Actually there may be a reason or two they can't pass a bill that makes pro-choice voters (like me!) entirely happy: they (we) may need the anti-choice votes. But the larger point above, and the FDR comparison, seems right on: progressives should ask for all we can get (and more, for a stronger bargaining position), but we should take what we can get. Our elected officials (including some strongly pro-choice ones) seem to understand that... I wish more folks in the progressive blogosphere did.

We've all heard this argument before. We've simply rejected it. FDR railed against bankers, he didn't play patty cake with them like Obamam does.

You say we shouldn't take every conservative demand. But that is EXACTLY what the Democrats have done. They gutted the public option. The subsidies are a joke. There is no real guaranteed issue or rescission bans. Yet we're all going to be forced to buy health insurance that doesn't work. There's nothing that prevents insurance companies from denying care. Nothing at all.

Democrats are a shitty, worthless party and it's pretty clear that they have just been lying to the rest of us about what they actually believe. It's clear they don't really share my values and I'm not going to be voting for them or Obama again.

I'm tired of seeing this ridiculous Social Security comparison- it's a load of crap. The House bill, and the still more oderiferous turd that will come out of the Senate, can in no way be analyzed as a shell which can be filled with better content later, a foundation to be built on later, or [insert your silly metaphor here]. What we will get is something that makes the problems WORSE by forcing unwilling customers to pump even more money into a totally corrupt and dysfunctional system, further accelerating the runaway inflation in health care costs. Any real reform in the future will have to start by torpedoing the whole thing, but unfortunately by then the predictable disastrous failure of this "reform" will have discredited the whole idea of heath care reform for yet another generation.

and what would you do differently, in their shoes, soullite?

Accomidatingly, if this is the best they can do, that doesn't send the message you seem to think it does.

It's not good enough. Just like the stimulus wasn't good enough. Just like non-existant financial reforms weren't good enough. Just like continuing rendition isn't good enough. Just like not giving a damn about gay people isn't good enough. Just like 10% unemployment isn't good enough. There are no A's for effort in being President.

"Where reform advocates come up short this year -- if they come up short -- it's not the end of the fight."

In other words, liberals will continue their assault on American liberties.

Um .... yeah.

Roosevelt created the FDIC. Roosevelt pushed and shoved for the Federal Trade Commission to have regulatory powers -- actual real true powers! amazing! -- over big business. Real people were provided with help for their mortgages, jobs were created under the aegis of the WPA and the CCC. Farmers were helped -- the real thing, not the conglomerates we have now.

Honestly, there's no difference at all between FDR and Obama, is there? FDR provided a stimulus that actually helped everyone. Obamas provided a stimulus to bail out the rich and get them back on track screwing over the rest of us.

Al- When I hear that stuff, I get curious- just what liberty did you have last year, that you no longer have?

Kevin, first of all I wouldn't have given recruiting blue dogs priority for elections over every other faction of the party like Rahm has done for the last 10 years. Then we wouldn't have been in this position in the first place. I wouldn't have abandoned progressive challengers right after they beat my hand-picked blue-dogs like Rahm did. They could have cut off campaign funds. They could have stripped money out of appropriations bills. They could have used Joe Lieberman to send a message (the did, in fact, that message was just : Do whatever you want and we'll cover your ass). Most of all, I would have tried. We have no evidence that Obama wanted anything but what was in this bill.

Stop pretending that nothing could ever be done, and that Obama and Emmanuel didn't have anything to do with creating the current political landscape.

Sorry, Steve, You may believe that this watered down, jury rigged, Rube Goldberg of a health care bill is an improvement (it probably is, barely, but I remain skeptical), but to cast aspersion on the unfavorable comparison of Obama to Roosevelt. seriously, do you think this essentially center-right Republican compares favorably to Roosevelt? Like clinton, on domestic policy he he pretty much to the right of Nixon. Hell, I'll compare him unfavorably Truman and Lyndon Johnson, too.

I'm sure the Republicans are cheering, because this is how the Democratic unraveling begins. Everybody insists upon ideological purity rather than recognizing that:
1) the federal government is so close to ungovernable that I would be surprised if ANY healthcare bill is approved, and
2) it is going to take time for the Democrats to learn how to use their new-found power effectively.

If "progressives" prematurely desert the Democrats then the Republican Party will be revived, perhaps much more quickly and spectacularly than you may think.

Look: it is not as if there were no Dems advocating a single payer. there were. yet, they hardly ever appeared on the news -- even if only to create the appearnce of strife among dems. why is that? two reasons: firstm it is the single best solution to our problem and (2) it will adversely affect the advertising dollars of the media magnates who place ads for Humana and their ilk. the media is the villan. they control the spigot of information and they have tilted the playing field away from single payer. Had Obama pushed single payer, i have no doubt whatsoever that the fury directed at him by the MSM would make all else pale in comparison.

Consider this like baseball. The economics of the playing field favors the yankess, year in and year out. that does not mean that the Marlins or the Rays cant win the World Series, they just have to do it with a view to the long run.

There was zero chance of single payer. Zero.

if you really beleive that the people would rally around single payer than you have not been watching the disproportionate press given to the tea baggers. The people have rallied around a robust public option and we hear next to nothing about that in the MSM.

eric

there's no reason in the world they can't pass a strong bill, with a public option, and without measures like the Stupak amendment.

