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Democrats released a compromise health-care reform proposal

PH2010020901444.jpg

On Friday, I posted about the guest list for the White House's health-care summit, but I missed the big news in the accompanying invitation (mostly because I didn't notice that there was an accompanying invitation). Here's the money bit:

Since this meeting will be most productive if information is widely available before the meeting, we will post online the text of a proposed health insurance reform package. This legislation would put a stop to insurance company abuses, extend coverage to millions of Americans, get control of skyrocketing premiums and out-of-pocket costs, and reduce the deficit.

It is the President’s hope that the Republican congressional leadership will also put forward their own comprehensive bill to achieve those goals and make it available online as well.

As the President said earlier this week, "I’m looking forward to a constructive debate with plans that need to be measured against this test: Does it bring down costs for all Americans as well as for the Federal Government, which spends a huge amount on health care? Does it provide adequate protection against abuses by the insurance industry? Does it make coverage affordable and available to the tens of millions of working Americans who don't have it right now? And does it help us get on a path of fiscal sustainability?"

That bit about posting a proposed health insurance reform package is important. I spoke to the White House over the weekend and they indicated that the president's package will not be a new White House plan, but a compromise between the House and Senate bills. That is to say, the White House expects that the House and Senate will have a compromise plan by February 25th.

That's not necessarily surprising: The two chambers were pretty close to agreement on a compromise package before Scott Brown's election threw everything into chaos. Presumably, that'll be dusted off for this meeting. The Republican response to this is that they're demanding that the House and Senate refrain from coming up with any unified plan before the summit, which is sort of an odd argument. In essence, the Republican position is that a free and frank exchange of ideas sounds great as long as the Democrats don't bring their ideas.

The fact that Republicans are making bizarre requests to change the rules of the summit rather than just ignoring the gambit altogether suggests they've not figured out how to deal with the event. This is the first time since the Massachusetts election, in fact, that's it's been them, rather than the Democrats, who've seemed confused. The White House deserves some credit for that, and we'll see if they can keep congressional Democrats in line long enough to press the advantage.

You can download the full letter here (pdf).

Update: Jon Cohn has more.

Photo credit: P Photo/Pablo Martinez Monsivais.

By Ezra Klein  |  February 15, 2010; 9:04 AM ET
Categories:  Health Reform  
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Comments

"In essence, the Republican position is that a free and frank exchange of ideas sounds great as long as the Democrats don't bring their ideas."

This has always been the Republican definition of bipartisanship.

Posted by: adamiani | February 15, 2010 9:22 AM | Report abuse

@adamiani: "This has always been the Republican definition of bipartisanship."

And it's seemed to be the D.C. Democrat idea of bipartisanship--the free and frank exchange of Liberal Democrat ideas, Republicans, Joe Leiberman, and Zell Miller need not apply--up until just recently. And the change seems to pre-date Scott Brown, to the point I'm wondering if that softening of the former anti-Republican hard line is coming directly from the Whitehouse.

That being said, I don't think the Republicans are confused. They are just attempting a strategy. No unified plan before the summit? Because that's "excluding the Republicans" again and "the American people say in polls that they hate this liberal Reid-Pelosi healthcare plan, and want it scrapped". And coming up with a unified plan is not "scrapping the current, bloated, tax-raising legislation".

Which is not to say any of those are legitimate objections, only that it isn't confusion, it's a strategy which may succeed or fail to varying degrees, depending on what is done next.

Posted by: Kevin_Willis | February 15, 2010 9:35 AM | Report abuse

Kevin, could you clarify that bit on when the softening towards including Republican ideas occurred? I'd say that they included Republican ideas right from the start by going for a private market-based solution rather than single payer, but surely it must have been the Senate Finance Committee bill at the latest. That isn't to say that Republicans do or should love that version of the bill, but it clearly incorporates "Republican ideas" to some extent.

Posted by: MosBen | February 15, 2010 9:45 AM | Report abuse

Hey Kevin-- How about more republican ideas, less republican rhetoric. We've all heard the talking points about uncompromising Democrats.

Let's just put aside the Gang of Six, and all the compromise and overreach in the Senate that led to jack-nothing because of Republicans looking at short-term political advantage over what's right for America.

Do you have any ideas that might actually help the problem, or is attacking the other side all there is?

