Harold Pollack ran the numbers and is very pleased that the Senate bill will eventually spend a lot of money on subsidies going to private insurance companies to make insurance affordable for the uninsured:
As others have noted, Democrats are on the brink of enacting an imperfect but historic bill that will cover 30 million people and correct egregious defects in our current health insurance system. Fully implemented, the bill would provide about $200 billion per year down the income scale in subsidies to poor, near-poor, and working Americans.
$200 billion is a big number. It exceeds the combined total of federal spending on Food Stamps and all nutrition assistance programs, the Earned Income Tax Credit, Head Start, TANF cash payments to single mothers and their children, the Department of Housing and Urban Development, and the National Institutes of Health.
Harold Pollack is clearly pleased that a lot of money is being directed to help people (even if it is in a very wasteful way). On the other hand, I see this large number, and it fills me with terror. First, even as large as this number is, it is nowhere near sufficient to make quality health insurance universally affordable. Because they did not truly reform our broken health care system, the cost of expanding coverage is extremely high.
What I see when I look at that $200 billion number is a huge target for Republicans and conservative Democratic “entitlement cutters.” The subsidies only go to a small fraction of Americans who are not politically connected. I can easily imagine the already low-quality insurance on the exchange slowly being scaled back to basically nothing. I fear the Republican solution to the high cost of the program will be their same solution to all programs; Deregulation.
What progressives should really want to see is a smaller number attained by using much more cost-effective public insurance programs to expand coverage. The Senate bill is an extremely expensive expansion of very-low-quality insurance to a small group of low income Americans. That does not sound like a recipe for a workable, long-term reform program. This big number is something that should fill progressives with fear; not joy. It will only enrich the enemies of reform and be a huge target for “deficit reduction.”



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This bill actually takes money from middle and working class and makes it look like they are giving it to poor people, so ignite class war and distract, while they give it to the richest people in the country and in turn these fat CEO’s give to the corporate politicians.
If this bill dies, the Republicans won’t even need a target in the mid-terms.
And if the bill passes, they’ll have the biggest set of targets ever given to them. The attack ads on this bill are almost limitless.
And good for them. If the Democrats pass this POS, they deserve the attack ads and the losses in 2010.
Precisely: in another election cycle (or even starting next year) the rallying cry will be ‘Balanced budget!’. These subsidies will be on the chopping block in no time.
Why should anyone, left or right, be happy about waste? Insurance companies are obsolete: they add no value to the end product at considerable cost, and, as pointed out by Luke Mitchell http://www.harpers.org/archive/2009/12/0082740 are an increasingly commoditized service.
To those who say this bill can be improved later, that is an absurd contention when there is so much evidence to the contrary. To compare this bill to the Social Security Act or Medicare is misleading: those bills did not start by shoveling billions into private, for profit industry. This bill will be extremely hard to repeal and, if passed, risks delaying real reform such as Medicare for All for generations at the cost of billions in taxpayer dollars and personal financial ruin for countless families.
I defiantly see it as Obama’s “mission accomplished” moment.
From DK
Gotta admit this bill is going to pass:
In the inteview, Grijalva confirmed that House Dems were beginning to discuss the idea of revising the Senate bill in conference to move up the implementation date for insurance coverage and make it more in line with the earlier date in the House bill.
I asked Grijalva if he could support the bill if such a change were made, even if it lacked a public option or other similar concessions sought by liberals.
“It would sweeten it somewhat,” Grijalva said, “if they speed up the coverage mechanism.”
He added: “That would be something I’d have to look at very closely.”
Asked if he was suggesting that he’s open to supporting such an outcome, Grijalva answered in the affirmative, but insisted that he would have to evaluate the changes in conference before making any decision. He said House liberals would continue to push for a public component and a repeal of the anti-trust exemption for insurance companies. And he demanded that conference negotiations not merely “rubber stamp” the Senate bill.
The first necessity is taking out whatever massive poison pills are in the Senate Version of the bill that we can.
Since this is at the Conference stage, what is on the table are areas where the two Chambers have different language.
The two biggest poison pills that can be taken out in Conference are the Union-busting Excise tax, and the Individual Mandate.
Ezra Klein has been caught in – and then repeats – a massive sleight of hand on the individual mandate, where the Insurance Death Spiral problem is raised by comparing an individual mandate to doing nothing, and then concluding “risk of death spiral”.
This is, however, simply nonsense. If the House employer mandate is redirected to the employees health exchange account when that employee has a health exchange account, that would be a much more effective circuit breaker on the death spiral than a 2% of income penalty. And it does not “force” anyone to buy insurance from the hated insurance companies.
