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What today’s health-care summit can accomplish [updated]

The real value of today’s White House health-care summit came clear to me during a conversation with my friend Steve Luxenberg. Steve, who was editor of The Post’s Outlook section for many years, was speaking generally about what he saw as the difference between “honest disagreements” and “dishonest disagreements.”

If today’s summit does nothing else but to sort out the difference between these two kinds of disagreements in the health-care debate, it will be a huge success.

At the heart of the fight between Republicans and Democrats is an honest disagreement over the role of federal government. The Republicans don’t want our national government to play a major role in solving the core problems of our health-care system. They insist that more federal action will simply make things worse. (Although they then turn around and criticize any cuts President Obama proposes in Medicare, which, last I looked, is a federal government program). The GOP’s suggestions are small because they don’t want government to do much. The party’s main health-care proposal would spend $61 billion over 10 years -- in other words, an average of $6 billion a year -- and cover an additional 3 million people, according to the Congressional Budget Office. The amounts they propose are a smidgen compared to the value of the tax cuts the Republicans voted for during the Bush years.

And the truth is that if using the federal government to solve some of the problems in the health-care system had been a priority for Republicans, they could have passed something when they controlled the White House and both houses of Congress. They chose not to.

Obama and the Democrats, on the other hand, believe that the federal government must take large steps to repair a broken health-care system. The proposal the president put on the table this week would spend $950 billion over 10 years to insure 31 million people.

If both sides are honest about this core difference, they probably won’t reach agreement, but at least Americans will know why we are having this fight. In fact, it’s absurd to expect sudden compromise from two parties so far apart philosophically and so far away from each other in how much they want to do. Does anyone really think they can, say, split the difference between $950 billion and $61 billion?

That’s the honest disagreement. Then there are the dishonest ones, which I hope today’s lengthy discussions can clear away. I offer my top candidates for arguments that deserve to be thrown into the trash bin:

“We don’t need a 1,500 page (or 2,000 page -- or, well, pick your number) bill to solve this problem.”

If Democrats printed exactly the same bill in 6-point type single spaced and therefore instantly cut it down to, say, 200 pages, would Republicans suddenly support it? You know the answer. Once Congress decides to pass comprehensive health-care reform, which affects about one-sixth of the economy, it’s stuck writing a long bill. There are new regulations, new taxes and new tax credits to subsidize the uninsured, changes in Medicaid, changes in Medicare, and a slew of other matters to deal with. One provision can have an unintended consequence unless it is tempered by another provision. This is not only a dishonest disagreement; it’s dumb.

“Everyone wants to ban discrimination against people with preexisting conditions. Let’s just pass that.”

There are many variations on this theme, all of which claim that passing some insurance reforms could be counted as a big victory. But insurance reforms on their own couldn’t be effective. If health insurers were required to give coverage to people with preexisting conditions, for example, the premiums of healthy people will rise inexorably to cover their costs. The way to prevent this is to mandate that everyone buy health insurance. This creates a broad pool, spreads the costs and prevents spikes in premiums. No mandate, no effective insurance reforms.

“These health bills bust the budget. Oh, yes, why do they include all these tax increases?”

No, these bills don’t bust the budget precisely because they do include tax increases. The Medicare prescription drug benefit passed under President Bush was not paid for and has added to the deficit. And these bills include cuts in other government programs to balance off some of the increased costs. The Congressional Budget Office, which is very tough on these matters, says these health bills will cut the deficit in the long run. If someone wants to argue otherwise, they need to offer evidence. And while there is plenty of room to argue over which taxes should be raised to pay for health care, you can’t claim to be fiscally responsible and oppose all the tax increases included in these bills.

“We can do lots of good things without spending this much money.”

The most honest conservative approach has involved getting rid of the tax exclusion for health benefits and using the revenue for tax deductions and credits to help more people buy health insurance. If Republicans put an idea of this sort on the table today -- say, something along the lines of a bill introduced by Sens. Ron Wyden (D-Ore.) and Robert F. Bennett (R-Utah) -- that would be serious. (I say that as someone who respects the work Wyden and Bennett have done, but has some qualms about their proposal.) What’s not serious is to pretend that much can be done with little money. Obama’s proposal is expensive because health insurance is expensive and insuring an additional 31 million people will cost a lot of money. If you don’t want to spend public money, you’re not going to get a significant expansion in the number of Americans who have health insurance.

You can tell that I have very low expectations for sudden bipartisan concord out of today’s meeting. I’ll be perfectly happy if today clarifies for Americans what the choices are. And I think that if Obama does his job right, Democrats will find the courage (and the votes) to pass comprehensive reform. Then voters can render a judgment on their actions in November. Advocates of reform will have an easier time defending themselves if they pass a bill than if they throw away this opportunity. Today should represent the first steps in the final lap.

