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Why bipartisan health-care reform has proven impossible

By Ezra Klein


"Every time we moved toward them, they would move away." -- Hillary Clinton, 1995.

As an addendum to the previous post, it's worth thinking about partisanship and health-care reform not in terms of President Obama, but in terms of presidential efforts over the last century or so. And that story has gone something like this: Democrats moved right every time they failed. And Republicans moved further right every time Democrats tried.

The original idea, of course, was a national health service run by the government. Harry Truman proposed it and fell short. Lyndon Johnson got it for seniors and some groups of the very poor. But Republicans said that was too much government, and it was unacceptable for the whole country. They proposed, through President Richard Nixon, an employer-based, pay-or-play system in which the government would set rules and private insurers would compete for business.

That didn't go anywhere, because Democrats, led by Sen. Ted Kennedy, weren't ready to give up on a national health service. By the 1990s, they were. President Bill Clinton proposed an employer-based, pay-or-play system in which the government would set rules and private insurers would compete for business. Republicans killed it. Government shouldn't be telling businesses what to do, they said, and it shouldn't be restructuring the whole health-care market. Better to center policy around personal responsibility and use an individual mandate combined with subsidies and rules making sure insurers couldn't turn people away. That way, the parts of the system that were working would remain intact, and the government would only really involve itself in the parts that weren't working.

That was what Sen. John Chafee -- and Bob Bennett, Kit Bond, Chuck Grassley, Orrin Hatch and Richard Lugar -- proposed in 1994. It's what Mitt Romney passed in Massachusetts. And so it was what Democrats proposed in 2010. The Republican answer? "Hell no, you can't!"

By this point, there were no more universal health-care approaches for Republicans to hold out as alternatives. So they just turned against the idea entirely. Cato's Michael Cannon organized "the anti-universal coverage club." John Boehner released a bill that the CBO said would cover 8 percent as many people as the Democrats' plan.

So over the last 80 years or so, Democrats have responded to Republican opposition by moving to the right, and Republicans have responded by moving even further to the right. In other words, Democrats have been willing to adopt Republican ideas if doing so meant covering everybody (or nearly everybody), while Republicans were willing to abandon Republican ideas if sticking by them meant compromising with the Democrats. But because Democrats were insistent on getting something that would help the uninsured, they've ended up looking like the partisans, as they keep pushing bills Republicans refuse to sign onto.

By Ezra Klein  | November 12, 2010; 7:35 PM ET
Categories:  Health Reform  
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Comments

Cannon also identified the "Church of Universal Coverage."

http://tinyurl.com/ChurchoUC

So there's that, too.

Posted by: DJZeemus | November 12, 2010 8:27 PM | Report abuse

A nice historical re-cap, Ezra. So what's the big takeaway for the Democratic party, now, in 2010, when one party won't cease their existentialist quest to destroy the other while the other keeps compromising and placating and sucking up? What's the bottom line?

Posted by: scarlota | November 12, 2010 8:38 PM | Report abuse

Every other democratic, industrialized nation has some form of national health insurance which prohibits for-profit health insurance companies from offering services included in the national plan. These democracies do not vote to change their systems to an American system. We stand alone as the richest nation in the world that lets 46,000 of our citizens die each year simply because they don't have a means to pay for health care (Harvard Study, 2009). For-profit health plans are the problem (not the govt.) Premiums skyrocket each year; for-profit plans report record profits each year while fewer people can afford health insurance. We took our interstate highway system from the German autobahn (conceived of by the Nazis). We should take a serious look at what these other nations are doing since they cover everyone and have as good or better medical outcomes as we do - according to WHO and the Commonwealth Fund. We do not need insurance companies. They do not provide the health care nor do they generate revenue independent of our premiums to pay for health care. They are unnecessary middlemen who are destroying our health care system. Do we have to have people die in the streets like a third world nation or the Warsaw Ghetto before we can get enough politicians who care about governing instead of the next election? We need a national health insurance program that does not include for-profit health plans. Single payer is the most cost-effective but I'll settle for a German or Swiss "Bismarck" model over what we have here. Our system is imploding.

Posted by: chrzcatt | November 12, 2010 9:59 PM | Report abuse

And of course the outcome is a flawed reform that, while likely to seriously improve coverage (though who knows what that will mean for ACCESS), actually leaves many of the significant pivot points in the hands of Republican politicians all across the country.

