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Jane Hamsher's 10 reasons to kill the bill

I've gotten a lot of requests to respond to Jane Hamsher's list of 10 reasons to kill the Senate bill. At this point, I'm not sure there's much in the way of productive dialogue to be had here. Some of the list is purposefully misleading and is clearly aimed more at helping activists kill the bill than actually informing anyone about what is in the bill. Some of it points out things that really should be changed in the bill but aren't central to the legislation itself, and are simply being leveraged to help activists kill the bill. But maybe there's some utility to putting the document in context.

1) Forces you to pay up to 8% of your income to private insurance corporations -- whether you want to or not.

"You," huh? For the 85 percent of the country already covered by health-care insurance, it doesn't force "you" to do anything at all. People on Medicare are not going to be paying money to private insurance. People with employer-based care will not see their situation change.

For the nearly 50 million Americans caught in the ranks of the uninsured, here's the deal: The bill expands Medicaid, a public program, to cover about 20 million of, uh, "you." Private insurance gets nothing. If you make more than 133 percent of the poverty line, but less than 400 percent, there's a huge system of new subsidies to help you afford private coverage. There are also new regulations on insurers forcing them to spend between 80 percent and 85 percent of every premium dollar on medical care, barring them from rejecting you or charging you higher premiums due to preexisting conditions, ensuring they can't place any annual caps on insurance benefits, and more.

But here's the catch: So long as insurance won't cost more than 8 percent of your monthly income, you have to buy into the system. You can't wait until you get sick or get hurt and and then buy insurance, shifting the costs onto everyone else. The cost of having a universal, or near-universal, system is that people have to participate. The promise is that, for the first time, participation will be possible.

2) If you refuse to buy the insurance, you'll have to pay penalties of up to 2% of your annual income to the IRS.

Again, who's "you?" If you don't have employer-based coverage, Medicare, Medicaid, or anything else, and premiums won't cost more than 8 percent of your monthly income, and you refuse to purchase insurance, at that point, you will be assessed a penalty of up to 2 percent of your annual income. In return for that, you get guaranteed treatment at hospitals and an insurance system that allows you to purchase full coverage the moment you decide you actually need it. In the current system, if you don't buy insurance, and then find you need it, you'll likely never be able to buy insurance again. There's a very good case to be made, in fact, that paying the 2 percent penalty is the best deal in the bill.

3) Many will be forced to buy poor-quality insurance they can't afford to use, with $11,900 in annual out-of-pocket expenses over and above their annual premiums.

How many is "many?" For a look at how various families will fare with reform and without reform, see this table, and this article. But if you don't want to click the links, this graph, which shows the financial risk that medical costs pose to families with different incomes with and without reform, tells the story:

Rec Reform - Dollars.jpg

The vast, overwhelming majority of families will be better off under this bill. The families in the greatest danger get the most help. They will have insurance that they can use, and if they need it, subsidies to help them afford it. Compared with the status quo, in which about 50 million people have no insurance and tens of millions more have insurance they can't afford to use, this is a massive improvement. As Jonathan Cohn writes, "This is a hugely progressive program to bolster economic security, the likes of which we haven't enacted in this country for a long, long time."

4) Massive restriction on a woman's right to choose, designed to trigger a challenge to Roe v. Wade in the Supreme Court.

The Senate bill is better than the House bill on this score, but it's still disappointing. That said, the restriction here is not on the right to choose, but on whether primary insurance covers abortion. In the House bill, the exchanges can't offer primary insurance that covers abortion. In the Senate bill, individual states can choose to bar abortion from their exchanges, but it is not the default.

5) Paid for by taxes on the middle class insurance plan you have right now through your employer, causing them to cut back benefits and increase co-pays.

"You" probably don't have these plans, which are tilted towards the rich, not the middle class. Your plan probably doesn't cost more than $23,000 a year. And if it does, the only part that gets taxed is the part in excess of $23,000 a year. The average family health-care plan costs about $13,500 -- almost a full $10,000 less than the plans this policy taxes. If we don't manage to slow the growth in health-care costs, this policy will, over time, hit plans that are less generous. But economists consider the excise tax, which functions as a tax on insurers who let premiums grow too quickly, one of the most effective cost-control mechanisms in the bill.

There's an equity aspect here, too: The problem with the excise tax is that it doesn't go far enough. All plans should be fully taxable. This policy begins to chip at the edges of one of the most regressive elements of our system: Health benefits, which are mostly given to better-off workers, are protected from taxes, while income isn't. A worker at Wal-Mart with no health benefits sees his entire paycheck taxed. If that worker goes to buy insurance on his own, the money he uses to buy it is taxed. A worker at Goldman Sachs with a $40,000 health-care plan is getting $40,000 of his paycheck tax-free. It's wildly regressive, and not something that liberals should support. More here.

6) Many of the taxes to pay for the bill start now, but most Americans won't see any benefits -- like an end to discrimination against those with preexisting conditions -- until 2014 when the program begins.

It's not even clear what Hamsher is referring to here (the accompanying link is broken). The main tax in the bill is the excise tax, which starts in 2013, not "now." And the bill isn't funded primarily by taxes. It's funded primarily by changes to Medicare. It would be useful if Hamsher explained what tax changes people are going to notice in, say, 2011. My understanding is that the answer to that is, essentially, "none at all." The word "many" is obscuring a lot more than it's illuminating here, making it seem as if the majority of the bill's funding mechanisms trigger immediately. They do not.

