirty million people coverage -- but they don't seem to address any of the other points or the notion that the subsidies wont usefully cover the cost.

Posted by: kcraybould | December 16, 2009 4:23 PM | Report abuse

gary4books, sorry to say you're just wrong. There is no limit on debate for the adoption of a conference report, which means it can most certainly be filibustered.

Posted by: gedwards1 | December 16, 2009 4:34 PM | Report abuse

I have a question for Nate: Are you deluded enough to believe that medical subsidies won't be the first thing on the chopping block to balance budgets and/or when Republicans get control of congress.

I mean, seriously, subsidies? You've got to be kidding me.

Posted by: DAinLA | December 16, 2009 4:38 PM | Report abuse

The consumer protection ideas are nice and all, but why is there any reason to believe that they will be enforced?

Even if the insurers don't find a loophole, Obama's track record thus far suggests that he'll levy a fine of maybe 10 cents per person unlawfully rejected or rescinded, and the penalty for failing to pay the fine is that Obama will frown at you and give you a tax cut.

Posted by: mellifluent | December 16, 2009 4:40 PM | Report abuse

How many of the people who like the plan as it is now shaping up are employed by the government? Get your health coverage paid by the taxpayer?

If you are a public employee, this "reform" may seem just fine. For you, personally, there's no downside.

But if you are a private sector small business owner and employer? A contract worker or free lancer? Someone who must pay for your own coverage and perhaps that of others? It's not only a grave disappointment, it is genuinely enraging.

40 years of Republican crocodile tears for small business, primarily in aid of the best interest of their corporate supporters, was never able to convince me of something just a few months of this debate has done; Democrats haven't a clue about how things work in the private sector, and are totally out of touch with the lives and values of huge numbers of Americans.

You think the Dems are just giving the shaft to THE LEFT with this dog? Wait until you see the response of independents and moderates when they realized that Democrats walked away from efforts to increase competition and affordability in favor of a plan that will force them, under threat, to turn over their books to Uncle Sam and beg and grovel for subsidies.

This plan will prove to be a political disaster.

Posted by: mschumacher1 | December 16, 2009 5:03 PM | Report abuse


Coverage will rise to about 97% of the population, rescission and bias on pre-existing conditions (aside from a regulated price differential for certain categories) will be prohibited, and there are projected to be significant cost savings and lower premiums, although there's lots of uncertainty there. You can go research the latest CBO reports for more detail on cost. Hope that helps.

kcraybould- a 85-90% requirement for medical spending (loss) would force the insurance companies to spend premiums on medical care, not just pocket it as profits. While the market is far from perfect, there's still enough competition between insurers to prevent an insurer from jacking up all premiums.

Besides, this bill is only the first step in reforming the health care system. If competition doesn't work out and premium growth is unconstrained, there's nothing stopping the implementation of a public option or more strict cost controls.

Posted by: etdean1 | December 16, 2009 5:12 PM | Report abuse

"kcraybould- a 85-90% requirement for medical spending (loss) would force the insurance companies to spend premiums on medical care, not just pocket it as profits. While the market is far from perfect, there's still enough competition between insurers to prevent an insurer from jacking up all premiums."

Wouldn't the requirement just jack up the premiums, as they seek to recover profits that way (though, of course, if they did that, they would jack up the coverage too, so perhaps that is not as bad as I thought)

And where does the extra competition come form? Most places in the country currently are monopolies and quasi-monopolies. Th exchange doesn't change that, as far as I can tell, for most people.

"Besides, this bill is only the first step in reforming the health care system. If competition doesn't work out and premium growth is unconstrained, there's nothing stopping the implementation of a public option or more strict cost controls."

In our politics? It seems much more likely that the subsidies would be cut and the regulations gutted.

Posted by: kcraybould | December 16, 2009 5:29 PM | Report abuse

I'm going to disagree that our system has any skill at cutting subsidies, but even then, how is that an argument in favor of scrapping this bill in favor of a Unicorn bill that does everything right?

