To the phones!

An interesting read is the Sunlight Foundation’s “Party Time,” showing the various fundraisers and their sponsors. For example, on July 21st, there’s a fundraiser for Pete Stark hosted by healthcare interests.
“…”Probably not the best timing for this,” the person noted in reference to the fact that the House Ways & Means Committee is to begin marking up the House Democrat’s massive health care reform overhaul legislation later this week.”
http://www.politicalpartytime.org/

But D-Day thinks the battle is over, that a public plan is fait accompli,

i don’t agree with dday. the public plan i’ve seen from the house doesn’t even meet the hcan def of public plan (available nationwide from day one) we’ve been calling our reps for (i’ve been mostly calling for the cpc list, but that’s harder to meet).

or maybe the amendments have changed the bill? or am i reading the wrong bill?

such hard work even getting the Least Worst out of your Democratic politicians.

like nailing jello to a wall.

even if some tactical victory is achieved, remember the real objective was Single-payer, right?

We tried your way in 2000, and got Bush. Or do you still think Bush and Gore are the same? (The Republicans sure don’t, which is why they give millions of dollars to you guys to strip voters from the Democrats — which has the net effect of shoving the surviving Dems further rightward.)

p.s. i should add that i’m happy about the amendment to permit states to try single payer, but i don’t know anything about any of the other amendments.

Yupper! And don’t forget to target the hometown papers of the Blue Dogs — letters in those papers reach hundreds of thousands of local voters, which is why they scare the beejeezus out of the BDs.

Jane, I used you automagical Letters to the Editor page (via slinkerwink’s diary at DKos) to send LTEs regarding all seven of the Blue Dog Dems. I wanted to let you know that got two auto-responses from the LA Times that suggests that at least one of them, maybe two, were submitted as articles, not LTEs. Maybe need to check to see if the right email address is in your program?

Also, got an out-of-office note from Jay Evensen at the Deseret News in Utah saying I should send it to someone else (Marjorie Cortez at marjorie@desnews.com.)

Thought I’d pass those on in case you were interested in “fixing” them.

Great work on this, Jane. You’re a hero.

Well, as the title says: “Victory-Sort Of.” Maybe we should just accept that for the time being.
It took me a long time to come around. At the same time many of your out there were behind this from day one. The big difference is I’m the one that’s going to have to pay for it (with a few exceptions out there). It’s always easy to spend other people’s money.
Still, I’m not complaining. But as for the next big issue lets make it something that doesn’t cost money.
I have a great suggestion: Term limits for Congress. I can think of no better issue.
I would also suggest one issue that would cost me money but I would be fine with: Ending hunger right here in the United States. What a disgrace to have people in this country going to bed hungry when we lead the world in obesity.

One other point on health insurance. If people can not be turned down due to pre-existing conditions why would anyone buy it when they are healthy?

Situation Normal — All Fucked Up. This is the price of favoring an extremely ambiguous public option over the known quantity in single-payer. Single-payer comes from a distinct philosophy that’s missing in the crumbling public option political gambit, viz., accessible quality health care for all without exception (including visitors from other countries and immigrants).

As CBO’s Elmendorf stated:

If, instead, only one design option was offered and all residents were required to enroll in it, then concerns about adverse selection would not arise. That approach could also reduce the administrative costs that doctors and hospitals currently incur when dealing with multiple insurers.

The largest risk pool achievable would be through a single-payer system where everyone is enrolled under a single plan that covers everything. With no negative risk effect from adverse selection, no one has to be excluded on that basis.

In any event, I’m still struggling to understand who’s on what side of what, here? :P What is Obama for? I’m less sure at this point than I was over the weekend.

That’s why once you’re in this framework, there has to be an individual mandate, backed up by penalties. It’s designed to prevent this predictable “free-rider” problem.

Why have you concluded that a co-op plan won’t work?

Because you’re smart, maybe? Okay, now that I have the snark out of the way, a co-op plan won’t work because it can’t get big enough fast enough to survive.

When the insurance industry decided that health care should be a for-profit enterprise, the first thing they did was to buy up (or force out of business) all the not-for-profits (nfp) they could. Once upon a time, the Blues were not-for-profit entities. I don’t know of any nfp Blues that remain. There are precious few nfp insurers left. Those that do remain were vertically integrated and large enough to survive (Kaiser Permanente is a good example).

