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Five reasons to worry about health-care reform


Jonathan Chait makes the case for continued optimism on health-care reform. I basically agree: I view American politics through a structural lens, and almost all of the relevant forces are pushing Democrats toward completing a bill. But in the interest of full disclosure, here's what worries me:

(1) The collective action problem: Even though passing a bill leaves all Democrats better off, voting for a bill leaves some Democrats worse off. There are members of the Democratic Party who desperately need a bill to pass, but also feel that they need to be able to vote against that bill. These people are probably going to lose their elections one way or the other, and virtually none of them seem willing to simply admit that and do an enormous amount of good for the American people before Democrats inevitably and predictably lose their unsustainably large majority.

(2) Individuals are not rational: Which means predicting what they'll do based on the "this makes overwhelming sense" criteria is not a foolproof strategy.

(3) Legislators do not understand health-care reform very well: A lot of these congressmen don't know much about the bill, or the health-care system, or the interaction between the two. Some on the left think the absence of the House's public option renders reform meaningless, even though the public option in the House's bill would have made very little difference either to people or to costs. Some on the right think this bill will increase costs despite scores of evidence showing otherwise, and despite the fact that the delivery-system reforms and the construction of a competitive insurance market represent the most ambitious cost control effort that's ever been passed into law.

(4) Inaction is easy: If health-care reform was guaranteed a vote, I'd be pretty confident in its passage. But if the House and Senate simply do nothing, the legislation dies. That means there's a path of least resistance -- which is not the same as a path of least consequence -- that Democrats could end up walking, even as they continue to promise that they're committed to voting on health-care reform sometime soon.

(5) The House and the Senate hate each other: And for health-care reform to pass, they're going to have to trust each other, at least a little bit.

Photo credit: Melina Mara/The Washington Post.

By Ezra Klein  |  February 23, 2010; 12:34 PM ET
Categories:  Health Reform  
Save & Share:  Send E-mail   Facebook   Twitter   Digg   Yahoo Buzz   StumbleUpon   Technorati   Google Buzz   Previous: Why David Brooks should support health-care reform
Next: Lunch break


"Individuals are not rational: Which means predicting what they'll do based on the "this makes overwhelming sense" criteria is not a foolproof strategy."

It's an elitist attitude to say that if you don't vote for this bill you're just STUPID.
There are many things I would vote against, even at the expense of my pocket, because it makes sense to serve other ideals.

It's not's wise.

Posted by: WrongfulDeath | February 23, 2010 12:50 PM | Report abuse

"Some on the left think the absence of the House's public option renders reform meaningless, even though the public option in the House's bill would have made very little difference either to people or to costs. Some on the right think this bill will increase costs despite scores of evidence showing otherwise"

I think the problem here is that you're talking past the folks on the left and right and vice-versa. You're taking a literal interpretation of the bill in terms of what it offers. The "folks on left and the right" and focused on the direction the bill will take us. The public option isn't going to impact anything as constructed, but its reasonable to have expectation of what it could become once constructed. Similarly, while CBO and other have scored the bill as deficit neutral, there are more than ample reasons, based on historical precendence, for assuming the cost-savings in the bill won't materialize.

"despite the fact that the delivery-system reforms and the construction of a competitive insurance market represent the most ambitious cost control effort that's ever been passed into law."

DRGs in the 80's as part of Medicare reform was a more ambitious cost control attempt than this bill. That actually changed billing for inpatient care, which was more heavily the cost burden at that point than now, in similar fashion to the bundling discussions now. The difference is that the DRGs were pertinent to a specific episode of care rather than course of disease (bundling inpatient and outpatient). But it actually changed reimbursement for inpatient care with the same cost control hopes that are now in vogue with bundling. And that was actually implemented, not simply piloted.

Posted by: wisewon | February 23, 2010 12:57 PM | Report abuse

--"an enormous amount of good for the American people"--

I do believe. I do believe.

Posted by: msoja | February 23, 2010 1:14 PM | Report abuse

This is a good post, Ezra, but I think you need to review your understanding of what a "collective action problem" is.

Posted by: erh1103 | February 23, 2010 1:19 PM | Report abuse

Wisewon -- remind me how DRGs and PPS were implemented. Was there a Congressional vote? Was it just a HCFA decision? Certainly the passage of PPS with DRGs dropped inpatient lengths of stay dramatically and very swiftly. Are you arguing that bundling cannot do the same?

As for Ezra's worries? I wouldn't go as far as saying the House and the Senate "hate" each other. "Distrust each other" would be more fair and with some good reasons.

But I do believe that with the mobilization of HCAN, Move On, etc. in the next few weeks, Democrats in Congress will get a clear message that they need to act and act now. It's just a shame that it takes SO much energy to get them to do something that is obvious to those of us outside Washington!

Posted by: LindaB1 | February 23, 2010 1:20 PM | Report abuse

Point #1 - Nonsense!
Point #2 - Correct..they are politicians!
Point #3 - True...neither does the Obama administration!
Point #4 - Maybe, but action is needed to curb increasing costs
Point #5 - True, true, true! But they will never trust each other! Ego, ego, ego!


Posted by: my4653 | February 23, 2010 1:20 PM | Report abuse

Ezra, you contantly make comments about how this group or that group simply doesn't understand Obamacare (implying that they are stupid) because if they did truly understand how joyous it is they would never stand in its way. Please. Maybe the problem for Obama and the liberal Democrats pushing this big government monstrosity is that they understand it too well and that's the reason they are opposed. Maybe they don't want the federal goverment telling them what kind of insurance they have to buy or that they have to buy insurance. Maybe they don't want their "cadillac" healthcare plans to be taxed for the collective good of cost containment. Maybe they don't want the vast new goverment bureacacies and new government spending Obamacare entails. Maybe they don't believe Obama when he tells them that they can keep their present doctor when many, many provisions of Obamacare say they won't. Maybe the 85% of the U.S. population who are satisfied with their healthcare don't want to throw out the current system to satify the tiny portion of the population that could be helped other ways. Maybe they see rich Canadians coming to this country to get medical procedures we take for granted because their own government run system doesn't support cutting edge medical technology. Maybe they see their future in those Canadians and realize they won't have any place to go because once the U.S. goes government run healthcare there won't be anyone left in the world to produce those medical breadthroughs. Maybe people aren't as stupid as you think Ezra.

Posted by: RobT1 | February 23, 2010 1:30 PM | Report abuse

Once again, all Americans can see that the loony-left d-crat socialists DO NOT WANT REAL REFORM; they want ONLY NATIONALIZATION of the American healthcare industry and full federal government control of OUR healthcare.


Posted by: TeaPartyPatriot | February 23, 2010 1:33 PM | Report abuse

"Some on the right think this bill will increase costs despite scores of evidence showing otherwise, and despite the fact that the delivery-system reforms and the construction of a competitive insurance market represent the most ambitious cost control effort that's ever been passed into law. "

I haven't seen scores of evidence showing otherwise. And massively increasing demand through the creation of tens of millions of new consumers who have Other People's Money at their disposal, while doing next to nothing to increase supply or reduce quality WILL either increase cost or reduce quality. You can have universal health care. You can have first class health care. You can have affordable health care. You can't have all three at the same time. And if you hugely expand one element of the triad, one or both of the others will suffer. Unless Obama really is the Messiah. If he is, it's all good.

Posted by: bgmma50 | February 23, 2010 1:38 PM | Report abuse

Ezra, you continuely spout that Obama's Healthcare plan is "popular". I did a little research and here are the latest numbers:
%For %Against
RCP 38 52
Newsweek 40 49
Rasmussen 39 58
ABC/Wash P. 46 49
CNN 38 58
USA Today 39 55

Why do you persist in claiming the Obama plan is "popular?"


Posted by: my4653 | February 23, 2010 1:39 PM | Report abuse

Calling people stupid is all you have left?

Posted by: obrier2 | February 23, 2010 1:49 PM | Report abuse

Pardon...scores of evidence proving this legislation will not increase costs? Doth mine eyes deceive me? Praytell,what evidence is there that will cause me to defy logic?...the logic that the federal government will take on the responsibility of administering and/or contracting health care services for people who currently do not have the money to purchase it now without a single extra penny? Because we've already spent millions in labor and resources drafting the darned thing already.

Posted by: forgetthis | February 23, 2010 1:51 PM | Report abuse

"Ezra, you continuely spout that Obama's Healthcare plan is "popular"."

This is not true. Ezra continually spouts that the public option is popular. Not the overall plan. But, by all means, keep doing research if it keeps you off the streets and out of trouble.

Posted by: slag | February 23, 2010 1:52 PM | Report abuse

Hey Erza!

Since when is what's best for the Democratic Party what's best for the country?

This article is filled with evidence that Democrats just can't be trusted with anything. I recommend that Erza ask for any tuition he paid back, as he clearly lacks the education to comment on this health care debacle with any objectivity at all.

How about this SIXTH reason to worry about the monstrous bill the Holy One is trying to get passed: The BILL is bad for America!

How about that one little thing?

Posted by: Indpnt1 | February 23, 2010 1:57 PM | Report abuse

I think Ezra what 'cost control' measures you talk; those are not fully proven or not full proof. Things like good Excise Tax and Medicare Commission; those are either diluted or absent. So the charge that Dem proposals do not control costs well is still true and applicable.

Posted by: umesh409 | February 23, 2010 2:03 PM | Report abuse

"Calling people stupid is all you have left?"

The truth of an assertion is the only airtight defense against libel, if I recall correctly.

