It's not within Harry Reid's and Nancy Pelosi's power to change that.

Well its not strictly true that Harry Reid has no power in this circumstance. I agree that its unlikely but he could initiate a change in the rules that would make people like Nelson and Lieberman irrelevant. Obviously that would be politically explosive but the truth is that nothing will change until the Senate rules change. As long as there are states like Nebraska, and as long as the filibuster rules remain as they are, this is what we can expect to happen. Elections won't change that. Not really.

Perhaps it would be better to buy a starter home that's made of concrete, or at least wood, rather than one made of sand?

The objection, remember, the serious one, that everyone is making but so-called "realists" are ignoring, is not that the bill isn't liberal enough, or that it doesn't cover enough people, it's that it's going to collapse spectacularly.

All of these arguments that are addressed at some mythical body of people who are claiming that the problem with it is that without the Public Option, it's just not liberal, are pointless, and Steve, you really should know better than to promote them. You're not making any sense.

Most people understand concepts like compromise. But compromises have to be workable, they have to create something that in some kinda fashion works at the end of the day. A "compromise" that leaves us with a reform bill that's an exact mirror of 1990s Californian energy deregulation is not a compromise that works.

OK, you don't want a public option, and you don't want price controls. Well, that's fine, we can work with that. But we need something to counter the effect of the loss of that on insurance prices. As it is, the bill now not only has no control on insurance prices, it has a number of things, like the absurdly conceived 80/85% thing when combined with the so-called "Price hike means being kicked out of an exchange" thing, that will result in the exchanges having the exact same priced insurance as is available now.

So, guess what, people still aren't going to be able to afford insurance. Except now we're going to force them to, and if they don't, we're going to make them pay higher taxes.

That won't work. Make it work. At least water down the mandate so that people who can't afford insurance aren't forced to buy it anyway or face higher taxes for not doing so.

If you do that, or you put price controls in, you have my support. If you continue to pretend my argument, even after that, is that I hate the bill because it's "not liberal enough", then you're tilting at windmills.

Steve, stop tilting at windmills, and listen to what critics are actually saying.

You tell 'em soul!

And before you go into your room to put on your headphones, make sure you slam your door really hard!

Don't forget to write "Henry Rollins" on your ballots in '10!!

"I'm not going to post here again, but folks should now what manner of people they get their opinions from."

Well, now that you are not going to post here again, I can get input from people who really make some sense - such as Benen and Ezra Klein.

Shhhh....

In Lieberman, Nelson, etc. hear this they are going to start threatening to filibuster the bill unless all Democrats promise never to work on health care again.

Great post, Steve.

I do hope that more people do come to realize that this is a keep-your-eyes-on-the-prize kind of moment. The bill itself doesn't matter as much as what it helps to establish-- health care as a right, not a priviledge.

Personally, this legislation may very well be one of the biggest deciding factors for whether or not I have children. I am self-employed and have a monthly premium that is affordable only because I opted-out of anything related to pregnancy/maternity/childbirth. (Monthly price difference? $400.) As it stands now "pregnancy" qualifies as a pre-existing condition, so if I were to get pregnant I couldn't even increase to the more expensive policy to cover it-- it just wouldn't be covered.

Anyways, I know a lot of my fellow lefties have dug in their heels over this and are convinced it marks some kind of catastropophic failure for dems. What would be a truly catastrophic failure would be not to pass it at all, not not start reforming the system and push it back a year or two or more. I am one of those tens of millions of people who cannot afford for it to be delayed another 2 or 5 or 10 years or more.

This is truly just the beginning, not the end, of health care reform.

Soul, the Democrats DON'T HAVE 60 votes in the Senate. They have a more or less reliable 58 VOTES, plus the two senators from Big Insurance - Nelson (NE)and Lieberman (CT).

Insurance is a dominant industry in both states. Nelson used to be an insurance executive. Lieberman will probably do a Billy Tauzin and go to work for the insurance industry after this senate term expires, since his chances of re-election are nil. Both of their campaigns are richly supported by Big Insurance.

Let's elect more REAL Democrats, so we can tell Nelson and Lieberman to go f*** themselves.

We have to fight the battles that are actually before us and not the ones we'd like to fight.

It would really be nice if the cheerleaders would stop telling the progressives the outhouse is really a pot of gold. It's obvious it isn't even close, and you're just pissing people off.

soul -- Well, we will ask you to go out and work hard to elect more and better dems in 2010, and 2012 and 2014 ad infinitum. That's just the way it works. But staying home and not doing that? Well, that's going to do a lot of good, isn't it? Or voting for Nader?

squiggle -- it's not that we don't listen, it's that we don't agree that it will fail spectacularly. I guess I'm willing to take the chance that it will work (eventually) and in any case, it will work better than the status quo. Remember, we do pay for all of that health care anyway, through emergency rooms, etc. And, there will be no cost control at all without this bill. At least this makes a try in that direction. Hey, I just got my insurance update bill for next year -- 11% increase at a time of no inflation. But, of course, trying to change to another provider now? Forget it.

So, what happens if it doesn't pass? Not only do we get no change from the status quo, we get fewer and worse democrats next time around. That just makes no sense at all to many of us.

Just remember what Bush did with a Senate majority of 55. And what about reconciliation? Dems are reinforcing their long standing image of being wusses. If you go to a gun fight with a knife, you'll be blown away. That's what's happened. As has been said many times, I'm angry - not because of the outcome - but because of the strategy/tactics used by hapless Dems.

my view is that the battle right now is to stop this shitty bill...tho it looks like it is going to pass (corporate media has allowed the announcement to go out thru the land that 60 votes are obtained, the champagne is on ice...)

and then the next thing to do, after it passes, is to fight for real reform until it happens while seeing how this bill really affects society. and fighting for real reform in every which way...

but my view is also that the health care debacle is part of a bigger debacle that is the hollowed out economy, the neglect of the environment -- all of the gigantic crises we face globally that more than just impinge on the next strategy progressives will take on health care reform, these crises will dictate more and more what there is to do.

but there will be a lot to do and a lot of fights progressives have to make.

