What the right is reading

Precisely. This is central to the "debate".

And...if you follow up on this and think on it long enough, you end up seeing that...

Obama is responding in the best way possible.

The most effective way to respond to actual fear is to treat those fearful with respect and calmly answer those pieces of fear one at a time.

Many that support reform don't understand this basic way of relating.

So we have polarization.

It takes two to tango.

the creeping socialist dystopia inches forward in the US. I heard that one amendment in reconciliation will require all doctors and nurses to be called "comrade". /snark

The right is simply following the teachings of Saint Ron of California, who said, "Facts are stupid things."

The "size of the entire French economy" twaddle is also objectionable, though less important: we're a lot bigger than France, and we spend much more per capita on health care (for no better results).

The government already pays for almost 50% of health care services in the US now. Obamacare would increase the public share. The portion of the healthcare insurance and delivery systems that remain nominally private are heavily regulated and Obamacare will increase the amount of regulation.

While the Dem reforms would not eliminate the private health insurance they would turn them into de facto utilities. And the government's increasing monopsony power would make health care providers and drug and medical device makes effectively price takers. Steyn's characterizations are over-the-top but he's directionally correct.

This isn't rocket science.

Way back when middle class families decided they could pay for their own healthcare costs by maintaining market-driven risk sharing pools ran by private enterprises at a relatively small over-head of less than 5% cost.

Over the years, middle class familiies had to withstand several efforts of federally tinkering with the market-driven risk sharing pools that have gotten more and more dysfunctional over time.

All at once, Obama & Pelosi have orchestrated a duplicitous legislative effort to have the federal government regulate every single aspect of these market-driven risk sharing pools at the same time that they federally mandate everyone join them. Effectively they are no longer private---they are federally micro-managed healthcare contracting with subisides to pay for any shortfalls of covering the poor.

If the federal government were to straightforwardly try to enact a single-payer system it would not look much different, using private insurance companies as subcontractors for government with pre-existing hooks into the service.

Such an epidemic of bedwetting. If the underpants bomber doesn't get you then Nancy Pelosi's death panel will.

Can someone clarify: is there or is there not an employer mandate in the bill? I thought that was the issue with medium/large companies, who would probably rather pay the fine than have to provide coverage (so the argument goes). Can someone let me know what the reality is?

Mr. Klein, you are contradicting yourself.

You chide Mr. Steyn for calling the bill "centralized planning", saying, "calling it centralized planning suggests that Steyn doesn't know what the words 'centralized' or 'planning' mean..."

Yet, just two blog posts ago ("Health care reform IS progressive"), you yourself say that the new government-managed private insurance will be a "very different beast":

"It will have to spend 85 percent or 80 percent (depending on the market) of every premium dollar on care. It won't be able to reject people for preexisting conditions. It will be in a regulated exchange where it has to justify premium increases and bad behavior or face exclusion. And those exchanges, regulations and subsidies will also create the core structure of a universal health-care system in this country, which should be comforting to progressives..."

In other words, health care will be centrally managed (the feds are in charge of the exchange and forces everyone to participate), and it is planned (the feds define what exchange services must be provided, how much profit is allowed, and what classes of consumers must be covered.) If it wasn't centrally managed, it would hardly form the "CORE OF A UNIVERSAL HEALTH-CARE SYSTEM".

I'm a little embarrassed to point out such obvious flaws in your logic. You may want to stop listening to President Obama so much. He has a curious habit of saying and meaning two opposite things, at the same time. Very confusing!

fasteddie - Wanna bet?

I personally think if the government went ahead and offered a straightforward single-payer system by adopting everyone into Medicare it would look much, much different than the current bill.

Arguing that a single insuring entity with the power to set prices for providers across the board is the same as a set of state-based exchanges where insurers serve a fraction of the American population - if they so choose - is . . . odd, at best.

But I happen to be a fan of a single payer, so I say let's do it - Medicare for all, and we'll see if it looks anything like the current reform.

Given the paucity of your arguments, I'm likely going to regret asking this but . . . do you actually have an alternative option? Big fan of Paul Ryan's Medicare abolition? Or would you just like to strap yourself into 40 years of rising health care costs and eventual bankruptcy?

