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Obama's closing argument on health-care reform

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"We began our push to reform health insurance last March with the doctors and nurses who know the system best," Barack Obama said today, "and so it is fitting to be joined by all of you as we bring this journey to a close."

"Bring this journey to a close." Health-care reform seemed to have spun out of control in recent months. But it has settled in recent weeks. And the White House means to finish this process on its own terms. Obama's speech today was a reminder of how little has actually changed in the underlying dynamics of this process. Democrats still have their bills. They still have large majorities in both houses of Congress. They still want their bills to pass because they think it's best for the country and they still need a bill to pass if they're to have an even slim chance of surviving the midterm election.

And so Obama gave no quarter today. Gone was the pretense that Democrats and Republicans basically agree on health-care reform. "Many Republicans in Congress just have a fundamental disagreement over whether we should have more or less oversight of insurance companies," Obama said. "And if they truly believe that less regulation would lead to higher quality, more affordable health insurance, then they should vote against the proposal I’ve put forward."

Gone was vague language and gesturing coyness Democrats have favored on the path forward. "The United States Congress owes the American people a final vote on health care reform," Obama said. "We have debated this issue thoroughly, not just for a year, but for decades. Reform has already passed the House with a majority. It has already passed the Senate with a supermajority of sixty votes. And now it deserves the same kind of up-or-down vote that was cast on welfare reform, the Children’s Health Insurance Program, COBRA health coverage for the unemployed, and both Bush tax cuts."

So that's it, then: The health-care reform bill that Congress will vote on will be a close relative of the health-care reform bills that Congress has already passed. No Plan Bs, no starting over, no accommodation with continued obstructionism. "I have therefore asked leaders in both houses of Congress to finish their work and schedule a vote in the next few weeks," Obama said. "From now until then, I will do everything in my power to make the case for reform."

What's important about this speech is that it didn't leave any paths open. It attacked the Republican bills, the arguments for piecemeal reform, and the idea that procedural impediments are sufficient to excuse the further delay of a verdict. This is the end of the line. There's not a magic alternative behind the curtain or a hard reset that will lead to a harmonious bipartisan process. It all just is what it is. And now it's time for a vote. It's time for health-care reform to either pass or fail.

Obama's full remarks are copied below the fold.

Good afternoon. We began our push to reform health insurance last March with the doctors and nurses who know the system best, and so it is fitting to be joined by all of you as we bring this journey to a close.

Last Thursday, I spent seven hours at a summit where Democrats and Republicans engaged in a public and substantive discussion about health care. This meeting capped off a debate that began with a similar summit nearly one year ago. Since then, every idea has been put on the table. Every argument has been made. Everything there is to say about health care has been said and just about everyone has said it. So now is the time to make a decision about how to finally reform health care so that it works, not just for the insurance companies, but for America’s families and businesses.

Where both sides say they agree is that the status quo is not working for the American people. Health insurance is becoming more expensive by the day. Families can’t afford it. Businesses can’t afford it. The federal government can’t afford it. Smaller businesses and individuals who don’t get coverage at work are squeezed especially hard. And insurance companies freely ration health care based on who’s sick and who’s healthy; who can pay and who can’t.

Democrats and Republicans agree that this is a serious problem for America. And we agree that if we do nothing – if we throw up our hands and walk away – it’s a problem that will only grow worse. More Americans will lose their family’s health insurance if they switch jobs or lose their job. More small businesses will be forced to choose between health care and hiring. More insurance companies will deny people coverage who have preexisting conditions, or drop people’s coverage when they get sick and need it most. And the rising cost of Medicare and Medicaid will sink our government deeper and deeper into debt. On all of this we agree.

So the question is, what do we do about it?

On one end of the spectrum, there are some who have suggested scrapping our system of private insurance and replacing it with government-run health care. Though many other countries have such a system, in America it would be neither practical nor realistic.

On the other end of the spectrum, there are those, including most Republicans in Congress, who believe the answer is to loosen regulations on the insurance industry – whether it’s state consumer protections or minimum standards for the kind of insurance they can sell. I disagree with that approach. I’m concerned that this would only give the insurance industry even freer rein to raise premiums and deny care.

I don’t believe we should give government bureaucrats or insurance company bureaucrats more control over health care in America. I believe it’s time to give the American people more control over their own health insurance. I don’t believe we can afford to leave life-and-death decisions about health care to the discretion of insurance company executives alone. I believe that doctors and nurses like the ones in this room should be free to decide what’s best for their patients.

The proposal I’ve put forward gives Americans more control over their health care by holding insurance companies more accountable. It builds on the current system where most Americans get their health insurance from their employer. If you like your plan, you can keep your plan. If you like your doctor, you can keep your doctor. Because I can tell you that as the father of two young girls, I wouldn’t want any plan that interferes with the relationship between a family and their doctor.

