So the Dems cave again. The bill was meaningless to many of us anyway. It takes effect in 2013???? WTF. Come on, guys. The Dems will still have my vote vote but they're very nearly as bad as the Thugs stormtroopers..

There are more people uninsured in this country than there are people in Canada, everyone of whom has health insurance. The way the Cowardcrats are going, there will soon be more people in this country without health insurance than there are in the United Kingdom, all with health insurance.

F*cking coward Democrats.

. . . if lawmakers drop the public option, the rest of the legislation better be pretty damn amazing.

As "amazing" as the proposed reforms for Wall Street? As "amazing" as the vigorous crackdown on contractor fraud and corruption in Iraq?

As each month passes it looks more and more like Obama is nothing more than another tool of large corporations. But to give him the benefit of a doubt, maybe he's just a believer in the current legislative process and sees nothing wrong with Congress being tools of large corporations.

let me be a little sharper than the boyish "better be amazin'"

if there is no public option, the obama admin and the democratic majority are no longer busy bein' born... they are busy dying...

if obama fails getting something decent thru, his administration is effectively over. the republicans will smell blood and the media will be only too happy to accommodate such a message.

for another look at how utterly corrupt congress is, the nyt has an editorial about air passengers being stranded for hours on tarmacs and an attempt to pass legislation that after three hours held hostage, the airlines have to offer them an opportunity to deplane. because of airline industry lobbying, they can't even get something like that passed. of course, wait until one of those assholes gets stuck on a tarmac for 6 fucking hours -- then maybe some passengers rights legislation will be acted upon.

If Dems think they can pass a bill that forces people to buy private insurance (read: subsidize CEOs, shareholders and healthcare lobbying), and then claim that this will improve the healthcare system in America, they have another think coming. And if Rebublicans think such a disaster will make them popular, they're even dumber than I thought.

I hope that the White House and the Congressional Democratic leadership enjoy the time they have left in office. They've given up on everything that matters and, come the next election, we're going to give up on them.

as bob dylan sang, "there's no success like failure, and failure's no success at all."

Yup. my thought was that it was inevitable that the White Man's Millionaires Club would manage to make out of reform something worse than we already have. And here it is--a mandate to buy horrendously expensive and useless (when you need it) insurance. And even more profits for the insurance industry.

Inevitable. And totally Obama's fault. No regulation of the finance industry, huge bailouts and Wall Street bonuses, and even more useless Pentagon spending. Democrats are hopeless.

Never under any circumstances negotiate with Republicans. They are liars, traitors, and perverts. Every damn one of them should be stripped of his citizenship and put in prison forever. That the Democrats haven't figured this out is evidence that they are too stupid to be allowed in public office. The hell with all of them.

No Public Option will mean

OBAMA gets branded

L*O*S*E*R

for the rest of his ONE term in office...

politically, he will be just media-chewed bones with in six months.

and then the people of the united states will hafta pay for their undisciplined and transgressive vote to put him in office and will suffer at the hands of their washingtonian minders for the corporate interests...

a failure of obama and the dems makes that absurdity, newt gingrich (future of the republican party) the future of the united states of america, who will use mittens romney as a barbell to get ready to rally the crazies in '12 to beat barack.

you heard it here first, folks. now somebody just come shoot me...

Today's advice to the Restofus: Stay Healthy. . .

The only alternative to a public option would be a way to force insurance companies to lower their prices to the point where you could get enough money to cover your premium by picking up cans along the highway.

We voted out totally corrupt corporate shill Republicans for what? Moderately corrupt corporate shill Democrats? Hope and Change folks.

So, shouting beats discourse. Threats beat policy. Democrats beat themselves. Money beats people. Ignorance beats change. Palin beats hope.

Where's my fucking passport? Or better yet, can I talk to my death panel now?

How could Dancing With the Stars even exist if it had to compete against Sesame Street?

Or Hollywood Squares? Or Oprah?

Think what we stand to lose!

Health care, unlike so many other things government does, cannot be hidden. Everybody uses it, or can't get access to it, or goes bankrupt because of it. It deeply effects every American's life. If you fail to fix our broken system, you cannot depend on that failure to be a safe distance away from the electorate so that they will forget it by the next election. There will be every day reminders for every American all the way up until the next election day. This bill is shaping up to be a failure that will squander the unprecedented rise of the Democratic party over the last 3 years.

I am going to become a medical ex-pat. Mexico is nice and the healthcare is modern and not designed to enslave people.
I wasted my time and money on the democrats. This country is rapidly turning into a real shithole because of Republicans and corrupt, spineless Democrats.

You have to abandon all hope in order to proceed. Meaningful health care reform, as well as anything that requires going against our corporate masters, is never going to happen in our system. "Fighting" only prevents real progress, which has to come from within.

Generate new neural pathways. Step outside the box. WAY outside! Liberate your self. No other solutions possible.

How will the unrich who are uninsurable satisfy the new federal requirement for being alive? They must buy health insurance from companies who are only regulated by the states? Who will sell them the license to live and at what price? Talk about wrecking an economy. Of course the rich will get richer.
Dumb corrupt bastards all.

People who have read the House bill understand why it will take until Jan 1, 2013 to start offering actual policies. If someone would like to examine that time table and suggest how it could be shortened then fine, but it is not like you can just wave a magic wand.

First the bill proposes an 18 month time table from the date of enactment to get final requlations adopted. The first year of that is consumed in getting the Health Choice Commissioner nominated, confirmed, and the overall Heath Choices Administration staffed and up and running. At the same time the Benefits Advisory Committee will have to be put in place and do theirwork finalizing the details of the Essential Benefits package. I suppose you could do an end run on civil service rules to staff up and di a rush job on the benefits package but realistically how much time can you boil out of that first year?

The next sixth months is equally constrained by current law requirements about publication and public comment. Once again it is hard to see how you squeeze that.

Okay Jan 1, 2013 is a fixed date but obviously enactment is not. We can hope that that will be on Jan 1, 2010 or before, but in these matters hope is not necessarily the best plan, the authors had to count on some time slip.

But say everything does well and all regulations are finalized and in place by June 30, 2011. Why not start up? Well if you READ THE BILL you see that kicks off a contract negotiation period between those companies wanting to participate in the Exchange and the Commissioner. Once the contracts are approved the companies have whatever time remains between that approval and Jan 1, 2013 to administratively implement the plans and to market them to the individual insurance and small employer sectors in a way that allows them to start handling claims from day one. There is no magic wand that simply would have those forms and procedures write themselves overnight.

I have looked at the time table and calculated that in a perfect world you could squeeze a year out and with a Jan 1, 2010 enactment date be up and running by Jan 1, 2012. But there would be no room for error and plenty of opportunity for opponents to play 'I told you so'.

I don't have insurance and need it. Now. And most of the job opportunities open to me right now won't offer it. I would like nothing better than a magic wand magically putting a public and private infrastructure into place by this fall, it would be a great gift from Santa. Look! A shiny new Exchange!! But I have been living in the real world for five decades now and life doesn't work that way.

Generate new neural pathways. Step outside the box. WAY outside! Liberate your self. No other solutions possible.

Good idea. Then we can just pretend we're not sick and dying while not being able to afford or rely on getting treated. It's all about positive thinking, right?

Mr Benen, what was the last "amazing" bill passed in your opinion?

What was the last good bill, for that matter? A bill that genuinely benefited regular people and not the rich or special interest groups?

I do not think the Democrats ever wanted true health-care reform. And I'll tell you what this means, as far as I'm concerned. I will stop voting. I voted a straight Democratic ballot for the first time in my life in 2008, but since Democrats don't see a need to represent me, I don't see a need to vote for them.

F*CK AMERIKA...

Rethugnicans ready to screw over the Amerikan sheeple to f*ck Obama...
Rethugnicans ready to screw over the Amerikan sheeple to please their corporate masters...

Dumbocraps for sale to corporate Amerika...
Dumbocraps unwilling to fight for the Amerikan sheeple...

Toothless, spineless dumbocrap leadership in the senate...

A toothless, spineless president ready to accept a half a loaf of stale bread so that he can say he brought home the bread...

Read damn close to completely giving up the hope that the Amerikan sheeple can be served by the government and not just corporate Amerika.

Damned if I don't want to win the Powerball so I can afford to move to New Zealand.

For real change - Feingold/Sanders in 2012!

It seems to me that it is now more important, beyond the public option itself,

to prevent these kind of people, the lobbyist organized gangs, from having a victory in this.

They stopped the recount in Florida and gave us eight years of all but outright fascism, if they win here they're a political party whose first course of action will always be mob violence and physical intimidation.

no bruce, life doesn't work that way in corporate america where all the procedures trickle down form the high offices in a slow very controlled plan. life works bureaucratically, indeed, private or governmental.

but here's what you just missed... there aint a gonnna be no health care for you or me in 2010, 2011, 2012 or ever, as far as what is shakin' right now with obama and the dems.

no public option means it is all smoke and mirrors.. all of it.

you might as well go with john hamilton farr and bishop berkeley and just play games with your neural pathways -- and may i suggest as a final option, opiates?