In order for a co-op to survive and provide competition for Aetna and United and the rest of the rent-seekers it would have to be heavily subsidized. I can predict the economic response of Aetna, Cigna, United, et al. to a co-op system right now. They will strong-arm their provider networks (if you contract with them we won’t renew our contract with you). Providers who are vertically integrated with for-profit insurers (e.g., Health South and Columbia Hospitals) won’t contract with the co-op at all.

It won’t work because the for-profit health insurance industry doesn’t want it to work. That means that the co-ops will require huge subsidies to stay in business until they become large enough to be an economic force. As an alternative to subsidies, we could have strong (i.e., intrusive) government regulation to force providers to deal with the co-ops and prevent the for-profits from penalizing them for doing so.

Jane, I just don’t agree that Obama just wants this off his plate. If that was the case, he could have rammed through a bill with the co-op or triggered plan months ago. It’d be nice if he would take those options off the table completely, but realistically, there’s no way he’s not going to leave himself an out.

Actually, the latest news makes me fairly optimistic. There’s something about Senators crying that they “need more time” to study a bill that universally translates as “We don’t want to vote for this but we don’t have a good reason not to, so give us time to come up with one.” Based on Orzag’s comments to John King yesterday, the Administration recognizes this and isn’t afraid to push back against it.

I may be wrong, and I agree that we should keep pushing right up until the end. But I do think the prospects for a bill are better than ever.

Got it!
Thanks.

Thank you! That’s wonderful news.

The emails come from the Blue State system so there isn’t any way to change them, but really appreciate you taking the time to follow up and let me know.

I do agree with you on that: prospects have never been better. Stakes are too high to take any chances, though, so appreciate everyone’s help building that firewall.

Repeat after me:

Term limits do not work.

Is that clear enough? California has the strictest term limit provisions that I know of. The effect of term-limiting the legislature has been to shift power to the lobbyists. Lobbyists aren’t term-limited, and they know the system better than the Assemblycritters and Senator-critters.

If you banned lobbyists (good luck with that, the U.S. Constitution guarantees us the right to petition and address the Government for redress of grievances), the legislature would become captive to its research and bugeting offices. Those folks aren’t elected.

Term limits for the executive branch might be okay (I’m not convinced of that, but I’m not convinced that they don’t work either). But term limits in the legislative branch have been a disaster everywhere they’ve been tried.

Look, I was an advocate of term limits for many years. It was after seeing their effect that I concluded that term limits are a solution worse than the problem.

Term limits do not work.

What rot. Forgotten in this narrative are the previous eight years when the party shifted to the right to get more votes from “centrists,” effecting the alienation of the left from the party much further back than suggested. The party lost it with LBJ, as a consequence of Vietnam, and has been scrambling ever since.

My view is Obama wants several thing, with varying priority:

1. bend the cost curve for health care costs so it doesn’t control/doom the budget and the economy

2. cover more people and have a way to pay for that

3. End the abuses by insurance companies prohibition

4. plant the public option seed so that it can gradually unwind the private/employer-based insurance system and reenforce 1-3.

Right now, the House and Senate/HELP bills take a decent stab at all of these, and he’s still fighing for all. He’s put his Presidency on the line to achieve them, but I agree with Jane that he’s forced to choose, #4 is the most vulnerable. I think we have to convince the public/media/Congress that #4 reenforces/strengthens 1-3, and so it’s essential.

Recall we all supported the SCHIP bill, which directed about $35 billion to provide insurance to about 4 million more kids, and paid for by a tax on tobacco. Great progressive legislation.

These bills would provide Medicaid coverage and/or subsidized insurance to about 40 million more people, outlaw the abusive insurance practices, lower total health care costs in the economy, force insurers to compete against a public, non-profit model, and pay for it with surtax on the wealthiest. It’s huge.

We already know that given the massive option to going this far, that single payer would be crushed.

And we’re uncertain what to do? We’re split on this?

We should be all over Congress to get it done. Time to pull together, because this window will not be open much longer and there will not be another, for a long time.

i think the current bill makes it illegal for the insurance companies to deny an insurance policy because of pre-existing conditions, but it does not (at least if it does i can’t find it) prevent the kind of denial of care for policy holders that the sarkisyan family encountered (re liver transplant)

hoping someone will correct me if i have that wrong.