The assumption that disappointment in hopey-changey has made progressives give up is wishful Villager and corporate thinking.

Progressive victories are historic molehills built on mtns of defeats -- we're just arguing now about which category this shitty bill is in... it'll pan out after enacted...but the fight goes on.

xenomera - my comment isn't addressed to you, it's addressed to Steve and the people he quotes. Those people are arguing not that it'll work, but that it's a step forward. That's not the right argument to use when addressing people who are saying it'll not work, that it'll fail and damage the cause of health reform for generations.

Look at the arguments Benen quotes and uses himself. He's not even spending a second on the issue of the bill's viability. He's pretending that people like Howard Dean are against it because it isn't liberal enough. He's pretending that a correct answer to Dean is "But it moves healthcare forward!" He's pretending that Dean's complaint is that he wants a Pony when all that's on offer is a donkey, when Dean's complaint is actually that the donkey has cancer and isn't going to survive the month and will bankrupt us in vet bills. (Jesus, what a dark analogy. I have a really bad headcold right now, apologies.)

This seems to be the point that the Talking Heads, including, alas, Benen, Klein, and even the usually knows-better-than-this Krugman, are repeating ad-nauseum at the moment. "You can't get what you want, so just vote for this, it's a step in the right direction." Why they think that such an argument is going to convince any of us is anyone's guess, but it shows a remarkable lack of intellectual honesty, and quite frankly, it'll entrench opposition to this bill.

I think the next fight should be to get the Senate to change the filibuster rules...that's the huge problem right now.

I would love for the progressive community to take up that cause loud and clear...make support for any Senate candidate contingent on support for changing the filibuster and keep fighting that fight.

Did social security mandate giving dollars to a PRIVATE company, rather than the government, to provide "benefits"?

And under this "plan," once those mandated dollars are given, there's no opportunity for oversight or control.

Please, Washington Monthly, you're better than this. Why have you been taken in by Obama and his legion of excuse-makers?

Go read Glenn Greenwald [Salon.com], or Marcy Wheeler & Jane Hamsher [FireDogLake.com] for what's really going on here.

This is not a "foundation," it's a huge hole blasted into the earth. [Think meteorite.] Try "building" from 8 feet below ground level.

Democrats will be so hated after the effects of this legislation kick in and are understood that they'll not be able to "build" anything. And that's just the way the Repubs and insurance companies want it.

I think they are wrong about this.
The foundation they will build on is one of mandating individual citizens purchase a commercial insurance product, just as they did with Medicare part D.
Since the implementation of Medicare part D the premium seniors and the disabled pay has doubled.

No one is getting health care out of this bill. They are getting a mandate to purchase health insurance and a penalty if they don't.

> squiggle -- it's not that we don't listen, it's
> that we don't agree that it will fail
> spectacularly. I guess I'm willing to take the
> chance that it will work (eventually) and in any
> case, it will work better than the status quo.

Well, you give every evidence of not only not listening but of holding those who disagree with you in contempt. That's a bit of a problem for the subsequent lecture about how hard I should work for Obama, Emanuel, etc in the 2010 elections.

However, please answer me this: how did the experiment of letting Wall Street run riot with no regulation, no adult supervision, and no checks/balances on what they could do work out? Hmmm, I seem to remember a global financial crash in 2007/2008 from which we have not yet recovered. So, perhaps an experiment worth running, but now it is time to re-regulate, right? Oops, can't do that: AIG International has twice in 6 months called up the Secretary of the Treasure of the United States and threatened to destroy the financial stability of the US if any attempt is made to regulate or control AIG. Goldman Sachs hasn't made any public threats, but one suspects they have said the same in private. That's good for the average US citizen.

So, please explain exactly how this experiment with letting the private medical plan companies run riot with minimal, easily circumvented regulation is going to work out?

And please don't quote Ezra Klein to me; as smart as the kid may be he hasn't worked a day as a manager in a profit-making business in his life. And he hasn't worked outside the media/DC cocoon for that matter.

Cranky

NO! NO! EVERYTHING MUST BE PERFECT NOW! NOW NOW NOW NOW NOW! OBAMA=BUSH!

-The Left

squiggleslash: I REALLY like your somewhat morbid but totally right-on metaphor.

That's what this health "care" bill is: a donkey with cancer.

And we can't even get the poor thing covered with vet insurance. Pre-existing condition, y'know.

Did a comment from soullite get deleted? That's a bit unfair.

Cranky

Let me play devil's advocate: If this bill sucks, but is the best that could be gotten, and is the foundation for near-future improvement, then just say that. Enough with the Biden-esque "this really is a pretty good bill" crap. The Left has already been sold out; no one has been fooled about that. Labor's already been shafted: no secret there. How about just telling the truth: if this is bill is ass-sucking (and it is: see again the fate of Disproportionate Share Hospital funds from Medicare) but a necessary first step, then leave it at that--further cheerleading is offensive and an insult to our intelligence.

"Elect more and better Dems" is also a beginning, but nowhere near enough--and for all you liberals still bashing leftists, I have a question for you: how come every time I'm involved in a voter registration drive or a GOTV door-knocking campaign, I'm always surrounded by Greens and Reds, but only a light dusting of Dems?

xenomera - "So, what happens if it doesn't pass? Not only do we get no change from the status quo, we get fewer and worse democrats next time around."

I hate to be the one to tell you, but we're gonna get "fewer and worse Democrats" the next time, because a) the American public is going to be PISSED about mandatory deductions from their paychecks [those few who still have jobs] to buy crap health insurance, enforced by the IRS; and b) Republicans are going to remind them ad nauseum that it was DEMOCRATS who supported this crap.

In addition, progressives who voted for, worked for and donated to Obama and many Democrats are pissed. They may not vote for Republicans, but they're sure as hell not going to put the effort in to support "traditional [Rahm Emanuel] democrats." Most will be looking around for third party candidates or other venues for their efforts.