It looks like dmarney doesn't know what "centralized" and "planning" mean either. Maybe right-wingers need to look up "regulation" and "oversight" just to round out the education.

The only way I've ever been able to read such things without my head exploding, is to believe that approximately a quarter to a third of the American population is paranoid to a clinical degree. It is, of course, undiagnosed, since this is the American health care system we're talking about.

And they're probably watching Meet The Press where the moderator, David Gregory, is constantly declaring without qualification that the public is dead set against the health bill.

I've never understood how republicans get away with arguing against government run health-care, and at the same time how they defend systems like the VA or Medicare. Patients who use the VA or Medicare are much happier with their care, then those in the private sector. I wish the medicare buy-in was allowed into the bill, that way it would start for 60 year olds, then slowly work it's way down to people in their 50's, and 40's and so on. Once people got a taste for Medicare (oooh scary government run health-care) they would love it.

"But this is what people on the right are reading. No wonder they're scared."

Oh, if only people really understood what was in the bill, they'd agree with you. Uh huh.

Actually the "right"'s reaction is the same reaction they've had to essentially any non-tax-cut program since FDR (or possibly since Teddy the Roosevelt). The sky has or will fall.

When the Republican National Committee sends out a 'message' presentation that openly admits that their key to their future success is FEAR, then what follows will be Chicken Little. "Its the end of the world as we know it". Somehow fear is the GOP replacement for doing anything worthwhile about any serious problem (or, if possible, cutting taxes).

If you thought that GOP meant Grand Old Party you missed the U-turn that made it into Galloping Outright Paranoia. Careful folks, it is very contagious, without any treament possible, and completely silly in a fifth-grader kind of way. All they need to do is change their name to Know Nothing Party and join our flow of history back into the 19th century.

Yeah, I'm constantly torn between believing that most (but not all!) conservatives are either ignorant or arguing in bad faith or some mix of the two. I guess I could make a third category for people that are just completely separated from reality too, and beyond the reach of argument an/or debate.

We already annexed the health care sector and turned the country socialist in 1965 when we passed Medicare.

See: http://krugman.blogs.nytimes.com/2008/10/03/raising-the-white-flag-of-surrender-to-medicare/

so playing devil's advocate here Ezra isn't the thought that the exchanges could be opened up to all and that would present economies of scale that even Medicare does not have?

What's to stop future legislators to say that if you don't do "X" you can't participate in the exchange that now has upteen hundred million participants.

You know they did try this with the public option. They tried to tell providers that if they accepted medicare they HAD TO accept the public option for a period of 2 years minimum.

Yeah, how dare he use such overheated and inflammatory rhetoric to overstate the goals and intentions of people who disagree with him on health reform. We should always be level-headed when discussing this stuff, or else next thing thing you know someone will say something like Joe Lieberman wants to kill hundreds of thousands of people to settle a political score.

My solution would be:

1. Decouple employment from healthcare immediately---this could be accomplished by raising taxes on those who get the break, or cutting for those who aren't...either way.

2. Create a federal tax break for catastrophic healthcare coverage(with or without comprehensive), such that it is made cheaper for everyone.

2. Federal funding grants to states who meet targets for reducing cost of healthcare in matching funds.

3. Encourage a MArty-Feldstein style catastrphic plan to be implemented on a state-by-state basis(per #2), that increases access to healthcare services by limiting the exposure of any consumer of healthcare to a cost no greater than 15% of their income.

4. Create a "Good Citizen" tax credit for insurance companies who meet certain state requirements for coverage % goals, low profit margin goals, ----encouraging innovation for insurance companies who helo states meet ambitious golas for providing access to all of its citizens.

5. Encourage states to reduce payouts to trial lawyers, money harvested from healthcare industry by greedy trial lawyers who game the system through frivolous lawsuits.

I wonder what people on the left are reading about health reform:

"if you get sick, your insurer will just drop you!"

"your insurer will jack up your rates for no reason just so they can make more profit"

"insurer X made (insert some ominously large number completely devoid of context) dollars in profits last year!"

Let's not turn this into a pissing match of which side's pundits use the most inflammatory rhetoric to make their case, because that's a game nobody wins. If you'd like I'm sure we can find countless examples of left-wing pundits saying things no less exaggerated than Steyn (and far be it from me to want to defend Mark Steyn and the National Review), even right here on this blog, but that is a fool's errand.