The Republicans aren't confused. They don't have solutions and they don't want people to notice. Let them bring their own bill to the summit. I bet it'll be as popular and effective as Rep Ryan's mess.

The theme of this summit is simple, and ultimately non-partisan:

talk policy or step off.

Posted by: itstrue | February 15, 2010 9:48 AM | Report abuse

I could be wrong about this summit, but it seems to me to be a White House political ploy. Why did the Republicans ever agree to show up for this? To the extent the President cant get a final bill because of moderates in his own party, why would the Republicans agree to play the foil here? My sense is they've walked into a trap.

The stronger political tactic here would be to say something akin to we have no need to deal with health care reform now, and should be focused on jobs(or terrorism or whatever), and that the President's party controls both houses of Congress and if they have a plan worth passing, they oughta pass it, knowing that they dont have the votes and that health care reform would die.

Allowing the White House to change the narrative back to a Republican-Democrat divide being the reason health care reform died strikes me as nuts.

Posted by: zeppelin003 | February 15, 2010 9:48 AM | Report abuse

From a tactical point of view, Zeppelin makes a good point about Republicans losing control of the narrative. Getting off the subject of health care and onto jobs, wars and money would have been a shrewd move.

I think they really screwed the pooch on that one. Very out of character for those guys. Must have really caught them unawares.

Right or wrong, the R's will be fighting on enemy territory.

I'd real like to see a real policy breakthrough, but that would have already happened long ago. These Republicans aren't policymakers... they just play for keeps.

Posted by: itstrue | February 15, 2010 9:56 AM | Report abuse

back and forth, back and forth.
more name calling, recriminations and false starts.
more twists, posturing and contortions than one sees at le cirque du soleil.
they better just get something passed already.

Posted by: jkaren | February 15, 2010 9:59 AM | Report abuse

The Kabuki is getting old. That's for sure.

Posted by: itstrue | February 15, 2010 10:01 AM | Report abuse

more posturing from both sides is to be expected. Republicans will stall so nothing gets done because the status quo works for them election wise and Democrats will come in with their plans in hand and talk a game of bipartisanship but there will only be talk of tort reform, association health plans and selling across state lines (similar to the President's speech back in September). More of the same from politicans who are more worried about keeping their jobs than helping anyone.

Posted by: visionbrkr | February 15, 2010 10:05 AM | Report abuse

"Kevin, could you clarify that bit on when the softening towards including Republican ideas occurred"

I wasn't restricting my context to this bill, but even initially the public face of this legislative effort seemed to be "We (the Democrats) are doing this, then the Republicans will get to vote for it and take some of the credit, and that's bipartisanship!"

I could be mistaken. But from the point of a view of a casual observer, it seems like that approach of the Whitehouse and the Democrats now is to seriously attempt to do the bipartisan thing as one would objectively define it, where before it seemed bipartisan seemed to mean that the Republicans would be allowed to vote for this super-popular, ultra-awesome piece of legislation.

There may have been more bipartisanship going on behind the scenes at the outset, but the public face of the process seems, to me, to reflect a 180° shift from what it was.

Posted by: Kevin_Willis | February 15, 2010 10:12 AM | Report abuse

"to the point I'm wondering if that softening of the former anti-Republican hard line is coming directly from the Whitehouse."

There's no doubt about it; Obama is achingly, horrifyingly, unpleasantly sincere about his belief in bipartisanship.

We saw this going back to the stimulus, in early 2009-- Obama has very consistently appeared to believe that he could find a middle-way policy and get everyone to put aside their differences and sign on. This has not borne fruit, as Ezra has diagnosed, because we have political differences, not policy ones.

Posted by: adamiani | February 15, 2010 10:21 AM | Report abuse

I'm still convinced health care reform's actual chance of passing into law and being signed by the President in 2010 died the night Scott Brown won the election, and that all of this summit nonsense and "bipartisanship" talk is just a ploy designed to give the White House and Democrats in Congress something to plausibly say to their base about how they managed to snatch defeat from the jaws of victory yet again. I doubt it will work, and the bloodletting will be immense this fall, and Eric Cantor may end up being Speaker of the House as a result.

Posted by: zeppelin003 | February 15, 2010 10:22 AM | Report abuse

@istrue: "Hey Kevin-- How about more republican ideas, less republican rhetoric."

