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photo by Jonathan W
We are now starting to see the beginning of a game of health care Jenga. The problem is the Democrats have seriously constrained themselves on what they can do. Obama set an arbitrary numeric cap of around $900 billion and demanded reform be fully paid for. Conservatives like Baucus, Conrad, and Snowe demanded that health care reform be paid for with only dollars inside the health care system. Sweetheart deals with the the different industries (hospitals, pharmaceutical companies, etc.) eliminated the possibility of producing hundreds of billions of savings with serious system-wide reforms. Fierce opposition to “too much government” solutions or a Medicare-like public option also took some of the biggest money savers off the table.
These many restrictions make it nearly impossible to add to new, meaningful reforms. Without the room to add to the bill, creating compromises becomes extreme difficult. For example, a theoretical compromise for weakening the public option would be to add for liberals more affordability subsidies or improvements in Medicaid. Another example: reducing the excise tax on health insurance benefits could be paid for with the money saved from drugs re-imporation. Neither of these compromises is now possible because of the different restrictions and secret deals.
Really, the only option left for concessions is the removing of things that one group or another find most objectionable. The result is a destructive downward spiral that best can be called health care Jenga: Different groups keep trying to remove building blocks while trying not to knock over the whole towering health care reform bill.
The employer mandate was removed to appease Olympia Snowe. To get the bill under budget, affordability tax credits were slashed. To increase the number of people “technically” insured without spending more money, what is defined as minimum insurance was scaled way back. It now seems that without a public option, progressives may threaten to join conservatives in killing the individual mandate. Block by block, reform is being both reduced and made less stable.
The White House may credit their secret deals with the different stakeholders (i.e. health industry lobbyists) with getting reform this far, but the strict limitations those deals put on possible compromises may prevent it from getting any farther. At least not without America getting left with a very wobbly new system, full of gapping holes.
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At least not without America getting left with a very wobbly new system, full of gapping holes.
This is my fear – that we’ll end up with something complicated and utterly useless. At the end of my nightmare, the Democrats will pass the thing anyway, so they don’t lose “momentum” on health care reform. As if passing something that makes the problem worse is the kind of momentum we want to create.
The WH is a sell-out to its campaign contributors. That’s just their excuse for public consumption of naifs.
My wish (besides the pony) is for no medical care reform this year. Nothing that will happen will be reasonable, and if we wait, pressure will mount for a better plan.
I think that this will turn out to be the best choice from our point of view. Unfortunately, it won’t be the best choice from the politicians’.
Well, I put it behind the pony that I won’t get either.
I think it’s time to play “Priorities Now!”
I don’t see why the health care bill can’t cost $1.2, $1.3, hell $1.8 trillion. Balance it by cutting the war nation-building budget in both Iraq and Afghanistan.
Wouldn’t hurt to insist that AIG and all the rest of the bailout crew paid dividends back to the People until they can buy themselves back.
Seriously, it’s about priorities and they’re all screwed up in DC.
How has that plan worked since 1993?
Agreed.. and Progressives should kill it with a clear Grayson Style message as to why they did.
I need a pony too..)
How many die each day from lack of care?
Baucus got the pony – we get the fertilizer.
How can one assess your Q, since there was no real proposal during all those years.
Besides, the only reason why medical care reform got so far this year is because more people are becoming disgusted with their own experiences. The public was not ready to fight the industry previously, and needs another coupled of years of being gouged before they’re ready.
It seems to me that we are at a point where several things have become apparent. The first is that the netroots progressive community is in broad agreement as to why the PO is an essential element of HCR. The second equally important is that as a group it has been influential in having the PO advanced to the point of near acceptance.
I think it is time to take the next logical step which is to assure its passage by exerting the only influence that counts, namely financially influencing the outcome. A concerted well planned effort should be undertaken to finance alternative candidates to unseat present democrats who are opposed to the PO, this is a sufficient reason to unseat them.
Acting in reasonable unison contributions of $25 to $50 a piece assuming 400,000 like minded progressives give or take, the influence on who becomes elected would be determinative.
