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Who does health-care reform help?

Jon Cohn spent part of Saturday wandering through the patches of protesters on Capitol Hill. What surprised him, however, was that the protests seemed less about health-care reform than about redistribution itself. To the protesters, Jon says, health-care reform is "about having their money taken for the sake of somebody else's security. When they hear stories of people left bankrupt or sick because of uninsurance, they are more likely to see a lack of personal responsibility and virtue than a lack of good fortune."

I see this a lot in my inbox, too. So it's worth taking a moment to talk about whom health-care reform is really meant to help. There are three major subsidies operating in the health-care system. The first, and most obvious, is Medicare, which covers the elderly. Then there's Medicaid, which covers some of the very poor. But then there's the one that people normally forget: The tax break for employer-sponsored health-care insurance. At $250 billion a year, it's much more expensive than health-care reform, and it subsidizes people with good jobs that offer health-care benefits.

Health-care reform is focused on another group: the working class. People with jobs, but not jobs that are good enough to offer them health-care benefits. People with paychecks, but who aren't making quite enough money to bear the cost of insurance. People who're buying insurance on their own, which means they don't get the good deals that big employers get, and they don't get a giant tax break to help them out. But these aren't lazy people, or layabouts. These are people who've been left behind in the system. We spend a lot more money to give a lot more help to a lot of folks who need it less than this group does.

That accounts, at least, for the spending side of health-care reform. The new rules on insurers go to help another group: People with bad luck. A preexisting condition is not the fault of the individual. What it means is that they got sick or injured at some point in the past, they get their insurance on their own rather than as part of a bigger group (like an employer's pool, or Medicare), and they're not being fraudulent in their dealings with the insurer. When someone who has coverage and then gets sick finds their policy rescinded, that's also usually not their fault. They had the bad luck to get sick, and the bad luck to have an insurer looking for a loophole to deny them coverage, and then the bad luck to have their insurer actually find one.

These are the folks health-care reform is meant to help. The fact that they can't afford insurance, though, isn't evidence of some abdication of personal responsibility. It is evidence that they're not old, or very poor, or employed by a large corporation that offers health-care insurance. Sickness and health might be capricious, but access to health care doesn't have to be. It isn't in other countries, and if Democrats win the vote tonight, it won't be in ours, either.

By Ezra Klein  |  March 21, 2010; 12:18 PM ET
Categories:  Health Reform  
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Next: Vote scheduled for 9pm


An excellent point Ezra. It's been frustrating that this point hasn't been made clearly enough, the primary beneficiaries will be the working class.

Posted by: sfmandrew | March 21, 2010 12:33 PM | Report abuse


every size employer is eligible for Section 125.

"They had the bad luck to get sick, and the bad luck to have an insurer looking for a loophole to deny them coverage, and then the bad luck to have their insurer actually find one."

this is also something the Dems hang their hat on way too much. The incidence of recision is very rare. Wrong always when it happens but still rare.

I agree with your overall assessment though and sfmandrew's. Its meant to help the working class so that they don't fall down to the Medicaid line. To that extent this legislation is very good.

Posted by: visionbrkr | March 21, 2010 12:38 PM | Report abuse

And I would like to repeat again the case of folks who have generally a good job, but then loose the job due to hyper competitive world and then face months of darkness (and potential bankruptcy) until they find new jobs.

What can happen when an engineer is laid from Google, Intel, Apple & Cisco? With Intel I heard the story - an engineer in Europe who looses job after 20 years of service is let go with a Half Million dollar package due to labor laws whereas the same engineer in USA will be lucky to get a package of 2 months at the best. After a month COBRA finishes and these engineers and their families are on their own. Engineers with 'patents under their belt', engineers with great products designed, engineers with excellent accomplishments, engineers who risk everything for a next big idea in a start up; all of them face the same problem. This bill will provide affordable 'bridge insurance policies with much less caveats'.

Which 'moron' from that yesterday's Tea Party can call these engineers incompetent or lazy?

What about a competent, play by the rules, middle manager in Manufacturing and even some in Banks? What about Pilots who served Airline Industry for 25 years are then laid off? Why are these people lazy?

What our current health system does is it pulls off a cruel joke on any Middle class, competent family, in a blink of eye when job is not there for a month or so and like a hell these families are on road.

So yes, Ezra, this is all about redistribution. But I also think, our worst fears are turning out true too. So many Tea Party folks in USA want to simply bring back Racist & Bigotry Policies.

Granted these may be few incidents, but look at some of the posters in the rally. It is lot darker.

Where are Glen Beck and Sarah Palin? Where is their patriotism? Or it is all about minting millions while dividing this country further?

Posted by: umesh409 | March 21, 2010 12:41 PM | Report abuse

You are making the classic Dem mistake of assuming rationality will convince anyone. What motivates the tea partiers (the extremely involved and very vocal opponents) is fear and anxiety. Rational arguments don't help. Ironically, what will help is a stronger safety net that might make them less anxious. That is one reason why the GOP fights it so much--they profit from a climate of fear and anxiety.

As someone said in the last couple of days, the idea that no one should have to pay for "someone else" is not only anti-community but also undermines the whole notion of insurance itself, because some people pay more in premiums than they get back in health care and some need much more care than they paid in via premiums. Who are really the lucky ones? I'd say the healthy ones, yet they feel resentment, calling everyone else a free-rider.

Posted by: Mimikatz | March 21, 2010 12:43 PM | Report abuse

This is a good post, but it's also an area where common sense isn't really adequate to address what's going on here. The fierce resentment of the underclass in this country has structural issues (more diversity, lack of a strong welfare state), but it's also the psychology of free market fundamentalism that has pervaded the way we think about these issues. In other words, it's an issue where, as one critic wrote (whose name I've forgotten), "Freud cries out for Marx and Marx cries out for Freud." The belief that the underclass are morally inferior comes from the belief that money/success=moral standing and lack of money/hardship=moral inferiority. The whole premise of market fundamentalism is THAT THIS LOGIC IS NEVER QUESTIONED. It's this strange "religion" that dominates our political debate in this country. It's the reason why following the financial collapse we bailed out banks instead of nationalizing them. And it's also the reason why so many Americans believe that people suffering economic hardship just aren't trying/working hard enough.

Posted by: dhs08 | March 21, 2010 12:52 PM | Report abuse

"When they hear stories of people left bankrupt or sick because of uninsurance, they are more likely to see a lack of personal responsibility and virtue than a lack of good fortune."

The idea that someone's misfortunes stem from a lack of personal responsibility and virtue assumes (incorrectly) that everyone has the same opportunities in life and that the less virtuous have simply squandered theirs.

Such a view is simplistic and completely devoid of empathy (and apparently a core tenet of the Republican Party).

Posted by: onewing1 | March 21, 2010 1:23 PM | Report abuse

The reform will help my son. When he graduates from college in May he will be without health insurance. In this economy it is unlikely that he will find a job without health insurance the next day. He has a bone disease that makes him ineligible for private insurance for the one thing he may need treatment for. If he trips and gets hurt while moving out of the dorm after graduation he will start his adult life thousands of dollars in debt.For the sake of my son and so many others like him -pass the bill!

Posted by: babloom | March 21, 2010 1:53 PM | Report abuse

What you and many other supporters of this bill ingore is the terrible policy that requires citizens to purchase healthcare insurance against their wishes. When did this country morph from one that honors the rights of individuals to one where the government requires you to spend your money on something you may not need or want. If I am a healthy 27 or 29 year old, and I do not want to spend $10,000 dollars a year on health insurance, that should be my decision, not Obama, not Pelosi, not Hoyer, and not Reid. Regardless of the outcome of this vote, the Democrats will pay for this in November. I will retain my right to make my own decisions about health care and the Federal Government absolutley has no business telling me what to do. Period.

Posted by: fairfaxfirefighteriniraq | March 21, 2010 1:59 PM | Report abuse

Where the personal responsibility argument really falls apart is on those who are inadvertently affected by somebody's irresponsibility. Take children for example. Many children don't do well in school because they don't have the proper parenting structure at home. Should our government really give them a short lecture and say it's their responsibility to do well when they don't have the resources to accomplish such a goal? It's time to stand up for those who need help. I'm all for making sure that mom is accepting that job offer over continuing to accept welfare, but where I (and everybody else should) draw the line is when the personal responsibility argument harms those who are inadverntently affected.