Essentially, my proposal would change three things about the current health care system:

First, it would end the worst practices of insurance companies. No longer would they be able to deny your coverage because of a pre-existing condition. No longer would they be able to drop your coverage because you got sick. No longer would they be able to force you to pay unlimited amounts of money out of your own pocket. No longer would they be able to arbitrarily and massively raise premiums like Anthem Blue Cross recently tried to do in California. Those practices would end.

Second, my proposal would give uninsured individuals and small business owners the same kind of choice of private health insurance that Members of Congress get for themselves. Because if it’s good enough for Members of Congress, it’s good enough for the people who pay their salaries. The reason federal employees get a good deal on health insurance is that we all participate in an insurance marketplace where insurance companies give better rates and coverage because we give them more customers. This is an idea that many Republicans have embraced in the past. And my proposal says that if you still can’t afford the insurance in this new marketplace, we will offer you tax credits to do so – tax credits that add up to the largest middle class tax cut for health care in history. After all, the wealthiest among us can already buy the best insurance there is, and the least well-off are able to get coverage through Medicaid. But it’s the middle-class that gets squeezed, and that’s who we have to help.

Now, it’s true that all of this will cost money – about $100 billion per year. But most of this comes from the nearly $2 trillion a year that America already spends on health care. It’s just that right now, a lot of that money is being wasted or spent badly. With this plan, we’re going to make sure the dollars we spend go toward making insurance more affordable and more secure. We’re also going to eliminate wasteful taxpayer subsidies that currently go to insurance and pharmaceutical companies, set a new fee on insurance companies that stand to gain as millions of Americans are able to buy insurance, and make sure the wealthiest Americans pay their fair share of Medicare.

The bottom line is, our proposal is paid for. And all new money generated in this plan would go back to small businesses and middle-class families who can’t afford health insurance. It would lower prescription drug prices for seniors. And it would help train new doctors and nurses to provide care for American families.

Finally, my proposal would bring down the cost of health care for millions – families, businesses, and the federal government. We have now incorporated most of the serious ideas from across the political spectrum about how to contain the rising cost of health care – ideas that go after the waste and abuse in our system, especially in programs like Medicare. But we do this while protecting Medicare benefits, and extending the financial stability of the program by nearly a decade.

Our cost-cutting measures mirror most of the proposals in the current Senate bill, which reduces most people’s premiums and brings down our deficit by up to $1 trillion over the next two decades. And those aren’t my numbers – they are the savings determined by the CBO, which is the Washington acronym for the nonpartisan, independent referee of Congress.

So this is our proposal. This is where we’ve ended up. It’s an approach that has been debated and changed and I believe improved over the last year. It incorporates the best ideas from Democrats and Republicans – including some of the ideas that Republicans offered during the health care summit, like funding state grants on medical malpractice reform and curbing waste, fraud, and abuse in the health care system. My proposal also gets rid of many of the provisions that had no place in health care reform – provisions that were more about winning individual votes in Congress than improving health care for all Americans.

Now, despite all that we agree on and all the Republican ideas we’ve incorporated, many Republicans in Congress just have a fundamental disagreement over whether we should have more or less oversight of insurance companies. And if they truly believe that less regulation would lead to higher quality, more affordable health insurance, then they should vote against the proposal I’ve put forward.

Some also believe that we should instead pursue a piecemeal approach to health insurance reform, where we just tinker around the edges of this challenge for the next few years. Even those who acknowledge the problem of the uninsured say that we can’t afford to help them – which is why the Republican proposal only covers three million uninsured Americans while we cover over 31 million. But the problem with that approach is that unless everyone has access to affordable coverage, you can’t prevent insurance companies from denying coverage based on pre-existing conditions; you can’t limit the amount families are forced to pay out of their own pockets; and you don’t do anything about the fact that taxpayers end up subsidizing the uninsured when they’re forced to go to the Emergency Room for care. The fact is, health reform only works if you take care of all these problems at once.

Both during and after last week’s summit, Republicans in Congress insisted that the only acceptable course on health care reform is to start over. But given these honest and substantial differences between the parties about the need to regulate the insurance industry and the need to help millions of middle-class families get insurance, I do not see how another year of negotiations would help. Moreover, the insurance companies aren’t starting over. They are continuing to raise premiums and deny coverage as we speak. For us to start over now could simply lead to delay that could last for another decade or even more. The American people, and the U.S. economy, just can’t wait that long.