Most of these arguments could also apply to the public plan — the current system will see it as a threat — because it is — and will do everything they can to make it fail or be insignificant.

The main differences between the public plan and co-op concepts are governances and viability at the national level. The co-op was intended to avoid government control/guidance, but what does a member-run natinal co-op look like? What powers/authority does its governing board have? How are they chosen and empowered. When you think this through, the co-op has to become the same as a public plan with federal authority to function — and that is what the co-op advocates are determined to prevent. The name is not the issue, nor the non-profit aspect; what matters is whether this “thing” can function as needed at the national level, so that you truly have a “national health insurance option” that can force the existing industry to shape up or lose market share.

If the industry and Congressional supporters are willing to accept a co-op, it means they know it will be unable to function effectively and thus unable to pressure them to change.

There you go again, explaining carefully and making sense. Honestly? You are my FDL hero. I rarely comment on some of this, because I feel so far behind the 8-ball. You embolden me to at least say this much. Not fawning. What the hell would that net me?! *g*

have you taken a look at the tri-committee bill re “can’t get big enough fast enough to survive?” it’s only available via the exchange and access to the exchange is quite limited.

thanks!

Except that if the public plan is administered by CMS (and there is no reason on earth to reinvent this particular wheel) the for-profits play the restraint-of-trade card at their own peril.

We know that the for-profits want a public option just slightly less than a return of smallpox. The co-op bullshit is okay because they can drown that (or believe they can) fairly easily.

We already know that given the massive option to going this far, that single payer would be crushed.

no actually we don’t. it’s a much easier sell to people because of the immediate and simple benefits. i’m not saying it would succeed, or even that it wouldn’t be crushed…. just that we don’t know.

Thanks for your comment which I realize is for the larger audience. I expect after all is said and done in the conference committee, the reform components that survive will leave us with something not much unlike what we have now, except there will be more administrative overhead and the costs attending that. Not everyone will have access to whatever health care is indicated and people who do will still pay out of pocket. It’s enough to “make people with the future of the human race at heart despair,” to quote aunt Agatha (from Wodehouse).

Because it will be required by law that they participate in the plan, otherwise it won’t work. They thought this through. A fine will be assesed to those who try to opt out. This is absolutely necessary for the plan to work. In fact if all citizens from the day they are born, pay a premium for health insurance, the cost will be low because of volumn and there will be plenty of money to pay for Health Care. In Insurance this is called “spread the risk”

scarecrow, jane’s been asking us to call our reps to ask that they pledge NOT to vote for this bill unless the public plan is available to everyone from day one, etc. now you are saying we have to pull together FOR the bill — as is?

i’m way confused.

Think this through. The Wyden Bill, which has everyone eligible to purchase via the exchange on day 1 sounds great. Day one is five years from enactment = 2015. If it’s not ready, that can be delayed, but assume it’s ready. We get full access by 2015.

The House “restricted access” provisions start in 2013, expand a little in 2014, and then allow the Sec. of HHS to expand as much as she thinks the public plan can handle in 2015. If it’s not ready, you don’t want it to fail on a larger scale. If it is, it will eat up the market in due time.

A single payer plan would confront similar schedules, because everything has to be ready all at once. It might even be phased in, to make sure everything is working. It can be done all at once, and possibly sooner, but it’s hard and there’s not guarantee, and no one should have any illusions about what it would take to move from where we are to where we want to be.

You’re asking people to fall on their swords over these predicted differences?

I’m looking at 2020. Where do we want to be by then? I’ll take any of these routes, but only the first is being offered. But for us to be split on this is dismaying.

The bill raises $500,000,000,000 over ten years to expand coverage and does it by taxing the top 1.5% or so. Are you willing to see it defeated because you wanted what’s behind door number 3?

If spreading the risk is the goal, the least amount of risk is founded in a single-payer system. These arguments should be aired in the House and Senate and pushed by the White House and sundry party apparatchiki.

Not necessarily. CMS handles conventional Medicare/Medicaid with about 2.5% overhead. There is no reason they couldn’t (beefed up, of course) handle a public option similarly.