Posted by: davis_x_machina | February 23, 2010 2:04 PM | Report abuse

Okay, I accept that you are a bright young reporter who seems to me about 10 years old. You are just doing a job, it is clear. It is also clear you don't know beans from balony.

Two of your points, the only ones mentioning, speak of the essence of the problem: 1) People are terribly ignorant, including Congressmen, and 2) People are irrational.

But none of this is news. What a news story should do is also identify as best as possible the truly ignorant and irrational. Cite some examples like DeMint, Boehmer, McConnell, McCain, Ben Nelson, Lieberman.

Making your kind of list at this point in the history of this Republic is easy. It is Weekly Reader for pre-teens. Get real, get to the facts, and take a side based on those facts, Chicken Little.

Posted by: walden1 | February 23, 2010 2:16 PM | Report abuse

Headline: Consumer confidence falls sharply.

Confidence falls unexpectedly in February, as consumers' worries about jobs escalate. Consumers - aka the public - feel Obama and Congress are screwing them with higher taxes for health care and energy.

We can't afford to pay for alleged AGW carbon taxes. Consumers do not want to pick up the tab for anymore government scams.

Posted by: alance | February 23, 2010 2:23 PM | Report abuse

Here's the hook, of course not mentioned in this article. Obama and his admitted radical buddies are willing to give up and compromise on several things just to get the basics of this 2000 page mess passed.

The reason is simple. CONTROL! Buried in the bill there are dozens of boards, commissions and committees created and funded to set rates, compensation and health care rationing. This is the controls they are really after and the other stuff can come later.

Remember, in Obama's world the end justifies the means, and therefore breaking promises, deceiving and bribery are acceptable because it helps fulfill their agenda.

And, if anyone thinks they are not going to ration health care they have their head in the sand. We already have a shortage of doctors and nurses and adding millions into the system will overwhelm it.

Posted by: thehamptons1 | February 23, 2010 2:24 PM | Report abuse


Yeah, that's the word that comes to mind when you T baggers come

'Wise' would recognize it was being stupid and allow the adults to clean up its mess.

Seriously though, who needs al qaeda when you've got the GOP?????????????????

Posted by: mmax | February 23, 2010 2:26 PM | Report abuse

"How about this SIXTH reason to worry about the monstrous bill the Holy One is trying to get passed: The BILL is bad for America!"

Or how about this SEVENTH reason to worry about the bill: The BILL eats puppies!

Or this EIGHTH: The BILL slept with your sister!

Seriously, Ezra, do your job next time and include ALL the reasons the BILL shouldn't pass, please.

Posted by: slag | February 23, 2010 2:29 PM | Report abuse

American public is DEAD certain against this! Obama, like Hitler, is training armed forces near Ft. Leonard wood for a military take over after the dollar collapses!!!

Posted by: houston123 | February 23, 2010 2:33 PM | Report abuse

Ezra didn't say Congresspeople were stupid, rather that many of them don't understand either health care or the variuous components of reform very well. This is evident from his lengthy interview with Lamar Alexander and from statements (or comeplete lack thereof) from the many Congreesspeople who aren't on the committees that have studied this for years.

He also said they6 were not rational., which is not the same as asaying they are stupid, and he said this made predicting their behavior difficult. That's also true.

I think his points are all well taken. Consistently Ezra has said that the bills that have evolved aren't perfect but they get us in the right direction. They can be improved but above all we have to think about the millions of uninsured, some of whom will die because of lack of access to care, and the effect of the horrendous individual market on small business and entrepreneurs. For how long can we ask our fellow citizens to remain at the mercy of the insurance cos while we all debate the finer points of policy and strategy?

Posted by: Mimikatz | February 23, 2010 2:35 PM | Report abuse

"American public is DEAD certain against this!"

Liar. Check the polls, moron.

Yes, ask Glenn Beck if it's OK for you to check the

Posted by: mmax | February 23, 2010 2:36 PM | Report abuse

Slag..........the public option is the fundamental bedrock of the Obama plan. It is his objective to get to a "single payer" healthcare system. If the public option is the most important part of the plan, then it is unpopular by default. The public option is Obama's way of paying back the far left and those seeking another "entitlement" progaram that elected him! The CBO can't even cost this plan! The taxpaying public is not stupid........gullible, maybe!!


Posted by: my4653 | February 23, 2010 2:41 PM | Report abuse

I am tired of ideologues dominating the health care debate: Anyone who has a parent on Medicare knows that the government does a much leaner and more honest job in covering the health of Americans, than the big five do. Personally, I would choose the public option, yet the Republicans are denying me that choice. Do Republicans not stand for choice? The status quo forces Americans into the clutches of a cartel of overpriced, wasteful, unsavory, and extortionist contracts. I want a reliable alternative to the corporate predators lurking between me and my doctor.

Posted by: othpromanuel | February 23, 2010 2:44 PM | Report abuse

Ths short answer to this hogwash is "Don't worry, be happy."

Posted by: ClassicDoc | February 23, 2010 2:51 PM | Report abuse

The one common denominator among all the reasons is the unassailable fact, that there are those who practice white supremacy in Congress.

Posted by: demtse | February 23, 2010 2:53 PM | Report abuse

The one common denominator among all the reasons is the unassailable fact, that there are those who practice white supremacy in Congress.

Posted by: demtse | February 23, 2010 2:54 PM | Report abuse

There are issues of both process & substance.

Judging from the spectacle of the President’s public humiliation, it’s evident he’s lost the support of virtually all Americans. If this is what he meant by 
‘consensus’, he’s achieved it: moderates, conservatives and liberals are united 
in their opposition. The ‘reforms’ are variously considered a sham, trivial or an
institutionalization of the current disastrous health care system (only with 
more public subsidies to the insurance industry). The complete and utter 
powerlessness of this President is all too evident in the drama unfolding in DC, as he seeks ‘bi-partisanship’ for a proposal the voters of neither party support. 
Pity Obama, the Democrats and the nation.

The confusion and endless gyrations evident in the plan (try reading it) are the result of trying to fit ‘reform of the system’ into the system’s current contorted, inefficient and costly contours (in other words, the plan is not a ‘reform’, but more pasting things on to a broken system).

Here’s what the people wanted when the Democrats started:

“A mere seven months ago (that would be around June 2009), The New York 
Times/CBS poll found that 72% of Americans ‘supported a government-
administered insurance plan—something like Medicare for those under 65—
that would compete for customers with private insurers.’”

From then until now, Obama has:

1. Rejected single payer; 

2. Stiff-armed the government option;

3. Mandated individuals and families pay premiums to private sector insurers; 

4. Assured billions in tax payer subsidies for private sector insurers;

5. Stipulated actual health care service at 80 cents of every dollar, while 
insurers can spend 20 cents of every premium dollar on lobbying, ‘sympathetic’ 
candidates, CEO bonuses, ‘administration’, fighting claims for treatment and, 
now we can add, participating on the new Federal ‘rate review’ Board.

The substance of the President’s proposal is the current costly, inefficient and 
ineffective insurance system on Federal steroids.
The process, which the President invited on himself, is resulting in little more than the public pillorying of the 
weakest President since Jimmy Carter.

If Obama wanted to cast himself as a leader, this was surely his last chance, and he blew it with a plan to keep the current system in place, while supplementing it with taxpayers’ money in the form of mandated premium payments and Federal ‘subsidies’. That’s no reform at all. That's the main reason to 'worry about health care reform'.

Posted by: theworm1 | February 23, 2010 2:55 PM | Report abuse


its not just Lamar Alexander. I went to a town hall meeting in August and my representative (Frank Pallone) one of the architechts of one of these plan (or so he said) didn't even understand the laws as they are in his home state of NJ where he's been a legislator for 30 years. He said insurance companies could raise rates based on health conditions and they absolutely can not in NJ. The lack of understanding and comprehension is at an epic level which only goes to undermine its potential for passage in any form.

Posted by: visionbrkr | February 23, 2010 2:55 PM | Report abuse

WOW! I do believe that you missed the main, real, and only Constitutional reason to be [concerned] about health care reform (as per the Democrats Take-Over plan.)

It is unconstitutional!

The following is taken from

Staying Focused On The Main Issue of Federal Health Care
Debra J.M. Smith - Informing Christians
December 08, 2009

Though we can use the details of government ran health care plans, to show just how far off the beaten path many in our federal government have gone and how severe the need is to replace them, we must keep to the fact that any federal government ran health care is unconstitutional.

If someone broke into our homes to steal from us, we would not stand there and debate with them, what they could and couldn't take or in which way they can and cannot carry out the job. We would call the police to get their rears out of our homes!

We would not debate with a would-be rapist, as to what he could and couldn't do to us.

We would not debate with a murderer, on what method he could kill us by.

Why on earth, would we debate with Congress over what way they can go against the U.S. Constitution and take over our health care?

We must keep focused on the fact that it is all wrong to begin with! And we must use this to educate voters and to remove those people in government who are not upholding and defending the U.S. Constitution.

For those citizens, who do not appreciate and do not wish to defend the U.S. Constitution, we need to point them in the direction of Canada. Let them move to a country that allows for such a thing.

Posted by: DebraJMSmith | February 23, 2010 3:02 PM | Report abuse

Here is a brief summation of my understanding of the health care issue.
A fundamental part of the dynamics of health insurance, or any insurance market, is that it has to balance the number of people purchasing insurance but who never really use it or receive less in benefits than they pay out in premiums against people who receive more in benefits than they pay in premiums and co-pays. There is simply no profit in it otherwise. The most obvious ways to make this work are to one get lots of relatively healthy people into the system or two- deny care to people who have already paid and make sure that people who are most likely to need expensive care never make it into the system.