Bruce, I too need insurance and need it now. The longer this takes, the more it's gamed for the money and gutted for us.
And when I see Democrats like Cong. Heath Schuler refusing to support health care, I wonder if this two party thing isn’t a joke. I seem to recall Hunter S. Thompson (may he rest in peace) sayin’ “The Progressive cause in America will advance over the corpse of the Democratic party”, and I’m beginning to think he was right.
“Keep your Government out of my Medicare” sums up the stupid.
And I’ve come to realize all this Death Panel stuff is pure Freudian Projection: these old bastards would send me to death because I'm gay, as well as the poor or ‘undeserving’, so they think we would tell doctors they were candidates for euthanasia.

Sure it's a letdown, but let's at least discuss how reforms could at least make things better.

How many people bitching and moaning in liberal blogs bothered to go to a town hall meeting carrying big ass sign demanding a public option?

Sure it's a letdown, but let's at least discuss how reforms could at least make things better.

spoken like a good ol' democrat...maybe you and kent conrad can come up with somehting really really cool, man... maybe that's why you are the b team...

i'm thinkin' more of ol' joe... heart of darkness...

zhak said:
I will stop voting. I voted a straight Democratic ballot for the first time in my life in 2008, but since Democrats don't see a need to represent me, I don't see a need to vote for them.

After Clinton proved to be nothing but a Republican-lite liar who couldn't keep his pants zipped, I voted for the Green Party in 1996. When Al Gore couldn't decide which manufactured persona to wear week to week, I voted Green again in 2000. In 2004 the stakes were too high and I held my nose and voted for Kerry. Last year I thought I had a candidate who really would put the interests of people like me -- oh well . . . .

When I voted for the Green Party, I wasn't voting for Ralph Nader. I was voting to get the Greens over the threshold to get a permanent spot on my state's ballot and to get them into the debates.

Don't give up your right to vote. Use it to get someone besides the Pro-choice Corporate Party and the Anti-abortion Corporate Party into the public discussion.

Speaking as someone who is in a country with multiple parties, if this happens, it's time for the "progressives" of the Democratic Party to break away and form their own "Progressive Party".

That's the only way you're going to get the message thru to the Democrats that your votes cant be taken for granted.

Heck, don't even worry about running a presidential candidate for now. Just make it a Congressional-only party.

i didnt get to a lot of town halls, just one -- but i did kill and eat some of the teabaggers... they do indeed taste just like chicken...

and by the way, there are sill plenty of townhalls to go to.

i'd suggest yelling leftwing abuse at yer congresscritter as counterpoint harmony with the teabaggers' rightwing craziness. have a real nice choir effect...maybe a circle dance'll breakout and everyone takne up to hebben...

is there a point to your question or is it just, you know, scapegoatin'?

Plus the House Bill is pretty amazing. Now I get that the Senate Finance Bill is going to suck and that Conventional Wisdom is that it will have to be the basis of any subsequent legislation but I don't see any satisfactory explanation why that has to be.

I asked a similar question yesterdat at dKos and people treated me like I fell off the turnip truck. But no one gave an answer.

I can see no Constitutional barriers to Senate leadership simply taking up a passed House Bill and sending it directly to the Senate floor. In fact by the strict language of the Constitution that is the normal order for a revenue bill. Once the bill is on the floor all actions to specifically delay it or amend it require 51 votes. So while opponents can extend debate they have no ability to reshape the bill without a majority.

Now on the Baucus plan the shoe is on the other foot, once he gets the Finance Bill established as the starting point he can beat back amendments via a threat of the filibuster, he only needs 51 votes for final passage.

So if we start with the House Bill supporters of the Public Option just have to maintain 50 votes to block changes, and this knowing that some Reps will never vote 'Yay' on any part of this legislation, and the default position is the pretty good House Bill. In this scenario Baucus' only real weapon is a filibuster on final legislation. While if we start with the Senate Finance version all the control is on his side. Yet the working assumption is that we have no choice but to surrender right away?

Why? Senatorial courtesy and a bow to tradition? An appeal to some bi-partisanship that doesn't exist and won't be there? A belief that when it comes right down to it Blue Dog Senators want to face their constituents having done nothing but kill the legislation?

dKos commenters all argue on the lines of "well, that is not how it has been done for decades" or "the Courts have refused to rule on this". Well tough shit, it is time to play hard ball. And the Constitution could not be clearer on this:

"Article 1 Section 7 - Revenue Bills, Legislative Process, Presidential Veto

All bills for raising Revenue shall originate in the House of Representatives; but the Senate may propose or concur with Amendments as on other Bills."

So why not give a big FU to Baucus and proceed as follows:
Step one: Dodds and reps for Kennedy negotiate with Pelosi and the Chairmen of the Tri-Committees to get changes needed to get a 50 vote count on final in the Senate PRIOR to passing the bill in the House
Step two: the now modified bill passes the House
Step three: Reid brings that bill to the floor as is
Step four to whatever: Let Baucus try to get 51 votes to get his version substituted or to make other changes.

What is the legal obstacle to this? If there is no such obstacle, what is the political downside? Pissing off Baucus and Conrad? Because for me that would be a feature and not a bug at this point.

What is fucking point if no public option? You can talk all you want for regulations for the bloodsuckers insurance industry, but Jesus, give me a fucking break. Everybody knows there will be workarounds on that bullshit. Yikes.

Neill I don't like it either, but if we don't figure out how to make good of the bill that can pass, we won't even have half a loaf. But please continue to press for better than that.

BTW, us commentators don't have votes in Congress and it's apples and oranges to compare us to legislators. We only have the power of the pen, or recycled electrons (not counting new ones coming from beta decay, pair production, etc.), to argue how best to take advantage of what we have.

SteveT, it's sad but true that votes for Greens etc. usually just get Repugs elected. Not voting for the LO2E is usually a vote for the GO2E. The Greens etc. need media outlets, appointments in cabinets etc. more than to try to muscle into two-party politics.

Victory is in the air. We can pass a good health reform bill, not a big government health reform bill. Sorry, leftwingers, but it appears your socialistic dreams will have to remain fantasy for now.

@SteveT: I never thought Obama was as much a man of the people as his rhetoric suggests. I live in NH, which means I get to choose from the whole pile for the primary, and I did not vote for Obama. I did vote for him in the general election, because the shift of power and governance to the right (& not just to the right, but to the stupid right; they've totally parked their brains at the door, it's sickening) over the past 40 years has taken my country to its lowest point, I think, in its history. The Democrats needed to have a chance to right the wrongs of the last decades. But that is not happening. What we're seeing is all sorts of gentlemanly conciliation to the minority party.

It's the minority party for a reason.

Unlike FDR's time, nowadays only a tiny percentage of the American public is really paying attention, and of those, only a small percentage looks beyond the soundbites to the actual merits of each side. (I got a big kick out of the people saying FDR had it easier because there weren't blogs & such, but there was a huge, intelligent, energized bulk of the population and the radio ratings for political events were massive.) I think Reagan's "reform" of educational standards has had a lot to do with the rise of the stupid.

But it's fairly clear, even this early on, that modern-day Democrats are unable to represent the people who voted them into office. And therefore, there is no representation of the people.

There has never been a really good president in my lifetime -- Clinton was the best of the lot & he watered things down so badly that, as you say, he was basically a Republican in Democrat's clothing.

It's just all very disappointing. My father & his generation helped raise America to an incredible height. But instead of following through on that promise, we've squandered it. And squandering it by pandering to a small but vocal group of crazy people and a bunch of politicians owned by insurance companies is just too much for me.

As far as negotiating strategies go, the Dems long ago adopted the losing position of pre-concession as a way of.....avoiding disappointment? Avoiding conflict? Avoiding being held responsible? Avoiding taking principled positions, and fighting for them? Making nice; soothing ruffled feathers so's to ease the passage of future legislation? Taking the 'long view'? Harry Reid is the poster boy for this uniquely American penchant for "being nice," but a destructive passivity lurks at the core of everything Dems do. I think it's both structural (a disparate caucus open to highly individual worldviews) and personal (folks who truly believe that aggression and assertion of power of any kind, even if focused and principled, are unacceptably distasteful). Regardless, I'm with Benen and Krugman. This is a litmus test, one that holds for myself not insignificant real world consequences. If I'm going to be forced under threat of penalty to buy health insurance, and if said insurance is backbreakingly expensive, the Dems better believe that I and many, many like me might have something to say about their job security. Unlike other posters here I'm not going anywhere, and I'm not going to withdraw from engagement. The Dems better internalize, quickly, that this legislation has enormous consequences for their future as a leadership party. It's long past time for Team Obama to put the pressure on, and I'm going to make my own predictive assessment here. Based on the evidence, and in particular some of the statements of Obama's chief of staff, I think the Dems, and in particular Team Obama, might be making some extremely poor political assessments and calculations. I hope I'm wrong. But the evidence for a bill giving actual relief to working Americans is not good, and if Team Obama's recent activity/attempts to 'reframe' the debate are any indication they are in way over their heads with this one. Chicago rules and “making nice” ain't gonna win this, and the calculation that ANY bill would be a 'victory' (see: Rahm Emanuel), which might bear in the short term, will have long term negative consequences for the health, physically and politically, for this country. Our elected representatives need to start pushing like they mean it, because they are and will be judged not on their behind the scenes policy legerdemain, but on their perceivable passion, commitment, and willingness to fight for what they believe in. Calm and cool will not win this battle.