I'm actually not that worried about the electoral losses nationally, but the prospect of people like Rick Scott and Rick Perry establishing health exchanges sickens me. How is reform supposed to work when its most important policy mechanism is supposed to be enacted by people who openly loathe the idea of expanding health coverage? Even if some right-leaning state governments want a successful exchange, can they even do it with Tea Party austerity budgets? All in all, I think it's very possible that the Republicans could make Obamacare look like a failure, simply by refusing to implement it correctly.

All that said, the one thing that gives me hope is that they've effectively ceded the idea of covering pre-existing conditions. Their refusal to honestly engage the debate last year means very few conservatives seem to get the linkage between that goal and the hated individual mandate. So they virtually all say, "Oh don't worry, we'll keep that." If they try to tear everything down and start over while trying to keep that piece, they'll be shocked by radical their solutions need to become. Maybe we're closer to single payer than we think.

Posted by: NS12345 | November 12, 2010 10:06 PM | Report abuse

Good summary Ezra, though perhaps your use of "national health service" is a bit confusing, since that's the British term for their system of govt owned hospitals run by govt employed doctors (sort of like our Veterans hospital system, organized by a GOP President, Herbert Hoover, in 1930).

The Truman proposal-- Wagner-Murray-Dingell bill-- was a single payer insurance system, to quote our friends at the War Department:

"The bill provided that health insurance would be established by the creation of a national medical care and hospitalization fund, to which employers and employees would each contribute 1.5 percent of the first $3,000 of annual wages, making 3 percent in all. Self-employed would contribute the entire 3 percent themselves"
http://www.historians.org/projects/GIRoundtable/Health/Health4.htm

Clinton and Obama both made precisely the same mistake, they had an opportunity to pass healthcare reform (albeit, by expanding Medicare instead of regulating private insurers) during their first summer in office by attaching HCR to a filibuster-proof reconciliation bill. By taking the 60 Senate vote route instead, both presidents foolishly chose to, as Churchill put it, climb into the water to fight the shark. That rarely ends well (I can only think of one exception).
http://surftherenow.com/2009/03/13/diver-fights-and-kills-12-ft-tiger-shark-photos/

Posted by: beowulf_ | November 12, 2010 10:27 PM | Report abuse


You guys should stop complaining because, one the health care we have now isnt as good as it was supposed to be. also the law has just been signed so give it some time. so if u want to say u have the right to choose tell that to ur congress men or state official. If you do not have insurance and need one You can find full medical coverage at the lowest price check http://bit.ly/bandYw .If you have health insurance and do not care about cost just be happy about it and trust me you are not going to loose anything!

Posted by: patriciajeff13 | November 13, 2010 12:27 AM | Report abuse

While all the wasted years of achieving some kind of Universal Health Care System has been cataloged here, by several of those commenting, once again I have noticed no effort whatsoever to discuss the same wasted period of trying to arrest in any way, the spiraling run-away Costs, which none of the other Industrialized Countries experienced when they introduced their various versions of Universal Health Care.

The 'Ambulance Chasing' advocacy lawyers, have had the most profound & Cost significant effect on the Practice of Medicine. The Hospital Methodologies, & staff, all trying to serve in the practice Medicine, have had to be looking over their shoulder, & going overboard to be seen 'Practicing Due-Diligence' as if they were also trained Legal people as well Health Care Professionals, has been responsible in very large part to production of a 2,300 page document in trying to address the scope of the mess that has resulted from all those things I've mentioned here.

It was never gonna happen, & only a 'Soothsayer' would be further setting-up the non-implementable 'The Health Care reform legislation', as a straw man for the Republicans, is as sinsister as it can get.

I don't care who may be called as 'Review Board', if one was ever called, to examine the 2,300 page Bill, as it stands,by the the time they had reviewed the first 300 pages, there would-be, & or maybe, a UNANIMOUS VOTE to scrap the entire 2,300 page, of convoluted, back-door, gerry-mandered, piece of Legislation, sunset it right quick, & start again, & this time starting with Fundamentals, like, tackling the Run-away Costs.

I purposely ended with 'Costs', because jump high & or do double flips with half-gainers, until Health Care costs are not only examined, but dealt with in a way to Arrest the run-away costs,& reduce the costs, which average about a factor of 8 times higher than all the other Industrialized Countries, the whole exercise is a waste of time, or simply an exercise in Futility.