Healthcare though is unique in that it has the problem of people using emergency care, where they cannot be denied treatment, as their primary care source. With no option for preventative care they usually wait until they have developed serious and expensive conditions before seeking care. Unable to pay the full amount for their care, they usually don’t even try and end up paying nothing and the cost gets passed on to the provider and to local jurisdictions. Requiring them to buy subsidized insurance gets them to pay at least something into the system and many would then over time join the ranks of possibly paying more into the system than they consume.

Increasing the number of people in the system would theoretically drive down the costs of premiums. The only way to ensure that premiums actually get downward pressure though rather than large insurance providers just pocketing the increased number of consumers as extra profit is to one- institute direct price controls or two- increase competition either through non-profit or public options. Increased demand plus increased competition usually leads to lower prices and higher quality.

I haven’t read the entire bill in any of its versions so I don’t doubt that there are plenty of specifics that are legitimately objectionable but the basic mechanics of how price can be lowered and quality can be maintained or improved seem pretty simple and aren’t really a seismic shift in American Democracy.

I haven’t thoroughly researched the issue but it also seems that most of our medical breakthroughs come by way of private medical and biotechnology interests as well as university funded research, all of which seem to be pretty separate markets from insurance and primary care markets. So I don’t see where reforming the insurance market would lead to the doom of medical advancement.

Posted by: bran-solo | February 23, 2010 3:03 PM | Report abuse

Once again, all Americans can see that the loony-left d-crat socialists DO NOT WANT REAL REFORM; they want ONLY NATIONALIZATION of the American healthcare industry and full federal government control of OUR healthcare.

Wow!! Seriously!! The Post Office didn't take over the shipping industry! And Medicare didn't take the Health Care Industry, so why would REFORM?

Posted by: Angryman | February 23, 2010 3:04 PM | Report abuse

"Slag..........the public option is the fundamental bedrock of the Obama plan"

Great! I'm feeling better already knowing that our plan for socialist-fascist-monarchism is moving forward as scheduled. And here I thought it was languishing under the half-baked, mediocre bills cooked up by lazy and mildly corrupt Congressional "centrists". But with this new information, liberals can now all relax and begin rejoicing!

Thank you! Thank you for setting our minds at ease. Liberals everywhere owe you one.

Posted by: slag | February 23, 2010 3:05 PM | Report abuse

Oh my goodness. For a man who claims to know a thing or two about economics and policy, your grasp of mathematics seems to clearly missing. You can't enter the market, confiscate (by taxation or borrowings) a trillion dollars from the private-sector economy and spend it in an inefficient manner (as all government spending is by definition inefficient compared to the private-sector due to the costs of government being unavoidable) and then claim it will reduce costs. Sir, here's a basic hint for you: 2-1=3 is not a mathematically correct statement.

The problem is that these people all believe they are doing the right thing, but fail to acknowledge their own refusal to account for their so-called "plans" in a sober, responsible and mathematically correct manner. And please, spare us the CBO line - if you tell them your assumptions are that fish will fly, so the whole ocean is available for harvesting at cut-rate prices, those political hacks will score your alternative reality and report you are geniuses, but only you are believing them and that's why we are all angry. You don't get it and you now appear to be congenitally inhibited from learning from your continued mistakes.

I can find no poll that supports this article's assertions on the desirability for so-called "health care reform" and I can find no poll that says spending our money for the purposes of allowing Democrats to sustain political power by controlling human behavior are supportable either.

Perhaps you would like to break with tradition and cite some real facts instead of the puffery you seem to have adopted as the new "standard"?

Who do you think you are fooling with this, anyway?

Posted by: rainmaker1145 | February 23, 2010 3:09 PM | Report abuse

"Some on the right think this bill will increase costs despite scores of evidence showing otherwise, and despite the fact that the delivery-system reforms and the construction of a competitive insurance market represent the most ambitious cost control effort that's ever been passed into law."

Sorry for the lengthy quote but this encapsulates the Democrat's biggest problem getting health care reform past -- This is the worst kind of magical thinking imaginable and a lot of people, including a great many Democrats, don't buy it.

Here's the deal. You cannot provide universal health care, increase the quality and lower the cost at the stroke of a pen. Study-schmudy. I don't care what the "studies" say. This violates the basic principles of supply and demand. Any study that concludes that government "reform" can somehow repeal these principles has merely demonstrated that it is a grossly flawed study.

Effective reform works within the law of supply and demand. There are certainly many health care reforms that could be made that do. Things like allowing insurance companies to operate across state lines and non-profit insurance co-ops are a good place to start. But effective reform is going have to rely on market forces, not overide them by fiat.

Posted by: anon99 | February 23, 2010 3:14 PM | Report abuse

It's breathtaking for Klein to write: "Some on the right think this bill will increase costs despite scores of evidence showing otherwise."

The scoring was narrow and almost totally based on moving and optimistic variables. History tells us that this bill will dramtically increase healthcare costs and insurance premiums. It will end the insurance industry and it guarantees health services rationing.

Klein is intellectually and critically thinking challenged.

Posted by: arp2 | February 23, 2010 3:14 PM | Report abuse

I wonder if the health care summit will be as wildly successful as the jobs summit.

Posted by: hz9604 | February 23, 2010 3:16 PM | Report abuse

2) Individuals are not rational: Which means predicting what they'll do based on the "this makes overwhelming sense" criteria is not a foolproof strategy.
Funny, I have always heard the exact opposite- that individuals behave rationally, while groups do not. Hence the term 'group think.' Regardless, I fail to see what either has to do with anything at all. Must mean I'm stupid or something.

Posted by: pswift00 | February 23, 2010 3:16 PM | Report abuse

There are some very informative comments here. I enjoyed reading them (from both sides of the aisle). I am a democrat and I am trying to interpret this bill as many others are. I need to know more about health care and the 18% of gdp it is using up. Where will we be in 20 years? There are still 40 million people w/o care in this country? Insurance comapnies are raising rates again. Can we do better?

This comment confused me. Was that Beck ?

"American public is DEAD certain against this! Obama, like Hitler, is training armed forces near Ft. Leonard wood for a military take over after the dollar collapses!!!"

What rock did this idiot crawl out from under? Aren't there real issues to debate and intellectual arguments to be had?

Send the teabaggers away, please.

Posted by: tutnyc | February 23, 2010 3:16 PM | Report abuse

How dare you even attempt to decide the potential benefit of this awful bill on individual Americans. You are not smart enough, period. Individuals are not rational is perhaps the only thing you've stated that is an absolute, with you being the example. Legislators do not understand the bill, neither does Obama nor yourself. It's all about just getting something passed that Obama can sign. Inaction is good as it relates to this bill, bad legislation needs to be defeated and once again none of you are smart enough to craft anything good. Finally, who cares if the Senate and House hate each other, when they do more often than not Americans don't get screwed.

Posted by: davispope | February 23, 2010 3:18 PM | Report abuse

'Some on the right think this bill will increase costs despite scores of evidence showing otherwise,'

If there's any such evidence, I've never seen it. What I've seen are studies showing modest savings in the first ten years, wholely predicated on the basis that taxes for this program will kick in a full three years before any benefits are disbursed.

Posted by: pswift00 | February 23, 2010 3:18 PM | Report abuse

Wow! This piece "Five reasons to worry about health-care reform" says it all for me! I agree with everything Ezra Klein is saying - from what's going to happen to the Democratic Party if health-care reform is NOT passed to the fact that the vast majority of us do not understand the reform. It was easier to latch onto simple concepts like "the public option is core to reform" than it was to read and UNDERSTAND the reform proposals. What I'd really like to see happen is for at least a couple of the Republicans to show up on Thursday ready to negotiate in good faith. So much of the President's was taken from Republican ideas of a decade ago. I'd feel better about backing these ideas that I don't personally like if there was some sense of being met halfway.

Posted by: CarolynFuller | February 23, 2010 3:21 PM | Report abuse

This article simply confirms that Human Nature is a constant. Congress has behaved like this since it's very inception.

Sad - but people are people.

Posted by: lufrank1 | February 23, 2010 3:28 PM | Report abuse

Ezra Klein needs a visit from the maturity fairy. He is convinced he is God's gift to political reporting and he is not even close. He has a lot of growing up to do.

The public option is the critical piece to a single payer system. The END GAME is the real thing to look for and the real worry.

Posted by: hz9604 | February 23, 2010 3:28 PM | Report abuse

Don't you guys love it when Ezra makes an erroneous statment as if it were a fact?

like this one:

"Even though passing a bill leaves all Democrats better off,"

or this one:

"Some on the right think this bill will increase costs despite scores of evidence showing otherwise"

oh ya, that's not what Medicare actuaries stated. Even CBO says that individual premiums will be higher under both the house and senate's plans than the status quo. Nice try though Ezra, the partisan puppet.

Posted by: Magox | February 23, 2010 3:30 PM | Report abuse

Mr Klein, This healthcare legislation in a blasphemus monstrocity inbred by hundreds of political fathers and constituent sins.

The only people in congress that seem to have a clue about how ridiculous this one-shot massive legislation is are the six republican and two democrat physician congress members.

This massive trillion dollar PLUS bill is unwanted by the American people. Like any good lib...oops sorry,I meant progressive, you know what you should do with this unwanted baby... abort it now.

Posted by: gjeiii1 | February 23, 2010 3:34 PM | Report abuse

How much did the White House and the Dems pay you to write this piece of propaganda?