So, no matter which approach you favor, I believe the United States Congress owes the American people a final vote on health care reform. We have debated this issue thoroughly, not just for a year, but for decades. Reform has already passed the House with a majority. It has already passed the Senate with a supermajority of sixty votes. And now it deserves the same kind of up-or-down vote that was cast on welfare reform, the Children’s Health Insurance Program, COBRA health coverage for the unemployed, and both Bush tax cuts – all of which had to pass Congress with nothing more than a simple majority.

I have therefore asked leaders in both of Houses of Congress to finish their work and schedule a vote in the next few weeks. From now until then, I will do everything in my power to make the case for reform. And I urge every American who wants this reform to make their voice heard as well – every family, every business owner, every patient, every doctor, every nurse.

This has been a long and wrenching debate. It has stoked great passions among the American people and their representatives. And that is because health care is a difficult issue. It is a complicated issue. As all of you know from experience, health care can literally be an issue of life or death. As a result, it easily lends itself to demagoguery and political gamesmanship; misrepresentation and misunderstanding.

But that’s not an excuse for those of us who were sent here to lead to just walk away. We can’t just give up because the politics are hard. I know there’s a fascination, bordering on obsession, in the media and in this town about what passing health insurance reform would mean for the next election and the one after that. Well, I’ll leave others to sift through the politics. Because that’s not what this is about. That’s not why we’re here.

This is about what reform would mean for the mother with breast cancer whose insurance company will finally have to pay for her chemotherapy. This is about what reform would mean for the small business owner who will no longer have to choose between hiring more workers or offering coverage to the employees she has. This is about what reform would mean for the middle-class family who will be able to afford health insurance for the very first time in their lives.

And this is about what reform would mean for all those men and women I’ve met over the last few years who’ve been brave enough to share their stories. When we started our push for reform last year, I talked about a young mother in Wisconsin named Laura Klitzka [KLITZ kah]. She has two young children. She thought she had beaten her breast cancer but then later discovered it spread to her bones. She and her husband were working – and had insurance – but their medical bills still landed them in debt. And now she spends time worrying about that debt when all she wants to do is spend time with her children and focus on getting well.

This should not happen in the United States of America. And it doesn’t have to. In the end, that’s what this debate is about – it’s about the kind of country we want to be. It’s about the millions of lives that would be touched and in some cases saved by making private health insurance more secure and more affordable.

At stake right now is not just our ability to solve this problem, but our ability to solve any problem. The American people want to know if it’s still possible for Washington to look out for their interests and their future. They are waiting for us to act. They are waiting for us to lead. And as long as I hold this office, I intend to provide that leadership. I don’t know how this plays politically, but I know it’s right. And so I ask Congress to finish its work, and I look forward to signing this reform into law. Thank you.

Photo credit: By Charles Dharapak/Associated Press

By Ezra Klein  |  March 3, 2010; 3:08 PM ET
 
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Comments

Quick...everybody get on your white jackets...

Posted by: FastEddieO007 | March 3, 2010 3:10 PM | Report abuse

I realize all politicians, and especially all presidents, do this sort of thing. But having all the doctors nurses photo-opping around him with the clapping and the adulation is just a little too Leni Reisenthal for me.

Look! It's a good idea! I've got people dressed like doctors and nurses around me--who would never otherwise come to a formal gathering dressed like this--because we asked them to. And they all just happen to think HCR is the bees knees. So all other doctors and nurses must, too.

He should have had some angels, and a bearded old man in a white robe who spoke with a God-like echo to his voice saying, "I support Barack Obama. And Healthcare reform is da bomb."

That being said, in the end, this is the approach he has to be taking and should have been taking all along. If he's hoping that the general public and independents will suddenly see how obstructionist the Republicans are being and punish them in November, he's sadly mistaken. The only think that might happen is that the Democrat base punishes Democrats by not showing up.

If this passes, I do not hold out a lot of hope of it turning out well. I think it's going to be a case of too many cooks spoiling the broth.

Posted by: Kevin_Willis | March 3, 2010 3:14 PM | Report abuse

On this, I happen to agree with the President: the House has held a bill -- a bill accepted by a supermajority in the Senate, mind you -- for a full two months and it is far past time for the Speaker of the House to bring the bill up for a fair up-or-down vote by a simple majority.

Speaker Pelosi's obstructionism has to end: pass or fail, the bill at least deserves a vote. The fact that an individual -- the Speaker of the House -- has so much power over life and death is frightening: when a minority of one (Speaker Pelosi) can hamstring the entire legislative process, something is definitely wrong.

In this case, the delay has shifted the end of the 6-month health care reform implementation window so that both premium reductions (which will manifest themselves as higher prices paid by citizens) and Federal savings (which will manifest themselves as higher State and Federal taxes) are shifted beyond the November elections, offering a definite political advantage to the Speaker's party. Perhaps in the future the rules of the House can be changed so that bills cannot be held for such political purposes.