Posted by: zackool | March 21, 2010 2:03 PM | Report abuse

You know, when one of these teabaggers, already getting heath care through medicare or a generous company or government plan, protests the possibility of expanding coverage to millions of our fellow citizens who don't currently get it -- what's at work is hypocrisy pure and simple.

The reason we have a democracy is not so every selfish knucklehead can get their way; the reason is to allow majority rule. That's what's happening now, that's what's happening when we finally pass this thing, and all I can say is, God bless America.

Posted by: leoklein | March 21, 2010 2:03 PM | Report abuse

fairfaxfirefighteriniraq wrote: "If I am a healthy 27 or 29 year old, and I do not want to spend $10,000 dollars a year on health insurance, that should be my decision,..."

I commend you for arguing on the merits without attacking people who disagree with you. There is little of that in this debate.

But what happens when a healthy 28 year old gets seriously sick or injured. Are you prepared to pay $50k, $75k or $100k to a hospital? The cost could destroy your life, you could lose your home, your credit rating and much more. Families are torn apart by these tragedies.

The costs to the nation of the current economics of health care is far too great. But the burdens of those costs are unfairly distributed and affect the least fortunate more than the well off. How do we as a rich and advanced society best protect the interests of a nation as a whole? That's what the debate is about.

Posted by: thuff7 | March 21, 2010 2:15 PM | Report abuse

The tea baggers I have heard don't make it so much a matter of personal responsibility as they make it a matter of privilege.

Good health care is a privilege that you have to work hard for. You have to advance through the working ranks to get to a job that provides it. It is a goal to strive towards, just like owning a home or a new car.

Tea baggers think that by allowing access to health insurance to people who haven't fought for it like they've fought for it, that you devalue what they have. It's like making a new car affordable to everybody. How can you play "keeping up with the Jones'" when the government levels the playing field?

Just like they hated cash for clunkers. Who had the clunkers? The poorer and less worthy. How can you feel superior to your neighbors when the government helps them buy a newer car than you have? Especially when you worked hard for the new Ford you bought a few years ago, and your neighbor just got $3,000 for his junker Yugo, and turned around and used that for the down payment to buy a new Kia.

This is another thing the tea baggers resent. The value of their health insurance is a marker of their success in life. The harder you work for what you've got, the more it is worth.

The philosophy of tea baggers is that one needs to be worthy to get health insurance and/or access to health insurance and health care. Health insurance is every bit as much an indicator of their view of a meritocracy where those without insurance deserve what they get. Even if it is a terminal illness that could have been treated by early or preventative care.

So you cannot make the moral case with people who think like this. It just will not be effective. You cannot appeal to compassion where none exists. Better to take the route that they are subsidized, and that the underclass (health insurance-challenged) will level that playing field if they don't cooperate, i.e. they will have to pay the true cost of their insurance.

And that is a tactic that we did not see in this debate. If the issue of how those with employer provided insurance are largely subsidized by all tax payers to a large degree, then you can use the economic leverage of the tax break to force the issue of tax fairness on tea bagger who've taken advantage of it, but are unwilling to extend a subsidy to others. The tea bagger who takes his subsidy for his health insurance is no better than his neighbor who took the government payment for his Yugo, at least when you measure it on his own terms. So it is hypocrisy for a tea bagger to take a subsidy for health care, yet decry others who may get the same through health care reform.

I've always thought that the threat to take away selective tax breaks and credits for health insurance--in all its forms--would have been the best way to force the unwilling to the negotiating table.

But that is not the Democrat way, unfortunately.

Posted by: jc263field | March 21, 2010 2:24 PM | Report abuse

It's certainly true that this is more about the use of government to redistribute wealth than it is about health care. Another marker of this is that the Tea Partiers don't know anything about health care. They have no special knowledge, other than as occasional patients, so it is not their analysis of dynamics within the system that is driving them.

But there is something else Ezra hasn't addressed: Why? Why this vehement rage against redistribution from some of the very people it would help?

As dhs08 put it: "The belief that the underclass are morally inferior comes from the belief that money/success=moral standing and lack of money/hardship=moral inferiority. The whole premise of market fundamentalism is THAT THIS LOGIC IS NEVER QUESTIONED. It's this strange 'religion' that dominates our political debate in this country."

I think we can make it a little less strange if we see it in the light of tribalism, and to be blunt, racism and bigotry. Americans tend to see the poor as "other" rather than as people just like them because their image of the poor is of people who don't look like them. They come from different ethnic backgrounds, different cultures (or subcultures). So they don't see the poor as people just like them who had bad luck in their parents, etc., but as people who as a class are inferior, culturally or genetically. Not only that, these people are sucking away "our" money and infecting our culture. They have images of both contagion and thievery as a result of this tribal Us/Them thinking.

Compare the US and Europe in this regard. Up until the last 20 years, the US had a far higher visible minority population than most of Europe. Europe tended to think of their poor as part of the "us" because they looked the same and were part of the same culture. We know the sordid history of the US in contrast, with its large minority of African-Americans and then Hispanic immigrants.

Further confirmation of the connection between racism and the Right is what you now see in Europe. Growing immigrant communities from Africa, the Middle East, Asia and the poorest parts of Eastern Europe have triggered Far Right parties in every European nation. These parties unify smaller government rhetoric with anti-immigrant rage. The Tea Partiers are the brothers and sisters of Austria's Freedom Party, Belgium's Flemish Block, France's National Front, Italy's Northern League, Norway's Progress Party, the UK's British National Party, etc.

The racial epithets thrown at SC's senator the other day were not the words of a lone "bad apple" in the Tea Party movement. The racial and cultural animosity is one of the driving engines of the movement.

Posted by: jdhalv | March 21, 2010 2:28 PM | Report abuse

FairfaxFirefighterInIraq said

"If I am a healthy 27 or 29 year old, and I do not want to spend $10,000 dollars a year on health insurance, that should be my decision"

Yes, the same decision that I made when I decided that I don't want to pay your medical bills when you get injured because you don't have insurance.

Posted by: mssnatchquatch | March 21, 2010 2:30 PM | Report abuse

By bringing up a $250 billion tax break your presumption is that taxes are fair in the first place. The tax break is there to incentivise employers to offer health care, which they have done.

People always bring up tax breaks for corporations or big business as if there is some responsibility the corporation has to pay huge taxes. That dividends people receive should be taxed at 50% to 70% because it is "unearned income."

I'm no tax protestor but it bothers me when people act as if any tax is a good tax because it helps some unfortunate get a leg up. I mean, come on, where's my $300 per month card from the Dept of Agriculture (food stamps) that would allow me to buy food without having to pay for it?

Posted by: hc2254 | March 21, 2010 2:36 PM | Report abuse


Although 125 is available to every size of employer, Ezra's point is that small (and many medium) -sized employers cannot afford to provide group insurance, so effectively this tax subsidy is not available to those employees.

Also, you may say that recission is rare but estimates have ranged as high as 25,000 per year. That doesn't include its more common cousin, purging, in which insurance companies raise premiums for sick customers to the point that they can't afford them.

We do agree this is a good (not great or even very good) bill. It's a real start.

Posted by: gingles | March 21, 2010 2:42 PM | Report abuse


If Obama is so concerned about wasting tax dollars -- how is it, "60 Minutes" can find Medicare fraud, in a few days?

And why did it take catching ACORN on videotape suggesting FELONY acts, before Bwarney Fwrank threw them under the bus? After ACORN incompetently ran voter drives -- but Obama gave ACORN millions of TAX DOLLARS.

Obama is an organizational LIE.

He and ACORN cannot run anything competently.

So many LIES have been told in this, it is DISGUSTING.

"USA should be like Switzerland." Sure -- and Bwarney Frwank should not be gay. Gimme a break.

"Pre-existing conditions!" Hey STUPID -- stop SMOKING, DOPE, BOOZE, over-eating and doing idiot things. You'll cut your medical bill by 40%.

Fat Mike Moore and "look at the poor injured lumberjack!" How much sense does it make to work in a DANGEROUS field WITHOUT insurance???

And competent government? Kid, you have lost your mind, you are deluded. Two words: VAN JONES.

TAXPAYERS will fight the STEAL-O-CRATS to the end on this. Only 273 days until Nov. 2.