I'm not sure why you keep saying this. There still seems to be too few votes in the Senate and the House had to include the despicable Stupak absurdity just to get enough House "Dems" onboard. Those seem like reasons to me.

2009 taught me that Democratic primaries matter. Big time!

Improvements to social security were made possible over time by a transformation to the left in American thinking about the role of government that lasted in some form and to some extent until Reagan. I see no similar transformation occurring now, and without a similar, decades-long shift to the left I don't see healthcare reform getting the opportunity to be refined.

Dr Lemming, exactly how much time do think the Democrats have to use their power effectively?

I'd suggest you read up on FDR & his Bank Holiday, which basically saved the day, back in the day.

If Democrats were truly Democrats, we'd have a decent health care bill, and it'd be enacted immediately, not years into the future when the Republicans can undo it.

You are correct in (some) progressives abandoning most Democrats -- they deserve it. I, for instance, have nobody to vote for, since there are two parties whose interests are not the interests of just a regular wage-earner struggling to get by.

And finally, the whole thing about the Social Security bill -- read up on how it came about, the historical context of it. It was meant to be incremental even in the day, a stop-gap measure to discompose the Townsendites.

Roosevelt correctly gambled that Republicans would eventually recognize its importance, too: it was, after all, Eisenhower who eventually expanded it.

Does anyone have a sense of how many real votes there are, for what form of bill, in the Senate? That is, forgetting for the moment the crap about Joey L and filibusters etc., how many hard votes exist for Senate bil with Public option, vs. Senate bill with some lame - o opt in Ben Nelson is ok with it sort of turd?

Really, you all know this won't work. This isn't an 'incremental step', it's a dead end. These 'reforms' will be abandoned, not built upon, when some future congress decided to actually take this issue on.

But go ahead. Clap for having done nothing. Congratulate yourself on your victory over... who knows. You certainly didn't actually win anything.

The eventual health care reform bill of 2009 will be a compromise as the Social Security act of 1935 was, but health care reform is not as radical a change as Social Security was for Americans. For that reason I don't expect the new health care regime to rapidly evolve as Social Security did into a quasi-retirement program, but to remain more or less the same as Medicare has since 1965.

What this round of health care reform amounts to is covering those currently uninsured under a hybrid private-public insurance exchange. I'd have preferred a single-payer Medicare-for-all system but I wasn't under the illusion that it would happen. Honestly, given the political realities of the Senate it'll be quite an accomplishment to get the House bill through mostly intact. It's also worth keeping in mind that FDR had to compromise on Social Security when Democrats held 69 seats in the Senate in 1935!

The problem is we should have had the bad limited healthcare reform bill 20 YEARS AGO. Along with the bad limited climate bill.

We have let too many problems sit and fester for too long. We lost EIGHT YEARS during the Bush administration when if anything we regressed on a number of progressive fronts. And let's not even get into how badly Reagan and Bush I screwed us over.

Ah, I knew we'd hear the predictable whining about how "the left" is trying to destroy the Democrats by enforcing "ideological purity". The truth is diametrically opposite. The only chance the Democrats have for holding on to power more than briefly is to leave off fellating their corporate masters for a while and actually do something for ordinary Democratic voters. They screwed up on job creation (which will bite them in the ass bigtime a year from now), and they're about to screw up just as badly on a health care bill that will be a very unpopular failure when people start to see what it actually does. Obama will also screw up with a massively unpopular escalation in Afghanistan. This is the party that just doesn't want to win, for whatever reason.

Dr. Lemming, if the system is close to ungovernable, then it's time to change the system. What kind of idiot says "Gee, this system is destined to fail. Better work within it extra careful!"

Look in the mirror. Yep. That kind of idiot.

ckelly, I agree that it's vanishingly unlikely the Stupak-Pitts amendment will be stripped out by the Senate.

It's idiotic to cast aspersions on progressive Dems because of ConservaDems. And it's idiotic to say that ConservaDems are no different than Republicans. Both assertions are contrary to the facts.

Progress requires that we do the best we can with the hand we're dealt, and then we work to get a better hand (i.e., elect more progressives) the next time and the time after that and the time after that. Many thought that our job was done in 2008. We're learning now that it's a lifelong journey -- one that we'll probably have to pass on to future generations.

Me? I'm fired up and ready to go for the 2010 Dem primaries. But if I'm stuck with the lesser of two evils in the general, then I'll always show up and vote for the lesser of two evils. I'm not going to risk accelerating our destruction out of spite.

This is one of those arguments where I think everyone is wrong.

FDR was a little more feckless (Obama-like?) than he is remembered to be. He also still fought for a lot more than Obama does.

FDR also didn't have an opposition voting in lockstep against everything. The problem is this fact works for and against both sides. Obama has to accept weaker bills because the opposition votes in lockstep; whenever any Dems bolts, a major problem exists. OTOH, if this continues I don't see how we ever get anything more than what is initially passes. This essentially kills the incrementalism argument.

So I remain confused and ambivolent. I like the bill if incrementalism is still possible, I'm mad at Obama for not fighting for anything and accepting everything, I'm woried that things are going to be much worse once the senate gets through with it.

This comparison is totally apt, and the commenters at the top of the thread denying this have their idealistic heads buried in the sand.