I dare any reader to dispute, with evidence, ANY of what I've written here, please feel free to so do.

Posted by: buntyp | November 13, 2010 12:37 AM | Report abuse

While all the wasted years of achieving some kind of Universal Health Care System has been cataloged here, by several of those commenting, once again I have noticed no effort whatsoever to discuss the same wasted period of trying to arrest in any way, the spiraling run-away Costs, which none of the other Industrialized Countries experienced when they introduced their various versions of Universal Health Care.

The 'Ambulance Chasing' advocacy lawyers, have had the most profound & Cost significant effect on the Practice of Medicine. The Hospital Methodologies, & staff, all trying to serve in the practice Medicine, have had to be looking over their shoulder, & going overboard to be seen 'Practicing Due-Diligence' as if they were also trained Legal people as well Health Care Professionals, has been responsible in very large part to production of a 2,300 page document in trying to address the scope of the mess that has resulted from all those things I've mentioned here.

It was never gonna happen, & only a 'Soothsayer' would be further setting-up the non-implementable 'The Health Care reform legislation', as a straw man for the Republicans, is as sinsister as it can get.

I don't care who may be called as 'Review Board', if one was ever called, to examine the 2,300 page Bill, as it stands,by the the time they had reviewed the first 300 pages, there would-be, & or maybe, a UNANIMOUS VOTE to scrap the entire 2,300 page, of convoluted, back-door, gerry-mandered, piece of Legislation, sunset it right quick, & start again, & this time starting with Fundamentals, like, tackling the Run-away Costs.

I purposely ended with 'Costs', because jump high & or do double flips with half-gainers, until Health Care costs are not only examined, but dealt with in a way to Arrest the run-away costs,& reduce the costs, which average about a factor of 8 times higher than all the other Industrialized Countries, the whole exercise is a waste of time, or simply an exercise in Futility.

I dare any reader to dispute, with evidence, ANY of what I've written here, please feel free to so do.

Posted by: buntyp | November 13, 2010 12:37 AM | Report abuse

While all the wasted years of achieving some kind of Universal Health Care System has been cataloged here, by several of those commenting, once again I have noticed no effort whatsoever to discuss the same wasted period of trying to arrest in any way, the spiraling run-away Costs, which none of the other Industrialized Countries experienced when they introduced their various versions of Universal Health Care.

The 'Ambulance Chasing' advocacy lawyers, have had the most profound & Cost significant effect on the Practice of Medicine. The Hospital Methodologies, & staff, all trying to serve in the practice Medicine, have had to be looking over their shoulder, & going overboard to be seen 'Practicing Due-Diligence' as if they were also trained Legal people as well Health Care Professionals, has been responsible in very large part to production of a 2,300 page document in trying to address the scope of the mess that has resulted from all those things I've mentioned here.

It was never gonna happen, & only a 'Soothsayer' would be further setting-up the non-implementable 'The Health Care reform legislation', as a straw man for the Republicans, is as sinsister as it can get.

I don't care who may be called as 'Review Board', if one was ever called, to examine the 2,300 page Bill, as it stands,by the the time they had reviewed the first 300 pages, there would-be, & or maybe, a UNANIMOUS VOTE to scrap the entire 2,300 page, of convoluted, back-door, gerry-mandered, piece of Legislation, sunset it right quick, & start again, & this time starting with Fundamentals, like, tackling the Run-away Costs.

I purposely ended with 'Costs', because jump high & or do double flips with half-gainers, until Health Care costs are not only examined, but dealt with in a way to Arrest the run-away costs,& reduce the costs, which average about a factor of 8 times higher than all the other Industrialized Countries, the whole exercise is a waste of time, or simply an exercise in Futility.

I dare any reader to dispute, with evidence, ANY of what I've written here, please feel free to so do.

Posted by: buntyp | November 13, 2010 12:40 AM | Report abuse

"By this point, there were no more universal health-care approaches for Republicans to hold out as alternatives"

WRONG. Third party (government or govt designed plan) payer is the piece that has to go. The primary financial relationship works best from provider to patient. Otherwise the incentives are misaligned. People don't trust others to ration for them, they would prefer to get a budget to ration themselves. Some of us take an aspirin where others would demand surgery, don't force us to pay for their profligacy.

Of course, many Democrats believe this too. Including at least one that didn't run for re-election this year. Why bother? Idiots on both sides of the aisle clamor for fantasy budgets with thinly veiled bribes for votes.

