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Posted at 6:42 AM ET, 01/18/2011

Wonkbook: Health-care debate, round two

By Ezra Klein

PH2010122602463.jpg

Health-care reform isn't getting repealed this week. It's getting re-debated. The GOP's control of the House -- and thus of at least some of the agenda -- gives them a second opportunity to make their case against the bill. It also, however, puts the Republicans in a position Democrats will recognize immediately: They're behind a specific piece of health-care legislation with sweeping implications, some of which are popular, and many of which are not. In the coming days, Americans will hear a lot about the Congressional Budget Office's estimate that repealing health-care reform will cost more than $200 billion, and they will hear a lot about the government's estimate that as many as 129 million Americans under age 65 have a pre-existing condition, and they will hear a lot of individual stories emphasizing the dysfunction of the status quo that Republicans would return us to. Just as Democrats found themselves stuck with the downsides of reform, Republicans are going to be lashed to the dysfunctions of the status quo.

In the end, repeal will pass the House -- likely tomorrow -- and quickly die in the Senate. Then comes the more interesting phase of the fight over health-care reform: The GOP's effort at revision. Republicans, who already know that repeal will fail, are preparing to begin the longer and more complex campaign to replace, rewrite, or simply undermine various parts of the bill. The relevant committees in the House will try to develop alternatives, while the GOP will look for Democrats willing to sign onto targeted attacks on the legislation. That will allow them to focus their energies on the parts of the legislation that are tough for Democrats to defend, rather than letting the Democrats force them to focus on the parts of the legislation that are easy for Democrats to defend. But this strategy has its own dangers: As the least popular bits of the bill are either successfully preserved or somehow changed, more and more of the bill's opponents will lose their reason for fighting the legislation. There'll still be a smaller group looking for full repeal, but they'll have to contend with not only the bill's supporters, but also those who just want to move forward and see how the legislation works and what then needs to be done to fix it.

Previewing the Repeal Debate

The GOP's strategy for repealing health care reform extends beyond this week, reports Janet Adamy: "Republicans in Congress have been picking up Democratic allies interested in swapping out parts of the law, including taxes levied on insurers, the creation of a long-term care insurance program and penalties for Americans who don't carry insurance...The new Republican majority in the House is expected to pass its repeal measure Wednesday. It may pick up a small number of Democratic votes but will likely go no further. The Senate isn't expected to take up the legislation. President Barack Obama's veto pen would await any unexpected twist. On Thursday, a day after the repeal vote, the House will pass a measure directing committees to craft new legislation."

Democrats, however, are finding the fight over repeal more congenial than the fight over passage, reports Jennifer Haberkorn: "'We welcome, in a certain sense, their attempt to repeal it because it gives us a second chance to make a first impression,' Sen. Chuck Schumer (D-N.Y.) said Sunday on NBC’s Meet the Press...During floor debate, House Democrats plan to share stories of people who have benefited from the legislation — and issue a warning that those people would be hurt if the law is repealed. Internal polling by pro-reform groups such as Families USA has found that personal stories are more effective than a list of consumer-friendly provisions.

As many as half of all Americans have a pre-existing condition, reports Amy Goldstein: "As many as 129 million Americans under age 65 have medical problems that are red flags for health insurers, according to an analysis that marks the government's first attempt to quantify the number of people at risk of being rejected by insurance companies or paying more for coverage. The secretary of health and human services is scheduled to release the study on Tuesday, hours before the House plans to begin considering a Republican bill that would repeal the new law to overhaul the health-care system. The report is part of the Obama administration's salesmanship to convince the public of the advantages of the law, which contains insurance protections for people with preexisting medical conditions."

Five provisions employers would like to see repealed: http://bit.ly/hAUyV0

The Center on Budget and Policy Priorities runs a Myth/Fact on the legislation's CBO score: http://bit.ly/hGpUJ0

More Top Stories

President Obama has begun an effort to simplify the government's regulations, writes, well, President Obama: "This order requires that federal agencies ensure that regulations protect our safety, health and environment while promoting economic growth. And it orders a government-wide review of the rules already on the books to remove outdated regulations that stifle job creation and make our economy less competitive. It's a review that will help bring order to regulations that have become a patchwork of overlapping rules, the result of tinkering by administrations and legislators of both parties and the influence of special interests in Washington over decades...We are also making it our mission to root out regulations that conflict, that are not worth the cost, or that are just plain dumb."

More Republican leaders are calling for Congress to block an increase in the debt limit, reports Elizabeth Wilkinson: "Three potential Republican candidates for president came out against boosting the federal debt limit without substantial spending cuts, raising the temperature in a debate that is quickly becoming a test of Washington's newfound appetite for financial discipline. Rep. Mike Pence of Indiana and former Republican House Speaker Newt Gingrich on Monday joined former Minnesota Gov. Tim Pawlenty in calling for spending cuts and opposing any increase in the $14.3 trillion debt ceiling without them...Congressional GOP leaders say a vote to raise the limit is inevitable if the nation is to avoid defaulting on its loans. They hope to formulate a compromise that combines increasing the debt limit with a package of spending cuts."