This is what progress looks like. Messy. But this is the real world, not the ProgFantasyWorld of idealistic, naive, get all my cookies now activists who don't understand the game.

This. Will. Be. Improved. Later. And that does not deny that the system is screwed. Which words in this post do you not understand?

I love FDR, but by the standards of Progbagging Idealists, shouldn't he be slammed for not intervening in to stop the Holocaust, too? Couldn't he have bombed the camps? Huh? So he was "weak", right?

Come on, people. Deal with it. Obama is doing pretty decently. So sorry he's not Superman, though.

This. Will. Be. Improved. Later.

No It. Won't. Because. It. Can't.- You. Don't. Understand. The. Bill. And. Should STFU. Until. You. Do.

I try not to be too cynical, but I think there are genuine reasons to be more pessimistic than this post suggests.

(1) In the 1950's, not quite 35% of the work force was unionized, compared with roughly 10% today, and most of that is in the public sector unlike 50 years ago. Unions represented the real organized political power of ordinary Americans and had real influence in Washington. In their absence, the concerns of the average American are almost non-existent compared with those of industries with professional lobbyists.

(2) Wealth inequlity is far more dramatic today than it was 50 years ago, and there do not seem to be any policies being debated that are going to address it. This results in increased power for the already wealthy and the political marginalization of those of us who are just getting by.

(3) Coming out of WWII, Americans had a greater sense of the reality that we are all in this thing together. Contrast that with today, where half the country believes that such a notion is "communist" and a betrayal of American ideals.

My feeling is that things are going to get much worse before they get better, but maybe, hopefully, I am wrong.

I understand that we have (unfortunately) ConservaDems and that good things take time, much like SS matured from a pretty bad bill in 1935 to a good one in 1950. I get that.

The issue for me and I suspect others is that we don't seem to learn from our past That given all of our knowledge, including historical knowledge that 'these things take time', we still seem to accept that 'it takes time' instead bursting from the gate with a good plan. Not one that will require the kind of tweaking necessary to actually realize a strong bill in 3 or 5 or even 10 years, long after the kind of reform we'll ultimately see actually helps the people that really need it. And not to mention after elections that may hurt in the short term.

But that is the way it is. I don't have to like it. I just look at the rest of the civilized world, who look at us curiously, and are confused at how the most powerful country on earth can simultaneously have such power yet deny the essential right of universal health care that everyone else enjoys. We're a laughing stock on this.

There are many differences between the times of FDR's soc sec bill and the Saturday night women-bashing done by Democrats last week. Judis and Benen are doing that liberal history-as-a-crutch thingie -- give it up, boys, you been watching too many re-runs on yer teevees...

If government had evolved and progressed over the last 70-years things would be quite different. But it didn't. The corporations did. And we are not that many months past a serious attempt to completely undermine FDR's New Deal and DESTROY SOCIAL SECURITY. Remember? We had criminals running the country this time last year.

So let's not have this bullshit FDR comparisons please. There is a full, strong majority of Dims and Repugnants who are loyal to Corporate America -- bought and paid for by 'em -- and traitors to the American people. They are the government and they are gonna screw us every time the corporations say, "Screw 'em." you saw them effortlessly betray the women of the country on Saturday -- that should never be forgotten...

Please spare me with the "it'll get better bull shit..." and just wait to see the shitload of Corporate policy built into the Clown Car Senate 'healthcare reform' bill.

And prepare to throw up...

Remember how it was funny that big-talking loudmouthed conservatives always wanted to enforce ideological purity and railed at people like Lindsey Graham and Bob Bennett for being insufficiently right-wing?

It is right that progressives should fight like hell for the most robust bill they can pass, but the party leadership should also be prepared to compromise the hell out of it to make certain that something passes this year...the sooner the better.

In the end, whatever compromise is reached will be reached without any constructive engagement on the part of the GOP, so it is essential that there be enough compromise so that it is clear to any rational voter (as opposed to the 30% of the voting public that appears to be totally irrational), that the Democrats attempted to negotiate in good faith and that there was no good faith on the part of the GOP at all.
If that is the perception the Democrats will win big...if not in 2010, then in 2012.

We have two directions as a society:

Plan A:
Take money out of politics and profit out of media, then armed with the truth, pass real healthcare/energy/education/foreignpolicy reforms.

Plan B:
Keep money in politics and profit in the media, fight against the barrage of misinformation, get exhausted and pass half-assed reforms, and call it victory.

You decide.

I work in politics, have a grad degree in policy, etc.

Oh, and so you think you know more than Judis, too? About history and policy?

Maybe YOU don't understand what's going on. Or you're so invested in your "the world is more corrupt than you think and I'm smarter than you because i know that" POV that you can't debate with anyone. And this is why you don't get politics.

The logical extension of this worldview is to just give up and withdraw completely. So why don't you just do that?

Ohioan - of course you are spot on re: role of money. But should we just wait on everything else and let things deteriorate until that moment comes along? Plan A and B are NOT mutually exclusive. Baffled that you can't see that.