It's too bad that it took Democrats so long to figure out [if they have figured out; clearly you haven't] that the've put themselves in a lose-lose situation: damned as weak wusses if they don't pass a bill; damned as selling out to insurance companies [and drug companies] for mandated crap.

Karl Rove couldn't have planned it better.

I certainly didn't intend to treat those that oppose the health care bill with contempt. I think I do understand the argument that the private health insurance companies are likely to try everything in their power to circumvent the rules. I just don't agree that this necessarily will lead to catastrophic results, and I'm willing to take the chance, because the alternative (the status quo) is much worse.

Your example of the financial industry demonstrates my point. For many years, the regulations that were in place worked fairly well. When they were removed, all hell broke loose.

I think regulations can work, and have done so in the past in a lot of instances. Environmental regulations, minimum wage, OSHA laws, etc. etc.

What's going on now is that the health insurance industry does not have adequate regulations, so this bill does put some in place. If the regs don't work, well, let's work to make them do so.

Did a comment from soullite get deleted?
Apparently so.

see, i see all these brilliant blog-chair quarterbacks saying there is nothing in this bill and the 'establishment' Dems are selling us a bill of goods. but i have trouble finding many historical examples of Krugman or even Harkin doing a lot of sugar-coated salesmanship for the corporatocracy. so while i might think every one of my friends here in the WM comments are as qualified to opine as Ezra, or Nate, or Kos on the other side and give your thoughts the same weight, you'll pardon me if I give a little more weight to Krugman's credentials and Harkin's experience and access to the best information and refrain from joining the sky-is-falling chorus. (With apologies to Dr. Dean, who I also greatly value.)

"The question -- if we're to assume that this bill will, in fact, survive -- then becomes what progressive champions of reform are prepared to do to build on the starter home's foundation."

That assumes it doesn’t get repealed in 2012.

Can’t WAIT to see the Democrats trying to argue in the 2010 campaign that people only have to wait FOUR MORE YEARS to be protected from being denied coverage with a preexisting condition, and Obama arguing in 2012 they only have to wait TWO MORE YEARS.

Slaughter.

I'D RATHER SEE THE STATUS QUO, WITH MILLIONS STILL UNINSURED, THAN THIS BILL! SUBSIDIES FOR THE POOR ARE A MYTH! BANNING DROPPING PEOPLE FOR PRE-EXISTING CONDITIONS WON'T WORK! OBAMA=BUSH! AAAAAAAH!

That assumes it doesn’t get repealed in 2012.

Can’t WAIT to see the Democrats trying to argue in the 2010 campaign that people only have to wait FOUR MORE YEARS to be protected from being denied coverage with a preexisting condition, and Obama arguing in 2012 they only have to wait TWO MORE YEARS.

"And if you don't keep us in office, it'll NEVER come into effect."

Fuck Reid and Obama.

Why would I want a measley 31 million more people to have access to health insurance? Who cares if people continue to get denied benefits for pre-existing conditions, or have caps on annual or lifetime benefits? Fuck them too!

I don't give a shit if no one has to pay more than 8 percent of their income for health insurance, or if there's $900 billion in subsidies for the poor and working poor! That's fucking corporatism anyway!

Markos and Howard aren't pleased, damn it, so neither am I! After all, Obama promised single-payer during his campaign, didn't he!?! Just like he promised peace in Afghanistan! How dare he go back on his word?

Damn corporations! I'm goin' tell everyone I know just to stop working for profit-making corporations. Just quit your job. That'll teach 'em!

zoe,

"I do hope that more people do come to realize that this is a keep-your-eyes-on-the-prize kind of moment. The bill itself doesn't matter as much as what it helps to establish-- health care as a right, not a priviledge."

Not at all.

The Senate bill allows the for-profit private-sector health insurance corporations to charge older people THREE TIMES what they charge younger people.

It will only be a "right" if you can afford it.

Squiggle:

You say there are no cost controls.

What then are the myriad of pilot cost control programs in the bill that people like Paul Krugman have praised? Read the latest articles by Paul Krugman and Karen Tumulty over at Swampland to see parts of the bill that could help reduce costs.

http://krugman.blogs.nytimes.com/2009/12/19/the-insincere-center/
http://swampland.blogs.time.com/2009/12/19/putting-some-of-the-reform-back-into-health-reform/

Furthermore, insurance companies that want to enter the exchange cannot unfairly jack up prices, and are barred from the exchange if they do so. That's not a cost control?

And the public option that progressives are so upset about losing would not have controlled costs either according to the CBO, because it was so weak. The expanded Medicare option might have though, and that is a regrettable loss. But until someone can tell me how to get 60 votes for exapnded Medicare, it's a loss I can live with.

The Needle,

"And if you don't keep us in office, it'll NEVER come into effect."

Oh yeah, that’ll get the Democratic faithful stampeding to the polls, all the while they are being forced to buy over-priced health insurance policies from the for-profit private-sector health insurance companies who will have no restrictions on increasing premiums every year, and will be laughing all the way to the bank.

People will be royally PISSED and I would not be surprised if this get’s repealed.

I'm disappointed there is no public option. I'm disappointed there is no medicare buy-in. However, while I can appreciate the idealism that is behind the "kill the bill" group -- we are still left with the same Washington players as before. After 2010, the ratio most likely will be worse.

I have to tell you though, as a 53 year old who is self-employed with a pre-existing condition who has been denied coverage for the past two years because of said pre-existing condition -- I'm grateful as hell that I may finally be able to get insurance.

Oh, and I also had to file bankruptcy in 2007 because of medical bills. I wouldn't wish that upon anyone.

The political syllogism:

1. Something must be done
2. This is something
3. Therefore we must do this

You can't sell me a trailer by telling me it's a starter home.

Jeff,

"What then are the myriad of pilot cost control programs in the bill that people like Paul Krugman have praised?"

Just that. Pilot programs which will not have any effect whatsoever on overall healthcare cost containment.

"And the public option that progressives are so upset about losing would not have controlled costs either according to the CBO, because it was so weak."