I'm all for that. Unfortunately, I'm not in charge of them.

"because of Republicans looking at short-term political advantage over what's right for America"

I expect they're looking that their future political successes as being so totally awesome for America that, compared to passing some Democratic-tax-and-spend-hodge-podge-mess-of-a-healthcare-bill, there's no contest. It may make you feel good to think about Republicans twirling their Snidely Whiplash mustaches while chortling in a most evil manner, but politicians tend of have an over-inflated view of their own self-importance, so tend to think their political victories are way more important for the good of the country than anything else. Thus, they aren't making some shrewd, self-serving calculation that they'll deny millions of Americans healthcare coverage so that they can get elected. They'll defeat some messy Democratic healthcare bill that wouldn't work anyway, and then they'll win majorities again, and lollipops and rainbows will ensue, just because they are so totally kickin'.

"Do you have any ideas that might actually help the problem, or is attacking the other side all there is?"

I don't think I'm really attacking the other side, and my ideas are the most banal and boring of the ideas the Republicans have already pitched out there. Health insurance portability via allowing insurers to sell across state lines (by fiat, not a "if the states and insurers all agree and hug" type of plan). Then extending medicare benefits to the unemployed.

Then, see if we can get that done without trying to micromanage the healthcare industry or put in mandates that have language that imply potential jail time for people who don't get health insurance or deal with end of life counseling, etc.

But, it's really not up to me.

Posted by: Kevin_Willis | February 15, 2010 10:23 AM | Report abuse

"it's them, rather than the Democrats, who've seemed confused"

Let's not jump to conclusions here. If the Democrats aren't confused, why even have this stupid summit? They should just pass their bill already. As for the Republicans, I can understand why they are confused: it's damn hard to see the point of all this. You think if they were at the brink of passing one of their prime legislative goals they would pause for a month to hear out the other side? I sure wouldn't.

Posted by: toweypat | February 15, 2010 10:28 AM | Report abuse

"Health insurance portability via allowing insurers to sell across state lines (by fiat, not a "if the states and insurers all agree and hug" type of plan). Then extending medicare benefits to the unemployed."

Throw in an employer mandate (because otherwise you'll have people who literally can not afford to work), and then a set of Federal Regulations so 'allow insurers to sell over state lines' doesn't become 'total removal of all insurance regulation' (including minimum coverage levels, a ban on discrimination for preexisting conditions, annual or lifetime payment caps, rescission, et cetera), and it'd probably be worth passing.

But I don't hear a lot of Republicans calling to expand Medicare to cover the unemployed. I just hear them calling for the total elimination of state-level regulation of insurance with nothing to replace it.

Oh, and tort reform. Of course.

Posted by: adamiani | February 15, 2010 10:41 AM | Report abuse

Kevin, the entirety of the reform plan was specifically designed to abandon various liberal ideas on HCR in order to come up with a plan that conservatives and moderates could accept. Nevertheless, you had people like visionbrkr and various republican senators who INSISTED that it was all a conspiracy to implement a government takeover of the health care system by implementing a British style NHS. Meanwhile, republicans could have gotten (and did get) many ideas incorporated into the bill they wanted, but they didn't support the very premise of HCR to begin with.

And, at the end of the day, you will remember that it wad Lieberman who was allowed to get whatever he wanted in the bill, to the point of being more conservative than even he had previously advocated.

Posted by: tyromania | February 15, 2010 11:08 AM | Report abuse

@adamiani: "But I don't hear a lot of Republicans calling to expand Medicare to cover the unemployed. I just hear them calling for the total elimination of state-level regulation of insurance with nothing to replace it."

Well, I think there is an understanding that you have to have a replacement of state-level regulation, if you abandon it (which you don't necessarily have to do--if I'm in Tennessee and I buy Texas health insurance, then that insurance is regulated by the state of Texas, I just get to buy it in Tennessee; that's one way to handle it).

I realize there aren't a lot of Republicans calling for the expansion of Medicare, and I understand why. I just think something along those lines would have been doable. And would have been done well before September, had they gone that route. That being said, I realize the Republicans aren't offering much (except Paul Ryan, who is offering a radical solution, rather than a conservative one). I would like it if they would come up with something. Admittedly, most liberals wouldn't like it (ala, The Contract with America), but right now there doesn't seem to be much.