So take out the individual mandate in exchange for making the employer mandate a “play or pay to account” system, and take the House funding over the Senate excise tax, and the two biggest poison pills will have been removed.
It will still be a stinker of a bill, but we have to fight until the last tick of the clock to keep the Senate version from being the one that goes for final passage.
What -and I can’t say for sure because I haven’t read everyone yet- is that the legislation enshrines in stone the idea that health insurance will ONLY be provided by Insurance companies(unless -so far- you’re a vet,which I thankfully am).
That there is NO ‘call to arms’ about that one aspect amazes me; sorta like saying ‘fuck me and please do it again’.
And now the House is preparing to roll over and accept the Senate bill(of course with the typical posturing and statements of ‘we did all we could’).
Why is it that no one is calling out Obama for the lies he is telling? He says he didn’t campaign on a public option BUT see here.”If you do not have insurance you can choose to enroll in the new public plan,which will offer benefits similar to what every federal employee and member of Congress gets. Or you can choose private plan options through the national health exchange.”
They won’t comment about the efforts put forth by the WH re Dorgan’s amendment for re-importation YET “Would allow reimportation of prescription drugs from other developed countries if the drugs are safe and prices are lower outside the U.S.”
One can go through both here and (PDF)here and see Obama is lying.
Yet we are all supposed to be happy that a ‘historic’ event has taken place; yes, it is ‘historic’ that the government has ‘explained’ that only private industry can address the problems of this country.
If I sound disgusted, it is because I am.
It’s the pain for profit lobby doing what the banksters did on Wall Street.
Enjoy.
Word. The Dems are destroying themselves after only one election period “in control”.
They are about to eat some electoral shit, but at least it is their own shit they will be eating.
Serves them right.
Nelson said that if anything is changed he won’t vote for it. I’m really tired of Nelson. He is remarkably dumb – to put it nicely.
How come all you “progressives” supported the Clintons and Edwards for re-election? If you bothered to read up on what the Clintons proposed in 93-94 and re-stated in the 2008 campaign, you would learn that their proposed legislation was a complete giveaway to the insurance companies.
There were not 60 votes for single payor and never have been. Who lives in a bubble here?
The fact that the Progressive Caucus is caving on their commitments, again, is the reason I think they should be challenged in their primaries too. Pretty words mean nothing.
The other reason to challenge the Progressive Caucus with progressives who will vote like progressives is that their seats will probably not be lost to Republicans.
the insurance industry swine will (or probably already have) figure out how much of their “product” each level of individual subsidy pays for, then charge twice that amount. Thats what happens in the only moderately corrupt federal student aid program. It will certainly be worse in the full blown racket known as the insurance industry. No, on second though they will TRIPLE the cost.
There is also nothing that says a bill requires 60 votes, other than the Senate itself. So the Senate itself could change it back to only requiring 51 votes, as it should be.
The Constitution is pretty clear on the things that require super majorities. Passing a bill isn’t one of them.
Primary Candidate Obama was against individual mandates:
http://www.youtube.com/watch?v=EoSnqofelsQ
“If the mandate was the solution, we could try that to solve homelessness by mandating that everybody buy a house.”
except Obamas aricraft carrier is sinking. hes gonna look pretty stupid sliding off the deck sideways.
Yeah, I know but the CMM won’t comment/confront him on his lies and ,apparently, no one in the Congress -at least on the Dem side- will either.
And I am truly disappointed Senator Sanders allowed himself to be bought off so cheaply.
First the Bill is going to Pass.
the fixed has been in for a long time.
Progressives need to view this Bill as a direct attack on the Progressive movement.
2008 scared the Powers that Be! The idea of a progressive uprising is not what they want.
To kill and destroy the progressive movement enters Barack Obama.
Look at Barack Obama actions, he has not really done anything that progressive want done. He has in essence carried the Bush Agenda forward.
Why do troop supposely come home in the summer of 2011? why not 2010, why not now? Oh I forgot 2011 is an election year
Why not implement insurance mandate in 2011? why not 2012? Oh I forgot 2011 is an election year.
THE BIG QUESTION IS WHY DO YOU IMPLEMENT THE INSURANCE MANDATE IN 2014?
If you want to kill the idea of a real progressive candidate getting in the white house in 2014, you hang the idea that he or she will make young people buy insurance.
Progressives let us not all fall for the Hope A Dope.
Obama and Rahm are not friends of the Progressive Movement.
What did Rahm say in that famous liberal news paper the Wall Street Journal? Oh I, remember Liberals and Progressive don’t matter.