Nope.

The Public Option was the ONLY major engine for cost control that the CBO scored.

"But until someone can tell me how to get 60 votes for exapnded Medicare"

It only takes 50 votes.

LJI,

"However, while I can appreciate the idealism that is behind the "kill the bill" group -- we are still left with the same Washington players as before. After 2010, the ratio most likely will be worse."

That’s a Straw Man argument the White House is pushing.

NOBODY is suggesting we “kill” healthcare reform, but “kill” the Senate bill instead and return to the House bill and make it even stronger. There is still plenty of time, and then the Democrats would actually have something incredible to run for reelection on instead of being lambs to be slaughtered.

That’s a Straw Man argument the White House is pushing.

A Straw Man argument that Jacob Hacker who self-describes himself as "the thinker most associated with the public option, which I’ve long argued is essential to ensuring accountability from private insurers and long-term cost control" is seemingly pushing now as well.

http://www.tnr.com/blog/the-treatment/why-i-still-believe-bill

Mauimom said: "This is not a foundation, it's a huge hole blasted into the earth. [Think meteorite.] Try "building" from 8 feet below ground level."

At the risk of overextending your analogy, try looking at how one builds a skyscraper: http://curbed.com/uploads/2008_06_WTC%20Bathtub.jpg.

This isn't exactly fair because single-payer is by far the best foundation. Nonetheless, from the moment the bill passes the conversation stops being "Health care is a disaster, we have to have a public health system that gives everyone access to health care" (versus "No way in hell") and starts being "This public health system isn't doing what it needs to, how can we fix it?" (with any Republican recidivism looking mean and mercenary). We are unlikely to say, "relying on insurance companies isn't working, let's replace it with nothing" and are more likely to say, "relying on insurance companies isn't working, let's cut out the for-profit middlemen", following the logic of Education Secretary Arne Duncan in http://www.edgovblogs.org/duncan/2009/12/wall-street-journal-op-ed-banks-dont-belong-in-the-student-loan-business/

I have to say I agree with the folks who think this bill's final result will be catstrophic failure.

For one thing, our friends the teabaggers - how many of them do you suppose will line up to buy health insurance as mandated by the federal government? Hell, I can see a bunch of them cancelling their employer-provided plans just to make sure they don't have to pay taxes that will go to providing health care for poor brown people.

That doesn't mean it's a failure. I've been thinking for years that the only way we would ever actually fix healthcare would be if the entire existing system collapsed. Currently we have 15% of the population uninsured. There's at least that many people with insurance who are bug-fuck crazy enough to drop it because of the taxes or to refuse to buy it under the mandate. So the net effect of this legislation is likely to be MORE uninsured than we had before - only this time, the uninsured people will be ones who elect not to have coverage, not people who either can't afford it or who have pre-existing conditions. If that happens, cost of premiums will shoot through the stratosphere, and discussions about how to make private insurance more "affordable" will be rendered moot. The insurers themselves will be begging the government to step in and fix the mess, lest they go under and cease to exist.

IMHO, this legislation may be the catalyst to bring the existing system crashing down. We'll know in the next couple of years.

Joe,

In the beginning they wont (due to limited scope), but as the programs are implemented and tested we can see which ones work which will then enable us to expand the useful ones down the line, at which point they will control costs. Same with the Medicare board. You have to think long term about the benefits, not just what will be the immediate impact.

Also you didn't mention anything about insurance companies not able to unfairly jack up prices or be barred from the exchange.

And no it doesn't take 50 votes unless you take the reconcilation path. If you do though, you have to split up the bill, as only the parts of the bill that have to do with the budget can be used in reconcilation. And then you still have to get 60 votes for the remaining other bill. Meanwhile you've pissed off people like Lieberman and Nelson who might just end up voting against that other bill. And you've delayed the bill about half a year at least during an election year where typically congress is far less productive due to the election year. And the more that this is delayed the more likely the bill is to become unpopular.

That's not a risk I want to take just to put in a piece of legislation that won't make that much of a difference on the outset.

Also, where you getting this idea that the CBO said the public plan would lower premiums?

LJI,

"A Straw Man argument that Jacob Hacker who self-describes himself as 'the thinker most associated with the public option, which I’ve long argued is essential to ensuring accountability from private insurers and long-term cost control' is seemingly pushing now as well."

I don’t care who’s pushing it, tell me who is suggesting we “kill” healthcare reform ?

It’s still a bogus argument.

Joe Friday: NOBODY is suggesting we “kill” healthcare reform, but “kill” the Senate bill instead and return to the House bill and make it even stronger.

Thats a bogus argument to make the "kill the bill" crowd seem less extreme and you have to know it. There is no way the House bill ever passes the Senate. There is no way an improved House bill even comes to the Senate floor. What magic wand do you think is out there that changes Lieberman, Nelson, Lincoln, Landreiu, Bayh, Snowe, Collins etc to accept anything more progressive than what is now pending in the Senate? What Rovian Math do you know that no one else in the party has access to?

Jeff,

"In the beginning they wont (due to limited scope), but as the programs are implemented and tested we can see which ones work which will then enable us to expand the useful ones down the line, at which point they will control costs. Same with the Medicare board. You have to think long term about the benefits, not just what will be the immediate impact."

That’s going to make some great political reelection campaign commercial for the Democrats.

Would somebody explain to me HOW you could claim to pass healthcare reform, when it doesn’t ban one of THE most egregious and sinister provisions, namely denial of people with preexisting conditions ?

Are they CRAZY ?

"And no it doesn't take 50 votes unless you take the reconcilation path. If you do though, you have to split up the bill, as only the parts of the bill that have to do with the budget can be used in reconcilation. And then you still have to get 60 votes for the remaining other bill."

And the remaining parts of the bill are wildly popular and would have no trouble getting 60 votes.

"Meanwhile you've pissed off people like Lieberman and Nelson..."

Good. Maybe next time they will think twice about being backstabbers.

"Also, where you getting this idea that the CBO said the public plan would lower premiums?"