That’s the precisely the sort of thing that has the for-profit sector fighting this tooth-and-nail: they are trying to protect (and if possible, expand via a mandate system) their rents.

I support the bill’s general framework. Jane has the strategy for keeping that framework together and maximizing progressive influence to achieve that. I agree with what she’s doing 100%.

You’re making the case that we should be starting a single-payer system as soon as possible, given your projections. In five years time, we would’ve lost to currently proposed reform measures yet to start, even a formal discussion of single-payer already old hat in most of the civilized world.

it wasn’t my fracking list of requirements — i wanted to use your’s or cpc’s. so you don’t have to convince me the list was stupid. but since that was the list we were asked to whip to and it seemed to me to be better than nothing (especially the available everywhere bit), i supported the whipping efforts by calling.

please put aside, just for the moment only, whether you think the bill as is should be supported. my point is that it doesn’t meet the requirements we’ve been asking our reps to sign on to. how can we be supporting a bill AND asking our reps to vote against? is that what you are asking me to do?

I’m sure the private insurance industry puts as much as they can to ‘administrative costs’ to hide their windfalls. That part is not changing under reform measures proposed. The addition of administration from the government side, including the Health Exchange thingy would be the main difference in cost, whatever the percent overhead.

Alan,

We need to be clear about something. Health insurance of the sort under discussion is not like auto insurance (or term life insurance, for that matter).

A number of the expenses are entirely predictable and have to be built into the premium system from the outset. We want everybody vaccinated: we have to build that in. The system’s 50th birthday present is a colonoscopy: we have to build that in. We want women to be screened annually for cervical/breast cancer: we have to build that in. The list goes on, of course.

The idea behind Health Care Savings Accounts was that we’d let people set aside money in a tax-deferred (or even exempt) vehicle to pay for this stuff. It doesn’t work, because the price that I have to pay for a colonoscopy bears no discernable relationship to the price that BC/BS has negotiated.

Maybe because they might have accidents? Catch swine flu? Get TB? I paid for health insurance for decades while I was healthy.

No. The three conditions are crafted to exclude other outcomes, such as “trigger” before anything happens (available on day one) or a “co-op” (national, Congressional accountability) that doesn’t work. It’s also designed to be “simple” enough to work with, given the huge complexities and interconnected parts. It’s not possible to whip something people can’t explain or understand. There is no conflict, but there is always complexity, so crafting a message that’s both sensible and simple is an art. I’m fine with what they’re doing. But also I’m writing about what else people need to be thinking about, once you get the core features.

I seem to be missing your point. Can you clarify?

*nevermind*

Poverty and obesity often go hand in hand because poor people eat poorly. We need to address the subsidies for corn. If anything, it’s the food corporations that get subsidies that are killing us with high fructose corn syrup and chemicals. That’s where the sin tax needs to be. Not on cigarettes and alcohol which, of course, effect the poor.

There’s a movie out called Food, Inc. which points out the dilemma you raise here about affordability of healthy diets in America. Recommended.

Term Limits do NOT work. They do not work here in Montana. You are right. Lobbyists control the legislature. Monsanto took a committee out to dinner and lo and behold, the anti GMO legislation was tabled.

What we need are public financed elections, in other words, we need money limits while you are in office. Or your PAC money must go to educating citizens on important issues rather than getting your friends elected. We needed real ethics reform, but got a teeny bandaid.

Okay. Let’s take Homeowner’s insurance as a model for indemnity insurance. Buying a policy amounts to placing a bet: you’re betting that something bad happens. The insurer is taking the other side of the bet.

For the vast majority of us, nothing bad (as defined by the Homeowner’s policy) happens to us, and the insurer pockets our premiums and says, “Thanks for the business! Sign up again next year!”

The policy is priced at the mean loss plus overhead plus profit. Provided that we have been responsible insurers (that is, we have our insured spread widely so that the losses are essentially uncorrelated), this is an excellent business model if you have enough policy holders. Prices are pretty reasonable, because all the policy holders are paying at their expected loss (plus the insurance company’s vigorish).

