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The drawbacks of the GOP's all-or-nothingism on health-care reform

By Ezra Klein

To this day, no one has even attempted to argue against the following claim: The health-care law that President Obama signed into law in March is similar to the law that Mitt Romney signed into law in Massachusetts, and similar to the plan that Sen. John Chafee (R-R.I.) wrote and many currently serving Republican senators co-sponsored in 1994. All three laws featured the same basic structure: An individual mandate, subsidies for low-income Americans, regulations stopping insurers from discriminating based on pre-existing conditions and other applicant characteristics, and exchange-like markets to make insurance products more accessible and competitive. The Wyden-Bennett bill also included these features. That legislation was sponsored by a Republican senator, and, at various times in its life, co-sponsored by many more.

"Similar" does not mean "the same," of course. You'd expect that a health-care law written and passed by Democrats would be not be precisely to the Republicans' liking. But you'd also expect that a health-care law that shared a basic structure with previous proposals championed by Republicans would offer them an appealing platform upon which to make modifications. In some ways, it's a major opportunity: Democrats did a lot of the hard stuff, and they did it on behalf of what was once the conservative vision for health-care reform. That should be, for Republicans, a huge gift. But they're not going to take it.

I've tried to follow the Republican rhetoric on how to handle the health-care law closely, and as far as I can tell, there are literally zero Republicans interested in taking the bill that Democrats passed and turning it into a bill that Republicans like. There's no set of policy changes they want made, or objectives they want achieved. They don't want to add medical malpractice reform or more high-deductible options. There's no interest in going further than the Democrats did on ratcheting back the employer-tax exclusion or streamlining the process for cutting costs in Medicare -- both traditionally conservative objectives. It's all about repeal. And they're probably not going to get repeal. And so it's all about rhetoric, and maybe some tweaks around the edges.

How we got here isn't a mystery, of course. Republicans decided early on that heath care was going to be Obama's "waterloo." They knew full well that cooperation on a reform of this size would anathema to their base and an electoral gift to the Democrats. But in order to mount an opposition strategy, they couldn't tepidly oppose parts of the bill they thought could be made better. They had to really fight the thing. It was all-or-nothing. It was death panels and "hell no you can't!"

Whether that worked depends on who you ask. It completely failed to stop the legislation. It did do a lot to make the legislation unpopular. But it's also left Republicans unable to support health-care reform ideas they once believed in. It's left them, at base, with a lot of politics, but no policy.

The reality is that they probably do have the votes to make some serious changes to the bill -- plenty of conservative Democrats would accept that as part of the 2010 election -- but because they can't convince their base that anything but total repeal is acceptable, it's going to be impossible for them to make the sort of technocratic changes that suggest an accommodation with the new law's existence. So they'll lose on full repeal rather than win on substantial revisions. The opportunity to make health-care reform something that conservatives could support will be totally overwhelmed by the necessity of making Obamacare something voters opposed.

By Ezra Klein  | November 10, 2010; 11:16 AM ET
Categories:  Health Reform  
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Comments

The problem is that people keep acting like Republican words should be regarded as sincere. They don't really want to get rid of health reform, they just want to demonize it endlessly. If they actually managed to vote it out somehow they wouldn't have an issue to demagogue. Plus, the insurance companies are helping in the demonization by blaming all of the inevitable cost increases on the new law.

Posted by: AuthorEditor | November 10, 2010 11:30 AM | Report abuse

Ezra:

You overstate your case. Only 25% (11) of current Republican Senators were in the Senate in 1994, and two of those are retiring this year. So to state as you do:

"But it's also left Republicans unable to support health-care reform ideas they once believed in."

is simply factually incorrect.


The world has changed a great deal in the last 16 years, and one thing that has been diminished is the Moderate wing of the Republican Party. HCR won't be repealed, the votes simply aren't there.

However in 6-8 years we will be appointing the first of many subsequent commissions to tell us how to "fix" HCR so it won't be so terribly expensive.

Posted by: 54465446 | November 10, 2010 11:37 AM | Report abuse

The people will just elect more republicans next time, and Obama will be a 1 termer. But whatever, you have your tax on healthcare plans.