Where are you getting the idea that I posted such ?

Try cost containment. However, it could also lower premiums.

zeitgeist,

"There is no way the House bill ever passes the Senate."

Only takes 50 votes, the same way Chimpy Bush and the Republican Congressional Majority passed unpopular and failed tax cuts for the Rich & Corporate.

Jeff - read what I argue before responding, seriously. The bill contains provisions to lower the cost of medical care itself, but nothing to lower the cost of _insurance_ which is what I was addressing. The CBO report itself said they expected at least a 1% increase in premiums. I think that's an underestimate myself.

There's nothing that caps, directly or indirectly, insurance rates, and there is a central dynamic that'll keep them up - insurance companies are forbidden from massive increases, which means they'll go in with the rates they have (which are already extreme and unaffordable), and the 80/85% thing means that an increase of 50% in administration costs and/or dividends means that an insurer has to put the price of a premium up by that amount in practice (they can't just increase the percentage that goes to administration without also increasing the percentage that goes into "healthcare". You get "more", but in practice you'll be paying extra for things you don't need so that insurers can raise their own salaries and pay their shareholders.)

It's a killer dynamic, it means that we'll "start" with the rates as they are (the entire point of the exchanges was so that rates would fall to the levels corporations tend to negotiate), and see them go up, year after year, with the improvements in "costs" people like Krugman celebrate being undermined by insurers having a direct interest in making healthcare as inefficient and as expensive as possible.

That's what's wrong with this bill. The dynamics for a central part of the bill are all wrong, which is why it's going to be a catastrophic failure. Instead of making insurance affordable and reducing waste, the central dynamic undoes everything that was supposed to bring those two about by forcing insurers to encourage waste if they want to put prices up, and by encouraging them to keep the prices they have now.

People are going to be forced to buy expensive insurance or face regressive higher taxes. If anyone thinks that's going to result in Democrats increasing their majority so they can undo the damage done by Lieberman et al, they have another thing coming.

The largest social policy advancement since the Great Society. Holy Christ, could someone possibly swallow more Kool-Aid?

Holy Christ, could someone possibly swallow more Kool-Aid?

Wow, that sounds really familiar. Kinda takes me back to 2008. Could it be that we've got a bunch of leftover HRC and JE sour-grapers attacking Obama when they think he's vulnerable???

Joe,

What's your basis for saying that bill doesn't ban insurance companies from denying people with pre-existing conditions?

Jeff,

"What's your basis for saying that bill doesn't ban insurance companies from denying people with pre-existing conditions?"

The bill.

It states the ban on denial of coverage for people with preexisting conditions is not implemented until 2014.

When this baby is voted in, I look forward to Reid and Pelosi going on TV and saying: "F-- you America. You are owned. Time to start to kiss our asses".

Joe,

Then your statement is misleading, since it does ban them, just not till 2014. And whether it comes in 2010 or 2014, the fact is this bill will lead to the banning of denying people with pre-existing conditions.

Furthermore, some parts of the bill go into immediate effect

* Establish a high-risk pool that will give uninsured Americans with a pre-existing condition access to coverage;
* Prohibit insurance companies from dropping coverage for Americans because they get sick;
* Prohibit the imposition of lifetime limits on coverage;
* Require insurance companies to report the percentage of premium revenues that they spend on medical benefits for their enrollees, and force them to rebate any excessive costs or profits;
* Require insurance companies to provide free preventive services;
* Require insurance companies to cover dependents up to age 26;
* Provide a discount on drug costs to seniors who fall into the Medicare Part D doughnut hole.
* Provide a tax credit to small businesses that provide health insurance for their employees

The House should be happy, they have the beginnings of a good bill.

The Senate should hang their heads in shame. That bill is a travesty. It's the Nelson/Lieberman/Obama Fuck the Middle Class Act of 2010.

Jeff,

"Then your statement is misleading, since it does ban them, just not till 2014."

No, as I previously posted just that.

"And whether it comes in 2010 or 2014, the fact is this bill will lead to the banning of denying people with pre-existing conditions."

Good luck getting reelected in 2010 and 2012 with that campaign banner.

Then it gets repealed.

Dean also said that some cost containment mechanisms have been restored, and also that the Senate should vote on this bill and work out the problems in conference

http://thinkprogress.org/2009/12/20/howard-dean-senate-bill/

Well, let’s start with the positive things. Over the last week, there were things that were improved. There were some cost containment mechanisms that were gutted. They got restored. I would certainly not vote for this bill if this were the final product, but there are, the House bill is quite a good bill. This bill has improved over the last couple of weeks, I would let this thing go to conference committee and let’s see if we can fix it some more…so there are a lot of things that need to be fixed, but if they are fixed you may actually get the foundation of a bill, coming out of the House. If most of the House provisions survive, then we can have a bill that we could work with…I don’t think this is the compromise that has been achieved. I think we have yet to see the compromise that could be achieved.

Jeff,

Except Nelson said he would vote against it if the bill the Senate sends to conference comes out changed.

Why are the Democrats throwing themselves over a cliff for this monstrosity ? If you’re going to fall on your sword, then at least do it for something noble.

I keep asking, why didn't the Dems try or at least threaten reconciliation? Pardon if a fabulous excuse has been given, I'm not aware. Keep an eye on other things too: like whether cap gains rates are put equal to other rates etc, that shows how much Congress is really thinking of working people.

As for half a loaf or house metaphors, they are fallacious. Something with interlocking controls is not like a homogeneous substance, of which x% to have is x% as good to have. Think of taking a gyro or radiator from a rocket or care ...
BTW, maybe all this "whining" from the left put some scare into Democratic strategists and explains some of putting better parts back in.