7) Allows insurance companies to charge people who are older 300% more than others.

The status quo is that insurers can charge people as much as they want, and they can refuse some people altogether. Hamsher doesn't present it this way, but the bill is a huge improvement on this front.

8) Grants monopolies to drug companies that will keep generic versions of expensive biotech drugs from ever coming to market.

This is correct. The bill gives pharmaceutical companies a 12-year exclusivity period, and then changes get 12 years atop that. It's one of the worst elements of the bill, and should be changed.

9) No re-importation of prescription drugs, which would save consumers $100 billion over 10 years.

This isn't really part of the bill, so much as it's a failure to pass a change that people have been trying to pass for a decade now. People should keep trying. But saying you'll torpedo trillions in subsidies and protections for the poor if you don't also get drug re-importation is a bit like saying you'll refuse to pay the sale price for this TV if Best Buy doesn't also let you use a coupon.

10) The cost of medical care will continue to rise, and insurance premiums for a family of four will rise an average of $1,000 a year -- meaning in 10 years, your family's insurance premium will be $10,000 more annually than it is right now.

It's not even clear what this is supposed to mean. According to the Congressional Budget Office, this bill reduces the average cost of premiums by a little bit for most people, and a ton for the people the bill directly affects. According to the Center for Medicare and Medicaid Services, the bill cuts spending in the long term. According to everybody, it decreases the deficit. The bill has at least five major cost controls that won't exist in its absence. Hamsher, earlier in this list, came out in opposition to two of them. And the bill does all this while covering more than 30 million people, ending the ability of insurers to discriminate based on preexisting conditions, creating a new and more competitive insurance market, taking the first steps away from fee-for-service medicine, and much more.

And that's the problem with Hamsher's list more broadly. The points about the bill's provisions are, in most cases, misleading. Sometimes, the facts are off. Other times, Hamsher obscures the affected population. But much more problematic is that Hamsher's list implies that the bill is failing relative to a world in which we don't kill the bill.

But in that world, there's still no drug re-importation. Still 50 million uninsured. Still rampant cost growth. In the world where we pass the bill, most everything gets somewhat better, if not good enough. More people have insurance. The insurance industry ditches its worst practices. Fewer families go medically bankrupt. More people catch diseases early, when they can be cured, rather than late, when they become fatal. People who would otherwise have died live. The medical system begins the process of updating itself for the 21st Century, and responding to the cost pressures it's placing on the rest of the country.

The world in which we kill the bill is a world in which everything just continues to get worse, and politicians are scared away from the issue for decades. A world in which we pass the bill is a world in which things get better, and politicians remember that they can pass big pieces of legislation that take on, or begin taking on, big problems.

By Ezra Klein  |  December 21, 2009; 3:29 PM ET
Categories:  Health Reform  
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Next: What Obama did, and didn't do, on health-care reform


Won't the 8% of income exemption just exempt much of the middle class right off the bat? And won't this provision ensure that the mandate will just fade away if costs continue to rise?

Posted by: eleander | December 21, 2009 3:50 PM | Report abuse

Congress and Obama can do better than this bill.

In all honesty, nothing much is really being done to address healthcare costs.

Second, I understand that income inequality is a problem in America, and one of the reasons (in addition to costs) why many Americans do not have health insurance. But in my humble opinion, we are using healthcare reform (through expensive subsidies) to alleviate income inequality, rather than addressing the problem of income inequality to alleviate the problem of the uninsured. At the end of the day, healthcare reform has become a very expensive wealth redistribution program.

There are better ways to address income inequality. There are better ways to address affordability (i.e. actually tackling healthcare costs head on).

Posted by: RandomWalk1 | December 21, 2009 3:52 PM | Report abuse

This conclusion is the essence of why you and Jane are talking past each other. Jane is comparing the bill to an ideal bill- though it's not clear to me why the simple addition of a public option or Medicare buy-in suddenly makes it that much closer to ideal- while Ezra is comparing it to the status quo. Jane, despite her talk of alliances with the right-wing, isn't saying don't do health care, she's saying start over and make it more ideal. Ezra is saying if you don't pass this, you're not getting the ideal, you're getting nothing for another 20 years. It's a political question, not a policy question.

Posted by: _SP_ | December 21, 2009 3:53 PM | Report abuse

'There are better ways to address income inequality. There are better ways to address affordability (i.e. actually tackling healthcare costs head on).'

True. Now get 60 votes in this Senate for them.

Posted by: davis_x_machina | December 21, 2009 3:56 PM | Report abuse


It might be helpful to compare this bill to the social security act of 1935, which, when passed, had some really bad elements. Most significantly, the bill excluded domestic and agricultural workers, which meant a large number of poor workers, especially African Americans, were not eligible for retirement or disability benefits. (The provisions were, of course, inserted to get the votes of southern senators who controlled key committees.) It also required people to pay into the bill for several years before seeing benefits. But subsequent legislation in the 1950s and 1960s expanded those covered to the point that it became a fairly universal component of the American welfare state. Indeed, even Barry Goldwater consistently voted on social security expansion in the 1950s senate. Now today is certainly different than the senate but social security shows that adjustments that broaden existing systems are far easier to pass than the creation of new components of a welfare state.