Posted by: obrier2 | November 10, 2010 11:37 AM | Report abuse

Van Jones was right about Republicans.
Simple as that.

Posted by: DAMNEDGENTLEMEN | November 10, 2010 11:40 AM | Report abuse

I'd add that the Republican position wins on abstraction. As the Kaiser survey shows, when you get into the details, they lose almost every time.

Any attempt at modifying the current policy will be met with cries of selling out by the base, but would also draw attention to the stuff people actually like, but costs money, raises taxes, or adds a regulatory burden.

They simply can't make it more to their liking, both due to their base's power and due to everyone else, who will only buy into their do-nothing philosophy if they're convinced the other side does nothing they like.

Knowing the wall they're backed up against, this represents an opportunity for Democrats and moderates who don't win elections by being crazier than the other guy. Republicans know this. They can't just say "Repeal." They have to add, "Repeal and Replace." But they have nothing.

A study committee to make modifications to the ACA could improve the legislation, make it more appealing people with real grievances about it, and make the whole endeavor legitimate, taking some of the fire out of the Repeal crowd.

Instead of Repeal and Replace, what about "Listen and Fix?"

In this congress, Democrats should be the party that's listened to people, and wants to make this thing work. They can still take the lead on this in the White House and in the Senate. They could really split the GOP caucus too.

Republicans only win as long as the argument is over whether to repeal it all or not. That's a fine line to walk in many, many ways.

Posted by: itstrue | November 10, 2010 11:40 AM | Report abuse

To paraphrase Matt Yglesias on deficits, Republicans don't care about public policy. They care about:

1) winning
2) rewarding their friends/campaign contributors
3) sticking it to liberals

Posted by: redwards95 | November 10, 2010 12:05 PM | Report abuse

redwards is correct. the thing is that the dems must know this and don't seem to mind.

Posted by: obrier2 | November 10, 2010 12:21 PM | Report abuse

Ezra,

How about an interview with one of the Republican Co-sponsors of Chafee's bill that is still serving where you ask him why he supported these things in '93 but not now?

Posted by: cstar | November 10, 2010 12:22 PM | Report abuse

You realize that by arguing (correctly) that the health insurance reform bill Obama fought for and the Senate passed is essentially Republican, you're either directly contradicting the claim that it was the most progressive policy passed since LBJ, or you're claiming that modern progressivism equals '70s Republicanism. And then you wonder why the Democratic base isn't shouting the bill's praises.

Posted by: stonedone | November 10, 2010 12:28 PM | Report abuse

I fully endose Govenor Perry's comment, “You let California, New Mexico, New York, Texas, and Florida compete against one another, and they'll be laboratories of innovation,” Perry said in an NPR interview on November 5. “They will come up with the best way to deliver health care.” I also give Romney a hurrah for leading out in State developed Health Care plan. He saw the vision that States should make decisions for their State. Federal Health Care should never have been an option. Romney had the courage to move forward first. If we can repeal the Federal Health Care program, then States can move forward. Many states will learn from Massachuetts and improve on their plans. It will be a trial and error thing for them as well. Make no mistake about it, there are few programs that reach perfection in the first go around. We learn and we improve and there is nothing wrong with that. Obama Care was just the wrong venue for solving the Health care crisis in the first place. I hold no ill will for Mitt Romney for seeing a need and moving in a forward direction to find a solution
Flag this comment

Posted by: manwaringjd | November 10, 2010 12:29 PM | Report abuse

redwards:

You description fits Nnacy Pelosi to a tee. Which is why she was so successful in her job. I don't like her at all, but she is very good at what she does.

Posted by: 54465446 | November 10, 2010 12:55 PM | Report abuse

Ezra:

I waited a while to point out the obvious, because I do it too often. LOL

If you think Romney's reform was good, don't you think his background in business as a highly successful hedge fund manager had something to do with it? Maybe, just mabye you might want to interview one of these guys sometime, or even link to things they've written, instead of a university professor, or another twenty-something blogger.