Posted by: rmgregory | March 3, 2010 3:18 PM | Report abuse

"First, it would end the worst practices of insurance companies. No longer would they be able to deny your coverage because of a pre-existing condition. No longer would they be able to drop your coverage because you got sick. No longer would they be able to force you to pay unlimited amounts of money out of your own pocket. No longer would they be able to arbitrarily and massively raise premiums like Anthem Blue Cross recently tried to do in California. Those practices would end."

And we'll pay for it with the magical money trees we've planted on the Whitehouse lawn. And healthcare costs will be greatly reduced from here on out, because cancer has been cured by leprechauns.

Seriously, those are all great things, but how do you expand risk exposure by insisting insurance companies cover pre-existing conditions and can't ever drop anyone who gets sick (good ideas, certainly) and yet prevent them from raising their rates. There will be additional expenses that will have to be covered, via premiums, of covering folks with pre-existing conditions and not being able to drop the folks who are sick. The money isn't going to come out of thin air, and is unlikely to materialize purely as an artifact of cost savings.

And how will insurance companies cut costs? Probably in ways that hurt the customer, such as cutting representatives or agents to answer questions or other expenses that otherwise help a customer process a claim.

I see a mess coming. I hope I'm wrong.

Posted by: Kevin_Willis | March 3, 2010 3:20 PM | Report abuse

This is the first step, not the last, of the fundamental reform of our health care (non)system. Now is the time to push the congress to pass this set of reforms. The next step will be take on what is left on the cost containment and quality of care agendas. For those who want to write something like "these bills will do nothing to (contain costs, raise quality, rein in XXXX industry abuses)" do us all a favor and actually read what is in the bills first. If you really are for cost-containment, covering the uninsured and raising quality you will be pleasantly surprised what is in the bills but has been flying under the reconciliation, government takeover, death panel stuff that is filling the air. Now is the moment for a tremendous step forward, pray that we don't let the perfect become the enemy of the good (for millions of Americans who currently lack health care or lack quality health care).

Posted by: alan24 | March 3, 2010 3:23 PM | Report abuse

i believe that the health care reform bill is going to pass, and president obama is going to get great credit that he deserves for it
. the democrats will be strengthened, and the country will finally get some lift. we will be able to move forward.
and under incredibly difficult circumstances, president obama, and all of the many who greatly support him, who have been completely overlooked recently by the media....by the nabobs of negativity on both sides....
are going to say,
"yes we did!"
it was a huge fight, against great odds...just as the election was, just as the awful problems he inherited from the two presidents before him,.but president obama will prevail and keep his promise to the american people....all the while, staying presidential, while cantor, boehner, daschle, rangel, weiner, frank, dean....were willing to hurt the american people, abandon bills and/or cut and run. president obama held fast with calm and dignity and civility, throughout this entire process.
we will move forward from here:-)
i believe will have a great accomplishment to celebrate soon!
i dont think it is premature to buy my confetti!!!!!

Posted by: jkaren | March 3, 2010 3:27 PM | Report abuse

Now that's the man I voted for. I'm fully insured and I have one payment left on surgery I had in October 2007 (routine, 24-hour turnaround time, surgery), and seven payments left on the post-surgical scan. Deductibles and 20% coinsurance, you know. I'm not supporting Obama and health care reform because my situation is so awful or because I want him to make it better. I'm supporting health care reform because I'm one of the lucky ones. And that's absurd.

Posted by: Jenn2 | March 3, 2010 3:28 PM | Report abuse

Same old same old. I can't figure out why he even bothered. I heard it, but didn't see it. Did he have stunt doctors in borrowed lab coats again?

Posted by: bgmma50 | March 3, 2010 3:29 PM | Report abuse

Ahahaha. Just noticed the photo at the top of the blog post. He DID have stunt doctors in borrowed lab coats again. ROTFLMAO!!!!!!!!!

Posted by: bgmma50 | March 3, 2010 3:31 PM | Report abuse

"If this passes, I do not hold out a lot of hope of it turning out well. I think it's going to be a case of too many cooks spoiling the broth."

well, there will be many millions of people who will not be agreeing with you, as they hold onto their health insurance and others gain insurance.
we will be celebrating this hard-won victory ...and the nabobs of negativity can have their anti-party with lipton's tea and weak broth and a main course of sour grapes.

Posted by: jkaren | March 3, 2010 3:35 PM | Report abuse

Very interesting. The reason Mr. Obama has not been able to "pass" a health care bill is that the Democrats cannot agree with each other (no big secret). We'll see what kind of horse-trading takes place over the next months. And then listen to the governors complain as Medicaid complications ensue. No, we'll be on the treadmill of "healthcare reform" for quite a while in this country, regardless of whatever kind of bill happens to materialize. The real challenge is coming with entitlement reforms in the next ten years.