Posted by: staticvars | November 13, 2010 1:10 AM | Report abuse

This is a great post and profoundly important.

As you say, Republicans, for purely partisan purposes, have for many decades repeatedly rejected health reform proposals they've promoted in the past. In other words, they've been willing to leave millions of Americans uninsured simply to gain political power.

Now they're doing the same thing with our economy -- demonizing the very concept of an economic stimulus (a previously-uncontroversial economic approach that they've generally accepted in the past) simply as a way of bashing Democrats and gaining political power. It's worked. But millions of Americans are unemployed as a result.

Of course, it's not news that a political party has abandoned intellectual integrity and adopted a problematic policy position in order to maximize its power. But the extent of the GOP's dishonesty, and the amount of harm created by their positions on health care and the economy, is breathtaking. This is beyond politics as usual. This is deep and persistent immorality. Yet it is so poorly understood that even few partisan Democrats appreciate it.

The only way to prevent this from happening in the future is to educate Americans about it. Obama and the Democrats should be making this point. But the truth is so ugly that few Americans would believe them.

Ezra, you need to turn this into a longer article and talk about it at every turn. Because there are few more important stories in our country that so badly need to be told.

Posted by: Dynatic | November 13, 2010 4:04 AM | Report abuse

GOP followers are foxtards. The GOP itself is a collection of the selfish and the greedy whose motto is "screw them before they screw you."

Posted by: pdurand | November 13, 2010 7:44 AM | Report abuse

It's a nice summary of the history of health reform in this country, but would have been nice if you'd finished it with current state summary. Which is that Democrats finally (after 60+ years?) passed a HCR bill that's "near" universal in covering all Americans, and Republicans are now scrambling to try to dismantle it.

Still wish they'd done Medicare for All. Or even the Clinton bill. Oh well.

Posted by: JERiv | November 13, 2010 7:47 AM | Report abuse

Quick clarification on my post. What I meant to say is that the Democrats, after 60+ years are no longer playing offense, but have finally scored the touchdown, and now it's the Republicans playing offense, with the Democrats playing defense.

It will be interesting to see if Republicans manage a field goal here (removal of individual mandate) or a touchdown (full outright repeal), or if the dynamic switches again and the Democrats go on offense again for either a full universal bill.

Either way, the game has changed dramatically, and it has been (at least policy-wise now, probably politically-wise in the future) in the Democrats favor.

We shouldn't lose sight that the HCR bill was called historic when it passed earlier this year for a reason: because it culminates 60+ years of offense played by the Democrats in favor of covering every American.

Posted by: JERiv | November 13, 2010 7:55 AM | Report abuse

--*Democrats moved right every time they failed. And Republicans moved further right every time Democrats tried.*--

How can that not be a bald lie, Klein, when eighty years ago there was little to no government involvement in health care markets, and today the government accounts for fifty percent or more of same? How is your creeping commie-ism not creeping leftism? By rank assertion of what the facts plainly contradict?

You're a propagandist, Klein, and a dim one.

Posted by: msoja | November 13, 2010 10:03 AM | Report abuse

buuntyp - see my comment to the previous posting. I try to avoid multiple postings.

staticvars - As usually you simply ignore data from other countries. Briefly, there are 16 bottom line public health statistics and we rank below average in all of them (OECD). On average other industrialized countries pay HALF as much per person for health care. If our system were as efficient, we would save $1.3 TRILLION each and every year. What do you think that would do to the economy? Perhaps increase demand and thus increase the number of jobs?

BTW all these other industrialized countries from Switzerland to the UK have some form of universal government controlled system. Why do we keep arguing about where to put band aids on a TB patient when the rest of the world is using antibiotics?

Posted by: lensch | November 13, 2010 10:21 AM | Report abuse

Why? Simple. One side wants to give cyanide to a kid. They would allow a "compromise" of delivery method only.

Posted by: illogicbuster | November 13, 2010 1:26 PM | Report abuse

lensch wrote:

"What do you think that would do to the economy? Perhaps increase demand and thus increase the number of jobs?"

Actually no one can predict the employment effect of going to a single payer government run system. Think of how many people are currently employed BECAUSE ot this system that would lose their jobs otherwise.

Also, while we pay more for health care, we receive far more of it than any other nation in the world. A debate about the actual effects of that would occupy a lifetime of posts, but it is a fact.