At this stage, the number of candidates that need to be influenced have fortunately been reduced to a manageable few. Such as Lieberman, Landrieu, Lincoln, Nelson and maybe Bayh. The need to take this step has become clear because all that has been gained by sheer of effort has not been enough to detrmine the outcome. Having come this close, the opportunity should not be lost.
The fact that a galvinized electorate can influence the adoption of popular measures is a message that will shake the very foundation of the current system that is so detrimental to the public good
I disagree with the position of do nothing; that is exactly what Rethugs and Insurance companies want, and I don’t want to hand them victory.
What I think, is that the debate needs to be expanded to our priorities; put it all out there. Americans really are sick of war, and they’re , well sick and tired of Insurance companies and being sick and tired.
Debating the issue in a pure health care “silo” isn’t helping, and IMO, it’s creating this result we’re seeing develop.
Damn the war! Fund health care! Fund Science! Fund Green Jobs, and well all kinda JOBS! Why don’t we have a modern CCC?
Yep, my wish too. I’ve been saying as much for some time now.
Then start off the new year with SINGLE PAYER. The Democrats could call a big news conference, announce how they tried all year long to compromise with the Republicans, but to no avail. Therefore, since the Republicans aren’t going to compromise, we’re just going for what the Democrats want, and thas it Single Payer, improved Medicare for ALL.
Run with that, and you just might get single payer. At the very least, you’ll get Hacker’s original Public Option, because that’s as far as we’re compromising.
Let’s see them stop that shit in an election year. Polls show overwhelming support for the PO, and most of the time majority support for single payer. So, let’s do this in an election year. Maybe contrary to CW, that’s the BEST time to do this.
But my fear is this. Some bullshit, cop out plan will pass. And then we’re “done” with health care reform for another generation. Look how long it took to try again after Clinton passed nothing!!! You know how long it’s gonna take if they pass a bullshit bill???
Ya think we can raise $263 million!
You can’t fight a modern war with pony’s and horse soldiers.
We should all have a Sherman Tank to plow thru the political resistance lines.
And I guess, we do. It’s our vote, for 2010 and ’12.
I don’t think ‘they’ GET it, that we lifelong dem’s and the Indie’s who enabled Obama Change, will DUMP the party in a New York Minute if we don’t get a full and vibrant public option with all the goodies that starts NOW.
Not to mention the majority of the general public, that’s gonna be pissed off and looking to BLAME someone. Dem’s could be slaughtered. Overnight.
Link didn’t show up. Here it is.
So Obama gets this shit signed into law, trumpets his “accomplishment” and in 2013 when it kicks in we all find out we’ve bought a pig in a poke, but we’ve re-elected the lobbyist-pwnd snake-oil guy for four more years, what do we do?
I just have that question rolling around in my pea-sized brain.
Sorry. I understand your point but I wouldn’t send money to any of those you mentioned if someone threatened me. We cannot continue to buy our congress – that’s the problem in the first place – they are available to be purchased or bribed.
Perfect forecast.
Find out, like you don’t already think that.
Yes, that is, in part, my point.
Exactly so.
Then resign yourself to always being ignored by them. The point of contributions isn’t to bribe these guys, it’s to point out that they could just as easily go to someone else. That’s what the insurance, drug, and health care people are doing. The only thing most of these politicians will really respect is people or organizations who have the ability to hurt their chances of re-election, or of obtaining some other form of power they want. Anyone who can’t do that is irrelevant.
Jenga is the perfect analogy.
I will never understand why they needed to produce five different bills, merge two of the Senate bills, go through conference, etc.
Are you implying that one should favor ANY plan purporting to be “reform” regardless of its merits?
Fair enough.
But take it further. How many will continue to die with a bullshit bill being passed?
And how many proposals will come up after the bullshit bill is law?? The politicians will claim “We don’t need new proposals, we already “reformed” health care. Let’s give those reforms a chance to work.”
Then we’re looking at an entire generation of, say, 25,000 dying each year instead of 45,000. I mean, if folks just want to play the numbers, I can play them too where it’s better to pass nothing this year. One more year of 45,000 needless deaths is better than 20 more years of 25,000 needless deaths, no?