Frank C. still doesn't get it. It's not about smug generaliations about political history, Judis's or anybody else's. It's that this specific bill, if it's even a step forward at all, is also at least a step and a half backward. It only strengthens the stranglehold of the insurance companies on a crazy system that it does nothing to render more sustainable. Future reforms, when they finally come, will NOT be able to build on it because there is nothing to build on. Future reformers will have to blow it up and start from scratch. That day will only be delayed after the likely consequences of this bill have once again discredited the whole idea of health care reform in the public mind.

The pro-choice Dems held their noses and voted for this to move things forward, recognizing the greater good, despite the Stupak Stain. Now if the Stupak Stain is removed in committee, I wonder (rhetorically, that is) if the conservadems who pushed the Stupak Stain will be as open and 'forgiving' as pro-choice Dems were, and be man (or woman)enough to recognize the greater good and vote for the final bill (assuming this ever gets to such a stage).

What this comes down to is whether or not providing health care coverage for 45 million Americans is worth passing health care reform as it now stands. It isn't single-payer to be sure and does preserve the current insurance system, but if the choice is either accomplish nothing or cover those now without health insurance, it's a decision worth taking seriously.

Roosevelt, the towering political figure of the 20th century, with an electoral mandate, a Democratic Congress.....

Stop right there. In 1932 the Democratic Party was hardly more liberal than the Republican Party. Roosevelt himself ran on a balanced-budget platform. The pressure for social spending came from maverick Republicans, Democrats, Independents, and third-party Congressmen, mostly from the Midwest and West.

Conservative Democrats have always been with us. The DLC is just a continuation of the conservative Bourbon Democrats.

We should keep this quiet. We don't want republicans to find out about it until the final bill is signed into law. Better that we should seem a bit demoralized and that ws didn't get what we want so things proceed as smoothely as possible. Then strike when it's too late.

A lot of the Americans who'll be getting coverage with federal subsidies under the new insurance exchanges will be women. And unless President Obama and the leadership force the Senate to remove the Stupak amendment from the final bill, many of those newly insured folks will have less choice than others. This amendment is a blunt instrument that the anti-choice right can use to deny women choice in ALL areas of their reproductive lives. During the campaign, the president talked a good game about the right to choose and it's place in ensuring equal opportunity for women in all areas of life. Since his inauguration, he's been backing away from that forceful support of reproductive rights (for example, characterizing the Hyde amendment as "tradition"). It's deeply disappointing that this incremental and limited reform has been bought with women's rights. I might be more disposed to accept that price if the bill attempted real structural reform; that would have been genuinely "courageous". As things stand now, I'm not hopeful that the president and the Senate leaders are courageous enough to strip the Stupak/Pitt amendment from the final bill.

What this comes down to is whether or not providing health care coverage for 45 million Americans is worth passing health care reform as it now stands.

That coverage, if it ever really materializes, won't last long at all if nothing effective is down to bring down the insane costs of care in this country. Meanwhile, the individual mandates will make a lot of voters very angry, with good reason since the (largely farcical) insurance they're going to be forced to buy is going to quickly escalate in price as the insurers recover the costs of things like the ban of exclusions. Oh, which will piss off the people who currently have coverage, too, since they also will see their premiums escalate. Pure political genius!

You can't fix a system suffering from runaway cost inflation and multiple layers of skimming by forcibly shoveling even more money into it. Quite the contrary.

What ckelly at 11:10 said. What does Steve Benen know that Dick Durbin doesn't?

To hell with incrementalism. The bill is a steaming pile of dung. KILL THE BILL!

We are so far beyond having any more excuses for not doing what's right. There's no reason whatsoever to make insurance companies more wealthy. KILL THE BILL and start over with true single-payer. Enough is enough. No more compromises.

Steve LaBonne--do ever offer anything positive, ever? Seriously, if you truly are as negative as you appear, you'd probably be better off just crawling in a hole somewhere and waiting for the end of the world, because you're never going to be happy--certainly not with anything the Democrats ever do, or try to do. That is beyond clear at this point.
Otherwise, you should be making much better use of your time by working with a third party, not whining and generally acting like a condescending ass on a near daily basis with you fellow nihilist, deadenders like neill, among others.

KILL THE BILL and start over with true single-payer.

Because we know single payer is what's needed (it is), and the very act of our knowing that and wanting it is enough to make it pass where a far less comprehensive form of reform couldn't.

You can't fix a system suffering from runaway cost inflation and multiple layers of skimming by forcibly shoveling even more money into it. Quite the contrary.

I have a different take on the dynamics of health care, which is that once everyone is covered and there's federal money helping to pay for it we'll no longer be able to just sweep rising costs under the rug since employers won't have the option of continuing to raise deductions or simply not providing care at all as they do now. That's because one of the features of the health care reform effort is not to allow the sale of ever crappier health insurance but to set a floor for what must be covered.

Whatever, how is it "negative" to try to warn a party bent on committing political suicide to mend its ways before it's too late? What I presented is my analysis (and you'll find that the very knowledgeable likes of Marcia Angell, writing in HuffPo, agree) of how a bill like this will play out, substantively and politically, if passed. If that assessment is gloomy, it's because the bill is genuinely far worse in both aspects than its cheerleaders realize.

But I would indeed love to volunteer for a serious progressive party that's not just a platform waiting to be exploited by egomaniacs like Ralph Nader. Wake me up when there is such a party.

oh, and John Dingell must really be getting played, because he seemed pretty pleased and optimistic on Saturday--and he knows more, and has accomplished more regarding healthcare reform than anyone here ever will.