If this is the end of health care legislation, I too would be dissatisfied, but logically, it can be seen as the second step after medicare/medicaid toward the creation of a broadly universal health care system.

Posted by: Needs1 | December 21, 2009 4:11 PM | Report abuse

if Jane hates insurance companies so much then why does she have Aetna as an advertiser on her pages? I don't know if its a system related issue where she can't choose who advertises on there but to me its more than a little hypocritical. I've called her on it before and never get a response. To me if you're going to say you're above reproach you need to actually BE above reproach.

Jane can say that because "SHE CAN AFFORD TO GO WITHOUT COVERAGE" just like Keith Olbermann, Dr. Dean and other wealthy left wing pundits. Those hanging on by a thread with very little to their name that will benefit from this reform plan should remember this tact taken by her and them.

Posted by: visionbrkr | December 21, 2009 4:15 PM | Report abuse

Elander (first comment) makes exactly the right point. If costs continue to rise, the mandate drops off. This is a natural cost containment mechanism, and it incentivizes insurance companies to keep costs down so that they can keep us in that mandated racket that they negotiated.

This is the Obama admin's attempt at a "win-win" - good for business and good for consumers.

How well it works will remain to be seen.

Posted by: benintn | December 21, 2009 4:20 PM | Report abuse

One thing for sure this bill falls way short of the CHANGE that I and numerous others voted for. Those that are so concerned about the costs should be pointing out that there was an option that that the GAO report showed would be very cost effective. The sad thing is that this option was not even allowed on the table. Single payer Health Care! I love the way supposed supporters of this bill conveniently ignore this.
I wonder what Jefferson would say about this Bill and what type of action he would endorse?

Posted by: raypc800 | December 21, 2009 4:21 PM | Report abuse

Wow, that's really rich that Ezra is calling other commentators purposefully misleading after his turd of a Senate Health Care bill apologia. Ezra, how you say that the bill is what the president campaigned on. This is so patently absurd I know you know better. Here's a (probably partial) list of major things Obama campaigned on that aren't in the bill

Public option
Employer Mandate
No individual mandate
Government coverage of catastrophic costs
Drug reimportation

Say this is the best we can get. Say you think its a big improvement over the status quo if you think so. But you know this bill well enough that's its simply dishonest, or 'purposefully misleading' if you will, to pretend this bill is what Obama campaigned on. People come here for information about Health Care, not disinformation.

Posted by: DrDoug1 | December 21, 2009 4:28 PM | Report abuse

In response to raypc800

I would love for a single payer system to be passed. It would be the best, most cost effective system the US could pursue, though it would likely create some fairly chaotic years of transition.

However, it's difficult to imagine how legislation enacting a single payer system could be passed by this Congress. In lieu of such a system, I will support a bill that reduces costs (though they're still high) and mitigates the discriminatory tactics that insurance companies currently utilize (and will continue to utilize in the absence of this bill). In a debate between this bill and the ideal, this bill loses. In a debate between this bill and the possible, this bill wins.

Posted by: Needs1 | December 21, 2009 4:30 PM | Report abuse

Re point 8) "Grants monopolies to drug companies that will keep generic versions of expensive biotech drugs from ever coming to market."

It's my understanding that currently there are NO generic versions of biotech drugs allowed, so while it is arguable 12 years is too long to protect a patent, it is a fair improvement over "FOREVER."

Posted by: DCista | December 21, 2009 4:35 PM | Report abuse

Excellent Ezra, thanks.

Posted by: LiberalForReal | December 21, 2009 4:35 PM | Report abuse

Ditto what _SP_ said. Ezra is the member of the reality-based community here.

Jane and FDL have done a vast amount of good pressing for a better bill, and they need to keep pressing for a better bill. But the whole ballgame is hanging by a conservaDem thread that can be easily unraveled if the House presses too hard at the urging of FDL and friends. I hate it, but that is the way it is.

Posted by: wvng | December 21, 2009 4:37 PM | Report abuse

Ezra, once again, thanks for taking the time to do this. Even though you've explained all these things multiple times before in previous blogs, it's so much easier to have you do it again, in this format (responses to FDL's take and to Republican talking points), than it is for us to search the bill, the manager's amendments, your previous blogs, others' previous blogs, and related articles). :)

Still one question re: start date for restrictions on insurers (pre-ex condit, rescissions)... thought those kicked in immediately, not later. No?

Posted by: onewing1 | December 21, 2009 4:40 PM | Report abuse

""You" probably don't have these plans, which are tilted towards the rich, not the middle class."

This is pretty close to incorrect.

Geographic variations in care is significantly more of an issue, meaning states like California, Massachusetts, New York, Florida are disproportionately impacted by these taxes. There have been a number of studies looking at this impact-- none suggest that this is about the rich having "Cadillac plans." In fact, the new Health Affairs has an article suggesting that 4% of the total variation in premium costs are accounted for by overly generous benefit packages. As others have shown, variations in care is a key driver instead.

The taxes may be good policy, but they will unquestionably impact the middle class in certain states. It actually causes me to doubt whether these taxes will be in force in 2015-ish when the taxes starting kicking-in for a reasonably large chunk of people. Based on the project impact, there's a reasonable chance these taxes are pulled long before any real increase in tax revenue is seen.