We have far more of the most expensive type of procedures per capita than any other nation in the world such as transplants and replacements.

Then If you REALLY want to open a can of worms, start attempting to decide whether insurance, any insurance Medicare or toherwise, should pay for a something like Provenge which costs $93,000 and extends the life of terminal prostate cancer patients on average 4 months in studies so far. Few other countries in the world would pay for such a drug even at one quarter of the price.

Posted by: 54465446 | November 13, 2010 1:52 PM | Report abuse

I see 3 reasons:
First, Republicans don't want Obama to have accomplishments to campaign on in 2 years;

Second, they want lower taxes so they favor fewer entitlements (unless it helps them get re-elected); and

Third, there is a feeling that entitlement undermines personal savings. And there is an ideological belief that high personal savings rates lead to responsible, moral, people - it is good for country and capitalism.

My economic thoughts here:
http://www.kentwillard.com/5-ducats/2010/11/replacing-government-entitlements-with-private-savings-plans.html

Posted by: kentwillard | November 13, 2010 2:39 PM | Report abuse

Some wonderful words of wisdom to GOP freshman from Sarah Palin on dealing with the liberal media like the Washington Post and the three major TV networks.

"Remember that some in the media will love you when you stray from the time-tested truths that built America into the most exceptional nation on earth. When the Left in the media pat you on the back, quickly reassess where you are and readjust, for the liberals' praise is a warning bell you must heed. Trust me on that." Sarah Palin

Posted by: tmonahan54 | November 13, 2010 3:56 PM | Report abuse

Such a poor analysis that completely ignore history and plays fast and loose with the truth. What really happens when Republicans compromise with Democrats? Let's look at G. H. W. Bush - he worked across the aisle with tax reforms that resulted in higher taxes and what did the Democrats do? Attack him for breaking his tax pledge when he did so as a compromise gesture to Democrats.

Lesson learned? Democrats will stab you in the back if you reach across the aisle. History is full of such examples.

The truth is it has been the Democrats who have been the most partisan - so much so they could not even get Olympia Snow on board. Klein's attempt to rewrite history will not stand.

Posted by: Narnian | November 13, 2010 4:07 PM | Report abuse

Another extremely poor one sided post from this columnist. No mention of the Democrats who initially stood against this bill. No mention of republicans trying to negotiate with Obama (Tort Reform, Health Savings Accounts, Purchasing across state lines etc.) only to be told, elections have consequences and we won. Is it any surprise moved away from this kind of "negotiation".

Due to Obamas inexperience, and lack of maturity, a golden opportunity was lost for real health care reform. The reform that was passed is too expensive, too complicated, too idealogical and too incompetently put together. It is no wonder that it only passed through bribes, shady deals and reconciliation.

Posted by: mckenna7 | November 13, 2010 5:28 PM | Report abuse

"You're a propagandist, Klein, and a dim one."

More piddle from the paddler: msoja pines for the days before penicillin, when manly manly men survived and dying of infection meant you were too weak to care about.

Posted by: pseudonymousinnc | November 13, 2010 6:23 PM | Report abuse

"No mention of republicans trying to negotiate with Obama (Tort Reform, Health Savings Accounts, Purchasing across state lines etc.) "

Why should there have been negotiations on those issues? At best, they represent empty market sloganeering; at worst, they are detrimental to the goals of providing universal affordable coverage, best practices and cost control.

Ezra has noted many times here that tort reform is a smokescreen; cross-state-lines is an invitation for lowest common denominator regulation, akin to that for credit card companies in South Dakota; HSAs are boondoggles.

It's like complaining that you didn't negotiate with someone who offered to steal your car and cut holes in your roof.

Posted by: pseudonymousinnc | November 13, 2010 6:29 PM | Report abuse

"Think of how many people are currently employed BECAUSE ot this system that would lose their jobs otherwise."

My bad. I didn't realize the $1.3 TRILLION we waste on an inefficient health care system was actually for a make work welfare program.

Posted by: lensch | November 13, 2010 7:45 PM | Report abuse

Maybe if the Dems had compromised when they had their chances, but no, their positions have always been "my way or the highway". Positions have a shelf life of however long their proponents are around, they're of a time and place that exist for the moment.