But hey, it's not a single payer system, so let's forget about doing anything and continue with the same failed system for another couple generations until sometime in the future, maybe, when the parties have completely changed or a third party takes their place or something maybe changes so we can get the dream system that we can't get all at once now.
really, I have to laugh at some folks here who are demanding a single payer system when a public option can barely be passed. You're just as bad as the Repubs who are content to see the current system continue. You're demanding the same thing but for different reasons, but equally indifferent to the lives which will be saved by passing some reform now.

Because we know single payer is what's needed (it is), and the very act of our knowing that and wanting it is enough to make it pass where a far less comprehensive form of reform couldn't.

shortstop gets it.

I have to admit, it's funny to see some progressives parrot the same Green Lantern style of politics that wingnuts on the right do. Sorry, but you just can't will something to happen, even if you stare at it real, real, real hard. Unless it's a fainting goat.

But hey, it's not a single payer system, so let's forget about doing anything

Now you're just being stupid. It isi possible to make things worse, and I believe this bill stands a good chance of "accomplishing" exactly that. Analysts who know more about the health care system than 500 Dingells think so too. And if you're going to argue on the basis of who's "happy", the insurance companies plainly are quite happy at the direction this is going. That should tell you something but you're evidently too dim to get the message.

The only way this bill works is by making people so furious about the health insurance system that they can force single-payer (expanded medicare or whatever) into law.

The odds are just as good, though, that the people will sweep Republicans into power and health care reform will be set back another 20 years.

The people arguing that this bill is a good state have given fuck all for explanations about how this could be so.

By the way- the real incrementalist path, obviously, would be allowing people younger than 65 to buy into Medicare, staring now at, say, age 55 and gradually expanding the age range downward later on after the initial expansion was seen to work and attracted strong public support. Go ahead and try arguing that a modest, paid-for expansion of a highly popular program would have been politically infeasible. It's not electoral politics that gets in the way, it's corporate campaign cash.

(Also buy the way, that would actually begin to solve the fiscal problems of Medicare, which stem from the fact that it currently covers only the oldest and thus for the most part sickest patients.)

By the way- the real incrementalist path, obviously, would be allowing people younger than 65 to buy into Medicare, staring now at, say, age 55 and gradually expanding the age range downward

We're *already* buying into Medicare though, just as we're buying into Social Security. So the model you're proposing doesn't work, unless you raise that portion of the payroll tax that goes to Medicare for all payroll tax payers and not just those people who chose to enroll. That in effect is a single-payer system, not that there's anything wrong with that. But it's not as simple as just allowing people to enroll into a Medicare-at-55 health care program.

David W., to appease the phony "fiscal conservatives", I would make Medicare available at 55 on the basis of paying an actuarially sound premium rather than as an entitlement, with subsidies for the less affluent as generous as could be gotten though the current Congress (paid for by one of the mechanisms employed in the current bills to pay for their subsides.)

The point is that it's daft to focus only on the government's expenditures rather than the cost of the health care system as a whole (which expansion of Medicare would unquestionably begin to curb). Democrats, starting with Obama, have been extremely remiss in allowing the debate to be framed in this dishonest way.

We simply cannot continue to spend several percentage points of GDP more than the next most expensive country. Any "expansion of coverage" that doesn't deal seriously with this issue will prove to be illusory and short-lived. And again, it's wealthy special interests that stand in the way, not voters.

Soulite: "There is no real guaranteed issue or rescission bans. Yet we're all going to be forced to buy health insurance that doesn't work. There's nothing that prevents insurance companies from denying care. Nothing at all."

Wrong on every point. That is a rant totally detached from reality.

Sec 103
(1) GROUP HEALTH INSURANCE MARKET.—Section 2712 of such Act (42 U.S.C. 300gg-12) is amended by adding at the end the following:
‘‘(f) RESCISSION.—A health insurance issuer may rescind group health insurance coverage only upon clear and convincing evidence of fraud described in subsection (b)(2), under procedures that provide for independent, external third-party review.’’.
(2) INDIVIDUAL HEALTH MARKET.—Section 2742 of such Act (42 U.S.C. 300gg-42) is amended by adding at the end the following:
‘‘(f) RESCISSION.—A health insurance issuer may rescind individual health insurance coverage only upon clear and convincing evidence of fraud described in subsection (b)(2), under procedures that provide for independent, external third-party review.’’.
So where is the weak point in that language? Which is backed up here:

SEC. 212. GUARANTEED ISSUE AND RENEWAL FOR INSURED PLANS AND PROHIBITING RESCISSIONS.
The requirements of sections 2711 (other than sub- sections (e) and (f)) and 2712 (other than paragraphs (3), and (6) of subsection (b) and subsection (e)) of the Public Health Service Act, relating to guaranteed availability and renewability of health insurance coverage, shall apply to individuals and employers in all individual and group health insurance coverage, whether offered to individuals or employers through the Health Insurance Exchange, through any employment-based health plan, or otherwise, in the same manner as such sections apply to employers and health insurance coverage offered in the small group market,

The only exception is for non-payment of premiums. As to denying care we have this:
SEC. 221. COVERAGE OF ESSENTIAL BENEFITS PACKAGE.
(a) IN GENERAL.—A qualified health benefits plan shall provide coverage that at least meets the benefit standards adopted under section 224 for the essential benefits package described in section 222 for the plan year involved.