So with the demise of the public option, what are we left with? A mandate forcing everyone to buy insurance from private companies that will fix prices at the highest level possible(as they so clearly do now -- or why would the government have needed to provide a public option to force them to compete?). Yeah, that'll bring costs down.

And is it just me or is "they'll have to cover you" masking a massive loophole -- ie. yes, the insurance companies will have to accept you as a paying customer but they can still deny specific treatment they deem "non-cost effective" (that might cut into their bloated profits and CEO compensation) or raise your premiums to stratospheric levels few can afford. Supposedly some treatment will be mandated, but enforcement will be such an overloaded nightmare that the companies will literally get away with murder before the government can force them to pay. They'll game this any way they can and when the public becomes outraged at a system that's demonstrably worse than now-- the health care industry and the Republicans will blame... Obama!

I'm amazed the Democrats don't see this coming.

"if lawmakers drop the public option, the rest of the legislation better be pretty damn amazing."

That's why there MUST be a Public Option, as there is no way the rest of the legislation will be anything even close to amazing.

People really do need to read the House bill.

Why are insurance companies screaming even though the bill will deliver them millions of new customers?

Because Sec 116 of the House Bill guts their ability to game the system in the predatory way they do today. The Public Option is very, very important particularly in the long-run. It is worth taking the fight to the last breath, because it leaves ultimate power pretty clearly in the hands of the public, they can walk from any private plan that manages to game the system. But really under the protections built into Sec 111-116 gaming can only happen with the specific collusion of the Health Choices Commissioner and the private companies. Which of course if we ever get another Bush is exactly what would happen. But if the rules are applied as written Private companies are simply handcuffed, even if they get around Sec 111-115 their profits get controlled by the rebate provisions of Sec 116. In order for them to continue their current practices they need to kill not only the P.O. but Sec 113 and Sec 116 as well. And they know it, if you look closely you can see that they are focused in their like a laser beam. The devil is in the details.

SEC. 113. INSURANCE RATING RULES.

(a) IN GENERAL.—The premium rate charged for an insured qualified health benefits plan may not vary except as follows:
(1) LIMITED AGE VARIATION PERMITTED.—By age (within such age categories as the Commissioner shall specify) so long as the ratio of the highest such premium to the lowest such premium does not exceed the ratio of 2 to 1.
{me- Insurance companies are holding out for 5 to 1 or 7 to 1 ratios}
(2) BY AREA.—By premium rating area (as permitted by State insurance regulators or, in the case of Exchange-participating health benefits plans, as specified by the Commissioner in consultation with such regulators).
(3) BY FAMILY ENROLLMENT.—By family enrollment (such as variations within categories and compositions of families) so long as the ratio of the premium for family enrollment (or enrollments) to the premium for individual enrollment is uniform, as specified under State law and consistent with rules
of the Commissioner
{me- nor can they screw around by charging different co-pays for various elder or family specific coverage}

SEC. 116. ENSURING VALUE AND LOWER PREMIUMS.

(a) IN GENERAL.—A qualified health benefits plan shall meet a medical loss ratio as defined by the Commissioner. For any plan year in which the qualified health benefits plan does not meet such medical loss ratio, QHBP offering entity shall provide in a manner specified by the Commissioner for rebates to enrollees of payment sufficient to meet such loss ratio.

Shorter version of Sec 116: You can't make money by insuring only health people or by simply denying care. Over the last couple of decades private insurance has driven its 'medial lost ratio' (i.e. care actually paid for) down from 95% to 80% with much of the difference going right to profits and management compensation. Under 116 any medical loss ratio under that set by the Commissioner means rebates. Sec 116 changes the whole game even if we end up losing on the public option.

So I suggest some of the "They killed Kenny!!" contingent where 'They' is Sebelius and Obama need to get a little down and dirty with the actual bill language that Baucus et al are certainly trying to gut. HR3200 is a carefully constructed bill introduced by John Dingell, the guy who has been introducing a universal coverage bill in Congress each year since 1955. Please don't assume that the Kennedy-Dingell Bill will automatically be a sell-out just because Rahm and Baucus can't restrain themselves from cutting deals with the opposition. They are not the only players in the game, no matter what the WaPo says.

Public policy that can only be as smart as the dumbest Republican

No public option...
Then I am out.

Team Obama can stop sending me emails...
They won't get another penny from me: EVER.

And Gabby Giffords my bluebelly congresswoman?

She can go bugger herself with the wrong end of the flag. I won't be voting for her in the next election. My prediction is: She, and a bunch of dems are going to lose big in the midterms for being chickenshit artists. And they deserve to lose.

No public option...

And I am done with this country and American politics forever. I can't imagine ever giving a damn to even want to vote again. That's will be my personal liberation. Bring it on. Set me free.

We only have the power of the pen

Then stop using yours like a crayon that only spews insipidities, Pollyanna.

Hi, I'm not an american, I'm writing from Hungary, so excuse my bad english. I might be completely wrong here (it's your political system, you know a whole lot more about it than I do) but a lot of people around the world are following the health care debate in the Unted States - so I tought I would give my view as an outsider.

I consider myself a liberal progressive hungarian. I can't stand hungary's conservative party. But when it comes to health care we come together. We have a system you could call "socialist". This "socialist" health care system payed my bills when I was in the hospital suffering from a pneumonia that almost killed me. It took care of me my whole life. So health care around the world is an important issue for me.

That said, I think to say Obama caved is an oversimplification.

From what i've gathered throuh international media (mostly CNNI), it was always the White House insisting on a public option, even when the american media basically argued against it. (In any other country, the media would grill those OPPOSED to a goverment run health care).

I think before blaming Obama, progressive activism must look in the mirror first. I think the Huffington Post totally slept through the whole thing, going on an on about deals Obama made with the industry, while under the radar the public option slowly died. Why act surprised now? The signs were there weeks ago. Durbin said it, I even heard Carville say, the public option is probably dead, more than a week ago on CNNs Situation Room. It was clear, Obama had to face reality.

So intead of pointing fingers at each other, american progressive activism must ensure, that its voice is heard. Right now, the screams of the right wing nutjobs echoes through the world - and from liberals: Silence. Fight that the bill has enough power to pull a punch even without a public option and SUPPORT Obama - don't blame it all on him. I'm all for holding his feet to the fire, but don't bloody him up for the conservatives - Obama's doing all he can. he's slowly pushing american health care, inch by inch, in a better direction - while the wind keeps blowing in his face. Liberal activism must help him push. So let your voice be heard, pressure those lawmakers that aren't on board with Obamas Plans. On health care basically the whole world is behind the liberals in america.

Greetings from Hungary

And is it just me or is "they'll have to cover you" masking a massive loophole -- ie. yes, the insurance companies will have to accept you as a paying customer but they can still deny specific treatment they deem "non-cost effective" (that might cut into their bloated profits and CEO compensation) or raise your premiums to stratospheric levels few can afford.

No Dalloway it is not just you, in fact you are joined by millions of people who equally seem not to have bothered to read the bill.

Insurance companies cannot refuse treatment of conditions in the Essential Benefits Package (which is a requirement to get their plans Exchange eligible). Sec 121 (a). The outlines of the Essential Benefits Package are outlined in Sec 122 and include a requirement that there be no annual or lifetime limits on coverage 122 (a) (3). Sec 122 (b) lays out Minimum Services which are pretty comprehensive and unconditional (i.e. 122 (b) (1) says simply 'Hospitalization'). Sec 122 (c) establishes limits on Cost Sharing, meaning they can't just jack your premiums up beyond the set levels. The limits on Cost Sharing seem kind of high at $5,000 per individual and $10,000 per family but are offset by Affordability Cost Sharing Credits at varying levels for families making up to 400% of the Federal Poverty Level (the Senate is trying to cram this down to 300%-another thing to resist) as outlined in Sec 244.

Really the House Bill is worth fighting for, people should not allow their basic cynicism to trump their critical reading skills. This bill is not the Dingel-Waxman-Brown Sellout of Decades of Work on Health Care Act of 2009. Unless of course we just say 'screw it' and let Rahm ram-rod us.

http://energycommerce.house.gov/Press_111/20090714/aahca.pdf (1.8 MB pdf)

The problem with activism in this is that confronting the mobs at townhall meetings would be an outright riot and inevitably the progressives will be blamed for it, for just daring to show up.