Posted by: wisewon | December 21, 2009 4:42 PM | Report abuse

The contrast between Ezra and the Post's "premier" Op-Ed writers like Samuelson is simply painful. I do wonder how long Mr. Hiatt will endure actual substantive thinking in his paper. Here's Krugman taking a too easy swipe at Samuelson's latest atrocity: What has health care reform ever done for us?

Posted by: wvng | December 21, 2009 4:44 PM | Report abuse

Hmm, no embedded code. Here's Krugman:

Posted by: wvng | December 21, 2009 4:47 PM | Report abuse

"I would love for a single payer system to be passed. It would be the best, most cost effective system the US could pursue, though it would likely create some fairly chaotic years of transition. "

NOT TRUE. There are other universal care models that would be more cost effective and palatable to the US public that would also provide some fairly easy transition options. The problem we have is that the liberal talking heads never bothered to consider any other universal model; they went straight from "single-payer doesn't have a chance" to talking about a convoluted public insurance plan that had ZERO to do with universal *care*.

As soon as the discussion started to focus on the [put your number here] million uninsured, it became a guaranteed bonanza for the insurance industry and a loss in terms of any kind of reform. Extending a broken model to more people is like building a new story on a house with a sinking foundation --- and ten years from now, that's just what people will be saying happened here.

Posted by: Athena_news | December 21, 2009 4:47 PM | Report abuse

I remember when the left prided itself on being the "reality-based community". I ask all those who would like to see this bill killed, (and who can point to many possible better plans - so can I, whoopie!), in what reality would any of those bills get 60 votes? Not this one.

Posted by: jeirvine | December 21, 2009 4:47 PM | Report abuse

Ezra, thanks much for this explanation. You've done some great work keeping us informed in a way that is factual and non-hysterical. Good on you!

Posted by: suekzoo1 | December 21, 2009 4:48 PM | Report abuse

"People on Medicare are not going to be paying money to private insurance. People with employer-based care will not see their situation change."

And people who have satisfactory coverage in the individual market -- a population that you ignore every time you write about the issue -- will see their premiums rise considerably as the new provisions are implemented before the mandate. For some reason, liberal talking heads don't think the think the 40+ million who are paying their own way today are unimportant. The focus has been on a) protecting people whose bills are paid by someone else and b) finding ways to fund more of the same.

I think its shameful that neither you, nor any of the other liberal bloggers you cite all the time seem to have given ten minutes thought to those who are already in the individual market. You routinely brush all objections aside by implying that the critics are ungenerous.

I didn't vote for Obama to increase the divide between haves and have nots -- and that includes those who have corporate benefits and those who do not. I voted because I wanted a *universal* health care plan. What we are now getting is an even more rigid stratification.

Posted by: Athena_news | December 21, 2009 4:57 PM | Report abuse

I can't see how the bill's opponents on the "left" are anything but a bunch of spoiled, insulated brats who have never had to even think about the terror of a serious illness with no insurance.

As a person who has, there are no words for my rage and disgust. This is Nader 2000, the 2009 Health Care Edition. If I lose my insurance this year -- for which the small nonprofit I work for pays $35k a year -- I can't afford COBRA. And my MS medicine costs over $2000 a month. You gonna help me with that, Jane Hamsher, Glenn Greenwald, Markos K..., you selfish [bad word]s?

At least Obama went to West Point to make the announcement when he decided to kill and maim. I haven't heard one word of appreciation from these so-called progressives for the sacrifices they DEMAND from me and the tens or hundreds of thousands of other people, many much worse off than I, who stand to be gravely injured if this bill doesn't pass. Aren't you going to at least call me a hero, Jane Hamsher, as you demand I risk blindness, loss of ability to walk, loss of control of bladder & bowels, etc? Aren't you going to give me a medal to show how grateful you are? Or are you going to just stamp your feet and whine that it's your RIGHT not to have to pay for your share of medical insurance costs?

They are, in their selfishness and lack of compassion, and even in their ideology, almost indistinguishable from Republicans.

Posted by: JaneG | December 21, 2009 4:57 PM | Report abuse

Re point 8) "Grants monopolies to drug companies that will keep generic versions of expensive biotech drugs from ever coming to market."

It's my understanding that currently there are NO generic versions of biotech drugs allowed, so while it is arguable 12 years is too long to protect a patent, it is a fair improvement over "FOREVER."

Posted by: DCista | December 21, 2009 4:35 PM | Report abuse


Do you know how much those drugs cost? You seemingly are trying to justify corporations with 20% profit margins with the fact that well at least it won't be forever. At $40,000 a pop many life saving cancer drugs or actually life prolonging cancer drugs will be unaffordable for the masses. The system will still be unreachable for many. This to me was actually one of the points FDL was right about. I also really don't see them go after who is actually MAKING the monies from the system (doctors). Insurers are just doctors conduit for their profits while taking too big of a chunk for themselves.

Posted by: visionbrkr | December 21, 2009 4:57 PM | Report abuse

Ezra, you got tripped up into falling for even replying to these people. You could tell them the sky is blue all day long, and they will still believe its purple.

The FDL group is the absolute bottom of the barrel when it comes to intellectual/policy discussions on the left.