DO nothing or give millions of new customers to private insurance under force of law, while leaving millions more uninsured or facing bankruptcy… while facing the threat and promise of costs continuing to skyrocket?
If we let Dems prove Republicans and Blue Dogs correct.. that government doesn’t work… that (all above) could be much worse than doing nothing.
Though I do like the meta message idea… we can and are doing that really. Of course we need to do more..)
Thanks, I think the meta “priorities” meme is getting out there, but not as voluble as I’d like.
Your point about mandates – YUCK! I Hate the idea with private insurers alone, but I like it with the Dean Idea; opening up Medicare to 50 year olds.
I’d say expand it to children and young adults to, pick an age, maybe through college age, 25 years old. Then the mandatory policies for the young healthies, 26 – 49, could be catastrophy based, but then take the premiums into account for non-catastrophic occurrences, like diabetes, etc.
That’d push a bunch of the profit out. And I think that’s the point.
People could call it “Trojan Horse Single Payer” and it’d be totally fine by me!
What makes you think our system which was designed by the Framers to thwart dramatic change is ever going to do that?
I am for fighting like hell to get the best bill we can this year. Then, over time working to make it better.
Like it or not, incremental change is how progress is made under our Constitution.
26-49 includes child bearing years when women need comprehensive coverage.
As others have pointed out it is better if this Year 2009 version of reform is not passed as it has become too weak a vessel to fulfil the need to be done reform tasks.
The Obama WH did not start out with the most logical reform position ( American Single Payer/Medicare For All ) that carries the truest cost control/containment capacity and presents the strongest long term reform of American employer based healthcare,for profit health insurance and levels access,delivery and follow through thresholds for all Americans.
I blame this on President Obama. He came into the WH riding the theme of change and he has not lived up to that premise repeatedly.
Blaming it on the Republicans is like blaming dogs for liking bones and blaming it on the Democrats in Congress is like kicking a cat for licking itself. Both creatures just doing what they do. President Obama needed to shoot from outside and score big on being the man who would push real change and change the framing from FISA,torture,warmaking and yes American healthcare reform.
He did not take the step. Too bad about his failure of leadership.
So — this reform is best left to die — run the 2010 elections and clear off some or many of the worst players then in 2011 restart healthcare reform.
There is no need to rush this failed 2009 American healthcare reform into place.
This may suit the Obama WH but that is one very poor reason for doing anything or with this failed and fully too compromised reform — nothing.
By my figuring, %50 times 400,000 would be $20 million and this amount could be be applied successively against each of these opponents. This degree of influence would more than drive the message home to these and other recalcitrant candidates.
I do foresee the possibility where the Supreme Court as currently configured would rule that corporations can directly contribute to campaigns, as a repprisal. All he better since this sort of a showdown would clarify the battle lines more clearly and may one day lead to the demise of the corparate state.
The arbitrary budget number of “$900 billion” drive me nuts because health care reform is complicated enough without trying to figure out if thats for an annual amount (like the new budget that’s passed annually) or biannual total (a la the stimulus package) a 5 year number (used in reconciliation bills) or a 10 year number (used in CBO scoring). I’m pretty sure the $900 billion is for 10 years. Of course, they save money to meet the arbitrary goral by delaying the coverage start for three years. No worries, its not like anyone dies for lack of health care, so what’s the rush (Lyndon Johnson got Medicare rolling in less than a year).
Hell, the House might as well pass a single payer plan with a $900 billion annual price tag and then call a press conference to pat itself on the back for meeting the president’s price goal.
I may not have been clear, my point is that the mentioned Senators would be unseated by our supporting alternative candidates that we would postulate to run against them with the money we would provide on their behalf.
I hear you, I just disagree with you.
There’s nothing in the Constitution preventing Single Payer from being passed tomorrow, and taking effect next week. Nothing.
Other than the will to do so.
And for those who think “anything” is better than “nothing” please explain to me how an individual mandate without a public option (or with a bullshit public option) is better, please. Not only are we keeping an unnecessary level of “profit” but we’re also keeping out a necessary curb to costs.
Sometimes, yes, IMO, “anything” can be worse than “nothing.” So, like I said, I just disagree with you.