Update, 3:30 p.m.: The health-care summit has actually done a lot that I hoped it would -- in particular, making clear the deep philosophical divide between the parties and the fact that Republicans simply don’t want to pass a comprehensive health-care bill. It also dealt with many of the particulars I thought it needed to dispose of -- the foolishness, as I see it, of talking about the number of pages in the bill came across in an early exchange between Rep. Eric Cantor (R-Va.) and President Obama; the reason for the individual mandate, which Obama discussed in coming clean on the fact that he had opposed it during the Democratic primaries and why he had changed his mind; and the impact of the bill on the budget.

By E.J. Dionne  | February 25, 2010; 12:18 AM ET
Categories:  Dionne  | Tags:  E.J. Dionne  
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Comments

This is a cirque D' Obama. This is the modern version of the spider and the fly. This is the uncivil inviting the unwilling to a luncheon of mockery, derision, scoffs and scorn.

Obama cannot contain his glee. His hubris and arrogance convinces him that he will win the day and turn the public around from their dislike for his rationing, government controlled boondoggle, travesty of a mockery of a sham trillion dollar fiasco.

The CBO said it cannot fix the cost of the President's website plan as it is not specific enough.

The question remains why didn't the Democrats just pass their bill and use the nuclear option? They could have done it. They had the votes.
The obvious answer is that they want the Republicans to share the blame of this boondoggle, this travesty of a mockery of a sham of rationed, expensive miserable, government controlled, tax raising, budget breaking Obamacare.

Why has the President invited the Republicans to Blair House on Thursday? Why does a spider invite a fly into his web?

This cirque d' Obama to be played on on television is just another political game, a trap set for fools.

Obama is not a kind politician who wants to work things out. Obama is a Chicago politician who wants things his way. The hubris, the arrogance, the audacity, the delusions of infallibility of the President is palpable. What other president would attack the ruling of the Supreme Court while the Justices who made the ruling were present and during a State of the Union address?

Reagan told the Soviets to tear down the Berlin Wall. He called them an Evil Empire. Obama calls for the GOP to tear down their principles and calls them the evil party.

This country is more divided now than it has been since Grant and Lee were in the killing fields of the Civil War. The difference is that we are not shooting bullets at each other and we don't have a civilized man in the White House, who sought peace "with malice toward none and charity for all."
Lincoln didn't attend Harvard. Maybe that's Obama's problem.

Health insurance companies must compete for business across state lines just as automobile insurance companies do and the free competition ( a word that is not in Obama's vocabulary)
will lower prices. Take away their anti trust exemption waiver and make health insurance portable. Do not tax insurance provided to employees and give employers a tax deduction for the moneys spent to provide it.
That is the simple and free market solution offered by the GOP and that is the way to go. if it fails and it won't there is always time to pass a trillion dollar bureaucracy horrific government takeover.
This is the United States of America and we are great because of free enterprise, not government control of every part of society.
P.S. automobile insurance is not mandatory for those who do not drive or own automobiles or trucks. Obamacare is the work of the oligarchy. Mandatory and a travesty of a mockery of a sham.

Posted by: mharwick | February 25, 2010 12:56 AM | Report abuse

Mharwick,
Your 'talking point' comments are cute, but quite off base. Uncivil? Arrogant? How do you justify comments like that? Have you looked at some of the ignorant and hypocritical comments coming out of the GOP? Your dig at Harvard and false patriotic themes are silly. Did you actually read Dionne's column? Do you actually understand the health care issue?

Posted by: ladodger | February 25, 2010 1:38 AM | Report abuse

There is not sense trying to TALK with anyone on either side. Congress just does not care. They will continue to argue and fight, call each other names and as usual nothing will get done and we continue down a course of NOWHERE>

I am 50 years old as of 7 minutes ago. My insurance company is ending my coverage as of the end of the month.
TO buy it on the open market will cost me 51% of my TAKEHOME PAY (premiums alone). Add in the other costs of meds and copay, deduction and the like AND I HAVE TO CRY.

I cannot afford to insure myself. Due to a serious medical condition, without the necessary medications I will die.

THANKS TO THE STUBBORNESS AND SELFISHNESS of my fellow AMERICAN citizens for whom I have helped in my work as a social worker -- I have a quick expensive death to look forward to.

THANK YOU AMERICA

Posted by: kare1 | February 25, 2010 1:53 AM | Report abuse

Dionne writes: "The way to prevent this to mandate that everyone buy health insurance." Here is your biggest problem - requiring people to purchase something they may or may not need or want. Where's the freedom in this? The choice? What if this conflicts with my ability to persue happiness? Didn't the Constitution guarantee my right to persue said happiness? Why are you trying to violate my rights?