Signed - the ignorant peasantry

Posted by: cjgh | February 23, 2010 3:42 PM | Report abuse

If the Democrats don't pass a robust public-option they'll be kicked out of office in November.

The bill as it stands now is one giant gift to the insurance industry. After the White House posted its bill on their Website yesterday health insurance stocks took off like a rocket to the moon.

Posted by: Maddogg | February 23, 2010 3:45 PM | Report abuse

How come there is a liberal based movemant afoot to do away with the Electoral College and allow a plurality of America to elect a President but we cannot get throught to those on the left that a plurality of Americans do not want THIS health care reform. I guess the east coast elite just know better on this one.

Posted by: bbarbee2 | February 23, 2010 3:47 PM | Report abuse

Why do you think the collective is more rational than the individual?

How can you be so confident that this bill will improve the healthcare system? You clearly don't understand the basics of the insurance industry and you don't appear to understand basic economics so why do you think you're competent to make such a judgement? Being informed about the ins and outs of the political environment doesn't make you qualified to engineer a healthcare system. You're probably even less qualified than the average Congressman and that takes some skill.

You need to stop pretending you represent the rational position. You're confusing arrogance with intelligence.

For every crazy person that disagrees with you there's probably ten lunatics that swallow your text more passionately than you lap up Democratic talking points.

Posted by: fallsmeadjc | February 23, 2010 3:48 PM | Report abuse

"Overwhelming sense"? We understand that passage of health care reform in any form benefits the Democrats in the House and Senate. At this point let's face it, it's mostly about saving face. But does it really benefit the American people? Truthfully, does it bring down their costs? If so, does it do so at the expense of future generations? Do we not owe our children and children's children a responsible, sensible plan? Does the currently proposed plan improve the quality of health care? IF it's such a great plan, why not everyone climb on board, including our congressmen, senators, and all public officials on up to the president? Sadly, we do need health insurance reform. Too bad it wasn't important enough to have taken a bi-partisan approach from the beginning. Instead it's all been about politics as usual.

Posted by: lbataille55 | February 23, 2010 3:51 PM | Report abuse

Most posters are justified in knocking this article for its disingenuousness; have you forgotten that Ezra is a committed Progressive using Alinsky tactics, especially the one that says if you tell a lie often enough, the masses will believe it. There are at least 4 lies in this article; see if you can find them.

Posted by: apberusdisvet | February 23, 2010 3:52 PM | Report abuse

I don't think many of the posters here are looking at the long-term. Many may be satisfied with their current plans, but what will happen to the premiums if Congress did nothing? To be correct, one would have to look at what would premiums and services covered be in the future without government action and what they would be with government action.

Political rhetoric and blather aside, one must real;ize that the government -- especially the federal government -- already has a major role in health care. Also, the uninsured do receive health care but it may not be timely or it may be at emergency rooms which can drive up everyones premiums. Further, if Canadian health care were so bad, they could get rid of it. The reverse happened. The health insurance companies and the Canadian Medical Association fought universal coverage in Saskatchewan in the 1960's but now all Canadians (and some U.S. citizen, albeit illegally) have access to universal health insurance.

Parenthetically, it was amusing to see Republican Senators arguing against this bill because it may involve cuts in MEDICARE when they predecessors vehemently fought against MEDICARE.

Posted by: edubin1 | February 23, 2010 3:53 PM | Report abuse

bran-solo hit the nail on the head. and that's why you free market folks are missing the point. unless we repeal the law that says hospital emergency rooms can't turn people away regardless of ability to pay, there is no supply and demand at work in health care. making people buy insurance is a cost saving measure. but it can't be scored because CBO is not permitted to, and couldn't if it tried, figure out how many fewer uninsured ER visits there would be by folks who wouldn't have gotten that sick if they had doctors to go to, or by folks who don't need an ER in the first place but go because they have no doctor. just eliminating the cost shifting from the ER to the insured is a good thing, even if it didn't entirely pay for itself, and you need the individual mandate to be able to eliminate preexisting condition provisions, which the insurance industry (rightly) would never stand for if you could wait until you were sick to buy insurance and the insurers had to sell you a policy. If we did that without a mandate, the cost of policies issued with that premise would be huge.

Posted by: JoeT1 | February 23, 2010 3:55 PM | Report abuse

Let's see if we have this right...
1. Take one for the team; you're going to lose anyway.
2. Left is right, right is wrong (stupid actually), let's do it.
3. Some on the right believe costs are understated. When has that ever happened in government programs?
4. Legislators are fundamentally lazy, we can't let natural sloth prevail.
5. There's fratricide between both houses of Congress. Get over it.

An amazing piece of analysis by someone who never met a government program he didn't like. We can do 'better than Ezra.'

Posted by: ecrutle | February 23, 2010 3:59 PM | Report abuse

I can't wait to see the Collective Action Problem at play next November.
At last, Americans will have a say over the inane politicians and pundits who seem to feel they know what's best for us.

Posted by: mtpeaks | February 23, 2010 4:00 PM | Report abuse

OK let again.

Health care reform, to include dental, is easy. Provide to the American people the EXACT same coverage that ALL members of congress and their families receive at taxpayer expense.

Posted by: KBlit | February 23, 2010 4:03 PM | Report abuse

Good points Mr. Klein, I agree. It is a terrible shame that this is indeed what it comes down to, politics.

If you take the time to actually think about it and quit questioning the motives of the opposing side our democracy is supposed to work this way. Republicans believe one way and Democrats the other.
That keeps a certain balance.

It seems however, that this time even though the democrats won the majority vote, Republicans are hysterically opposing everything creating a gridlock that is not good for this country. It is one thing to disagree with an idea but to
irrationally and viciously lie about President Obama or his intentions in the name of politics is ridiculous.

These are supposed to be grown men, leaders of our country, and who did they just have representing the Republican party at their CPAC conference? Glenn Beck?

Ezra has it right about the House and the Senate hating each other also. It used to be these men in Congress were friends after the days business was over but now, due to the media hype and no one wanting to be seen as actually agreeing with the opposing side they are fighting tooth and nail to look like the strong offender or defender whichever the case may be. Gridlock.

As for the money, if we can afford to pay for two wars, we could certainly pay for health care.

Posted by: MaggiePi | February 23, 2010 4:04 PM | Report abuse

(6) Obama is president.

(7) Dems control the House and Senate.

Posted by: Lomillialor | February 23, 2010 4:06 PM | Report abuse

Last month 1500 bureaucrats from the federal SEC were caught watching porn all day on government computers.

Add that to the DMV and the US Post Office (do you send anything important by USPS or by Fed Ex?) and you have government run health care.

Posted by: edgar_sousa | February 23, 2010 4:08 PM | Report abuse

Who is this young squirt Erza Klein? My God what a stooge and sycophant he is for Obama. It is downright sickening to read his stuff. Hey, Klein, you are in for a big surprise in November. Your master Obama is fading fast and no one at the Washington Post can help Obama now.

Posted by: walterndebby | February 23, 2010 4:15 PM | Report abuse

For those of you that think any Gov't bill will go towards reducing costs, you are delusional.
Democrats all hold hands and jump off the cliff with the radical leader.

Posted by: steveiev | February 23, 2010 4:15 PM | Report abuse

Ezra, If you your desire for government to control our lives because our esteemed leaders know more than we do, that is your right. But many of us prefer the risks of liberty over the false cmfort of cradle to grave socialism.

but i certainly can't argue with point "(2) Individuals are not rational: Which means predicting what they'll do based on the "this makes overwhelming sense" criteria is not a foolproof strategy." Your recent columns about the healthcare and strident whing divorcedfrom reality regarding the public's supposed support for this bill MAKE YOU EXHIBIT #1 and incontrovertible proof that this point is correct. overwhelming sense in this case is clearly listening to the public, but I guess that they are too stupid and uniformed to trust their opinions.

Posted by: TuckerAndersen1 | February 23, 2010 4:23 PM | Report abuse

Left Right what crap for real. Something has to pass. HC keeps going higher and higher and peeps keep dieing and suffering. Something should have happened 30 years ago.

My wife is an attorney and I am a Marketing Consultant we can afford HC but some of my homeboys, co workers, clients can't afford it. How many of my friends have filed bankruptcy because of health cost. How many people are dieing slowly because of cost. Its the death and suffering that bothers me.

If Congress does not take action the death is on them. Congress doing nothing maybe the indirect 'Death Panel.' Congress can saves lives for real by coming together and passing law. But most people who are creating the narratives and have the voice can afford HC. I guarantee this if everyone in congress for 2 months had to live the life of people who are struggling with HC their mentality would change. If they saw death, bankruptcy, literal change of life because of cost I believe they would create way more urgency. Those people in media saying no on any HC is ridiculous. Again HC has little effect on them if HC passes or not. If you are making $80,000 to $10 Million plus in Congress or as a News Entertainer what is HC to you? It's like talking about the Super Bowl wait till next year. People in DC and million dollar news entertainers just like to ego argue, make points and get ratings. I really do not think they have American Citizens interest. Now I am not going to blame all dem peeps in DC and the Media Comedy Show its American people banding together to form voice.

It's been 30+ years getting HC together pass something.

Posted by: Press4 | February 23, 2010 4:23 PM | Report abuse

Like I have said before, Ezra, how much is the White House paying you for all this cheerleading?

Posted by: lisaaitken | February 23, 2010 4:23 PM | Report abuse


The entirety of the Republican argument against healthcare reform encapsulated in bumper sticker lingo. Good work, team.