And you, too, kid.

Posted by: russpoter | March 21, 2010 2:46 PM | Report abuse

"Good health care is a privilege that you have to work hard for. You have to advance through the working ranks to get to a job that provides it. It is a goal to strive towards, just like owning a home or a new car."

And how do the children of people who are crippled, ill or otherwise unable to work earn that privilege? I would say they earned it by being born in the richest nation in the world.

But it seems to me that the carpet baggers, eh, I mean tea baggers are only interested in protecting the meek when it is advantageous to them or their families and are strong supporters of social Darwinism when it doesn't.

The whole notion you describe is nothing more than survival of the fittest. That may be valid for species of wild animals, but for a so-called superior species, humans need to possess the qualities of altruism and compassion.

That many of the teabaggers denounce the concepts of evolution under the Darwinian model of genetic evolution while espousing the same model in society cannot be ignored.

Posted by: thuff7 | March 21, 2010 3:03 PM | Report abuse

fairfaxfirefighteriniraq, you miss the point of the individual mandate. The reform bill prohibits insurers from denying coverage to those with preexisting conditions. If we're going to require this of insurers, mandatory coverage is necessary, or someone can decide to go without coverage until they become sick, immediately take out a policy, and then drop the policy when they become well again. This means that everyone else insured by that company would be subsidizing potentially very expensive care for someone who is just gaming the system. And there would be no reason for people not to insure themselves only "as needed." In fact, since the penalty for non-insurance is so low, I suspect that many will do exactly that anyway.

Posted by: rashomon | March 21, 2010 3:11 PM | Report abuse

Over the last 35 years big money/big business has had a plan to depress the middle class workers and increase profits for shareholders. Reganomics and eight years of Bush gained great strides in achieving this goal. CEOs wages have increased 600%, profits for oil, health insurance and wall street are setting world records, BUT for the American worker wages have had no increases! The Republican are puppets for big money/big business, Everything they have passed in Washington DC in the past 50 years has been for big money/big business with the explaination that it will trickle down to the peasants. Well now we have a President and political party that believes in the "trickle up" theory! The Country is only as strong as its weakest link. It used to be this way in the 50s, 60s, 70s! Help the bottom workers and it will trickle up to the top. Kind of like Henry Ford, Ford Motor Company believed years ago when he started his company. The Republican Party needs to be stopped and I think President Obama can do it.
Democrats Care!
Republicans Don't

Posted by: lunetrick | March 21, 2010 3:13 PM | Report abuse

How will we ever solve the problems of our society when folks like russpoter can only vent a tirade of anger, racism and homophobia in response to a real debate on the quality of our lives.

One can only wonder where his convictions would lie if he lived in the WWII generation when Americans came together, fought fascism, racism and homophobia in Nazi Germany? Would he agree with the Nazis that these people should be eradicated?

If the solution to health care is to let the poor, the weak and the unfortunate die from lack of health care and let those who can afford it live healthy, prosperous lives, what makes them any different from the evil forces of the 1930's and 40's?

The German Nationalist party (Nazis) came to power by blaming the Jews and the homosexuals for all their social and economic problems. There solution was to eliminate the people they blamed. It sounds horrifyingly similar to the ultra-nationalist tea baggers who bring guns to protest rallies, utter racist and homophobic slurs and spit on congressmen who don't support their radical agenda.

Where are we headed? Civil war? Social de-evolution?

Posted by: thuff7 | March 21, 2010 3:16 PM | Report abuse

My husband and I have been self-employed for almost 20 years, and have bought individual coverage ever since. We use health care services minimally and keep ourselves physically fit. I've been amazed at the tricks, arbitrary denials, exclusions and other terrible treatment from the few companies that do most of the policies in our metro area. All we want is coverage in case of a bad accident or disease, and pricing leverage for routine treatment. But even with big deductibles and condition exclusions, our premiums still run about $12,000/yr for the two of us. Denials on whim are routine. A simple sprain or ultrasound test can bump our annual out of pocket cost to $20,000, easy.

Just as bad, hospitals and labs charge us many times more for the same procedure/test than they do if Blue Cross (or any insurer) covers it. I get charged $900 for a routine blood test that costs $100 via Blue Cross. Crazy stuff.

Unless we decide to deny all care to all the non-insured (now they get it free, on everybody else's nickel), we must require everyone to buy -some- insurance. We can debate how extensive the coverage. But something.

Young adults too. They can have accidents (bike, sports, car), cancers, ectopic/unplanned pregnancies--conditions that blindside the healthiest, and potentially expensive to treat. At cost to taxpayers and premium-paying chumps like me.

Let's cover everybody. Everybody should pay something; they are guaranteed by law to get care; this access shouldn't be free. Sure, let's debate what minimum coverage should be, and what everybody's personal responsibility is. But let's stop delaying & pretending.

Posted by: Hunter | March 21, 2010 3:21 PM | Report abuse

What about the young adults graduating college and can't find a full time job due to the economy and work part-time ? My daughter fell in to this category last spring. Many more will have this happen to them shortly when they graduate. Making only $300 a week or less on a part time job won't pay for health care. This bill is not perfect but it will let these kids stay on their parent's health care thru 26 years old. I imagine fairfaxfirefighterinIraq has health care so his complaint is disingenuous at best. I agree with Ezra and wish his views were more widely circulated. The teabaggers are just ignorant and hurting themselves and their families on this issue.

Posted by: Falmouth1 | March 21, 2010 3:49 PM | Report abuse


Posted by: whocares666 | March 21, 2010 3:54 PM | Report abuse

i love the argument about those graduating from college. Its as if those costs to cover them just disappear.

Its the Democrats version of MAGIC!

Posted by: visionbrkr | March 21, 2010 3:58 PM | Report abuse

Entrinched politicians are the only people helped by this bad bill. It makes "We the People" slaves to the state.

Posted by: markandbeth | March 21, 2010 4:01 PM | Report abuse


I agree that recision needs to end (as I've said) and you quote statistics with no proof. Fine I'll assume that figure is correct.

As far as your definition of purging its 100% incorrect.

When insurance companies raise their rates due to cost (mainly due to the lack of a mandate) then that is not purging. They do not and cannot single our individuals. They raise rates on the entire population in a market segment because of the costs of that segment.

They don't (no matter what you incorrectly believe) single out "Mary Smith" because she had $1 million in claims. The market segment Mary Smith belongs in costs go up because of those claims. Mary Smith normally stays covered (as long as she can afford it) because her healthcare costs otherwise would be exorbident. Its her healthy co-workers that would go without coverage.

That's what happened in California with Anthem.

I just wonder who the new bogeyman will be.

Posted by: visionbrkr | March 21, 2010 4:04 PM | Report abuse

The error in the thoughts of many is that somehow the role of Government is to assure that everyone succeeds in life. That is false, indeed bad things happen to people, many times it is due to their own actions other times not. The issue is that : Such is life, not everyone can be at the top of the pile of life. It is almost impossible to not get healthcare even with no money, no insurance or other issues. Indeed some folks do go bankrupt, but folks go bankrupt for other reasons, should we protect them also?

Posted by: macira | March 21, 2010 4:10 PM | Report abuse

Hopefully the bill can be gutted so that the money spent is reduced. Reduce the subsidies, reduce the number eligible for Medicaid, reduce the age to go on parents insurance. This bill will bankrupt the country and the outlays and monetary giveaways must be cut back -- also NO FREE prevtative tests like Mammograms - people must pay something - there should be nothing for free. There must be a significant co-pay. Also eliminate brand drugs from Medicaid.

Posted by: Lavrat2000 | March 21, 2010 4:12 PM | Report abuse

It just goes to show you that when the Congress hands out tax breaks, not only does it undermine Federal revenues and create more deficit but there is always a group that gets screwed.


The tax break problem applies not only to health care but other things as well. The mortgage interest deduction thoroughly screws the people who will always be renters. Renters pay for the mortgage interest tax deduction for the wealthy incomes of this country and get no benefit for it.

My uncle the home builder complains about U.S. socialism but home builders are the biggest recipients of socialism in America.

But tax breaks are the big Federal handout that the politicians love to claim as their big influence to constituents.


Let's require that tax break legislation be bundled with debt ceiling legislation always.