Maybe we could even have an experienced doctor or hospital administrator talk about health care costs, or an energy company exec chat about alternatives.

Yeah, I know. I get crazy like that sometimes.

Posted by: 54465446 | November 10, 2010 1:02 PM | Report abuse

stonedone, arguing that this is a fairly conservative bill, or at least that it's based on conservative ideas, does not mean that it's not a progressive victory or that modern liberalism is 70s conservatism. The bill that passed is not the bill that most liberals either in Congress, the White House, or in the country would have passed if they were king for a day. But we don't have king for a day, we have a Senate with a de facto 60 vote requirement for any significant piece of legislation. The ACA isn't a perfect or liberal bill, but it accomplishes some liberal goals and, most importantly, unlike any other bill, liberal or conservative, proposed in the last half century, this one passed. It's not great, but it's still a great achievement.

manwaringid, why are the states so much better suited to experimenting? The ACA provides for experimenting on a state basis, but I've never understood the conservative fascination with state-level government. Why not have county laboratories, or regional laboratories. Maybe a coalition of Western states would be the place to discover the best way to bring costs down. I just don't see any independent and logical reason why the lines drawn separating the states makes for an ideal testing ground for healthcare, or why they can't do these experiments under the ACA, which again, permits it.

Posted by: MosBen | November 10, 2010 1:03 PM | Report abuse

Stonedone - you're 100% right.

MosBen - you're wrong, every significant bill for the last 30 years passed with fewer than 60 votes, usually under reconciliation, including new health care programs like SCHIP. If you look at the facts, not the Democrats' messaging, you'll come around to the view that HCR was a flop.

Posted by: michaelh81 | November 10, 2010 1:10 PM | Report abuse

Manwaring--

I agree that if you let states come up with their own plans, they'll come up with better models. This reform law lets them do that.

It's just that it sets a floor for what should be covered, and what rights we have as consumers. It also raises revenue and saves money in ways that states can't, like in changing Medicare, or messing with federal taxes. It doesn't add to the debt.

States can apply for (and receive) waivers for all sorts of modifications to Medicaid and beyond. They can enter into compacts with other states. They can open the exchanges to everyone. They could underwrite their own Public Option if they like.

It's not one big Federal monstrosity. I'd love to see Governor Perry take control over Texas health care using whatever free market principles he wants. Open the exchanges, governor. Let the companies compete for all of our business. Show us how it's done in Texas. No joke.

I don't want to see Governor Perry (or anyone else) leave consumers in the cold, paying astronomical premiums for insurance that's terrible. For that reason, I support the federal role in health reform.

Posted by: itstrue | November 10, 2010 1:13 PM | Report abuse

I'm somewhat of a student of water quality policy and this reminds me of the progression of water quality laws beginning with the 1948 Water Quality Act which was a giant wounded duck that did absolutely nothing to positively affect water quality. But the law was successively amended and fixed in 1956, 1965 and then ultimately replaced by the revolutionary Clean Water Act in 1972. If this bill puts us on a 24-year path to something like a sane healthcare system in this country, then it really is a success. Republicans know that and that's why they hate it.

Posted by: klautsack | November 10, 2010 1:33 PM | Report abuse

michael81, can we please avoid little jabs like the end of your post? I won't assume you're some kind of nut and you'll assume I'm not just a parrot for talking points, and maybe we can just discuss the issues?

Your statement that every major bill of the last 30 years has been passed with fewer than 60 votes and mostly through reconcilliation, strikes me as wrong, and likely relying on a cherry picked definition of "significant" bills. Still, the use of the filibuster in the last two years is unprecedented to a degree that even if I agreed that there wasn't a de facto 60 vote requirement in the past, there certainly is one now. (And so we're clear, though bills may pass with fewer than 60 votes, they need 60 to get there, hence the de facto)

Passing bills is not a pretty process, and though I'd love a single payer system, I've never seen a proposal that had the votes to get passed the Congress. Indeed, I haven't seen any proposals other than *this one* that had the votes to pass. The ACA isn't the law I would have chosen to pass, but it's superior to the law I would pass in that it is in fact a law now, and not one of my day dream fantasies. It also covers millions of people, gives some expanded protection to patients, and takes a few tentative steps towards cost control (though obviously not enough or what I'd like to see, but again, reality), so I consider that a win for progressives, even if it's not a grand slam home run.