Posted by: zosimos | February 25, 2010 2:46 AM | Report abuse

It is becoming increasingly apparent that Democrats are not prepared to be the majority party. It was poor strategy on Harry Reid and the Democrats' part first to allow Max Baucus to hijack the health care hearings for up to three months last spring and summer, then to wait until after the August recess to take any concrete action.

This allowed Republicans enough time to mobilize opposition to health care legislation, using Dick Armey's Tea Party movement as its wedge.

If Harry Reid and the Democrats now intend to use reconciliation as a means for getting significant health care legislation passed, the obvious question is why didn't they just use reconciliation a year ago? This notion of having a bipartisan bill just for the sake of bipartisanship is silly. Republicans aren't interested in it and they've made that clear from the start.

Finally, President Obama himself shares some of the blame for allowing the process to take on the circus atmosphere it now has. It is nothing short of condescending of him to expect Republicans to jump on board and give him a significant victory on health care for...what? To help him become a successful two-term president?

Eventually, Democrats are going to realize that leadership sometimes means taking people even where they don't want to go, even if you have to do it kicking and screaming. Republicans have never been on board and, just three years out of the majority themselves, are much more interested in re-taking the majority in the Congress than in seeing Barack Obama succeed as president.

Given the Democrats poor stewardship over this issue the past eighteen months, maybe we should just give the majority back to the GOP.

Posted by: sthomas1957 | February 25, 2010 3:54 AM | Report abuse

GET A JOB, E.J.


"Then voters can render a judgment on their actions in November"

Go ahead -- make our day.

Love to put you STEAL-O-CRATS, out of office.

Posted by: russpoter | February 25, 2010 4:42 AM | Report abuse

There is nothing "honest" about the Republicans' "disagreement.

They purport to be in favor of some kind of healthcare reform other than proposals offered by the Democrats when in fact they are oppossed to any healthcare reform whatsoever.

Their only concern is the best interest of the insurance industry not that of the people.

Posted by: WESHS49 | February 25, 2010 5:01 AM | Report abuse

"Their only concern is the best interest of the insurance industry not that of the people"

And yet it's the Democratic proposal to force us to buy insurance from the industry that you so despise.

So which is it?

Are the insurance companies evil?

If yes, then isn't it evil to force us to buy insurance from them?

If no, then why are we having this discussion.

You're poorly thought out on this issue.

Posted by: Ombudsman1 | February 25, 2010 5:37 AM | Report abuse

Regarding Zosimos' comment above: first, a technicality. The Constitution says nothing about a "pursuit of happiness." That's the Declaration of Independence, an important historical document, but not part of American law. Something not technical: if you think you are pursuing happiness by not paying for medical insurance when you think you don't need it, you overlook the time to come when you almost surely will need it, and might not have it because of the selfishness of people pursuing their own idea of happiness by pretending nothing can ever happen to them. You live in a fool's paradise. This is how any kind of insurance works: you pay for coverage, but really, really hope you never have to call on it.

Posted by: sirach | February 25, 2010 5:59 AM | Report abuse

The real value of today's WH HC forum is that it will show Republicans for what they are: a bunch of sore losers who despise American people. They want a Democrtic administration to fail, come hell or high water, and they could not care less about taking the whole country down. Republicans are traitors to this nation.

Posted by: Gatsby10 | February 25, 2010 6:31 AM | Report abuse

If anyone would know about dishonesty, it's E.J.

Posted by: jpost1 | February 25, 2010 7:33 AM | Report abuse

Dishonest - Republicans we know thy name.

Posted by: chucky-el | February 25, 2010 7:55 AM | Report abuse

The 11 Page Obama plan released earlier this week is just a national version of Republican Mitt Rommney's Mass-Care plan writ large. The Republicans want tax cuts for the rich only, and nothing for the middle class from governments.

They are arrogant liars; nothing less.

Posted by: bert8 | February 25, 2010 8:12 AM | Report abuse

I am shocked -- SHOCKED -- that all four of the examples Dionne gives of "bad faith" positions are GOP positions. If he believes that the President and the Democratic leadership are acting in good faith, I have a bridge in NYC I'd like to sell him.

With bloody-eyed partisan fanatics like Dionne on the loose, Democratic pleas for bipartisanship are a joke.

Posted by: miglefitz | February 25, 2010 8:18 AM | Report abuse

E.J., I agree with you whole-heartedly and you have helped the debate by pointing out the distinction between honest and dishonest disagreements. It's the difference between civil rational discourse and hypocritical political fire-bombing. The Republicans have chosen the latter.