Insurance companies can screw this up, because they have salescritters that are too good or they get too greedy or whatever. The way you screw this up is to get concentrated in a few markets subject to common loss. Oh, say, you’re selling homeowners insurance primarily in neighborhoods along I-210 (the Foothill Freeway) in California. One big fire in the hills, and the insurance company is hurting. Those losses weren’t uncorrelated, but your premium model said they were.

Reality has a way of biting people when they ignore it in favor of their models.

Okay, the thing about health insurance is that we are not talking about insuring people against individual catastrophes. We could do that fairly cheaply, actually and it follows the indemnity model pretty well. We are talking about providing something close to first-dollar coverage for a lot of screening procedures (and we ought to!), and that is going to raise the bill considerably.

It’s why I’ve been saying since I started getting involved that stating the problem as health insurance mis-states the issue. The problem is health care finance, that is, how are we going to pay for it.

I’ve given my views about the health insurance model.

As for financing, even the public option involves premiums that people who subscribe to have to pay out of their income or savings for coverage that is only partial, not complete. The initial outlay of $2 billions in the house bill to pay claims is to be recouped by premiums received. The government stands to profit from a public option if implemented. The administrative overhead would be the main added cost which might be offset by premiums, but nevertheless is a new cost to the entire health insurance system.

The Pillars of a Robust Public Option

1. National and available everywhere: A strong public health insurance option will be a national public health insurance program, available in all areas of the country. The insurance industry is made of of conglomerates that have national reach. In order to have the clout to compete with the insurance industry and keep them honest, the public health insurance option must be national as well.

2. Government appointed and accountable: The entire problem with private health insurance is that they aren’t accountable to you or me. A public health insurance option must have a different incentive. A public health insurance option doesn’t have to be a government entity necessarily, but its decision makers must be appointed by government and must be accountable to government.

3. Bargaining clout: The whole point of health reform is to lower health care costs. Clearly, the insurance industry has failed to lower costs when left to their own devices. As the President says, we need a strong public health insurance option to lower rates, change the incentives in our health care system, and keep the industry honest.

4. Ready on day one: The private health insurance industry has utterly failed to control health care costs or provide their customers the quality they’ve paid through the nose for. With one person going bankrupt every 30 seconds due to health care costs, we cannot afford to wait any longer for a real fix. We need the public health insurance option to start lowering prices now. That means no trigger.

the pledge:

Will you commit to vote against any health care bill that doesn’t contain a public plan which is:

1. available nationwide
2. on day one
3. and answerable to Congress and the Voters?

the plain meaning of the words of the pledge are not that complicated.

the current bill’s public plan has limited availability in 2013, and expansion is dependent on hhs (after another pres election to boot — iirc 2015?).

even if you want to call 2013 “day one” — access to the exchange is very limited. how does that assure bargaining clout? and, while there is no trigger specified, expansion is up to hhs (not even congress).

At this point, I really don’t care what it costs. They manage to find money for everything else – wars, bailouts, lots of pork, etc. Let them drop some of that mess and we can all have good health coverage.

But for us to be split on this is dismaying.

i agree completely. but the split happened last summer (or earlier) when the top down marketing campaign was decided without consulting with the activist base and then NEVER making the case to them or to fence sitter wannabes like me. it should be no surprise that many remain unconvinced (or worse, not trusting the process).

Absolutely!

All the birds that were here have moved on to another tree! :P

Good points and questions.

ok. thanks. will try to check back here later though in case anyone has an explanation.

A bad bill is a bad bill. And people are dying. And more and more people are losing their homes, jobs, and health. We can “manage” this problem or we can solve it. We are a $15 trillion economy. We have the money. We can easily afford 150 billion a year. Close down some of our 761 military bases in 150 out of 190 countries in the world. The Iraq occupation costs over $100 billion per year. We just gave the IMF $100 billion. Come on, we have the money. We just don’t have the will.

It is shameful that all the discussion is “cost, cost cost” squawked by the chicken little legislators who are bought and paid for. The energy bill was written by coal. The health bill will be written by the sickness industry. Goldman Sachs will make trillions on the cap and trade scam. The insurance companies who are probably broke will get relief by mandating insurance. Next up will be a way of getting social security money.

Why are people here content to screw middle aged Americans by making them “hope” they can make it to 65 years old without a major health problem which will bankrupt them? And economy wise, we don’t have the time to “manage” this problem.