Posted by: kjlepak | March 3, 2010 3:35 PM | Report abuse

@jkaren: "well, there will be many millions of people who will not be agreeing with you"

Well, good to know that you don't think the Republicans did any damage to this bill whatsoever.

Because that's kind of my point.

Posted by: Kevin_Willis | March 3, 2010 3:37 PM | Report abuse

Hey Ezra,

Princeton health economics progresor Uwe Reinhardt had a great Health Affairs column two days ago on what he learned during the summit last week. The noted health economist basically says what you've been saying all along -- that there are irreconcilable philosophical differences on health care reform between Democrats and Republicans and the American people want to have their cake and eat it, too. Here's the link: http://healthaffairs.org/blog/2010/03/01/lessons-from-the-health-care-summit/.

Posted by: moronjim | March 3, 2010 3:37 PM | Report abuse

the day this bill passes, i am pulling out my gigantic and prized collection of obama buttons and i am going to decorate my "change we can believe in" shirt and march around, just as jubilant as the day when he was elected:-)
i cant wait!!!!!!!!!

Posted by: jkaren | March 3, 2010 3:38 PM | Report abuse

So let's get this straight. Single-payer, the system that has been demonstrated over and over again to produce excellent outcomes at greatly reduced costs, even within our own country (Medicare)? Seems that's "neither practical nor realistic." Hmm. Well, what about deregulating the insurance industry, the idea that everybody not literally bought and paid for by that industry knows would wreak cataclysmic harm on our already failing system? Obama is "concerned" about that approach, and "disagree[s]" with it.

Good to know we have a president who's working to move the goalposts in our favor. Progressive Reagan, hello.

Posted by: fumphis | March 3, 2010 3:51 PM | Report abuse

Alan 24 is exactly right - this is not the end of health care reform in the united states - the system is far too broken for that - but it is an excellent beginning.

It ends some of the most egregious practices of the health insurance companies (recission, pre-existing), ensures that the large majority of Americans are in a shared risk pool (by the somewhat circuitous method of mandated private insurance rather than tax revenues - but that is american politics!), it sets up exchanges where products can be compared and most vitally makes a START on payment reform and cost control with experimental schemes in bulk payment, the medicare commission etc, plus it will hopefully have a "gold plated insurance" tax. Overall this bill, as imperfect as it is, constitutes a huge step forward!

This bill will not be a silver bullet by any means - but it is a start. I think that one of the most vital things that it will do is show that health care reform (and indeed bold political action on the problems that face the US) is NOT anathema: reform can be achieved with some political will. It will also show the public that reform can be achieved and none of the doomsday scenarios that republicans have been predicting will come to pass! (No death panels! No government takeover!) If this bill fails the chances of the NEXT bill making vital comprehensive changes to health care would become almost unimaginable - if a popular new president with a once in a generation supermajority could not touch healthcare then who else would dare to?

I am sure that all the wonks on this board would like to see something more transformative, more fundamental, and something that really attacks the cost issue head on. What that reform might be (market based reform or single payer, or whatever) depends on the persons viewpoint, but this bill is probably about as comprehensive and far reaching a bill as could possibly survive the current political reality; this can be seen by the troubled path that this incredibly moderate bill has travelled!

Posted by: lazza11 | March 3, 2010 3:52 PM | Report abuse

PS can anyone post a link to video of this speech? I wouldn't mind watching it...

Posted by: lazza11 | March 3, 2010 3:55 PM | Report abuse

It will be wiser to create jobs, before any changes in insurance.
We have opportunity to create 100 % of employment, therefore and insurance, be energy independent, and fight climate change with only three countries in the world-USA, Canada and Mexico (North America is only one continent between Atlantic and Pacific oceans and influent climate from France to Japan).
Read more: Xlibris.com "Economy and climate change or KGB agent"

Posted by: mioffe | March 3, 2010 3:57 PM | Report abuse

It's official - Ezra's blog will be changing its title to "Barack Obama Is My Hero and I Follow His Every Word Without Question".

Posted by: novalfter | March 3, 2010 4:00 PM | Report abuse

fumphis - as much as I would support a left wing style reform that set up a basic, taxpayer funded (out of general revenues) "floor" of coverage - kind of a VA for all Americans, and then let those with the means go outside that system, I think that what Obama said "neither practical nor realistic" would probably be a fair assessment.

This is the US after all, not Canada or the UK, and we are talking about 16% of the economy. The basic calculus you have to do it that there may not be the votes even to pass this incredibly moderate bill - Medicare for all would not stand a chance... not even half a chance - there are not enough committed liberal democrats in the house or senate to go that route, and probably never will be.