Everyone knows this, but we haven't mentioned it.

So what do we do?

No public option DOES NOT matter for pure political reasons: Obama will be hailed as the victor even if he gets to sign a D+ bill. Bill Clinton said this obvious truth the other day,.

The failure of some progressives to realize this basic dynamic is baffling.

Now, I'm certainly hoping we get a public option, but doomsaying is completely nutty.

Wow. These comments are amazing and depressing. Right here we see the counterpart to the teabagger ignorance and hysteria.

What is fucking point if no public option? You can talk all you want for regulations for the bloodsuckers insurance industry, but Jesus, give me a fucking break. Everybody knows there will be workarounds on that bullshit. Yikes.

This comment is precisely comparable to those of the reform opponents who, regardless of what the bills actually say, "know" how it will all work out in the end.

What are you people thinking? That the "public option" meant...we were getting a single-payer system? That the "public option" would be some no-premium giveaway to any American who wants it? Are any of you paying any attention to the substance of these bills??

If it were the case, as many here imagine, that the availability and mandate for those relatively small number of people who can't get it via their employer or Medicaid meant that the private companies could charge huge premiums (as they do already) and the public option would charge small premiums or give it away...then this outrage would make sense. But that was never on the table. In the bills being considered the public option would have rough competitive parity with the private insurers in terms of premiums. One reason for this is because the law would require the private insurance to be affordable or free, either through law or subsidies. More to the point, the public option as considered has been designed to be revenue neutral or even revenue positive. That means it's not going to be in the business of giving away health insurance for free.

Refusing to support this health care reform is like cutting off your nose to spite your face. This reform is so much larger than having a publicly run insurance company providing coverage to the relatively small individual market. Probably only a small number of commenters above would need or be eligible for the public option. But everyone who isn't on Medicare/Medicaid/VA above—which is almost everyone, I'm sure—will hugely benefit from the comprehensive insurance reform in these bills. No rescission. No denial of coverage for pre-existing conditions. No more caps on coverage and a limit on how high deductibles can be.

And if you're such a fan of the public option, then why doesn't it occur to you that it might be implemented later? And why doesn't it occur to you that if the entire reform fails now, it will be a good while before it's attempted again...and there will still be no "public option".

It's ironic that the dominant rationale for the public option has been market economics. It's a quasi-market oriented approach to keeping the insurance companies "honest". A more direct, more progressive approach would be to simply regulate them to be honest. There's no guarantee that the public option would have the intended effect.

While the public option might be, or might have been, a Trojan Horse means to achieve, over the long-term, a health care system dominated by a public single-payer, almost everyone writing these bills, and the President, have been emphatically saying this wasn't the case. This crazed support for it accompanied by threats to oppose the bill if it lacks it, plays right into the hands of the teabagger paranoia. It could only be that important if you think it will effectively be the health care system, and that's what the teabaggers fear.

Individual mandates make sense for car insurance where my bad or irresponsible driving may cause damage or harm to others.

Forcing me to buy insurance from a private company if I prefer not to, or penalizing me for failure to do so, is probably unconstitutional. Without a public option, there will be lawsuits, there will be delays, the whole package probably falls apart.

What do you call a president that raises hope to such a high level and fails repeatedly, systematically, and utterly to deliver on that promise? I wouldn't have thought anyone could take the title away from Bush, but Obama's on his way there now. Miserable failure. Worst President Ever.

NealB that is pretty harsh. Medicare is already here, as a mandatory program paid for by involuntary taxation. You could refuse the service, you could buy extra insurance, but AFAIK you can't refuse to pay the Medicare deduction to trade for not being covered. I figure, if it was unconstitutional conservatives would have challenged it thereby.

Maybe having to buy from at least one private company? Well, auto insurance is required in most States for many years, and again I see no effective challenge.

So, what do you think we should do? (I'm open, as long as you don't say things are OK as is ....)

No Public Option will mean
OBAMA gets branded
L*O*S*E*R
for the rest of his ONE term in office...

No. He also campaigned on being bipartisan, flexible, appreciate of various points of view. Instead, Obama can look good either way: as a visionary who really did change things, or as a moderate guy who gave America only the first steps it could handle at the time.

Watch Obama's polls rise even after he signs legislation that is crap. Hopefully we get something a little better than crap.

The No Public Option SELLOUT by the Dems is completely unacceptable.
What good are ALL these great insurance reforms the President is promoting, if the premium price spiral continues and coverage remains unaffordable for the "Middle-Class" ?
I also want to "Throw-UP" everytime Senator Conrad says 60 Votes aren't there in the Senate for the Public Option. We only need 60 votes to avoid the filibuster. Conrad is part of the "Senseless Six" in the Senate. Where the HELL is his vote....YES for the public option?
Here's the REAL joke, the Dems will give up the REAL Competition factor, the Public option to appease the Senate Republicans FOR HOW MANY Republican votes?
Another Joke, the Chamber of Commerce likes the Co-op Idea.
What a horrible SMELL originating from the "SENSELESS SIX".

I'm furious at the prospect of the bungling Democrats dropping the public option. How amazing could the reform be without it? What we need, really, is universal non-profit healthcare. A public option to compete with the profiteers was already a compromise compared to what we really need. If the Democrats abandon this, they have failed.

I'll go along with co-ops if medicare is abolished and everyone has the same options. Watch the crazy if that happens.

So... Obama begins his move towards the center.

Gotta improve those poll numbers, you know.

I really want to thank Bruce Webb and Keith M. Ellis for mixing in some sanity here. Bravos.

And Bravo and thanks to you too, KTL.

Might I again suggest the nuclear option? As in, hell no we're not going to accept a bill or new law that REQUIRES us to do business with a for-profit insurer? As in, MAKE ME BUY IT, MF.

If enough healthy people simply refuse to accept and pay for private insurance coverage, these A-holes in Congress can sit around yanking their puds all the live-long day making laws to "protect" the private insurers - it's not going to make a tinker's damn of a difference if we all just STOP PAYING them and drive them out of business. How long do you think they'd survive en masse cancellations of policies? 3 months? 6 months? Maybe limp along for a full year?

And then they - the biggest barrier to doing something that ACTUALLY MAKES SENSE - will be out of the way.

Fully 80% of insured people do not file claims on their medical insurance in any given year. So while we wait for the naysayers to weigh in on how this is just an unworkable idea, let me just point out that if everyone drops their coverage en masse and bankrolls the money they've been paying into premiums, we could care for our own through collective action until the dust clears.

I don't know about you, but there's just no damn way I'm going to accept being told that I am under mandate of law to do business with a bunch of thieves. It's bad enough that right now they systematically defraud their customers and the only alternative to them is to go without and be one illness or accident away from bankruptcy - but hell, they drive about 600,000 of us bankrupt each year as is - people who have been PAYING for their crap "coverage". Goddamn it, people, are we mice or men? We're not talking about dragging people to the guillotine here - we're talking about simply NOT GIVING THEM OUR MONEY. How hard is that?

The only way for all citizens in the US to have health care, and the only way to make Insurance Companies lower their premiums to a reasonable level, will be for us to have a public option. Insurance Companies will continue to not cover, or will get rid of those who need the coverage most. They will continue to ration coverage. They will continue to pick and choose who they will cover. Come on Democrats and morally responsible representatives of the people. stand up for what is right. If we can afford an immoral war, we can afford to send billions overseas to help others in need, how about us helping our own.

I was wondering if I could even make it to the three year target but I guess that's just a joke now.

So what will be next for the Democrats? I figure they will decide that Bush's tax rollback for the wealthy was really a good idea after all.

Sorry, Bruce Webb and Keith M. Ellis,

I'll stand with Howard Dean, if you don't mind.

You present a fairly media-friendly and public-relations oriented walkback on the idea of actually reforming a system that is bankrupting people, ruining their lives, letting them die without hope, and creating profits heretofore unimagineable in the days of the robber barons. If the public option is allowed to wither on the vine, then the vine itself means nothing. Change means an end to the runaway profits of corrupt insurers who drop people when they get sick and create their own "death panels" that are designed to deny people coverage for pre-existing conditions and to deny life-saving surgeries.

Shilling for the corporate whores who hold the leash that is strangling people is unbecoming on a progressive site, no?

Why blame Obama, though? It's not like he didn't tell us he was going to throw in with the people who hate Howard Dean with a passion.

It is mindboggling how stupid the public can be and how easily the republicans can still scare people into making the wrong decisions with a lot of lies. I have government run health care and it is the BEST in the world. I work for the US govt. Our govt insurance is not from the govt, it is from cigna, blue cross blue shied, kaiser etc, all at our option. Here is the difference- all those companies charge the govt a lot less for better coverage. there is no such thing as denying pre-existing conditions, no throwing you off the plans ever, you just get to change from one to another once a year if you'd like. So while BC and BS may pay a doctor 1000 dollars for an xray under our plan that same doctor only gets 100 dollars and they are happy to get it. My cost is piddly compared to others, yes the govt pay 72% of my health care, but even at that rate it IS still cheaper than what my private party insurance counterparts paying. Had you been smart enough to urge your senators to vote for this, that BC and BS plan you are paying say 1200 dollars a month for now, could have cost you like 500 since the govt would have negotiated the better price for you. Unbelievable to me, big insurance has won again on this one folks

Shilling for the corporate whores who hold the leash that is strangling people is unbecoming on a progressive site, no?