And I support tort reform in principle, but I think the cost savings are probably limited.

Posted by: Kevin_Willis | February 15, 2010 11:15 AM | Report abuse

@tyromania:

"Meanwhile, republicans could have gotten (and did get) many ideas incorporated into the bill they wanted, but they didn't support the very premise of HCR to begin with."

Now, that's true. And if they did, they sure don't know, because there's blood in the water.

"And, at the end of the day, you will remember that it wad Lieberman who was allowed to get whatever he wanted in the bill, to the point of being more conservative than even he had previously advocated."

Again, my time frame for the original comparison stretches well beyond this bill, or even the Obama administration. And the Leiberman example is a good place to point to regarding when the Democrats (at least, the supposedly liberal ones) started going soft.

But you make good points. The Democrats and the Obama administrations approach on this has, on the whole, been oddly conciliatory, given their unprecedented majorities. I don't think the Republicans would have been quite so hesitant about taking advantage of a super majority.

Posted by: Kevin_Willis | February 15, 2010 11:21 AM | Report abuse

tyromania,

I love how I get lumped in with Republican senators in your mind.

how many times do i have to tell you I'd sign the senate bill today but I'd like to see more cost controls. As i've said ad nauseum (as has AHIP) what cost controls do to me is cost me money. I make less with cost controls. The status quo (in the short run) makes me more money but I'm 100% against it. If that is obstructionism please explain it to me becuse your definition of it and mine are completely different. It sound like you just can't get past your talking points to have a rational discussion. i know the status quo is unacceptable and unsustainable. i'd prefer that EVERYONE take a haircut though. That includes insurers, doctors, hospitals, unions, EVERYONE.

I also btw like Kevin's idea of medicare being assigned to the unemployed although for simplification it'd be better probably if it was medicaid.

Posted by: visionbrkr | February 15, 2010 11:24 AM | Report abuse

Insurance company' abuses? How about the abuses of Obama and his comrades against insurance companies in particular and Americans in general to force us to swallow the obamacare SCAM?!

Obama's backroom deals will force insurance premiums to go up! He's worsening the problem and using the problem to further demonize the insurance industry and force us to swallow the scam!

Obama's abuses forcing insurance premiums to go up include his secret deal with the pharmaceutical lobby through which Big Pharma can keep drug prices high in exchange for helping Obama enslave us with Obamacare.

"The memo... says the White House agreed to oppose any congressional efforts to use the government’s leverage to bargain for lower drug prices or import drugs from Canada — and also agreed not to pursue Medicare rebates or shift some drugs from Medicare Part B to Medicare Part D, which would cost Big Pharma billions in reduced reimbursements. http://www.floppingaces.net/2009/08/14/obama-pharma-make-secret-deal/

The health insurance industry's average profit margin is between 4 and 5 percent. Compare that with the profit margin of the pharmaceutical industry. The profit margin of Johnson & Johnson (JNJ), for example, is 20.76% http://www.lockergnome.com/swordofdestiny/2009/08/13/are-these-evil-for-profit-health-insurance-companies-really-so-evil/

We may have issues with insurance companies, but our main problem is not the insurance industry but Obama and his comrades, bent on forcing us to swallow Marxist scams like Obamacare.

Posted by: AntonioSosa | February 15, 2010 11:33 AM | Report abuse

You are right, zeppelin003. The “bipartisan” health care summit is just another trick from Obama and his comrades to force us to swallow the Obamacare scam.

Obama and his comrades have been planning to vilify and demonize health insurance industry for years, since they planned the Obamacare scam. Robert Creamer, a CONVICTED FELON and Obama’s ACORN associate, outlined the guidelines for the Obamacare SCAM in his 2007 book, “Stand Up Straight: How Progressives Can Win.”

As per Creamer’s book, the main objective of Obamacare is only to increase the power of "progressives" (Marxists) through the “democratization of wealth” (socialism/Marxim) as per the teachings of Saul Alinsky. Creamer wrote in his 2007 book:

* “We must create a national consensus that the health care system is in crisis.”
* “Our messaging program over the next two years should focus heavily on reducing the credibility of the health insurance industry....”
* “We need not agree in advance on the components of a plan, but we must foster a process that can ultimately yield consensus.”

