Editore"s Note
Tilting at Windmills

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December 16, 2009

WHERE DEAN STANDS, WHERE DEAN STOOD.... We talked yesterday about the debate among supporters of health care reform -- progressive activists/operatives who believe the existing plan should be defeated, and progressive wonks who believe the plan advances the cause of reform and still needs to pass.

Howard Dean, who was largely on board with trading a public option for a Medicare buy-in, yesterday sided with the activists/operatives: "Honestly the best thing to do right now is kill the Senate bill, go back to the House, start the reconciliation process, where you only need 51 votes and it would be a much simpler bill."

Kevin Drum argues that Dean is living in a "dreamland."

If you don't like the Senate bill, fine. Don't support it. But in what universe will healthcare reform get revived anytime soon if it dies this year? 2010? With the legislative plate already jammed, healthcare reform probably polling in the mid 30s, and midterms coming up? 2011? After Republicans have gained a bunch of seats in both the House and Senate thanks to public disgust with Democratic disarray? 2012? A presidential election year? 2013? 2014? [...]

[T]he fate of failed major initiatives is so obvious that I can't believe anyone is taking this seriously. When big legislative efforts go down in flames, they almost never spring back onto the calendar anytime soon -- and that's especially true when big healthcare bills fail.... If healthcare reform dies this year, it dies for a good long time. Say what you will about the Democratic leadership, but Harry Reid, Barack Obama, Rahm Emanuel, Nancy Pelosi, and Steny Hoyer all know this perfectly well. So do John Boehner and Mitch McConnell. (Boy do they know it.)

When reform bills go down, health care tends to be too hot to touch for about 20 years. And when the issue is brought back, it's less ambitious than the previous effort. As Ezra explained last month, "Failure does not bring with it a better chance for future success. It brings a trimming of future ambitions."

What's more, let's not forget that the existing Senate Democratic plan -- with no public option and no Medicare buy-in -- is already far more ambitious and much more progressive than what Howard Dean was proposing just five years ago. Go ahead and read Dean's 2004 health reform plan -- his signature issue -- and notice that it features no competition for private insurers, fewer consumer protections, and would cover fewer of the uninsured.

This is not to disparage Dean, who has done as much personally to advance the cause of health care reform as anyone in the country, but rather to highlight just how far we've come in a short period of time. In 2004, Dean, considered a liberal firebrand, offered a health care plan that even he would dismiss as weak and tepid today. If Republicans presented Dean's 2004 plan today, Democrats would laugh them out of the room.

Five years later, a Democratic president has a vastly better, more ambitious, more liberal reform plan nearing the finish line ... and Dean wants to kill it?

Kevin's piece summarized some of the strengths of the Democratic plan:

* Insurers have to take all comers. They can't turn you down for a preexisting condition or cut you off after you get sick.

* Community rating. Within a few broad classes, everyone gets charged the same amount for insurance.

* Individual mandate. I know a lot of liberals hate this, but how is it different from a tax? And its purpose is sound: it keeps the insurance pool broad and insurance rates down.

* A significant expansion of Medicaid.

* Subsidies for low and middle income workers that keeps premium costs under 10% of income.

* Limits on ER charges to low-income uninsured emergency patients.

* Caps on out-of-pocket expenses.

* A broad range of cost-containment measures.

* A dedicated revenue stream to support all this.

What's more, for the first time we get a national commitment to providing healthcare coverage for everyone.

And we get a strong foundation that can be built upon going forward, just as Social Security and Medicare were expanded in time, and just as every other country that has universal coverage has done in other industrialized democracies.

To let this rare opportunity slip away would be a mistake.

Steve Benen 9:50 AM Permalink | Trackbacks | Comments (112)

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Comments

Dean just doesn't want to join in the happy talk about the shit sandwich still on the Clown Car Senate plate with regard to health care 'reform'.

Or maybe he's just not seeing all the Big Fun that Pres. Hopey is seeing.

Kevin's happy talk also entails Dim "disarray" -- Gee, I wonder where he got that idea? ...Sandwich, Steve? Try the dijon...

Posted by: neill on December 16, 2009 at 9:53 AM | PERMALINK

Keep trying to sell something it's clear people aren't buying, see how well that goes for you.

As long as reconciliation existed, nobody really cares what excuses you make. Democrats didn't have to do this. They wanted to do this.

Posted by: soullite on December 16, 2009 at 9:54 AM | PERMALINK

Politicians had the luxury of dropping health care for 20 years back before people spent as much on premiums as they do rent or mortgage. Even if Dean meant to "kill" the bill -- he didn't, he said to pass one via reconciliation -- there is no reason to believe that voters aren't going to keep this issue front and center in every election until cost containment is addressed.

Posted by: square1 on December 16, 2009 at 9:55 AM | PERMALINK

Howdy y'all from Texas -

I read yesterday a comment I thought was very interesting - that in fact Dean SUPPORTS the bill, but he realizes that anything he supports ass-hat Lieberman would NOT support, so this is a jujitsu move on Dean's part to get support. If so, good thinking on Dean's part.

Posted by: LarryK on December 16, 2009 at 9:56 AM | PERMALINK

I think I can speak for most here that extreme disillusionment has set in, as we see the same dynamic time after time with the democrats. They have a solid majority, and if they simply had the political guts to go out on a limb and do something without being cowtied or bullied by the republicans this country could be in such better shape.

We worked very, very hard to get a seemingly progressive president elected, and as soon as the Washington beltway culture set in he turned into just another pawn of the men behind the curtain.

If Obama had campaigned as hard for a real health care reform including a public option or medicare buy-in as he did on the campaign trail, he could have energized the base they way he has demonstrated he can and a real bill could be a reality.

Instead, we have a handful of conservative politicians making the democratic majority bow down and lick their boots.

At what point do we realize that our system of government is completely and purposefully inept and corrupt?

Posted by: citizen_pain on December 16, 2009 at 9:58 AM | PERMALINK

You missed the entire point. If Dean says "Vote Against" then JoeMentia will think it is a pile of crap and will vote for it. If Weiner had said he HATES the idea of the Medicare buy in for 55-64 Joe would have voted for it to spite him.
It is easy to control people that reflexively vote against you. If you want them to sit down, tell them to stand up.

Posted by: joyzeeboy on December 16, 2009 at 9:59 AM | PERMALINK

Steve, let's assume for the moment that you're right and the bill is still worth passing. You yourself posited as recently as yesterday that "liberal enthusiasm" for the medicare buy-in proposal was what prompted Lieberman to reject it. Under that rationale, isn't "kill the bill" what Dean should be saying if he DOES want it passed?

Posted by: American in Exile on December 16, 2009 at 9:59 AM | PERMALINK

I'm with LarryK on this one!

Posted by: Jessica on December 16, 2009 at 10:00 AM | PERMALINK

You can always work on adding the Medicare buy-in at a later date in a much more simple fashion. So-called Netroots Activists are starting to piss me off, and I've always explicitly been on their side.

Posted by: Christopher on December 16, 2009 at 10:02 AM | PERMALINK

No where do you address the huge trump card the insurance industry and its bought and paid for Senate have now played: they get a mandated insurance coverage with virtually no real protection or oversight. It is a complete win for them. They can absorb the need to cover all in many clever ways and there is no oversight. At least with mandated car insurance many states have Insurance Commissioners. Where is our State and National Health Insurance Commission!!!! Dean is right: we are screwed if we pass this legislation.

Posted by: curious sampler on December 16, 2009 at 10:04 AM | PERMALINK

BTW, Hidassah is a spokes person for Susan G Komen, the wonderful orginization that has done the most work searching for a cure for Breast Cancer. My wife, a breast cancer survior (thankyou thankyou thankyou, as I LOVE my wife so much!) wrote an email to them to bitch about this.
http://ww5.komen.org/Contact.aspx
I will be doing the same.

I hope many of you will do the same.

Posted by: joyzeeboy on December 16, 2009 at 10:04 AM | PERMALINK

Thanks Steve(and Kevin by proxy)...I think we all need to take a very deep breath. The vagaries of living in a republican democracy rather than a parliamentary democracy mean that this type of compromise is the norm here especially with an intransigent opposition party. If Obama was the head of a parliamentary democracy, like the UK or Canada, and had a large majority in that parliament then he could pass pretty much what he (and we) liked. The Founding Fathers, in their wisdom, decided that that type of system didn't have enough checks and balances so this is where we are. You start with this health care reform and go from there. I completely agree that it is unrealistic to believe that if we shelve this now we somehow be able to revive HCR next year. That's a pipe dream and not passing anything will ensure a Democratic wipeout next year. Republicans know this and must be laughing hard at the divisions appearing on the left.

Posted by: Heather on December 16, 2009 at 10:04 AM | PERMALINK

No where do you address the huge trump card the insurance industry and its bought and paid for Senate have now played: they get a mandated insurance coverage with virtually no real protection or oversight. It is a complete win for them. They can absorb the need to cover all in many clever ways and there is no oversight. At least with mandated car insurance many states have Insurance Commissioners. Where is our State and National Health Insurance Commission!!!! Dean is right: we are screwed if we pass this legislation.

Posted by: curious sampler on December 16, 2009 at 10:05 AM | PERMALINK

Additionally, to echo a post from a reader yesterday, this bill in it's current form is political suicide for the democrats.

Forcing people to buy insurance during a serious economic downturn, and fine them if they don't?

Having government subsidize insurance premiums?