Posted by: ronjaboy | November 13, 2010 8:15 PM | Report abuse


Come on Ezra, the Democrats, as you call them, were never more right than when many of them opposed the 1964 Civil Rights Act, and it's been downhill to the Wright ever since. Now you have Progressive-Zilla Devouring the Party of Jackson, Van Buren, and Polk...

The Moore of The Democrat Party is eaten by the Monster from Move-on.Code-Punk, the less of a Party it is, and the Moore people will run from it as moore than 300 ex-incrumbents (Dx3) have found.

This situation has just been addressed in this current election cycle, a whole lot of ol' dogs have ended up *lack, *lue, and *icking wounds...

Seriously though, isn't the contrast startling? A gang of Smarmy Carpet-Baggers holed up in Tent City @ 1600 Progressive Pirate Ship Ave., and a fresh, energized and determined pantheon of not-so-clueless young Amateur Patriots stepping into the whistling wind at the brink, boarding the USS Golden Goose sailing US back to the shore of the good land of 'Prosperity', and Plenty of IT?...and all y'all got is: what kind of a wedge can we possibly drive into the middle of, what you hope will be a divided reformation coalition on the Hill, and in the Houses of Shame brought to America from the abyss, by the Bamster and his brinksters?

Posted by: RichNomore | November 13, 2010 8:21 PM | Report abuse

Insurance is not healthcare. The more people on insurance the higher the cost of healthcare. Insurance for Healthcare should be structured similar to home owners or auto. Since when does it make sense to pay one industry for access to another. Where else to you see this?

Posted by: Fuzzled | November 13, 2010 9:48 PM | Report abuse

"they've ended up looking like the partisans," Wrong word, "partisans." The Democrats have ended up looking like patsies.

And, looking like fools. Because: they are fools; fools to have ever believed the GOP would agree to any kind of government intervention in health care. A zero-dollar, single-payer system, which is what should have been passed, would have generated no more opposition that the miserable giveaway to the health insurance industry that was passed.

Posted by: jrconner | November 13, 2010 10:00 PM | Report abuse

"they've ended up looking like the partisans," Wrong word, "partisans." The Democrats have ended up looking like patsies.

And, looking like fools. Because: they are fools; fools to have ever believed the GOP would agree to any kind of government intervention in health care. A zero-dollar, single-payer system, which is what should have been passed, would have generated no more opposition that the miserable giveaway to the health insurance industry that was passed.

Posted by: jrconner | November 13, 2010 10:03 PM | Report abuse

if the dirty little whiny girl ezra had ever tried to run a buiness or had any sort of a real job--she might understand better.

Posted by: carlbatey | November 13, 2010 10:30 PM | Report abuse

lensch wrote:

"My bad. I didn't realize the $1.3 TRILLION we waste on an inefficient health care system was actually for a make work welfare program."

Could you break that down for me, or are you simply saying that every single dollar spent on health care is a waste?


Posted by: 54465446 | November 13, 2010 11:12 PM | Report abuse

psuedo wrote:

"At best, they represent empty market sloganeering; at worst, they are detrimental to the goals of providing universal affordable coverage, best practices and cost control."

Your argument is internally inconsistent. How can having nationwide insurance instead of local be detrimental to best practices and cost control. It is an oxymoron. In efficient businesses, universality is a goal not an enemy. It also goes against the concept of the Independent Payment Advisory board which Ezra has pushed. If nationwide cost controls and interstate prices are good for Medicare, why not for all insurance.

The idea that universal single payer health care is ideal, but that individually chaotic 50 different health care insurance markets is the next best thing is ludicrous on it's face.

Posted by: 54465446 | November 13, 2010 11:24 PM | Report abuse

It's not just that democrats move right, and republicans move right every time this is tried. The public does, as well. This and the 94 election are so obviously about the same thing. Yet you deny it and claim healthcare was not the issue in this election. The Clinton plan, with its regional alliances and semi autonomy for the regions, was far less centralized and less coercive.

Posted by: truck1 | November 14, 2010 6:55 AM | Report abuse

"Third, there is a feeling that entitlement undermines personal savings. And there is an ideological belief that high personal savings rates lead to responsible, moral, people - it is good for country and capitalism."

It's not a feeling. Entitlement DOES reduce saving.

Savings is necessary because it funds investment. For decades, we haven't saved enough to fund our investment spending, so we've imported the difference from savers abroad via a capital account surplus - the flipside of that is the current account deficit, driven primarily by the trade deficit.