Posted by: MosBen | November 10, 2010 1:53 PM | Report abuse

manwaringjd @ November 10, 2010 12:29 PM: I really don't care what a secessionist, Perry, has to say. I find it very revealing that no Republican/Conservative/Tea Partier gave him a stern lecture for being a secessionist. But then again, according to them I am not a 'real' American, whatever that means.

Posted by: AMviennaVA | November 10, 2010 2:02 PM | Report abuse

manwaringjd @ November 10, 2010 12:29 PM wrote "Federal Health Care should never have been an option. Romney had the courage to move forward first. If we can repeal the Federal Health Care program, then States can move forward."

Put aside that people travel, so I as a Virginian should know that I am covered even if I go to Texas or Mississippi (2 states with the worse record on social services of any kind).

The main flaw with your post is that the Republicans/Conservatives/Tea Partiers did NOTHING other than say NO in 1993-94 and 2009-10. Only Romney has done something, and even he lacks the courage to defend it.

Therefore, it is senseless to rely on the Republicans/Conservatives/Tea Partiers for anything.

Posted by: AMviennaVA | November 10, 2010 2:09 PM | Report abuse

MosBen,

imo the country's too big to do it in because some sections of the country will be negatively impacted as i've stated before. If we had a national exchange that required everything NJ wanted to be covered poorer states couldn't afford it. if we had a bare bones plan that poorer states could afford the complaint would be employers would dump employees on cheap, crappy plans and richer states employees would revolt.

counties are too small to get anything done. States are the best place for this IMO.

Posted by: visionbrkr | November 10, 2010 2:57 PM | Report abuse

Most of these discussions seem surreal to me. If the Republicans weren't so blinded by their psuedo libertarian ideology, they could mount a successful court challenge based on something much more basic: unequal treatment. It is discriminatory to require that individuals pay for coverage (usually with retirement savings) with after-tax dollars while continuing the benefit exemptionfor those who get someone else to pay for their coverage.

Sometime before 2014, a group of individuals will file a class action suit about that and the whole reform package will be sent back to Congress for fixing...where it will wither.

We need universal health*care* in this country. If we have learned anything this past year, it should have been that Washington can't/won't deliver that. The individual states need to get busy.

Posted by: Athena_news | November 10, 2010 3:32 PM | Report abuse

itstrue wrote:

"It's just that it sets a floor for what should be covered, and what rights we have as consumers. It also raises revenue and saves money in ways that states can't, like in changing Medicare, or messing with federal taxes. It doesn't add to the debt."

Sorry evertyhing you wrote about it is untrue. You can like the bill for it's good provisions such as no pre-existing conditions, but it will be a huge cost both to the Federal government and to the states, and the "floor" you speak of will in fact become the celieng for most businesses.

Posted by: 54465446 | November 10, 2010 3:35 PM | Report abuse

athena wrote:

"If the Republicans weren't so blinded by their psuedo libertarian ideology, they could mount a successful court challenge based on something much more basic: unequal treatment. It is discriminatory to require that individuals pay for coverage (usually with retirement savings) with after-tax dollars while continuing the benefit exemptionfor those who get someone else to pay for their coverage."

How can I say this nicely? Oh well, that's not really me. Legally speaking, you don't know what you're talking about.

Posted by: 54465446 | November 10, 2010 3:39 PM | Report abuse

MosBen - I apologize if you took it personally, but you seem smart and have good principles and it's just sad to see someone like you believe Rahm Emanuel's lies.

We had the 51 votes necessary to pass a public option. We had the 51 votes to pass a Medicare expansion. There were actually even more than 60 votes to pass prescription drug price negotiation, but even 60+ isn't enough.