It is beyond mind boggling that the democrats still don't realize the republicans will pounce on this next election cycle and this will result in serious losses for the dems.

It's as if they STILL think they can simply reason and explain to people their motives.

Posted by: citizen_pain on December 16, 2009 at 10:05 AM | PERMALINK

Dean didn't give away mandates for a pittance.

Good luck EVER getting anything done in healthcare after you give insurance companies mandates. They will not only have what they want and fight everything else tooth and nail, they will have more than enough cash to buy all the legislators they will ever need and then some.

That's why people want to kill this bill, not just because it's incrementalist BS, it's likely the last healthcare reform bill that will ever be passed if it does get passed.

Posted by: soullite on December 16, 2009 at 10:08 AM | PERMALINK

BTW, there is no chance this bill is going to fail. If it did, it might take 4-8 years to pass another bill, but the terms at that point would almost certainly be far, far worse for the insurance carriers.

But Kevin Drum is too much of a clown to understand that the insurance industry does not leave money on the table just because they got what they wanted long ago: the individual mandate. If liberals had had the balls to demand a robust public option, the industry would have taken the deal. But the corporations will keep demanding more and more and more and more as long as liberals like Kevin Drum are willing to capitulate. A deal will only be cut when liberals finally walk away from the table. Then and only then will the other side toss just enough scraps back on the table (e.g. triggers, or limited Medicare buy-in) to close the deal.

Posted by: square1 on December 16, 2009 at 10:08 AM | PERMALINK

I swear, all you people with your magic happy talk about reconciliation....

IT DOES NOT WORK THE WAY YOU THINK IT DOES.

There's a reason why people that actually do policy for a living don't cry out for it, and it's not because they are pussies. It's because it's a terrible solution that carries some very stiff consequences, like a 5 year sunset provision.

Steve has done a great job if being pragmatic about the situation, and trying to paint the bigger picture. Yet so many of you continue to stamp your feet because you didn't get ponies.

Taking your ball and going home isn't the answer.

Posted by: John S. on December 16, 2009 at 10:10 AM | PERMALINK

Everyone, calm down. There is no way the Democrats are going to "kill the bill."

The insurance lobby won't let them.

Posted by: kc on December 16, 2009 at 10:11 AM | PERMALINK

But in what universe will healthcare reform get revived anytime soon if it dies this year? 2010? With the legislative plate already jammed, healthcare reform probably polling in the mid 30s, and midterms coming up? 2011? After Republicans have gained a bunch of seats in both the House and Senate thanks to public disgust with Democratic disarray? 2012? - Kevin Drum

Doesn't this also apply when people promise that we can fix healthcare later? When would that be?

If healthcare reform dies this year, it dies for a good long time. - Kevin Drum

Not if Democrats get off their cowardly asses and start hitting back against the Republicans -- hard. And if the corporate-controlled media continues to blame the Democrats, then hit them too.

Obama needs to use unfiltered events like the State of the Union to lay out the history of Republican obstructionism, and say to the American people, "Many of you may not have heard all this before, but that's because the people who call themselves 'the Fourth Estate' no longer do their jobs'.

Insurers have to take all comers. They can't turn you down for a preexisting condition or cut you off after you get sick.

Or they'll get fined $0.25.

Community rating. Within a few broad classes, everyone gets charged the same amount for insurance.

So people will have the satisfaction of knowing that everyone's getting screwed by skyrocketing rates.

Individual mandate. I know a lot of liberals hate this, but how is it different from a tax? And its purpose is sound: it keeps the insurance pool broad and insurance rates down.

Taxes are progressive. The subsidies will be inadequate.

* Caps on out-of-pocket expenses.

In H.R. 3200 the annual cap is $10,000 per family -- no matter their income level. Won't it be wonderful that so many families are forced to pay for insurance that they can't afford to use?

Posted by: SteveT on December 16, 2009 at 10:11 AM | PERMALINK

I suspect LarryK and others are right - having been burned on the buy-in, Dean now realises that if he signals acceptance of anything, Presidents Lieberman, Nelson, Snowe, and Collins will immediately decide that it's unacceptable to them. They will only be happy with a Bill that the "far" left bitches and whines about... so leftists should bitch and whine about Bills they're perfectly happy with, thereby allowing the "centrists" to declare them sober and moderate bipartisan compromises.

Posted by: toro toro on December 16, 2009 at 10:15 AM | PERMALINK

I keep hearing variations on the argument, 'don't make the perfect the enemy of the good,' but I think a lot of people making that argument are actively making the abhorrent a proxy for the good. Nothing but wishful thinking, or more cynically, they hope for Obama to get a reelection bullet point.

I simply won't support a bill that is nothing more than a transfer of wealth to giant, soulless insurance companies. A bill with a mandate and absolutely nothing about price controls or overhead reduction?

And I don't often disagree with Steve, but what's with the 'we won't have another chance for 20 years' fear mongering? The country wants reform. As the situation degrades further, and it will continue to, that desire will only intensify. And I disagree with your assertion that the bill is more ambitious than Dean's. It may be in some respects, but in others it's unsustainably atrocious. Let's also not forget that Dean's plan was five years ago and lot has changed since then.

When this bill fails, we'll have another shot again sooner than you think. And for anyone who argues that means 45,000 deaths per year for the uninsured, you're simply fooling yourself if you think any bill that passes this congress would help them.

Posted by: doubtful on December 16, 2009 at 10:24 AM | PERMALINK

Politics is "the art of the possible." Get this done now. More will be possible very very soon.

Posted by: sjw on December 16, 2009 at 10:30 AM | PERMALINK

More will be possible very very soon.

Why?

Posted by: square1 on December 16, 2009 at 10:31 AM | PERMALINK

'Not bring it back for twenty years' - what a load of bullshit. If the dems wanted to bring it back the next day they could. Maybe the thinking is that Mr. Hopey Changey won't want to play ball after he has his ass handed to him?

Posted by: DougMN on December 16, 2009 at 10:33 AM | PERMALINK

I want a single payer system. I know I won't get it.

I could support this bill if it eliminated the mandate to buy insurance. Otherwise I agree with Governor Dean because I feel this bill will do more to put Democrats in the Minority than anything else. It doesn't control premium costs. It doesn't control caps and it will hurt progressives in the long run and in the next several election cycles.

If Democrats become the Minority party you can forget about this bill. They'll scrap it and make us relive the bush43 years.

And honestly, I'm really tired of you 'wonks' telling progressives who are not happy to shut up and sit down. None of you are addressing the repercussions and the ramifications of the whole picture. You're only repeating the small snippets where it'll help the few. It's political suicide and helping the few isn't worth chucking it all.

Posted by: kindness on December 16, 2009 at 10:33 AM | PERMALINK

I'd like to ask all those (like neill and soullite) to point to the specific parts of the bill that prove their points.

Because it's obvious they can't. They haven't read the bill, they never have, and they're just talking out their asses.

And I'd also like to ask how Obama going on TV and railing against the Republicans is going to persuade Lieberman or Nelson or any of the DEMOCRATS that are holding up reform to vote for a public option or Medicare buy in?

And doubtful, would you kindly provide us with a time table as to when this more progressive bill you imagine can be passed?

And how you will be able to overcome the opponents of this bill then when you can't do it now?

Especially after they'll be embolden by the victory of defeating this legislation?

Really, you and the rest of the whiners are living in a dreamland.

If we can't pass, according you and your ilk, such a shitty bill now how can we pass a more progressive one later?

Oh, and be specific, show your work. I want time tables, vote tallies and talking points.

Better yet, why haven't you done what you're going to do already?

Bunch of WATB.

Posted by: Dr. Morpheus on December 16, 2009 at 10:36 AM | PERMALINK

If the bill passes, progressives will eat a S...T sandwich, because Democratic and Obama polls will go up. Watch. They are disconnected from political reality of the majority of people out there.

They generalize from their own gut.

Posted by: Stevie Blunder on December 16, 2009 at 10:36 AM | PERMALINK

Forget about 20 years. If you pass this bill, the insurance industry will have enough money and clout to kill every reform bill for the end of time.

Posted by: soullite on December 16, 2009 at 10:37 AM | PERMALINK

In H.R. 3200 the annual cap is $10,000 per family -- no matter their income level. Won't it be wonderful that so many families are forced to pay for insurance that they can't afford to use?

So H.R. 3200 is now a POS as well? Good to know.

More will be possible very very soon.

Why?

We've got two competing memes here. The first is that we should kill a bad bill now to save for later the extremely complex but good bill that we were unable to pass. The second is that we won't be able to add a much more simple and straight-forward Medicare buy-in at a later date. So which is it? If we can pass the *current* bill later, surely we can pass Medicare buy-in later. So which is the easier task?

Posted by: Christopher on December 16, 2009 at 10:38 AM | PERMALINK

A $10,000 per family out-of-pocket limit would be a HUGE improvement over the situation we have now, in which so many families are liable for the intireity of their mdical expenses. Yes, a $10,000 debt is a burden, but it is a managable one. Few people would lose homes or go into bankruptcy over it. Major illnesses and injuries can easily result in hundreds of thousands of dollars in costs. That's where the problem is.

There is much in this bill that is good and we would be crazy not to take the reform we can get. This is not about sticking it to the insurance industry - it's about getting to a rational helath care system. This takes us several steps towards that goal. If we stay focussed, the rest can come later.