Posted by: truth5 | December 21, 2009 5:02 PM | Report abuse

Re point 5: I was just over at the "Mandates" post, where I mentioned in a comment that arguments for the surtax tend to be highly manipulative and misrepresent the situation. And here you are, playing the Goldman card. At present, although I'm not I'm not a highly paid financial industry executive (I'm not even highly paid), I am lucky enough to work for a company that provides comprehensive health insurance -- they estimate it's value at around $9000 for a single person. Not bad really, and I have no quarrel with paying a tax on the amount over $1000. (Nor would I quarrel with paying taxes on the full value, or higher taxes in general, if those taxes were helping to fund a truly universal HC system.) I can't be the only moderate income person in this position; and with insurance costs varying as they do from region to region, I suspect there are many in areas with high health care costs. Do you have figures that support your claim that only a very limited number folks will be affected? As you note, if insurance premiums -- in your framing "health care costs" -- continue to rise rapidly, more people like me will be subject to the excise tax. And more employers will be looking for ways to trim costs and pass those taxes along. The excise tax is great in theory, but what's to prevent it from being a disincentive to providing full comprehensive care and thus helping lower the standards for care across the board?

Posted by: sandrine1 | December 21, 2009 5:02 PM | Report abuse

Up is down. Night is day. And left is right. Numbers 1,2,3,5,6, and 10 could have come right out of an op-ed written by Karl Rove or the Wall Street Journal. Funny to see the left trying to kill the bill using the right's rhetoric.

Her argument is mostly from the perspective of individual rights. Never thought i'd hear a progressive make these arguments.

Posted by: MBP2 | December 21, 2009 5:14 PM | Report abuse

BTW: On bio-tech drugs patent exclusivity -- it will never be shortened as long as Bio tech companies are headquartered in the Dem strongholds of CA and MA. Can't have that.

Posted by: MBP2 | December 21, 2009 5:17 PM | Report abuse

MBP2 -- What makes you think progressives don't respect individual rights?

Posted by: sandrine1 | December 21, 2009 5:35 PM | Report abuse

Ezra, this great and quite a sensible way to do the wonkery on this topic.

Hope Left joins on this one.

Posted by: umesh409 | December 21, 2009 5:43 PM | Report abuse

I find it interesting that the thread basically goes blah, blah, blah ... another word for the blah is as usual settle, at least it is a start.
Until Corporate money is taken out of Politics and term limitations voted in. Our government will do as there great master the almighty Corporate backed $$$$$ commands.
For these true reforms to happen anyone care to name off any of our congressional members that would vote for these needed changes to cleanse our Government of it's oh so noticeable affliction??

Posted by: raypc800 | December 21, 2009 6:19 PM | Report abuse

""You" probably don't have these plans, which are tilted towards the rich, not the middle class. " -- Ezra Klein

So why then, are 2/3 of employers saying that they will be cutting back coverage to come in under the limit?

"Or are you going to just stamp your feet and whine that it's your RIGHT not to have to pay for your share of medical insurance costs?" --

As opposed to the 80% of citizens who are content to be charitable with other people's money? How can someone who doesn't pay anywhere near market rates for his/her coverage have the nerve to condemn those who do for voicing legitimate concerns about the consequences?

To be clear, there is a thriving market for individual coverage today. It is not perfect but the fact is, most of the people who do are currently paying will be adversely affected by this bill. They will not be eligible for subsidies and their premiums will become more expensive.

Ezra and his ilk always talk in terms of "average families" but the average is made up of a wide range of situations...and talking about families doesn't help the millions of singles who, even if they are "eligible", are unlikely to ever see a dime of subsidy.

Posted by: Athena_news | December 21, 2009 6:33 PM | Report abuse

@Athena_news, when Ezra uses average premiums, he knows damn well that the figure is not weighted by coverage, and that there are substantial groups in higher risk fields like coal mining and heavy industry where the "average" in the group and the "national average" have little relation to each other.

Hedge Fund Democrats and their hangers on don't much care about folks working in heavy industry, though. That's why they support free trade for the working class and protectionism for professionals.

He also knows perfectly well that when he gives the argument that the alternative to an individual mandate is an insurance death spiral, he is taking dictation from Kaiser and Krewe ... with the level of subsidies in place, the House version of the Employer mandate would work nearly as well, and a version where the "pay" portion when straight into the account of those employees in the health care exchange would work better than a 2% penalty. Sure, Nate Silver does not know enough economics to understand the point and has to take it on faith, but Ezra is just pretending when he overlooks such a basic point.

Most of all, he knows that he's out of his depth when it comes to issues like political legitimacy, so he simply must ignore that fact that the individual mandate to buy corporate insurance will be seen as "Taxation Without Representation", politically crippling any efforts to "make it better" under the "take what we can get and make it better later" strategy.

Indeed, that's part of the point. Its a substantial enough political poison pill that the health insurance companies (and Wall Street speculators, as witness health insurance company share prices) can be confident of shooting all the restrictions being so seriously studied by the CBO and loudly proclaimed by the Administration apologists so full of loopholes that they are only a minor annoyance, and well worth the price of the direct infusion of public funds into the private health insurance industry.

Posted by: BruceMcF | December 21, 2009 6:55 PM | Report abuse

Those of you who are making ad hominem attacks against Jane Hamsher know nothing about her. She is not rich, and she is a three-time breast cancer survivor who knows whereof she speaks when she talks about being stuck in nightmarish plans that deny coverage. You are truly disgusting people.

Posted by: TheFritoPundito1 | December 21, 2009 7:46 PM | Report abuse

how do you know "she is not rich"? Do you work for her? Are you her confidant?