All of these things were prevented not because of the filibuster or Joe Lieberman, etc., but because the White House had already struck deals with the industries preventing these policies from consideration. I know, the truth sucks, and I didn't want to believe it at first either, but it's true.

Posted by: michaelh81 | November 10, 2010 4:04 PM | Report abuse

54465446 wrote:

"Sorry evertyhing you wrote about it is untrue. You can like the bill for it's good provisions such as no pre-existing conditions, but it will be a huge cost both to the Federal government and to the states, and the "floor" you speak of will in fact become the celieng for most businesses."

What are you actually saying? The federal government will pick up 90 percent of the increases in Medicaid forever, and the cuts to Medicare lower the deficit. You're just making assertions and not backing anything up.

Sounds like you've made up your mind about the whole thing without actually reading what the AARP, CBO, AHIP, AFL-CIO, AMA, AHA, and a dozen others have to say. Probably too much Fox, Drudge and the rest with no counterpoint.

Wake up. We need this. If you don't like certain aspects, work to make it better, but don't throw this away.

Yes, business will have to pick up the tab for some of this. Yes, people will need to pay for their insurance. Yes, it costs money. So what? Look at the cost curves for Medicare, premiums, unnecessary ER visits, people going bankrupt or dying. What are the personal costs of people being sick and unproductive? What are the costs to employers?

Insurance companies will charge you a fortune unless everyone, even the healthy people are paying premiums. We're America. We live together or we die together.

Insurance means you spread your risk with other people. Some of them need to be healthy. All of them need to be in the system, or the whole thing collapses and only the rich, young and healthy get what they need.

Most people can't just fend for themselves if they get sick, and besides, it's just plain immoral to leave people to die. Suck it up. We're well past "survival for the fittest." It's here to stay.

I'm fed up with this libertarian garbage. It's anarchy, plain and simple. You call it freedom, I call it barbaric.

Posted by: itstrue | November 10, 2010 5:58 PM | Report abuse

visionbrkr above states the ultimate recognition of the problem: "the country's too big to do it ... States are the best place for this IMO."

That simple fact -- that a plan which attempts to meet the needs of a huge and diverse nation is doomed to fail -- is widely acknowledged, albeit grudgingly. From leftists, the recognition comes in the form of comparison of the US not to the EU but to EU member states: time and again, proponents of the Obama/Pelosi PPACA dodge the question about the size and composition of EU states compared to the US as whole. From patriots, the recognition comes in the form of direct historical fact and references to the written plan of US governance.

Knowing that the PPACA is doomed to fail -- and even Klein has noted that the act is likely to become "zombie legislation" -- why would the Obama/Pelosi Regime want to preclude sovereign states from pursuing viable health care reform? Among the possible answers are (a) the Regime is childishly arrogant and unwilling to accept the facts of failure and/or (b) the Regime truly does wish to usurp states' sovereignty and to lessen the freedoms available to citizens.

The Road to Freedom from the Obama/Pelosi PPACA is, at this point, relatively clear: by forcing strict enforcement of the act's various provisions early on, the act's failure will come before the elections of 2012 -- becoming yet another "achievement" which can be appropriately "applauded" by voters. In effect, Obama's HHS is now painted into a corner: HHS must either continue to grant waivers (limiting the effectiveness of the PPACA in a measurable manner) or begin to enforce it (harming businesses both large and small in a manner measurable both by academics and by employees).

Sun Tzu describes this sort of losing battle -- but Democrats have apparently placed his book beside The Road to Serfdom.

Posted by: rmgregory | November 10, 2010 6:10 PM | Report abuse

itstrue:

You are running together ideology with facts. I might even be on your side on the notion that we need national health care, BUT this bill does not in any way pay for itself.

"The federal government will pick up 90 percent of the increases in Medicaid forever, and the cuts to Medicare lower the deficit. You're just making assertions and not backing anything up."

There are no cuts in Medicare. The ones listed in the bill were waived off shortly after the bill was passed. Look it up yourself. The SGR had a backed up cut of 21% that will never take place.