Gee, I thought I was shilling for the millions of Americans without health insurance and everyone who is denied coverage for pre-existing conditions, for everyone who has their coverage retroactively denied when they get a major illness, everyone who has deductibles so high they might as well not have insurance, everyone who finds when they get seriously sick they have a cap on benefits, and basically the 300 million or so Americans who stand to greatly benefit from health care reform passing, even without the public option.

So who are you shilling for? People who want the status quo to continue? People who want to be able to claim they beat down the blue dogs?

You wrote:

Change means an end to the runaway profits of corrupt insurers who drop people when they get sick and create their own "death panels" that are designed to deny people coverage for pre-existing conditions and to deny life-saving surgeries.

Are you aware that all the bills out of committee end, by law, insurers dropping people when they get sick and denial of coverage for pre-existing conditions? Completely independently of the public option?

You're obviously as poorly informed and responding to your hysterical fears of "what everyone knows will happen" if the reform bill passes as the abysmally ignorant teabaggers. And, like them, your ignorance is your impetus to materially affect millions of Americans' health for the worse by virtue of your opposition to reform that you don't like because you can't even be bothered to understand what it is.

These fantasies about the public option are exactly comparable to the fantasies of the teabaggers about the death panels. You've heard a couple words, know that people who share your political views care strongly about them, and manufacture facts to support your arguments out of thin air, as needed.

>So who are you shilling for? People who want the status quo to continue?

That's *fucking* hilarious.

Yes, I support Howard Dean and I support the status *fucking* quo.

>These fantasies about the public option are exactly comparable to the fantasies of the teabaggers about the death panels. You've heard a couple words, know that people who share your political views care strongly about them, and manufacture facts to support your arguments out of thin air, as needed.

Now I'm a teabagger? Sorry, Charlie. Compromise is fine, but don't pee on my leg and tell me it's raining.

The public option:

The AAFP has had clear policy since the mid-1980’s calling for health care coverage for all and physician payment reform. For several years, the AAFP has supported proposals that would rebalance our health care system in a way that improves patients’ access to health care, the quality of that health care and the efficiency in the way health services are delivered. Earlier attempts to "fix" the system by tweaking its edges have not solved the problem, and comprehensive reform is needed. We need a system that provides financial access to health services and ensures that primary care physicians are available to provide care. Our current system has placed more value on medical interventions and procedures, and less value on prevention and health care management. The emphasis has been on volume of treatment or procedures rather than on the patient experience and results. As a result, we pay more for curing diseases that could have been prevented in the first place. And in turn, the cost of treating preventable conditions drives up the cost of insurance.

We’re also seeing the erosion of primary medical care, which is the foundation of high quality health care systems. Each year, fewer medical students choose primary care specialties, and that trend worsens patients’ access to health services on two levels. Patients don’t wake up one morning and decide they need to see a gastroenterologist. Generally, they are referred to such a subspecialist by their primary care doctor. With fewer family physicians and other primary care doctors, patients have less access to both the preventive and subspecialist care they may need. Moreover, primary care physicians are most likely to serve in rural and urban areas that are at highest risk for being health professions shortage areas.

Health reform proposals that enable Americans to have a personal physician in what is known as a patient-centered medical home will help solve many of the challenges our health system poses for patients. We need to re-value primary medical care and begin to compensate for the telephone calls, consultations with other health care professionals, interactions with hospitals, home health agencies, long-term care facilities and community resources, and other medical home services that go far beyond the face-to-face interaction between doctor and patient in the examination room.

The AAFP would support a public option if it meets specific criteria. The public plan cannot be Medicare. It should not force providers to participate and it should not use Medicare payment rates. We also have said the public option and the private insurance market should have the same governing rules and regulations. The public option must be actuarially sound and both the public and private insurers should adhere to the same rules regarding reserve funds. We support the concept if it increases patient choices in insurance plans and improves the access to insurance, not if it limits those choices. What I hear from many of our members around the country is that patients are often locked into one insurance plan in a region or even within a state. Some states, one private insurance plan will have 90 percent or more of the market share. That doesn’t provide choice for the patients and it severely limits the ability of the physicians to negotiate contracts with the insurance companies. A public plan option or other insurance co-op are ways to increase the availability and competition among insurance providers.

read some more, if you dare:

http://www.dailykos.com/storyonly/2009/8/16/767575/-Interview-With-Dr.-Lori-Heim,-FAAFP,-President-Elect,-American-Academy-of-Family-Physicians

What in the Hell is going on!!!! I voted for CHANGE! This is the same bullshit that we have been dealing with for the last 8 years. I thought Obama was going to be a lightening-bolt, but he is just turning out to be thunder. A whole lot of noise. I really thought he gave a damn about the citizens of the U.S. but it is turning out that maybe he too is a soldier of big business. Why is it that the Republicans have such an "awesome" way of getting things done, and the Dems just cower. Do they not realize that being too cautious hurts them. It makes voters not care, and I believe that is what the Republicans are counting on. They talk a little shit and sit back and laugh at the cowards. Unbelievable !!!!

that was incoherent, my last point was cut off. This system sux.

Keith Ellis,

you can compromise on a phased-in public option, you can compromise on the plan itself, but I see the government throwing in the towel so they can make insurance companies happy.

Don't you think you've lost all credibility when your response is to call anyone who opposes what is going on a *fucking* teabagger?

Or did you work in the Bush Justice Department before you decided to shill for your corporate masters?

That's *fucking* hilarious.

Yes, I support Howard Dean and I support the status *fucking* quo.

If you don't support reform, with or without the public option—and certainly if, like some above, you oppose it without the public option—then, yes, you are shilling for the status quo. There's no way around that.

Also, you're an idiot. Somehow, in your ignorance, you've equated Dean and the AAFP with a true progressive policy on the public option. Did you even read what you quoted. There's this:

It should not force providers to participate and it should not use Medicare payment rates. We also have said the public option and the private insurance market should have the same governing rules and regulations. The public option must be actuarially sound and both the public and private insurers should adhere to the same rules regarding reserve funds.

Do you understand what that is saying? First, it guarantees that physicians won't see their pay cut because of reimbursement rates being controlled a la Medicare. This is a physician friendly policy, not a progressive policy. Second, it doesn't require that any physicians accept it. Now, given the first condition, most probably wouldn't mind. But absent it (which is a physician-friendly "no, we're not serious about controlling costs via the publicly run plan"), then physicians would avoid accepting the public insurance...just as they currently do with Medicaid. Have you ever tried to find a doctor who takes Medicaid? Of course you haven't, you're clueless.

The last part about governing rules and regulations and being actuarialy sound is a...insurance company giveaway. It guarantees that the public plans won't have a competitive advantage with regard to its funding or anything else (excepting that it might have lower overhead, not needing to make a profit).

So this is what you imagine a good, progressive health reform would be which included the public option. Apparently, you're not aware that it is less progressive than what came out of the HELP committee. But, by God, it's Howard Dean so you just know that it's good.

Also, you might be interested in knowing that it's basically what's coming out of the Finance committee. So is everything else you quoted.

Keith Elis is speaking, but it's Karl Rove's fist inside the puppet.

Those of us that want insurance reform (if I can put on my indignant hat here) and a public option and who support Howard Dean aren't teabaggers and we're not ignorant. Without Dr. Dean, there would be no 60 votes in the US Senate. There wouldn't be any "red" states in President Obama's column without Dr. Dean. We support change and we voted for change. Compromise with all concerned is necessary and I was trying to demonstrate that I get that. Any child who thinks that the insurance company CEO is going to walk away without a wad of cash is dreaming of utopia. I support the President and I will happily vote for him again.

Those of us who are paying attention can see through your unhinged hatred of Governor Dean. We're not birthers or maniacs or fools.

We're Americans.

Keith Ellis,

Blue Texan drinks your milkshake:

So Obama campaigns for 2 years with the public option as the centerpiece of his health care reform. He's elected by the largest majority in 20 years, and the public gives him 60 Democratic seats in the Senate and 256 Democratic seats in the House. Obama then publicly lobbies for said public option after he takes office.

Then Kent Conrad, who represents like 7 people, and a handful of corrupt Blue Dogs say "No way." And Obama caves.

Big victory!

Oh well. At least Ezra Klein and Matt Yglesias will be happy.

http://firedoglake.com/2009/08/16/the-end-of-the-public-option/

Actually, I like Dean. I'm not impressed with the AAFP's position on the public option. And it's obvious that you think that the AAFP's position is far, far more progressive than it really is.