As far as an incremental approach, well, that’s why I support a strong public option. I’m told it’s politically not feasable to get single payer today because of how our “framers” built the system. OK, Fine, in that case instead of being stubborn then I’ll accept a strong PO. Then, an incremental approach to getting there is fine by me. But what if what passes doesn’t take a step toward’s fulfilling that incremental approach??? Is that still better than nothing???
I just don’t buy that “anything” is better than nothing when, if IMO, the “anything” not only doesn’t get us any closer to the end result incrementally, it actually makes getting there harder and longer.
Of course, as usual, YMMV.
I don’t buy “anything” is better than nothing. But, I know we are going to get “something”, even the Baucus bill meets that standard, and that is better than nothing.
The benefit of having a well informed large bloc of progressives that wield significant and decisive financial electoral influence, would permit the passage of a reasonable PO plan as contemplated in the current bills. Ideally this influence would be exercised as often as needed.
Although it would help to have the elements of a viable PO plan determined with some degree of mathematical rigor, it would appear that as currently conceived a PO plan would be viable as long it satisfied the following conditions: a suficciently large number of participants with the requisite raio of low risk to high risk cohorts, in the plan. Currently there is 47 million uninsured participants that are eligibler for the PO with the requisite ratio of participants needed. Hopefully this would suffice for the time being.
The fact that there is a mandate is in fact helpful since by the PO plan providing lower premiums, you would likely have a larger number of low risk enrollees in the PO plan.
At some point it would be necessary to in fact show the political clout of the galvinized progressive movement. Some exercise of this clout has to become apparent.
There is no point in trying to construct an unworkable Public Option substitute in an effort to seek broader support. I was encouraged today by TheHill’s report that Pelosi told Democrats she thinks she has the votes for a robust Medicare+5% public option. That potentially huge breakthrough got essentially no mainstream media attention today.
In fact the NYT story of the day is another weak trigger proposal that unnamed House Democrats are said to be pushing. The NYT helpfully added that the PO is “not necessarily as crucial” as the public thinks. Good thing I still have COBRA, because reading this almost gave me a stroke.
http://prescriptions.blogs.nytimes.com/2009/10/15/another-public-option-but-still-not-for-you/#more-10345
To extrapolate from your remarks: I too fear a “crap bill” — full of mandates and IRS enforcement, but without any cost controls. Then, as Mr. & Mrs. America realize what hit them [they open their pay envelope to see ever-increasing deductions for that wonderful "required" health care; the abuses by the insurance companies continue unabated], AND they realize that it was DEMOCRATS who foisted this shit upon them . . . . they are going to be turned off to the Democratic party for DECADES.
Why oh why can’t Obama and Rahm see this? [Answer: because they're too fixated on their picture of the Rose Garden "signing ceremony" and the political ads they can make from it.]
Jeeze, has EVERYONE in this administration/White House drunk the Kool-Aid, ’cause it’s not too far of an imaginative projection to see this ending DISASTROUSLY for Dems.
What I also see is Republicans coming out of the woods to vote for something if it’s a shit bill. There’ve got to be a few retiring Republicans who don’t care, and who can’t WAIT to hang this anvil around the Democrats’ necks.
Larue, I was so busy replying to OFG @ 14 that I didn’t see you making nearly the same point @ 16.
Ditto re shootthatarrow @ 31.
a one dollar bet?
That plan didn’t work well because of Bill Clinton playing Politics and George Bush being against reform. This is a different time. The pressure for reform is much greater and the Obama Administration won’t be able to keep reform of the table next year if it fails this year.
It’s all about priorities and progressives ought to tie up the Senate until a real health care reform package is passed, by filibustering everything else. Force them to pass health care reform or get rid of the filibuster.
Hi OFG, I was with you up to here:
But I can’t agree with this:
I don’t think a bullshit cop-out plan will end the movement for health care reform. Not now. The movement’s too strong. If we don’t get a good result this year we’re coming back in 2010 for enhanced Medicare for All, single-payer. The only think that can kill the return is a really robust PO which might work. Anything else is just BS, and won’t fool anybody.