Don't believe me. I'm nobody. Do your own research. Ask any doctor you know anywhere. There will be NO Medicare provider cuts, and actually payments will increase as the doctors who take Medicare patients are demanding.

Also did you see the story this week on Provenge a "vaccine" for terminal prostate cancer patients. It's about to be approved. It costs $93,000 and extends life on average 4 months. Once it is approved, Medicare will almost certainly pay for it.

This is not unusual. If you start making cost-benefit analyses, everyone over 60 screams "death panels". There is absolutely no way to contain Medicare spending without taking down the current system and starting over completely.

Posted by: 54465446 | November 10, 2010 6:29 PM | Report abuse

54465446:

Now you're talking facts. Cool. Yes, I have an ideology. And sorry for coming off a little too salty there. We all mix ideology with facts. But the facts stand alone too.

Medicare Advantage pays out 110-120% of standard Medicare rates, and doesn't do anything to improve the quality of care, outcomes, what have you. There's hundreds of billions in that which go to paying for this. That's where a huge amount of the savings come from.

Medicaid is going to cover everyone to 133% of federal poverty. The difference between what states pick up now, and what the new rules say they have to cover will be reimbursed to 90%, leaving the state with a 10% copay. Most of the places that complain about it already get a 70/30 split from the feds and have upwards of 20% of their state on Medicaid. Look at Mississippi. Someone's got to pay for it. Maybe taxes have to go up. Life goes on.

The Medicare cuts to providers, the 21% in the bill, probably won't happen. I definitely agree there. But so what? People need the coverage. Doctors need the income. We need to pay for it. Providers already take a hit on Medicare reimbursements compared to BC/BS or whatever.

The real problem is how the system works, how pricing is determined, whether something is worth the QALYs, etc. The death panel stuff is where the real action is.

I also think that Medicare Part D could be a goldmine for cost recovery. Billy Tauzin rammed it through reconciliation and now works for PhRMA. There's no negotiation on Rx prices, and it costs $500B/10 years without any plan to cover it. Where were all the deficit hawks then? Nobody's talking about it, but a little negotiation on those prices could free up a few $100B.

My wild ideologically-driven assertion: I think this whole package is going to cost more than the CBO estimates, but over 10-20 years, there is room for tremendous innovation at both the state and the private levels. But this all will cost money. Having a healthier workforce that can change jobs or start a small business on their own is well worth it.

In the long run, giving people security and certainty for themselves and their families will pay off. In the long run, insurance companies will have to fight for our business. Quality and cost will improve.

We all need to demand the changes to the bill that can make this happen. We need to get real about what this will cost. End the employer tax deductions. Open the exchanges to all. Foster some real competition. That would be a start.

But throwing the whole thing out would be a huge mistake.

Posted by: itstrue | November 10, 2010 7:13 PM | Report abuse

Ezra raises a lot of good points. This is basically a Republican bill, but introduced by the Dems. Republicans don't like things when the Dems introduced them, even if IDENTICAL to what the GOP previously advocated for.

It'll never get repealed. The health insurance industry and the large employers don't want repeal. But we can improve on it and we should.

Posted by: chi-town | November 10, 2010 7:33 PM | Report abuse

itstrue:

Thanks for the reply. Ah there's the rub, we're no longer talking about HCR as it is but as it could be.

Not only is there no negotiations on pharmaceuticals, but no selling insurance across state lines either.

There's also this to consider from today's NY Times:

"For years, employees have seen what they pay toward health care go up as companies ask them to contribute more to premiums and deductibles. But now, as people enroll in health plans for the coming year, the sticker shock is more jolting than ever because so many companies are passing on to their workers most, if not all, of the higher costs.

Corporations had absorbed some higher costs in recent years, along with their workers, but have recently passed all, on average, onto employees. In 2010 alone, a worker’s share of the cost of a family policy jumped an average of 14 percent from the previous year, according to a recent survey by the Kaiser Family Foundation. In real money, that is an additional $500 a year deducted from a paycheck."

So premiums will increase to workers even though the President promised they would not. Realistically speaking, how can you cover the additional adult children and NOT charge anything for them?