Norwegian pop interlude: Annie plays "Heartbeat" live.

Got tips, additions, or comments? E-mail me.

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Still to come: Regulators are behind in implementing FinReg; up to half of all under-65 Americans have a preexisting condition; a GOP Senator is proposing gun control legislation in the wake of the Tucson shooting; the recession could permanently reduce greenhouse gas emissions; and a robot that can mimic human movements in real time.

Economy

The SEC and CFTC are behind on implementing FinReg, report Jean Eaglesham and Victoria McGrane: "Regulators have missed or postponed several deadlines to write rules needed to implement the financial overhaul triggered by the Dodd- Frank law. The Securities and Exchange Commission and Commodity Futures Trading Commission are straining to keep up with the workload of turning the language in last summer's law into regulations in time to begin enforcing some of the new rules this summer. SEC officials postponed at least seven of the agency's self-imposed deadlines related to the law, including revising the definition of an 'accredited investor' to whom higher-risk investments can be sold...Two of the Dodd-Frank proceedings delayed by the SEC have since been completed."

The FDIC is working on implementing FinReg's "resolution authority" provision, reports Brady Dennis: "An important part of that new tool allows government officials, should a large failure occur, to create a 'bridge' institution that would keep critical parts of a firm operational while it is dissolved and liquidated over time...At the same time, the new powers represent a daunting challenge for the FDIC, which has plenty of experience shutting down troubled firms but has dealt primarily with small banks. Focusing on some of the nation's financial behemoths, observers say, will require a different set of skills...The Office of Complex Financial Institutions will have a staff of about 150, composed of FDIC employees and outside hires."

The administration wants to ease up pressure on China on its currency: http://politi.co/hrJJGu

But Sen. Chuck Schumer is introducing legislation targeting China in time for Premier Hu Jintao's US visit, reports Ian Swanson: "Sen. Charles Schumer (D-N.Y.) is using a Sino-American summit to strike at Chinese economic policies. Schumer and two other Democrats announced Monday they will introduce legislation hitting China for currency manipulation just as Chinese President Hu Jintao is set to arrive in the United States for a critical summit with President Obama...Hu downplayed criticism of China’s currency, and sought to turn the table on the U.S. by criticizing the Federal Reserve’s bond-purchasing program, which is meant to stimulate the U.S. economy and lower the unemployment rate."

Revaluing China's currency won't bring the US jobs, writes Mark Wu: "I recently did an analysis of the top American exports to our 20 leading foreign markets, and found little evidence that an undervalued Chinese currency hurts American exports to third countries. This is mostly because there is little head-to-head competition between America and China. In less than 15 percent of top export products -- for example, network routers and solar panels -- are American and Chinese corporations competing directly against one another. By and large, we are going after entirely different product markets; we market things like airplanes and pharmaceuticals while China sells electronics and textiles."

We need a new bankruptcy law for state governments to prevent bailouts, writes David Skeel: http://on.wsj.com/fosPib

Rise of Skynet interlude: A robot that mirrors human body movements in real time.

Health Care

My column imagining what the health-care system will look like in 2030: "As we know now, the law was the first word in health-care reform, not the last. The next big policy change came five years later, when the failure of a modest deficit-reduction bill caused the bond market to send interest rates on Treasury debt soaring. Congress got serious about deficit reduction, and fast. Three months later, the Balanced Budgets and Sustainable Growth Act of 2015 was signed into law. Among other things, it ended the deduction for employer-based health insurance and replaced it with a refundable tax credit for everyone, no matter where their coverage came from."

Former Senate Majority Leaders Bill Frist and Tom Daschle are proposing new state-based health care reforms: http://politi.co/gB2OhQ

Republican health care reform cost estimates are dishonest, writes Paul Krugman: "First of all, says the analysis, the true cost of reform includes the cost of the 'doc fix.' What’s that? Well, in 1997 Congress enacted a formula to determine Medicare payments to physicians. The formula was, however, flawed; it would lead to payments so low that doctors would stop accepting Medicare patients. Instead of changing the formula, however, Congress has consistently enacted one-year fixes. And Republicans claim that the estimated cost of future fixes, $208 billion over the next 10 years, should be considered a cost of health care reform. But the same spending would still be necessary if we were to undo reform. So the G.O.P. argument here is exactly like claiming that my mortgage payments, which I’ll have to make no matter what we do tonight, are a cost of going out for dinner."

The Center on Budget and Policy Priorities runs a Myth/Fact on the legislation's CBO score: http://bit.ly/hGpUJ0

The GOP can have a civil health care discussion if it wants one, writes EJ Dionne: http://wapo.st/huU8Zk

Domestic Policy

GOP Sen. Richard Lugar wants to renew the assault weapons ban, reports Shira Toeplitz: "Sen. Richard Lugar (R-Ind.) this weekend called on Congress to reinstate the assault weapons ban that expired in 2004. Lugar is the first GOP senator to call for increased gun control following the Tucson tragedy that killed six people and wounded 13 others, including Arizona Rep. Gabrielle Giffords. But Lugar, who supported the initial 10-year-long assault weapons ban when it passed in 1994, said he's not optimistic about the chances for passing gun control legislation this Congress...Lugar is going out on a limb by expressing his support for bringing back the now-defunct assault weapons ban - especially because local Tea Party activists have promised to field a primary challenger for the six-term senator."