Posted by: justin84 | November 14, 2010 10:50 AM | Report abuse

--*More piddle from the paddler*--

You didn't even attempt to refute my assertion, mousie. Klein premises his entire entry on a lie, and apparently that's fine with you? Why do you think a premise built on a lie is not a faulty premise?

Posted by: msoja | November 14, 2010 3:55 PM | Report abuse

"What really happens when Republicans compromise with Democrats? Let's look at G. H. W. Bush - he worked across the aisle with tax reforms that resulted in higher taxes and what did the Democrats do? Attack him for breaking his tax pledge when he did so as a compromise gesture to Democrats. Lesson learned? Democrats will stab you in the back if you reach across the aisle."

Let me get this straight. Bush faces up to the reality that taxes aren't high enough to pay for the government we want, and works out a deal with Congressional Democrats, who support the deal while discreetly failing to mention that Bush is breaking his most high profile campaign promise. Then election season comes around. Pat Buchanan runs against Bush in the primary, repeatedly reminding voters of Bush's broken promise not to raise taxes. Bush wins the primary and faces Clinton in the general election. Clinton (who wasn't party to the negotiations between Bush and Congressional Democrats) doesn't criticize the tax increase as a policy matter, but does run some ads suggesting that Bush voters shouldn't believe Bush's campaign promises. From this we are suppose to conclude, not that making a high profile campaign promise you are not prepared to keep is a bad idea, but that Democrats will "stab you in the back if you reach across the aisle?" Right.

Posted by: KennethAlmquist | November 14, 2010 11:35 PM | Report abuse

I think the idea of them moving is wrong. More likely is that Republicans would propose the plan they thought they could get away with. The democrats kept moving right because either the american public forced them too. The support for even this "conservative" bill was very weak.

Posted by: MonticelloRob | November 15, 2010 12:44 AM | Report abuse

Your history is good, but dead wrong on today's Democrats and government healthcare. And I'll prove it with a link the NY Times.

This time, Democrats killed a private alternative that would have destroyed forever any hope for government healthcare. It's cheaper and better.

Seattle's, Group Health Co-op provides significantly better healthcare ... at a significantly lower price than government could ever hope to achieve.

1) They employ their own doctors ON SALARY. Don't so-called Progressives want that?

2) They own their own pharmacy and hospitals. Already, we have ELIMINATED 99% of all claims processing .. which means cheaper than government. Progressives want to preserve claims processing costs?

What about quality? It's a Co-Op. DOCTORS ARE EMPLOYED BY THEIR PATIENTS. See the Times link on quality of care.

And competition between different co-ops should work a lot better than a dysfunctional Congress.

My own observation as a past member. Have you ever rushed your kid to the ER, only to learn it was nothing serious. GHC members have access to a nurses' hotline with FREE (no extra cost) medical advice, 24/7.

Have you seen anything like that in Medicaid? Medicare? You never will. All the incentives are backwards. As an HMO co-op, GHC treats you at a FIXED monthly cost for an entire year.

THAT is how to make healthcare more efficient -- incentives to be more efficient, instead of the ObamaCare gestapo. Is this still America?

Here's another. Can you deal with your own doctor via email or phone call? Wouldn't it save a LOT of money if the doctors were encouraged to treat you (or answer concerns), without you having to drag your but to their office? Duh?

Does anyone really expect to EVER see that with Medicare/Medicaid/ObamaCare?

(In my own 17 years with GHC, more than half my own concerns were handled by a simple phone call to the nurse hotline. And when my appendix burst, it was the nurse who got me the ambulance))

The REAL reason both parties can't get it done is ... stupidity ... both of them. Or power. Take your pick.

Too many Democrats want universal healthcare WITHOUT first reducing the cost to taxpayers.

Republicans know you need to cut costs first (or in the same bill), and several of their proposals would achieve that: tort reform and selling across state lines. But too many Republicans are owned by the insurance companies and would NEVER favor EFFECTIVE non-profit co-ops.

Now the low-down filthy part. Group Health Co-Op was going to be THE model for non-profit co-ops, which you can see at the Times web link.

What happened? Purely a guess: one of those backroom deals we kept hearing about. Like I said, GHC-modeled healthcare would destroy any possibility of a public plan or option. Forever.