Posted by: lazza11 | March 3, 2010 4:06 PM | Report abuse

@Kevin_Willis

I'm sure you've read on this blog that the way you stop rates from rising is to mandate that healthy people have coverage as well. Ending bans on pre-existing conditions will add more high-risk people for sure, but you then broaden the pool with lower-risk people to keep premiums in line. That is how it is paid for.

The hikes you mention would happen if these healthy people weren't added to the insurance rolls.

Posted by: kmani1 | March 3, 2010 4:09 PM | Report abuse

Kevin, I mostly agree with your first post that this is what the President should have been doing from the start and that at the same time this is pretty much political theater.

At the same time, it does irk me when conservatives insist on refering to the "Democrat base" rather than "Democratic base". I don't know, you're usually pretty reasonable about that kind of stuff, so maybe it was a mistake.

Beyond that, we just disagree about the bills generally. I wish we had a better bill, but better to pass what we've got than live with the current system. Whether this bill passes or not, there are still going to be a lot of reforms that need to be implemented in bills down the road. My only hope, and it's ever so slight, is that we'll get our politics to a place where members of both parties can work out some serious solutions, especially on cost control. I know, I'm not holding my breath.

Posted by: MosBen | March 3, 2010 4:22 PM | Report abuse

lazza11, never is a really long time. At one time the Congress passed the New Deal, Social Security, and Medicare/Medicaid. There have been eras when Americans were generally more liberal (at least in some ways) and maybe another era will come around again.

I'm not super hopeful about that being any time soon, but it's possible.

Difficult to see. Always in motion is the future.

Posted by: MosBen | March 3, 2010 4:28 PM | Report abuse

lazza11 - Actually a Medicare buy in (or Medicare for all) could pass, if the Dems really wanted it. It could easily go through reconciliation, thereby avoiding the need for 60 votes.

It won't happen because, quite frankly, too many Dem congresscritters are just as owned by the insurance companies as the Republicans are.

The only way I can see it happening is if it was campaigned on. If it becomes an issue in the next Presidential campaign and the eventual winner campaigned on a Medicare buy in then yes, I can see it passing through Congress.

I realize there is little chance of this happening, but I'd love to see a bill a year or two from now that had three parts 1) Medical Malpractice Reform (the smart kind Ezra blogged about a few days ago) 2) Collective Bargaining with Pharma (Every other country has it) 3) A medicare buy in.

Posted by: nisleib | March 3, 2010 4:28 PM | Report abuse

OK agreed never is a long time, and I would love to see the 3 components that you mention nisleib! I strongly feel that passing the current health care reform bill makes further reform more likely if anything.

HCR passing would show politicians that health care reform is not impossible, it would show the american people that health care reform does not lead to the end of medical care as we know it (as Republicans have suggested), and a plan like medicare buy in could easily be a part of the exchanges (heck - if it were not for Joe Lieberman it might already be in there!)

Posted by: lazza11 | March 3, 2010 4:36 PM | Report abuse

What took him so long? Many pundits are saying the president has been right on policy but bad on messaging - is he now taking their criticisms to heart, or has he known where he was headed all along?

Posted by: jduptonma | March 3, 2010 4:37 PM | Report abuse

lazza11 - I hope you are correct.

One of the problems we are having now is how long ago it was that Medicare passed. If it had passed more recently maybe people would remember that the Republican talking points of today are the same talking points they used against Medicare. And since Ronald Reagan didn't end up telling his grand kids what it was like to live in a free country maybe people would realize that those talking points are nothing but 20 pounds of poo shoved in a 10 pound bag.

Posted by: nisleib | March 3, 2010 4:43 PM | Report abuse

"I'm sure you've read on this blog that the way you stop rates from rising is to mandate that healthy people have coverage as well."

Not if the only penalty for opting out is $750 per year and guaranteed access to coverage if you get sick even if you previously chose to opt out.

Posted by: bgmma50 | March 3, 2010 5:24 PM | Report abuse

What took him so long? Many pundits are saying the president has been right on policy but bad on messaging - is he now taking their criticisms to heart, or has he known where he was headed all along?
=======================
What I notice about the American public is that they really don't listnen.

The president that you see is and has been the same all along. He has steadfastly said that he is not in to political tricks and gimicry. He said that he would listen and take in to consideration all points of view. He has done that.

Now having watch this play out and having met with the Republicans, having taken their good ideas he is ready to move on.

This is the man that I got up at 6am to stand in line and vote for. Today I am a proud American!

Posted by: justonevoice | March 3, 2010 5:27 PM | Report abuse

"Not if the only penalty for opting out is $750 per year and guaranteed access to coverage if you get sick even if you previously chose to opt out."