Jane strategy of joining forces with the Tea Party on this issue, does a lot of damage to Obama and Rahm agenda of killing the progressive movement.
There were not 60 votes for single payor and never have been. Who lives in a bubble here?
You do, unfortunately.
This blog has repeatedly made it clear that the whole 60 votes thing is fiction. It is.
“60″ is a number invented by the Senate in the past; they could easily change it to what the Constitution dictates: A simple majority. That would be the number “51″.
Would you like to be pinned now, so that we can release you from that bubble, or are you comfortable in that confined space?
I totally agree all Dems that vote for this Bill should be challenge.
My reaction was, “My god, the subsidies are going to the insurance companies, not the people buying the insurance? WTF?” Definitely a Lando Calrissian moment: “This deal is getting worse and worse all the time.” On top of that, if we refuse, or cannot afford, to buy an independent plan, we will be penalized in our tax returns? What happens to all the people who have to choose between coverage and putting groceries in the refrigerator? I’ve been there, and it is an ugly place to be. This bill will make that uglier.
This is beyond horrible.
As opposed to who?? It’s always the lessor of two evils. Dems offer platitudes. Republicans offer fear of those platitudes. You just hope there’s a way to keep them honest after you’re saddled with them.
Big Brother knows more about your budget than you do. /s
Pisses me off that I see so many good health care ideas presented here, and so many flaws pointed out in that thing the Senate has cobbled together that I seriously wonder what kind of idiots are running the country. I feel I have to constantly watch to see what’s happening because I believe I might hear a sudden cry of “run for your lives, they’ve dropped the bomb, pushed the button, opened the flood gates,” take your pick of disasters. And I wouldn’t be one bit surprised.
$200 billion is a big number. It exceeds the combined total of federal spending on Food Stamps and all nutrition assistance programs, the Earned Income Tax Credit, Head Start, TANF cash payments to single mothers and their children, the Department of Housing and Urban Development, and the National Institutes of Health.
Yeah and about a fucking month or two in Afgh and Iraq.
You CAN refuse to pay the insurance and you can refuse to pay the tax penalty. Really. The language in the bill as it now stands creates a tax penalty but also removes any and all teeth. See, the language states that no one can come after you or your assets if you fail to pay the tax. They cannot take your house, your car, cannot garnish your wages, cannot do anything.
Thus, do the right thing: refuse to pay for the insurance you cannot afford anyway AND refuse to pay the tax. That’s what I will be doing.
That and voting AGAINST any and all who vote for this bill – or support the passage of the bill in underhanded manner, ie, by being one of the 60 votes in the senate but still trying to say they vote “no” on the floor. Uh-uh, not good enough. A vote for cloture is the same thing as a vote FOR the bill regardless of what you vote on the floor. Hear me Feingold? Hear me Sanders?
Sheesh. It is not our job to create their legislation for them. But here goes: the House bill is fine. Use that.
Fixed.
Or, if you want baby steps: remove the individual mandate. Fixed.
There are a number of things that would improve the bill but they are all off the table because Obama doesn’t want to hurt his insurance company paymasters.
Interesting ideas. I’m not so familiar with the details, but somebody in the House should look at those.
Yes. It’s a set-up. This Republican give-away to fat cats is getting positioned as a progressive reform initiative. Hugely expensive and accomplishing nothing, it is a gift to the Republicans to paint “progressive reform” as useless failure.
Not only will the subsidies be gutted — I see this as the opening to destroy Social Security and Medicare, in the name of freedom, efficiency, and balanced budgets.
I’ve never seen the government’s role as wholly-owned subsidiary of big business so nakedly on display. And MSM has never played its role so well.
There’s a technical term for the alignment of government to corporate interests that we see so clearly here. I can’t bring myself to go there…
Medicaid for all is a great use of minimal dollars for maximum return.
To rephrase a sentiment our conservative friends are wont to say, this dependency on government handouts will make our corporations weak, unproductive and unable to compete. This tyranny of low expectations demeans their exceptional management skills. Better that they be weaned before they suckle, so they learn to use their competitive teeth and not their government handout gums.
The role reversal is precious. Unlike poor families, who recycle money in the blink of a rent check or grocery store bill, corporations acquire and accumulate. They live until their money stops coming in, growing weaker or more powerful according to its flow. This reform will make them as rich as Croesus and as hungry as Cronus.
We do! But some of us progressives also realize that at this point in time, we do not have the votes in the Senate to clear a filibuster on such a plan.