Mark Steyn is both stupid and nuts. Why would you even link to him? He's made his millions off a book whose entire premise was based on a mathematical error and complete failure to grasp basic statistics. Check out the climate-change denialist rants he's been spewing in Maclean's mag (Canadian publication)for a whole other taste of the crazy.

ab13
The difference is that what Steyn wrote is demonstrably false. Your examples of what the "left" is reading - insurance companies dropping sick patients, jacking up rates, making huge profits - are all demonstrably true. And FWIW, "jacking up rates...so they can make more profit" is a reason, so it's not for NO reason. They're supposed to make a profit. That's part of why the system is so screwed up - denying claims is the best way for insurers to maximize profit.

"We should always be level-headed when discussing this stuff, or else next thing thing you know someone will say something like Joe Lieberman wants to kill hundreds of thousands of people to settle a political score."

Actually, what Ezra said was that Joe Lieberman was *willing* to kill hundreds of thousands of people to settle a political score. An inflammatory statement, perhaps, but when you consider the fact that (a) most studies show that tens of thousands of people die annually from lack of health insurance (b) Lieberman wanted to filibuster the bill on the basis of a provision that he supported several months earlier...it's a factually defensible statement, at least. Certainly, it's nowhere near as idiotic as what Steyn is saying.

and while we're on this topic (left vs right) I've got a gripe that I'd love a liberal to take up for me.

Scenario 1: small business owner is struggling and gets a tax break with the new "jobs bill" of $1000 or whatever but the left whines that "He would have hired them anyway, you're just giving it to rich people"

Scenario 2: housing tax credit that continues to get extended. If people were "going to buy a house anyway" (including Ezra might I add) then how is that not EXACTLY the same thing?

TomServo:
I have no desire to defend Steyn or NR, but it's not accurate to say that what he wrote is "demonstrably false". People who have contributed and support this health care bill readily admit that they view it as a path to single payer. So while he may overstate the immediate impact of the specific reforms on the table, it is not at all inaccurate to view as a stepping stone to gov't takeover of our health care system (and for many people this is seen as a feature, not a bug).

------"Your examples of what the "left" is reading - insurance companies dropping sick patients, jacking up rates, making huge profits - are all demonstrably true."

Insurance companies don't drop sick patients, they drop patients who misrepresent their medical history on an application. I'll be the first to say that we need some more oversight of rescission practices, and that there have been companies that abusing it, but that is the very rare exception. The issue of rescission is actually a very minor one affecting very few people, but to read about it from the left you'd think that insurers everywhere are just indiscriminately dropping people as soon as they get sick. That is an exaggerated and overblown view of the issue, no different than Steyn's overblown view of the health reform bill.

And your last claim "making huge profits" is not at all true. The insurance industry simply isn't that profitable, but the reporting on the left uses the disingenuous "cite a large number with no context" technique (a technique that Ezra just last week accused Paul Ryan of using) to make it appear to be a bigger issue than it really is.

-----"That's part of why the system is so screwed up - denying claims is the best way for insurers to maximize profit."

That's just silliness. They still pay out ~80-85% of premiums in medical care, and their profitability has been basically unchanged for a long time.

My point is that it is beyond ridiculous to single out one partisan article and say "look what the other side thinks about health reform". There are plenty of misleading and selective arguments, inflammatory rhetoric, and disingenuous posturing coming equally from both sides, including sometimes from this very blog, and definitely from other liberal bloggers he is happy to link to. It is above Ezra to write posts like this, and not at all helpful to the debate.

PeterH1, there are 40,000 people who die in auto accidents every year. We could eliminate every one of those if we imposed a national speed limit of 10 miles/hour, punishable by an extremely harsh sentence (say, 30 years in prison) as a deterrence. Maybe we could even have gov't-mandated governors installed in all cars to prevent them from going faster. If you do not support that legislation you are willing to let 40,000 people die every year, and I think Ezra should write a blog post accusing you of that fact.

ab13:

Well said.

ab13, there are positions you could take about lowering the speed limit and they would balance the costs and the benefits. It may be that the argument would convince people that reducing the speed limit to 10mph is not worth the cost in lives, but it's disingenuous to try and say that the argument isn't about lives.