The National Labor Relations Board is suing to block state constitutional amendments banning "card-check" organizing: http://nyti.ms/eYSopP

Bruce Reed is Joe Biden's new chief of staff, reports Anne Kornblut: "Vice President Biden named former Clinton administration domestic policy adviser Bruce Reed as his new chief of staff on Friday, the latest move in a reshuffle that has brought several Clinton-era veterans into key roles in the Obama White House...Reed's hiring suggests a potential rightward ideological shift as well, especially on economics. Along with Daley and former Clinton economics adviser Gene Sperling, Reed encouraged free trade and deficit reduction during the economic boom years of the 1990s. While their return has triggered dismay among liberals, it has delighted moderates who believe the administration needed more experienced hands to manage the economy for the next two years."

Sen. Mike Lee thinks child labor laws are unconstitutional, writes Ian Millhiser: http://bit.ly/eNmsGp

Pro-gun logic doesn't hold up, writes Bob Herbert: "The contention of those who would like college kids and just about everybody else to be armed to the teeth is that the good guys can shoot back whenever the bad guys show up to do harm. An important study published in 2009 by researchers at the University of Pennsylvania School of Medicine estimated that people in possession of a gun at the time of an assault were 4.5 times more likely to be shot during the assault than someone in a comparable situation without a gun...We need fewer homicides, fewer accidental deaths and fewer suicides. That means fewer guns. That means stricter licensing and registration, more vigorous background checks and a ban on assault weapons. Start with that. Don’t tell me it’s too hard to achieve. Just get started."

Video game music interlude: The Office theme song, played in Minecraft.

Energy

The recession could permanently cut emissions, reports Matthew Wald: "The previous Congress failed to pass climate change legislation, and the new House is openly hostile to the idea. But what the government has not mandated, the economy is doing on its own: emissions of global warming gases in the United States are down. According to the Energy Department, carbon dioxide emissions peaked in this country in 2005 and will not reach that level again until the early 2020s...The Energy Department’s projection of emissions in 2020 was lower in 2008 than in 2007, and has kept falling...Of course, the recession will end one day, but the economy will look different when it does, experts say. By then, the United States will be further along in its multidecade trend away from energy-intensive industries and toward a service-based economy."

Americans' concern about gas prices is growing: http://bit.ly/huezbR

Secretary of State Hillary Clinton has named climate change one of our top priorities with China, reports Ben Geman: "Secretary of State Hillary Clinton used a wide-ranging speech on U.S.-China relations Friday to call for expanded cooperation on curbing greenhouse gas emissions. China and the U.S. are the world’s largest emitters, and her comments come ahead of Chinese President Hu Jintao’s state visit to the White House next week. 'Our cooperation at the U.N. climate conference in Mexico was critical to the conclusion of the Cancún agreement. Now, we must build on that progress by implementing the agreements on transparency, funding and clean energy technology,' Clinton said in remarks at the State Department."

A major solar company is moving to China, reports Keith Bradsher: "Aided by at least $43 million in assistance from the government of Massachusetts and an innovative solar energy technology, Evergreen Solar emerged in the last three years as the third-largest maker of solar panels in the United States. But now the company is closing its main American factory, laying off the 800 workers by the end of March and shifting production to a joint venture with a Chinese company in central China. Evergreen cited the much higher government support available in China. The factory closing in Devens, Mass., which Evergreen announced earlier this week, has set off political recriminations and finger-pointing in Massachusetts."

Policymakers in Europe are moving away from energy efficiency: http://nyti.ms/h2V6Cy

Closing credits: Wonkbook is compiled and produced with help from Dylan Matthews, Mike Shepard, and Michelle Williams. Photo credit: Brendan Hoffman Photo

By Ezra Klein  | January 18, 2011; 6:42 AM ET
Categories:  Wonkbook  
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Next: Repeal vs. reform

Comments

Again, I thought the Republicans had sworn off "symbolic" votes such as this. I'd rather see them vote on a resolution congratulating Miss Cornhusker than debate health care again.

I'd also like to see the Democrats forswear participating in the debate. What's the point? Let the Republicans debate themselves, pass their silly bill, and then we can get on with the business of governance.

Posted by: Hieronymous | January 18, 2011 7:53 AM | Report abuse

Democrats must engage in all debates. Otherwise, the GOP will dominate the debates and dictate how a majority of Americans (who cant think for themselves) will think on the issues. And this will translate to increased support for GOP ideas and election fortunes.

Ford once dominated Nascar, but stopped racing in Nascar out of protest to rule changes that favored GM, and as a result GM has dominated Nascar ever since (even after Ford returned to Nascar).