We must fight for a non profit health care system like the other countries. Pick Singapore, Switzerland, or Germany. All have insurance companies, but they are all non-profit.

We have a state wide rally at Blue Cross Blue Shield this week for single payer. The momentum is growing here. Write letters to the editor. There is NO reason that Baucus should be in charge of health care reform. He should recuse himself because of the $1,170,313 he got from insurance and $1,016,276 from health professionals. With Pharma and HMOS and hospitals he has a total of $3,902,785.

We need a national strike if we don’t get a national health care plan now. And dump these Republicans in donkey suits.

Hail fellow, well met!

Scarecrow is the person I look to in order to tell me whether something is going to be workable or not. If he says “this won’t work,” I listen to him.

We want to get something we can build out and achieve single payer. The day that becomes unworkable, and it’s just a ton of money pumped in to reinforce a bad system, that’s when I’m ready to pull the plug.

Thinking that we can wave a magic wand or click our heels and achieve single payer in an instant are just unrealistic. It would take months and months of work (if not years) to iron out all the details of the impact that single payer would have on the largest industry in America. Nobody did that. It was kabuki and people who care about single payer should be upset that people led this crusade without doing that.

Thinking that we can wave a magic wand or click our heels and achieve single payer in an instant are just unrealistic.

Erm, is this really a fair assessment of what is being sought? We can’t even get a formal discussion going, let alone implement a scheme. We can’t even get Congress to end the war/occupation in Iraq, for that matter.

I hate to spoil this because this is the best discussion I have seen on the FDL main page ever.

“Cost” as an explanation for Obama’s declining rating on healthcare has three parts. There is cost as in the number of $1 trillion, cost as in the idea that this legislation won’t control the incentives for exploding healthcare costs, and cost as in the idea that the legislation will and people won’t be able to get advanced procedures.

(Hey, you can tell when EW’s stuff gets crossposted because of the avalanche of one-liners)

Jane,
Are you willing to settle for a public plan that is not available to everyone and that will not be implemented until 2003?

I’m not.

And I have a real problem with seeing my president out at rallies telling people that if they like their insurance, they can keep it, and if they don’t like it, they will have other options, including a public option. As recently as Saturday, he made that statement. But the current proposal does *not* offer that, and as you have stated, even the current public plan seems to be endangered. So, is he out there lying to the American people or what?

I’m seeing (or at least I think I’m seeing) a disturbing trend at dkos where people are willing to cheer on whatever Pres. Obama is calling for, regardless of whether it’s real healthcare reform, regardless of whether it has a real public plan, and just to see Obama “take on” Republicans like Jim DeMint with his Waterloo statement.

I can’t believe we’d be that stupid. But apparently, many are. A win, any kind of win, is all they are looking for.

selise, I share your confusion. In a few short days, it seems that suddenly we are not fighting for a strong public option available on day one. Instead we are fighting to pass some kind of healthcare reform as rapidly as possible, and there are few people who seem to understand fully what it is.

What happened? Did I miss a memo in the last few days?

The president is still out there telling people that they will have a public option.

You know, Scarecrow this might be complex, but it’s not rocket science.

It took seven years to put a man on the moon.

We converted the auto industry into an armaments industry in a matter of months during World War II. And the British, in a matter of a few days, moved half a million children out of London to safer places (homes) all over the country. Hell, we fought the entire war in less than the time you’re prescribing to put these relatively simple procedures into place.

It shouldn’t take more than a year to implement a program such as this.

It’s bureaucracy. No new technologies need developed. No breakthrough medical procedures. And we’ve got a fully operational public plan right here, right now. Medicare. I just don’t buy your arguments.

In the interim, how many people are going to die or go bankrupt in the 5-7 years in which it’s going to take to implement this program?

All members of Congress should be deeply ashamed of their failure to work for the public good.

We are so far into the weeds on this issue that we’ve forgotten about the simple human issues at stake. We’ve forgotten that the situation right now is already critical.

OFA is getting a LOT of heat for those ads – we don’t care mind you, but the dems attacking dems meme is scaring some of the members, they are afraid to do the wrong thing which can morph quite easily into doing nothing. keep going, we’re hitting the wall now, push. y’all know what we are up against.