The "bill" that's left after the foodfest of special-interest politicking is a deep disappointment, and a lasting lesson learned for people who worked for change through electing Democrats. It's mostly crap that this "health care" bill is a great step forward. True, I have not read 300 or 500 or 1000 pages of bill, but I do listen, and a two-sentence explanation by Howard Dean of how age discrmination and benefit caps (which are legal) effectively vitiate the "outlawing" of pre-existing condition denial goes farther with me than the chorus of the President and the Vice-President and a Speaker and 12 Senators and 5 Cabinet ministers shouting that NOBODY can now be denied coverage due to a pre-existing condition (actually it's 4-5 years). Same with all of the other so-called significant changes. And rhapsodies for all the low-income millions getting access to "affordable" health insurance is a disingenuous way to describe the billions of $$ in subsidies to the insurance companies. And what cost controls? Even the hallelujah chorus has not explained just how costs will be controlled. We are not getting fair value for the effort we put into real health care reform. And when, like George Bush's pharma bill, their great victory proves to be a shabby thing full of holes, we Democrats will be blamed - won't we?

Finally, I do blame President Obama for mismanaging the project from start to finish, but most of all I blame him for the cowardly way he has chosen to paper over his failures and proclaim victory. That's a Republican tactic. Even if I grant that, at the end of the ordeal, the substance could not be improved upon, and it is either this deal or nothing, I still have to fault him for his dishonesty, and his failure to point toward a next step. Rather than attack progressives as "irrational" and "shortsighted", the President could have promised to support House Democrats to re-introduce the public option and Medicare buy-in (they're both budget issues) under reconciliatin rules. Really, only the insurance regulations had to be subject to 60-vote rules. Oh, and the political culture had to be obeyed, making any bill loaded with thousands of gimme's for every legislator's favorite lobby. This could have been President Obama's chance to talk about change we could believe in. He chose not to.

It's amazing how the blogosphere elite is united in pushing this piece of shit. It's pretty easy to see who pays their bills.

Joe,

Well yes that's what Nelson is saying. But at least so far he's indicated the willingness to compromise and to back off his statements (unlike Joe Lieberman). Remember that he was initially demanding far more than what he actually got. And was threatening to not sign on if if he didn't get all he wanted.

And the reason they're "throwing themselves over a cliff?" Because they think in the long run it will improve the status quo and set the stage for even more meaningful reform, and will help the lives of millions of people.It's the same reason people like Krugman and Hacker think the bill should be passed, even though they have strong disagreements.

Mnpundit and others appalled by this Bill and Democrats and liberal bloggers: In perusing some explanations such as this one:
http://www.fivethirtyeight.com/2009/12/insidious-myth-of-reconciliation.html

I can see that Obama/Reid did not have a cost-free, magical way to get the perfect Bill. Reconciliation sounds good but has its quirks and costs. Nuclear has its costs. We all need to appreciate that. Above all, staying home and pinching pennies will ensure the worst imaginable outcome. We need more Democrats so they don't have to grovel for 60th votes, not fewer.

Jeff,

"And the reason they're 'throwing themselves over a cliff?' Because they think in the long run it will improve the status quo and set the stage for even more meaningful reform"

How ?

By which congress ?

If they pass this mess, they will either lose both houses and it will be repealed, or if they're really lucky they will keep their majorities by the slimmest of margins and won't have the votes to do anything “more meaningful”.

Look, the plan in two easy steps:

1) You pass all the popular stuff first which even some Republicans will vote for. You bring up a separate bill that bans the denial of coverage for anyone with a preexisting condition. Any Republicans vote against ? You have a fabulous ready-made campaign ad against them for the next election.

Same with rescinding policies after the fact, and annual and lifetime caps, etc.

2) Then you pass the Medicare buy-in and the Public Option and any other damn thing you want that is known to be successful with reconciliation.

Real healthcare reform that the Democrats can GAIN seats in the congress by campaigning on.

A 'STARTER HOME'

I would like to hear from Grayson on this.

NO PUBLIC OPTION, NO MANDATE!

The insurance vultures become taxing entities if there is no real public option that everybody mandated to buy insurance is allowed to join every time they raise a premium or a co-pay. Therefore this bill is clearly unconstitutional - and we have a supreme court that will leap at the chance to strike it down.

"We can fix it later." Isn't that what we heard about the Medicare drug benefit - currently bankrupting the program because the government cannot negotiate prices?

Then there is re-importation of drugs. All the FDA has to do is certify that it is safe to import from Canada (which we already do because a lot of the U.S. manufacturers make them in Canada.

It's all smoke and mirrors, folks. There's a "GOTCHA!" in every line of the bill.

Ah yes, the more dysfunctional our senate becomes the more it deserves praise for accomplishing ANYTHING.

With the all the abuse of the filibuster from our current republican minority it's easy to see that had these guys been in power when Medicare came up it never would have passed...nor civil rights. Just imagine all the good legislation we would now have with our dem majority were it not for the abuse of this senate rule....as it is the only future we have to look forward to is one of collapse...only a question of how long we have left.

Only democratic socialism will save us yet look how it is demonized by these idiots who are stupid enough to think wealth will protect them from collapse. We are at "peak" everything...not just oil

And Please stop with this "losing the dem majority if they don't pass a good HC bill etc"...with what the very ones who just ignore HC, who brought us our current disaster in all areas.

"Bring back the Bushies and let them finish the job?" These obstructionist losers offer nothing so why threaten to put them back in power. Like saying "since you didn't get the rapist prosecuted let's reelect the rapist". Have you shut your mind off to Rush, Hannity, Beck, DeMint, McCain, Palin and all the rest. Don't be stupid, all republicans are the same...pathetic hypocrites...not one of them can stand up against the rest.

Your frustration is misguided. We have 51 good progressive senators already...just demand the senate change the filibuster rule...that is the problem...not the dem party. It is only a handful of dems causing all this crap and without the filibuster they don't matter.

Go read Glenn Greenwald [Salon.com], or Marcy Wheeler & Jane Hamsher [FireDogLake.com] for what's really going on here.

And those critics run the spectrum, all the way from eggshell to ecru!

Just how easy will it be for the opposition to dismantle the house made of straw or sticks, when the jobs picture does not improve and a sweeping, similar to 1994 lays out the red carpet for the Party of Refugees from the human Race is rolled out and their hubris re-emerges even before the public can see any real structural changes to their healthcare in 2012?