As per those guidelines, Obama and his comrades planned to demonize the insurance industry and to agree to ANYTHING to get their scam approved. They don't care about the "components of the plan." All they want is CONTROL over our health care and our lives.

They want complete power as that of the Marxist thugs who are destroying Latin America. They plan to increase their power through the “democratization of wealth” (socialism/Marxism).
http://the-classic-liberal.com/progressive-agenda-for-structural-change-stand-up-straight/

As Presidential candidate Alan Keyes warned us months ago, “Obama is a radical communist… He is going to destroy this country and we are either going to stop him or the United States of America is going to cease to exist.”

Posted by: AntonioSosa | February 15, 2010 11:39 AM | Report abuse

"Change the rules of the summit"?

There were rules? Whose rules? Wasn't the Republican response a request for certain rules? So it's acceptable for Democrats to negotiate with special interests, threaten and pay off legislators, write bills in secret, negotiate a compromise between party leadership and then demand that Republicans either approve of the package less Congress pursue reconciliation? Is that how one defines bipartisanship? Setting the rules and forcing our opponent to relent to your demands with threats?

Whatever happened to our Democratic party that it had to resort to Marxism and Stalinism and the undermining of our democratic institutions and legislative traditions to lead America?

Posted by: cprferry | February 15, 2010 11:40 AM | Report abuse

*Whatever happened to our Democratic party that it had to resort to Marxism and Stalinism*

Is it any wonder that, ultimately, you can't take the right wingers seriously on this issue?

Posted by: constans | February 15, 2010 11:52 AM | Report abuse

constans,

We've heard prominent progressives question the very existence of the Senate, and as well as its filibustering rules and 30 hour wait periods after procedural votes. We've heard threats of reconciliation and the nuclear option. The EPA threatened to expand its power. The President and Congress criticized the Supreme Court during the SOTU address. Meanwhile legislators have been bought off and the Census handed over to ACORN-type groups. And that's just one year!

In the Senate health care bill alone we saw back-room deals, paying off Senators, 1:00 am votes to undermine the 30-hour debate rule. All fast tracked to get a vote done before the Christmas holiday. Why? Because Reid was holding together a fractured Democratic party with a bill disliked by the populace. To get the bill passed, he needed to get the vote done before Senators returned back to their constituents.

This is democracy? This is respect for government? It used to be that liberals supported the government and saw fit to use it to introduce their agenda. Now that agenda is so far left (that even the public, hoodwinked by empty "hope and change" messages and anti-Bush attitudes just 15 months ago, doesn't like it), that similar Marxist ideas of dismantling and redesigning government institutions seem to be a fair tactic to them.

Posted by: cprferry | February 15, 2010 11:54 AM | Report abuse

cprferry, middle of the road reforms to health coverage and making deals between senators in exchange for votes are not "Stalinism and Marxism." There is something about the very premise of health care reform that is driving a lot of people on the right completely insane.

Posted by: constans | February 15, 2010 12:02 PM | Report abuse

Kevin:
"(which you don't necessarily have to do--if I'm in Tennessee and I buy Texas health insurance, then that insurance is regulated by the state of Texas, I just get to buy it in Tennessee; that's one way to handle it)."

That doesn't look like a way to handle it, to me-- it suggests a straight-on rush to the bottom. There won't be Tennessee insurance or Texas insurance, there will only be Delaware Insurance-- or whichever state becomes their analog in this case. There's just no way consumers can reasonably be expected to price preferred regulatory environment into their insurance purchase decision.

Posted by: adamiani | February 15, 2010 12:36 PM | Report abuse

Republicans don't accept the whole premise of the White House's plan, because they don't believe healthcare is the number one problem in the U.S. today. They should say that boldly and honestly. They should say that doing this is like asking a critically sick patient to get out of bed and run a marathon. They should say that there has to be a greater justification than presented to force every person in this country to have his life turned upside down, all his current medical arrangements altered, his children's care, should they get critically ill, imperilled and at the mercy of a bureaucrat.

Posted by: truck1 | February 15, 2010 12:51 PM | Report abuse

constans,
The efforts to get HCR passed and its the consolidation of power to bureaucrats by undemocratic means and in the language of class war fare is very much typical of Marxist and Stalinist ideology.