And you're absolutely right that insurance in most state markets is a quasi monopoly, with some insurers having something like 80% of the market. I'm a little heartened about the idea that OMB can approve national plans for the exchanges, which would help on that. So what prevents Aetna from jacking up premiums is that BCBS will swoop in and get their customers for a cheaper price. After all, while premiums right now are growing at an unsustainable level, they are somewhat limited. What's stopping insurers from jacking up premiums right now? At least under the bill they'll have regulated profits that force them to spend premium money on medical care.

By the way, I completely agree that a non-profit option (true non profit) is needed, and I supported the PO, but the PO was a necessary casualty. If people really care about the issue, they'll make a point of it in the 2010 elections and a PO of some sort will pass some time between 2010 and 2013. Given the alternative, I find piecemeal legislating a-ok.

Posted by: etdean1 | December 16, 2009 5:37 PM | Report abuse

That question should more accurately be stated as, "How many times will we actually get to give $300 billion in subsidies to a for-profit institution so that we can still be forced to pay a substantial co-pay if we become sick or injured?"

I guess another way of putting it is, "How many times will we get a chance to transfer $300 billion in tax revenues to a for-profit industry that provides an over-priced, low-quality product?"

My personal preference is, "How many times will Republicans be given a chance to dismantle Medicare and Medicaid under the cover of compensating for a $300 billion 'progressive' cash give-away to private insurers."

Posted by: besmit02 | December 16, 2009 6:07 PM | Report abuse

"But after Senate debate on the Conference bill begins, 51 votes (or 50 and Biden) will pass a bill."

The motion to proceed to debate of a conference committee report is privileged, and can't be filibustered.

But the motion to approve a conference committee report *is* subject to a filibuster.

So you do need 60 votes...

Posted by: davis_x_machina | December 16, 2009 6:11 PM | Report abuse

I would ask a 21'st question. Imagine a bill that has a public option, subsidies for those who can't afford premiums, no recission, no denial for preexisting conditions and delivery systems as proposed by the Republicans, that is, any policy approved in any state can be offered anywhere (still, no denial, etc). That is, no exchanges, etc. Do you think that would be a better bill than the Senate bill? I suspect a lot of people would.

Posted by: windshouter | December 16, 2009 7:53 PM | Report abuse


Thanks for your attempt to answer my questions, but your response seems to be based on the PREVIOUS senate plan, not the new plan, SANS public option or medicare-buy-in.

In recent days we've learned that annual maximum loopholes exist in the latest plans, so naturally, I am also wondering just how much we really know about these plans, especially now that the gvmt options have been removed.

There are at least 30 million uninsured now. We have a recession and high unemployment. Income is DOWN and few people who don't have insurance probably can't afford to buy it now or pay the gvmt penalty if they don't buy insurance. We also know that gvmt subsidies (as planned now) will not be sufficient to assist all these 30 million to buy insurance, and since there will be no gvmt option, that means we are about to create millions of criminals (Americans without insurance).

If Ezra and others are so sure this new plan is manna from heaven, why can't they answer my questions with specific details? No site I visit (and the CBO has not yet scored this new plan) has published these answers/details.

I don't make leaps of faith. I rely on specifics to make my personal decisions. I want answers, not factless political exhortations. That's why Sarah Palin and I will never see eye to eye on most issues.

Posted by: Lomillialor | December 16, 2009 9:41 PM | Report abuse

Why does Klein keep pimping Nate Silver. Silver is a former outsourcing consultant who is very good with baseball stats. He is worth a link when talking numbers but he knows absolutely nothing about health care except that it is cheaper to hire workers in India.

Posted by: PMuldoon | December 16, 2009 9:51 PM | Report abuse

Since when does the government need a thousand page bill to steal a hundred billion from its citizens?

Posted by: msoja | December 17, 2009 2:02 PM | Report abuse

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