Posted by: slag | February 23, 2010 4:25 PM | Report abuse

in 2 words: single payer!! if your elected representives actually cared about the American people instead of the insurance companies who have bought them, the healthcare disaster could of been fixed yrs. ago.

Posted by: hitch78 | February 23, 2010 4:27 PM | Report abuse

Five reasons to worry about health care

1. Obama/Pelosi/Reid/Dodd/Democrats

2. Obama/Pelosi/Reid/Dodd/Democrats

3. Obama/Pelosi/Reid/Dodd/Democrats

4. Obama/Pelosi/Reid/Dodd/Democrats

5. Obama/Pelosi/Reid/Dodd/Democrats

They're Crap on Steroids


*Two Thirds of Americans are very Disatisfied with Government

*The Rasmussen Reports daily Presidential Tracking Poll for Monday shows that 23% of the nation's voters Strongly Approve of the way that Barack Obama is performing his role as President. Forty-two percent (42%) Strongly Disapprove

*Democrats are dropping like flies in a Zapper

*Bye Bye Dodd, Bye Bye Dorgan, Bye Bye Kennedy, Bye Bye Reid, Bye Bye Bayh, Bye Bye Super Majority , Bye Bye Obama/Pelosi Government Crap Care of NO CHOICE, Bye Bye Democrats, Bye Bye Crap on Steroids.

Yes, there really is Hope

Posted by: sophic | February 23, 2010 4:28 PM | Report abuse

Reading Ezra Klein's column and then the reader comments is fascinating. One wonders why he's the columnist . . . and most of the others are readers/posters. When he says "scores of evidence" he cites none, and as many others point out, what he says violates a rather important economic law: supply and demand. I don't read Ezra very often. When I do, I don't find reasoned arguments, but rather something approaching liberal talking points. Many months ago a Time writer (subsequently tarred and feathered?) said: How are you going to add tons of people (using free money) to the health care system without adding costs and reducing quality? Does Ezra know the answer to that question? If not, then what's he doing writing about health care "reform." Addition: Kudoes to those who recognized the new Leftist slogan: "The American people are much too stupid to support our great ideas." The Decline and Fall of the WaPo is everywhere evident to those with eyes to see.

Posted by: TalkTop65 | February 23, 2010 4:32 PM | Report abuse

This comes down to leadership. Obama should caucus with all Democrats, give them an order to pass the bill, or risk being set free when election time comes. No party support or money or campaign appearances in the individual's name and you can be sure that there would be a 100% vote for the bill. Every one of the Congress depends on the party to prop them up and most are riding on the coat tails of the President. It is time for him to step up and let the party faithful know that this is one issue upon which there is no second chance and it better be passed or there will be a wholesale revolt by the public and the party for those who did not support it.

Posted by: ronjeske | February 23, 2010 4:34 PM | Report abuse

In general, as broad, unchallenged assertions, I can agree with much of what you say, Ezra. But if you drill down, each of the points has issues.

In particular, Item #3, is just hot air. Legislators don't understand all of the things they write laws about. On the downside, that's why lobbyists have a lot of power -- they (or their organizations) do understand the arcane points -- loopholes -- about their pet issues.

But on the upside, Congress is full of the best and brightest who work for many of the legislators. Many of them do understand healthcare.

So to suggest that healthcare or any other policy is too complex for a Senator or Congressperson to understand is a bit of a cop-out. We should be demanding them to understand it, not giving a pass.

But let's be honest. The healthcare bills as put forth are not that hard to understand. The notion of a public option is not hard to understand. That curbing "waste fraud and abuse" alone will not make a dent in skyrocketing healthcare costs is not hard to understand.

The media has tried to portray this as quantum leap astrophysics. It's not. The Republicans know it isn't, but prefer to play dumber than Gomer Pyle.

That has to come to an end.

Posted by: jade_7243 | February 23, 2010 4:35 PM | Report abuse

Sounds like this is more group-speak.

Health Care died along time ago - these people are trying to talk themselves back into it - against all reality and rational thought.

OK - let's go over this one more time - why is it a good idea to send a whole bunch of democrats over a cliff???


Posted by: 37thand0street | February 23, 2010 4:35 PM | Report abuse

It has been suggested by many that liberals and conservatives are attacking health care reform from two different angles:

Liberals are more concerned with covering everyone who doesn't have insurance (about 8% of the population, when you consider many have access but don't take advantage of it); conservatives are more concerned with lowering costs.

The liberal version covers most people but at the expense of those who already have insurance, either by raising their taxes or raising their premiums.

Conservative ideas would affect more people positively, by lowering their premiums,which would also make coverage cheaper for those who don't have it.

Which sounds better?

Posted by: boosterprez | February 23, 2010 4:36 PM | Report abuse

"you need the individual mandate to be able to eliminate preexisting condition provisions, which the insurance industry (rightly) would never stand for if you could wait until you were sick to buy insurance and the insurers had to sell you a policy."

Now this is a good point but it doesn't really make the point the writer hopes.

Increasing portability should be an important piece of market-based reform. Portability increases competition because it increases competition among health insurers since people don't get "locked in" to one provider.

So why not require health insurers to cover pre-existing conditions after the insured has had insurance -- any insurance -- for, say, two years? (This is already, in effect, how a lot of group plans operate.) That eliminates the risk that people will get, for example, cancer and then sign up for coverage. Once a person is covered by insurance, the net cost to the industry (and probably to individual companies since some insured with PECs will move to other companies while some will sign up with them) of pre-existing conditions would be zero. Portability is, then, no longer a problem.

This does not, please note, require everyone to sign up for insurance. But it does make it easier -- and cheaper -- for everyone to sign up for insurance. The net result is more, though not universal, coverage.

Posted by: anon99 | February 23, 2010 4:38 PM | Report abuse

“An elephant is a mouse built to government specifications.” A quote from Lazarus Long.

Like the tax code, so-called health care reform seems to be about every special interest group being given some sort of undeserved benefit leading to an unmanageable byzantine program funded by psychedelic accounting.

Posted by: SteveR1 | February 23, 2010 4:38 PM | Report abuse

"Reading Ezra Klein's column and then the reader comments is fascinating. One wonders why he's the columnist . . . and most of the others are readers/posters. When he says "scores of evidence" he cites none"

Here, let me google that for you:

I believe "scores" was a bit of a pun. But my liberal talking point generator doesn't tell me whether my intuition is true or not, so don't quote me on it.

Posted by: slag | February 23, 2010 4:39 PM | Report abuse

The American People do NOT want this health care bill - that is ONE GOOD REASON TO RUN FROM THIS BILL.

I have no idea why this article has the "this is going to happen" attitude.

The democrats are like lemmings - convincing themselves that they have to run even faster over a cliff.


Posted by: 37thand0street | February 23, 2010 4:39 PM | Report abuse

A comment on buying insurance. You cannot simply opt out now with the expectation that you can opt in later. Especially if you chose to opt in only when you are sick. Insurance companies, like most every one else, cannot earn 20,000% or 30,000% percent off of premiums in order to pay claims and make a (tidy) profit. This means that claims have to be substantially paid for out of premiums.

If every policy holder had $100,000 in claims then the premium would need to be $100,000, or nearly so. Overhead costs and profits would then be made on returns on investment. While this business model would theoretically work for insurance companies its a bad deal for policy holders as their costs, short term or long term, for the policy are substantially equal to their costs paying directly for the service.

So, insurance companies spread the risk across thousands of healthy people to pay claims for the few that happen to be sick at any given point in time. When this is not the case, if during any given period the number of paying healthy people, those paying premiums but not making claims, drops premiums must rise. This is the issue at Anthem Blue Cross. You can b%^&h about profits all you want but Anthem is 100% correct, if costs rise, or those paying premiums but not making claims drops, then premiums must rise. There is simply no business or moral case to be made against the 39% increase. It is what it is.

If you insist on the option to "opt out" then it has to mean you opt out forever. You also never receive any medical care you cannot pay for immediately by check or credit card. No going to the emergency room then trying to make payments or declaring bankruptcy since hospitals simply transfer those losses to those of us that can pay or go out of business. If it is wrong for you to pay taxes for a government program it is equally wrong for me to pay via a private system for your medical care because you refuse to participate from the get go, essentially transferring your costs to me.

Posted by: elkiii_2008 | February 23, 2010 4:41 PM | Report abuse

responding to sophic:is it your idea is to elect republicans again. the previous administration did such a good job, look at the state of America, 2 wars, a economy on the bring, bank bailouts, Al-Queda (OBL) still alive & polting the next 911. the clowns of Bush&co. are the most inept, arrogant and complete morons ever to hold office!

Posted by: hitch78 | February 23, 2010 4:43 PM | Report abuse

Anyone with hands on dealing with regulations written in DC will be shuddering in the night until this piece of crap goes away.

Doubt it? I give you the IRS code...OSHA regulations...Clean Air regulations and, for the final abomination, bunk bed safety standards.

Anyone wanting the government to pass health care legislation should read any of the above regulations or, gulp, try to understand your own health care policy.

We will be like Moses wandering 40 years in the wilderness wondering what in hell possessed anyone to vote for government run health care.