Posted by: cprferry | February 15, 2010 1:07 PM | Report abuse

Take a look at how the Repubs passed Medicare Part D. Marxist and Stalinist to the bone! Except they hid the estimates about how much it would cost, of course.

Posted by: Lee_A_Arnold | February 15, 2010 4:08 PM | Report abuse

No part of medicare controls the care of every single citizen. No part of it requires all Americans to purchase a product or face jail time. No part of it requires every single American to relinquish what he now has. This plan does all that. and more.

Posted by: truck1 | February 15, 2010 5:13 PM | Report abuse

Medicare doesn't apply to people under 65, while old people without any additional health insurance are limited to its coverage. The threat of jail-time was removed from the Senate bill and poor people are provided with financial aid to make the requirement anyway. The whole point of this reform is so people can keep what they have now (although it looks like many of them are losing it in the mean time. Freedom, baby!)

Posted by: Lee_A_Arnold | February 15, 2010 7:29 PM | Report abuse

.

Hey Democrats,

Mr. Biden danced around the questions about a civilian trial for Khalid Sheikh Mohammed, the admitted mastermind of the 9/11 attacks. On "Meet the Press" and "Face the Nation," Mr. Biden said the president would soon make a decision on what to do—never mind that in November Americans had been led to believe we had a decision when Attorney General Eric Holder announced that KSM and four other operatives would be "brought to New York to answer for their alleged crimes in a courthouse just blocks from where the twin towers once stood."

In an interview in yesterday's New York Times, Mr. Holder set up the U-turn: "I think that I make the final call," he said, "but if the president is not happy with that final call, he has the ability to reverse it."

BYE BYE

DEMOCRATS


.

Posted by: kstobbe1 | February 15, 2010 8:51 PM | Report abuse

"Medicare doesn't apply to people under 65.." That's what I said. It is not life transforming for every living being in America, like the senate plan would be. Oh, the senate plan got rid of the threat of jail. How nice. How very humane. Glad to hear it. It remains the case that Ezekiel Emanuel (temporarily shoved out of the spotlight) has written that medical care should not be guaranteed to those who are not productive citizens, meaning the cognitively impaired, the extremely old, and so on. You WILL have to beg a bureaucrat for the life of your disabled child under this inhuman plan.

Posted by: truck1 | February 15, 2010 9:38 PM | Report abuse

I'm writing about the firestorm that erupted this week when Anthem Blue Cross announced plans to raise premiums for self-employed Californians by up to 39%. This announcement came at a time when the company posted record profits. My question is this: Why in god's name do we continue to require that the healthcare insurance industry should be for-profit? Bad enough that costs for actual care continue to spiral out of control, but why should we, the consumers, be on the hook to pay corporate healthcare executives and shareholders billions of dollars each year? Why shouldn't the profits earned by the insurance industry go to supporting the uninsured? Or lowering costs for care? It's time to do away with the notion of privatized care.

Posted by: commpro | February 15, 2010 9:46 PM | Report abuse

truck1: "It remains the case that Ezekiel Emanuel (temporarily shoved out of the spotlight) has written that medical care should not be guaranteed to those who are not productive citizens, meaning the cognitively impaired, the extremely old, and so on. You WILL have to beg a bureaucrat for the life of your disabled child under this inhuman plan."

Scaremongering nonsense from Betsy Whatzername. Emanuel was writing a pretty boring article about how you define "basic" from "discretionary" care (answer: you let the family decide.)

I defy you to tell me how the people of the United States are going to deny care for children, the weak, the infirm (answer: they let private insurers do it.)

Posted by: Lee_A_Arnold | February 15, 2010 10:03 PM | Report abuse

The Republicans have four elements in the bills yet voted against both plans. "Compromise" is over. The American public supported reform until the public option was removed in the Senate bill. The only compromise we want is an option that does NOT raise our premiums 39% on corporate whim. If the Republicans don't like that, then let them be the party of big business as they were in the McKinley years - and had to yield to the march of progressivism. The tea bag people must also wake up and realize no one is taking away their insurance or pressing them into the Gulag - the government must offer them and all of us OPTIONS so we can have a moral system of care that is not corrupted by profits over people. We must get a system that is humane, not profit driven. If you want to direct 20% of your income into health insurance, fine, but those in the middle class cannot afford that. Let this compromise be for US, not for the insurance companies and their Congressional toadies.