However, please revisit your comment that the Repubs did "nothing" (your word) when they controlled things. Go back and look up the prescription drug, Medicare reform bill that was passed. Now, while Congress showed its true colors by prohibiting the importation of drugs and federal negotiation for lower drug prices, they did pass something!

Obama and the Dems have been such a disappointment on health care because their proposals, too, have excluded similar common sense provisions and kowtowed to the health insurance industry. Obama, remember, rightly skewered Hillary for her proposal to mandate that people buy insurance--the only real solution here is fully-funded, tax support, single-payer insurance.

Posted by: Astrogal | February 25, 2010 8:19 AM | Report abuse

We must decide whether or not we are a "country" or merely a "markeplace."

If we're a "country," then we've made the decision that we're all in this together. If not, then let's let our more unfortunate citizens die in the gutters while we strut the globe flexing our military muscle.

The marketplace is all about creating "competitive advantage" for companies. What is "competitive advantage?" It's about institutionalizing a for-profit advantage where a company screws other companies. All the time.

You do it by having a better widget, and or you do it by permanently tilting the playing field your way so your competitors don't have a chance.

We Americans need to wake up, and come into the light that is the 21st century. All other western democracies have government run health care programs.

Why in God's name we would want to "reform" our rotten health care system by forcing everyone to buy insurance from private for-profit companies is beyond me.

Just offer Medicare to everyone. Include it in the tax system. End of story. End of hand-wringing.

Posted by: Adirondax | February 25, 2010 8:28 AM | Report abuse

I voted for Obama because I want universal health care, but not now! Why can't Dionne et al understand we have to get the economy going before we incur more debt? And this plan is expecially egregious because we start paying now and get no benefits for 3 years. Doesn't that tell you something, i.e. we can't afford it?

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Posted by: tuytriuwtuyigtrywrt | February 25, 2010 8:37 AM | Report abuse

Kare1 situation is just one example of what is occurring across this country. It amazes me how the people of this country continue to be manipualated by the fear campaign constantly waged by the Right wing Republicans. They always vote against thier own self interest because most dont understand the issue and rely on dis-information. Yes, thank you America for being so selfish and ignorant to allow this to happen. Another comment that the country is deeply diveded. Well, lets solve that. Draw a line from say NC down, straight across the continent, let the Republicans and nut bags have the south, and people with some comman sense, the Democrats will live in the north. Isnt that really how is should have been anyway. Oh, yeah, we will throw in Alaska so you can all worship that stupid idiot Palin.

Posted by: rjb121891 | February 25, 2010 8:43 AM | Report abuse

“These health bills bust the budget. Oh, yes, why do they include all these tax increases?”

My only comment is this: From what i understand the proposed legislation is morphing back and forth ie. Do you include a public option or not? Do you tax "cadillac" plans or do you postpone and water down this option? Therefore, I am not so sure that the CBO can reliably estimate the down the road cost of Health or Insurance Reform. E. J. do you really expect the government to be able to make the tough decisions to keep this from becoming another unfunded mandate?

Posted by: heinekinrules | February 25, 2010 8:56 AM | Report abuse

Zosimos writes " Dionne writes: "The way to prevent this to mandate that everyone buy health insurance." Here is your biggest problem - requiring people to purchase something they may or may not need or want. Where's the freedom in this? The choice? What if this conflicts with my ability to persue happiness? Didn't the Constitution guarantee my right to persue said happiness? Why are you trying to violate my rights?"
Does he drive a car? What does he do when he has to buy car insurance? This narrow minded selfish attitude defines the Republican approach to the huge problem. They are happy to let insurance companies rake in huge profits ( up 56 % in 2009 )while denying coverage. If consumers did not have to contribute to the redistribution of wealth to CEO's who, among the 5 largest companies averaged $ 24 MILLION last year, maybe the Republican argument could be a little less laughable.
The Republican mantra of freedom, choice and happiness, taken to its ultimate conclusion, means everyone for themselves. This attitude would not have worked very well when we came together to fight WWII, for example. The glue that makes us great is SHARED SACRIFICE. It is the glue that made our efforts in WWII so incredible. We came together to defeat an enemy. The polar opposite is the freedom, choice and happiness BS. We need to look at the health care crisis ( 45,000 Americans died last year because they lacked health insurance ) as a crisis. Left uncorrected and to the voracious greed of private insurers, health care will put a quick end to any perceived " freedom, happiness and choice" that you have.

Posted by: waters1 | February 25, 2010 9:18 AM | Report abuse

mharwick is a fool and is beneath contempt.