Or just another one of her mindless adoring sycophants?

Hamsher is the one who's disgusting.

Posted by: sanelib | December 21, 2009 8:07 PM | Report abuse

Ezra, you can't buy insurance "the minute you need it." Insurers will have an open enrollment period. Also, the 8% affordability exemption is--bizarrely--indexed to health inflation, so it will get progressively harder to avoid the mandate.

Posted by: bmull | December 21, 2009 8:32 PM | Report abuse

"she is a three-time breast cancer survivor"

without passage of this health care bill, others will not have the chance to survive.
to those people and all of those who love them, this bill will make the difference.
every one of those lives is also a universe.
every life matters.

Posted by: jkaren | December 21, 2009 8:34 PM | Report abuse

The abortion restrictions are unconscionable and for that reason alone progressives should oppose the bill. Only those who believe the canard that people are dying due to lack of insurance (as opposed to lack of good healthcare) could think this bill is a net benefit to lower-income women.

Posted by: bmull | December 21, 2009 8:41 PM | Report abuse

Ezra, you can't accuse Jane of being "misleading" and at the same time pretend like the excise tax won't eventually hit almost everybody. CWA has an eye-opening report on the tax:

As for bending the curve, you are the one being misleading. Your numbers are cherry-picked and your assumptions are rosy. CMS shows health spending at 21% of GDP in 2019.

What's the alternative? As someone who will probably benefit from subsidies, I say do nothing. I don't want my neighbors to have to pay for me to buy expensive insurance I can't afford to use. I want real universal health care.

Posted by: bmull | December 21, 2009 9:01 PM | Report abuse

bmull, Ezra has not ignored that at all, he's said that it's one of the BENEFITS of the tax that, if the cost curve isn't bent, the tax would hit far more plans. The reason why this is a benefit is pretty obvious. Health care costs can't keep going up like they have been forever or we're screwed, tax or no tax.

Posted by: Chris_O | December 21, 2009 9:22 PM | Report abuse

"Health care costs can't keep going up like they have been forever or we're screwed, tax or no tax."

Insurance premiums are not health costs. Provider charges determine premium levels and squeezing the middleman to try to effect cost control is a losing proposition.

Insurance companies can lower premiums quite easily by diminishing coverage. That's been going on for 2 decades. Even if we wring to get an extra 5% out of the insurance companies (which BTW is unlikely given the ratios in the bills), it would be a one time thing and pemiums would continue to rise as costs do.

And of course that most of those savings will come, not from executive salaries but from "customer service": shorter telephone lines, outsourced reps in India and the Phillipines, etc.

The secret to controlling the cost of care control provider charges. It's things like negotiating for bottom dollar rates on drugs, to stop rewarding hospitals for poor care that prolongs patient stays... that kind of thing.

Expecting insurance companies (whether private or public) to control those costs is like spitting in the wind; they've been trying to do just that for over a decade and look where it has gotten us.

Posted by: Athena_news | December 21, 2009 9:46 PM | Report abuse

"The abortion restrictions are unconscionable and for that reason alone progressives should oppose the bill. "


if this bill is not passed, would you be able to sit down face to face, with a critically ill person, who could not receive the care they needed because it was not passed, and tell them that you opposed the bill because of the abortion restrictions?

could you really do that?

Posted by: jkaren | December 21, 2009 10:05 PM | Report abuse

Your responses are typical of a young, healthy professional with a good income and employer-paid health benefits. Try being late 40s/early 50ish and involuntarily forced out onto the "consulting"/temp-professional/permatemp job market with no employer-paid benefits. Too young and too many responsibilities to quit working, too young for Medicare, your income cut by 30-50% over the last 5 years. This is the situation that millions of Americans have been forced into over the last 10 years, that they will never escape from, and to whom the great "bargains" that are about to come their way in health insurance don't look quite so great.


Posted by: sphealey | December 21, 2009 10:20 PM | Report abuse

Oh my, Ezra. No good deed goes unpunished. No matter how hard you try to be rational, it will do not good with this element of the left. I unsubscribed myself from firedoglake today because I was furious at Jane Hamsher's stupid and misleading email. There are plenty of things to argue about over health reform, but there's no need to be misleading about it. Keep doing what you are doing. Some will never get it or appreciate it.

Posted by: LindaB1 | December 21, 2009 11:54 PM | Report abuse

Ezra, you can't buy insurance "the minute you need it." Insurers will have an open enrollment period. Also, the 8% affordability exemption is--bizarrely--indexed to health inflation, so it will get progressively harder to avoid the mandate.

Posted by: bmull | December 21, 2009 8:32 PM | Report abuse

actually bmull open enrollment periods typically are in employer sponsored plans and not individual plans. I'm not sure how the legislation takes that into account though although i'd love to know. If pre-ex is ended and everything else stays equal there is no reason that individuals can't necessarily pick up coverage whenever they want and then all that would do is increase cost at a time when people likely can't afford it while allowing them to opt out of coverage and pay a small fine when they do need it. Same thing happens in the individual market in NJ which has a short pre-ex window and no individual mandate. Individual prices in NJ are easily approaching $800 for a single person for horrible coverage. high deductibles, 50% rx coverage etc. They really need to ensure that open enrollment is somehow tied to individual plans too so people can't game the system and people that are sick aren't then negatively affected by others gaming the system.

its amazing to me that people think its OK for individuals to game the system but don't think its Ok for insurers to play by the given rules. Fine then, end pre-ex under those circumstances and then when people most need coverage and likely can't work to pay for it then they won't be able to afford it. Exactly how is that a solution?