Thousands of people die each year for lack of healthcare. We can decide what the costs and benefits of providing everyone healthcare is, and maybe we'll decide that it's not worth it to provide everyone with healthcare, but the debate is very much about lives.

Leiberman was called out because in a serious debate with lives in the balance he chose to be petty, vindictive, and hypocritical.

As to your post about reform being "a path to single payer", well, it's *not* single payer. Some people who support single payer view it as a positive step that will hopefully lead to single payer. Some supporters of single payer view it as a sell out to the insurance industry and want the bill killed. But at the end of the day this bill is *not* single payer. When someone proposes single payer you can oppose it because you oppose that policy. Until then, we've got a set of policies before us and we should evaluate them on their merits, not what some people who we disagree with think might possibly happen in the future.

AB13,

Again, you're missing the point. We're not talking about some complex cost-benefit analsis that Lieberman was making. Lieberman was going to filibuster the bill on the basis of a provision (Medicare buy-in) he himself
*supported a couple of months before*. It was not Lieberman's opposition in and of itself, but the hypocritical "logic" behind the opposition, that got so Ezra so exercised.

And the idea that people "People who have contributed and support this health care bill readily admit that they view it as a path to single payer" is just not true. Maybe that was true of the public option, but the public option is no longer part of the bill. Are you aware of all the attacks on the Obama bill from the left as a giveaway to the insurance industry?

MosBen, you are making the assumption that "lives in the balance" means this bill will save lives, more than alternative reforms, and more than lives lost due to expanding coverage without lowering costs (eventually leading to less care available for all). Like many others, you are framing the argument as "this is the only way to reform health care and anyone opposing this plan opposes saving lives."

I know this bill is not single payer, but many people involved in the creation of it truly believe it will lead to single payer and have the intention of it doing so. If you wanted to go to Seattle and you start driving me west on I-90 and I say "I don't want to go to Seattle" it's not a worthwhile rebuttal to say "we're in Montana, not Washington, and there's a chance I could turn off before we get there, even though that's where I want to go". The fact is you're trying to get me to go to Seattle, just as the people designing this bill want to eventually get to single payer, and it is not inaccurate for me to start the argument from there.

Is Lieberman allowed to change his mind? Did Lieberman want to maintain the status quo or implement some other version of health reform? You're not going to get anywhere with this "we have it right and anyone who opposes wants people to die" type of argument.

Plenty of House Democrats refuse to vote for the Senate bill, do they want people to die too? Because if they would vote for the Senate bill this thing would be done already.

----"And the idea that people "People who have contributed and support this health care bill readily admit that they view it as a path to single payer" is just not true."

Yes it is. It was not just about the public option.

----"Are you aware of all the attacks on the Obama bill from the left as a giveaway to the insurance industry? "

Yes, and those are ill-informed attacks by people with little knowledge on health care policy. I give them as much thought as they deserve.

AB13,

Of course people are allowed to change their mind, but they should provide some logical reasoning to explain their shift. What logical reasoning did Joe Lieberman provide for his shift on the Medicare buy-in a matter on months? It is really so unreasonable to suggest that Lieberman was motivated by spite, vanity, narcissism, etc rather than by principle?

And please find me an example of a prominent supporter of the bill -post public-option, post Medicare buy-in - who has said the bill will put us on a path to single-payer.

Also, AB13, as far as I know none of the major people in the Obama Adminisration working on health care - Nancy Ann DeParle, Kathleen Sebelius, Ezekiel Emmanuel, Peter Orszag - advocated single-payer before they entered the Adminisration. Emmanuel specifically attacked single-payer systems in his book, "Healthcare Guaranteed."

Thanks to our right wing extremist wingnut friends for bringing home the point Ezra was making: yes they really are nuts and there's nothing that can be done about it.

"The difference is that what Steyn wrote is demonstrably false." The cognitive dissonance here is almost deafening. Just two posts ago, Ezra posted that "But the fact of it is that this bill represents an enormous leftward shift for American social policy." Thanks for your admission: Mark Steyn is correct. That's what he was saying. Is it hard to understand that those of us on the right don't _want_ an enormous leftward shift?