Posted by: Virginia on December 16, 2009 at 10:38 AM | PERMALINK

Heather, none of this has anything to do with living in a republic or a democracy or not having a parliament or with the so-called wisdom of the founders. This has to do with the filibuster. The filibuster is a senate rule that can be changed any time. It is not in the constitution. Get rid of the filibuster and this would have been done in July.

Posted by: Mark on December 16, 2009 at 10:39 AM | PERMALINK

You are comparing apples to oranges.

Dean's plan was less ambitious, but it also wasn't a giveaway to the healthcare industry.

Here is Dean's Plan:

First, and most important, in order to extend health coverage to every uninsured child and young adult up to age 25, we'll redefine and expand two essential federal and state programs -- Medicaid and the State Children's Health Insurance Program. Right now, they only offer coverage to children from lower-income families. Under my plan, we cover all kids and young adults up to age 25 -- middle income as well as lower income. This aspect of my plan will give 11.5 million more kids and young adults access to the healthcare they need.

Second, we'll give a leg up to working families struggling to afford health insurance. Adults earning up to 185% of the poverty level -- $16,613 -- will be eligible for coverage through the already existing Children Health Insurance Program. By doing this, an additional 11.8 million people will have access to the care they need.

Many working families have incomes that put them beyond the help offered by government programs. But this doesn't mean they have viable options for healthcare. We'll establish an affordable health insurance plan people can buy into, providing coverage nearly identical to what members of Congress and federal employees receive.

To cushion the costs, we'll also offer a significant tax credit to those with high premium costs. By offering this help, another 5.5 million adults will have access to care.

Third, we need to recognize that one key to a healthy America is making healthcare affordable to small businesses.We shouldn't turn our back on the employer-based system we have now, but neither should we simply throw money at it. We need to modernize the system so employers will have an option beyond passing rising costs on to workers or bailing out of the system entirely. Fortunately, we have a model of efficient, affordable and user-friendly healthcare coverage: the federal employee health system.

With the plan I've put forth to the American people, we'll organize a system nearly identical to the one federal workers and members of Congress enjoy. And we'll enable all employers with less than 50 workers to join it at rates lower than are currently available to these companies -- provided they insure their work force. I'll also offer employers a deal: The federal government will pick up 70% of COBRA premiums for employees transitioning out of their jobs, but we'll expect employers to pay the cost of extending coverage for an additional two months. These two months are often the difference between workers finding the health coverage they need, or joining the ranks of the uninsured.

Finally, to ensure that the maximum number of American men, women and children have access to healthcare, we must address corporate responsibility. There are many corporations that could provide healthcare to their employees but choose not to. The final element of this plan is a clear, strong message to corporate America that providing health coverage is fundamental to being a good corporate citizen. I look at business tax deductions as part of a compact between American taxpayers and corporate America. We give businesses certain benefits, and expect them to live up to certain responsibilities.

I believe that is a much better plan then what is now being put forward.

With the plan currently in congress, many people are going to be forced to buy insurance that doesn't cover their needs and they can't afford. They will not be voting for Democrats again.

Posted by: DR on December 16, 2009 at 10:40 AM | PERMALINK

More will be possible very very soon...Why?

Because bringing 31 million currently uninsured into the system will dramatically underscore the provider shortage that healthcare workers have been bitching about for years and a second bite at the apple that trains doctors, nurses and allied health professionals will be a necessity.

Posted by: Blue Girl on December 16, 2009 at 10:42 AM | PERMALINK

If the tone of the comments here and at Drum's are an accurate reflection of progressive thought, health care reform is 'effed. Not because Lieberman is a prick, which he is, but because progressives aren't willing to settle for half a loaf instead of none. By stamping our feet and demanding the other half we will succeed in helping Lieberman damage our President, our party, and our chances for political control and progress.

Oh yeah, and a lot of folks will suffer for lack of health insurance and we will lose the opportunity to do anything meaningful on health insurance reform and health care reform for a generation. Why? Because we don't have the votes for doing anything more ambitious than the bill before the Senate now and we'll suffer losses in 2010 after the GOP and the press beat Democrats about the head and shoulders for the failure to pass health care reform.

Posted by: AK Liberal on December 16, 2009 at 10:45 AM | PERMALINK

AK Liberal,
It isn't that we aren't willing to settle for half a loaf. We aren't willing to settle for half a loaf after it gets shit on by the Insurance Industry.

To take the analogy a bit further: People are starving, and the Democrats get elected telling them they will give everybody a full loaf of bread. The Republicans cut the loaf in half, and shit on it. The Democrats insist everybody must eat it, since, hey it is half a loaf.

Do you think anybody is going to re-elect those Democrats? They would have much rather not gotten the loaf of bread at that point.

The fact is that "progressives" don't think forcing people to buy un-affordable ineffective health insurance is a good idea. Actually, we think it's a terrible idea.

Posted by: DR on December 16, 2009 at 10:55 AM | PERMALINK

"What's more, let's not forget that the existing Senate Democratic plan -- with no public option and no Medicare buy-in -- is already far more ambitious and much more progressive than what Howard Dean was proposing just five years ago."

That isn't the point. The point is that this bill makes the situation WORSE. It isn't half a loaf or a tenth of a loaf. It's become a horrible idea that not only doesn't solve any problems but makes them actually accelerate. Costs will go up as the insurance companies have a captive market with no alternatives to buying insurance whatever they choose to price it at. Recission is not really stopped since they are still allowed to deny coverage for fraud (which is the excuse they use anyway).

The bill is an abomination and tying health care reform to the results of this bill is a sure way to kill any chance at real reform for a generation. It has every aspect necessary to taint the very concept of reform for decades. and to turn off the democratic base leading up to a tough election.

Besides which you ignore that dean didn't say "kill the bill and stop the effort." He said move to reconciliation, which yes has serious drawbacks but nothing so bad as the current bill.

Posted by: Tlaloc on December 16, 2009 at 10:59 AM | PERMALINK

Steve, you remind me of Rahm Emanuel. I concede your focus is on tactics right now, and you may be right about the diminishing chances of revisiting reform next year or anytime soon. The problem is strategic. The administration has done an absolutely shitty job of selling this piece of shit bill. There has been no explanation besides trust us. Well, I believe we have a very big problem on the horizon, the disgust from the people who supported Obama. I don't think his support is going to carry into 2010, and then what we'll have is a legislature which will be lucky to pass one bill, because at this rate, many progressives and independents will sit it out and the republicans will be back in control. If that happens, look out for 2012.
If this administration wants to keep working, there had better be a crystal clear explanation of exactly how this bill was worth passing, and there had better be some good old fashioned revenge against that asshole Lieberman.

Posted by: rbe1 on December 16, 2009 at 11:01 AM | PERMALINK

pass a shitty bill and change it later to get the desired results...how's that medicare prescription plan workin' out? yes, unless rendition is used, there is little that can be done. but for the glass half full people...try to understand the frustration at once again seeing the drunk fall down in slow motion from the beginning, knowing how it will end, and being helpless to change it. i'm sure you feel the same frustration...and maybe we're not being pargmatic enough, to you a little whiny...but heath care users, and voters aren't known for their pragmatism. sometimes the bold move wins the day out of sheer emotion. what could that move be? if i was smart enough to know, i wouldn't be the un-elected senator from maryland, tapping on a keyboard. you guys are smart...don't just tell us we need to hold our noses and eat the shit sandwich, because something is better than nothing. i understand why that may be needed to get reform's foot in the door. but most people won't. and they'll be voting in 2010...voting with emotion, not pragmatism. everything comes with a cost...this just seems like a lose-lose for we the people...and the democrats. give us whiners some hope...we really don't want to take our ball and go home. happy holidays to all.
medicine bad-whiskey good.

Posted by: pinkpatudy on December 16, 2009 at 11:03 AM | PERMALINK

The thing that puzzles me is that you think there's a supportable status quo, and that we CAN just 'come back to it' in 20 years.
This is an insupportable state. The health insurance industry is not only killing thousands of people, they're killing corporations, destroying the country's ability to innovate, bankrupting millions of people.
And the rates are going up.
This is breaking the back of America.
The alternative to HCR is not 'oh, well...'
If the situation isn't remedied, we become a second-class nation and a death trap that no one will visit let alone invest in.
Death Trap.
Not 'reform bills become political poison.'
The status quo is a death trap for this nation.
The people know it.

Posted by: pbg on December 16, 2009 at 11:04 AM | PERMALINK
pass a shitty bill and change it later to get the desired results

Yes, but obviously you missed Steve's history lesson from yesterday. That is EXACTLY what happened with Medicare AND Social Security. They were woefully inadequate when first enacted, but significantly improved upon over the years.

If people like you had your way, NOTHING would have been passed initially until the entire thing as it exists today was rammed through. And that means it NEVER would have happened at all.

But keep bitching and whining about your ponies.

Posted by: John S. on December 16, 2009 at 11:09 AM | PERMALINK
The status quo is a death trap for this nation. The people know it.

And those who are paying attention know that this bill would do nothing to change that, and indeed would prolong it by shoring up the finances of the insurance companies for a bit longer (while giving nothing but loophole-filled lip service to preventing them from denying the care their customers have paid through the nose for.) And that, since there is nothing to contain premium increases, even the subsidies will be swallowed up in short order. And that a government mandate to give money to the bloodsuckers will be political poison.

There's exactly one reason why the insurers will permit their serfs like Lieberman to vote for this bill in its current state: they know it's a Medicare part D- like boondoggle for them.