Posted by: dlbrackett | February 23, 2010 4:46 PM | Report abuse

5 Reasons To Worry:
1) Obama
2) Pelosi
3) Reed
4) Elitist Attitudes
5) Bankrupting the country

Posted by: tbastian | February 23, 2010 4:47 PM | Report abuse

"TeaPartyPatriot" obviously doesn't understand the nature of the health care problem itself (out-of-control provider costs facilitated by a for-profit, third-party transfer-payer system); the economic issues involved (ballooning deficits, lost productivity); or what really hangs in the balance (fiscal solvency for the United States Treasury itself); while dismissing the thousands of EXPERTS in a hundred different specialties trying to create a new regulatory framework as "loony-left d-crat socialists".

I'm old enough to recall the Civil Rights conflicts of the 1960's. His words (his tone especially) echo what one heard from arch-segregationists fighting Civil Rights legislation in the South (substitute "Communist" for "Socialist" and it's spot on).

This incredibly complex problem can't be solved incrementally or in a random piecemeal fashion because it is systemic -- one reason why the few large corporations that benefit from it immensely (while pauperizing the American people) can fight quite effectively against reform, as they have done and continue doing. This reality is right in front of his eyes yet "TeaPartyPatriot" doesn't see it, any of it (because Limbaugh, Beck, and Fox News have put blinders over his eyes?).

Nor does he see where his true economic interest really lies (in the Thomas Frank "What's the matter with Kansas?" sense). He's been brainwashed, in a word, into seeing evil where none exists while rejecting the very notion of complexity itself. What he wants -- a simple, black-&-white solution -- doesn't exist in the real world, so he recasts the problem as a simple "either/or" choice between two nebula ("socialism vs free market"), conveniently ignoring an inconvenient fact that corporate socialism lies at the heart of the problem, why a free market in health insurance doesn't exist in the United States. The fact that he's fighting the creation of precisely such a free market and imposition of free market discipline on a handful of monopolistic corporations he doesn't see as well.

And he considers himself a patriot!

Posted by: hogsmile | February 23, 2010 4:48 PM | Report abuse

Ezra is a good example of your typical elitist Progressive yuppie who knows what is best for all us stupid folks (65% of the U.S. population), who don't want the government taking over our lives. I vote to put all the Progressives in California and let them live with their brilliant ideas - and leave the rest of the country alone.

Posted by: L80bug | February 23, 2010 4:49 PM | Report abuse

The American people dont want this plan. Polls show they want generic health reform which really means nothing, but not this particular plan of health reform.
The Democrats seem to need this plan for their own purposes, but certainly not because this plan will lower costs, improve care, or for that matter cover more people.
Why 535 Congressmen, 1 President and all their experts think they know the best way to supply me, and the 300 million other Americans with health care services is beyond me? Arrogance, hubris, and conceit are the only possible answers.
Government rules have created the healthcare mess and more rules wont fix it.

Posted by: bruce18 | February 23, 2010 4:50 PM | Report abuse

"who knows what is best for all us stupid folks (65% of the U.S. population), who don't want the government taking over our lives."

Well, the majority of you stupid folks do want a public healthcare option. So, there's that.

Posted by: slag | February 23, 2010 4:52 PM | Report abuse

Question...(and I am so pessimistic about the Dem/Rep divide that I'm betting I'll get very differect opinions from each side) Nevertheless, a family member, 25, is a musician, considered "self-employed", can barely pay his rent, doesn't eat well (of course) and cannot afford health insurance. As I understand it, if this bill passes, he either HAS to get insurance (which he cannot afford) or pay a penalty to the gov't. Tell me, how is this bill helping him?

Posted by: scmonty1 | February 23, 2010 4:54 PM | Report abuse

"So why not require health insurers to cover pre-existing conditions after the insured has had insurance -- any insurance -- for, say, two years? (This is already, in effect, how a lot of group plans operate.)" posted by anon99

Quite right, anon99. There are lots of carrots and sticks that can be employed to incentivize the healthy to sign up for insurance without the necessity of an unpopular and difficult to police mandate.

Posted by: bgmma50 | February 23, 2010 4:58 PM | Report abuse

Not a ******* thing here on what is best for the people....

lowlife partisans ......the 2 party system is broken..and needs to be blown up!!!!

anyone with a D or R after their name...needs to get the HE!! out of Washington.....taken to gitmo and put in a shark tank.....

Posted by: FletcherChristian1 | February 23, 2010 4:59 PM | Report abuse

News Flash! We do not have the money to pay for it! We cvannot afford to give deals! We cannot afford to pay ofr illegal aliens! We cannot afford new taxes! Why the manical focus on this dead-end thinking?
WH needs to focus like a lazer (BArry's words) on jobs. Try energy independence and not caulking jobs! Idiocy seems to prevail!

Posted by: NeoConVeteran | February 23, 2010 5:10 PM | Report abuse


The entirety of the Republican argument against healthcare reform encapsulated in bumper sticker lingo. Good work, team."

This sums up the attitude of many Democrats who are pushing health care reform. "We know what's good for you better than you do. If you don't agree with us, you must be stupid."

The idea that we are smarter than the market seems to come around once a generation. People on the left seem particularly prone to it.

But we are not smarter than the market and its iron laws always catch up with us eventually. A planned health care economy won't work any better than any other kind of planned economy.

Every engineer knows the rule, "You can have it fast, good or cheap. Pick two." In health care, that translates to, "You can have universal coverage, high quality or lower cost. Pick two." There is no way to avoid this. If you want to cover another 40 million people, you are going to have to have more hospitals, more machines, more Drs. etc. That will cost a lot more money. If you don't want to spend the money, then quality will suffer.

And that is under the best-case scenario. By trying to strong-arm market forces, it is perfectly possible to end up with a less efficient system where costs go up and quality goes down.

Posted by: anon99 | February 23, 2010 5:13 PM | Report abuse


Posted by: connyankee1 | February 23, 2010 5:20 PM | Report abuse

"But we are not smarter than the market and its iron laws always catch up with us eventually. A planned health care economy won't work any better than any other kind of planned economy."

And yet, there are countries on this planet who do have a planned healthcare economy. They do have either single-payer or socialized medicine. And their WHO outcomes are better than ours.

The Market isn't Magic. It's time you grew up and observed that fundamental reality.

Posted by: slag | February 23, 2010 5:32 PM | Report abuse

Once again, all Americans can see that the loony-left d-crat socialists DO NOT WANT REAL REFORM; they want ONLY NATIONALIZATION of the American healthcare industry and full federal government control of OUR healthcare.


Posted by: TeaPartyPatriot | February 23, 2010 1:33 PM | Report abuse


Real original name buckwheat???

Posted by: kare1 | February 23, 2010 5:37 PM | Report abuse

NEWS FLASH... I just conducted my own poll..... 90% want some form of healthcare reform.... WOW that has to mean everyone loves Obama and his plan.... WRONG... what I left out was that I asked another 2 questions..... 1)Do you want the Govt to control healthcare like they do the Post Office and Frannie Mae and Freddie Mack ( answer 75% NO ) and 2) Do you want to pay higher taxes for required by law coverage ( 78% NO )

So..... you can make a poll say anything when you phrase it and frame it for the outcome you want.

Yes, Americans can all agree that something needs to be done but the majority of Americans ( by ANY poll taken ) do not want the Govt to control and run it.

Posted by: tbastian | February 23, 2010 5:51 PM | Report abuse

I'm not an expert on healthcare, but then neither are you Mr. Klein. You graduated from UCLA in 2005 with a B.A. in Political Science. Your professional life consists of blogging. You refer to "scores of evidence" that the healthcare bill will reduce costs. Evidence consist of facts, not forecasts and assumptions. The cost savings in the bill requires significant reductions in Medicare spending, something that is not likely to happen in your lifetime. Facts: The Texas Medical Association reported recently that only 57% of primary care physicians in Texas accept Medicare. I have a sister who lives in Houston. Her Gynecologist stopped accepting Medicare two years ago. Her primary care physician recently told her that his practice is considering refusing Medicare because they keep reducing the reimbursements. The Mayo Clinic location in Arizona recently announced that they will no longer accept Medicare because they are losing money on Medicare patients. They are studying the issue at their other four locations. My primary care practice has stopped accepting new Medicare patients. All of this because the only way Congress has found to reduce Medicare cost is to reduce payments to providers. The bill will provide coverage to an additional 30 million+ individuals. Opinion: As fewer doctors accept Medicare and the number of primary care physicians declines, it is likely that it will be increasingly difficult to find a primary care physician who will accept any type Government controlled reimbursement mechanism. That leaves those who are covered by the Government programs either without a doctor or forced to pay cash. I agree that we need to reform the healthcare system but I would like to see a bill that has realistic cost reductions and does not create more problems than it solves. This bill has become a political issue rather than an economic issue. Government funded and controlled healthcare is not the answer.

Posted by: NoExpertOnAnything | February 23, 2010 5:53 PM | Report abuse

I still don’t understand the number of people shouting that it’s impossible to cover more people and bring down costs. The insurance industry makes profit by betting against the average. The basic bread and butter economics of the insurance industry- health, auto, home, whatever- is that the larger the pool of people paying into it the greater the profit margin for the insurer or the greater the savings to the consumer if the insurer chooses to pass the savings on to them. The insurer will pass those savings on while at the same time maintaining quality if they are in rigorous competition with each other for the consumers’ business.

Mandate to buy into the system- distasteful maybe but not without precedent in American Democracy- creates increased demand. Public Option or non-profit exchanges as alternative providers creates increased competition. There you go- increased demand plus increased competition almost always yields lower costs and higher quality (Insurance companies love that first part, it’s the second part that they want to kill). Not to mention probably some job growth as the insurance industry starts hiring to manage the increase in consumers.