Let's get back to free market principles.

Posted by: hz9604 | March 21, 2010 4:17 PM | Report abuse

Ezra - you are holding the Cadillac plans as carved in stone. These plans need to be taxed and taxed NOW. THAT will put the lower wage earners on an even footing. Beyond that we CAN provide financial incentives for the lower wage earners to even the playing field.

But you are a dyed-in-the-wool Liberal and the only solution you know is to create government dependency which is a massively destructive state of being.

Posted by: hz9604 | March 21, 2010 4:22 PM | Report abuse

The issue that many miss is that this law will probably lead to the bankruptcy of our country. The political fallout, loss of seats by Democrats is of no significance, but the fact that the Government will continue to spend more than it collects is.Look at California, there is what the U.S. will soon look like, then there will be no place to go to plead for money(is that not what the Health Insurance scam is about). Will the liberals then pass a law demanding a "Bug Rock Candy mountain"?

Posted by: macira | March 21, 2010 4:24 PM | Report abuse


"How will we ever solve the problems of our society when folks like THUFF7 can only vent a tirade of anger, racism and homophobia in response to a real debate on the quality of our lives.

"One can only wonder where his convictions would lie if he lived in the WWII generation when Americans came together .."


Hey pinhead -- my dad's a WWII vet. And he HATES SOCIALISM and COMMIE-LOVERS. Idiot.

And BTW: non-gays have rights, too. Fool.


Posted by: russpoter | March 21, 2010 4:32 PM | Report abuse

I thought Cash for Clunkers was an excellent program, and my car qualified as a clunker. However, I can't afford a new car even with the subsidy. But I'm glad to have been able to chip in with my tax dollars to buy a new car for someone who could afford one. If I were the government, though, I could have just bought a new car with deficit spending - just like we're going to pay for health care reform. Common Sense: no matter how good or noble your goal, if you can't afford it, you can't afford it. BTW - the CBO's cost estimate was required to assume as fact a $500 billion Medicare reduction and $300 billion reduction in payments to Medicaid doctors. Just pointing that out.

Posted by: dragonlady1226 | March 21, 2010 5:05 PM | Report abuse

hc2254 said about employment-tied health insurance plans "The tax break is there to incentivise employers to offer health care, which they have done." The history of employer sponsored health insurance is that during WWII, when the government put in controls on wages and employers were competing for workers, employers began offering health care insurance because they couldn't offer higher wages than the competing employer. For some reason this was not treated as taxable income to the employee, but rather as both a tax deduction to the employer and tax-free to the employee.

Whether it "incentivises" employers or not, I don't know. I do know that it is a $250 billion a year tax break for those employees. And there are lots and lots of anecdotal reports of people who wanted to change jobs but couldn't risk losing their health insurance, or wanted to exercise good old American entrepeneurship and open their own business but, again, they'd lose their employment-tied health insurance and (1) couldn't afford individual health insurance because of the cost (particularly with a start-up business) or (2) had a family member who would be considered uninsurable because of a pre-existing condition.

We are the only industrialized democracy in the world that does not treat access to health care as a right that does not depend on one's employer or income. By many reports, this universal access to health care that is not tied to employment is one of the factors that allow those nations to sell their products (often in the U.S.) for less. Most of those nations have better overall health statistics at a lower national cost.

We may have the "best health care system in the world", but only for those who have excellent insurance or can afford to pay for health care out of pocket.

Posted by: vklip1 | March 21, 2010 5:08 PM | Report abuse

There is a continuum between individuality and community. Go too far toward community at the expense of individuality and you get, not socialism, but Marxism-Leninism, where the individual has no rights. Go too far toward individualism and you get a society where no one feels any responsibility towards anyone else. We seem to be far too close to that in this country.

I know a family (not mine) where the husband had been a hard working employee until a couple of years ago his workplace closed down. He lost his insurance then, of course. Before he could find another job (hard to do in a recession in his 50's), he was diagnosed with cancer. He is now uninsurable, unemployable, and his wife and young son also now have no insurance.

Where is the morality in this? Everyone talks about dollars and cents, but they ignore that this is flat-out immoral, that a hard-working (not lazy) person is to be simply tossed on the scrap heap with his family through no fault of his own?

Posted by: pauldavison | March 21, 2010 5:27 PM | Report abuse



The rest of us will see our premiums continue to skyrocket and our claims denied. People who need help will NOT get it. Obama is planning to dismantle Medicare and Medicaid as soon as he can.

He is on the side of the insurance companies and banks. NOT US.

And I am a LIBERAL. A proud, bleeding heart liberal and have been since I first voted. But this bill is nothing but Obama's gift to big business, just like EVERYTHING else he has done since he's been in office, and I have no problem calling him out on his lies and his utter contempt for the very people who voted for him.

I have nothing but contempt for Obama now and I see more and more of the people who voted for him waking up to the fact of what a fraud he is.

Posted by: solsticebelle | March 21, 2010 5:46 PM | Report abuse

We need insurance regulation to stop the practices of not insuring pre existing conditions and dropping insureds when they are chronically ill. We need a moral and compassionate government who wont make promises it cant keep. My issue with this bill is the financial trickery and fiction of the medicare cuts used to pay for this promise. Those supporting obama care cite medicare and social security as parallel entitlements that are successful. I disagree, financially their are not sustainable. Promises of more benefits than costs are always popular just like a free lunch. That is what we have here. See the NYT article today by a former CBO director.
We are assuredly going to see promises and benefits paid for in medicare and social security go unkept. The independent commission working as we pass this bill of promises, are deciding which promises in medicare and social security have to be changed and how much higher taxes will have to go to keep those reduced promises. Yet we see congress bringing us new promises in obama care, which are also based upon an unsound funding mechanism. I want an honest government who only makes promises it can afford to keep. We sorely need lower cost of living and cost of hiring here, no one talks about that, we layer on more regulations and taxes without ending those that have not worked. Jobs go over seas, fixed income retirees see lower standards of living and some who relied on medicare and social security promises may see live impacting results from either this commission or the next one in another decade to make more and more fixes. We have too many lawyers in congress and not enough common business sense. This isnt about us versus business or us versus insurance or us versus government. It is about what we can afford. We live like a rich country on borrowed debt. Our national debt is nothing compared to the $100 trillion government estimate of unfunded liabilties in medicare and social security with more to come in obamacare.

I pray for financial honesty from DC. CBO is good as far as it goes but it ignores unfunded liabilities and the likihood the medicare cuts will be made to pay for even the 5 years of cost in the first 10 years of this bill.

Posted by: Johnhw2 | March 21, 2010 5:53 PM | Report abuse

If this Bill passes today, it will mark the END of the DEMOCRATIC PARTY in this Country. The "blow back" from the American people on having this incredibly expensive bill rammed down their throats during the worst economic down turns in the history of this Country will certainly produce an ANGER VOTE that will be unpresidented, and unlike any the US has ever seen. Nancy Pelosi is sadly bringing forth not only the end of our very proud Democratic Party, but also ending the Obama Administrations opportunity to true make long term serious changes. A win on this vote will almost certainly end the careers of any and all Career Democratic legislators beginning in November, and as all the analysts are clearly stating, most likely lead to impeachment procedures for President Obama. Was the Health Care Bill actually doomed from the start? No, with the proper timing and building of support it probably would have been very successful. However in the midst of this current economic situation, and the fact that it is having to be forced down the throats of all American without their support, and against their wishes, at a time when they simply can not afford it, will certainly produce a backlash of anger voting that will destroy any and all chances of bringing true long term changes to our Country. Goodbye Democratic Party...bad timing, poor judgment and a forced vote have determined your fate. Goodbye Career Democrats, Nancy Pelosi rushed in too fast, with the wrong timing and fumbled the ball at a time when the economic climate has forced the American voter to "find someone to blame".
If this passes, it will be the straw that beaks the back of our once proud, and extremely powerful party.
Goodnight all.

Posted by: dnrainmaker | March 21, 2010 5:56 PM | Report abuse

While agree wholeheartedly with the principles of extending healthcare insurance coverage to the 10% of Americans who do not have it, I'm very nervous about this bill.

Nervous because I frankly am not sure I can trust Congress to do this right. I'm worried about all the unintended consequences. I've lived with national healthcare in Europe and was very unsatisfied with the level of care. Yes, I got my medicine free (and appointments surprisingly quickly), but the level of care given was not good.