Posted by: lauren2010 | January 18, 2011 7:59 AM | Report abuse

happy birthday to michelle obama* * * who is setting an example for how the gratitude of a birthday should be spent....
by doing community service.

leading by example.

Posted by: jkaren | January 18, 2011 8:00 AM | Report abuse

If the debt ceiling is voted down, it seems like it would be a good time to get the US military out of foreign wars and bases of occupation.

Posted by: lauren2010 | January 18, 2011 8:04 AM | Report abuse

The GOP's opposition to healthcare is about profits, not progress. This won't be revealed in the debates this week, but what truth is uncovered when politicians gather in the Capitol? Get ready for more fear-mongering sound bites and catchy talking points that mean nothing... http://bit.ly/eWu3Se

Posted by: BeckingOrder25 | January 18, 2011 8:11 AM | Report abuse

--*As many as half of all Americans have a pre-existing condition*--

The insurance biz is no longer a hedge against risk. It's plain and simple redistribution.

Posted by: msoja | January 18, 2011 8:33 AM | Report abuse

No redistribution.

The people who get health insurance largely pay for it. That includes all that medicare-D money.

Medicare-D is in fact redistribution and corporate welfare, as it takes from the middle class and gives to the insurers and care givers.

There will be some subsidies, but if you prefer to call that redistribution, so be it. I call it the Christian thing to do since the capitalist element of American society rations health care by income.

Posted by: lauren2010 | January 18, 2011 8:49 AM | Report abuse

--*I call it the Christian thing to do*--

Yes, Christ was big about pointing his gun at people's heads and forcing them to do his bidding.

Posted by: msoja | January 18, 2011 9:05 AM | Report abuse

"With all the subsidies flowing to hospitals, doctors and drug companies, Washington is also in position to impose price controls on these industries. The new exchanges will control insurance prices, and by extension will influence prices on drugs and care."

http://washingtonexaminer.com/politics/2011/01/tick-tick-tick-cost-obamacare-time-bomb

Price controls == shortages. Oh, goody!

Posted by: msoja | January 18, 2011 9:09 AM | Report abuse

Many Senators, like Gillibrand of New York, are now openly welcoming changes to the costly and invasive Obama/Pelosi PPACA. Other Senators -- from states like Missouri, Montana, Ohio, and West Virginia -- are considering their positions carefully: to be re-elected, these Senators must heed the call of their constituents and vote to repeal (or at least to retract portions of) the costly and invasive Obama/Pelosi PPACA.

The symbolism of the vote this week is that the will of The People can't be ignored: no matter what happens immediately, there will ultimately be an Omnibus Budget And Medical Amendments Act (OBAMAA) which eliminates the troubling portions of the costly and invasive Obama/Pelosi PPACA. Moreover, the President will sign -- not veto -- such an Act.

Posted by: rmgregory | January 18, 2011 9:19 AM | Report abuse

lauren,

that's a load of crap. The people that have health insurance DO NOT pay for it. If that was the case then we wouldn't need to "clean up" the risk pool with healthy young invincibles that will pay premiums but likely not use their coverage.

If you have a baby for example it will likely cost your insurance company an average of $25,000. It will take several years of NOT putting in any claims at all (which won't happen with kids) to recoup that money put in.

If you have a heart attack you can be expect to have paid for you by your insurance company $1 million dollars.

http://blog.insweb.com/2010/05/heart-attack.html

You will NEVER, EVER repay that in the form of premiums. To say otherwise is just making you seem foolish.


The biggest part of Wonkbook that is scary here is the fact that 129 million of us have a pre-existing condition. The point is that the risk pool can't get clean enough to which point we can afford it unless we all take better care of ourselves. To do that we need incentives (SAFEWAY). Will we have them, I don't know.

Posted by: visionbrkr | January 18, 2011 9:28 AM | Report abuse

visionbrkr:
"The biggest part of Wonkbook that is scary here is the fact that 129 million of us have a pre-existing condition. The point is that the risk pool can't get clean enough to which point we can afford it unless we all take better care of ourselves"

How much better would you like me to take care of myself? I have a BMI of 22, work out 5x a week, don't drink or smoke, and have cardiac arhythmia and arthritis in my spine, hands, hip and knee, and I'm only in my early 50s. If I didn't have a job--or lost my job--I would be uninsurable. The risk pool will never get "clean enough" if everybody has insurance in a population that is rapidly aging. Shame-blaming about "incentives" is not a solution.

Posted by: ciocia1 | January 18, 2011 10:15 AM | Report abuse

ciocia1,


you're not the problem. The problem are those that have issues like that or worse and don't take care of themselves. We wouldn't have 129 million with pre-existing condtions and 30% of our popuation that is obese if there wasn't a problem.

Shame blaming worked for smoking didn't it? It was started for obesity but for some reason its pretty much stopped. We need the same vigor for obesity that we had for smoking in the 90's that strongly curtailed that and that includes taxes on sodas and other sugary drinks.