Sling mud about the specifics of how to get there all you want but it almost has to be called willful ignorance to claim that the principle behind the over-arching strategy doesn’t exist when it is right out of any intro to macro-economics textbook you care to pick up.

Posted by: bran-solo | February 23, 2010 5:54 PM | Report abuse

No one with an IQ over 60 wants this horrific invasive massive so called health care bill which is nothing but a government takeover of one sixth of our economy. This President and his cronies could give a flying fig if you or I fell off the curb. They are not concerned about our care or they fact they will bankrupt this nation. They are creating this maize of government agencies that we all know will be a cesspool of waste and fraud. The government has not run anything efficiently and why would they start now? This is a fraud. This summit is a sham. These are incredibly evil men who are acting deaf dumb and stupid to the will of the people. It is clear the people do not want this bill making us pay more for less. They are lying to us saying we cannot afford not to do something. Nothing is better than bankrupting this country with this pathetic bill. I vote for nothing.

Posted by: greatgran1 | February 23, 2010 5:55 PM | Report abuse

Another thing I like about the trolls-

Ever notice how it is as though there is a microphone, and each troll takes turns walking up and shouting something?

Trolls very rarely actually converse, they just have their little catharsis and then return to the back of the line to await the next chance to shout again.

Posted by: Patrick_M | February 23, 2010 6:21 PM | Report abuse

the democraps better start making jobs soon . after the first of the yr they probly going to need one the way they are doing

Posted by: mahye1935 | February 23, 2010 6:29 PM | Report abuse

"Legislators do not understand health-care reform very well"

True. I sent an identical letter to my two senators and representative urging passage of the senate HCR bill. One senator sent a pro-forma response saying she supported HCR, etc. The other senator sent a response that, at least, referenced the points included in my letter and indicated her support. Both make sense since they had already voted for the Senate bill.

The response from my Representative was troubling. While sharing my desire for HCR legislation, she said, "there are too many problematic sections of the Senate bill, which makes passage of it very difficult."

She outlined a few points, including, "the Senate bill does not in any significant way reduce the deficit." That seems factually wrong since CBO projections indicate the bill passed by the Senate provides greater deficit reduction than the bill passed by the House.

I'm not sure if my Rep. actually believes the Senate bill is inferior on deficit reduction or was simply giving me kitchen sink arguments to defend her unwillingness to simply pass the Senate bill. Nevertheless, distressing to have at least one argument be factually wrong.

Posted by: bbebop | February 23, 2010 6:45 PM | Report abuse

The PHOTO on this page looks like all the CLOWNS standing all in a row. PELOSI with her chest puffed out, and the rest looking look the CAT that swallowed the CANARY. They will do what ever they want to PASS THIS HEALTH CARE BILL. They will change the rules as they go along to MEET THIER NEEDS. BUT I WONDER IF THIS HEALTH CARE IS SUCH A GOOD IDEA!

Let me get this straight......we're trying to pass a health care plan written by a committee whose chairman says he doesn't understand it, passed by a Congress that hasn't read it but exempts themselves from it, to be signed by a president that also hasn't read it and who smokes, with funding administered by a treasury chief who didn't pay his taxes, all to be overseen by a surgeon general who is obese, and financed by a country that's broke.

What the hell could possibly go wrong
Will someone please explain to me why is everyone blaming the HEALTH INSURANCE COMPANIES for their HIGH COSTS? Has anyone very questioned WHY HOSPITALS CHARGE WHAT THEY CHARGE? Example: I had a 2 1/2 hour procedure in the hospital as man out patient. MY BILL, $7395.00. $2,598.00 per hour: I looked over the charges as I was curious as to HOW THIS CAN BE SO HIGH. There were charges on that bill that I never knew existed. HOSPITAL GOWN RENTAL 42.00 , those little booties, 18.00: There was a charge for 1,695.00 for basic set up. CURIOUS I called the insurance company LIVID at the charges on my bill. I asked what in the H&LL is basic set up. I was told that , that is the cost for someone to put that little tray of instruments that thee doctor uses, it also costs $1,495.00 to take it away. I told them I would have done it for $500.00. THIS IS THE PROBLEM PEOPLE, The hospitals are charging OUT OF CONTROL COSTS. Have any of you who have been in the hospital ever notice all the people walking around I mean I counted almost 50 people all well dressed with name tags walking around trying to look important and that was only while I was waiting to get signed in. MAYBE THE OBAMA administration should STOP and LOOK AT THE REAL PROBLEM<> GAUGING by he hospitals. Just like the new CREDIT CARD LAWS that just passed. BIG DEAL, According to the new law, THE CREDIT CARD COMPANIES CAN CHARGE WAHT THEY WANT, they just have to let you know. In other words the CREDIT CARD COMPANIES CAN $CREW US ALL, THEY JUST HAVE TO IN FORM US TAHT WE ARE GETTING $CREWED. WOW, way to go OBAMA. Still working for the BIG BUSINESSES..

Posted by: itscc721 | February 23, 2010 6:47 PM | Report abuse

2 questions--

How come we are the only major nation in the world without health care which covers everyone?

Why do we hear about all the troubles in Canada (insurance company line) but we don't hear about Germany or France?

Posted by: gusmiller1922 | February 23, 2010 7:06 PM | Report abuse


Liberals and conservatives ARE approaching healthcare from different angles.

Liberals approach it from the premise that in this day and age when we are spending so much money on foreign wars and foreign aid we should surely be able to ensure that everyone in our country can afford health insurance.

Conservatives are more interested in lowering costs, that is true. Lowering any costs to themselves.

Conservatives claim that in attempting to cover everyone it will cost them by raising premiums or their taxes.

Why not offer a good public option in there to give the insurance companies competition. They would have to lower premiums and costs in the long run.

That way we could cover everyone and lower costs. Which sounds better now?

Posted by: MaggiePi | February 23, 2010 7:09 PM | Report abuse

Ok people, it took you eight years to get mad but quit trying to blame President Obama with everything that has gone wrong in this country politically. It has taken it many years to get this way and will not be fixed overnight. He is having enough trouble trying to get Congress to move on anything. If you can't be part of the solution quit being part of the problem.

Posted by: MaggiePi | February 23, 2010 7:15 PM | Report abuse

Question: What do you get when a person graduates with a B.A. in Political Science, from a liberal university?

Answer: Another liberal

Informing Christians

Posted by: DebraJMSmith | February 23, 2010 7:16 PM | Report abuse

This bill must fail. America is bankrupt today, the lie about this bill is that it can be paid for; the President even goes so far as to say that without it the budget will suffer. I say that with it, the U.S. will have to exercise bankruptcy, and will never recover in the world.
Think about it, Obama says 2/3 of this bill will be paid for by savings we take out of Medicare. MEDICARE is broke, there is no money there to get, and it is a sham.
We have elected a flim flam man to the highest office in the land, a man with no background and whose only skill is the ability to read a teleprompter with gusto.
Since he can not dazzle the world with his brilliance he is trying to baffle the world with his B.S.
He will say anything to try to make this happen only because he wants the Govt. to control our country. The Federal Govt. was limited in our constituion by our founders so that it could not do these types of things. They have no legal right to control Health care. IF you think that having the Govt. force you to buy healthcare or fine you a large sum is the American way, then you just don't understand that freedom is taken away.
This man can still be a good President, there are many things he can accomplish, but to do it he will have to surround himself with accomplished patriots for advice instead of the has been's and wannabes that are now occupying space in the White House.
Americans are meant to be FREE. Let us all see to it that we remain that way.

Posted by: texian1 | February 23, 2010 7:28 PM | Report abuse

"Why not offer a good public option in there to give the insurance companies competition."

Things like this come up again and again. They represent a very basic misunderstanding on the part of some proponents of overhauling the healthcare system.

Insurance companies ARE NOT the problem. They ARE NOT driving up costs significantly. Insurance company profits just aren't all that high. The industry averaged 5.6% last quarter.

It is the cost of health care itself that is high. A public option will make this much worse, not better, because more people will be trying to access more healthcare. This means, once again, that we will need to build more hospitals, etc. or we will need to cut quality.

For example, hospital beds are in fairly tight supply. If you want to increase the demand on those beds, you going to have to deny people with less-serious conditions access to them. If you have two people who need the same bed, only one is going to get it.

There are many factors driving health care costs. The insurance companies, while they do have problems that can and should be addressed, are only one factor, and a minor one at that.

Posted by: anon99 | February 23, 2010 7:33 PM | Report abuse

Let’s simplify things about the health care debate. Republicans are for states rights. They generally would agree with a health care proposal that has the most limitations on the federal government. Democrats are for federal initiatives. They disagree with the republicans that states should solve national problems and wish to maximize national solutions. The libertarian camp has recently entered the debate in the form of Ron Paul. They go a step beyond Republicans to maximize individual rights over the rights of individual states. I would recommend that there is a forth point on the political compass that is being ignored. That point could be called the “Statist” solution. A statist solution would delegate our democratic freedoms to a panel of experts for a time to solve a problem. This solution would be the way that countries like Germany have traditionally solved problems. Countries like Germany hire a commission of experts to solve these problems, and then take the governing of this solution out of political hands so that the commission can stay the course and solve the problem. Recently, our president set up a bipartisan commission of two former deficit hawks in both parties to remove this blind spot from our eyes. I believe that our president is on the right track here. Why shouldn’t this same strategy work on health care?