And, for all the horror stories paraded before Congress from people without healthcare, I can match with horror stories of poor care under European systems.

I know this bill isn't strictly "nationalization," but I worry about the direction toward more government intervention in my health.

Posted by: k_auman | March 21, 2010 6:06 PM | Report abuse

"You know, when one of these teabaggers, already getting heath care through medicare or a generous company or government plan, protests the possibility of expanding coverage to millions of our fellow citizens who don't currently get it -- what's at work is hypocrisy pure and simple."

You're misunderstanding. Nobody is against people getting medical coverage. Nobody. But you're not saying that, rather you're saying "I want what I want (therefore it just became a right, and you have to pay for it. And if you don't pay for it, it just proves that you're selfish".

I would say that you should get medical coverage, when it's important, but don't expect that it will be as good as someone whose company has seen fit to give them better insurance.

Life isn't fair. Get over it.

Posted by: Ombudsman1 | March 21, 2010 6:07 PM | Report abuse

Excellent article. You are one of the bright ones on this newspaper's staff.

Posted by: GeorgHerbet | March 21, 2010 6:09 PM | Report abuse

The authors story is much better than the bill is. He should have written it, and kept it at a very few pages, with out all the extra built in unintended consequences, and Obama could have had his bill signed last January, and then begun to work on tort reform and some of the other maladies that have evolved to bedevil our current healthcare system..

Posted by: kesac | March 21, 2010 6:16 PM | Report abuse

The most irksome aspect of this debate is the disingenuousness of the right. It is troubling when a major political movement in a country resorts to misinformation and half truths. It reminds us of extremist movements in other countries that were also founded on falsehoods and fills us with fear that that could happen here in the US.

The right tells us that as a nation, this healthcare plan will increase the deficit and bankrupt us. But why is that the end of the discussion? How about we just make the large multi national businesses pay their fair share of taxes? After all, 58% to 68% of American businesses don't pay any taxes. Or we could revisit the whole Republican tax structure for the rich that began under Reagan and continued unabated through W's regime.

When Reagan raised the taxes for Medicare on the middle class, but not the rich, the fund soon had a trillion dollar surplus which he promptly raided and which has never been paid back. A trillion would pay for this plan for the next decade. Let's just ask for the money Saint Ronald never repaid.

All this talk about the deficit is a smokescreen. Republicans whole history since Reagan tells us they don't care about deficits as long as the money is spent on war and war materiel and that the military industrial complex is happy. Besides Ron Paul, can you name one Republican Congressperson who opposes the astronomic spending for Iraq and Afghanistan? One that opposes the war? The war is paid for with deficit spending. Where's the outrage? Where are all the teabagger demonstrations over that? And it's all for oil.

if the right were honest, and it is not, they would also oppose Medicare Part D which is a trillion dollar give-away to big pharma. Drug prices can't even be negotiated by Medicare and we tax payers ante up to one hundred times for some drugs that the VA pays a much lower price for. It's totally insane and yet the Republicans/ teabaggers say nothing about this horrendous waste. And it's horrendous. They are totally inconsistent.

We would respect them more if they entered the healthcare discussion honestly and not with a hidden agenda, which is 'I got mine and I ain't helping you. I only help big business and I don't give a hoot about the poor and the unfortunate and those who need help'. Saddest of all are the innocent, hard working people who fall for these Republican/teabagger lies and aren't smart enough to know they're being taken for a long ride.

Wait until they find out.

Posted by: flamingliberal | March 21, 2010 6:27 PM | Report abuse

If this isnt about the money try to tell that to the greeks now. We are headed their way courtesy of Obama and Dims in congress. Show me the source of big busiess does not pay taxes here. I know most do and more than a fair share compared to what they would pay if domiciled in other tax locations which is why some have moved and more will. We cant spend more double on health care (as a % of GDP) as other countries and compete globally. Like it or not its a global economy now.

Posted by: Johnhw2 | March 21, 2010 6:35 PM | Report abuse

My son was diagnosed with cancer when he was 2. We thought we had decent insurance, but we were way underinsured. We ended up owing about 80K after 6 months of treatment. Virtually everyone we knew who had a kid in treatment had terrible problems with insurance - being dropped, or far more frequently, exceeding their lifetime cap. This stuff isn't rare, guys. And I don't think even a Republican can claim that a 2 year old with cancer just had a poor lifestyle.

Posted by: bkmny | March 21, 2010 6:39 PM | Report abuse

The health insurers are also helped. They get 30 million more subscribers, so more money and a bigger pool to spread the risk. The rich get richer anyway, so they should quit their belly-aching!!!

Posted by: DontGetIt | March 21, 2010 6:46 PM | Report abuse

People who believe this "program" will help are so misled. Doctors do not have to take this insurance, and many simply will not. So, our already shortage of doctors will grow and the quality of our healthcare will decline. If you are able to find a doctor he/she will be so over tasked that it will now take months not weeks to get the needed services. EVERYONE THAT SUPPORTS THIS LEGISLATURE WILL GET WHAT THEY AREN'T PAYING FOR...that is the terrible bottom line to this terrible legislature. The supporters have misled and lied and now only time will show the supporters how terrible this is for America. Medicare is bankrupt, the VA Medical system is both bankrupt and disfunctional, and Medicaid is bandrupt. Now you want the government to manage healthcare through the insurance companies. Not very clever. I am glad I am nearing the end of my life, I will hate seeing America collapse to the level of a third world country.

Posted by: staterighter | March 21, 2010 6:53 PM | Report abuse

The worst thing about this bill is that it cements into place a shareholder-centric insurance system and actually rewards the demonic insurance companies that have mistreated the American people for decades. That is wrong. It is wrong to have what are essentially for-profit middle men--insurance companies--wasting our health dollars on fat paychecks, outrageous bonuses, and dividends for shareholders.


Why are Americans so stupid? Why do they vote against their own interests? Contrary to the propaganda you hear from politicians, the U.S. does NOT enjoy the world's greatest health care. We are far down the ladder in every respectable rating. The French are #1.

Do they have a for-profit health insurance industry squandering their health expenditures? NO!

Nor should we.

Posted by: GeorgHerbet | March 21, 2010 6:58 PM | Report abuse


you're as bad as the tea parties. Obama dismantling Medicare? and Medicaid which gets increases in dr fees and a large influx of patients (15 million)

And someone told me that pre-ex ends with this legislation. Did they quickly change that tonight?

Posted by: visionbrkr | March 21, 2010 7:05 PM | Report abuse

To FairfaxFirefighterInIraq.....From your name, I assume that you're a Virginian. If so, Virginia law requires you to pay for a liability insurance policy on your car. The reason for this is to protect other drivers if you hit them by accident. Requiring everyone to carry auto insurance also lowers everyone's costs because it increases the pool of insured people, thus spreading the cost. I bet that you'd NEVER consider driving without paying for car insurance -- the risk is too great, even if YOU are a careful driver.

The principle behind requiring health insurance is the same.

To maintain intellectual consistency, if you oppose mandatory health insurance, then you must also oppose mandatory auto insurance. Do you want to drive Virginia's road with no guarantee that the guy driving next to you has insurance?

Posted by: truly1 | March 21, 2010 7:09 PM | Report abuse

Ombudsman1: "Nobody is against people getting medical coverage. Nobody. But you're not saying that, rather you're saying 'I want what I want (therefore it just became a right, and you have to pay for it. And if you don't pay for it, it just proves that you're selfish'."

I think that's a dramatica mischaracterization what supporters are saying.

The first thing we need to decide is whether we think people should die because they lack access to basic quality health care, and whether people should go bankrupt because they got sick. If we decide these things should not happen (a decision made by every single one of our peer nations), then we have a variety of ways of structuring the system to produce that result (as our peer nations show by getting comparable outcomes to ours at far lower cost).

But all of those systems require that the rich subsidize the poor and the well subsidize the sick. There is just no other way to provide universal coverage at a reasonable cost. And that's what all of our peer nations do.