As for zosimos, I certainly have sympathy for the position that forcing people to hand money over to the health insurance industry is disgusting, to say the least. Personally, I would be in favor or getting rid of that provision if, and only if, the zosimoses of the world would agree that no medical treatment will be provided, without advance proof of ability to pay out of pocket, for people who make the choice to forego medical insurance, as zosimos presumably would. In other words, if the presumably healthy zosimos was in an auto accident, or suffered a heart attack due to an undiagnosed condition and was taken to the emergency room, he would be willing to have his financial situation be subjected to intense scrutiny before he would be shown the lobby. Whether he was treated would depend on his ability to pay for the estimated cost of treatment. If he couldn't pay, he would be left to die on the sidewalk. Are you willing to make that deal, zosimos?

And while you are at it, don't plan on going without insurance until something goes wrong, or until you turn 50 and think you might need it, and demand that your age and health not be taken into account. Originally, the goal of insurance (developed for the shipping industry several centuries ago) was to spread the risk among the insured, not to make fat profits for shareholders and give bonuses to the fat cats. If you don't want to be part of the risk pool when you are young and healthy, don't demand the right to jump in the pool when you start falling apart. Are you OK with that, zosimos?

Posted by: MyPostID27 | February 25, 2010 9:19 AM | Report abuse

bye dems.

Posted by: 12thgenamerican | February 25, 2010 9:34 AM | Report abuse

Lets see: you need doctors, nurses and support staff and of cause a hospital. You also need treatment. Lets see it seems we forgot there is a medical system besides insurance.

Well who needs doctors when you got insurance? Hmmmmmmmmm. Has anybody really seen a medical bill? How about the cost of research? Is there really something called cost control besides politcal speeches.

As a matter of fact what is this FDA agency and is it really protecting patients or maybe just drug companies. Since those in the FDA may go to work for drug companies isn't this a conflict of interest. Worse some people in research seem to have conflicts of interest.

And people throught the Roman empire was having internal problems what about our health care system? In the end it seems that the only reform you get is higher insurance or medical costs as everything and everyone wants more and more. And they call this reform!

Posted by: artg | February 25, 2010 10:01 AM | Report abuse

The Republican base has always favored:
- smaller government
- less regulation
- lower taxes
- free market approaches.
Republican leaders who go to Washington sometimes abandon these principles.
They better not abandon them today in the healthcare summit.
Hang tough. Solidarity forever.

Posted by: jfv123 | February 25, 2010 10:01 AM | Report abuse

Ombudsman1, The Democratic proposal to force us to buy from the insurance industry was a compromise offered to the Republicans … Removing the Public Option from the bill.
Put all the facts on the table before you accuse someone of poorly considering an issue.

Posted by: burtonpaul | February 25, 2010 10:11 AM | Report abuse

Posted by: zosimos Didn't the Constitution guarantee my right to persue said happiness? Why are you trying to violate my rights?
---

That same document instructed the government to "promote the general Welfare". It also established a legislature based on representative principles. So now 60% of Congress is controlled by a party that theoretically wants to solve a pretty critical problem. The minority is not at all committed to solving the problem. Instead, they want to promote "market based" solutions. The market solutions already exist, indeed that is the problem to solve. But it is pretty pointless to say all this. The GOP will agree to none of this. And they are just doing want they do best, saying "NO"

I fault the Democrats 100% They control 60% of Congress and still can't/won't get the job done. It's their constant dithering that is to blame. Even at this point the House could just vote the Senate bill and it would be done. It wouldn't fundamentally solve the problem but it would be a freakin miracle to even get that at this point.

Posted by: tfspa | February 25, 2010 10:20 AM | Report abuse

I voted for Obama because I want universal health care, but not now! Why can't Dionne et al understand we have to get the economy going before we incur more debt? And this plan is expecially egregious because we start paying now and get no benefits for 3 years. Doesn't that tell you something, i.e. we can't afford it?

Posted by: linus12

-------

Linus, buddy, you're arguing that you want Universal Care, but want to wait until it's affordable?

Think about it. When will health care EVER be affordable if changes are not made now? The system is fatally broken, yet you are content to stick with the status quo because it may cost more money?

Think about this … I'm willing to bet that if you receive a yearly bonus, it's roughly 4% of your salary. That's about the average size of a raise. On the other hand, health insurance companies regularly increase their fees by roughly 20% per year. Do the math.

No matter how well you do under the current system, you will be living on less and less because your health care costs will continue to outpace your salary increases. The older you get, the less you will have. Period.

Universal Care solves this problem. How much better would you be able to live knowing a health issue would not bankrupt you? How much more satisfied would you be knowing you had an extra $450 per month in your bank account or in your retirement account?

Think about it.

Posted by: burtonpaul | February 25, 2010 10:21 AM | Report abuse

mharwick

Don't sugar coat it. Tell us what you feel about fixing a broken, inadequate, unfair, overpriced heathcare system that denies so many Americans access to healthcare.