Posted by: Steve LaBonne on December 16, 2009 at 11:12 AM | PERMALINK

John, no they weren't Social Security wasn't great when it started out, but it was a real program that applied to most Americans. Medicare wasn't great either, and had opt-in elements to it, but it still covered most of the elderly.

This doesn't cover most people. It doesn't help most people. It doesn't create any new programs that can be expanded upon. It doesn't institute a workable regulatory framework that can be patched as needed. It creates some minor fixes that insurance companies will find a way around, probably before most of the bill is implemented.

Posted by: soullite on December 16, 2009 at 11:12 AM | PERMALINK

Even Ezra Klein says it would be at least a decade before anything gets fixed if this bill passed. And he's a supporter. So how is the situation really that different?

Pass something, nothing else gets done for a generation. Pass nothing, nothing else gets done for a generation.

But if you pass something, you get mandates... which may be great, or may discredit universal healthcare forever.

Posted by: soullite on December 16, 2009 at 11:17 AM | PERMALINK

I'm with LarryK too.

As for the complaint that this legislation is just a giveaway for insurance companies, then why are they working so hard to kill it? No, that argument doesn't wash.

Posted by: Gregory on December 16, 2009 at 11:17 AM | PERMALINK
As for the complaint that this legislation is just a giveaway for insurance companies, then why are they working so hard to kill it?

Were you born yesterday? They're (barely, at this point) pretending to fight it (having succeeded in gutting it of everything they actually didn't like.) Lieberman works for them; there's no way he'd support it if they really feared it.

Posted by: Steve LaBonne on December 16, 2009 at 11:21 AM | PERMALINK

And right on cue, here come the lies:

1) Dean's plan wasn't so good, this is so much better.

Right, so much better for the insurance companies, you mean. I see nothing in Dean's plan about forcing people to buy private insurance coverage from the private companies who will not be forced to actually provide good care.

2) This plan sucks, but we can improve it later, just like Social Security.

Wrong. The passage of both SS and Medicare created whole new public systems -- this bill reinforces the old system and goes out of its way to prevent government from doing the things necessary to bring down costs.

We can expect more of these lies from the liberal blogs and the Obama fanboys in the days ahead as they try and discredit those who think this plan is a big win for the insurance lobby and a big loss for Americans.

Posted by: Joesbrain on December 16, 2009 at 11:22 AM | PERMALINK

What Senate bill? We've had a stream of "bills", oscillating a bit, but generally getting progressively worse, always a few votes short of a 60-vote "majority". Wake me up when they actually pass something by President Lieberman.

Posted by: qwerty on December 16, 2009 at 11:23 AM | PERMALINK

The notion of killing all the advances that this bill offers confuses me. Yes, to the extent possible, insurers are likely to continue to gouge us. But they'll continue to gouge us anyway. Either way, we're screwed. Either way, insurers benefit. On that, we all agree.

But affordability IS provided for many among the poor (expansion of Medicaid, subsidies) and those of us with pre-existing conditions (no denials, community rating). Those reasons alone are enough to make me support this bill.

The goal was never specifically to stick it to insurers (that would have been a side benefit), but to increase access to quality, affordable heatlh care. This bill doesn't go far enough. But it's a significant start.

In fact, I'm among those that believe that if this bill passes, then we have a direct path to expanding Medicare via reconciliation without all the negotiations on the other stuff (once such expansion takes effect, the 5-year sunset would be a political winner in future elections). This path would become even shorter if insurers use this legislation as on opportunity to gouge policyholders.

I pray that progressive Dems see the benefit of passing this bill. In the meantime, we should start working to primary the ConservaDems and replacing the Republicans, so we can change get the 60 votes we need/change the filibuster rule to get the progress we deserve.

Posted by: cjo on December 16, 2009 at 11:30 AM | PERMALINK

Two quotes from Greenwald's column today:

"This bill appears to be legislation that the president wanted in the first place, so I don’t think focusing it on Lieberman really hits the truth," said (Senator Russ) Feingold. "I think they could have been higher. I certainly think a stronger bill would have been better in every respect."

. . . Yet numerous Obama defenders -- such as Matt Yglesias, Ezra Klein and Steve Benen -- have been insisting that there is just nothing the White House could have done and all of this shows that our political system is tragically "ungovernable."

-----

What we have here is the same echo chamber that existed under Bush. If the old administration wanted a message out there you could be sure the right wing blogs would oblige.

Now we will get the echo chamber of the Democrats as this site and others work to discredit Dean and the progressives.

Posted by: Joesbrain on December 16, 2009 at 11:31 AM | PERMALINK

All talk now is bloviation, its bluster, relax, take a deep breath. Dean's rhetoric is a balancing act for the Lieberman pus flow. In the end, the L idiot will vote for this bill, as will Snow probably. We live in a corporate culture and that's what constitutes American exceptionalism, embrace it and just wish you had learned American history when you had a chance.

Posted by: geodahir on December 16, 2009 at 11:32 AM | PERMALINK

you say: Individual mandate... its purpose is sound: it keeps the insurance pool broad and insurance rates down.
is there actually something in the legislation that makes sure it keeps rates down? any control or regulation of premiums? or are you "trusting the market" and some "invisible hand"? cause if you are, you are speculating.
frankly, i am sick and f'ing tired of people saying that this is our only chance to reform healthcare for at least the next 20 years! why would that be? are Dems planning on losing Congress and the White House? 'cause if they aren't, they should be able to revisit this at any time.

Posted by: joe in oklahoma on December 16, 2009 at 11:32 AM | PERMALINK

I'd like to ask all those (like neill and soullite) to point to the specific parts of the bill that prove their points. Because it's obvious they can't. They haven't read the bill, they never have, and they're just talking out their asses. Posted by: Dr. Morpheus on December 16, 2009 at 10:36

Have you?

The "bill" is constantly morphing and many Senators appear not to understand much of it.

I do know that things like "mandate" scare a lot of people of all persuasions. At one point, a penalty of 2.5% of income above $9,000 up to the average premium sold nationwide was bandied about, as was a straight $750 fine. Maybe people won't mind a government mandate forcing them to buy a product by a for-profit corporation. I know that health insurance companies are salivating over the idea. And what do consumers get in return? Some say the anti-rescission laws are filled with loopholes or simply don't offer enough penalties as deterrent. Health insurance exchanges are little better, as I understand them, since you're just getting more for-profit corporations to pick from.

I for one would prefer the choice of also buying into some sort of non-profit pool, be it government or otherwise.


Oh, and be specific, show your work. I want time tables, vote tallies and talking points.

Nice to see that,in making your case, you held yourself to the same standard by citing pages from the bill and independent statistical data.

Posted by: oh my on December 16, 2009 at 11:38 AM | PERMALINK

"When reform bills go down, health care tends to be too hot to touch for about 20 years."

Dean didn't propose scrapping healthcare reform, only the Senate bill. He wants to go back to the House bill.

Put away the Straw Man.

Posted by: Joe Friday on December 16, 2009 at 11:39 AM | PERMALINK

John,

"I swear, all you people with your magic happy talk about reconciliation...."

IT DOES NOT WORK THE WAY YOU THINK IT DOES."

Then why were Chimpy Bush and the Republican Congressional Majority so successful with it ?

Posted by: Joe Friday on December 16, 2009 at 11:42 AM | PERMALINK

Insurers have to take all comers. They can't turn you down for a preexisting condition or cut you off after you get sick.

This is so much bullshit it is literally starting to give me ulcers. To the best of my knowledge, the sole enforcement mechanism for this provision is that insurers who do not voluntarily agree to ban recision and preexisting conditions terms are not allowed to participate in the exchange unless the recision is based on fraud on the part of the insured.

So if you buy insurance through the exchange and then get sick, what happens if your insurer simply declares that some minor mistake on your initial insurance application from ten years ago constitutes fraud and as a result it rescinds the contract? NOBODY FUCKING KNOWS!!!

I have talked to THREE congressional aides who have been working on health care, and as near as I can tell, your only remedy for a fraud denial is to sue them (most likely in federal court), a process which is expensive and takes years. That's assuming the bastards didn't bury an arbitration agreement in the contract, of course. And if it works like ERISA litigation, at the end of it, if you win, all you get is the amount they originally denied you, which means good luck finding an attorney to take the case. There is nothing -- NO FUCKING THING AT ALL -- in the bill which even pretends to punish an insurer who wrongfully rescinds a contract on the basis of fraud.

Kill it.

Posted by: Alan on December 16, 2009 at 11:46 AM | PERMALINK

cjo' point is worth repeating. Insurance companies will gouge us with this bill, and insurance companies will gouge us without this bill.

So, we should pass this bill with its benefits for the poor and those with pre-existing conditions. Then let's drop all talk about a public option and immediately start a campaign to open Medicare to all via reconciliation. The sunset provision under reconciliation that gives some pause is actually a political winner in future elections.