Btw, the First lady was right on with her campaign against obesity and Sarah Palin was her usual idiotic self when she went against it. obesity and healthcare costs skyrocketing can't have any political affiliation.

Posted by: visionbrkr | January 18, 2011 10:31 AM | Report abuse

vision

Good morning. How are you?

I value your opinions. But I respectfully think you are overreacting and mixing apples and oranges.

Paul Krugman has an article today that explains in high level terms how health insurance works. I.e. everyone pays for INSURANCE (the apple) and some people et seriously ill and need lots of care (the oranges). Everyone else stays relatively healthy and helps pay for the care of the seriously ill, and still, the insurance companies make profits. Indeed, stock investors are betting that insurance companies CONTINUE to get profits even during the ObamaCare era.

msoja equates insurance to redistribution. Well, I call it insurance. After all, no one calls car insurance redistribution.

Take care friend

Posted by: lauren2010 | January 18, 2011 10:43 AM | Report abuse

http://krugman.blogs.nytimes.com/2011/01/17/health-care-basics/

That's the Krugman article I mentioned.

Posted by: lauren2010 | January 18, 2011 10:50 AM | Report abuse

lauren,


good morning.

over-reacting on what, the obesity problem? The problem is that when the oranges in your example outweigh the oranges by a significant margin costs go up to an unaffordable level. Personally I don't think people are reacting enough mainly because the costs are hidden by employers, by tax incentives etc. If we ever got a bill at the end of the year, each and every one of us as to what we've individually put into the system (Premiums) and what we've taken out of the system (claims) we'd all be shocked. I've seen those figures from some clients of mine and its staggering and only getting worse with biologic drugs and other live saving drugs that are about to become unaffordable if you're not ultra wealthy.


And handing 860 billion in either insurance subsidies or medicaid IS redistribution. you may feel its justified redistribution because of your being upset with the Bush tax cuts etc but it doesn't change the fact that it is redistribution.

Posted by: visionbrkr | January 18, 2011 11:07 AM | Report abuse

As I said elsewhere, the GOP has offered to bills to vote on that involve reform. Only destroy. They want to return to a system where private insurers only insure the healthy and where 32 million aren't insured and where 500,000 Americans go bankrupt every year due to health related issues and where insurers have hefty profits. Think about that. The GOP motives, as someone else said, are purely about profits and politics.

Posted by: lauren2010 | January 18, 2011 11:07 AM | Report abuse

"msoja equates insurance to redistribution. Well, I call it insurance. After all, no one calls car insurance redistribution."

Insurance protects against large, uncertain losses. If the loss has already occurred (i.e. a pre-existing condition), it is no longer insurable by definition. To require insurance companies to provide benefits to those with these pre-existing conditions changes the nature of the product from insurance to something else.

If the government required auto insurance companies to reimburse people who sign up after an accident occurred, then that too would be redistribution.

There is nothing wrong with redistribution per se - after all that's what charity is. It's only government mandated redistribution that is problem.

Posted by: justin84 | January 18, 2011 11:18 AM | Report abuse

vision

we discussed this before.

the 890 billion originates with the same people who benefit from it.

Also, you make it sound like it is impossible for private insurers to cover everyone. Is that what you are saying? That in order to profit, private health insurance MUST resort to recissions or rejections of pre-ex-people? If so, you are making the case for a public option.

To be frank, it is unclear EXACTLY why you said what I said was a load of crap. Please provide a specific and clear statement of exactly where the crap is. It just seems you are reacting to what I said with random issues instead of proving what I said was wrong.

By the way, do you call car insurance redistribution? Or long-term care insurance?

What part of Krugman's article that I linked to is crap?

Posted by: lauren2010 | January 18, 2011 11:23 AM | Report abuse

I'm skeptical that very much, if any, of the bill gets changed in the short-run (1-2 years). Now it is the Dems' turn to sit on the ball and let the clock run out. The longer PPACA is in effect, the more people will like it. Not even half of Republicans want it repealed at this point. And this gets back to the faulty premise of the GOP's resistance to the bill in the first place - it was a symbolic stand against a Democratic President with a "muslim-sounding" name. Their problem was never with the facts. As soon as we start talking specifics and the GOP talks about replacing the bill, you draw them into a serious discussion. At that point they lose the debate.

I think that the law will be changed and improved over time, but in the way the Tea Party types think. If anything it will be expanded - especially once the States are given free-rein to implement the law as they see fit.

This was an election-year gambit by the Republicans which paid them with a great number of seats, but very little substance behind their bluster. There are at least a few smart folks in the GOP caucus who understand this. Boehner may be one of them.

Posted by: willows1 | January 18, 2011 11:35 AM | Report abuse

justin84 -

Sounds like an excellent argument for a single-payer system. If insurance companies can't, by definition, help the people who need them, then why do they exist?