I am impressed with your ability to cleverly coin a phrase: " this travesty of a mockery of a sham of rationed, expensive miserable, government controlled, tax raising, budget breaking Obamacare."

Where you are not quite up to the task is in responding to the substantive points made by Mr. Dionne. Unlike another poster, I assume you read the column and your respnse is either due to your inability to understand what he said, or to form an answer using logic, reasoning, and evidence - probably both.

Insurance of *any* kind is viable only if those insured represent a large pool; the larger, the cheaper the insurance. Imagine if out of a group of 10 milion, only those presently in hospice care applied for life insurance this afternoon. I'm gonna guess premiums would be so high that no in the hospice could afford them.

Now, if these same 10 million people all took out life insurance 10 or more years earlier, you'd still have exactly as many in hospice care today, but their insurance premiums would be affordable - because the risk to the insurance company had been spread amongst all 10 million, only a small fraction of whom would be in pospice care.

Heath insurance rates are rocketing upward now, in large part, because the pool of insured is shrinking. People who have health risks are much more likely to buy insurance. Thus the companies need to raise rates; but as rates go up, those who are the next most healthy decline coverage, shrinking the pool further *and* creating a group of the least healthy swimmers. The process continues each year. This phenomenon has been called the "downward spiral" of rate increases, among other things.

We are seeing this now all over the country, especially California, where rate increases will be as high as 39% *in one year*.

I took the trouble to write the above four paragraphs, not so much to make the point, which has been widely made (although strangely, never by Republicans), but because I wanted to show you what an "argument" looks like. An argument consists of three components: 1) a claim; 2) reasoning, and 3) evidence that is tied logically to the claim.

Frankly, your post looks like that of someone who failed to take advantage of America's education system. I'm sure that's not your fault. But allow me to suggest that you calm down and think before writing. One thing I suggest thinking about is: Am I about to make an argument, or to make a complete fool of myself.

I am fully capable of the type of rant you wrote. I hope you found writing it cathartic and now feel better. I reserve my rants for my wife, and when writing for public consumption, do my best to use reason.

Except for being on my fifth marriage, it seems to work.

Posted by: jhocking1 | February 25, 2010 10:23 AM | Report abuse

It is SAID that Republicans & Conservatives favor small government and budgets. The REALITY is that the federal government explodes when Republicans control the government. Reagan & Bush each doubled the debt. It's what happens when you increase spending, and reduce revenues (cutting taxes does that) (not apolitical statement, but an observation of what happened).

Starting with Reagan, and especially with Bush, income inequity in this country has reached the levels that existed before the depression. (not a political position, just an observation). Hence the capitalists came with their handsout to, you guessed it, the federal governmnet; and Bush filled their pockets with almost no conditions.

It is time to take care of US, who actually pay the piper!

So, Republicans/Conservatives: keep your tax cuts, since they drove the economy to a free-fall. Spend money on us, since LIVING by itself requires a health care system. It is not an option, nor a consequence of being employed. It is a consequence of living. I hope that the 'por-life' party will try to improve the life of the living.

Posted by: AMviennaVA | February 25, 2010 10:26 AM | Report abuse

The President challenged anyone who had a health care plan that gave coverage to everyone, costs no more than we spend now, and had enough details to be examined by experts. Here is an answer.

We can give good coverage to everyone and spend no more than we are now spending, probably less. Furthermore there is a bill, HR676 that does exactly this and it is certainly detailed enough for Obama to submit to experts, but he doesn't need to because experts have already costed it.
This bill simply gives an improved Medicare to every man, woman and child. The elimination of private insurance companies would save $200 Billion in overhead and at least $200 Billion in physician and patient compliance costs each and every year. There is another $100 Billion that could be saved by lowering drug prices by the elimination of drug company marketing.
After all, other industrialized countries get better health care as measured by all 16 of the bottom line public health statistics and they do it at HALF the cost per person. If we could get efficiency like that we would save about $1.3 TRILLION each year.

You can google HR676, go to www.pnhp.org to see the facts. Further data can be found on the site of the OECD.

As for sustainability of Medicare, Uwe Reinhardt has computed that using CBO projectons, in 2050 the average guy will have 70% more money in real dollars after paying for Medicare than he does now. The runaway expenses are all in private insrance which has and is going up much faster than Medicare costs.

Posted by: lensch | February 25, 2010 10:27 AM | Report abuse

The Republican base has always favored:
- smaller government
- less regulation
- lower taxes
- free market approaches.
Republican leaders who go to Washington sometimes abandon these principles.
They better not abandon them today in the healthcare summit.
Hang tough. Solidarity forever.