Posted by: eliza on December 16, 2009 at 11:47 AM | PERMALINK

hey john s...thanks for the constructive criticism and special use of capitals. prescription bill...like i said...how's that coming? senate will surely close the hole in the current bill. you're right...the poop on my donut makes riding my pony more fun. i'm on your side...now make me feel better about what we're going to get...please. attacking me don't help...take a chill pill, as long as your not in the prescription donut. maybe change down the road can happen...get your foot in the door. it just seems the political playground ain't what it used to be. hope you have a good holiday, whichever one you celebrate. mine is the winter solstice...doasn't require faith and it happens the same time each year(so far).
medicine bad-whiskey good

Posted by: pinkpatudy on December 16, 2009 at 11:47 AM | PERMALINK

And doubtful, would you kindly provide us with a time table as to when this more progressive bill you imagine can be passed? -Dr. Morpheus

I said no such thing. I said that claiming the issue wouldn't be revisited for 20 years was fear mongering and that scenario was unlikely since the current system is unsustainable and degrading. I doubt the citizens would accept a two decade lapse before reform was revisisted. I made no assumptions that progressives would be anymore successful during such a revisiting.

Would you kindly read what people write before lashing out like and calling names?

Posted by: doubtful on December 16, 2009 at 11:48 AM | PERMALINK

They're (barely, at this point) pretending to fight it (having succeeded in gutting it of everything they actually didn't like.) Lieberman works for them; there's no way he'd support it if they really feared it.

And Lieberman's support still is far from certain.

Barely pretending to fight it? Nonsense. The TV ads in New Orleans that are intended to influence wavering so-called "Blue Dog" Senator Landrieu were thick and fast over the Thanksgiving holiday. I know; I was there.

When an industry likes a bill, such as with Bush's stupid Medicare prescription drug boondoggle, they don't pretend not to. I maintain that Dean's statement is political jiu jitsu aimed at Lieberman, but the insurance industry certainly wouldn't spend millions of dollars lobbying against a bill they like.

I agree that the bill is a disappointment, and contend that the Democrats conceded far too much in advance, but come on, now, let's not lose our heads.

Posted by: Gregory on December 16, 2009 at 11:51 AM | PERMALINK

"...we should pass this bill with its benefits for the poor and those with pre-existing conditions."

I agree. I don't want to leave others behind simply because I might not benefit (i.e., insurers will gouge us whether this bill passes or not).

As others have indicated, with this legislation out of the way, we can focus on expanding Medicare without the distractions. It's a simple concept, easily communicated, can pass via reconciliation, and is a long-run political winner.

Posted by: Chris on December 16, 2009 at 11:59 AM | PERMALINK

Lieberman's support is uncertain only because he's still deciding whether to try to make the bill even a bit worse. If his insurance-industry paymasters (and employers of his wife) just wanted to kill it, he'd have been saying "no way" all this time instead of trying to tailor it further to their liking.

Besides, the insurance companies are smart enough to know that openly favoring this piece of crap would be the fastest way to get our phony congressional progressives off the fence and onto the "no" side.

Posted by: Steve LaBonne on December 16, 2009 at 12:01 PM | PERMALINK

I guess what gets me most disgusted about the whinging on our side of the aisle is that we have in our hands the power to fix this thing, and always have. And we'll still have that power after this bill is passed.

That power is: simply refuse to do business with private insurers. We could have taken them down a long time ago if everyone just refused to stop handing them their money. And we'll still be able to do it after this bill passes - the only difference is, you'll get a fine for doing it, but that fine will be substantially lower than what you would have paid for your premiums, and it goes to the government, not to a private insurer, so the net effect is the same: it helps to bring down the private insurers.

I've brought this up before here and other places, and there's always a handful of people who pipe up with about how they can't handle the risk of going uninsured, etc etc. I understand, having gone without insurance for years myself. But the bottom line is, no one else is going to fix this, and crying about how we were sold out isn't going to change that.

If half the people in America dropped their insurance tomorrow, we'd get single payer. Otherwise, you're going to have to wait. And wait. And wait. Until it becomes clear after 20 years of tinkering around the edges of the problem that no matter what tinkering is done, the private medical system - both insurers and providers - are always going to find a way to rape us and squeeze us dry.

The choice now is the same as it's been for the past 20 years or more - take the risk now and drop your insurance, drive the bastards out of business and live with the inevitable anxiety of being uninsured for the year or two it will take to sort out the mess and transition into a sensible universal coverage system, or live with the inevitable anxiety of being squeezed harder and harder each year and bled dry over a decade or two.

As much as I despise Joe Lieberman and others of his ilk (I'm lookin' at YOU, Blanche Lincoln), I'm a little sick of hearing smart people bitch about how someone else won't fix what they've always had within their own power to fix.

Posted by: Jennifer on December 16, 2009 at 12:02 PM | PERMALINK

I love how reconciliation is too complicated and problamatic to pass HCR now but next year we'll do it to pass medicare buy-in or the public option. Right. It's one or the other. Use reconciliation now or forget about ever using it for HCR. Here's another thought for you though. It's not like if the Senate does pass this bill that it's suddenly pony time. To pretend that merging the House and Senate bills in conference is going to easy or workable is folly. The House bill passed by the barest of majorities and selling the Senate version to the House willnot be easy. The more they water down the Senate bill (don't forget Ben Nelso hasn't extracted his pound of flesh yet) the harder it's going to be to come up with a bill that will get through both houses. Gov Dean is right on.

Posted by: Todd on December 16, 2009 at 12:05 PM | PERMALINK

Kill the bill. The damage done and being done to the Democraps is entirely of their own doing. By caving and caving and caving again to the FUCKING MINORITY they prove themselves too incompetent and feckless to "lead".

The GOP, whether in majority or minority, gets what they want. The Democraps? They also get what the GOP wants whether they are in the majority or minority themselves.

Fuck 'em. The health care "reform" bill in the senate will make middle class (what's left of them) and poorer people's health insurance WORSE. It will start the process of killing employer insurance immediately, starting with a crash in the value and coverage of what IS offered. It doesn't prevent caps on coverage, and thus continues the fun process of medical bankruptcy. It has loopholes so big that you could drive Blue Cross/Blue Shield through it.

Fuck the bill, fuck the Dems. Kill the bill.

Posted by: Praedor on December 16, 2009 at 12:05 PM | PERMALINK

"...take the risk now and drop your insurance, drive the bastards out of business and live with the inevitable anxiety of being uninsured for the year or two"

Live with the anxiety or worse. Taking this advice might cause you to lose your life savings, your car, your home, and/or your life (or the life of somebody you love).

Worst advice ever.

Posted by: maya in kentucky on December 16, 2009 at 12:10 PM | PERMALINK

I particularly love how the assumption by so called progressives is that the bill can be hacked and slashed beyond to a point where it will actually make the system worse by Bayh, Nelson, Landreiu, Lieberman, and the rest of their putrid ilk, but Harkin and Sanders and the progressives are just supposed to bend over and take it.

They need to walk away from the table now.

Posted by: doubtful on December 16, 2009 at 12:16 PM | PERMALINK

the insurance companies are smart enough to know that openly favoring this piece of crap would be the fastest way to get our phony congressional progressives off the fence and onto the "no" side.

Openly favoring it is one thing; spending millions on lobbying against it is another.

Dean's political jiu jitsu cost nothing. TV ads and [strike]bribing[/strike] lobbying Congress costs millions. The insurance industry simply would be foolish to spend millions of dollars fighting a bill it supports, and frankly, it's foolish to suggest they would actually do so.

I'm as angry about the fecklessness of many Democrats in Congress and this administration as anyone here, but not enough to advocate for such an epic fail as to let health insurance reform go down to defeat again. The measures against recission and pre-existing condition denials alone are points in its favor.

Posted by: Gregory on December 16, 2009 at 12:16 PM | PERMALINK

but the insurance industry certainly wouldn't spend millions of dollars lobbying against a bill they like.

And this is why progressives always get beat, whether in poker or legislation. You don't think that an insurance industry that makes obscene profits wouldn't mind putting a little money on the table to leverage themselves even more? Hell, as Senate dems keep back pedaling why not just keep asking for stuff? Pretty soon they'll be wanting $billions$ in government money to "assist in the burden" of adding more staff to handle the influx of participants.

At some point you just have to call their bluff.

Posted by: oh my on December 16, 2009 at 12:17 PM | PERMALINK

"I love how reconciliation is too complicated and problamatic to pass HCR now but next year we'll do it to pass medicare buy-in or the public option. Right."

Despite the sarcasm, that is right. HCR is complex in it's current state, with pieces that are easily reconciled and other pieces that would not qualify for reconciliation. Also, ConservaDems would block this bill if they knew that reconciliation was part of the process.

No. Passing this bill now, would eliminate distractions that might prevent us from being successful with reconciliation in the future. If this bill passes, and the progressive movement doesn't give up and unites around the idea of opening Medicare to all, then we have a clear path to victory.

Posted by: Chris on December 16, 2009 at 12:19 PM | PERMALINK

I'm a little sick of hearing smart people bitch about how someone else won't fix what they've always had within their own power to fix.

People are quite understandably hesitant to take a risk that could directly, and quickly, lead to their own deaths. Having stood at the bedsides of two people leaving this world who could have stayed in it a lot longer had they been insured, I know how easily this could happen to anyone without insurance, regardless of income and network. Both of these people had had insurance up until 6-12 months before they developed serious illnesses, both had been healthy, and both were only middle-aged.

It's not like boycotting Wal*Mart. It's a huge, huge danger.

Posted by: shortstop on December 16, 2009 at 12:21 PM | PERMALINK

# "Yes, a $10,000 debt is a burden, but it is a managable one."

Over ten years thats $100,000 even if you don't get sick or injured.
Recall that the US median income is $50,000.

# "[W]hat Howard Dean was proposing just five years ago" ... is what Howard Dean thought he could get past the Republican congress of 2005.