It is a nightmare that our good-faith Senate did not exercise the Nuclear Option and force a simple majority to pass something that has immediate impact.

The Dean of the Harvard Medical School seems to have a different take than most left of center policy wonks on what the "broad consensus" on the impact of the current health care reform bills.

http://online.wsj.com/article/SB10001424052748704431804574539581994054014.html

Health 'Reform' Gets a Failing Grade

"In discussions with dozens of health-care leaders and economists, I find near unanimity of opinion that, whatever its shape, the final legislation that will emerge from Congress will markedly accelerate national health-care spending rather than restrain it. Likewise, nearly all agree that the legislation would do little or nothing to improve quality or change health-care's dysfunctional delivery system. The system we have now promotes fragmented care and makes it more difficult than it should be to assess outcomes and patient satisfaction. The true costs of health care are disguised, competition based on price and quality are almost impossible, and patients lose their ability to be the ultimate judges of value.

Worse, currently proposed federal legislation would undermine any potential for real innovation in insurance and the provision of care. It would do so by overregulating the health-care system in the service of special interests such as insurance companies, hospitals, professional organizations and pharmaceutical companies, rather than the patients who should be our primary concern."

These conversations are simply amazing. Shall we all recognize that a great many of people's disagreements are made on very large assumptions, many of which are coming from a very partisan perspective? For instance:

Voters will be furious about being forced to buy from private insurance

No, progressives might be angered. Personally, I think it's wrong that people have to pay to these scumbag companies. But we already do this with auto insurance. And despite mandatory insurance being in the bill from the very beginning, there's been no mass outcry from the public. Finally, and most importantly, it will affect very very very few people, as the vast majority of the voting public already has insurance.

The bill is going to be repealed by the Republicans

Not while Obama is in office, which I still expect to be for two terms (though of course that's an assumption). That aside, the Democrats will fight to death to protect it, and it will be very difficult for Republicans to repeal popular insurance regulation like banning pre-existing condition fine print, even if they haven't gone into effect yet.

Insurance premiums will skyrocket

The CBO has said the exact opposite. We've been relying on their estimates from the beginning. Why not have faith in them now?

I'm pretty disgusted by how this has gone down, but it simply does not make sense to drag this fight on when we really need to get to more important things, like the energy bill.

I think many conservative to centrist types find being forced to buy to be objectionable, and it could influence votes.

"No, progressives might be angered. Personally, I think it's wrong that people have to pay to these scumbag companies. But we already do this with auto insurance. And despite mandatory insurance being in the bill from the very beginning, there's been no mass outcry from the public."

Nobody has to own a car, it's a choice. Huge difference.

"That aside, the Democrats will fight to death to protect it, and it will be very difficult for Republicans to repeal popular insurance regulation like banning pre-existing condition fine print, even if they haven't gone into effect yet."

I kind of suspect that actually the republicans will have a good amount of help from dems to repeal this. Look at it this way- right now there is no constituency that is actually strongly for this bill other than the insurance companies. The right hates it. the left hates it. The centrist dems don't want to get blamed for the coming fiasco and centrist republicans are a myth at this point. Obama is the only one with a strong vested interest in keeping this going and that too will evaporate once the &^%$ hits the fan.

"The CBO has said the exact opposite. We've been relying on their estimates from the beginning. Why not have faith in them now?"

Read the CBO report, they openly admit they didn't actually refigure anything for the removal of the Public Option. They just assumed nothing would change.
Yes they are a source of info but you still have to be able to critically evaluate the info they produce.

"but it simply does not make sense to drag this fight on when we really need to get to more important things, like the energy bill."

There's three options:
1) don't do it at all
2) do it wrong, or
3) do it right

if we won't take the time and energy to do 3 then we're a lot better off doing 1. I'd vastly prefer 3, and I think we could do it pretty quick through reconciliation or passing several smaller scope bills, but if we aren't going to do that we still need to not pass this abomination.

It not a starter home its a toxic FEMA trailer, and that we will be forced to pay for whether or not we can afford it.

Is Congress keeping in mind that mandatory monthly check to businesses that are enormously profitable will come at the expense of mom and pop businesses, the home selling market, consumer goods, basic necessities like food and clothing, entertainment, travel and all the other economic markets that are now suffering from the recession, and will continue to suffer because of this mandate?

It's not a "starter home" if you can't unload it later in favor of something more suitable.

As for this bill leaving plenty of room for expansion, well, you can also take a crappy summer cabin and try to turn it into something you can actually live in year round. Good luck with that. There's this expression about spending good money for bad rope.

The "strong foundation" is an unsustainable bubble mortgage. We pay more than twice as much per capita as other nations for health care, and nothing in this bill will change that. More than half of every health care dollar will be wasted. The subsidies will, in effect, buy each person an expensive health care plan, set it in fire, then force the person to buy a crappy policy with their own money.

Sojourner,

"No, progressives might be angered."

Actually, I wasn’t predicting that people would object just to the mandate per se, but rather that their premiums would keep rising dramatically every year, they would not have any protection from being denied coverage with a preexisting condition, not to mention what looks like many other loopholes which will allow the insurance companies to deny people coverage or procedures, and many will be forced to buy these crappy policies even though they cannot afford them.

A whole lot of Americans will be asking themselves, this is healthcare reform ?

"Not while Obama is in office, which I still expect to be for two terms"

Not if he plans on running for reelection by telling people with preexisting conditions they have to wait another two years.

"it will be very difficult for Republicans to repeal popular insurance regulation like banning pre-existing condition fine print, even if they haven't gone into effect yet."

Simple as pie. They would only need 50 votes in the Senate, as they will have no compunction utilizing the reconciliation process.

"The CBO has said the exact opposite."

As Tlaloc pointed out, that was when the Public Option was still in the bill. There is nothing in the bill now in regards to cost containment or restrictions on premiums, other than the token pilot programs which there will be no votes for to expand later.