Steyn:¨The Soviet Union did, of course, and we know how that worked out.¨ I must have missed the story how the unremarkable but adequate Russian hospitals and polyclinics caused the collapse of the Soviet system.

These statements about the size of the bill relative to world economies are simply factually untrue. I'm continually impressed at the pervasive inability of people to understand and apply simple statistics.

The 10 year gross cost of the health care bill $1.4 Trillion. The 10 year net cost of the health care bill -$140 Billion

10 years of GDP= ~$142 Trillion, gross size of bill as percent of GDP less than 1%, net size of the bill as percent of GDP greater than negative .1%

10 year GDP of France $29 Trillion, gross size of bill as percent of France's GDP? Less than 4.9% India's? ~10%... You get the picture. These claims are false.

People will claim that the insurance regulations impose hidden costs. But the insurance regulations only apply to the individual health insurance market, which the CBO estimates increase to 17% of the total insurance market after the Senate bill passes. Since total premiums were $854 B in 2009. Then the individual market will be roughly $145 B/ year. So even if you add the cost of the entire individual market to the cost of the bill, it only doubles the size of the bill.(less than 2% of GDP) And this is a terrible assumption, because regulations will only change the individual insurance market, not obliterate it.

Worst case gross cost, is less than 2% of the economy. Conclusion? Mark Steyn failed math, in high school.

There is no reform! No change to cost except perhaps to increase it; No change from parasitic Insurance companies stealing as much of the Health care monies as possible; no change from a proliferation of Health Care payers necessitating more health care claims processors, deniers, coders, billers, collectors which has absolutely nothing to do with Health Care; no change to preventative care; No change to anything important! Presumably, this is all about getting young, healthy people to throw more money into the pie for the Health Care industries to steal and to provide some minimum "regulations" to end the criminal acts of the Insurance bandits, and to provide political points for the Parties to use in beating the other party to get the power they both so crave to ensure the continued enrichment of the political cronies! It is a BALD FACED LIE that these bills, these talks, these Republican weaseling has anything to do with Health Care!!

AB13, although I don't agree with what you've posted, thank you very much for your great contributions to the discussion. It has been a very long time since I've read such a REAL and fact-filled, non-insulting, discussion in the comments on wapo. Thank-you, all of you, it has been enjoyable to read, informative and all done without a single instance of name-calling. YAY!!! If only more comment boards were like this one, Chris Cillizza must be envious of Klein, considering the way his comment board has been highjacked by some very abusive, fact-free and insulting trolls.

People on the right are intellectually dishonest when they make their remarks, assuming they have any intellect to begin with.

In this world of five-second soundbytes, they can say whatever they want, take their talking points from the Rethuglican National Committee or Fixed News and repeat, repeat, repeat.

This is how they got away with two unpaid for tax cuts that have added more than TWO TRILLION DOLLARS to the budget deficit and a Medicare Prescription Drug Benefit that has benefitted the Drug Companies to an additional unpaid for ONE TRILLION DOLLARS.

Don't even get me started on the culture of corruption on the REthuglican side that led to two wars of choice in Iraq and Afghanistan that have never been paid for.

Now they're getting away with distorting the Health Care Reform debate.

This health care bill is not perfect, by any stretch of the imagination, but if it means that 30 million additional people will be covered with health insurance and in turn that leads to lower premiums for all of us, I'll take it over total inaction,

Death panel, anyone? The right's never been much concerned with the facts, much less intellectual honesty. The main thing is to "stand on principle" and thwart the Democrats. If that means being utterly irresponsible and selling the American people short, well, no one in Republicanland is losing much sleep over it.

Ezra, my plan is that the people "take back the words" and impute to them meaningful meanings ~ that is, that "central" becomes, once again "central", and "socialist" becomes "socialist".

Plus, I want to take YOUR WORDS, like "running dog lackeys" and make them our own.

And so on and so forth.

My other plan is to get Conservatives on the "citizen seats" on the "standards of care" committees.

That way we can plan on having Obamacare program in early death for our political opponents.

No doubt some of your friends have their eyes on those seats. They'd best be prepared to fight to the death Fur Shur.