I'd love a single-payer system. That's what I want. I'd be happy with a nationalized system. I'd be happy with Medicare-for-all. I'd prefer reform with the public option over reform without it.

But, apparently, because I argue that failing to support reform without the public option, or, worse, opposing it, is equivalent to supporting the status quo, then I'm Karl Rove's hand-puppet.

Well, except for the fact that my argument is all about supporting the proposed reform when Karl Rove emphatically opposes it in every particular.

Then Kent Conrad, who represents like 7 people, and a handful of corrupt Blue Dogs say "No way." And Obama caves.

Big victory!

You know, I care a whole hell of a lot more about the millions of people who will be able to get health care they previously couldn't if reform passes than I care about the blue dogs feeling victorious and people like you feeling like they lost. My concerns are about actual peoples' lives but yours, apparently, are all about your hurt feelings. Again, quite similar to the teabaggers. Grow the fuck up.

Without a public option there is no reform...just fodder for the lobbyists to increase their campaign contributions on.

Wall street, the banks, and private ins along with pharma own congress. This is the end of the greatest democracy ever to have existed and it met it's death over the issue of Health care ins reform. Those very greedy few just could not reign in their greed enough to ensure their own country's existence.

I am so sick and tired of politicians who want to do a good thing and then you let some other politician come along and disrupt, try to destroy and make everything that is good for the country a total mess. President Obama I voted for you, I think your views for health care is what we people in this country need. I am so sick and tired of these radicals at these town-meetings who are just flipping off at the mouth and creating nothing but total chaos. People wake up stop listening to these Republicans, who by the way are behind all this non-sense,and get a grip on life. We need Health Care Reform in this country and we need to get behind President Obama and support him. This is essential. President Obama, I voted for you because I felt finally someone who has everyone in mind not just certain people. Please stick to what you want to do. The Democrats control, please use it. This is to your advantage, they need to listen to you and what you want to do. Work it. You have the ability, the power, the intelligence and of course the knowledge, use it.

Neil B ♪: Medicare is single payer for retired people; a government run, PUBLIC program. We all pay it prior to retirement to provide for basic health care needs after we retire.

The individual mandate, which it seems, is going to be the only major change to what we have now, will FORCE everyone who doesn't have health insurance now to buy it from a PRIVATE insurance company.

There's no comparison to medicare.

Unless there is a public option.

Obama's campaign slogan wasn't just a promise that he would fundamentally change the way government in Washington worked. He promised change we could believe in. 60 million voters were convinced and agreed to the promise Obama described at the end of the convention a year ago in Denver when he said, forcefully, "Enough!" Enough of business as usual. Enough of the betrayals. Enough of the lies. Enough of the abuse of the American public by corporations, by lobbyists, by profiteers, and by corrupt politicians.

One year later it appears he has capitulated almost completely on the "promise" he described so unequivocally. One year later, he is in the process of betraying those to whom that promise meant so much. I say he's heading toward being a worse failure than Bush because of WHO he is betraying: the least among us, those that most needed to hope and believe, again, in this country and its leadership. The damage he's doing is worse than Bush's criminality, worse than Clinton's deceit, worse than Reagan's act, worse than Carter's bigotry, not just because of what he promised and what he's failing to deliver (with the largest Democratic majority in Congress since the 60s), but for whom he's failing to deliver.

Democracy: Rule by majority, irrespective of societal "bottom lines" such as health, nutrition, education, and housing!

America, you are missing the opportunity to be a great nation.

The individual mandate, which it seems, is going to be the only major change to what we have now, will FORCE everyone who doesn't have health insurance now to buy it from a PRIVATE insurance company.

There's no comparison to medicare.

It's not the only "major" change to what we have now. What about the fact that everyone who is currently uninsured (excepting illegal immigrants) will be able—will be required to—get health insurance? What about the cap on deductibles, on premiums? What about the elimination of dollar caps on coverage? What about the elimination of recission? What about the subsidies for the poor that will make it affordable to those who get coverage via the exchanges? What about the expansion of Medicaid?

The public option as it has been formulated in all of the bills which have come out of committee would only be available to a portion of those Americans who cannot otherwise get insurance. It would not affect the overwhelming majority of Americans. Yet you and people here claim that, without it, reform won't change anything. But the public option, as formulated in all the bills, won't change anything for most Americans! And on that basis you're willing to give up on reform??

Furthermore, as formulated, for those insured, the public option in terms of availability and cost would be no different from the private options. Yes, it might have long-term systemic effects. But to someone who currently doesn't have insurance and either can't get it or can't afford it? There will be no difference between the public insurance and any of the private insurance options.

So what you're saying is that you just don't like the idea of being forced to pay money to a private insurance company (as you currently do with regard to your auto insurance). Not that it will make a material difference to you, assuming you're among the few to whom this would apply. It just offends your ideology.

The 50M Americans who will continue to have no health insurance if reform fails, be damned.

How is this any different from the ideologically based objections to health reform from the right which complain about public involvement in health care? That ideological concern trumps everything else, even their own self-interest in seeing unfair things like recission ended. No, they want the government to stay out of health care, and they'll oppose reform for any and every reason because they fear and hate this. You oppose reform without the public option because you fear and hate the idea of paying required premiums to a private insurer.

It's ideology and partisan politics gone insane. Both sides are looking for reasons to oppose reform on the basis of ideology and not on the basis of actual people living their actual lives.

>My concerns are about actual peoples' lives but yours, apparently, are all about your hurt feelings. Again, quite similar to the teabaggers. Grow the fuck up.

Destroy everyone who opposes you, scream them down, make fun of them, pretend to have mastery over the debate, anyone who doesn't think the way you do is stupid, etc.

Yes, Rove taught you well, grasshopper.

My feelings aren't hurt. My government is failing to listen to the real concerns of people who want reform.

Of course, I'm the only one who's upset, so fire away, Charlie. Fire away.

KME you have some points, and getting some reform is better than nothing (as I too argue.) However, don't forget that people worry, that insurers can still make life difficult for many of us through loopholes and high prices. Remember COBRA, to make them keep covering people who were laid off? Ever see those godawful premiums? And I too don't want to have to buy from a private source - I think, either public or not mandatory.

Also, that Gang of Six is a pretty sick bunch when freaks like Enzi (who wants to make the situation even less regulated - a regression!) are involved. The Dems should kick him out, to hell with tradition.

But I appreciate your taking such an interest, just reflect on what I told you ...

BTW: NealB, Obama is not a dictator as the Right imagines. He has to work with a messy Congress, many of them bluish due to (ironically -?) Rahm's strategy of getting them elected over being "correct." But I do worry some about Big O, and his commitment to true progressivism. Keep hope, but keep a look out ...

What about the fact that everyone who is currently uninsured (excepting illegal immigrants) will be able—will be required to—get health insurance? What about the cap on deductibles, on premiums? What about the elimination of dollar caps on coverage? What about the elimination of recission? What about the subsidies for the poor that will make it affordable to those who get coverage via the exchanges? What about the expansion of Medicaid?

The public option as it has been formulated in all of the bills which have come out of committee would only be available to a portion of those Americans who cannot otherwise get insurance. It would not affect the overwhelming majority of Americans. Yet you and people here claim that, without it, reform won't change anything. But the public option, as formulated in all the bills, won't change anything for most Americans!

Let's unpack this a bit: on the first point, forcing everyone to buy private insurance, the rates are already bloated. That's why we spend so much more than any other country. If costs are a concern, this is the best way to undercut support for a "reform" - make it as costly as possible by doing nothing to dial back the bloat.

Second, on the public option, you're just wrong. The public option in these bills is open to anyone who prefers it to a private insurer. Duh. It has to be; otherwise it doesn't create the competition that forces the private insurers to reel in their profligate profit margins and bloated CEO salaries.

But the most salient point, and the one your "any reform is better than none" viewpoint doesn't take into account, is that it leaves private insurers with huge wads of cash that they can - and will - use to throw around on Capitol Hill to chip away at whatever watered-down, ineffective version of "reform" sans a public option might get passed. Again, duh. That's why the public option is so important - they can't fricken LOBBY their way around a competitor that delivers a better service at a better price.

In short, we're being offered a shit sandwich, and you're insisting that it's better to eat it than to go hungry. I disagree, for all the reasons outlined above. A reform without a public option competing for customers is a joke that will be eroded in each and every session of Congress while we continue to pay 1/3 more for our health care than the citizens of any other nation.

I used to think that any bill with more than three republican signatures on it wasn't worth the paper it was printed on it. Now I have to revise that to include dems as well... I though the dems won the election. You''d never know that with this class...

Second, on the public option, you're just wrong. The public option in these bills is open to anyone who prefers it to a private insurer. Duh.

And there will be death-panels.

You're badly misinformed. In none of these bills was the publicly run plans open to anyone who wanted them. Look it up. There's lots of commentary on the public option, as well the text of the bills available online.