Note the word 'shall'. Plus there are separate provisions banning annual or lifetime limits. And I don't see a lot of holes in the list of mandated coverage:
(1) Hospitalization
(2) Outpatient hospital and outpatient clinic services, including emergency department services.
(3) Professional services of physicians and other health professionals.
(4) Such services, equipment, and supplies incident to the services of a physician’s or a health professional’s delivery of care in institutional settings, physician offices, patients’ homes or place of residence, or other settings, as appropriate.
(5) Prescription drugs.
(6) Rehabilitative and habilitative services.
(7) Mental health and substance use disorder services, including behavioral health treatments.
(8) Preventive services, including those services recommended with a grade of A or B by the Task Force on Clinical Preventive Services and those vaccines recommended for use by the Director of the Centers for Disease Control and Prevention.
(9) Maternity care.
(10) Well-baby and well-child care and oral health, vision, and hearing services, equipment, and supplies for children under 21 years of age.
(11) Durable medical equipment, prosthetics, orthotics and related supplies.

You are bitching about a bill that exists only in your fevered imagination. With the obvious exception of Abortion and to a lesser degree unequal treatment of the undocumented this is an excellent bill that provides comprehensive health care coverage to an estimated 94% of residents. (96% if you think the children of the people who pick your food and mow your lawn deserve to go without medical care.)

Look: it is not as if there were no Dems advocating a single payer. there were. yet, they hardly ever appeared on the news -- even if only to create the appearnce of strife among dems. why is that? two reasons: firstm it is the single best solution to our problem

Single payer is the best solution to our overall problem, the immediate problem that the only Single Payer proposal out there was a POS designed more to send an ideological message than to actually solve the problem. HR676 is not 'Medicare for All', instead it starts by tearing down the entire infrastructure that serves existing Medicare and starts over on new grounds.

We know what a real Medicare for all bill looks like. It looks like the April 2007 Kennedy-Dingell Medicare for All Bill. http://www.pnhp.org/news/2007/april/kennedydingell_medi.php It didn't totally eliminate private insurance, people could still choose to be gouged if they liked, but it did extend Medicare to everyone.

What it didn't do is to try to transform the entire health care sector on both the insurers AND the provider side to 100% non-profit status. HR676 requires EVERY private investor in health care to divest their entire interest with compensation determined by the government and paid out over 15 years.

SEC. 103. QUALIFICATION OF PARTICIPATING PROVIDERS.
(a) REQUIREMENT TO BE PUBLIC OR NON-PROFIT.—
(1) IN GENERAL.—No institution may be a participating provider unless it is a public or not-for-profit institution. Private physicians, private clinics, and private health care providers shall continue to operate as private entities, but are prohibited from
being investor owned.
(2) CONVERSION OF INVESTOR-OWNED PROVIDERS.—For-profit providers of care opting to participate shall be required to convert to not-for-profit status.

Under the language of HR676 'institution' and 'provider' would equally apply to every optician, dentist, pharmacy, and hearing-aid company. And no provider could actually charge any customer any additional cost for anything covered under the bill.

(c) NO COST-SHARING.—No deductibles, copayments, coinsurance, or other cost-sharing shall be imposed with respect to covered benefits.

Not that you could have supplemental insurance to start with:

SEC. 104. PROHIBITION AGAINST DUPLICATING COVERAGE.
(a) INGENERAL.—It is unlawful for a private health insurer to sell health insurance coverage that duplicates the benefits provided under this Act.

Man I'm going to miss that AFLAC Duck. HR676 would vastly expand the range of services available to current Medicare enrollees while eliminating all premiums, co-payments or out of pocket expenses for everyone in the country. Good-bye supermarket pharmacy section! We hardly knew ya!

HR676 goes far beyond Single-Payer and would drive Capitalism out of the medical sector altogether in ways that go far beyond what even the British NHS system does (private insurance and for profit medicine are still legal in England where they wouldn't be here). The only things that separates HR676 from out-right nationalization is that it allows the Nuns and Jewish non-profit agencies to continue running their respective hospital systems, as well as maybe certain Co-op based systems like Group Health out here in Washington State. Otherwise it totally turns the medical care delivery system upside down.

I am not afraid of socialized medicine, but proponents need to be clear of what they are actually proposing. HR676 is NOT just opening Medicare to All. You could only believe it was if you knew either nothing about how Medicare is currently structured or what was actually in the language of the bill. Or both.

Interesting how we keep seeing totally unsupported assertions that the bill will really accomplish what it purports to, and no attempt at all to respond to the reasons that have been given why this is unlikely. Once again, it's just delusional to believe that simply forcing even more money to flow into a clearly unsustainable system characterized by runaway costs will accomplish much of anything, not for very long at any rate. And guaranteed "availability" of coverage by insurance companies means nothing if you can't afford the coverage in the first place.

All private-insurance-based systems that actually work in other countries (though none of them work nearly as well as public systems in delivering the most care for the buck)rely on NON-profit insurance and extremely tight government regulation of insurers, of which there is no trace in this bill.

The people arguing that this bill is a good state have given fuck all for explanations about how this could be so.