Maybe - I can certainly follow that line of reasoning... It is worth noting however that a very similar scheme seems to have worked quite well in Massachusetts. I think that people do want to carry insurance and if they can afford to then they will - especially if they have to pay a certain percentage of that money out in the form of a fine if they don't...

Posted by: lazza11 | March 3, 2010 5:31 PM | Report abuse

Wonder what might have been had he hit the campaign trail last February instead of this February? Trying to be bipartisan doesn't imply being silent. Had this issue received the support, promotion and campaigning all along that it is getting now, it would be a much better bill and a done deal 6 months ago.

Congressional bickering is simply not a substitute for leadership.

Posted by: pj_camp | March 3, 2010 5:36 PM | Report abuse

"Not if the only penalty for opting out is $750 per year and guaranteed access to coverage if you get sick even if you previously chose to opt out."

Maybe - I can certainly follow that line of reasoning... It is worth noting however that a very similar scheme seems to have worked quite well in Massachusetts. I think that people do want to carry insurance and if they can afford to then they will - especially if they have to pay a certain percentage of that money out in the form of a fine if they don't...

Posted by: lazza11 | March 3, 2010 5:31 PM
******************

Actually, it hasn't worked well in MA -- what has happened is what one might expect with a weak individual mandate -- when people need health insurance to pay for their medical expenses, they obtain it, and when they don't, they drop it. I've read that the average person in MA keeps their health insurance for about 5 months. The minimal penalties in MA (which are higher than in the Senate bill) are no deterrent to people's behavior in this regard.

Plus, under the President's proposal, the penalty would be lowered to $325 in 2015.

Posted by: Policywonk14 | March 3, 2010 6:04 PM | Report abuse

Get out your best brain recipe. It's time for a zombie party!!!

Posted by: fallsmeadjc | March 3, 2010 6:33 PM | Report abuse

We're not allowed to debate this issue anymore. According to rule 4037 on page 50043 there is to be no further discussion of healthcare reform. Offending parties will have to pay a harsh fine of up to $10,000/offense.....someone's got to pay for the bill.

Posted by: fallsmeadjc | March 3, 2010 6:36 PM | Report abuse

From a cursory search of the internet it looks like around 97% of MA residents were insured? Now perhaps that is not full year insurance, or the numbers are wrong or something (I have no figures to suggest that however), but to me it does seem that the individual mandate in MA is doing a pretty reasonable job at brining more people into the shard risk pool.

http://www.mass.gov/?pageID=eohhs2pressrelease&L=1&L0=Home&sid=Eeohhs2&b=pressrelease&f=091014_uninsured_survey&csid=Eeohhs2

Posted by: lazza11 | March 3, 2010 6:57 PM | Report abuse

"Plus, under the President's proposal, the penalty would be lowered to $325 in 2015."

Where do I sign up?

Posted by: bgmma50 | March 3, 2010 7:20 PM | Report abuse

@bgmma50: "Ahahaha. Just noticed the photo at the top of the blog post. He DID have stunt doctors in borrowed lab coats again. ROTFLMAO!!!!!!!!!"


Ahahaha. Actually they were all real health professionals. But we thank you for the usual substantive commentary from the peanut gallery.

Want to see a stunt President? Check out the bomber jacket and codpiece get-up worn by George W. Bush for his "Mission Accomplished" speech.

Now that was a stunt!

Posted by: Patrick_M | March 3, 2010 8:11 PM | Report abuse

"Gone was vague language and gesturing coyness Democrats have favored on the path forward."


Give me a break. He couldn't even bring himself to use the word reconciliation.

Posted by: Bob65 | March 3, 2010 10:43 PM | Report abuse

"At stake right now is not just our ability to solve this problem, but our ability to solve any problem"

As a Canadian, I can't believe there are so many things broken in the States, from Health to Education. And so many areas lagging, like Transportation and Energy.

This whole fear of "Big Government" is just stupid. After all, insurance works because of size. Like building highways, size works, not competition.

Posted by: shshao | March 4, 2010 12:12 AM | Report abuse

My goodness, Patrick. You seem to have developed an undue interest in my commentary. Would you like to be my own personal troll?

For your reading pleasure: http://www.rollcall.com/news/43722-1.html

Posted by: bgmma50 | March 4, 2010 12:57 AM | Report abuse

"My goodness, Patrick. You seem to have developed an undue interest in my commentary."

You're right. Interest in your commentary would be entirely undue.

Thanks for the link, and I am sorry for your inability to understand the process that is about to unfold (just remember: pass, patch, pass).

Again, the House will want to see the reconciliation language and receive assurances that the Senate will have the votes to pass the reconciliation measure. And those assurances will be forthcoming, as the House and Senate work together on crafting the reconciliation bill. In case something about all of this still unclear...