I appreciate technological tools like twitter that open up this debate to small voices like mine to enter the fray. Many of the news commentators and journalist have a vested interest in selling advertising. They choose to interview people who are controversial so they can increase their ratings. I do not believe that the German solution has much controversy or democratic input to drive public policy debate. That is why it is currently a blind spot in the health care debate. America is a country made up of salespeople. We love to give our best pitch and hear about ideas we believe in. I think it is time to give the Americans with more or an engineering perspective a turn to govern. The health care system is broke and it needs to be fixed. Should we consider all possible solutions? Problems that do not appear in the blind spot of our rear view mirror may be better solved by us looking directly to the experts for a time until the problems are more easily seen.

Posted by: pparris | February 23, 2010 7:57 PM | Report abuse

The Health Care crisis that we are facing has nothing to do with Liberals or Conservatives or Rich and Poor it has to do with the People's confidence in our Government.

We have stood by and watch our elected officials steal from our Social Security program and when they couldn't pay it back they want to tell us that Social Security is an entitlement program, if a company did this to their employees 401 they would be in jail. But what is worst than what they did to Social Security is what they have done to the American People they have sold us down the river to Lobbyist, Special Interest Groups, and Corporate America for Campaign Funds, Gifts, and trips.

Here is what we need to do to fix Health Care.

First let me say that my plan is not government ran or paid for by us, the TAXPAYER, or corporate America. IT IS PAID FOR BY THE ONES WHO USE IT. And secondly we cannot let the insurance companies decide who gets coverage, what type of services they get and who lives and who dies. Nor can we let our government do the same. And we cannot let the high cost of Health Care bankrupt our families and our Government.

1. Everyone pays X amount of dollars a week to be covered per person.
2. We change the tort laws so Health Care Professionals do not face frivolous law suits.
3. All Health Care Professionals will have a federal license only so that all disciplinary actions can be handled swiftly and so that person can’t lose their license in one state and go practice in another state.
4. All of your medical needs will be covered Health, Dental, Glasses, Chiropractic and Pharmaceuticals.
5. All that is collected for Health Care program stays in this program it can be invested but not borrowed by the federal government for anything such as has been done to the Social Security program.
6. Price control of services fees and medicine.
7. Money can be paid by payroll deduction or you can pay at your bank.
8. We set up a phone and computer bank where the people can say what they feel is needed and can vote on the final bill so our elected officials can know what the people want.
9. Once this program is adopted it can only be changed by a vote of the people.

We the people need to take the lead on this issue no one person has all the answers so send this to all our elected officials and demand they take action or we will take action in November.

Posted by: rklkdavis | February 23, 2010 8:24 PM | Report abuse

Maybe the solution to this whole devisive situation is to:
1)Get the government out of health care payment entirely. 2) Those who can't pay for their doctering should just go out and find a quiet place to die. 3) We could all then sactimoniously wring our hands and shake our heads and moan that it should not be this way.

Posted by: TAMPADUDE | February 23, 2010 8:37 PM | Report abuse

Ezra rhymes well enough with "Oh, duh!" for poetic use, your parents were bright.

You however, are merely smug and condescending. Without reason in my eyes.

Posted by: deadmanwalking | February 23, 2010 8:58 PM | Report abuse

Open mic night for trolls remains a smashing success! Next! Step right up...

Posted by: Patrick_M | February 23, 2010 9:05 PM | Report abuse

Patrick, some of them are probably paid to flood the blog comments. This has become part of the public relations battle by special interests on other issues, too, and it is probably offered by PR firms as part of the package. The giveaway is the similarity in the complaints, and the way they center upon 2 or 3 memes daily. (e.g. "young" Ezra, Dems will pay in Nov. etc.) Real people usually have very different approaches to their arguments, and don't use personal attacks.

Posted by: Lee_A_Arnold | February 23, 2010 9:40 PM | Report abuse

Lee -

I actually suspected as much, but I nevertheless find these empty-headed troll clusters, even when they are just an "astro turf" charade, to be weirdly entertaining, just for the pure repetitive mindlessness of it all.

Posted by: Patrick_M | February 23, 2010 9:55 PM | Report abuse

Awwww. Looks like the trolls have a curfew.

Posted by: Patrick_M | February 23, 2010 10:51 PM | Report abuse

Ezra, like many others you don't understand "insurance" and you don't know how or what drives cost in healthcare. Either the House or the Senate plan will cost our nation more in healthcare over 10 years than any so called analysis is predicting. The idea that it will reduce costs is ludicrous. Obamacare is an action that will bring US health care into a position below that of most European programs and below Canada within 5 years. You writers, pundits and 95% of politicians know nothing of the destructive elements of our current system. Any physician that was honest enough to say this out loud will tell you that their defensive medicine methodologies add at least one fifth to the cost of medical analysis and treatment.The trial bar spends hundreds of millions of dollars at the state and federal level to sell their lie that tort reform wouldn't lower the costs importantly enough and it's greedy ins companies that push for reform. Did you ever consider that if these lawyers were so concerned about the average citizen getting justice they would be willing to cap their compensation to $250,000 after expenses. No way they want 30 to 50 % of the settlement. Have you considered what would happen to pharmaceutical and biomedical research under the Obmacare plan. The US would go from the leading medical research nation to some 2nd rate congtibutor in 10 years. Ask yourself the key question- why do people who are seriously ill or need sophisticated surgery or treatment come to the US. That quality is not cheap. And the rest of the world rides our research and technology in medicine like they ride our military strength to protect them while they criticize us as we protect their interests. Get your head out of your liberal,Democrat buttocks and look at the real world.

Posted by: mrtro | February 23, 2010 10:57 PM | Report abuse

A late night bonus troll! Thanks for that. "Get your head out of your liberal,Democrat buttocks and look at the real world." Nice one!

Hard to top "liberal,Democrat buttocks," but anyone else want to take a turn at the microphone?

Step right up...

Posted by: Patrick_M | February 24, 2010 12:15 AM | Report abuse

The damage done to our once great country, will be far deeper than the damage done by Bush's and Dem Senate's 2 wars. What this debate is doing is permanently splitting Americans in half. This my friends....may never be fixed. Obama will go down in history as the President to blame for the complete bankruptcy and fracture of the USA.

Posted by: Intuition1010 | February 24, 2010 3:11 AM | Report abuse

Ezra: Point #3 is correct, lawmakers don't understand what they are voting on. However, We The People understand it perfectly well and don't want any part of it. It is an effort by a socialist few to give the government control of 1/6th of the US economy. There are plenty of free markety options to help control healthcare costs without taxing everyone to death. BTW, in case you haven't noticed your newspaper subscriptions are dropping like a rock because your journalistic malpractice. Please start reporting on the realities of Obamacare instead of cheer leading for it.--pp

Posted by: professorpooky1 | February 24, 2010 8:01 AM | Report abuse

I hate to break this to you, but the United States Congress has no Constitutional authority to even discuss this, much less attempt to pass legislation on healthcare.
The last time I looked, ALL states have a State Legislature and and Insurance Commissioner.
This egregious legislation breaks several ammendments, including the 10th (states rights) and the 5th (taking your property,i.e. cash payments) without just compensation.
If you begin to pay NOW but there will be no coverage until a few years from now, just how is that just compensation? What if you die in a car crash prior to the legislation becoming active? Do you think they're going to return that money to your heirs? Think again.
While you're at it, think about how the federal government is already doing that with social security and medicare. It is, however you look at it, unconstitutional.
Entitlement programs are all unconstitutional, and once they're in play, they are virtually impossible to withdraw, not to mention unsustainable.

Posted by: Olderndirt | February 24, 2010 9:36 AM | Report abuse

Mr Klein says "A lot of these congressmen don't know much about the bill...". No one with an ounce of sense would make the biggest investment of their life without sufficient knowledge of what they were investing in. It is a prescription for disaster.

Posted by: buffndm | February 24, 2010 12:54 PM | Report abuse

Two components that would make me more inclined to let Congress proceed with passing healthcare reform:

1. Mandate that all members of Congress are subject to same rules and regulations of healthcare legislation and they are not allowed to bypass the system, even with their own money. If it's good enough to force down our throats, then its good enough for them.
2. Establish an exit strategy from the legislation for when costs skyrocket and rosy projections provided for passage of this bill do not come true. The problem with all government legislation of this nature is that they never let it die. Social Security and Medicare, regardless of their pending insolvency, are "untouchables".

In the absence of these two items, I have no reason to trust the politicians on how good their healthcare reform will be.

Posted by: KJGreen | February 24, 2010 9:26 PM | Report abuse

The lack of intelligence behind the advocay of socialized medicine (I know, that's not the sophisticated label, just the historically accurate one) is revealed in the 5 points.
1. The collection action problem means that those who advocate that we citizens engage in self-sacrifice for the sake of society are to be guided by indiviudal elected officials who somehow can't be persuaded to do the same.
2. Individuals are not rational sounds good, but lacks a definition of rational. Makes good sense means conformity to the group think, not actual reasoning done by an individual. Amazing how the human capacity is always the thing to be denigrated, when socialist policies aren't going well.
3. It's obvious the Legislatord don't understand health-care reform, economics, the rights of American citizens, including doctors, finance or much else OR they would not be voting on government as the master of this area of social need.
4. Yes, Obomba's "present" votes put him in a position to not declare a policy preference that would generate negative votes. But, that isn't supposed to be good for Congressmen.
5. House and Senate hate each other. You mean that nearly a century after you sabotaged the powers of the States to select Senators, you are no closer to unity between the two Houses of Congress? Praise be to the Founding Fathers for their vision of the division of powers.

Posted by: pbeaird | February 24, 2010 10:27 PM | Report abuse

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