HR3962 has premium controls. Insurance companies cannot simply raise premiums at will. Insurance companies cannot deny any coverage mandated by Sec 222 of the bill, and that coverage is very comprehensive. Yet the talking points floating out there somehow are working on the weird assumption that Senator Kenned'ss final life's act was to bind America up and bend her over a couch while putting out an open call to the Insurance companies to come and do their will.

I can't do anything to convince paranoids that there really is not a wide ranging conspiracy where Obama, Pelosi, Kennedy, Dingell, Waxman, Rangel and Brown secretly pledged to sell American out to AHIP by passing over a piece of stinking garbage as reform. But you would think that rational people might actually check the bill language to see what attempts to control insurance companies were actually in the bill and THEN explain why they are going to be ineffective. But I guess it is just easier to assume that Captain K is a lone Superhero out to protect you from Supervillain Speaker P

Let me repeat from the preceding post. HR676 is somewhere between a political joke and a straight out ideological manifesto. Not only is its structure unworkable (we are not going to outlaw Walgreen's, Perle Vision Centers, and Professional Services Corporations overnight), the bill has elements that would make it a non-starter politically. Take the very first section of the bill:

SEC. 101. ELIGIBILITY AND REGISTRATION.
(a) IN GENERAL.—All individuals residing in the United States (including any territory of the United States) are covered under the USNHC Program entitlingthem to a universal, best quality standard of care. Each such individual shall receive a card with a unique number in the mail. An individual’s social security number shall not be used for purposes of registration under this section.
(b)( REGISTRATION.—Individuals and families shall receive a United States National Health Insurance Card in the mail, after filling out a United States National Health Insurance application form at a health care provider. Such application form shall be no more than 2 pages long.
(c) PRESUMPTION.—Individuals who present themselves for covered services from a participating provider shall be presumed to be eligible for benefits under this Act, but shall complete an application for benefits in order to receive a United States Mational Health Insurance Card and have payment made for such benefits
(skip)
SEC. 102. BENEFITS AND PORTABILITY.
(a) INGENERAL.—The health care benefits under
this Act cover all medically necessary services, including at least the following:
(A very comprehensive list follows that includes all emergency, routine and preventive care, glasses, dental work, and hearing aids)
(b) PORTABILITY.—Such benefits are available
through any licensed health care clinician anywhere in the United States that is legally qualified to provide the benefits.
(c) NO COST-SHARING.—No deductibles, copayments, coinsurance, or other cost-sharing shall be imposed with respect to covered benefits.

Hmm. No use of Social Security number, no detectable method of actually establishing LEGAL residency (the bill says simply 'residing'), presumption of eligibility after simply filling out a form, unlimited range of medical services from major surgery to eyeglasses to dental work, and no cost sharing of any sort allowed.

Christ there is already a run on ammunition in this country, imagine what will happen when the Reichnuts and Minutemen hear that Kucinich is proposing in the first six pages of his bill to extend free, unlimited medical, dental, vision, auditory with no questions asked to every illegal immigrant family that escapes the notice of ICE and can make it to a post office to fill out a form. Or sign one filled out by someone else.

Now in an ideal world the people picking our food, landscaping our lawns, and making beds in our hotels deserve access to health care either through employer paid or individual insurance, and certainly their children should have access to health and education without regard to what piece of paper is in their parents' wallets. But anyone thinking we can sneak this through right up front is certifiably crazy, Kucinich's bill does exactly what every frothing mouth-breather out there insists is the Democratic Party's secret plan: give free unlimited health care to illegal immigrants. And in this case those mouth breathers have a lot of company among remaining not crazy conservatives, independents, and moderate to left-center Dems.

HR676 is just not a serious piece of legislation and I find it hard to believe it got so many co-sponsors. I suspect they heard "Medicare for All " and thought this was just some new version of Kennedy-Dingell. No this goes FAR beyond that.

All private-insurance-based systems that actually work in other countries (though none of them work nearly as well as public systems in delivering the most care for the buck)rely on NON-profit insurance and extremely tight government regulation of insurers, of which there is no trace in this bill.

Insurer profits are controlled by insisting that they have to demonstrate they have met a set Medical Loss Ratio, They have to guaranteed enrollment and renewal unless they can prove fraud, and not fraud by their own definition, but by the government, and subject to outside review. The list of services is set out and is quite comprehensive, and they are not allowed to set annual or lifetime limits on clinically appropriate care as determined by the physician. No doubt the regulation could be tightened up but those who say such regulation has not even left a trace are not working from the legislation as it exists.

From what I see PNHP has successfully promulgated a series of bogus talking points that have been eagerly swallowed up by people with a particular ideological pre-disposition common on the actual left which can be summed up in two words: Revolution Now! and has the corollary Never Trust the Man!

Well fine. But historically that has never been the path to social democracy, although it has always been a perfectly good way to get a bunch of plate glass smashed and newspaper boxes set on fire.

You. Don't. Understand. The. Bill. And. Should STFU. Until. You. Do.

No trace? Man remind me to not hire Steve S as a hunting guide.

Thanks for revealing that you know absolutely nothing about the comparative features of health care systems around the world, and thus have no idea what you're babbling about. Go look, evidently for the first time, at the kind of regulation of insurers that exists in Switzerland and Germany and come back and try to tell us with a staight face that there's anything bearing even the remotest resemblance to that in this bill.