For your reading pleasure: http://www.politico.com/livepulse/0310/Harkin_Reconciliation_is_a_go.html

Posted by: Patrick_M | March 4, 2010 1:29 AM | Report abuse

"My goodness, Patrick. You seem to have developed an undue interest in my commentary."

You're right. Interest in your commentary would be entirely undue.

Thanks for the link, and I am sorry for your continuing inability to understand the simple process that is about to unfold (just remember: pass, patch, pass).

Again, the House will want to see the reconciliation language and receive assurances that the Senate will have the votes to pass the reconciliation measure. And those assurances will be forthcoming, as the House and Senate work together on crafting the reconciliation bill. In case something about all of this still unclear...

For your reading pleasure: http://www.politico.com/livepulse/0310/Harkin_Reconciliation_is_a_go.html

Posted by: Patrick_M | March 4, 2010 1:32 AM | Report abuse

November cannot come soon enough.

Posted by: letscheck | March 4, 2010 4:59 AM | Report abuse

Even with the failure of Socialism in California and Europe staring them in the face, absolutely everything Obama & Co. are doing is aimed at creating more government jobs for AFL-CIO. Big Socialist Labor killed U.S. industry. Big Socialist Labor is killing U.S. Government. Look it up: Executive Order 10988 signed by JFK in 1962. EO#10988 allowed public employees/bureaucrats to join AFL-CIO and bargain collectively. Why? Bureaucrats then already had Civil Service protection. The Obama Administration is doing everything it can do to increase the number of jobs available to AFL-CIO bureaucrats. With Obama & Company leading the way, organizing government workers is Big Labor's last hope. That is all.

Posted by: ironmule | March 4, 2010 6:06 AM | Report abuse

The real victory for Americans is that they have succeeded in making their President very Angry...at them! Hate is back in fashion and it couldn't feel better.

Posted by: MIJI | March 4, 2010 6:37 AM | Report abuse

If the Democrats pass this bill... after all the discussions, and clear opposition...

This Summer it will be: "Vote EVERY Democrat out of office, EVERYWHERE..."

I am tired of being insulted by Washington.

Posted by: wilsan | March 4, 2010 6:47 AM | Report abuse

Closing argument? Closing? Really? What can be passed by reconciliation CAN AND WILL be repealed by reconciliation. Count on it.

Posted by: jchu591 | March 4, 2010 6:54 AM | Report abuse

As for the picture, unhappily, 60% of the Dr. images were portrayed by men. Once again showing tired old deferential treatment to women. Further, the Message Director declined to include even one Asian or Hispanic doctor. What affrontery. Also, does hysteria over radical Muslims affect the ability of our Presedential Message Director from including Muslim doctors in this picture.

Posted by: jchu591 | March 4, 2010 7:01 AM | Report abuse

Hey MossBen. Hate to Erk you, but you're a DEMOCRAT. That makes you part of the DEMOCRAT BASE. Idiot.
Now, beyond that fool, I'd like to say that this Narcissist, with the Mussolini gestures and facial expressions, is DESTROYING OUR COUNTRY. He's a little radical PUNK, who never did a hard days' WORK in his life. EVERYTHING out of his mouth is a LIE. (or is that just the BOOZE talking)
The great UNITER is tearing this country apart. Because that's what he wants. That's who he is. He's Frank Marshall Davis. He's Jeremiah Wright. He's Bill Ayers, and he's Bernadine Dohrn. He's Louis Farrakhan and Khaleed Rashidi. He's ACORN and the Black Panthers.
NOBODY immerses themselves and doesn't get wet. He has been surrounded by Marxists, Communists, Socialists, Anarchists, TERRORISTS, and Maoist, ALL HIS LIFE. He surrounds himself with them NOW. He doesn't need any steenkin rules. He'll get what he wants, the old fashion way. BY ANY MEANS NECESSARY.
Everybody likes the term: TIPPING POINT. Well, we're there. And this is the last straw. This will 'OVERWHELM THE SYSTEM'. I believe that's Cloward and Piven. A strategy to IMPLEMENT their beliefs: COMMUNISM - without firing a shot.
I'll give you the LAST WORD on this Plan. It's GERONIMO. And we haven't got a chute.

Posted by: GoomyGommy | March 4, 2010 7:25 AM | Report abuse

jchu591 says:

"What can be passed by reconciliation CAN AND WILL be repealed by reconciliation. Count on it."

Remember that what will be passed in reconciliation are only a few narrow amendments to the current Senate bill.

If you repeal "What can be passed by reconciliation," you will be left with the current form of the Senate bill, completely intact, and it will include the "Cornhusker Kickback."

Is that what you want?

Posted by: Patrick_M | March 4, 2010 2:20 PM | Report abuse

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