# "The status quo is a death trap for this nation. The people know it."

That would suggest they would support nationalizing the industry, but they don't -- yet.

# "Medicare AND Social Security [...were] woefully inadequate when first enacted, but significantly improved upon over the years."

Thanks to Democratic congresses with guts. We don't appear to have one, and the polls indicate that passing a mediocre-at-best bill will hurt the prospect of acquiring one.

# "As for the complaint that this legislation is just a giveaway for insurance companies, then why are they working so hard to kill it?"

The phrase you want is "Please don't throw me in the briar patch!"

Posted by: Forrest on December 16, 2009 at 12:23 PM | PERMALINK

Thanks to Democratic congresses with guts. We don't appear to have one, and the polls indicate that passing a mediocre-at-best bill will hurt the prospect of acquiring one.

It quite possibly will, but what I never hear kill-the-bill proponents discuss is how they think the Dems will fare at the polls in 2010, 2012, etc. if we pass nothing. Where are we going to get the stronger majority that will allow us to get it right next time?

I'm not suggesting there's a win to be found anywhere here, by the way. I just want to know why people think we'll be in a stronger position down the road if the whole reform effort goes down now.

Posted by: shortstop on December 16, 2009 at 12:28 PM | PERMALINK

It's the mandate that is the problem. Without a public option to keep costs down for the underprivileged, a mandate is an incredibly regressive tax and a financial windfall for the insurance companies. It's a giveaway to big business and a takeaway from poor people.

Lose the mandate, or support it with a public option, and I'd have no problems with this bill. I suspect Dean is thinking along similar lines.

Posted by: Remus Shepherd on December 16, 2009 at 12:29 PM | PERMALINK

You don't think that an insurance industry that makes obscene profits wouldn't mind putting a little money on the table to leverage themselves even more?

Of course they wouldn't mind, but the point is that they'd spend that money advancing their actual position, not the opposite of their actual position.

If the insurance industry liked this bill, then all those interest group TV ads spreading bogus Fear, Uncertainty and Doubt and focused on Landrieu would be pretty damn stupid, since she might actually prove the 41st vote the Republicans need to defeat health care reform, and then the insurance industry wouldget nothing.

No, the insurance indsutry doesn't like the bill, thank you very much, and for me that's reason enough to continue to support it.

Posted by: Gregory on December 16, 2009 at 12:32 PM | PERMALINK

The proposed healthcare legislation is such a good deal for the industry that I wonder if it might pass Congress even if the progressives in the House voted against it? Conservative Democrats, combined with Republicans who have been told by their corporate sponsors to vote for the bill, might be able to pass it.

Posted by: gizmo on December 16, 2009 at 12:36 PM | PERMALINK

Most of Kevin Drum's comments aren't true:

* Insurers have to take everyone, but they can jack up rates and craft their plans to discourage sick workers. The regulations on this front are largely toothless and won't do the job.

* I think most liberals are ok with an individual mandate when there is a choice of a public plan. But since insurers can craft their plans to cherry pick healthy workers, the mandate may result in millions of people who depend the most on insurance paying more, not less.

* There are significant subsidies, but they were scaled back to meet the arbitrary $900 million price tag. The result is that millions of middle class families will no have a mandate to buy more expensive insurance without subsidies.

* I believe Kevin Drum is wrong on the cap on out of pocket expenses. Reid stripped that out, or at least raised the cap, but the cap is still likely there.

* Kevin Drum says there is a broad range of cost-containment measures, but all the ones with real teeth were stripped out. By all reckoning, this bill does not slow the growth of health care spending that is choking off our economy.

* He's also wrong that we get a national commitment to health care for everyone. This bill still leaves millions without coverage. It's more like a national commitment to health care for most (which isn't to say that's bad, just that Drum's comment is entirely misleading).

Posted by: Anon on December 16, 2009 at 12:36 PM | PERMALINK

It quite possibly will, but what I never hear kill-the-bill proponents discuss is how they think the Dems will fare at the polls in 2010, 2012, etc. if we pass nothing. -shorstop

I'm a 'kill-the-bill' proponent, and I think that they'll do horribly in 2010 and 2012 if they pass nothing. Of course, I also think they'll do horribly in 2010 and 2012 if they pass what is rapidly become a blow job for the insurance industry, only that will cost the country a lot more.

The Democrats took a golden opportunity with the 2006 and 2008 elections and royally fucked it up. I think we're passed the point of being able to save the 2010 election, with one caveat: as the right wing becomes ever more unhinged, we can hope they'll run as a third party.

I think the White House hasn't been as bold as the campaign explicitly said they'd be, and that's going to cost them at the polls. For a lot of those new voters inspired by Obama, the time to inspire them has long since gone, and they won't be at the polls in 2010. I expect historically low turnout, and that's always good for the corporate candidates.

We're just seeing a number of problems come to a head. The Democratic party tent is too big. Tom Harkin and Ben Nelson do not subscribe to the same ideology, and there's nothing wrong with that unless you purport they do by assigning them to the same group. The Senate is broken, irrepairably. Nothing will ever fix it, and no good legislation will ever come out of it. And Obama can't lead for shit. What a dissappointment.

Posted by: doubtful on December 16, 2009 at 12:39 PM | PERMALINK

Anon - w/r/t "health care for most": that's really health insurance for most. I think all the almost-universal plans introduced by the Democrats have recognized that there isn't going to be universal insurance coverage in any system short of one where you show up at the doctor's office or hospital, show proof you're a citizen, and get treatment. Not hard to see why - there are people at the margins of society (the homeless for example) who won't be "in the system" and a certain percentage who will opt out of buying insurance despite the tax penalties for not complying with the mandate. We were never going to get more than 90-something-percent coverage under any of the proposals for the simple reason that you can't get to 100% unless you have a single-payer system.

Posted by: Jennifer on December 16, 2009 at 12:46 PM | PERMALINK

doubtful: I find a lot of your posts to be overly pessimistic. But since your take in the above post is pretty much exactly the same as mine, I find it insightful and astute. ;)

Posted by: shortstop on December 16, 2009 at 12:47 PM | PERMALINK

I heard Gov. Dean's comments on a couple of talk shows, and have to agree with him. He accepted the loss of the public option and Medicare buy-in - and specifically said those features could be resurrected through reconciliation. What Dean objected to was the so-called insurance safeguards that are being propounded as the glories of what remains of the health-care bill.

Remember, as recently as a month ago, Dean stated that the existing bill, without a public option, would still be health insurance reform, just not health care reform. Now, after reading the fine print, he says that most of these reforms have been vitiated - (1)there is no lifetime cap, except that there is, (2) preexisting conditions cannot be grounds for denying insurance, but that depends on what you call a preexisting condition - and denial of insurance. Most of all, there are no controls on what insurance companies can charge for their policies. Dean made it very clear that his change of heart was caused by the Senate's small-group rewrite of the insurance safeguards.

Posted by: Brownell on December 16, 2009 at 12:56 PM | PERMALINK

Todd,

"I love how reconciliation is too complicated and problamatic to pass HCR now but next year we'll do it to pass medicare buy-in or the public option."

You beat me to the point.

If they pass this monstrosity, the Dems will have FEWER seats in Congress after next year, as many Democrats will stay home for the next elections. How does that make reconciliation easier ?

It's now or never. Kill the Senate bill, go back to the House bill, and jam it through the way Chimpy Bush and the Republicans did the tax cuts for the Rich & Corporate.

Posted by: Joe Friday on December 16, 2009 at 1:01 PM | PERMALINK

So let me get this straight. The government mandates that people buy insurance from for-profit private health insurance corporations. What poor people can't pay (and poor people are defined as $16,245 income level) the taxpayer has to pay for them.....not to a government insurance program such as medicare, medicaid, or a "public option" but instead to the for-profit private health insurance corporations. Meanwhile, the for-profit private insurance corporations get to continue business as usual denying claims and inventing creative ways to raise their stock prices. Clamoring for premium rate hikes to cover pre-existing conditions clause in 3, 2, 1 ......

Many are saying that this is a foot in the door to something better. It could also be a foot in the door for something worse.

What if Republicans, when they're back in power in 2012/2016, extend this program to include medicaid or even medicare? We already know they want to kill these government programs and now they'll have the perfect vehicle to do it. This program, with its mandates and funding sources, will blur the lines between government and private insurance, allow the for-profit private insurance corporation industry to grow monstrous in size, and make the turnover of Medicare/Medicaid to the industry plausible.
Then everybody will have the pleasure of doing business with for-profit private health insurance corporations.

Posted by: oh my on December 16, 2009 at 1:03 PM | PERMALINK

I hear you Brownell, but I hold out hope that such rewrites will be fixed in conference. The Senate should pass the bill (and might also include amendments to improve some of these provisions), and then we should see what the conference report looks like.

Again, the expansing of Medicaid, the creation of low-income subsidies, and community rating are reasons alone to support this bill. We can come back the day after this legislation is signed and fight for "Medicare for All" (with no distractions).

Posted by: Chris on December 16, 2009 at 1:05 PM | PERMALINK

Don't forget Jim Dean, the brother. I've met Jim twice and he is sincere, intelligent, and cares about progressive values and the common good. I repaste the email I just got from him (sorry, no italics or active links):

Neil -

I'll get straight to the point.

If Democrats remove the choice of a public option, they can't force Americans to buy health insurance.