You weren't just there reasoning from first principles what these bills "must" contain, were you?

You, and apparently others, seem to be supporting reform proposals that never existed. You're not arguing for the genuine single-payer proposals, you're defending a version of bills that never existed. The bill out of the Senate HELP committee, the three bills conglomerated into the Tri-Committee bill, the Senate Finance bill, and even Obama's post-election proposals have never included a public option like you describe. They all emphatically retain the private health insurance industry as it already exists. Reducing or eliminating the private insurance industry was never on the table.

The only reason we've gotten as far as we have is because the reform largely protected the insurance industry's status quo. They'll still exist and still make money. Maybe you don't like that. Maybe I don't like that (I don't). But that doesn't change the reality.

The only health care reform that we can get is one that mostly preserves the insurance company status quo while achieving universal coverage and eliminating the many abuses of the insurance industry, such as recission and denial based upon pre-existing illness. The public option, as it exists in any of these bills, changes this very little. If the bill passes with the public option intact, you and many others are going to be in for an unpleasant surprise.

It's obscene to be complaining about insurance company profits when what is actually on the table means the difference between millions of Americans having health insurance, or not. We can argue all day about how much better these bills could be. What is indisputable is that these bills, with or without the public option, will mean the difference between life and death to millions of Americans who can't get or can't afford coverage, and others, besides.

I find the hysteria over President Obama's health plan including the option for public insurance insane. How many times does the man have to say that this is an OPTION, not a forced insurance. I question myself as to why I hear the explanation clearly and some are so dumbfounded and want to make more out of it than it is. This OPTION is a blessing for many that are not able to acquire insurance. My husband and I can't afford to get sick and we have insurance. If we go to the hospital and are admitted, for the first three days we have to each pay $900.00 each for a hospital stay, and that is per visi. We are on a fixed income and that would bankrupt us. Get real you hysterial people and listen up and try and not change the real truth.

All this demonstrates is the incompetence of Obama, who - in the name of "can't we all get along?" - has been willing to give away half the loaf on every issue (stimulus, climate change, health care) before starting to negotiate, in the mistaken belief that he could get the "nice ones" on the other side to help him keep the other half.

I regret every minute I spent raising every penny of the $350,000 I raised for that campaign last year, and will do nothing for him ever again if this is what happens.

Like Eugene Debs said in 1912: "It's better for vote for what you want, and not get it, than to vote for what you don't want and get it."

Anybody (including myself) who actually thought serious, transformative health care reform had a chance in succeeding in this country is naive. There are way too many powerful and mobilized interests that oppose anything other than the status quo (or some further marketization of the industry). It's not really Obama's fault. There's just nothing anyone can do; the problem is structural and endemic to the American political economy. It really doesn't matter "who" gets elected. They eat (and will always eat) at the same table as the big money players.

Please is right about what we're up against, but I counsel not giving up.

Ann, the "option" in "public option" refers to those who otherwise can't get insurance (or Medicaid) and who then enroll via the proposed insurance exchanges will have one publicly run insurance "option". That's what's optional.

What isn't optional is that all these bills have both employer and individual mandates. That is, everyone will be required by law to have insurance. This won't affect the majority of Americans who do have insurance—they will continue with their current insurer.

But employers who don't offer health insurance will be required to do so, and individuals will be required to have health insurance. That will not be optional.

This is absolutely necessary for reform. Affordability of coverage has a great deal to do with the size of the covered "pool". A portion—certainly not all, but a portion—of currently uninsured individuals simply choose not to be insured because they are healthy. Those people must be forced to pay into the system. Similarly, this is true for employers who don't offer insurance.

To alleviate the justified concerns of both employers and individuals who worry that they won't be able to afford to pay for this mandated coverage, all these bills include subsidies and other mechanisms which allow the insurance to be affordable to both employers and individuals who otherwise couldn't pay for it.

Keith M. Ellis' nonsense cannot go unanswered:

http://www.openleft.com/diary/14650/hahahahaha-sibelius-welcome-to-a-regressive-tax-which-will-rise-faster-than-wages-or-inflation

Shorter Sebelius: Welcome to a regressive tax which will rise faster than wages or inflation
by: Ian Welsh
Sun Aug 16, 2009 at 18:30

As Heinlein once said, I laugh because otherwise I'd cry (and scream, and pound my head against the wall)

Health and Human Services Secretary Kathleen Sebelius said the White House would be open to co-ops instead of a government-run public option, a sign Democrats want a compromise so they can declare a victory on the must-win showdown.(TL)

Ok, so let's say they ditch it and include an individual mandate, meaning you are forced to buy insurance from private insurers or co-ops (which won't be able to contain costs). What is that?

It is a regressive tax. Given the likely pathetic subsidies it will hit the working and middle classes hardest as it will be a higher proportion of their income than for the rich. Since health care costs will not be properly contained, they will rise faster than pay will (they have for decades now). So every year you will be forced to spend more of your money than the year before and will have less money left over.

A regressive tax which rises faster than pay rises.

This is forced increased spending on domestic financial services, which is what insurance is. I guess that's Obama's economic plan as well as his health care plan. And bonus, since there'll be no denials and no recessions, you won't be able to get out of it in any fashion, except death.

Death and taxes, the first gets you out of the second. And a health care mandate without effective cost controls is an ever growing tax till you die.

Sure like to hear the spin as to how rolling over and taking it, ungreased, is better. On my way out the door to go join my teabagger friends. Not.

I think this is just a trial balloon to see if we progressives raise enough hell to get Congress to take us seriously again. I don't know if a public option will be included in the end - as a single-payer supporter I never saw the public option as even the best of the bad options out there. But if House Progressives vow not to vote for a bill without the PO then the concessions will and should be large.

I don't have health insurance and really the public option was my only hope. With 2 chronic conditions, the industry will find some way to raise my premiums too high (age? delayed onset? only eligible for 2 out of 10 options, all too expensive?). I will yet again be one of those people making too much money for a subsidy, not enough to pay for the premiums. And on top of that I'll get fined for not having insurance. So I'll have to buy the crappiest, non-coverage available to avoid being fined. And I won't be able to use it because the premium and/or deductibles will be too high for me to pay to go for everyday care--just like now.

If Obama allows no public option, we are all screwed. The insurance companies will game the system just like the credit card companies did. As soon as "meaningful reform" was passed, the credit card companies started quickly raising all the rates and fees before it took effect, and, in my case, changed my fixed APR to a variable rate. So when the fed finally starts raising interest rates, once again the credit card company will be jacking up my interest rates to ungodly heights (and, yes, I am honestly trying to pay off the costs of medical bills and grocery bills while unemployed).

Was this country always this corrupt? I guess it was. Since I grew up in a middle class family, I didn't feel the brunt of it until the rich-poor gap started hitting the lower middle class and driving us down the economic rungs.

For shame, Congress and Obama. I may just stop voting. And work harder to get that nursing degree finished so I can just move to another country. I am appalled by what this debacle says about American "democracy." So much for the new era of change.

Health Care reform over for the Obama Administration. Democrats losing House in 2010. Democrats lose Senate and Obama administration over in 2012. Real health care reform dead until at least 2016.

Obama is just a slightly more polished version of Jimmy Carter.

"It is worth taking the fight to the last breath, because it leaves ultimate power pretty clearly in the hands of the public, they can walk from any private plan that manages to game the system. But really under the protections built into Sec 111-116 gaming can only happen with the specific collusion of the Health Choices Commissioner and the private companies. Which of course if we ever get another Bush is exactly what would happen."

Exactly. OR any spineless bureacrat taking big bucks from the insurance industry. You really think that if they kill the public option that the next to go won't be tweaks to favor the health insurance profits??? Maybe not right away, but you can be damn sure that with no public option to fall back on, the insurance industry will start priming Congress for amendments and changes down the line. Especially if Dems lose their majorities down the line, the first order of business will be for Congressional Republicans to tweak those all important details to favor "free market" principles.

And I've read conflicting info on who can opt for a public option. I was under the impression it was only the uninsured, self-insured and those who work for companies that don't offer insurance. Like everything else, it probably depends on which bill you look at. So, again, we have no idea what we'd end up with in the final bill.

To alleviate the justified concerns of both employers and individuals who worry that they won't be able to afford to pay for this mandated coverage, all these bills include subsidies and other mechanisms which allow the insurance to be affordable to both employers and individuals who otherwise couldn't pay for it.

The subsidies are inadequate. Only those making ~$30,000 a year or less will be subsidized or able to avail themselves of Medicaid. And that's only IF the current 300% of poverty income threshold survives in the final bill. The way this process is going it's hard to believe it won't be lower.

It's repugnant that Congress and Obama are in the process of approving a bill that will FORCE lower-middle and middle income people to give up more of their extremely limited resources to protect the interests of the health insurance industry.

And as I said, an individual mandate without a public option likely will be subject to legal action that will prevent its implementation. Health care reform without a public option is no reform at all, it's a giveaway to the health care industry at the expense of those least able to afford it.