Posted by: visionbrkr | December 22, 2009 12:13 AM | Report abuse

Those of you who are making ad hominem attacks against Jane Hamsher know nothing about her. She is not rich, and she is a three-time breast cancer survivor . . .

Posted by: TheFritoPundito1 | December 21, 2009 7:46 PM | Report abuse

really? How do you know her net worth? As a former movie producer and owner (i suspect) of one of the most famous liberal blogs out there i'm sure she makes more than a recently laid off factory worker struggling to survive but hey that's just me. I for one would LOVE to know how much Ms Hamsher takes in from her ad littered website. Either way I doubt she'll be struggling to pay her health insurance or healthcare bills like so many Americans if this bill doesn't pass. Again she's VERY hypocritical.

Posted by: visionbrkr | December 22, 2009 12:48 AM | Report abuse

It's sad to see the estimable Jane Hamsher, in her opposition to the healthcare bill(s), adopt Joe Lieberman-style tactics. As a Medicare-for-All proponent, the approach in these bills would not be my first choice. But the bills go a long way toward accomplishing what is the vital goal: more people with health insurance in a country where all citizens should have such insurance, as well as first-rate medical treatment.

Posted by: fredbrack | December 22, 2009 1:46 AM | Report abuse

Klein's arguments are utilitarian: if total uninsured goes down, then it is okay if some (millions) of individuals are screwed over, as long as costs/health improves.

FDL's arguments are rights-based: a bill that increases health and decreases cost is still unjust if a significant number of people are made worse off by it (say, but the mandate).

It doesn't matter how many times you say mandated insurance decreases the total number of uninsured, if you don't confront her basic accusation that it makes a lot of people worse off.

Posted by: Ulium | December 22, 2009 1:58 AM | Report abuse

100% agree with JaneG.

Posted by: kisfiu | December 22, 2009 6:08 AM | Report abuse

Ulium that argument would work better if it came with numbers. How MANY millions get "screwed over"?. Basically it works out to self-employed workers making $66,000 to $100,000. Because most of the families in that income band would likely have one or both workers with employer paid family insurance.

FDL's argument is that college educated median income plus households have no obligation to make any sacrifices to pay for health care for 50 million uninsured Americans. If a single dollar goes to a private insurance company. On the other hand they would be perfectly happy to pay equivalent taxes and more for universal single payer with no requirements for any cost-sharing at all (read the text of HR676 prior to the Weiner Amendment). That is not an economic argument, that is a purely ideological one, at least once you express it in dollars.

I was looking at the CBO score this morning and something struck me. Actually this bill moves 40 million people into new insurance and not 30, 30 is just the net. According to the score 4 million people net will move out of employer provided insurance and 5 million out of current non-group. Since employers can't force employees into Medicaid this means you have nine million people mostly voting with their feet, either choosing to enroll in Medicaid or moving to what is presumedly going to be a lower cost plan via the Exchange. So we have 30 million net new and close to 10 million net improved against around 16 million legal non-elderly uninsured (the remainder of the 23 million uninsured being undocumented) an undetermined fraction of whom would rather remain uninsured rather than pay a nickel to an insurance company. 40 million with new or improved insurance vs a relative handful of diehards. And they want to present this as a matter of principle!!?

Jane and slink have done some valuable work particularly as the bill got worse and worse over the last eight weeks or so, but the bill they are objecting to is not the one that came out of the Team of Ten and is squeaking through the Senate right now. They both lost focus and took their eye off the prize and as a result are sounding unhinged.

The 85/80 provision is huge and potentially rescues the bill all on its own. It was stripped out of the HELP/TriCommittee versions by SFC and the Pelosi version only to magically reappear at the last minute. It all by itself guts most of the insurance companies' predatory model, if you sit down and think through the implications. Something Jane et al have seemingly failed to do.

Posted by: BruceWebb | December 22, 2009 10:23 AM | Report abuse

"There's a very good case to be made, in fact, that paying the 2 percent penalty is the best deal in the bill."

That statement alone provides a very good case that any ties Ezra has to Aetna, etc. (or any ties his editors/publishers have) should be looked into.

Posted by: henry_blankett | December 22, 2009 11:08 AM | Report abuse

Bruce Webb:
How MANY millions get "screwed over"?. Basically it works out to self-employed workers making $66,000 to $100,000. Because most of the families in that income band would likely have one or both workers with employer paid family insurance.

Spoken like someone with employer insurance who has likely never been self-employed or worked at a small business that did not provide coverage. You say the only people who will get screwed over are "self-employed workers making $66,000 to $100,000......likely have one or both workers with employer paid family insurance." That's quite an arrogant assumption; employer based coverage is NOT the norm in this country anymore.

Perhaps you're unaware, but our economy has shifted to service-based jobs. Generally these jobs do not offer coverage. THAT'S what is not being addressed. Your personal trainer, your massage therapist, the sommelier and the chef at your favorite restaurant, your dry-cleaner, your barber, your dog- walker, these are the people that you think it's okay to screw over? Well, there can't really be that many, can there? What you're saying is it's okay that the whole middle class gets screwed? We already pay the bulk of the taxes, I guess we should just STFU and be content to be the first generation of Americans who will not fare better than our parents.