I wonder if we could bring along some Republicans to support the bill if we made sure that low-premium/high deductible plans with attached HSA accounts could be offered as an option on the individual market OR in the group market as long as the employer offers at least two choices of plans, one being a more traditional insurance plan and the other being the low premium HSA plan.
Wow, I am shocked to see liberals fighting over the mandate. Until today, I had only seen conservatives arguing against the mandate.
You need mandated coverage if you eliminate pre-existing condition clauses. And as long as you provide a sliding scale subsidy system to make sure that everyone can afford the mandated coverage, then I see no reason why it is a poison pill.
I do agree with your point on the taxing of union healthcare plans. The Senate should fund the bill like the House does.
Changing the rule to eliminate the filibuster would likely bring about a filibuster itself. The Senate rules require a 2/3 majority (instead of a 3/5 majority) to end a filibuster on a rules change.
Actually, the Constitution only gives examples where filibusters are required by the Constitution. It doesn’t prohibit the Senate (or the house) from making rules requiring super-majorities for anything else they want (because it enables them to make their own rules). In fact, the Constitution only mentions the requirement of a simple majority to establish a quorum. Other than that, there is no requirement for a simple majority.
You are absolutely and 100% incorrect.
The constitution ONLY mandates a simple majority for a quorum. There is NO other place where the constitution requires a simple majority from Congress for legislation. Period. Each house is allowed to make its own rules and the rules of the Senate include the ability to filibuster.
“60″ is actually 3/5ths, the amount required to reach cloture on regular legislation. To reach cloture on a rules change (i.e. what would be required to eliminate the filibuster), would require a 2/3rds majority. Good luck with that.
Do you think allowing the GOP to gain majorities is a good thing?
And none of this “if they vote for this, they might as well be Republicans”. One issue does not a Democrat make. That is why we are a better party than the GOP, who demands most if not all of their congressman and Senators fall in line. We, as Democrats, prefer people who are free thinkers.
The House bill wont pass the Senate.
With the pre-existing condition clause eliminated, how do you prevent anti-selection?
Actually, this is all pretty much incorrect.
If you want, you can start by reading here.
And as far as the Constitution goes, there is nothing that says a super majority is required to pass a bill either, exactly like you just pointed that there is nothing in it that says a simple majority is all that is required. Are we going to discuss everything that’s not in it?
The Senate could end the filibuster tomorrow if they wanted to.
You could have simply said that you support the use of the nuclear option, the same tactic the Republican THUGS used when Bush was in power in order to make sure his judicial nominees got passed.
The problem with the nuclear option is this… it requires a lie in order to work. For those who don’t know how it works, this is what the Democrats would have to do.
A Democrat would ask for a ruling from the chair if you could end debate with a simple majority.
The chair would say no, you may not end a debate with a simple majority as per rule 22.
The person would then immediately challenge the ruling of the chair. That challenge only requires a simple majority and is not debatable.
You would then only need 51 Democrats to vote in favor of the challenge and then the chairs verdict would be overturned, thus ending debate.
I DO NOT approve of the nuclear option because it is using a parliamentary “trick” in order to LIE about a clearly defined rule to get your way. It would have been wrong had the GOP actually did it and it would be wrong for the Democrats to do it.
No, we do not have to discuss what is not in it. All we have to do is discuss what is in it, and that is the ability for each house of Congress to determine its own rules, and that includes rule 22.
Via the lie of the nuclear option? Sure.
Via the actual procedure that is spelled out in the Senate rules? No.
David Dayen is upstairs!
Senate May Get Vote On Constitutionality Of Health Care Bill
Yeah, fine, except for two things:
First, the IRS will, I’m sure, continue to impose interest on the unpaid amount, interest that will be compounded over and over again over years. Then, at some point when the gov’t needs more revenue, Congress will get the bright idea of collecting all that overdue money, even if it means waiting and taking it out of your estate when you die. And with more and more people dying because they lack health insurance, the gov’t won’t have to wait long to get a lot of that money. And even for people who don’t die, once Congress changes this law and makes it a lien against your assets, it’s gonna show up in every credit report, every job background check, and most importantly, when/if you go to sell your house.
Second, if not enough people sign up the insurance companies will scream bloody murder over the lost revenue. This will then force Congress to either enforce the tax penalty collection or to increase the budget-busting subsidies.
Well, I think that this bill is so bad that if it passes the Republicans are going to win a majority in 2010. The problem is the way President Rahm has dissed the entire progressive community and the way President Obama has tried to re-write history (he supported the public option many times in 2007-8).
Dear ObamaBots and Democratic Party Gatekeepers,
Happy Trails as America sinks under Empeoror Obama and his court jesters!
The Healthcare Bill Sucks!!!