Posted by: willows1 | January 18, 2011 11:39 AM | Report abuse

reform cost estimates are dishonest, writes Paul Krugman: "First of all, says the analysis, the true cost of reform includes the cost of the 'doc fix.' What’s that? Well, in 1997 Congress enacted a formula to determine Medicare payments to physicians. The formula was, however, flawed; it would lead to payments so low that doctors would stop accepting Medicare patients. Instead of changing the formula, however, Congress has consistently enacted one-year fixes. And Republicans claim that the estimated cost of future fixes, $208 billion over the next 10 years, should be considered a cost of health care reform. But the same spending would still be necessary if we were to undo reform. So the G.O.P. argument here is exactly like claiming that my mortgage payments, which I’ll have to make no matter what we do tonight, are a cost of going out for dinner."

-------------------------------------------
Or, I have to have a financial analyst look at my budget.

I have a 243 thousand dollar extra payment that I make to a insurance provider to ensure that my retired employees over 65 have good health care.

I then come up with a comprehensive health care plan for all of my employees, retired and current, however, I discover that if I include the extra 243 thousand dollar payment in my accounting for health care costs, my health care plan is in the red.

I say that I don't have to worry about that in figuring the profit/loss of my new comprehensive health care plan, because I would have to be paying the 243 thousand dollar cost no matter if I had the new plan or not.

What the heck?

You don't have two budgets for doctors providing medical care from the federal government, all such budgets go from the Treasury to HHS. It's exactly the same as saying that my credit card situation is good because I don't owe anything on my Mastercard, but I neglect to say that I owe thousands on my Visa card.

By analogy to Mr. Krugman, it is the same as saying that I can afford to go out to dinner tonight because I have a zero balance on my Visa card (although I owe 100,000 dollars on my American Express card).

Posted by: PALADIN7E | January 18, 2011 11:51 AM | Report abuse

"Revaluing China's currency won't bring the US jobs, writes Mark Wu: "I recently did an analysis of the top American exports to our 20 leading foreign markets, and found little evidence that an undervalued Chinese currency hurts American exports to third countries."

Well you're late to the party on this, since I told you many months ago that the only things the US can export successfully are ag products and big ticket items like planes and ag equipment etc.

Watch this space, for what you'll be reading about elsewhere 4-6 months from now. LOL

Posted by: johnmarshall5446 | January 18, 2011 12:19 PM | Report abuse

lauren,


if you taxed rich people MORE so you could hand poor people vouchers that could only be used to purchase car insurance then YES that would be redistribution.

the part that i said was a load of crap was the fact that you said:


No redistribution.

The people who get health insurance largely pay for it. That includes all that medicare-D money

What do people on Medicaid pay? Do they pay into the system or only take out? There are 15 million or so more of them come 2014. Heck even those of us with private insurance don't pay what we put in that's why in state's like mine that already have an MLR costs are going up because of no mandate taking the healthy out while only the sick remain so premiums aren't enough to keep pace with claims.

Posted by: visionbrkr | January 18, 2011 12:22 PM | Report abuse

"A major solar company is moving to China, reports Keith Bradsher:"

Oops, told you this one also. Alternative energy leiglslation equals Chinese stimulus jobs.

Posted by: johnmarshall5446 | January 18, 2011 12:22 PM | Report abuse

"An important study published in 2009 by researchers at the University of Pennsylvania School of Medicine estimated that people in possession of a gun at the time of an assault were 4.5 times more likely to be shot during the assault than someone in a comparable situation without a gun."

Without being either pro or anti gun, this is truly a horrifically done study, psuedo-science, not science.

The vast majority of shootings in this country over 2/3, are either suicides or accidents. The rest is all projection without hard data. It's like estimating the number of people who aren't murdered because of the death penalty, a simply unknowable number.

Here is the methodology that even to the untrained eye is deeply, deeply flawed:

"Penn researchers investigated the link between being shot in an assault and a person’s possession of a gun at the time of the shooting. As identified by police and medical examiners, they randomly selected 677 cases of Philadelphia residents who were shot in an assault from 2003 to 2006. Six percent of these cases were in possession of a gun (such as in a holster, pocket, waistband, or vehicle) when they were shot.

These shooting cases were matched to Philadelphia residents who acted as the study’s controls. To identify the controls, trained phone canvassers called random Philadelphians soon after a reported shooting and asked about their possession of a gun at the time of the shooting. These random Philadelphians had not been shot and had nothing to do with the shooting. This is the same approach that epidemiologists have historically used to establish links between such things as smoking and lung cancer or drinking and car crashes."

I would LOVE to debate with anyone who thinks this a scientifically sound methodology!

So in essence what we have is 94% of the people who were shot, not having a weapon on their possession, yet somehow Penn researchers extrapolated that to mean that you were 4 times more likely to get shot with a weapon than without!!!!!!

This is why you should distrust all experts, and all expert sudies, until you have a chance to examine them.

Posted by: johnmarshall5446 | January 18, 2011 12:49 PM | Report abuse

Vision

I see. You are saying a progressive tax is redistribution.

Well, the wealthy benefit from many ways that we redistribute money from everyone else to them.

The dominant part of taxes diverted to medicaid are from middle class. But the wealthy do appreciate your advocacy, even though you are not advocating for the unfortunate.