Obviously there’s a big difference between a public plan and a “public plan.” But those opposing the bill entirely are using costs and taxes to kill it. And without effective pushback on that, the version of the public plan in the bill won’t matter much, as the legislation sits on a shelf because nobody can figure out how to pay for it.

That’s really all I’m saying. I think that if we don’t engage that part of the debate at some point soon, we’re in trouble.

exactly and no legislation, particularly an effort this size, is static. there will be changes, upgrades, adjustments for unintended consequences, and reform of the reform over time. delay = kill it, that can’t be underscored enough. send the bill out of both houses, reconcile and move it for signature. let’s try and get everyone in america a check-up and some scheduled follow-up care by new year’s eve. why not?

Insurance exchanges, co-ops … what the hell are these people smoking?? Why not a fucking lottery??

These are NOT appropriate models for providing health care, which should be provided as a public service and a matter of public health policy.

The issue is profit, and that’s where the fulcrum of the argument sits. Pollsters need to start asking the right question about the public’s attitude toward the administration of health care: should it, or should it not, be a profit-making enterprise?

The vast majority of us DO NOT TRUST THE HEALTH INSURANCE INDUSTRY, and it doesn’t matter whether they organize as for-profit corporations or disguise themselves as tax-exempt co-ops.

The only way out of this rabbit hole is for millions of us to climb out, and head into the streets!!

v. good point doctor! i have good health ins. at my job, free. i’ll chuck it all and go on the public plan cheerfully just out of sheer vengeful, all-american hatred of the health care industry. what a disgrace. if it weren’t for the intertubes i wonder if we would have majority rule in this country at all anymore. gah.

Single payer advocacy is “kabuki,” eh?

You know, back in the day, when I was coming up, “kabuki” was the blogosphere’s term of art for Village performances by insiders for the benefit of the rubes. Since the “little single payer advocates” are excluded and censored, they’d hardly be insiders, wouldn’t you agree?

Now, if I were to apply the word kabuki, I might consider applying it to a case where HCAN’t shills are paid to blog in favor of a complex, unproven, and Rube Goldberg-esque “bait and switch” operation whose putative cost savings are entirely “speculative”, and which won’t kick in ’til 2013, despite the demands that it be passed NOW NOW NOW*. But that’s just me.

Appreciate the pushback, though!

NOTE * Translation: Passed before the midterms, implemented after the next presidential election. What’s not to like?

NOTE It’s also the classic sign of Versailles insiderism to use “populist” as a term of abuse. Plus ça “change,” plus c’est la même chose…

The argument from authority is an appeal to progressive values, then?

But for us to be split on this is dismaying.

Possibly to you. Single payer advocates, like abolitionists, are used to being marginalized, and so at this point we’re impervious. Here are two very simple and concrete things you could whip for that might even bring a little pressure from the left:

1. Make sure states (and Puerto Rico) can implement single payer on their own (or in regional compacts). A Kucinich amendment to this effect passed, but it should become part of the conventional wisdom.

2. Make sure that a full analytical study that includes all costs (not just CBO scoring) comparing single payer to the other programs on offer is performed. Surely it makes sense to compare all the alternatives before making a commitment of this scale?

It was kabuki and people who care about single payer should be upset that people led this crusade without doing that.

i’ve been following the work of the single payer activists for years, and your characterization could not be more off the mark.

i have no idea what’s going on. and the lack of an explanation is not reassuring.

maybe i should have paid more attention to the months of no answer to my questions re “what public option?”

“Crusade…” Along with “populist” as a putdown; classic insider language. Like robust — have you ever heard a normal person use that word, in any context? (”Honey, those porch steps are robust!”) Like mildew, the rots begins at the leaves, in the style, but spreads quickly if not treated.

Kucinich did nothing. Not one single thing while the bill was in Committee to work out the details. He just dropped it in at the last minute. It’s completely unworkable within the framework already set out.

If you can prove differently, happy to see it. But it doesn’t exist so I’m not holding my breath. Even his “single payer or die” allies feel let down, like they got suckered.

ok, now *i’m* confused.

kucinich didn’t work on which bill, 676 or 3200? in which committee? dropped what in? what exactly is it that’s unworkable and in what framework?

if you’re saying he should have been working on hr 3200 all this time, i’m not sure i agree.