Posted by: jfv123

---------------


The Republican base has always had extremely short, confused memories
- smaller government - The Bush Administration oversaw the largest expansion of government in the last 100 years.
- less regulation - Like wiretapping?
- lower taxes - With unfunded tax cuts paid for by Chinese loans.
- free market approaches - That led to a world wide economic collapse and an arrogant, deeply corrupt corporate culture.

Yeah, hang tough guys. Ignorance and shortsighted stupidity forever!

Posted by: burtonpaul | February 25, 2010 10:29 AM | Report abuse

I had a beautiful BCBS HSA policy that I my employer wouldn't cover and had to take one of their "ok" policies. Now if I decide to change careers, I'd have change it over again. This is ridiculous in this age of modern e-Commerce

Just let us buy our insurance from any company in the Nation, make it portable between employers/selfemployment, as well as carryover during reasonable periods of unemployments.

Imagine this: if you think your insurance cost too much, and all of a sudden you can get an instant quote on the internet, just like you can do today with auto, life, and disability insurance. Every insurance co. *already* had the Web-based software infrastructure to post their products online. Costs would plummet.

What is so hard about this? Perhaps it just goes to show how much the liberal Dems are stuck in the 40s New Deal mindset.

Posted by: tom2 | February 25, 2010 10:36 AM | Report abuse

MyPostID27: hits the nail on the head. repeal the law that says the ER has to treat you regardless of ability to pay and we can talk about freedom. Until then, you can't guarantee me that you won't wind up in an ER and pass your bill on to me when you can't pay. so I want you to buy insurance for the same reason I insist that you have car insurance. you might hit me and stick me with the bill for the damage to my car.

Blue Cross of CA raised rates 38% because young folks have no choice but to bet they won't need health care because they can't afford their policies, and without healthy folks paying premiums and not needing care, there's nothing left over for the sick, so premiums go through the roof. The cost of care is skyrocketing.

What the analyses don't keep focusing on is that if we do nothing at all, it will cost a lot more than the president proposes to spend. that's why the CBO says this will reduce the deficit, not increase it.

and that's without scoring the savings that result from the uninsured going to their doctors instead of the ER, like they do now. that can't be scored by CBO because it's too hard to compute, but anyone in the hospital business knows that we will get back most of the money we spend on coverage in the ER visists that don't go unpaid for.

Posted by: JoeT1 | February 25, 2010 11:20 AM | Report abuse

tom2: democrats aren't opposed to your idea (which is on the mark), they just repealed the antitrust exemption for insurance companies, and they were the proponents of a national exhange for policies that could be sold nationwide. it's in there.

Posted by: JoeT1 | February 25, 2010 11:23 AM | Report abuse

These Dionne columns are all written by robots and smuggled out the White House back door.

Posted by: clankie | February 25, 2010 11:52 AM | Report abuse

The dishonest disagreements come from those on both sides who want to protect the massive profits of the health insurance companies and the way those companies exploit what is left of the middle class.

Those folks include most of the GOP and several Democrats too.

Posted by: tinyjab40 | February 25, 2010 12:23 PM | Report abuse

The fundamental problem with fixing the medical system is our tax codes and policies. For far too long, we have used taxation as a social engineering tool, and that should stop. If you want universal health care for everyone, some way has to be found that correctly allocates current medical insurance expenditures as part of our taxes. If I pay $100/wk in taxes and $100/wk in medical insurance, for a total of $200/wk., I do NOT want to see that total grow. But if you reduce my taxes and increase the medical, or increase the taxes and reduce the medical, then I'll seriously consider it.

Posted by: tmkelley | February 25, 2010 12:32 PM | Report abuse

The Republicans have managed, by sleight of hand, to completely obscure the only possible solution:

NOBODY, on either side, dislikes Medicare. Why do we even need Medicare anyway, as a program that is only applicable to people over 65? Is it because the private insurance companies can't make a profit insuring those folks, because they are the expensive end of the spectrum of health care consumers? Private insurers don't even want them as customers.

Why shouldn't Medicare apply to people over 55? Over 45? Over 35? You see where I am going. It's called single-payer.

As we have it now, the government has this public program that everybody loves, because it does a BETTER job of insuring people than private industry can do. So the argument that the Federal Government can't handle comprehensive health care turns reality on its head. It's PRIVATE INDUSTRY that can't handle it.

Posted by: zenwick | February 25, 2010 12:48 PM | Report abuse

If the healthcare bill passes, please include the added costs to the State of California. About two million adults are not insured and many more will lose their jobs and insurance when the State budget axe tries to solve a $20 billion deficit.
Since adults will be required to buy insurance, those who don't will be fined, and those who don't pay the fines will be incarcerated. So, California needs an additional $20 billion to start building jails and prisons to accommodate the millions who don't buy insurance or pay their fines. We also need to train prison guards to take care of a few million criminals who can't and won't buy health insurance. And, it is impossible for those in prison to get a job and difficult for them to get a job later. So, the Federal Government must be prepared to fork over about $20 billion a year for many decades to come. And, those politicians who vote for the healthcare farce just might want to watch their backsides.