Posted by: Churchlady1 | February 15, 2010 10:38 PM | Report abuse

That doesn't look like a way to handle it, to me-- it suggests a straight-on rush to the bottom. There won't be Tennessee insurance or Texas insurance, there will only be Delaware Insurance-- or whichever state becomes their analog in this case. There's just no way consumers can reasonably be expected to price preferred regulatory environment into their insurance purchase decision.

Posted by: adamiani | February 15, 2010 12:36 PM | Report abuse


Sure the right wing has their hysteria (Marxism etc) but this is the typical liberal hysteria. How about we fix this simply and easily. Mandate a floor of requirements that is agreeable to all. Problem solved.

Posted by: visionbrkr | February 15, 2010 10:54 PM | Report abuse

It's just a lie to say Ezekiel Emanuel concludes that the family should decide the worth of an individual's life -- though even that conclusion is a litte, well, dodgy. But he does not. He has developed a system for quantifying the worth of a life. He calls that system "complete lives." It is based on the idea that an individual is the most productive from his late teens to mid forties, and greater resources should go to sustaining that life than lives around the periphery of production -- those of the infirm, old and mentally impaired, for instance. This was presented at a paper for the Hastings Institute in the late nineties, but there is information about it other places as well. He has been attacked as a eugenicist in the tradition of the great despotisms of the 20th century and has defended himself by saying that the rationing (or allocation of "scarce" resources, as he would probably prefer to call it) is not based on race or ethnicity. Fair enough. But if his ideas were thought to be anything other than poison for the healthcare scheme, he would not be completely off the radar, as he now is. They have put a sock in his mouth for the moment.

Posted by: truck1 | February 16, 2010 8:23 AM | Report abuse

It's just a lie to say this has anything to do with the healthcare reform bills.

Posted by: Lee_A_Arnold | February 16, 2010 9:28 AM | Report abuse

It's a lie? This is the man who until recently was called Obama's top medical advisor. You don't dispute that there's anything wrong with his views as I outlined. You are just saying he and what he thinks will have no impact on the medical practices advisory board which WILL be set up under all the plans under consideration.

Posted by: truck1 | February 16, 2010 2:32 PM | Report abuse

"The whole point of this reform is so people can keep what they have now (although it looks like many of them are losing it in the mean time. Freedom, baby!)
Posted by: Lee_A_Arnold"

Was that even a reasonable promise?
It's already predicted that their plans won't stay the same. Premiums are expected to rise at higher rate. The overwhelming changes to the insurance pools, the industry and regulatory market will surely change their plans. There's also a great number that will be forced to increase their coverage to meet the minimal levels. Or onto newly mandated employer pools.
The additional changes to provider reimbursement rates and incentive programs will change the health insurance - health provider market and have implications for subscribers.
It seems to me the promise not to disturb what people had was an empty promise to pacify opposition and the inevitable sticking to status quo. In part, it may have been also been used to prevent charges that Obama was unwilling to take on difficult issues like the tax credits of employer-based health care and the coverage of abortion and procedures of dubious health necessity.

Posted by: cprferry | February 16, 2010 3:26 PM | Report abuse

truck1: "You don't dispute that there's anything wrong with his views as I outlined. You are just saying he and what he thinks will have no impact on the medical practices advisory board which WILL be set up under all the plans under consideration."

There are already medical advisory boards in every state in the union.

And I already disputed your outline of Emanuel. He's a useless philosopher, but you're still wrong. And even if you were right, it's got nothing do with anything. Try thinking it through. How do you figure bureaucrats will get away with denying care to anyone? Where does your nonsense come from? People aren't helpless. There would be a general rebellion and politicians would lose their jobs. You recall them or vote them out. It's actually easier to control politicians than to control the private insurers. In fact the healthcare reform bills are trying to STOP the private insurers from denying coverage, which THEY DO EVERY DAY.

Posted by: Lee_A_Arnold | February 16, 2010 4:33 PM | Report abuse

here is funny idea of health care reform.. http://www.typobounty.com/Funny/Health_Care_Reform.htm

Posted by: cheezweez2u | February 16, 2010 9:12 PM | Report abuse

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