FDL forever!

Posted by: hotpinko | December 22, 2009 12:02 PM | Report abuse

The problem here is that Ezra is equating "health insurance premiums" with "health care costs". The excise tax will only slow health insurance premium costs, not overall costs. The assumption by the CBO and Klein is that employers aren't presently efficient in shopping for health care. I can't speak for all employers but here in Montana we only really have 2 insurers who control 98% of the market. Our company plans premiums have increased a total of 300% over the past 10 years. Our coverage has declined so much that I pay more in deductibles, co-pays, and uninsured medical expenses than I do in premiums. For a family of 4 healthy people, I, since I'm the owner of the business pay $12,500 for a plan with a $3000/person, $6000 family deductible with no co-pays. There is no dental, optical, drug benefit or anything else. It's managed care so I don't get to choose my physician and everything must be preapproved. Since my son needed oral surgery for an infection in his mouth (not covered), and since my wife needs an antidepressent costing $150/mo., I will pay over $25,000 in premiums and health care this year. This bill will do absolutely NOTHING to improve that situation. If I have another year like this year in terms of the recession and health care, my 20 employees will be joining those uninsured, because my business and myself will be bankrupt. But, at least then we can get some crummy insurance in 2014!

The problem is that neither Ezra, nor anyone in Congress understands what it's like for small businesses which actually try to supply health care. By 2014, assuming my premium costs go up another 25% like they have every other year, I'll be broke anyway. Of course, by then the Wapo will be out of business, so Ezra might have a little bit more sense of urgency.

Posted by: buley | December 22, 2009 2:23 PM | Report abuse

When somebody is this intentionally misleading they are usually getting paid by someone to do so. Who wants to kill the bill enough to generate faux "progressive dissent"? How transparent is FDL's donor list?

Posted by: BillTibbitts | December 22, 2009 3:58 PM | Report abuse


you said:

That's quite an arrogant assumption; employer based coverage is NOT the norm in this country anymore.

Uh, actually yes it still is the norm. See the Kaiser Family Foundation for your proof. But hey why let facts get in the way.

Posted by: visionbrkr | December 22, 2009 7:09 PM | Report abuse

I also especially LOVE Ms. Hamsher's backtracking today on FDL. Well, wait, I didn't want to KILL the bill, I was just trying to strengthen it. I was just uh, "NEGOTIATING" through the conference committee. Well if that TRULY was the case then why not say that? Why not say, "I don't want to continue to have 45,000 people die each year" that I used personally as a talking point all througout the year.

All FDL has proven to do is push itself further out to the left and further into obscurity when it actually had the chance to move itself in front of more Americans to prove many of its valid points. Its a shame (IMO) for good writers on there like Jon Walker.

Posted by: visionbrkr | December 22, 2009 7:19 PM | Report abuse

Wow. I love how if you don't accept this lousy legislation you're called an "activist" as if it's a bad thing...or some other name. You're more than welcome to rely on "the tranquilizing drug of gradualism" (Dr. King), but some of us are not.

You're going after the messenger and not the message.

I don't care what numbers you throw around, if you are the working poor; if you have 2-3 jobs and still don't make ends meet, do you know what percent you have for health care? ZERO. Not 8%, not a 2% fine. You have nothing. You can't afford a co-pay...and ever increasing co-pay.

And it's alarming how many folks are saying that crappy legislation from 75 years ago makes it OK for crappy legislation now. What kind of ridiculous logic is that? I thought we're supposed to learn from mistakes, maybe even evolve a bit.

This country suffers from political Stockholm Syndrome.

Posted by: bedasso23 | December 22, 2009 10:15 PM | Report abuse

Ezra, thank you for this coverage. Can you tell us, and perhaps Buley above:

1. What will those of us who pay a 2% penalty get if we need healthcare? If the 2% penalty is "the best deal", what exactly IS the deal? (And, Should Buley take that deal?)

2. The 80-85% provision requires insurance companies in the exchange to spend that amount for healthcare, or reimburse subscribers the difference. What's to stop the insurance companies from maximizing profits NOW, by increasing premiums and/or decreasing coverage, and establishing new baselines for plans in the exchange, and bilking the taxpayers right out of the gate? Also, don't you think that legislating 15-20% of every healthcare dollar be shunted AWAY from quality improvement is a stunning gift to Wall Street? If 15-20% was used to create an evidence-based medicine database and analysis team, or a best practices propagation effort, that would be something to cheer about.

3. I've tried reading the "Transforming the Health Care Delivery System" section of the Senate bill, and the legal language is dense. Might you--or someone-- write about the intended purpose of these innovations?

Posted by: clie | December 23, 2009 2:27 PM | Report abuse

What's sauce for the goose...
Hampshire is not advocating ditching the current Senate/House bill in favor of the 'status-quo,' as you implied in item #7 and in your summary, so you're somewhat guilty of trying to mislead us as well. She's clearly advocating going back to the drawing board, starting negotiations with Single-payer.
And you say 'Fewer families go medically bankrupt,' which sounds deliberately vague. This is after taking Jane Hampshire to task for her use of the word 'many.' Aren't 'few' and 'many' just the extreme polar ends of 'some?'

Posted by: Robert56 | December 27, 2009 10:19 PM | Report abuse

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