See for yourself:

http://www.nytimes.com/2009/07/07/health/policy/07coop.html

Or http://tinyurl.com/mxnmeg

Prepare to be outraged at what we COULD have had.

And blame BOTH parties.


Posted by: LibertyIssues | November 15, 2010 7:22 AM | Report abuse

A very good article from a Democrat's perspective. From a conservative perspective, and generally Republican one, government has lttle business being involved in health-care. From this view, every setback the author mentions turns into a setback for the Republicans.

It is government that got us into treating a service that everyone needs into an insurance scheme, and then mandating to the insurance companies that they must cover this preventative or elective health procedure or another, helping to drive up the base care of insurance for everyone. The government turned insurance, something meant to cover an unforeseen or a bet for a hopefully distant death, into a form of government controlled socialist program. This insurance scheme, like any socialist enterprise, seeks to spread the wealth around while at the same time increasing the overall cost to everyone, and since, at least for now, insurance is still a personal choice, its exclusivity.

A conservative model would be a pay as you go system. You treat medical care as you do any other service, you pay for it when you need it, and if you can't afford to pay the whole thing, you borrow the money or go on a payment plan with the doctor. Medical insurance would not be an employer provided benefit, but the option of the individual to buy if they want. Medical insurance would be free to offer a wide range of plans based on the clients ability or desire to pay for it, just like any other insurance.

When I was a child, we had something called Catastrophic Insurance, a plan that insurance covered only truly unforeseen medical emergencies, like cancer or accidental injuries. This insurance was very inexpensive, but it did not cover the birth of my four siblings (pregnancy being the result of choice), but my parents paid for each birth on a payment plan with the hospital. Today, thanks to government benefit mandates, insurance companies no longer offer such inexpensive Catastrophic Health Plans".

We all complain of the high cost of medical care with out examining some of it's root causes. Government benefit regulation and employer subsidized insurance. Just look at the difference a doctor charges someone who has insurance versus someone who doesn't.

Posted by: billyrockville | November 15, 2010 7:24 AM | Report abuse

The difference between Democrats and many Republicans, is that Democrat consider health-care a right and many Republicans do not. Let's consider the following; almost everyone has a car, in many locations in today's society, having a car is a necessity for being able to earn a living. Because it is something most of us need, then, in today's way of thinking, it must then be a “right”. Imagine for a moment we treated Auto Insurance as we do Health Insurance. Not only would the insurance have to cover just accident, liability, and possibly collision, but also routine maintenance, the eventual purchase of a replacement car, and the fuel to go in it. Every automotive related expense would be paid for by insurance, predictably, auto insurance companies would be very profitable as they would now get a cut from every automotive expense and the overall expense would be even higher for the service provider because of the increased overhead. Now, lets add the requirement that these plans have to be affordable, and , of course, mandatory, and the insurance companies must meet government set standards or they will either not be able to stay in business or be co-opted by the government. Pretty soon you would have one government run system controlling what and who can the “right” own and operate private transportation. Draw your own conclusion on how many people would have private transportation and of what quality that transportation might be.

Posted by: billyrockville | November 15, 2010 8:10 AM | Report abuse

54465446 - We spend about $2.6 TRILLION a year on health care. Other industrialized countries spend half as much per person. Half of $2.6 TRILLION is $1.3 TRILLION

Here's some idea where it goes. Other countries have MLR's well over 90%. Our private insurance cos have MLR's around 70% - 80%. If you work it out, it comes to $200 Billion a year. There is another $200 - $400 Billion a year wasted by physicians and patients spending time and money filling out forms and fighting to get paid. We waste $100 Billion a year on high drug prices most of which goes to "marketing." The remaining $600 - $800 Billion is due to the wasteful way in which medicine is practiced in the US. Go to www.pnhp.org for details.

Posted by: lensch | November 15, 2010 12:55 PM | Report abuse

The usual nonsense from Ezra. Facts and wishful thinking combined with spin produces something that comes from the back-end of a horse.

The health care bill and virtually every bill passed by politicians on this matter over the last 50 years have driven up costs. Then they think they can simply reverse the cost trends their legislation has produced. It is all mindless "do-goodism". As usual, though he writes on it all the time, Ezra is seldom informed but never in doubt.

Had he ever had a job other than writing about he dreams of liberal Democrats, Ezra might write something worth reading. Still waiting.........

Posted by: buggerianpaisley1 | November 16, 2010 12:38 AM | Report abuse

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