Folks, the public option was never going to have premiums that were less than the private insurers.

Obama and the Dems involved in writing these bills and who supported the public option have been saying over and over and over that the public option wouldn't be unfairly competitive relative to the private insurers. If the taxpayers subsidized the premiums to make them much less expensive than the private premiums, it would necessarily be "unfairly" competitive. The public option as designed in each of these bills is intended to be basically comparable to the private insurance in every respect, except one: it wouldn't have the shareholder imperative to earn a profit. On the other hand, by design the public options are designed to at least break-even. It's not some huge giveaway.

People keep writing things like "the industry will find some way to raise my premiums too high" in complete disregard to what the bills actually say. It's exactly the same sort of fear-driven hysteria that ignores facts that the teabaggers engage in when they talk about how reform will end up socializing America. They don't know what's actually in the bills, but they are damn sure of how the world works and what health care reform will end up becoming.

A commenter I corrected above confidently stated that of course the public option in these bills will allow anyone to sign up for government run insurance. That's simply not true and it's very easy for anyone to look it up and see that it's not true.

If the public option in these bills were what so many people here think that it was, then I'd be just as outraged at the thought of abandoning it. But it's not what people here think it is—it's modest, would only be available to a small portion of Americans, and wouldn't put that much pressure on the insurance companies.

It's repugnant that Congress and Obama are in the process of approving a bill that will FORCE lower-middle and middle income people to give up more of their extremely limited resources to protect the interests of the health insurance industry.

Ah, so here's the moment of truth. What's becoming apparent to me is that people (middle-class people, not the actual poor) were okay with the individual mandate as long as they figured they wouldn't actually have to pay for their health insurance because they'd get it for free or cheap via the public option. I certainly hope you folks wished for a pony, too, while you were at it.

I repeat: in these bills, the public option will not be any less expensive for the middle-class than will the private options. Or for the lower-classes, for that matter.

If you wanted a public option that would essentially have eliminated the private insurance industry, or a straightforward single-payer bill, then the time to be agitating about it was approximately six months ago, if not earlier. To believe that the reform Obama has been promoting the last six months was something it was not, and to be angry that something which only existed in your imagination will be dropped from it, and therefore to no longer support reform, is unadulterated craziness.

Keith, the public option proposal wasn't all that great but without the public option the increases in rates were set at a max of 8 percent - that's in the house bill(the supposed better bill) - not the senate bill. Who gives a crap about deductibles if your rate is $350 or $500 a month? And if you think the insurance companies aren't going to be asking for 8 percent every year then I got a bridge to sell you. BTW I see no limits on actual insurance rates. Furthermore, I am willing to bet that they will still allow the healthcare version of liability only auto coverage. If you want to argue that what Obama is trying to pull off here is actually good then argue it in the "crack in the dam" form not the way you are doing it now.
The Dems can forget getting a vote from me and I am in a purple state. If they can't do it with 60 votes then they are bunch worthless pricks. These fools actually think that the birthers are going to vote for them. I will have to agree with my Republican friends if the Dems don't pass a decent public option that they are a bunch of pussy loser appeasers.

This is a classic example of the corporate shill--Keith M. Ellis--

being refuted, time and again, as he passionately fights his little fight, only to have the White House throw Kathleen Sebelius, and deservedly so, under the bus:

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

http://politics.theatlantic.com/2009/08/administration_official_sebelius_misspoke.php

An administration official said tonight that Health and Human Services Secretary Kathleen Sebelius "misspoke" when she told CNN this morning that a government run health insurance option "is not an essential part" of reform. This official asked not to be identified in exchange for providing clarity about the intentions of the President. The official said that the White House did not intend to change its messaging and that Sebelius simply meant to echo the president, who has acknowledged that the public option is a tough sell in the Senate and is, at the same time, a must-pass for House Democrats, and is not, in the president's view, the most important element of the reform package.

A second official, Linda Douglass, director of health reform communications for the administration, said that President Obama believed that a public option was the best way to reduce costs and promote competition among insurance companies, that he had not backed away from that belief, and that he still wanted to see a public option in the final bill.

"Nothing has changed.," she said. "The President has always said that what is essential that health insurance reform lower costs, ensure that there are affordable options for all Americans and increase choice and competition in the health insurance market. He believes that the public option is the best way to achieve these goals."

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

While shills like Keith M. Ellis continue to accept what is thrown at them, and fail to fight for what they think is right, real PROGRESSIVES stand up and demand their government to be just and honorable. They heard the outcry, and they're reacting to it, and that's ONLY BECAUSE of the negative reaction from people who support leaders like Howard Dean and real reform and change.

hate to say it, Charlie, but you've been punked like nobody has been punked, and even the people you shill for are running for cover.

This is a classic example of the corporate shill--Keith M. Ellis--

You're out of your mind. Look: nowhere in all my comments above (or anywhere else for that matter) have I argued against the public option. I'm in favor of the public option. I'm in favor of a single-payer system or even a nationalized system, too.

All I've been arguing against is the position that reform without the public option is not worth supporting or is even worth opposing. That position—that reform shouldn't be supported or should be opposed—is the position of the health insurance industry. Explain to me how your position and the health insurance industry's position are the same, and that I oppose it, somehow makes me the shill and not you.

Feel free to continue to agitate for the public option. I have, and will continue, to agitate for the public option. I strongly support it. But I will strongly support a reform bill that doesn't include it and I strongly oppose any supposed progressives who are willing to let reform die, or actively oppose reform, merely because it doesn't include the public option.

Your interests—in not supporting reform if it lack the public option—coincide with the interests of the insurance industry who oppose any sort of reform at all. My interests—which are to guarantee universal coverage and to much more heavily regulate the private insurance industry and to eliminate their most egregious exploitations—coincide with the interests of the poor and are opposed to the interests of corporate health insurance. I'm the progressive here and you're just a useful idiot for the insurance companies. But, hey, don't let little things like facts and reality get in the way of your fantasy of being a true fighter for social justice.

So let me see, you basically are saying that it's okay for Obama the idiot to sign a crappy bill because it's still reform. It doesn't matter that you rape even more people with a crappy bill. So your position now is that let more people get raped by the insurance cos so that things will get so bad that next time around(in another generation) we will get a better bill. Yeah, that's the way to deal with this. Excellent strategery. Hell, its almost as good as the WH's right now because they can't even unify behind a message.

It doesn't matter that you rape even more people with a crappy bill.

Millions more people will get raped by no bill than by a crappy bill. Don't pretend to take the moral high ground.

This is very comparable to the Part D legislation. It's far from ideal, it gave away a lot to entrenched interests, and it's far more expensive than it should have been. Yet it means that everyone on Medicare can afford to get their prescription medications when many of them otherwise would not. People like myself and my sister—both of us who are disabled and on Medicare and need prescription medications that we otherwise couldn't afford and/or would be forced to dedicate large portions of our incomes to purchase. You would be, and probably did, arguing against the bill because of its manifest flaws and be willing to ignore that millions of Medicare recipients are healthier with Part D than they would have been without it.

That's not a progressive position to take. And neither is it with regard to reform without the public option. The absolute bottom line is health care availability to Americans, especially those who currently cannot get insurance coverage. If you're willing to ignore that simple calculus in favor of some ideological consideration, then perhaps you're progressive in theory, but you sure as hell aren't progressive in practice.

Millions more people will get raped by no bill than by a crappy bill.

Sadly, this just isn't necessarily true. A bad bill may produce skyrocketing premiums which the insurers will "justify" as being required by the cost of complying with the new regulations, and there will be no public plan to even attempt to keep them honest via competition; meanwhile people will be "required" to buy a product that is priced beyond their means. THis has the making of both a substantive and a political disaster.

When you don't really know what you're talking about, you should refrain from browbeating well-informed people who disagree with you.

If the Public option is so insignificant, why is the Insurance Industry throwing MILLIONS of dollars against the wall to scare the pants off "STUPID" Americans.
A Reform Bill without a REAL public option is a total Con Job on our citizens.
The Insurance industry can adjust to making less on Health Insurance. We, Turkeys can't adjust to rising premiums due to lack of competition.
No one said it would be easy to attack a "Cash Cow".
It takes Dems with "REAL BALLS" to get REAL Change !
Without the Public option, Baucus & Conrad will be selling the notion, they did the best they could.
This type of opportunity for REAL change doesn't happen often.
I for one will stay home & refuse to vote for ANYONE in the future if they continue to SELL OUT !

Keith is obviously not a corporate shill. He's very well informed.

Keith - there's no way a health insurance bill of some kind won't become law. It's just a question of who caves - the conservative democrats, or the liberal ones. One of them will. Threatening to crush the whole bill is a neccessity to making sure it's the conservative democrats who cave.

Besides, I don't agree with your conclusion that the public plan won't be cheaper than a private one. With the industry's gross profit rates at 18%, that quite possibly translates into 18% cheaper premiums.