(deep sigh)

Nobody like the left tears apart and attacks their own side like the left.

Agree with bewilderedness.
Medicare Part D, put in by Bush and AARP... is what is costing Medicare so much as it was never funded and there are no cost controls. It was a handout to Big Pharma and health insurance co's.

Premiums have doubled and this plan pays me nothing-- nada.

Now, passing health care that is expensive, not cost controlled, and MANDATING that people buy it-- the Dems are really gonna lose big with this one. Wait til people start getting billed.

I hope they refuse to pay.

Nobody has to own a car, it's a choice. Huge difference. Tialoc

A car isn't a choice in places like Atlanta, Los Angeles, Cleveland, Detroit, Chicago, Kansas City, Dallas, Houston, hell the whole damn country outside of New York and small parts of Boston.

The car insurance analogy is more apt than not, except in many states they let you opt out of insurance if you can post a large amount in escrow.

The auto insurance analogy breaks down when you realize that there are a lot of auto insurance companies and only one or two health insurance companies in any community. Want health insurance reform, do away with the health insurance anti-trust exemption.

The analogy also breaks down when you realize that auto insurance is real insurance against the unknown (most drivers never use it) but health care insurance is really a mechanism to make sure you have enough money to pay for a universal human activity. Everybody sees a doctor sometime. Nobody can afford ordinary health care without health insurance. Well, some can but their last names sound like Gates and Buffett.

If health insurance were limited to catastrophic illness the analogy would be more apt.

The comparisons with Social Security, Medicare and Medicaid are fundamentally dishonest.

Social Security, Medicare and Medicaid were government run programs from the beginning -- nonprofit programs under open, accountable, efficient public administration.

This legislation establishes no such program. No single-payer, no public option. It doesn't even expand Medicare.

Instead, it establishes by law that America shall have a health care system which exists to provide profits for the for-profit insurance corporations, and will require every single American to guarantee the profits of the insurance corporations, in perpetuity, under penalty of law.

This bill is not a basis upon which a public, nonprofit health care system can be built -- it is exactly the opposite of that. It entrenches the for-profit insurance corporations and puts any "public option" off the table permanently.

In return for this, what we will get is some very meager regulation aimed at reining in some of the worst, most egregious, and literally murderous abuses of the insurance corporations.

Sure, that's not nothing. But the regulations may or may not be effective at curbing abuses or helping the American people get better treatment from the insurance companies to whom they are now legally compelled to fork over their hard-earned dollars. And any attempt to improve or expand them will be vigorously opposed by the same corporate money, corporate lobbyists and corporate-owned politicians who gave us this bill.

If "sensible liberals" want to argue for this bill on the actual merits of guaranteeing and protecting the profits of the insurance corporations in return for their acceptance of modest regulations, while keeping any new or expanded public health insurance system "off the table" for the foreseeable future, then that's fine. There may be a good argument that it's the best we can get, the regulations are worth it, and we can try to improve them later.

But to pretend that this bill is comparable to the establishment of nonprofit publicly-run programs like Social Security, Medicare and Medicaid is dishonest.

zoe kentucky wrote: "Nobody like the left tears apart and attacks their own side like the left."

Usually it is Ditto-Heads who talk about "the left" as if it were a monolith.

When it comes to this bill, the fact is that we are not all on the same "side".

I'm on the "side" of universal, single-payer, nonprofit health insurance under open, accountable, efficient public administration.

I can support anything that actually moves us in that direction. A "public option" would be good. An expansion of Medicare would be good too.

Neither of those are in this bill. Nothing like that is in this bill.

This is a bill of, by and for the for-profit insurance corporations. It entrenches their power and guarantees their profits in return for some relatively minor regulation, and it puts nonprofit public health insurance "off the table" permanently. It is the opposite of what the American people want, need and deserve.

I'm not going to quibble about what "the left" means, but it is pretty obvious that whatever label you want to use, advocates of universal nonprofit public health insurance are not in the same "left" as the politicians who "negotiated" this bill with the insurance corporations.

I'm with SA and the others who view this bill as nothing but the forced transfer of taxpayer dollars to the for-profit insurance industry with nothing real to build on--not to mention that there will very likely be smaller Dem majorities or Repub majorities in the coming years, so good luck with more progressive "improvements" to this thing.
Oh, and was just reading how California's anti-recission law was working out in practice. Turns out they simply don't have the money or manpower to match up to the companies in court, where the insurers can defend every single case. The Senate bill apparently works the same way, with no national oversight or enforcement, it leaves it to the states, who won't be able to challenge the big insurers, thus making the anti-recission that everyone's crowing about a meaningless provision.
For every supposed "victory" against the insurers, there's a giant loophole for them to drive through.

The auto insurance analogy breaks down when you realize that there are a lot of auto insurance companies and only one or two health insurance companies in any community. Want health insurance reform, do away with the health insurance anti-trust exemption.

The car analogy is apt because it shows that people do not have large qualms with being forced to pay insurance. Auto-insurance aside, there's lots of different insurances people are required to have at different levels of government.

Now, people may complain about EXPENSIVE insurance, but that's a different matter. The CBO says this will reduce insurance cost in the long term. If insurance costs skyrocket, then reform has failed, the CBO was utterly wrong, and we'll have no choice but to revisit this. However, if there is no insurance mandate, premiums are GUARANTEED to skyrocket, because the healthy will game the system.

"it will be very difficult for Republicans to repeal popular insurance regulation like banning pre-existing condition fine print, even if they haven't gone into effect yet."

Simple as pie. They would only need 50 votes in the Senate, as they will have no compunction utilizing the reconciliation process.

No, this is not true. You cannot use reconciliation to remove the health insurance regulation. This is why the Democrats do not want to use reconciliation, so many important regulations would not pass the test!

Furthermore, if reconciliation was used to pass anything, it would have to be reapproved five years from now, just like the Bush tax cuts. Those were popular, and guess what, they're going to expire and there's not a thing the Republicans can do about it. If health insurance reform was such a bruising battle, what makes you think it will go better later on?