It's not "if you don't pay for it, then you're selfish." It's "unless we all spread the risk by insuring each other, then the system can't work." Now if some people think we shouldn't have universal coverage, then the argument is over and we should just stop the discussion and vote. But if we think we should have universal coverage, then there will always be people who can't afford the market price, and some kind of government (taxpayer) service or subsidy will be required to provide them with basic medical care. (Same with education, where at a minimum some kind of government service or subsidy would be required for those who couldn't afford the market price in the private sector.)

It's not a matter of selfishness; it's a matter of realizing that universal coverage won't happen by itself.

Posted by: dasimon | March 21, 2010 7:16 PM | Report abuse

A major fact that is being ignored in this debate is that good health care costs a lot of money! It's not INSURANCE COMPANIES who are driving up health care costs, it's US!! For example, obesity leads to diabetes, heart disease, the need for hip and knee replacements, etc and it's largely preventable with lifestyle changes (see any of the current national practice recommendations on diabetes and heart disease on the internet). High-quality health care is not cheap, especially in a country with our standard of living! We have our priorities misplaced--we pay professional athletes millions of $$ a year but gripe about the costs of a doctor visit when that doctor spent years and hundreds of thousands of $$ to get established. Face it, it's going to continue to cost more if we want to maintain the quality of our HC system because of the time and money required to develop new drugs and therapies that keep us alive and healthy. But putting 1/6 of the economy under the control of a govt that's already incompetent and wasteful is not the answer. Making health insurers cover everybody with pre-existing conditions is a laudable goal but don't pretend that it's going to cost LESS to do that!! The way to FIX the current HC system is to minimize fraud and waste, get rid of frivilous lawsuits that increase the costs of care, and increase competition among private sector health insurance companies by allowing us to buy policies among states. Why not TRY that instead of throwing out the whole system when 80%+ of people say they like their healthcare plans? The choice is NOT Obamacare or NOTHING even though Obama and the media continue to perpetrate that LIE. Why does this administration insist on ramming this bill through Congress when the majority of the American people don't want it? Simple....they want control over every aspect of our lives.

Posted by: randy222 | March 21, 2010 7:31 PM | Report abuse

This is an interesting discussion. I live in Canada, where the debate on pooling our health dollars to help everyone equally happened a long time ago. Since almost immediately after the institution of universal healthcare federally, when folks started getting healthcare for themselves and their families without having to worry about selling the farm, or having to decide whether to do without healthcare altogether, apart from a few ideologues and some folks who just can't stand sharing (for anything beyond national defense, policing, and basic services), I don't think anyone seriously yearns for the time when it was every individual or family for themselves.

As to "sharing," I work for a small company, and no one is getting rich, but the work is satisfying and the company treats us well. I gross C$45,900 per year, of which I take home 74% after compulsory deductions for Income Tax, Canada Pension Plan, and Employment Insurance, and an optional deduction for our company health insurance plan for services not covered federally or provincially (e.g., dental, eyecare, disability insurance, etc.), which is about C$34.40/month.

Among the compulsory deductions, income tax counts for 18.4%, which includes my share of health insurance for every person in the country, including refugees, landed immigrants (U.S.: Permanent Residents), and so on.

If I break my arm or get sick and need help right away, I go to my local hospital emergency room; after being triaged by the intake medicos to determine the urgency of my case compared with others in the waiting room, I receive whatever care I need. There is no hierarchy of care in my experience; the staggering street drunk who cut his head in a fall is treated the same as the well-to-do lady who cut her hand in a kitchen accident. Although there might be some tut-tutting about the drunk being drunk in public (I AM in Nova Scotia after all...), no one seems to mind. My personal physician is only contacted before treatment if necessary.

At intake, I show my plastic health card, and that is the last bureaucratic thing I have to do. Period.

My needs have been few over the years, but I appreciate how much the system means to parents with sick or hurt children, pregnant mothers, and older folk with severe chest pains or who have had a bad fall. Just being without the anxiety of knowing you will have to come up with large sums of money when you go to hospital is a healthcare benefit in and of itself, in my view.

I wish my neighbours in the U.S.A. good luck with this bold new venture into helping each other. It may look scary at first, but it IS good medicine--even for the grumpy and reluctant.

Posted by: nickcw | March 21, 2010 7:32 PM | Report abuse

Our present economy is restructuring in ways that may not seem obvious. I am a science professor and many of my grad students are taking jobs in temporary service agencies because that is all that is available. For example, a recent Masters graduate works for XXX Services and is assigned to company AAA one month, then to company BBB the next month. This is done because these companies find it financially expedient to hire temporary workers for science R&D instead of full time employees (presumably to maximize their profits). However, XXX Services does not provide benefits. I tell you with all my heart and soul that my former students are not laggards. They are bright, industrious and extremely hardworking individuals finding cures for cancer and other diseases. I can't accept the fact that our country would not provide them access to basic health care as strong contributing citizens. We are in this country together and not as individuals. So, we need to make sure every citizen has access to fundamental needs. Ezra, it does disappoint me to hear you say that individuals exist in our great country that think they are somehow better than others because they have a certain type of job that provides benefits while other Americans who work for employers that don't provide HC don't deserve it.

Posted by: citizen4truth1 | March 21, 2010 7:35 PM | Report abuse

Not one of the "reform" advocates are addressing the the unintended consequences of this bill. The cost of this bill will be far greater than any CBO estimate. These are the geniuses that said in 1965 that Medicare would cost $9B by 1990. They were wrong by a factor of seven. The actual cost for 1987's special Medicaid hospital subsidy was 100 times what was predicted.

Young people forced to buy insurance will cease buying big ticket items. Home sales will plummet even more because money that used to be saved for a down payment will have to used for mandated insurance.

Caterpillar estimates the first year of this bill will cost their company $100M. That will be paid for in jobs. Jobs will be shed by the thousands.

As the nation's debt spirals out of control and revenues fall because of unemployment and nations like the Communist Chinese stop buying our debt the government will print more money and send us into hyperinflation.

There not voting on health care. They are voting on the end of America's economic and military superiority.

Posted by: EJHill | March 21, 2010 7:46 PM | Report abuse

The Republican plans will help the same group with the added benefit that we wouldn't have to grow government.

Posted by: hipshot | March 21, 2010 7:49 PM | Report abuse


If Canada has achieved medical nirvana why did Newfoundland and Labrador Premier Danny Williams have his heart surgery done in Miami? Why did Liberal MP Belinda Stronach have her cancer surgery in California?

One percent of Americans wait more than six months for non-emergency surgery. Average wait time in Ontario (according to the Canadian government): 291 days. Almost an entire year of unnecessary pain.

Posted by: EJHill | March 21, 2010 8:07 PM | Report abuse

$Money-Saving PREVENTATIVES still being Ignored in place of $Money-Sucking 'Disease & Sickness' $Waste & Suffering!! -- Passage Reluctant 'YES' Vote. But, We-the-people need to get something going!? - GOD,- 4+ Decades of 'do-Nothing' CRAP by a mostly do-Nothing CONGRESS!! -- But America,-- 'what' is really in, or Not in this BILL? - Hopefully the OBAMA Adminstration & 'turn-coat' RED &&& BLUE CONGRESS told the Truth about including "PREVENTION". DA!!?? - Not very likely. - Both, OBAMA, & CONGRESS pushed- supposedly For, and Demanded Real(da?)"PREVENTATIVES"! -- And the Most Needed, Most Important, and #1 over-All systemic health "PREVENTATIVE: IS:-- proper "DENTAL & ORAL Health Care!!! -- So if this so-called Health Reform Bill, does Not include "DENTAL" for all Suffering Adults in Poverty,- then this bill is just the same-ol' same-ol' pack of CRAP LIES!! -- And without "DENTAL",- it is still a $front for the Insurance & $Medical $Special-Interests,- $Profiting off of the SICK!! -- Without "DENTAL", this bill is a Joke,- and is still the same-ol' "SICKNESS & DISEASE" CRAP-ola!!! --- NO "DENTAL"= Systemic Diseases (Cancer, Heart Disease, etc)- Will Flourish as Usual!!

Posted by: jward52 | March 21, 2010 8:11 PM | Report abuse

EJHill: "The cost of this bill will be far greater than any CBO estimate. These are the geniuses that said in 1965 that Medicare would cost $9B by 1990. They were wrong by a factor of seven."

And they substantially overestimated the cost of Medicare Part D. Most people think the CBO is being very if not overly conservative in scoring the health care reform bill. And that's not even including the savings in the private sector, which the CBO doesn't score at all (because it doesn't affect the federal budget).