I'm with many others calling bullshit on the Social Security analogy. AND, like Steve S., and others, no there's not sufficient regulation in this bill.

Gadfly can you point to a cogent, text based argument why there is not sufficient regulation in the bill?

Because I think the solution they came up with is amazingly elegant and essentially self-enforcing. Insurance companies already publish the information needed to determine their Medical Loss Ratio in their tax returns, their SEC filings, and their rate change requests to the various state insurance commissioners. Plus it has up to know been a major talking point in their annual reports to shareholders. Take your total amount of claims paid out, divide it by the total amount of premiums taken in and there is your Medical Loss Ratio. Is that ratio higher or lower than that set by the Commissioner? If higher you have to eat it and perhaps petition for a change for the next Plan Year. If lower than you have to rebate the difference to your plan holders. The beauty is that regulators don't necessarily have to monitor any individual transactions, there are other opportunities for that. The key is that you cannot boost profits simply by denying care if in doing so drops you below the set MLR. Nor can you boost profits by simply insuring the healthy, if they don't make enough claims to drive your MLR up to its designated level the company has to rebate the difference. Under the bill the only way to boost profits is to compete on the basis of volume and efficient delivery of services rather than restricting your risk pool and denying care altogether, It turns the current model based on predation into a new model based on service. I don't pretend it is flawless but I would like to see some reasoned argument beyond "not sufficient". Why not?

In the original Tri-Committee bill this language was included in Sec. 116 which led me to ask in a post at Angry Bear back in July: http://angrybear.blogspot.com/2009/07/hr3200-sec-116-golden-bullet-or-smoking.html

And I still think those two sentences and their equivalents in the final version are the most important sentences in the bill.

‘‘SEC. 2714. ENSURING VALUE AND LOWER PREMIUMS.

‘‘(a) IN GENERAL.—Each health insurance issuer
that offers health insurance coverage in the small or large
group market shall provide that for any plan year in which
the coverage has a medical loss ratio below a level specified
by the Secretary (but not less than 85 percent), the issuer
shall provide in a manner specified by the Secretary for
rebates to enrollees of the amount by which the issuer’s
medical loss ratio is less than the level so specified. "

Now neither the word 'profit' or 'control' is included but that is exactly what this is.

Bruce,

Thanks for the extremely detailed and well written comments. As a skeptic, I have to say I feel a bit better after reading them.

All these remarks that are prefaced with "if" are about as useful as an ice cube in Antarctica. And about as intelligent. Those things DIDN'T happen and we are forced to deal with what IS, not what you think should be. I believe the phrase "get real", applies.
Don't know if anyone has realized but, if Obama has the "Blue Dogs", then FDR had the southern Democrats. To get legislation passed, FDR had to keep those southerners on board, just as Obama, Pelosi and Reid have to worry about "Blue Dogs" and "centrists".
Oh, and anyone not happy with Democratic achievements can do what was done in the 1930's: support your local Communist or Socialist candidate. See where that gets you...

Anybody reassured by Webb's BS is missing something that ought to be very obvious. The well-intentioned provisions preventing the insurers from discriminating against the insureds most likely to cost them money (pre-existing condition clauses and the like) WILL increase their claim payouts and thus, under the language of this bill, officially authorize them to raise their premiums. And not by a small amount.

But the Webbs of the world are perfectly OK if insurance executives maintain their big bonuses on the backs of the people who pay the premiums.

Again, anybody who claims there is adequate regulation in this bill MUST study the German and Swiss systems to learn about the level or regulation that is required to enable construction of a reasonably affordable, well-functioning system that has private insurance as a major component. Nothing in this bill is even in the same galaxy. There is absolutely nothing that will effectively contain costs, make coverage affordable- or from a political standpoint, mute the coming voter backlash against individual mandates unaccompanied by any effective measures to make them affordable.

Yes, FDR, that intrepid progressive who put Japaneese Americans in concentration camps and passed a Social Security ACt that covered about 7 people.

Think of that. FDR, a guy IN A WHEEL CHAIR passed a Social Security Act that didn't cover the disabled. Oh, and he also did nothing for Universal health care.

And then you have LBJ. Huge majorities, a mandate, filibusters were not the norm, and so we got Universal health care right?

Well no. Instead we got a program for the very poor in Medicaid, and when the average life span was about 70 a health care plan that doesn't kick in till you're 65 or about 5 minutes from death.

Oh and you have to go out and buy private insurance in addition to paying payroll taxes for medicare to tide you over until the Medicare kicks in. Great.

And yet people will say "if only Obama were more like FDR or LBJ. Please. I've always said Obama is demonstrably the most progressive person we've had in the White House since FDR. That doesn't mean he's as Progressive as I'd like, but the notion that FDR or LBJ were somehow these Progressive warriors who never backed down is horse shit.

I'm remembering that my mother worked as a full-time employee for a university for years, but was "non-FICA"-- back then (the 70s?), the law excluded certain state employees. She was full-time and permanent, but they called her temporary.

Anyway, yes, now that I think about it, Social Security didn't start as universal as it is.

I do think any decent bill with health care will gradually get better. It's just that a lot of us don't have much time to wait.