Posted by: lauren2010 | January 18, 2011 1:06 PM | Report abuse

johnmarshall5446 - Something seems to be missing, but I wouldn't dismiss it out of hand. I think what they were trying to do (just based on your summary) is to compare how the "been shot" population compares with the overall population in Philadelphia. The fact that 94% of shooting victims did not have a gun isn't the troubling part. The troubling part is that it suggests that gun possession rates in Philly are 6%/4.5 or about 1.2% that seems low. There's also a confounding effect which is that someone carrying a gun at the time they were shot may not have been a completely innocent victim. If they were carrying a gun, they may have believed they were in some danger of being shot and so don't represent a truly random sample.

I lived in DC in the mid-90s shortly after Marion Barry was widely lampooned for having said that most of the violent crime in DC was murder. I think what he was trying to say was that it was extremely dangerous for a small group of people, but that you could go about your daily life and not be drawn into it. I think there was some truth to what he was saying. Not that it made any difference to those already drawn into that life. But to the new residents (myself included) you could go to work, go out with friends, spend time in the parks, and live a normal life without encountering a violent criminal.

Posted by: willows1 | January 18, 2011 1:38 PM | Report abuse

lauren,

i'm not advocating for anything but the truth. When you step out of line and say something totally nonsensical that's when i confront you with the truth. That's all.

We can certainly put up here all the fancy graphs and great links to show it but when you show me that the top 1% control "X" percentage of the country's wealth I'll also show you that that same top 1% pay "X" percentage of the country's taxes. You can't have one without the other or to put one without the other puts you in line with the likes of Krugman and others who only put up PART of the stories. Same goes for those on the right that do the same although I don't personally follow them.

Posted by: visionbrkr | January 18, 2011 1:41 PM | Report abuse

"Sounds like an excellent argument for a single-payer system. If insurance companies can't, by definition, help the people who need them, then why do they exist?"

willows1,

Health insurance companies exist for the same reason auto insurance companies exist.

Health insurance companies help plenty of people who need them, provided they purchase a policy prior to that need developing.

Posted by: justin84 | January 18, 2011 2:02 PM | Report abuse

I think the sad truth is that many Americans were upset that Congress dived into health care reform when we needed job relief and now, instead of job relief, these lunk-heads are re-visiting health care reform. To let more Americans suffer because they can't get to a doctor or die because they can't make it to 65 while they ignore the hit this economy is taking on average American families while they diddle around like spoiled brats is most annoying. Some of them may have humble roots, but they haven't looked back. I can't think of a one that isn't out of touch.

Posted by: SarahBB | January 18, 2011 2:04 PM | Report abuse

Vision

Where have you reasonably proved I said something nonsensical?

I've seen you react to things I've said, but that's all.

I asked you to be precise about what you disagree about, but then you just quoted everything I said, without clarifications.

Anyway, I'm in favor of the least painful way for our society to ensure all people have good health care. If that involves, among other things, a progressive tax system and a few nuts instead complaining about redistribution (when in reality our laws overwhelmingly favor numerous transfers to the wealthy) then so be it.

I've seen no evidence a progressive tax system does anything but help solve massive problems.

But again, I'm sure the billionaires are happy you are here advocating for them, though prior to obamaCare 33 million were without care.

Posted by: lauren2010 | January 18, 2011 2:09 PM | Report abuse

justin84 - But just because you don't fit the model of someone the insurance company would like to cover doesn't mean that you stop needing health coverage. So these seem to be the people the government should cover. But as soon as you open up that possibility, there would be a strong incentive for health insurance companies to shed anyone posing the slightest risk to their bottom line. And the most expensive, most risky people would be covered by the government. Whatever you call this program would be expensive and constantly under attack.

Posted by: willows1 | January 18, 2011 2:33 PM | Report abuse

lauren,

an example of your being nonsensical.

you saying I'm advocating for billionaires when i'm simply advocating for the truth to be told.

Posted by: visionbrkr | January 18, 2011 3:21 PM | Report abuse

lauren,

how are the progressive tax systems of Portugal, Greece and Spain working out? Have you seen the riots there? Or do you just cleverly ignore facts that don't make your points.

Posted by: visionbrkr | January 18, 2011 3:23 PM | Report abuse

"But just because you don't fit the model of someone the insurance company would like to cover doesn't mean that you stop needing health coverage. So these seem to be the people the government should cover."

Let me ask you this - would it be moral for a sick man to put a gun to a rich woman's head, and force her to write a check paying for his medical treatment?

How do you think the government gets the money to provide this coverage?

Posted by: justin84 | January 18, 2011 3:30 PM | Report abuse

Vision

It is a fantasy to say their problems are due to progressive tax systems.

Really, do you believe that?

And as you forego concern for the tens millions of uninsured because of some theoretical issues with progressive tax systems, it is logical to assume you elevate the needs of the wealthy above the needs of the uninsured.