Estimates can be wrong in either direction. And the CBO has been off in both directions. So it's invalid to cherry-picking just those estimates where the CBO has been wrong in the direction that makes one's predetermined view look good.

"As the nation's debt spirals out of control and revenues fall because of unemployment..."

That's an amazing prediction. All of our peer nations, all of them, provide universal health care. Though their systems face the same cost pressures as ours, they spend far less than we do and get similar health outcomes.

And providing universal care can spur employment. People will be free to start their own businesses without losing health coverage. People who have to stay below a certain income level to qualify for Medicaid for their kid with a preexisting condition will be free to take higher paying jobs. Small businesses will get subsidies for providing insurance, reducing the expenses for those that do so.

This is a modest bill. The wealthiest nation in the world will not go into a death spiral because of it.

Posted by: dasimon | March 21, 2010 8:12 PM | Report abuse

In 1994, health care accounted for 9% of the economy. We did nothing and it has now become 17%, as predicted back then. If we continue to do nothing, it will be 25% by 2025. I believe that ANY reduction from that 25% is an improvement. If you want to argue about how expensive this reform plan is, compare it to the cost of inaction.

Posted by: AMviennaVA | March 21, 2010 8:16 PM | Report abuse

I was on the capitol lawn talking to the Tea party. One of the reasons insurance is so expensive and hospital bills are so high, is that the cost of the uninsured is passed on to the insured. Redistribution of cost is already happening. This reform is a step in the right direction.

Posted by: marylanddoc | March 21, 2010 8:24 PM | Report abuse

EJHill: "If Canada has achieved medical nirvana why did Newfoundland and Labrador Premier Danny Williams have his heart surgery done in Miami? Why did Liberal MP Belinda Stronach have her cancer surgery in California?

"One percent of Americans wait more than six months for non-emergency surgery. Average wait time in Ontario (according to the Canadian government): 291 days. Almost an entire year of unnecessary pain."

No one claims Canada is medical nirvana. Every system has things it does well and things it does badly. Yes, wait times in Canada for elective procedures are comparatively long. (By the way, how do you know that all of these people are in pain?) But if you need a kidney transplant, you're better off north of the border. Also if you have childhood leukemia or colon cancer. And we spend about 50% more than they do.

Again, I think it's wrong to cherry-pick your stats. There are some things that the Canadian system does better, and some that it does worse. But it sure costs a lot less.

As for people traveling here for treatment, I think that many Americans couldn't get the treatment that those people get. If you can pay out of pocket, you can get great care. But what if you can't, will your insurance cover it? What's your wait time if you don't have any insurance at all?

No one in Canada dies due to lack of access to the health care system. No one goes bankrupt because they got sick. Those are two things that the Canadian system does better than ours. Indeed, we are the only industrialized nation that allows those things to happen. We as a society will have to make some choices about what kind of a society we want to live in and what we are willing to contribute to make it happen.

Posted by: dasimon | March 21, 2010 8:26 PM | Report abuse

Once again Ezra Klein provides an excellent summation. Too bad this was not made clear in political circles a year ago. Some of these items will be small and unfortunately in some cases will not be seen for some time to come. I'll just keep my fingers crossed & hope this all works at least reasonably well, as everyone with a clue knows health care can't go on like this any longer. Costs are just way outta control.

Posted by: notamullethead | March 21, 2010 8:28 PM | Report abuse

dasimon writes, "All of our peer nations, all of them, provide universal health care."

And none of them do so at the quality of America. The NHS in the UK is a disaster. A recent study by Brunel University in West London found that the NHS conditions plays a part in two out of three patient deaths.

And your "wealthiest nation in the world" remark. Are you kidding? The Social Security Administration is now cashing in Treasuries it was forced to buy because our politicians couldn't keep their hands off the surpluses (This is how Clinton supposedly "balanced" the budget). This insolvency wasn't supposed to happen for another 7 years. And these Treasuries can only be cashed by the government printing money.

Canada's debt is now over 70% of its GDP. Germany 77% and Belgium 99%. Is that sustainable? This "peer" nation success is an illusion. Greece is just a precursor of things to come.

Posted by: EJHill | March 21, 2010 8:38 PM | Report abuse

EJHill: "And none of them do so at the quality of America."

That's simply not true. Look up the stats. I provided a link with some comparisons to our English-speaking peer nations. Read T.R. Reid's book "The Healing Of America." On just about any metric one cares to name, overall we do no better than our peer nations, and yet we spend far, far more than they do. Please do some research and get back to me (I highly recommend the Reid book).

And there you go again, cherry-picking the NHS as an example (without providing a cite). You don't look at France, or Germany, or Japan. Nor do you mention the thousands who die here every year because they lack access to quality care.

And we have lots of assets. We are a very wealthy nation per capita. Who is wealthier?

Posted by: dasimon | March 21, 2010 8:54 PM | Report abuse

EJHill: Apologies, you did provide a reference for your NHS claim (I wish there were a way to do revisions), though "conditions" is a pretty vague term. But the rest of my post stands.

Our fiscal problems could be solved with a relatively mild mix of tax increases and spending cuts. Our tax rates are low compared to just about all our peer nations.

Posted by: dasimon | March 21, 2010 8:58 PM | Report abuse

EJHill: Yes, Danny took a lot of political heat (undeserved in my view) for getting a particular heart procedure in the States, but politics is politics. Danny is very rich, and chose to pay for the doctor who pioneered the particular procedure. I don't blame him at all.

But let's be clear, "nirvana" is your word; no one in Canada ever claimed that level of perfection, or said that particular treatments or procedures are not done better elsewhere, or that specific doctors in other countries are not the optimum choice--if you can afford it. What I can say is that 99.999999% of Canadians' medical needs are more than adequately met in our system (every system has its horror stories and its exceptions).

As to wait times, I don't know where you got your "Canadian government" numbers, but Wikipedia, citing the federal government document: HEALTHY CANADIANS:
A FEDERAL REPORT ON COMPARABLE HEALTH INDICATORS (2008) (the pdf is attached if you'd like to read more), says:

"Health Canada, a federal department, publishes a series of surveys of the health care system in Canada based on Canadians' first-hand experience of the health care system.

Although life-threatening cases are dealt with immediately, some services needed are non-urgent and patients are seen at the next available appointment in their local chosen facility.

The median wait time in Canada to see a specialist physician is a little over four weeks with 89.5% waiting less than 3 months.

The median wait time for diagnostic services such as MRI and CAT scans is two weeks with 86.4% waiting less than 3 months.

The median wait time for surgery is four weeks with 82.2% waiting less than 3 months.

Another study by the Commonwealth Fund found that 57% of Canadians reported waiting 4 weeks or more to see a specialist, broadly in line with the current official statistics; 24% of Canadians waited 4 hours or more in the emergency room."

I'm sure you'll agree that for there to be genuine comparisons, there needs to be reliable data.

Posted by: nickcw | March 21, 2010 9:04 PM | Report abuse

dasimon - Reid's book doesn't explain a lot. He cites the costs of procedures but doesn't explain WHY the difference. You can say that a mandated lower price is cheaper but if you don't explain the government of that country is taking a loss on each and every one of them it's meaningless. France is forced to "reform" its system every few years to keep it afloat.

Posted by: EJHill | March 21, 2010 9:31 PM | Report abuse

nickcw - I don't know where the Commonwealth fund got their stats. I got mine from the Canadian Institute for Health Information, a Canadian non-profit.

And I cited the stats from Ontario since it's population is more like an US state. As they say in the commercials, results may vary.

Posted by: EJHill | March 21, 2010 9:40 PM | Report abuse

EJHill: "Reid's book doesn't explain a lot. He cites the costs of procedures but doesn't explain WHY the difference. You can say that a mandated lower price is cheaper but if you don't explain the government of that country is taking a loss on each and every one of them it's meaningless."

Government in many cases bargains for prices. That explains a lot. In Germany, doctors push back. Reid discusses that. Their systems face continual pressures--as does ours, so that's really not a significant point of difference--they have not collapsed. And that they've been doing so for decades, and in Germany's case over a century, should be pretty powerful evidence of success regardless of the "why."

"France is forced to 'reform' its system every few years to keep it afloat."