Here's the deal, Senate leaders are all over Washington claiming they finally have a healthcare reform bill they can pass, as long as they remove the public option. After all, they say, even without a public option, the bill still "covers 30 million more Americans." The problem is that's not really true.

What they are actually talking about is something called the "individual mandate." That's a section of the law that requires every single American buy health insurance or break the law and face penalties and fines. So, the bill doesn't actually "cover" 30 million more Americans -- instead it makes them criminals if they don't buy insurance from the same companies that got us into this mess.

A public option would have provided the competition needed to drive down costs and improve coverage. It would have kept insurance companies honest by providing an affordable alternative Americans can trust. That's why, without a public option, this bill is almost a trillion dollar taxpayer giveaway to insurance companies.

We must act fast. Both Democratic Majority Leader Harry Reid and Democratic Senators need to hear from you. Please stop whatever else you are doing and make the calls right now.

Senator Harry Reid
DC: (202) 224-3542
Carson City: (775) 882-7343
Las Vegas: (702) 388-5020
Reno: (775) 686-5750

Call your Democratic Senator too -- Senate Switchboard: (202) 224-3121

REPORT YOUR CALL AND TELL US HOW IT WENT

Without the choice of a public option, forcing Americans to buy health insurance isn't just bad policy, it's political disaster for Democrats -- a ticking time-bomb for years to come.

Does anyone think Republicans won't use this against Democrats in 2010?

What about in 2014 after the mandate goes into effect and the press reports all the horror stories of Americans forced to choose between paying their monthly health insurance bill to Aetna or paying rent?

The mandate is toxic and Democrats will own it. By the 2016 presidential election, is there any wonder how this will play out for Democrats?

CALL SENATOR HARRY REID NOW AT (202) 224-3542 THEN REPORT YOUR CALL HERE

The message is simple: No public option? No Mandate!

Thank you for everything you do,

-Jim

Jim Dean, Chair
Democracy for America


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Posted by: neil b on December 16, 2009 at 1:21 PM | PERMALINK

That power is: simply refuse to do business with private insurers. We could have taken them down a long time ago if everyone just refused to stop handing them their money.

I guess you don't work for a company that mandates health insurance coverage. Mine does. I am literally not allowed to not have health insurance.

Sorry, but "boycott the insurance companies" is pretty much the stupidest idea ever. The insurance companies are a big part of the problem, but they are not driving the huge increases in costs -- hospitals and providers are. Are we also supposed to boycott being hospitalized if we get appendicitis because the hospital charges $10 for one Tylenol? If not, then boycotting insurance will do approximately jack shit for controlling costs.

Posted by: Mnemosyne on December 16, 2009 at 1:22 PM | PERMALINK

Again, the expansing of Medicaid, the creation of low-income subsidies, and community rating are reasons alone to support this bill. We can come back the day after this legislation is signed and fight for "Medicare for All" (with no distractions).

Nah, Congress will be "too tired" after doing all this "heavy lifting". Just ask Claire McCaskill. Besides, we won't have the numbers in 2010 in any case.

Instead, by 2016 with a medicaid/medicare funding crisis caused by baby boomers, the fiasco of the Bush Recession, and and out of this world deficits, the Republican Presidential candidates will all be running on a platform to convert them both to this 2009 Health Care Reform health insurance giveaway boondoggle.

And they'll probably win.

Cheers.

Posted by: oh my on December 16, 2009 at 1:24 PM | PERMALINK

"When reform bills go down, health care tends to be too hot to touch for about 20 years."

That is not an immutable law of physics. We can behave differently in a crisis -- and that is what this is. However, that doesn't mean the answer is to pass absolutely something, anything, anything at all.

I've already explained where my line is. Where is yours, Steve? At point would this bill be so badly compromised that you feel it it is time to go back to the drawing board, where the bill would do more harm than good? That line has to exist somewhere. Would you speculate?

Posted by: Algernon on December 16, 2009 at 1:26 PM | PERMALINK

If the insurance industry liked this bill, then all those interest group TV ads spreading bogus Fear, Uncertainty and Doubt and focused on Landrieu would be pretty damn stupid, since she might actually prove the 41st vote the Republicans need to defeat health care reform, and then the insurance industry wouldget nothing.

No, the insurance indsutry doesn't like the bill, thank you very much, and for me that's reason enough to continue to support it.
Posted by: Gregory

Keep telling that to yourself, if it makes you feel better.

The point I was trying to make is that spending a pittance "fighting" the reform by airing these ads does these:

A) Keeps providing leverage for even more concessions by Democrats. It's worked very well so far; why stop now? We call this "providing negotiating room".

B) It gets the other side (e.g. you) thinking they must hate the proposed bill, with all its government handouts, money making mandates, and slap on the wrist penalties.

Don't throw us in the briar patch, indeed.

These are high stakes negotiations. Corporations do this every day and they're good at it.

Posted by: oh my on December 16, 2009 at 1:37 PM | PERMALINK

doubtful: I find a lot of your posts to be overly pessimistic. -shortstop

I really, really tried recently to be more positive, but I just don't think it's possible. I think trying to be positive has made me more of a pessimist. I no longer care if the glass is half empty or half full; either way that's 50%, and even on a generous curve, that's failing.

Posted by: doubtful on December 16, 2009 at 1:51 PM | PERMALINK
Won't it be wonderful that so many families are forced to pay for insurance that they can't afford to use?

They'll have to put me in jail rather than my being forced to pay for insurance that I can't afford.

Posted by: bellesouth on December 16, 2009 at 1:56 PM | PERMALINK

The point I was trying to make is that spending a pittance "fighting" the reform by airing these ads does these:

First of all, the insurance industry is not spending a "pittance." They're spending millions of dollars, and they expect a return on that investment. As such, they spend those millions advocating their actual position, not the opposite of their actual position.

Again, Dean could create the appearance that he opposes provisions he actually supports, if that's what he's doing (and I think it is) for free. The insurance industry is simply not going to spend millions of dollars opposing something they actually support just to give the impression to a certain segment of the voters, particularly not at the risk of having that message received by even more voters to the point that the reform effort fails.

If the insurance industry is creating the impression that they oppose the bill, it's because they do, in fact, oppose it. Somehow I find that more credible than your characterization of it.

Posted by: Gregory on December 16, 2009 at 2:00 PM | PERMALINK

First of all, the insurance industry is not spending a "pittance." They're spending millions of dollars, and they expect a return on that investment.- Gregory

Fortune 500
Industry: Health Care: Insurance & Managed Care
Revenues, Profits


Company Rank / Revenue (in Millions) / Profit (in Millions)


1 UnitedHealth Group 71,542 4,159
2 Wellpoint 56,953 3,095
3 Aetna 25,569 1,702
4 Humana 21,417 487
5 Cigna 16,547 1,155
6 Health Net 12,908 329
7 Coventry Health Care 7,734 560
8 WellCare Health Plans 3,763 139
9 Amerigroup 676 2,835 22 107 100
10 Centene 792 2,279 51 -44 -178
11 Medical Mutual of Ohio 2,039 100
12 Molina Healthcare 2,005 46
13 Sierra Health Services 1,719 140

---------------------------------
Gregory, meet Pittance.

Posted by: oh my on December 16, 2009 at 2:23 PM | PERMALINK

I should have added that those Fortune 500 figures are from 2007.

So in 2007, United Health Group alone netted themselves $4,159,000,000. That's 4.159 $billion for those of you with difficulty reading all those zeros.

Posted by: oh my on December 16, 2009 at 2:30 PM | PERMALINK

When do we get the Matt Taibbi piece on how Dean is trying to kill health care reform in his new role as a shill for the biotech industry?

Posted by: RS on December 16, 2009 at 2:33 PM | PERMALINK

Looks like the unions might come out against the Senate bill.

If they do, it's toast.

Posted by: Joe Friday on December 16, 2009 at 2:37 PM | PERMALINK

I really, really tried recently to be more positive, but I just don't think it's possible.

At this point, and where this issue is concerned, I don't think so, either.

Posted by: shortstop on December 16, 2009 at 2:41 PM | PERMALINK

I don't like being in a huff with people I mostly agree with, so I'll just finish with this.

If the pass-the-bill-improve-it-later folks expect me not to mind having a public option stripped out, then I expect them to not mind having the individual mandate stripped out right along with it. Since nobody seems to be giving a shit about serious cost controls anymore, this shouldn't be a problem.

Posted by: oh my on December 16, 2009 at 2:46 PM | PERMALINK

"...there's always a handful of people who pipe up with about how they can't handle the risk of going uninsured, etc etc. I understand, having gone without insurance for years myself..."

Presumably you don't have a chronic illness that requires expensive medications to keep it in check. Those of us with chronic illnesses (the dreaded "pre-existing conditions") can't afford to go without insurance. It's not a matter of anxiety over "what if I get sick?" We already ARE sick and it costs a fucking fortune to control the diseases without insurance, specifically prescription coverage.

I have Type 1 diabetes. I require insulin to survive. Not thrive, just survive. I use 1-2 bottles every month. Each bottle is over $100 apiece without insurance. I also use blood glucose testing strips to monitor my blood sugar. I need to do that at least 4 times every day. A pkg of 100 strips costs as much as $120 in some places. Said pkg lasts less than a month. These expenses occur every single month of every year of my life, with no prospects for a cure. There are illnesses that cost a lot more to maintain or control, but regardless, we are captives of the pharmaceutical and health insurance industries. They can charge us whatever the fuck they want to, because they know we can't survive without them.