Do you deny the "system" is designed to enable the powerful and wealthy the greatest chances to prosper? Because again, by worrying more about taxes for the wealthy instead of the suffering of the uninsured, you appear to advocate for the wealthy. In case you didn't notice, Obama did not raise their taxes, and instead extended their current rates. At what point will you direct your concern towards the downtrodden?

Posted by: lauren2010 | January 18, 2011 3:39 PM | Report abuse

justin84 - No, it would not. But luckily, Bernie Sanders' amendment giving guns to sick people for the purpose of extracting payment from wealthy women was filibustered.

However, it would be moral for a third entity to collect money from a broad base of people in order to make sure that all of those people could afford to have health coverage. This would include the man who is now sick but was once healthy and the wealthy woman who is currently healthy. It would also include children who were born sick and never contributed to the fund in any way.

Come to think of it, it sounds a lot like private insurance without the profit motive. Imagine that!

Posted by: willows1 | January 18, 2011 3:57 PM | Report abuse

willows:

I was not using the statistics as proof of anything other than that the study is pseudo-science, not science.

I quoted their own description of their study verbatim, so that you could see that they collected statistics that 94% of the people who were shot were not armed, yet their conclusion was that being armed made you 4 times more likely to be shot in an assault than someone who didn't have a weapon.

The study itself is simply an absurdity.

Posted by: johnmarshall5446 | January 18, 2011 4:20 PM | Report abuse

johnmarshall5446 - Look at it this way - I think we'll both agree that skydiving carries certain risks with it. And that if you skydive you increase your chances of injury or death. But if we look at the cause of death throughout the entire U.S., we find that waaay less than 1% of the population died from skydiving. So we'll conclude that skydiving isn't dangerous after all. Well, wait, you say. If only a few thousand people skydove last year and 15 of them are now dead, doesn't that suggest that among skydivers, the risk is greater? I would respond, that's true. So what we need to do is compare the two populations - the skydivers and the general population. Then we'll see how rates of injury or death compare between the two groups. That should give us a clearer picture.

Which is exactly what they did in that study.

I'm also not taking sides on this, but I don't think the science is as bad as you think. It certainly sounds like it could be improved or clarified (i.e. do suicides count?) but it isn't just plain garbage.

Posted by: willows1 | January 18, 2011 4:47 PM | Report abuse

"No, it would not. But luckily, Bernie Sanders' amendment giving guns to sick people for the purpose of extracting payment from wealthy women was filibustered."

willows1,

Single payer is essentially giving the guns to government agents to use on behalf of the sick. There is no difference between an individual robbing another for their health care and a group of individuals voting that government agents do it on their behalf, unless you believe in some modern form of the divine right of kings.

"However, it would be moral for a third entity to collect money from a broad base of people in order to make sure that all of those people could afford to have health coverage."

And what would happen if some of that broad base didn't want to be involved - say, they wanted to provide their own health care with their own resources. Does the "third party" simply shrug, say "okay, that's fine", and ask for more contributions from those who are willing?

Posted by: justin84 | January 18, 2011 5:05 PM | Report abuse

willows:

Thanks for the reply. We could carry this one round and round, so maybe we can just courteously respect each other's position.

As you may have guessed, this is 54465446 btw. I had to change names because Jennifer Rubin first censored me, and then banned me entirely (too liberal believe it or not). The system the Post uses however, left me unable to post on any column, not just hers. Therefore I am now and forever a new man!

Posted by: johnmarshall5446 | January 18, 2011 5:12 PM | Report abuse

justin84 - No, everyone pays. Because everyone benefits from it. Just like everyone pays for defense and roads and clean drinking water.

I was against the war with Iraq, but I still pay taxes that go toward fighting it. I was against an interchange upgrade built in some far-flung exurban suburbs that our governor happened to be from, but I paid for it anyhow. I was against using public money to pay for a stadium for our professional football team. But I paid for it anyhow. In each case, what I wanted was over-ruled by the majority of voters. So maybe I'm the one with a gun to my head and that healthy wealthy woman from the ex-urban suburb is the one holding it.

Posted by: willows1 | January 18, 2011 5:56 PM | Report abuse

"I was against the war with Iraq, but I still pay taxes that go toward fighting it. I was against an interchange upgrade built in some far-flung exurban suburbs that our governor happened to be from, but I paid for it anyhow. I was against using public money to pay for a stadium for our professional football team. But I paid for it anyhow. In each case, what I wanted was over-ruled by the majority of voters. So maybe I'm the one with a gun to my head and that healthy wealthy woman from the ex-urban suburb is the one holding it."

And you're okay with this?

Posted by: justin84 | January 18, 2011 11:52 PM | Report abuse

justin84 - I'm okay with setting ground rules which state that we elect representatives through a democratic process and that these representatives are supposed to look out for the interests of the voters. I'm not foolish enough to think that this is always the case, or even that having a majority bestows wisdom upon leaders, but it's better than some "opt out" provision for everything or the "take my ball and go home" mentality.

Posted by: willows1 | January 19, 2011 10:43 AM | Report abuse

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