Yes, it's a continual process. But what does that show, aside that continuing changes may be necessary? They still provide quality care at far less cost than we do.

And again, do you maintain claim that these other systems produce markedly inferior results to ours? Reid puts forward many metrics showing that we spend far more but get no greater overall bang for our bucks. Do you dispute that?

Reid is very upfront with pluses and minuses of different systems. Take wait times, for instance. In France, he could get elective shoulder surgery in about a month. In Germany, I believe it was a week. In Japan, about a week. In Canada, it was more on the order of a year. In Britain, the NHS wouldn't do it at all because their cost-benefit analysis wouldn't support it until it got worse--though he always had the option of going outside the system and paying out of pocket.

Posted by: dasimon | March 21, 2010 10:25 PM | Report abuse

EJHill: The document I cited above is a Canadian federal government document.

A comparison of the two countries, based on an OECD document using 2007 data, shows that total health spending accounted for 10.1% of GDP in Canada and 16% in the U.S.A.

Canada spent US$3,895 per capita in 2007 (adjusted for purchasing power parity), compared with US$7,290 per capita in the U.S.A.

Canadians' life expectancy was 80.7 years; in the U.S.A. it was 78.1 years. Infant mortality in Canada was 5.0 per 1,000 births; in the U.S.A. it was 6.7.

Here are some interesting statistical comparisons: As a percentage of government revenue spent on health, in Canada in 2007 it was 16.7%, in the U.S.A. 18.5%. But the percentage of the nation's health costs paid by government broke down as Canada 69.8% and the U.S.A. 45.4%.

In other words, the Canadian national health insurance plan spends less of the country's wealth on healthcare, but it covers far more of the nation's health costs. A truly suspicious mind would wonder if someone is gaming the U.S. healthcare system...

Those who can't argue with the numbers often jump to the anecdotal to make negative comparisons; e.g., 1) the quality is higher in the U.S.A.; 2) wait times are shorter in the U.S.A.

As to 1), there is no objective evidence that this is generally the case. In some specific instances it is no doubt the case, but in terms of an overall healthcare system and its value to the general population, such exceptions pale into insignificance.

As to 2), I have already quoted the national numbers for Canada; however, there is no systematized equivalent measure of wait times for the U.S.A. that I am aware of.

In sum, the U.S.A. is at worst embarking on an experiment that many will say is worthy, because the evidence that it is "disastrous" or "a perversion of U.S. fundamentals" simply doesn't exist--hyperbole, projection, and partisan politics notwithstanding.

The U.S.A. has long been admired as a source of innovation and a willingness to step bravely, almost brashly, into uncharted regions in pursuit of the right thing. This trait was marked by a sense of canny fearlessness and an always wider vision (remember?). Good luck with the next step.

Posted by: nickcw | March 21, 2010 10:58 PM | Report abuse

A free, public education is a right.
Health care should be also. What good is
an education if you are too sick to pursue your goals or utilize your talents?
All I know is that whatever company happened to be my father's employer didn't determine whether or not I got an education, whether or not I could go see a teacher.

Posted by: dcunning1 | March 21, 2010 11:02 PM | Report abuse

Yes, we pay more. But why? Our legal system is at blame for a lot it. Most doctors admit that 25% of all the tests they order are "defensive," that is, a defense against the trial lawyers. There's not one Democrat with a taste for tort reform.

Measuring the success of medical care across the globe with dry statistics doesn't address the cultural and lifestyle differences.

And that is the biggest worry here. This is fundamentally changing the relationship between the state and the citizen. As the state takes on more of the cost and feels it needs to control those costs, it will begin to interfere on the individual, day-to-day decisions of it's citizens.

All of these "peer" nations that you continue to praise are all dying institutions. Literally. The welfare states of Europe and Japan have fertility rates that, in some cases, are beyond that from which any nation in history has recovered from. Their populations are aging and the systems are ready to collapse under their own weight. I don't know why we should be eager to join them on their road to oblivion.

Posted by: EJHill | March 21, 2010 11:07 PM | Report abuse

Health care simply costs too much to give it freely, without limits. We don't mind food stamps, where you are given an amount of money to spend. We have ended up in a world where, insulated from the cost of care, we consume health care without regard to cost. I know people considering third surgeries for minor ailments, unlikely to be successful, but earning money for all. People demand brand name drugs and fancy doctors, and they want me to pay for it. I'd rather pay for public clinics.

Million dollar treatments are not affordable on a large scale in a land where very few make that much money. We may end up putting more and more of our money towards health care, as we try to cheat death.

I find the passing of this bill ultimately depressing, bringing our financial day of reckoning ever closer.

Posted by: staticvars | March 21, 2010 11:17 PM | Report abuse

nickcw - Citing the life expectancy and infant mortality stats, like I mentioned to dasimon, is more a measure of a country's culture than it's health care delivery system.

Posted by: EJHill | March 21, 2010 11:24 PM | Report abuse

EJHill: "Yes, we pay more. But why? Our legal system is at blame for a lot it. Most doctors admit that 25% of all the tests they order are "defensive," that is, a defense against the trial lawyers."

It may be a fraction of the higher costs, but the studies I've read about say that it's a small fraction. That doesn't mean it shouldn't be addressed, but it's not the main driver. I'd guess that our fee-for-service model is a much larger factor.

"As the state takes on more of the cost and feels it needs to control those costs, it will begin to interfere on the individual, day-to-day decisions of it's citizens."

If you've read the Reid book, you know that our peer nations are not interfering with day-to-day medical decisions of their citizens--certainly no more than our insurance companies do. And you don't seem to take into account the effects of our own system on day-to-day decisions: that people can't leave their jobs to start their own businesses because they'll lose their health care, or they can't take a better job because higher income will disqualify for Medicaid, or families go bankrupt because someone got sick, or people take only part of their medications because they can't afford the proper dosage.

"The welfare states of Europe and Japan have fertility rates that, in some cases, are beyond that from which any nation in history has recovered from."

I don't see how that observation is relevant to the fact that our peer nations have (again) been able to cover everyone, provide comparable health outcomes to ours, and at far lower expense. Again, do you dispute that?

And I don't know any precedent for declining fertility rates, so I don't know of any example of how a nation tried to "recover" from it, or whether they succeeded. Do you?

If our demographics follow theirs, then we're going to have medical expense problems regardless of what system we have (unless we just decide to let sick people die). If we don't follow their demographics, then maybe we won't have a problem. The demographic problem is separate from the overall insurance and cost control problem. And the evidence is overwhelming that these peer nations have gotten far more for their money than we have. Isn't that preferable regardless of where the demographics go?

Posted by: dasimon | March 22, 2010 12:14 AM | Report abuse

EJHill: "Citing the life expectancy and infant mortality stats, like I mentioned to dasimon, is more a measure of a country's culture than it's health care delivery system."

But you can cite lots of other stats too. You can cite 5-year survival rates for various ailments. You can cite life expectancy for older people (which would omit infant mortality and youth violence). You can cite life expectancy for those not in good health. You can cite death rates from conditions that are "at least partially modifiable with effective medical care." In none of them do we do substantially better than our peers, and in many of them we do worse. In the last one, the US came in 19th of 19 wealthy countries (though it did better than all the poor countries). As T.R. Reid says, "The number of people under seventy-five who die from curable illness in the United States was almost twice as high as in the countries that do the best on this measure: France, Japan, and Spain." For life expectancy at age 60, the US 23 of 23 countries surveyed; Japan was first. (The Healing of America, p. 32-33) And that's while spending a lot more, too.

One is hard-pressed to find a metric that the US is best in, except for cost where we win that one by a lot. So can we please put to rest the "best health care system in the world" claim? Or can those that claim it at least come up with stats that show it?

Posted by: dasimon | March 22, 2010 12:27 AM | Report abuse

staticvars: "Health care simply costs too much to give it freely, without limits."

And who is suggesting that we do so?

"I find the passing of this bill ultimately depressing, bringing our financial day of reckoning ever closer."

That's odd, since the CBO says it will reduce the deficit.

Maybe we should look at what's actually in this bill instead of projecting our fears. It provides subsidies for those who can't afford insurance; it doesn't say everyone gets every treatment under the sun.

Posted by: dasimon | March 22, 2010 12:45 PM | Report abuse

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