Posted by: hurleyvision | February 25, 2010 1:02 PM | Report abuse

To my way of thinking, there is a fundamental flaw in all of this. The free market has determined that 20 or 30 or 40 or whatever million people do not choose or do not contribute a significant enough component of value to the economy to justify that the other participants in the economic system pay for their health care.

What has changed to make this NOT so, other than a bunch of people saying it with conviction?

Is there anything more intrinsically American than if you don't have the money to pay for it, you can't have it?

There is no end of taking from the even moderately successful and giving it to the not, if we keep going down this road.

Fix social problems like this with a better economy and better jobs, not handouts and income redistribution.

Posted by: efg2 | February 25, 2010 1:05 PM | Report abuse

Thank you, Zenwick. You are 100% correct in holding up Medicare as the best argument for single-payer coverage (and for showing private health insurance to be the scam that it truly is).

Would those who oppose single-payer coverage oppose other cases where the public pays taxes and essentially pools risk? How about getting rid of public police departments, for example, and those that choose to can buy "crime insurance". If somebody breaks into your home, or assaults you, you can call a private sector cop, if you have crime insurance, and let that person handle your case. If you elect not to buy crime insurance, you will have to investigate the crime yourself. Or fire insurance - if your house catches fire and you have elected not to have fire insurance, do your best with your garden hose, or it will burn to the ground.

Of course, nobody (well, maybe except for about half the people who have posted comments here) would advocate getting rid of the form of insurance and pooled risk that police departments and fire/rescue services represent. And such services are not a condition of one's employment. Why should a reasonable, not to say extravagent, level of medical insurance be tied to employment? The bigger the pool, the fairer the results.

Posted by: MyPostID27 | February 25, 2010 1:19 PM | Report abuse

@MyPostID27

Exactly, thank you. No one would seriously propose privatizing all these non-defense government functions, and many more such as road construction.

I heard a very bright Libertarian-sounding person on the radio the other day, saying that the only solution is for informed consumers to shop for health care. If they pay for every service out of pocket, they will lower costs by finding the best value. Government need not be involved.

That's such a marvelous idea! When he's suddenly stricken with a heart attack, I fully expect he will be on the phone to speak with different ambulance services, doctors, and hospitals to see what they offer and at what price. He can check with Consumer Reports and the Better Business Bureau, also.

Posted by: zenwick | February 25, 2010 2:24 PM | Report abuse

What part of NO BIG GOVERNMENT SOCIALIST HEALTH CARE don't the arrogant vermin in Washington understand? EJ do something useful and go wash my car.

Posted by: carlbatey | February 25, 2010 3:47 PM | Report abuse

Note to carlbatey - do something useful and go wash your own car, you stupid piece of garbage.

Posted by: MyPostID27 | February 25, 2010 4:30 PM | Report abuse

"I heard a very bright Libertarian-sounding person on the radio the other day, saying that the only solution is for informed consumers to shop for health care. If they pay for every service out of pocket, they will lower costs by finding the best value. Government need not be involved."

A brilliant concept! 2 years ago I suffered a heart attack at 4:30am. I had so many options and so much time to do comparison shopping! Yes indeed!!

Actually, the reality is that I'd be dead if I did the comparison shopping bit. This 'market' stuff works fine with cars, knives, clothes, even food. But it does NOT work with emergencies (your house is on fire ... quick see which fire company is willing to come by in a hurry ... yeah! right!)

By the way, the CATO institute is the prime Libertarian think tank. It is interestingly named: Cato the Elder would neither feed nor care for his slaves who fell sick. They had to recover first. How is that for a health care plan?!

Posted by: AMviennaVA | February 25, 2010 5:03 PM | Report abuse

It should not surprise anyone that Dionne or Robinson would say Obama/Democrats came out of the summit looking good. When is the last time (or has there even been a first time) either of this liberals have critized the nobel peace prize award winning Barak Obama. The most important issue facing our nation is the economy but we get a summit on health care? Good to know these two are willing to give the president/democrats a pass on dropping the ball on what they even called "their number one priority." Oh but i forgot Obama's legacy is riding on the issue of health care. Democrats need to do a better getting their boss back on track (economy 1st) or else after the midterm elections in 2010 will put democrats in the minority. But maybe that's not such a bad thing.

Posted by: brett3sigep | February 25, 2010 7:37 PM | Report abuse

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