Sure, the Senate bill is supposed to contain language to prevent rescission due to pre-existing conditions, but what in there is to stop an insurance comp from charging obscenely high premiums for those people they can no longer deny? Keep in mind too that what is "reasonable" and "affordable" for a member of Congress is not necessarily reasonable or affordable for me. So once again, we with pre-existing conditions are at the mercy of the greedy, unscrupulous bastards that run the insurance comps and pharmaceutical firms.

Go without insurance? Not on your life.

Posted by: Kirsten on December 16, 2009 at 2:51 PM | PERMALINK

but what in there is to stop an insurance comp from charging obscenely high premiums for those people they can no longer deny?

The affordability credits are crafted such that your contribution to your premium is not tied to the overall cost of the policy; it's tied to your income. So if the insurance company increases premiums, the government picks up the slack.

And in any event, you should review the CBO's analysis of the impact of the reform legislation on premiums, here: http://www.cbo.gov/ftpdocs/107xx/doc10781/11-30-Premiums.pdf

Posted by: RS on December 16, 2009 at 3:07 PM | PERMALINK

So if the insurance company increases premiums, the government picks up the slack. -RS

And that money comes from magic pixies, of course.

Posted by: doubtful on December 16, 2009 at 3:26 PM | PERMALINK

Gregory, meet Pittance.

Yes, insurance companies make huge profits. So what? That fact doesn't mean that the millions of dollars spent on advertising and lobbying are a "pittance;" it means it's an investment -- an investment, as I said, the companies expect a return on. It certainly doesn't mean that insurance companies would throw that money away advocating a position that's the opposite of the one they actually hold. Your arguments that they would just don't hold water, and I'm honestly baffled as to why you continue to suggest they'd act so foolishly.

Posted by: Gregory on December 16, 2009 at 3:49 PM | PERMALINK
Steve: "Five years later, a Democratic president has a vastly better, more ambitious, more liberal reform plan nearing the finish line ... and Dean wants to kill it?"

I happen to very much agree with Gov. Dean's current assessment, Steve, and absolutely disagree with yours. Howard Dean is a former long-term governor and longtime practicing family physician who is intimately familiar with the current complexities and shortcomings of our country's health care delivery system. Meaning no personal disrespect, but what exactly do you offer in credentials that are comparable to Dr. Dean's background?

Speaking as both a longtime legislative analyst and a three-time cancer survivor who currently has to pay over $10,000 for high-deductible health care insurance, the Senate health care bill as currently proposed is worse than no mandate at all.

Have you even read the proposed Senate draft, prior to your comments about it? To be perfectly honest, I have my doubts that you have -- particularly when I note that you are apparently fully prepared to credit the president with success for an endeavor from which he has heretofore been curiously disengaged throughout nearly its entire deliberative process, save for a pretty speech to a joint session of Congress a few months ago.

Why would you mandate that people buy insurance policies from companies that are still allowed to set the terms and price of coverage, with no leverage worth the appelation of "Competition"?

Add to that the removal of any worthwhile provisions to control drug prices, and what you have is a measure that is at best the legislative equivalent of a rearrangement of the deck chairs on the HMS Titanic. As written, this Senate bill should be more properly be named the Joe Lieberman Insurance and Pharmaceutical Company Windfall Guarantee Act of 2009.

When congratulated by his subordinates upon finally prevailing over the Jewish zealots atop King Herod's old stronghold of Masada, Roman Gen. Flavio Silva was reported to have responded to them, "And what have we won? We now possess a barren mountaintop in the middle of the desert, and astride a dead sea."

If you're ready to declare victory with what the Senate is currently offering, I would ask roughly the same thing of you. What exactly have we won?

From my standpoint, I truly fear that we're gaining nothing in the way of reform, save for another lot full of empty pledges from bad actors who've repeatedly shown that their promises aren't worth the breath taken in expending the words.

Aloha.

Posted by: Donald from Hawaiii on December 16, 2009 at 4:41 PM | PERMALINK

To be completely non-wonky for a moment, I wonder at what point health care reform and other such issues are going to lead to a brain drain. The filibuster has basically made our government unable to do anything, other than bomb people, since the executive branch is able to act alone in such areas. I am sort of young and relatively healthy now, but I really do not want to deal with the risks of getting older in the U.S.

Posted by: JGH on December 16, 2009 at 4:50 PM | PERMALINK

I don't understand how Donald from Hawaii and others can blame Obama for the bad behavior of the Republicans, ConservaDems and the corporate media. I wonder how many of these people blaming Obama worked to elect progressives over ConservaDems in the primaries. I wonder how many of them even showed up to vote in the primaries.

Also, Donald from Hawaii, mandates lowered health care premiums in Massachussets. If mandates were the only aspect this bill, I'd still support it.

Posted by: Chris on December 16, 2009 at 5:42 PM | PERMALINK

CJO, I could not agree more!
Jennifer - If half the people in America dropped their insurance tomorrow.... You have kids? You ever been sick? You ever played Russian Rulette? You take that gamble, go ahead.

Posted by: joyzeeboy on December 16, 2009 at 5:55 PM | PERMALINK

Your arguments that they would just don't hold water, and I'm honestly baffled as to why you continue to suggest they'd act so foolishly.
Posted by: Gregory

Honestly I don't know how I could explain it any simpler. And these companies certainly aren't acting "foolishly", only greedily.


1) A congress embattled over healthcare reform but leaning ever so precariously toward public competition----------> 2) An industry that makes well north of 12 $billion a year in profits--------------> 3) A few million in advertising to work the lather up on the "keep your government hands off my medicare" types---------> 4) Room for Landrieu or Lieberman or Nelson or take your pick to negotiate even more favorable terms and conditions.

By the time this is done, the Democrats will have given away the farm, the farmer's wife, the cow and the three legged dog out back. Even then, they'll have to throw in an all-expenses paid vacation to the Health Insurance Execs to sweeten the deal. At which point Landrieu or Lieberman or Nelson or take your pick will get on board and let the bill come up for a vote. The bill will pass. The insurance companies will have gotten the best deal in history. But wait it gets better. These same "democrats" that are holding the bill hostage will end up voting "no", leaving the "progressive" democrats that passed this piece of shit to take all the blame.

This is the best corporate con job in at least 7 years.

Posted by: oh my on December 16, 2009 at 7:27 PM | PERMALINK

Two points:
1) I agree with Donald from Hawaii (except on a very minor point*). If there is not going to be a public option offered in the "exchanges", then remove the mandates.
)2 Chris @ 5:42 PM posted: "...mandates lowered health care premiums in Massachusetts." What mechanisms does MA have in place to regulate rate increases; as I find it difficult to believe that the insurance companies held those prices down of their own volition. And without such mechanisms, we are simply writing a blank check for the HI companies.
Checks, by the way, that may be cancelled by the next Republican administration. In order to "contain/reduce/eliminate (pick one)" the deficit, of course.

(*It was "RMS Titanic", not "HMS". Sorry, couldn't resist.)

Posted by: Doug on December 16, 2009 at 9:00 PM | PERMALINK

Reconciliation was the only way the HCR was going to happen in any useful form, right from the start.

If the Dems had realized that when they started the process, they would have been threatening anyone who wasn't on board right away, and operating from strength. Instead, they chose to try to mollycoddle the Blue Dogs, and as soon as they started doing that the Blue Dogs all thought, "Ho, fuck, yeah, I've got leverage here!" and started throwing monkey wrenches into the word. And all of that made the Dems look weak, so the Blue Dogs pushed more and more.


And in doing so, the Dems lost the faith of those "what brung 'em" to the dance, so all their trying to be nice guys with the Blue Dogs did nothing but lose them hard won ground.

The Dems have no one to blame but themselves.

They can salvage it ONLY by telling everyone RIGHT NOW, that they are putting X, Y and Z in the bill, enough to get the 51 votes and screw anyone who wants anything else. It's Reconciliation time, so get on board or get lost.

For the next year, ALL legislation that has spending attached goes that route.

IT IS THE ONLY WAY TO KILL CLOTURE, WHICH NEEDS TO DIE.

At least, cloture that requires more than a simple majority. There is nothing magic about 6o votes. Hell, it used to be 2/3, and before that it was 3/4. Let's let the evolution go to where it needs to be - at 5o plus the VP.

.

Posted by: SteveGinIL on December 16, 2009 at 10:08 PM | PERMALINK

I am with Dr. Dean and Senator Sanders on this. Along with the Democratic activists and strategists who know what a political killer for Democrats the current proposals are.

"Moments ago, Sen. Bernie Sanders (I-VT) announced that he is prepared to vote against the Senate health care bill in light of the recent decision to strip the public option and the Medicare buy-in provision from the legislation."

http://thinkprogress.org/2009/12/16/sanders-vote/

Posted by: Gary D on December 17, 2009 at 5:30 AM | PERMALINK

It is sad to the point of pathos what a bunch of pussies my fellow "liberals" are. Not to ask is not to get, and further not to demand is not to get. It's like the "centrists" who want to pass a bowdlerized bill came with their kneepads on, happy to compromise anything for a shred to hang their dignity on. Being unreasonable is the only thing that gets progress-see Martin Luther King or Joe Lieberman and Ben Nelson. Does nobody play poker in the vaunted halls of milquetoast liberal thinktanks and new media operations? Have none of you even seen a Shatner ad for Priceline? Demand the best and never be satisfied. Dean is doing God's work. He should be president.

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