Furthermore, covering those with pre-existing condtions is a noble good for society, but it HAS to drive up the cost of health care since these are the most likely consumers of more services.

Finally I cringe at the concept of health insurance markets. Haven't we learned from "energy markets" and "mortgage backed security markets" that regulators making $100,000 a year can never stay one step ahead of people who are making millions or even billions. If they're any good at their job they will be hired (like Tauzin) If not, the will be ignored.

We can't even begin to discuss yet, how the "floor" in coverage mandated by the government will soon become the ceiling for most businesses.

Ah stimulating debate!

Posted by: 54465446 | November 10, 2010 7:58 PM | Report abuse

Here's a test of the ability for repub's and dem's to work together on anything:

FIX THE PCIP CROWD-OUT rule.

The PCIP (new high risk pools) require you to be uninsured for 6 months before applying to the program. I know, because the programs start was so ambiguous that many of us applied even though we have partial private insurance (insurance that excludes our pre-existing conditions).

If it wasn't for special interests, I think an honest politician would agree that the US shouldn't discriminate against health insurance consumers that have done everything they can to stay (at least partially) insured.

The PCIP enrollment is very low. If you can afford it there is a good chance you are paying for defective private insurance.

This should be an easy bipartisan fix - get rid of the six month rejection of those of us that are partially ensured.

Republicans may not agree that a civilized country should supply some form of basic healthcare, but I think even republicans agree that US citizens should be able to purchase full health insurance at *some* price.

Oh, how is the government addressing the low PCIP enrollment - why dropping the price of course. Your tax dollars at work.

I tell people the PCIP is like a car dealership that will only sell to people that haven't owned or driven a car for the last six months. When the dealership has few customers, it thinks the answer is lowering the price of its cars....

Posted by: Jon30 | November 11, 2010 10:16 AM | Report abuse

Here's a test of the ability for repub's and dem's to work together on anything:

FIX THE PCIP CROWD-OUT rule.

The PCIP (new high risk pools) require you to be uninsured for 6 months before applying to the program. I know, because the programs start was so ambiguous that many of us applied even though we have partial private insurance (insurance that excludes our pre-existing conditions).

If it wasn't for special interests, I think an honest politician would agree that the US shouldn't discriminate against health insurance consumers that have done everything they can to stay (at least partially) insured.

The PCIP enrollment is very low. If you can afford it there is a good chance you are paying for defective private insurance.

This should be an easy bipartisan fix - get rid of the six month rejection of those of us that are partially ensured.

Republicans may not agree that a civilized country should supply some form of basic healthcare, but I think even republicans agree that US citizens should be able to purchase full health insurance at *some* price.

Oh, how is the government addressing the low PCIP enrollment - why dropping the price of course. Your tax dollars at work.

I tell people the PCIP is like a car dealership that will only sell to people that haven't owned or driven a car for the last six months. When the dealership has few customers, it thinks the answer is lowering the price of its cars....

Posted by: Jon30 | November 11, 2010 10:18 AM | Report abuse

The reason no one ever brought up the fact that it was nearly the same thing as the Repubs put out during the Clinton Administration is that the Democrats wanted to take full credit for it, and they were willing to accept defeat if it required "giving" the Repubs credit for anything. And the Repubs certainly didn't want it mentioned; that's for sure.

Posted by: gbush8 | November 11, 2010 2:03 PM | Report abuse

I find it interesting that the insurance industry threw its support to the GOP since their priority is doing away with the individual mandate, and that is the part of the bill that benefits the insurance companies. Short of repealing the entire bill (which won't happen while Obama is President), the only way to do away with the individual mandate is to also do away with rules prohibiting denial for pre-existing conditions and allow insurers to practice at least some form of rescission again. Otherwise, repealing the individual mandate alone or diluting it by, for example, lessening the penalties) would destroy the insurance industry. Similarly, the Health Care law gives insurers a huge windfall by allowing them to offload their sickest customers onto the new high risk markets that the law establishes.

Am I missing something? What is the explanation?

Posted by: ado211 | November 11, 2010 10:45 PM | Report abuse

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